Menstruation is a hassle, but is it wise to do away with it?by Shereen El Feki / September 20, 2003 / Leave a comment
Published in September 2003 issue of Prospect Magazine
The Museum of Menstruation, a quirky little website devoted to the subject, lists more than 400 different expressions for the curse, including the historical (catamenia), sociable (“the cardinal is coming for a visit”), geographical (“the Red sea has flooded”) and political (“communists in the arbour”). Call it what you like, most women will tell you that periods are a pain: messy, uncomfortable and the butt of a thousand deeply unamusing jokes. But what if there were a safe, effective and, crucially, reversible way of suppressing menstruation? Seasonale, a new oral contraceptive from Barr Laboratories, an American generic drugs manufacturer, claims to be just that. Like other versions of the pill, Seasonale contains levonorgestrel and ethinyl estradiol, synthetic versions of progesterone and oestrogen, sex hormones which regulate various bits of the female reproductive cycle, such as the ripening and release of eggs for fertilisation or thickening the lining of the uterus for pregnancy. These hormones are produced by the ovaries in response to a biochemical signal from the brain. Supplying regular extra doses, as in oral contraceptives, actually turns off these molecular signals, blocking the process. Unlike many conventional oral contraceptive pills, which are taken for 21 days at a time with a seven-day break to allow for bleeding, Seasonale has been tested, and packaged, to be taken for 84 days in a row, followed by a week-long hiatus, reducing menstruation to a quarterly event. If it receives the official blessing of America’s food and drug administration, Barr hopes to be selling the product in the US this autumn. There are no plans, as yet, to market the drug in Europe. Seasonale is old wine in new bottles: women-and their doctors-have long been rescheduling periods for special events, such as honeymoons or athletic competitions, simply by skipping the week-long pill holiday and continuously taking their packs. Indeed, pill-free breaks were introduced by the drug’s developers not for any particular medical reason, but in the hope that mimicking a woman’s natural cycle might win over critics-including the Vatican. But there is nothing particularly natural about a woman’s monthly bleeding. For much of human history, women’s reproductive lives were taken up by pregnancy and breast feeding which block menstruation. The average woman today can expect 450 periods in her lifetime, compared with an estimated 160 in her ancestor’s. Humans are among the few species whose females shed their uterine lining every month. Aside from signalling the absence of pregnancy, the purpose of menstruation is still a mystery to evolutionary biologists: ideas about its usefulness-“cleansing” the uterus of infection, for example-are hotly debated. In an age of home pregnancy kits, menstruation is no longer needed as an up-the-duff monitor. Some experts argue that regular bleeding is a medical liability, leaving women open to such complications as endometriosis (abnormal growth of the uterine lining) and anaemia. Some women certainly suffer more than others, debilitated by heavy bleeding, painful cramps, mood swings and migraines. Quite aside from this physical inconvenience, and decades of investment in tampons and towels, studies have shown that menstrual disorders significantly affect women’s productivity at work, and so the economy as a whole. While some celebrate periods as a hallmark of womanhood, many would welcome a break. A recent study of 1,000 women, led by Anna Glasier at the University of Edinburgh, shows that more than half of those surveyed in Scotland and China disliked having their periods (although, interestingly, most of the Nigerians and black South Africans polled welcomed them); and at least in Edinburgh, a third would like to do away with menstruation altogether. Hence the attraction of Seasonale. Glasier sees no reason why its extended regimen should pose any more risk of the sort of complications associated with conventional oral contraceptives-including blood clots, heart disease and stroke. Barr says its year-long trial of 1,400 women showed Seasonale to be as effective in preventing pregnancy as standard regimens, with no evidence of additional risks, except for a higher incidence of irregular bleeding-or spotting-in the first few months of use. But others are not so sure. Christine Hitchcock, a reproduction researcher at the University of British Columbia, worries that there are not enough studies on the long-term effects of extended oral contraceptive regimens on sensitive tissues, such as the breast. While there is less risk of dying from the pill than from unwanted pregnancy, Hitchcock is keen to see women-particularly teenagers whose reproductive systems are still developing-exercise caution when it comes to long-term use. That leaves the broader question of whether menstrual suppression through Seasonale, or other means, is merely a lifestyle choice or if it is turning a normal bodily function into a medical complaint. As Arthur Caplan, a bioethicist at the University of Pennsylvania notes, “If Seasonale takes off, women who bleed once a month might come to be seen like those who don’t shave their legs: earth mothers compared with the rest who choose a tidier approach.” As so much of our reproductive lives, from libido to childbirth, is already under doctor’s orders, perhaps menstrual suppression should be seen at best as a temporary fix rather than a lifelong escape from one of femininity’s more awkward features.