Menstrual suppression

Townsend Letter for Doctors and Patients,  Nov, 2004  by Jule Klotter

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Not surprisingly, women without access to birth control have far fewer menstrual periods during their lifetime than those with access. (Multiple pregnancies and breast feeding prevent ovulation and menstruation.) Some believe that the high number of periods may be unnatural, even harmful. Scientist Beverly Strassmann observed the reproductive profile of the Dogon tribe of Mali in the 1980s for two and a half years. She found that Dogon women average about a hundred periods in their lifetime. Western women with access to birth control menstruate between 350 and 400 times. Some researchers, like Drs. Elsimar Coutinho and Sheldon S Segal, believe that this 'incessant ovulation' is harmful, contributing to migraines, endometriosis, fibroids, and, possibly, to breast, ovarian, and endometrial cancers. Coutinho and Segal wrote the book Is Menstruation Obsolete? How Suppressing Menstruation Can Help Women Who Suffer from Anemia, Endometriosis, or PMS.

In September 2003, the FDA approved Seasonale, a birth control pill made by Barr Laboratories that causes just four periods a year. John Rock and Gregory Pincus, developers of the original birth control pill, knew that the hormones in the Pill suppressed ovulation and slowed the usual proliferation of the endometrium (uterine lining). Consequently, a woman taking the Pill could go months without having to menstruate (the process during which the endometrial lining is shed). The Pill's developers wanted to make the Pill's effect appear natural, so they instituted a system in which the synthetic hormones were discontinued every fourth week, resulting in a menstrual period. Doctors have known that women could take the Pill for six to twelve weeks before they have breakthrough bleeding or spotting and have even suggested this schedule to patients with anemia and other menstrual-related disorders and to those who wish to postpone their period until after a honeymoon or vacation. Seasonale, like other birth control pills, contains synthetic estrogen and progesterone. Women take it for 84 consecutive days before taking a week of placebo that will result in a period.

Instead of preventing ovulation by using low levels of synthetic hormones to trick the body into thinking that it's pregnant, some researchers hope to suppress menstruation by using gonadotropin-releasing hormone agonists (GnRHAs), according to a New Yorker article (10 March 2000). GnRHAs prevent the pituitary gland from ordering the manufacture of sex hormones. Malcom Pike, a medical statistician, and two oncologists, Darcy Spicer and John Daniels, want to use GnRHAs and just enough estrogen and progesterone to keep women's hearts and bones strong and the uterus healthy without increasing the risk of breast cancer.

Critics, like psychiatrist Susan Rako, view menstrual suppression as "the largest uncontrolled experiment in medical history." Dr. Rako says that testosterone deficiency can develop in women who eliminate their periods with products like Seasonale. This deficiency leads to diminished sexual desire, loss of muscle tone, reduced energy, and weight gain. Christine Hitchcock, a researcher at the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia, raises concerns about breast and endometrial safety and bone density. She also asserts that the studies on menstrual suppression are flawed because they do not include a control group of women who are not taking birth control pills. All of the subjects in menstrual suppression studies were already taking birth control pills, meaning they tolerate the synthetic hormones. Safety is a concern of many consumers also; but if researchers can find a safe way to suppress menstruation, market research by RoperASW says that two-thirds of women are ready to sign on.

Fried, Jennifer, Off the rag. http://archive.salon.com 24 November 2003

Gladwell, Malcolm. John Rock's Error. New Yorker 10 March 2000

Hoffmann, Karen, Foes raise red flag against suppression of menstruation. www.postgazette.com 24 June 2003

Seasonale. www.drugs.com

Van Buskirk, Audrey. No Flow. Thestranger.com 18 September 2003

COPYRIGHT 2004 The Townsend Letter Group
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