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Saturday, April 21, 2007

The Curse reversed - decades late

Apparently some women are actually outraged that there is finally a birth control pill that does not force us to have a period, supposedly because it is somehow "unnatural" not to have one every 28 days of our non-pregnant lives. And yet it is only due to a bizarre historical artifact that for the nearly 50 years that the Pill has been available, those of us using it have been forced to have our period thirteen times a year, even if we didn't want to.

Here's a brief summary of the human female menstrual cycle:
The first day of menstrual bleeding is arbitrarily designated as the first day of the menstrual cycle. During the first 4-5 days, during bleeding, hormones are at their lowest point. Over the next 10 days or so, an ovarian follicle develops, and once the follicle is mature, ovulation occurs. At this point, estrogen is peaking. Then, estrogen drops after ovulation and progesterone, which stimulates the uterine lining to develop in anticipation of receiving a fertilized ovum, increases. If the ovum is not fertilized, progesterone levels drop, which means the enriched lining of the uterus is not sustained, and menstrual bleeding occurs.

The birth control pill mainly contains progesterone. If you become pregnant, high levels of progesterone are maintained, which prevents further ovulation. Thus, the artificial introduction of progesterone essentially causes your body to behave as if it were pregnant, which inhibits ovulation. The traditional Pill introduces one progesterone-free week out of every four, so that menstrual bleeding will be simulated. It isn't true menstrual bleeding because we are never actually allowing our bodies to go through the cycle, we are just turning progesterone levels on and off like a switch to manipulate it.

If you ever thought about your reproductive cycle for ten minutes and asked your doctor why on earth you should be compelled to go through this ritual despite the fact that you have not even ovulated, you got some vague response about how it was not 'healthy' not to have periods. But women have been systematically misled for decades; there is absolutely no evidence whatsoever that there are health risks associated with the absence of menstruation. Certainly the lack of menstruation can be an indicator of some further health problem (such as abnormally low body fat), but it actually serves no function other than your body saying "whoops, not pregnant this time."

What furthers the outrage was the assumption that women must have 13 cycles a year to be "normal." I personally had about a six-week cycle before going on hormones, but at the time, I thought it was a reasonable trade-off to have more "periods," given that they were significantly less debilitating (of course, since I was not having natural periods). But this New Yorker article from 2000 pointed out that there is evidence that menstruating more often is a product of industrialized society, and that in pre-industrial societies, it is normal for women to menstruate as few as four times a year. The article further shows the positive correlation between lifetime number of menstrual cycles in women and cancers of the reproductive organs.

So why on earth does the traditional birth control pill force us to simulate menstruation, when for so many of us, it is a miserable few days?

Perhaps at the time the Pill was being researched and developed, in the late 50s-early 60's, people knew that the primary force behind that research and development was Dr. John Rock, who happened to be a devout Catholic. In fact, he pursued this line of research precisely because he was a Catholic, and wanted to give Catholic women more control over their reproductive lives without violating their church's rules. He reasoned that if the rhythm method was acceptable to the church, surely intervention - using the same hormones occurring naturally in the body - in order to make the cycle more regular and prevent a fertile period entirely, would be acceptable too. Of course he ultimately was wrong, and became an embittered ex-Catholic by the end of his life.

But the greatest travesty was done to women who simply wanted convenient birth control, and to have power over their own reproductive lives. A menstrual period every 28 days was arbitrarily introduced into the regimen by a Catholic doctor who thought it would appease the pope. A pope, who, eventually, decided Catholics were not allowed to use the Pill. So every woman who has used the birth control pill since is either a non-Catholic, or a "Catholic" who doesn't give a hoot what the pope thinks anyway. And yet for nearly 50 years we have been stuck with a Catholic Pill as our only option.

The one argument made in the Times article about forcing regular "periods" that made any sense to me at all was the psychological reassurance of not being pregnant. Fine, those women can use a period-forcing pill as far as I am concerned. Why should the rest of us be compelled to as well?

