Another look at Menstrual Suppression

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From the Canadian Women’s Health Network

You’ve likely read about it by now, in your favourite magazines, on TV and radio talk shows. There is a new campaign afoot promising women a care-free, stay-free life with no more PMS or cramps or pads and tampons—a future free of periods.

Periods are bad for you, we are told; they involve unnecessary blood loss and iron depletion, and if you are not wanting to get pregnant, who needs them?

About bloody time, say many of the news commentators. But hang on: periods are not the ‘curse’ that many of us are led to believe. In fact, eliminating monthly menstruation artificially by ingesting synthetic hormones may do much more harm than good.

Two new prescription medications promise to make menses a thing of the past: Seasonale, already approved in the United States and under consideration for approval by Health Canada; and Anya, not yet approved in either country, but already promoted as the wave of the future. Both are traditional hormonal contraceptive products that promise the ‘added benefit’ of menstrual suppression (those on Anya would have no menstrual periods; Seasonale reduces annual periods to only four per year).

Given the profitability of Seasonale in the US for its maker, Barr (sales of $22 million in the past year alone), one can only assume that similar products are in other company development pipelines.

But what is often left out of the hype around these products are the possible serious health implications of suppressing a woman’s menstrual cycle over the long-term.

Firstly, there’s too much that we don’t know about menstrual suppression for healthy women (those who have unproblematic periods).

No long-term studies have been conducted on the impact that menstrual suppression may have on fertility. No long-term studies have been conducted on the ways in which menstrual suppression may affect the development (reproductive and otherwise) of young women. No long-term studies have been conducted on the effects of exposing women to hormones over a longer period of time than regular contraceptive pills, and in some methods, in (small, but significant) higher doses. Seasonale, for example, exposes women to nine more weeks of estrogen and progestin every year than a regular birth control regimen.

If this sounds like too much nay-saying and prophesies of doom, let’s look at a recent example—which should constitute a warning—of what harm can result from messing with women’s natural cycles without scientific rigour or reason.

Until recently, women entering the menopausal years were advised that taking hormone replacement therapy (HRT) was the healthy thing to do—an ingestion of animal and/or synthetic hormones to artificially supplement their own naturally declining estrogen levels.

HRT (estrogen plus progestin) was believed to be nothing short of a ‘miracle pill’ that could improve heart health, enhance sex drive, offset depression, prevent osteoporosis and Alzheimer’s disease and contribute to an overall improvement in the quality of life. Advertisements to doctors and patients alike on the glowing qualities of HRT were so convincing that by the 1990s and into the turn of the decade, tens of millions of women in North America alone were taking HRT regularly as a means to improve their health.

Unfortunately, what was missing from this rosy picture was the science. No extensive randomized clinical trials had been conducted to assess the risks and benefits of healthy menopausal women taking HRT over the long-term, even though that is precisely what they were advised to do by many medical bodies, health practitioners and glossy women’s magazines.

Starting to sound familiar?

Then, well after decades of exposing millions of menopausal women to hormonal products in the name of good health, the Women’s Health Initiative study (the largest double-blinded randomized clinical trial of long-term HRT use by healthy women) concluded that HRT may be linked to an increased risk of strokes, heart attacks, blood clots, cardiovascular disease and breast cancer.

Almost immediately medical bodies and health practitioners did an about face and changed their prescribing guidelines and practices; they no longer recommend HRT as a standard ‘treatment’ for menopause. But not before countless women were harmed by an unnecessary meddling with their bodies’ natural functions.

It seems, sadly, that we’ve not learned our lesson.

Of course, there are many women who have chronic health conditions (such as endometriosis or fibroids), and for whom menstruation and menopause may be problematic, painful or unhealthy, and who need medical intervention. But for the majority of women—the target market for both HRT and menstrual suppression products—our cycles are a sign of health, not of illness.

Implicit in the medical model of interference in women’s cycles, whether it be menstrual suppression or hormone ‘replacement’ therapy, is the idea that women’s bodies are broken and need fixing. That our cycles represent a disease that needs to be cured or repaired.

Or even that women’s physicality is outmoded or defunct, too animal, too messy, too inconvenient, in need of updating, modernizing, mechanizing—masculinizing.

It is no small irony that when we are menstruating, there are drugs to make us stop (menstrual suppression), and when we stop bleeding (menopause), there are drugs to make us menstrual again.

What drives this push to fix what ain’t broken is a misunderstanding of the complexity of women’s cycles.

Menstruation is not just what happens when pregnancy does not—it is not just a failed process—but part of a complex cycle that is linked to other complex bodily systems that are directly involved in the development, health and wellbeing of women’s bodies. A healthy, regular menstruation signals that the body is well-nourished, that we are not overly stressed or under threat, and that we are potentially fertile.

A failure to respect the intricacy and finely balanced nature of menstruation and menopause, and an undervaluing of the innate correctness of the female body—it is not flawed at the outset—lead us to make the same mistake over and over again.

If there’s one thing we can count on as the march of science and medicine continue apace, it is the inevitable ‘pharmaceutical fix’ to cure women from the illness of being women.

But let’s break this particular unhealthy cycle and demand that the science come first, that we assess the real long-term risks of hormonal products against any possible benefits. Women only have true choices for their reproductive health when they are provided with all of the facts up front; in other words, an informed choice. Until then, long-term menstrual suppression is a gamble, an experiment for convenience with unknown consequences. We’ve gambled before and lost: let’s not wager again.

Kathleen O’Grady is the Director of Communications for the Canadian Women’s Health Network (currently on maternity leave) and a Research Associate at the Simone de Beauvoir Institute, Concordia University.

An earlier version of this essay appeared in the Globe and Mail, Saturday, November 11, 2005; Focus Section.