Managing the Monthly Cycle

It's fascinating, and a little scary, how quickly medicine can transform our notions of what "normal" is. The WSJ reports that drug makers are starting to market birth control pills as a way to help women eliminate their periods. Of course, not everyone likes this idea, since it threatens to eliminate a "touchstone of the female experience." (The pro-menstrual cycle side is an awkard coalition of liberal feminists and religious conservatives.) As I've mentioned before, I'm agnostic on the issue (men really shouldn't have an opinion on this sort of stuff), although it's important to remember that the current monthly cycle of women on the pill is itself a pharmaceutical construct, designed in the 1950s as a way to boost the acceptance of oral contraception by women and the Catholic Church.

As the article notes:

A lifetime of monthly periods isn't quite what nature intended. Women today menstruate nearly three times as often as their ancestors, who typically had more children and spent years breast-feeding, a practice that can naturally suppress menstruation. But with the onset of modern birth-control methods, and the fact that girls tend to menstruate earlier than in generations past, women now have more periods. Today, the average North American woman has about 400 periods in her lifetime. By comparison, an aboriginal woman in Northern Australia has about 150 periods during her life.

Some doctors believe reducing the number of monthly cycles in a woman's lifetime actually is better for her health. Keeping a woman's hormone levels constant and suppressing menstruation can lower risk for endometriosis, mood disorders, headache and ovarian cancer. (It's already known that monthly use of birth-control pills, which eliminates the ovulation process, lower a woman's risk for ovarian cancer.)

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"Of course, not everyone likes this idea, since it threatens to eliminate a "touchstone of the female experience." (The pro-menstrual cycle side is an awkard coalition of liberal feminists and religious conservatives.)"

Well, not exactly. There are many "liberal feminists" who disagree with the idea of the menstrual cycle as "natural" or "necessary" [as in this article by Annalee Newitz, http://www.alternet.org/columnists/story/37199/ which I find a bit reductive..]

Some women, whether or not they are "liberal feminists"(myself among them) prefer having a regular menstrual cycle to being on the pill. Other women prefer not to menstruate or would like to regulate their menstrual cycle. The real issue here is that there needs to be more research on menstruation, PERIOD [ba dum bump!] so that women have the information to make the choice that is best for them, whether it is in terms of nutrient supplementation, cancer risk, etc. regardless of what they c hoose.

I completely agree with everything you said, and I didn't mean to imply that ALL liberal feminists are opposed. I especially agree that we need to conduct more research. As I noted earlier:
"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."

"As I've mentioned before, I'm agnostic on the issue (men really shouldn't have an opinion on this sort of stuff)"

Yay! Thanks for saying that.

Just a note to say that as a woman, I do have an opinion on this, which is that it is a fantastically wonderful relief to take the pill for years on end and be done with the whole wretched ordeal of menstruation. I recommend this option to every woman- even if you don't have problems with it, it is much easier to be without the monthly event anyway. I wish more people knew the facts -that modern menstruation is not so "natural" - (in the context of our evolutionary history, it happens far too frequently and is not healthy)- and is therefore not so good for us! One of my greatest regrets of my life is I didn't learn about this option (of taking the pill straight through) earlier. PS. If one pill doesn't work well for your temperament and constitution, try another. I've found that each formulation has tiny differences.

PS. Apologies for the personal candor, I just think it's very important to enthusiastically publicize this marvelous option. It's a big deal. Nature dealt a lot of us ladies a very bad hand when it came to this issue and we are fortunate to have options. Not to mention that the pill does helpful little things like.....prevent unwanted pregnancy!!!

As a woman who took the Pill for years to treat painful cramping, I truly appreciate where Lizzie is coming from. But the Pill alters the levels of hormones which have a myriad of functions throughout a woman's body, some of which are not understood. That's why women often go through several dosages - to find one that "works" for them, without too many noticeable side effects. But what about the not-quite-noticeable side effects? Estrogen affects intangibles like mood, appetite, libido. . . you name it. We really do need more research.

Menstruation is, not to put too fine a point on it, gross! I'd love to avoid it completely. But I'd rather have my period, even with the nasty cramps, than feel like my personality is "off," and not know exactly why.

Let me be clear: the Pill, and reproductive freedom, is a wonderful thing for women. But I also think the Pill shouldn't become so routinely prescribed that women forget it is a drug! If you don't have a compelling medical reason to take it (like contraception or dysmenorrhea), I'd think twice about using it casually, just to avoid the inconvenience of a period. At least until research on women's bodies and brains catches up to where it should be.

Those are excellent points I'm glad to have spelled out. I can especially appreciate the call for more research. I just would add that for some of us, the Pill actually improves mood (and the other intangibles you mentioned) in a consistent way. Our bodies, created via the messy process of natural selection, are far from perfectly calibrated organisms. Sometimes "unnatural" solutions, such as the Pill or perhaps, say, serotonin boosters or cannabinoids, can correct natural deficiencies and fluctuations that make us miserable.