Here are some of my particularly favorite quotes in the article:

"It's not an easy decision for a woman to give up her monthly menses," said Ronny Gal, an analyst at Sanford C. Bernstein & Company.

There has also been a backlash among groups that celebrate the period as a spiritual or natural process, like the California-based Red Web Foundation. "The focus of our group is to create positive attitudes toward the menstrual cycle; suppressing it wouldn't be positive," said Anna C. Yang, a holistic nurse and executive director of the organization.

One [person] who attended the screening [of "Period: The End of Menstruation?"], Aviva Bergman, a 22-year-old student at Goucher College in Maryland, said she would not use products that suppressed her period because it seemed unnatural.

"I just feel that there's a reason you're getting it every month," she said.


You know what? Y'all can have as many periods as you like. You do your little spirit dances while you are washing the blood out of your underwear and popping the Advil like candy. If you believe in "natural," go live in a cave somewhere. Just don't have the gall to "backlash" against something that will make my life significantly more bearable, and that I should have already had for my entire adult life. Thank you.

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6 Comments:

Blogger Assistant Village Idiot said...

It sounds like it could be offered as a straightforward choice. If you find having menstrual periods natural, you could have a pill cycle that allows that. If you think them unnecessary, you could have a prescription that prevents it. I have to think there would be a market for the latter. Pharmaceutical companies like markets. Raise the flag there.

April 24, 2007 4:46:00 PM MDT  
Anonymous nat said...

I enteirely agree with you !! That's why after having 3 kids I ask my doctor a intrauterine device (the one with hormone). Since then, no bleeding (or negligible) any more. I had read a lot of idiotic argument about the psychological aspect of not having periods... it's so wrong ! I just feel free...

April 25, 2007 7:48:00 AM MDT  
Blogger ordinarygirl said...

I've seen two new pills out advertising, Yas and Seasonale.

Yas has a 4 day placebo instead of a 7 day placebo, which is supposed to help women with hormonal balance.

Seasonale is like 3 pill packs all in one, without the intervening 7 day placebo, except during the last pill pack. Why?

I looked into both because fewer periods have always been an attractive option to me, but because neither has a generic, they're expensive.. 8 times more expensive in my case.

Secretly I was hoping that I could just skip the 7 day placebo of Seasonale and start a new pack immediately. I'm not sure how they increase/decrease dosage though, so it might have been fruitless.

I never really thought of it the way you mentioned, but why not? I'll ask my doctor about it when I see her in a few weeks.

One other note. Years ago I went in for the shot (Depo Provera?). I loved the idea of never having my period. However, I found myself emotionally a wreck for the first few days after getting the shot, enough that I found it undesirable. I wonder if it's changed any in a decade plus.

April 25, 2007 1:03:00 PM MDT  
Anonymous Jake said...

couldn't you have been doing this your whole adult life if you wouldn't have taken the placebo pills in your monthly prescription and just started the next month's real pills? Wouldn't that have kept the progesterone levels high enough to prevent bleeding? Just a guy here, prob'ly asking a stupid question.

April 25, 2007 2:09:00 PM MDT  
Blogger ordinarygirl said...

I'm by no means an expert, or claim to know much about it, but I think it depends on the type of pill - monophasic, bi-phasic, or tri-phasic.

Monophasic pills contain the same amount of hormones per pill, bi- and tri-phasic pills contain differing amounts during the month, usually lower towards the end of the pill pack (from my recollection).

Plus usually you can only refill a prescription 5 before it will run out under an insurance plan, not 7 days+ before.

I was reading on wikipedia and there's a new pill called Anya that is monophasic and is meant to be taken with no break.

April 25, 2007 2:54:00 PM MDT  
Blogger Zeolite said...

Jake -

I did that for years, I just skipped the placebo pills and went on to the next pack - I was lucky enough to have some pretty smart doctors who made me aware of that option. It was great!

May 19, 2007 10:32:00 AM MDT  

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