Flow: The Cultural Story of Menstruation (5 page)

Sit down if this hasn’t really sunk in yet, because this is the spooky part—if you’re currently on the Pill, that thing you’ve been calling your period all this time isn’t one at all! It’s the Stepford wife of menstruation, in that it looks like a period and even kind of acts like one, but is ultimately not your period, plus is a lot better behaved and less argumentative. In other words, when you’re on the Pill, your normal hormonal rhythms—that complex chemical symphony that controls ovulation, endometrial buildup, and flow—are essentially shut off. You’re instead on an artificial merry-go-round of estrogen and synthetic progesterone, or progestin, which explains why there’s less flow, no cramping, and virtually no PMS to speak of. It may look like a period, but technically speaking, it’s not, at least not as any first-year medical student would define it.

So why not take it a step further, wondered some shrewd scientist working late one night at some big drug company. What would happen if a woman just skipped that placebo week altogether?

According to the drug companies, this kind of menstrual management is the revolution American women have been waiting for all their lives. In a “clinical trial” paid for by the makers of Loestrin 24 Fe, 85 percent of the women polled said that “having their period” was one of their five greatest annoyances, along with “gaining weight” and “having a bad hair day.”

Had we been polled, we perhaps would have written down “global warming,” “unaffordable health insurance,” and “the inexorable passage of time” as rating higher on the annoyance scale than our periods. We don’t think we’re alone on this one, either. Overwhelmingly, surveys not funded by drug companies have shown that most women simply don’t consider getting their period that big a deal.

Of course, it’s different for those who suffer from primary dysmenorrhea, endometriosis, fibroids, and the generic condition known as “bleeding like a stuck pig.” Many have opted for the most radical way to ensure that they will never again menstruate: that is, they undergo a hysterectomy. Hysterectomy involves the surgical removal of one’s uterus (with occasionally the cervix, ovaries, and fallopian tubes thrown in); and more than 600,000 are performed every year, making it currently the second most commonly performed surgical procedure in the United States. If you’re currently considering a hysterectomy due to killer periods, the option of simply popping some pills instead may well seem like manna from heaven.

In May 2007, the FDA approved Lybrel, the first contraceptive formulated for the express purpose of eliminating menstruation altogether. True, up to 40 percent of the women in the test group were still experiencing breakthrough bleeding by the end of the one-year study, which we think kind of defeats the purpose. What’s more, women found that not getting their period made it that much harder to realize they might in fact be pregnant, which can happen even if you’re on the Pill. Yet this most likely didn’t deter the champagne toasts and backslapping that went on the moment the FDA broke the happy news, and Lybrel landed on pharmacy shelves two months later.

Prior to their launch of Lybrel, Wyeth Pharmaceuticals commissioned a national study in which menstrual suppression (not surprisingly, considering that they paid for the study) got a thumbs-up from 97 percent of ob-gyns interviewed. Not only that, they reported other compelling statistics: women not only feel less effective during their periods, but take more sick days, avoid the gym, and wear dark clothes.

Dark outfits and not working out? Well, why didn’t you say so, man? This constitutes a national health emergency! Somebody, give those women a prescription for some expensive prescription drugs!

Come on, guys … can we have a reality check here? First of all, most women we know are already fond of dark clothing and don’t work out, even when they’re not menstruating. Furthermore, just because the drug companies appear to be stampeding, lemming-like, over the cliff of menstrual hysteria doesn’t mean that’s a compelling argument for most women to follow.

Overwhelmingly, surveys not funded by drug companies have shown that most women simply don’t consider getting their period that big a deal.

What we’d really like to know is, how did this all come about? When did menstruation become such an outlaw, on the lam and apparently wanted by the FBI?

One of the most influential antimenstruation arguments made was in the 1999 book Is Menstruation Obsolete? Written by Elsimar M. Coutinho, the book was met with glowing reviews, as well as respectful, in-depth coverage by such tony publications as The New Yorker and The Guardian. It claims that while many women insist on waxing sentimental about their periods, menstruation isn’t the “natural state” it’s cracked up to be. In fact, given the centuries-old tradition of women bearing and breast-feeding nonstop, Coutinho argues that regular periods are historically freakish, something that’s only come about recently, as a result of less childbearing and nursing in developed countries, as well as improved overall health and nutrition. Far from being a healthy, even meaningful process, menstruation is a dangerous, biologically costly anachronism that places women at risk for serious medical and psychological problems, which the book then happily proceeds to recount in gory detail. In short, Coutinho makes the point that menstruation is pretty much an unnecessary evolutionary holdover, about as useful, meaningful, and natural as a vestigial flipper.

Coutinho is far from a crank; he’s a respected professor of gynecology, obstetrics, and human reproduction. But he’s also one of the pioneers of Depo-Provera, the injectable contraceptive that he endorses so strongly in his book. And while it can indeed relieve endometriosis, fibroids, anemia, and other problems, Depo-Provera is also linked to irreversible bone loss, as well as a delayed return to fertility afterward. For those unfortunate enough to accidentally become pregnant while using it, it’s also linked to an 80 percent greater-than-usual chance of the child dying in his or her first year.

This, then, is yet another example of a widespread trend that can make a girl downright cynical: that far from being selfless and objective advocates of public health, doctors are more often paid spokespeople lurking in the pockets of the pharmaceutical companies … and take it from us, those are some mighty deep pockets. The pharmaceutical industry, after all, is routinely ranked as one of the top three most profitable businesses in the country.

