To Bleed or not to Bleed: New Options in the Birth Control Arsenal
By Kiesha McCurtis, MPH
“Menstruation is not a normal, healthy thing to happen.” 1
Since the recent introduction of “menstrual suppression” products to help women avoid or limit their periods, some physicians and scientists have made grossly unsupported claims -- like the one above -- with respect to menstruation. While the NWHN supports the availability of menstrual suppression products as an option for women, we have strong concerns about the unsavory manner in which these products are being marketed by manufacturers and health care providers alike.
As part of the menstrual suppression trend, in late May, the Food and Drug Administration (FDA) approved a “new” form of hormonal contraception – Lybrel – that is not quite as new as women might be lead to believe. Lybrel is the first birth control designed to completely eliminate a woman’s monthly period, the concept known as “menstrual suppression”. The idea isn’t new; for years, women have taken their traditional birth control pills on a non-traditional schedule in order to manipulate the timing of their periods (see below for more on how this works). In fact, Lybrel is not the only product on the market that has been designed to attract women who wish to avoid menstruation. Two other products -- Seaonale and Seasonique -- are intended to alter a women’s bleeding pattern so that she has just four periods in a year’s time, instead of the typical dozen.
The common thread for all of these menstrual suppression products is that they are chemically identical to traditional oral contraceptive (OC) pills. The active tablets in all of these pills contain a combination of levonorgestrel and ethinyl estradiol. The difference lies in the way a woman takes her pills: traditional OC is taken for 21 days, followed by 7 days of placebo pills, during which time the woman has her period. Lybrel uses the same hormones in a slightly lower dose, but has no change in hormone dose throughout the year and no placebo pills -- thus, the woman has no periods at all. With Seasonale and Seasonique, a woman takes one pill every day for three months and, during the final week of the pack, she takes placebo pills and has her period.
From a safety perspective, menstrual suppression products are probably an acceptable option for most women. The effectiveness of menstrual suppression products in terms of preventing pregnancy is very similar to regular OC pills. Women who can safely take traditional OC are unlikely to experience problems or difficulties with these new products. Although women who use menstrual suppression pills will take a few dozen more active hormone pills over the course of a year than do women who use 21-day OC, no evidence has been found that shows a meaningful or increased health risk from doing so. The small risks of stroke and blood clots that are associated with traditional OC (which are increased in women who smoke) are also associated with extended-use pills like Lybrel, Seasonale, and Seasonique.
The pill is the arguably one of the most researched drugs that is available on the market today. Nonetheless, OC products designed for menstrual suppression are still new products that could, potentially, develop unanticipated side effects over the long-term. There were high drop-out rates in the product safety and effectiveness trials for all of these menstrual suppression products, so the number of women who were observed and monitored was smaller than might be desired. One of the more important downsides is likely to be the high rate of break-through bleeding – which can last as long as a regular period but occurs without the predictability of a monthly cycle. Another concern is that women taking menstrual suppression pills will not be able to use a missed period as a sign of possible pregnancy; for this reason, the FDA recommends that women taking Lybrel or other menstrual suppression products use pregnancy tests if they suspect they might have gotten pregnant.
As women’s health activists, the Network regularly analyzes and criticizes the increasingly common process of medicalization of women’s bodies and lives. We are concerned about this process, in which natural experiences and socially created problems are treated as biological diseases that require medical (preferably pharmaceutical) intervention to “protect” women’s health. Disease creation has morphed; pharmaceutical companies are now considered to be the creative geniuses responsible for mending the “broken” female form. Examples of this process include premenstrual dysphoric disorder (e.g., PMS as a mental health condition); thin bones; and female sexual dysfunction (to be treated by drugs).
Menstrual suppression products are another option in the arsenal of fertility control, yes, but the manner in which they are being marketed is disconcerting. Pharmaceutical companies have begun to promote menstrual suppression products using the bogus assertion that monthly periods are somehow dangerous or unhealthy. Some scientists have even speculated that reducing the frequency of menstruation (and ovulation) reduces the risk of breast, endometrial, and ovarian cancers -- but none of these claims have been substantiated by scientific evidence.2,3 The fact is, there is no scientific evidence to support the hypothesis that the frequency of menstruation and ovulation directly causes reproductive cancers. It is precisely this type of false and misleading advertising that generates profit for pharmaceutical companies to the detriment of women’s health.
Greater variety in the available options on the birth control spectrum is a positive move forward, but it should not come at the risk of further medicalizing women’s bodies. Misleading information about the inherent “danger” of menstruation is not helpful, and actually harms young girls’ and women’s understanding of their bodies and natural bodily functions. Introducing menstruation to pre-adolescents and newly menstruating girls as a negative (and potentially dangerous) experience that is best avoided could strongly affect their body image and self-perception in negative and lasting ways. Young girls have their work cut out for them as it is in our culture; they shouldn’t have to battle a barrage of negative and misleading messages about a natural bodily process on top of the other challenges they face.
Women’s individual experiences of, and attitudes about, menstruation play an important role in determining their interest in menstrual suppression and may also affect the level of satisfaction with the method among women who use these products. Some women find the thought of not having a period (or as many periods) appealing for convenience, while others rely on monthly menstruation as a sign of a healthy body or a signal that they are not pregnant. For women who have monthly menses accompanied by pain, discomfort, or extremely heavy bleeding, menstrual suppression offers an accessible health benefit.
These products are yet another contraception option among many, and have the potential to expand options and increase convenience for some women. This advance should not be undermined, however, by stigmatizing menstruation or by passing products off as new and innovative, when they are really just newly packaged and promoted.
1. Rabin R, “The New Pill in Town: Controversial form of birth control delays monthly cycle,” Newsday, January 25, 2004, page 4.
2. Eaton SB, Pike MC, Short RV, et al. Women’s reproductive cancers in evolutionary context. Q Rev Biol. 1994; 69: 353-367.
3. Arthur C, “New Pill will allow women to have just three periods a year,” The Independent, March 14, 2002, p. 6.
Kiesha McCurtis is the NWHN Health Information Coordinator.