As a young adult, I had such bad menstrual cramps that I was bedridden for two or three days at a time. As I got older, the cramps subsided just as the mood swings took over. If someone had offered me a pill back then that promised an end to my monthly misery, I would gladly have taken it, no questions asked.
That was then, when youthful invincibility—or blissful ignorance—reigned. Today, such a pill, called Seasonale, reduces periods to four a year. Already available south of the border, the birth-control pill is currently being considered for approval by Health Canada. And today, being older, wiser, and a lot less impetuous, I have a list of questions as long as my arm about the effects of suppressing a woman’s menstrual cycle.
And I’m not the only one. North Vancouver’s Michelle Dunn, a 41-year-old life coach and mother of two, and 37-year old North Vancouver resident Corinne Beggs, a stay-at-home mom of three, both have serious misgivings about such a product. “I would have been all over it in my 20s and 30s,” Dunn says, “but in your 40s you tend to be more aware of the health ramifications of things. If it’s suppressing something, you have to wonder what it’s doing to your body.”
For Beggs, even taking a regular contraceptive pill is worrisome. “I was never that comfortable with something that interfered with my natural cycle,” she explains.
Still, enough women in the U.S. are taking Seasonale that profits last year reached US$22 million for manufacturer Barr Pharmaceuticals. A similar product made by Wyeth, called Anya, which is currently pending approval in Canada, stops periods altogether.
The idea that menstruation isn’t a necessary, healthy process—particularly for women who experience endometriosis (potentially painful lesions in the lining of the uterus) or severe premenstrual syndrome—was made popular in 1999 with the publication of the book Is Menstruation Obsolete? (Oxford University Press) by gynecologist Elsimar M. Coutinho and biomedical researcher Sheldon J. Segal, both men.
But the easy acceptance of menstruation as a curse to be eliminated and of the new generation of contraceptive pills concern many experts. In 2003, the U.S.–based Society for Menstrual Cycle Research issued a policy statement recognizing that menstrual suppression may be a useful option for women with severe menstrual-cycle problems but recommending that continuous oral- contraceptive use not be prescribed to women simply because they don’t want to have to deal with their monthly periods. (The paper is posted on its Web site at www.menstruationresearch.org.)
The society plans to make an even stronger declaration at its next meeting in June, notes Dr. Jerilyn Prior, scientific director of UBC’s Centre for Menstrual Cycle and Ovulation Research and a member of the SMCR’s board of directors. She has a special interest in the effects of hormones on women’s health and has researched extensively the use of the ovarian hormone progesterone.
Chief among her concerns about pills like Seasonale is the lack of long-term studies regarding the impact of menstrual suppression on fertility and on the reproductive development of young women, as well as the effects of exposure to hormones over a longer period of time than when using regular contraceptive pills. Seasonale, for example, exposes women to nine more weeks of estrogen and progestin every year than regular birth- control pills (which come in packs of 21; those with 28 include seven that contain no hormones).
You don’t have to look far to find an example of hormone therapy gone awry. It wasn’t that long ago that, after years of taking estrogen and progestin supplements (hormone-replacement therapy) in the name of health, millions of menopausal women were told to stop because the treatment was linked to an increased risk of strokes, heart attacks, blood clots, and breast cancer. Prior points out that recent studies have shown women taking a regular contraceptive pill have a 13 percent greater risk of stroke and breast cancer than those not taking any. Drugs like Seasonale boost that risk to 30 percent, she says. “It’s like going back to the higher-dose pills of the early days that were abandoned because they were too risky.”
As if all this isn’t bad enough, it’s not as though there aren’t other options, Prior points out, such as vaginal rings (the female condom) and spermicides, IUDs, and birth-control patches worn on the skin that last seven days.
Of course, there are women for whom menstruation is so painful and problematic that medical interventions like Seasonale must seem like a godsend.
But for most females, menstruation is a sign of health. Which makes Seasonale’s success in the United States even more astonishing. After all, Barr has managed to sell a pharmaceutical fix that, in essence, cures women of the “illness” of being women.