No More Menstrual Cycle?

Wyeth is currently waiting on FDA approval for a new birth control medication that stops women from menstruating. It's called Lybrel, and it delivers an uninterrupted flow of hormones (there is no week of placebo pills). As Sarah Richards notes,

Wyeth isn't the first pharmaceutical company to reimagine the menstrual cycle. In 1992, the FDA approved Depo-Provera, an injection that is repeated every three months. In 2003, Seasonale rescheduled the monthly period to four times a year. And in July, the government gave the go-ahead for Implanon, an implant that delivers a steady hormone stream for up to three years. But the pill is the favorite means of birth control of the nearly quarter of American women of childbearing age who take hormonal contraceptives. That means Lybrel--and the other brands that will surely follow--could change the menstrual cycle as we know it. The appeal is obvious: No more bloating, cramping, food cravings, and PMS jokes, not to mention the savings in unpurchased tampons and such. But in the end, for reasons both medical and cultural, it's not clear that putting the kibosh on the curse is a good idea.

As a male, I'm agnostic on the issue. I can't say if the menstrual cycle really is a "touchstone of the female experience," or just an annoying bodily tic that the original pill preserved in an attempt to make itself seem less scary. What I am amazed by is that medical science 1) still doesn't know what the long term effects of having, or not having, a menstrual cycle are and 2) that we haven't tailored our birth control medications to reflect that knowledge.

I still remember what a biology professor of mine once said: "If men had blood come out of their penises once a month, the menstrual cycle would have been understood back in the 19th century. And it wouldn't be happening anymore." While the silly debate continues over whether or not women are less "cognitively suited" for science, episodes like this make it clear that we need desperately need more female scientists.

Update: For those interested in a wonderful history of the pill, see this Gladwell article. Gladwell argues that John Rock, one of the inventors of the pill, kept the menstrual cycle intact in large part because he was a devout Catholic, and hoped that the Catholic Church would approve the oral contraceptive.


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Ha, I totally agree with that biology professor.

I've seen a lot of opinion pieces moaning about how terribly dangerous it is to mess around with the menstrual cycle, because we don't know what might happen, and how we'd better just leave it alone, to be on the safe side -- because after all having a period is just a trivial inconvenience. All the ones I've come across were written by men. And I have felt like saying "you know, if this was a problem you personally experienced, maybe you'd be feeling more adventurous and experimental."

I, personally, am prepared to take the risk and use this medication when it's relatively untested and little-understood. The only way we'll know whether stopping menstruation permanently is bad in the long term is if we try it and see what happens. I'm volunteering my body for science, because I'd like to avoid spending a quarter of my adult life messily bleeding from my crotch, if it's at all possible (without injections). If I can spare future generations from experiencing this lovely rite of passage entirely, that would be great.

It's really nice that some people have developed a feel-good mythology around menstruation to make it seem like a special womanly gift rather than an unpleasant burden which restricts personal freedom and wastes money -- but now that we can actually make it go away, we should let go of the crutch.

I'm with Confluence on hating the "menstruation is a womanly gift" crap. Like hell it is. Add in the week of PMS, and we're miserable for almost half of our adult lives. It's high time women had the option of only menstruating when they want to conceive. I personally don't use hormone-centric birth control methods because my body doesn't react well to them, but I'm all for giving women the choice to skip the whole damn process if they want to. For many of us, it'd be worth any risks, just like men who take Viagra consider the beneficial effects worth the risk. I don't hear anyone whining about how dangerous and "unnatural" THAT is...

It's eerily reminiscent of a short story by Connie Willis called "Even the Queen," set in a futuristic society where females are fitted with a sort of "shunt" device that keeps them from menstruating every month. Women can have it removed whenever they choose to conceive. But of course, there's an "alternative" back-to-nature, celebrate-the-glories-of-true-womanhood activist sect that crops up, who think it's evil and unnatural and a plot by the patriarchy to deprive women of their menstrual experience. *sigh* The amusing twist: the protagonist's teenaged daughter is on the verge of joining said cult and having her device removed, when she discovers that this whole menstrual thing actually involves (gasp) blood! Horrified, she opts out of joining the group.

It's a great story, by a truly great writer.... and now it might even come true!

If men had blood come out of their penises once a month, it might be something that was flaunted. Or, you know, "I have, like, TONS of blood come out of my penis each month, and that makes me a real man!"

