Pros and Cons of Menstrual Suppression
Some see it as a curse that dashes vacation plans, stains sheets and wreaks havoc on emotions. Others view it as an integral part of womanhood, a welcome sign that we are healthy—and not pregnant. But, in an age with a pill for just about everything, more women are looking at their menstrual cycle as something else entirely: optional.
“Fifty years ago, with the advent of The Pill, suppressing ovulation became an option for women who did not want to get pregnant. Skipping your period [altogether] is also an option, and I think a lot more women are going to do it,” says Leslie Miller, a Seattle obstetrician and gynecologist and founder of the website NoPeriod.com, which coaches people on how to become period-free, via various forms of contraception.
Drug companies have made it easier than ever. In July 2007, Wyeth Pharmaceuticals rolled out Lybrel, the first oral contraceptive designed to not only prevent pregnancy but also eliminate periods for a year or more. Before that, came the popular Seasonale and Seasonique, “extended cycle” birth control pills, to reduce menses to four times a year. Yaz, a top-seller in this country, reduces periods to three days or fewer; it is also said to address severe acne and premenstrual dysphoric disorder (PMDD). Then there is
Depo Provera, a quarterly injection, and the Merina intrauterine device (IUD); both can, in some cases, halt periods completely.
Unlike conventional birth-control pills, many such products are marketed to all women, not just the sexually active aiming to prevent pregnancy, via a slew of websites, industry-sponsored blogs, how-to books and TV advertisements, promising liberation from that messy time of month. “Fewer periods. More possibilities,” cheers one Seasonale ad.
But, amidst the celebratory media blitz has come outrage: from physicians, who fear we may be putting women in danger; government regulators, who say the ads go too far; and feminists, who wonder what message we are sending our daughters.
“It’s a horrifying prospect,” states Susan Rako, a Boston psychiatrist and author of The Blessings of the Curse: No More Periods? “Encouraging healthy young girls and women to do away with their periods for the sake of convenience, without educating them about the health benefits of a normal menstrual cycle, as well as the risks of menstrual suppression, is irresponsible and unethical.”
20th Century Roots
The notion of using oral contraception to keep menstruation at bay is nothing new. The first “pill” approved by the Food and Drug Administration (FDA) in 1957 was intended not as a means of preventing pregnancy, but as a remedy for severe menstrual disorders. During initial trials, women took a pill each day, suppressed ovulation and menstruation, and for many, their period became a thing of the past.
But, under pressure from religious groups, who thought not having periods seemed unnatural, the pill’s creators added a week of placebos, and the monthly, “withdrawal bleed” was born.
“The thinking was that women would find this more acceptable, that they would feel like they were having their normal period,” says Susan Ernst, a medical doctor and chief of gynecology services for the University Health Service at the University of Michigan. Ever since, doctors have quietly advised women with a looming honeymoon or camping trip to simply toss out the placebos and skip to day one in their next packet.
In the past decade, as drug companies have scrambled to repackage and thus, renew patents on old contraception, the once-hushed notion of ongoing menstrual suppression has become an industry, propelled by a marketing machine.
That worries Christine Hitchcock, Ph.D., a researcher with the Centre for Menstrual Cycle and Ovulation Research, in British Columbia: “We just don’t know what the long-term risks are,” she says.
Evaluating the Risk
Data from the Women’s Health Initiative, a 15-year research project funded by the National Institutes of Health, has shown repeatedly that oral contraceptive use is linked to increased risk of stroke, heart attacks and blood clots in women. According to the NIH, studies also have shown that women who take birth control pills are at greater risk of breast cancer. A 2006 review in the journal Adolescent Medicine found that use of certain forms of oral and injectible contraceptives can prompt accelerated bone loss, or stunted bone growth, in teen users. Although the data, overall, is inconclusive, a few small studies over the years have even suggested such pills may interfere with testosterone production, prompting reduced libido and depression. By skipping the placebos and taking The Pill continuously, are women further boosting these risks?
Other questions loom. Does bleeding itself rid the body of harmful elements such as precancerous cells in the uterine lining or excess iron? Researchers have hypothesized that the reason men and postmenopausal women have more strokes and heart attacks than naturally cycling women is because they don’t bleed—and thus, store excess iron.
Does a week of placebos give breast tissue a necessary break from all that estrogen? For anyone, including celibate women who opt to medicate away menstruation and its unpleasant symptoms, do the benefits outweigh the risks? For the most part, experts agree those questions haven’t been answered.
Critics also point out that cycle-stopping pills are notorious for prompting spotting between periods. Because they use lower hormone dosages to make them safer for continuous use, some fear they may not be as effective in preventing pregnancy.
For example, in one Wyeth-sponsored study of 2,134 women, 15 women who took the pills correctly got pregnant, anyway. Even the FDA has scolded advertisers of Seasonale and Yaz for overpromising freedom from menstruation-related problems, while underplaying the risks. In February 2009, Yaz began running a $20 million corrective ad campaign in response to FDA complaints.
"On the other hand," Miller points out, "periods can be painful and inconvenient and having fewer or none can be liberating. Because Western women have fewer children and don’t nurse as long as they used to, they have nearly four times as many periods as those in primitive, agricultural societies. Ovulation and menstruation are about getting pregnant,” Miller concludes. “If you aren’t going to get pregnant, you shouldn’t have to bleed.”
Medical issues aside, the idea of stopping menstruation carries with it significant cultural implications; many see it as nothing short of a threat to womanhood. “I think, as a culture, we have come a long way in trying to prepare young girls for menarche and tell them this is an exciting time in their lives,” observes Ingrid Johnston-Robledo, an associate professor of psychology and women’s studies at The State University of New York at Fredonia. “Now, we are sending a message that it is extremely bothersome and debilitating. It’s really pathologizing a natural bodily function.”
Lisa Marshall is a freelance writer in Estes Park, CO. Reach her at www.LisaAnnMarshall.com.