As for their studies, we have good reason to question them. The big drug companies love nothing more than distinguished experts and academics writing them and their products up flatteringly in articles, speeches, and yes, books aimed at general readers like you and me. Talk about getting a Good Housekeeping Seal of Approval! The companies therefore woo such potential opinion makers madly with expensive gifts, hefty speaking fees, and exotic trips to faraway conferences. A 2003 editorial in The Washington Post summed up the conflict: “Anyone arguing the drug companies’ case, no matter how neutral his or her academic or think-tank position may seem, should be questioned carefully with regard to sources of income.”

The big pharmaceutical companies have thus spent huge amounts to make some pretty crafty arguments about why we should seriously considering shortening, reducing, or even ending our periods outright. When they’re not creeping us out with medical horror stories, they pathologize the symptoms, demonize the event, and, ultimately, convince us to feel lousy about something that honestly shouldn’t be that big a deal to most women. The National Women’s Health Network recently reported on the increasingly negative way menstruation was being talked about in the world of health care and how it was subsequently spun by doctors to their female patients. By their reckoning, the propaganda is working all too well: there seems to be a spike in negative attitudes about menstruation, especially among younger women.

But what are the facts?

Is there in fact any truth to the many claims of those who endorse menstrual suppression? A woman will shed up to forty quarts of blood, mucus, and tissue in a healthy lifetime of menstruation, but to what end? What’s the point of monthly blood, anyway?

Funnily enough, virtually no medical school, scientific think tank, or research lab had ever seriously studied this question until 1993. As of the twenty-first century, no one has yet been able to prove exactly why we menstruate and how it affects our health. One theory is that the shedding of blood every month acts as a built-in cleaning system that regularly tidies away any contaminating microorganisms, especially those brought in by sperm. Critics of that theory retort that microorganisms love nothing better than growing in blood. Still others chime in that the whole point of menstruation isn’t about blood loss; the ongoing regrowth of the endometrium is just more cost-efficient than keeping it in constant running order.

Other theories abound. In her 1999 book, Woman: An Intimate Geography, Natalie Angier suggests that the human brain is so advanced, a developing fetus needs vast amounts of blood to feed it; therefore, the constant regeneration of the endometrium is actually a sound investment. Others argue that a fresh uterine lining every month, one that won’t respond to an invading foreign body with an inflammatory response, is essential to prevent rejection of a fertilized egg.

Since various organs perform numerous chores (the humble liver is responsible for more than five hundred), some believe that the uterus, via menstruation, helps reduce our blood pressure and iron levels, thereby trimming our overall risk of heart attacks and stroke. Furthermore, it can be argued that our heart health is helped by the presence of estrogen, which lowers the “bad” kind of cholesterol while increasing the “good.” Still others theorize that the hormonal shifts of menstruation are mysteriously linked to what we like to smell and how we ultimately choose our mates.

So little is actually known about menstruation that it’s hard to predict what the unintended effects of widespread suppression might be. And what of the drugs themselves and their long-term effect on our bodies? What exactly happens to us if and when we use hormones to stop our periods?

What freaks us out not a little is the extraordinarily skimpy testing that’s been done on menstrual suppression to date. Barr Laboratories, for instance, claims that Seasonale is safe enough to take from one’s teens all the way through menopause. But before you go rushing out to fill that prescription for your fifteen-year-old, do you want to know what this claim is based on? On a study of three hundred women who were tested for one year …total. To us, this is exactly not what we’d call reassuring.

So little is actually known about menstruation that it’s hard to predict what the unintended effects of widespread suppression might be.

Scientists from the Yerkes National Primate Research Center of Emory University and the Center for Behavioral Neuroscience in Atlanta conducted a study in 2007 on the synthetic progesterone used widely in contraceptives. They discovered that it made female monkeys more aggressive and anxious, while dampening their sex drives—not really an appealing combination for anybody. Obviously, this was only one study, but it might help explain reports of mood changes, heightened anxiety, depression, and loss of libido in women who use synthetic hormones for contraception … and conceivably for menstrual suppression, as well.

Another weird and disturbing long-term effect of menstrual suppression is actually environmental, and we’re not even talking about the typical pollution you’d expect from industrial manufacturing. In recent years, there have been Stephen King-esque reports from the United States and England about animals that live in or near the water: male alligators with undersize penises, male fish that produce eggs as well as sperm, male sea birds with distinct hermaphroditic changes.

Sounding like the setup for a not-very-funny episode of Futurama, this state of affairs is most likely caused by synthetic estrogen from birth control pills. More than 100 million women worldwide are currently on the Pill; every day, they excrete vast amounts of leftover synthetic estrogen (which is more potent than the natural kind), which eventually makes its way to the nation’s rivers and streams.

So what might this kind of unintended estrogen exposure do to humans, particularly the ones who eat fish? No one really knows yet, although there’s already speculation that it might be linked to early puberty in girls, breast cancer in women, and decreased sperm count.

Could it be we simply don’t have enough evidence to prove that menstrual suppression is reversible or even safe in the long run? While originally recommended only for women with physical problems such as painful endometriosis, suppression is now being hawked to everyone. The problem is that most of the women signing up are not the ones with actual medical conditions, but those who have negative attitudes about their periods, attitudes encouraged by the drug makers themselves. When it comes right down to it, is that really how we want to make decisions about our bodies?