By Katherine (not verified) on 19 Oct 2006 #permalink

As a man, I dont have much to say on this. However, I do support it because 1. it will lessen suffering and 2. I really want to see what will happen health-wise. The best way to find out what something does, is to stop it from occuring.

You can already stop your menstrual cycle using normal birth control pills. I don't see what the big deal is, unless with these pills, the general side effects of the hormones aren't so unfortunate for so many women. This sounds just like re-marketing the same thing. I bet it costs more.

Up until a year ago I had had Depo-provera shots once every three months for 5 years. A study came out shortly before I stopped the shot that showed a bone density loss of 33% in women that had been on Depo for one year. They had no idea how much bone density loss I might have had over the course of 5 years. I was encouraged to stop by my doctors. I have and now I hesistate to be a guinea pig for any more companies. I would encourage others to feel the same way. Until we know the long term effects, I am going to try to refrain from being the first group of women to prove how unhealthy this might be.

...medical science 1) still doesn't know what the long term effects of having, or not having, a menstrual cycle are...

Um, of course we know; we have over 40 yrs of data. [Women who use COCs don't have periods for the duration of use.] In healthy women, outside of planning a pregnancy, there's no known medical benefit to having a monthly period. [One instance when patients benefit from periodic blood loss is hemochromatosis (uncommon in women).]

And, of course, the health benefits associated with lack of monthly periods are well established--cancer (uterine, ovarian, possibly colorectal) protection, reduced risk of anemia, seizures, etc..

Bottom line: Brands like Seasonale and Lybrel have no effect on the frequency of the menstrual period (women using them don't have periods). They only shift the frequency of withdrawal bleeding (the fake period). Since the reasons for the q month frequency of withdrawal bleeding are "designer" ones (acceptance by politicians/religious people, etc.), there's no need to have a monthly fake period. It doesn't offer any health benefits, nor does the lack of a monthly fake period cause any health problems.

As I recall, women on the pill can choose to go straight ahead and skip the 7 days of sugar pills portion, and just continuously take the prog-loaded pills. So haven't women already been doing this on their own in some numbers for years now? If so, there should already be data on the risk of this method. Or am I just completely lost here?

By boojieboy (not verified) on 17 Nov 2006 #permalink

I've taken the pill continually (i.e. throw away the 4th week of fake ones and start a new pack) for years to suppress my periods. My doc started me on it due to my endometriosis. I had surgery but still needed narcotic painkillers for cramps and he and I agreed it would be better to suppress my periods. Added advantage - reducing ovulation reduces my risk of ovarian cancer, which killed an aunt.
One female ob/gyn says ovulating for 30 or more years is NOT normal- for most of human civilization women were pregnant or nursing most years, thus suppressing their ovulation and periods. So you can't say its unnatural.

The only issue I have would be fertility consequences. Birth control pill usage is near ubiquitous where I live, and something like this could conceivably become the same. So, the fertility consequences are a VERY important consideration, especially since most users would just assume that they wouldn't be given something non-safe, it could become an "unintentional" genocide. On the other hand, as millions of men find themselves suddenly surrounded by infertile women, immigrant women from the 3rd would would have their stock drastically raised, and the competition would likely be violent, possibly mass conversions to Islam. Hey, maybe the victim women would finally get their wish and be treated like men though, no longer being seen as anything but worker people. All hinging on the *IF* it causes significant infertility.

The Mirena IUD also stops periods in at least 1/3 of women who have it, for 5 years straight. I haven't seen any studies indicating that's a problem yet.

I think its really worth stressing the point ema made above, because its such a common misconception amoung women who take the pill and even amoung doctors, and you seem to share it:

The bleeding a women has when she is on a pill is *not* a period. Its withdrawal bleeding from having stopped taking the pill. It is not menstration - after all, the whole point of the pill is to stop her menstrating, in the sense of to stop her ovulating. Its a built in part of the design of the Pill, to make it still feel 'natural'.

So women taking the pill are already not menstrating, and have not menstrated once since they started taking it, how ever many years ago that was. What they *are* doing, is bleeding as a result of the withdrawal of the hormones they are taking in the rest of the month, because they stopped taking them for a week. There is no biological reason why they need to do this. What we should be arguing about is whether women have a social need to bleed for a week once a month.

I thought I had previouslty read the same as Moll says

Its a built in part of the design of the Pill, to make it still feel 'natural'.

Is this then incorrect? Is there an actually medical reason for the week off, rather than a social reason. If not, I don't see what is actually new

By G. Shelley (not verified) on 20 Nov 2006 #permalink