The Pill doesn't work for all women though. I took it for years and no matter the brand, dosage, whatever, I got migraines and worse cramps than when not on a Pill, and it was less of a pleasant experience. It's funny, I actually started taking them because I thought my periods were too infrequent and I was constantly getting worried that I was pregnant. I'm off them again now and have been for years. I'm far better off without them in many ways, my partner maybe not... but he's happier than when I had regular migraines instead. It may be inconvenient at times (I do a lot of field work), but I also feel like there's something wrong with not having your period for months on end. Otherwise you're likely just building up that mucus lining on the inside, not expelling that tissue, blood, and waste.

The difference with ancestral Aboriginal women: nutrition. If you go to third-world country where there is a lack of caloric intake and generally few vitamins and minerals in a diet, there are a women with significantly fewer periods. Women who are competitive runners or endurance athletes also don't get their periods for the similar conditions of fewer overall calories and greater stress on their bodies: their bodies think they couldn't handle having children. Overfed American women, yes, your bodies insist that you are in the proper biological conditions to handle childbearing, it will give you your period. Overcompetitive young gymnast females, anorexic women and girls: they all lose their periods. Why? Because their bodies can't take it.

Having your period so frequently basically means that you're well fed, not overly stressed, with good nutrition. It's not such a bad indicator.

I am both for and against this.

I am for it in any women on hormonal birth control because it makes no sense for women on the pill to stop taking them periodically just to get their period. The pill works by mimicking pregnancy. When you stop taking them, you body puts on the break, gives you your period... and then you start taking them again, starting the whole process up again. It's far more disruptive to your body's chemistry and less natural than simply not getting your period.

However, I am against the pill generally, because heck, it mimics pregnancy. This means it suppresses female libido. It also means that choose males that smell more similar to them instead of more different, i.e. have the same immune system genes.

What the heck is going on up there with all the weird comments? I totally have a good question, but the comments make it unlikely anyone else will make it down this far.

How closely does taking the pill continuously mimic the hormone levels of a pregnant or post pregnant woman? I could just look this up I suppose, but does anyone know?

The pill has terrible side effects in my experience. It keeps me from getting pregnant by making me not want sex. :(

By heather sf (not verified) on 14 Jun 2009 #permalink

Hormonal birth control generally consists of an estrogen and a progesterone mimic. Some hormonal birth control, especially long-term ones like Depo-provera, some IUDS, and emergency contraception (morning after pill) only contain progesterone.

The primary hormone responsible for pregnancy-like symptoms is progesterone, followed by estrogen (i.e. the pill). The pill does not contain human chorionic gonadotropin (HCG) which is the hormone responsible for increasing levels of progesterone produced during pregnancy.

At any rate, it's not surprising that most women suffer sexual side effects. After all, progesterone and estrogen have both been used in "chemical castration" i.e. all but eliminating any sex drive in male sex offenders. Giving males Depo-provera reduces recidivism rates from 47% to 4%.

First off, I'd like to say that I am a woman currently taking Ortho Tri-cyclen, so I'm clearly not opposed to hormonal contraception. ;-)

Lizzie (comment #4)

I wish more people knew the facts -that modern menstruation is not so "natural" - (in the context of our evolutionary history, it happens far too frequently and is not healthy)- and is therefore not so good for us!

The conclusion doesn't really follow from your premise -- just because something is "not so natural" does not mean it is not good for us. Consider the fate of the female aphid. She is raped by the male, and since she lacks a vaginal opening, this requires him puncturing her abdomen. This lack of a vagina also poses a problem for birth (aphids are live-bearing, not egg-laying). Basically, her babies burst out of her abdomen, killing her.

Nature ain't nice, and evolution doesn't optimize individuals any more than it has to.

One of the original arguments in favor of allowing monthly menstruation was to disrupt the body as little as possible, and also to avoid having endometrium build up too much. There was a very real fear that women would get endometriosis or even endometrial cancer if this material was not periodically flushed out. Though the question was not adequately studied at the time, I think it was fair for scientists of the day to have that concern.

Renee (comment #161)

However, I am against the pill generally, because heck, it mimics pregnancy. This means it suppresses female libido. It also means that choose males that smell more similar to them instead of more different, i.e. have the same immune system genes.

Did you know that a great many women become downright *horny* while pregnant? Seriously. A lot of this is due to the hormone surges, though the general discomfort of pregnancy can kill a mood pretty easily. As for me, I found my libido was actually increased by both pill and pregnancy. And I've liked my husband's odor at all times.

The research on women preferring certain scents has been interesting, but clearly can be abused. Research supports a general preference, but really does not support the idea that women will consistently choose genetically unsuitable mates while on the Pill. For instance, I've loved my husband's odor when on the Pill, when off the Pill, when pregnant, when nursing, when ovulating, and when menstruating. Clearly, individual variation is substantial, and probably enough that you shouldn't make too broad of a conclusion based on the available evidence. In any case, while it's enough to suggest some caution, it's not enough to indict the Pill entirely.

By Calli Arcale (not verified) on 24 Jun 2009 #permalink