If a new brand of birth control gets approved early next year, that time of the month could become the time of, like, the decade. Lybrel, a birth-control pill made by Wyeth, would be the first oral contraceptive to deliver an uninterrupted supply of hormones. Seventy percent of women who took it for six months were period-free, according to a preliminary study by the company.
Wyeth isn't the first pharmaceutical company to reimagine the menstrual cycle. In 1992, the FDA approved Depo-Provera, an injection that is repeated every three months. In 2003, Seasonale rescheduled the monthly period to four times a year. And in July, the government gave the go-ahead for Implanon, an implant that delivers a steady hormone stream for up to three years. But the pill is the favorite means of birth control of the nearly quarter of American women of childbearing age who take hormonal contraceptives. That means Lybrel—and the other brands that will surely follow—could change the menstrual cycle as we know it. The appeal is obvious: No more bloating, cramping, food cravings, and PMS jokes, not to mention the savings in unpurchased tampons and such. But in the end, for reasons both medical and cultural, it's not clear that putting the kibosh on the curse is a good idea.
Traditional pill packs contain a week of placebos for each monthly cycle, and, as a result, women who take them appear to menstruate. But it turns out that the bleeding serves no reproductive purpose. Since there's no egg to flush out, the bleeding is a symptom of withdrawal from progestin and estrogen, the hormones in the pill—in essence, it's a fake period. The inventors of the pill, which debuted in 1960, supposedly decided to mimic the menstrual cycle because they thought that would make women more psychologically comfortable with the product.
Western women today are estimated to average about 400 menstrual cycles over the course of their lifetimes. Pregnancy and nursing halt periods for a time, of course. And for years physicians have informally advised women with painful periods to practice "menstrual suppression" by taking hormonal contraceptives continuously. Birth-control medications tend to lessen menstrual and premenstrual symptoms to begin with, and some studies show that fewer periods may mean even more relief.
Now Lybrel is explicitly selling all of this, by prescription, at a drug store near you. Women can shut off their systems for law school, a trip around the world—even their entire 20s. Random spotting is common while using Lybrel, especially at the start. But in a study of another brand called Alesse, 90 percent of participants did not bleed at all after a year of use, according to Leslie Miller, associate professor of obstetrics and gynecology at the University of Washington. "We can manipulate menstruation," she says.
Life without getting your period, though, would be life without one of the touchstones of the female experience: a sisterhood of shared empathy, tampons and chocolate, and laundry lessons passed from grandmother to granddaughter. Liberation from premenstrual emotional peaks and valleys sounds great, but we would also lose the surge of creativity and libido that comes with the urge to strangle your houseplants. Would movies be as poignant, or garlic mashed potatoes ever taste as good?
In two different surveys of college women, Ingrid Johnston-Robledo, associate professor of psychology and women's studies at the State University of New York, College at Fredonia, found that women who were asked to name positive aspects of menstruation reported that it was a sign of health and fertility and that it helped connect them to other women and the rhythms of nature. * This may sound like an ode to the inner moon goddess, but it has relevance. Johnston-Robledo found that women who didn't like their periods were also more ashamed of their bodies.
At the same time, there may be some medical arguments for suppressing one's period, at least for a limited period of time. Hormonal contraceptives are known to decrease the risk of ovarian and endometrial cancers, so some doctors think a continual dose of the pill would further reduce those risks. No blood loss also means less anemia. And then there is the provocative argument of Brazilian gynecologist Elsimar Coutinho. In his 1999 book Is Menstruation Obsolete? (co-authored with Sheldon J. Segal),he writes that modern women experience "incessant ovulation," in contrast to our ancestors, who started menarche later and had many fewer periods because they gave birth and breastfed far more frequently. Women's bodies may not have evolved to handle so many periods and would appreciate a break, Coutinho thinks.
But if modern menstruation isn't completely natural, by prehistoric standards, suppressing one's period by taking hormones is even less so. No one knows the health effects for menstruating women of long-term continuous exposure, especially the risks of blood clots and breast cancer and the effect on later fertility. The uncertainties are especially troubling for adolescents whose reproductive systems continue to develop after they start menstruating, explains Jerilynn Prior, director of the Centre for Menstrual Cycle and Ovulation Research in British Columbia. Nearly one in five teens uses a form of hormonal birth control. Given the unknowns, perhaps doctors should consider setting a minimum age requirement for Lybrel, or limiting how long women can stay on it.
Nor is the pharmaceutical industry's track record on birth control exactly reassuring in weighing the risks and benefits. In 2002, the implant Norplant was pulled from the market after questions about its effectiveness and lawsuits by women claiming they were not adequately warned of side effects. In 2004, the FDA required that Depo-Provera include a label warning of risk to bone density. And last year, the FDA warned that the high levels of estrogen found in the Ortho-Evra patch increased the risk of blood clots after about a dozen young women died from clotting believed to be related to it. Maybe Lybrel will prove to be a dream drug with none of these problems; at the moment, we don't have the data to know. Periods, on the other hand, are time-tested. They tell you that you're not pregnant, and they're a sign that your body is working as it should. That's worth some fuss.
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