The end of menstruation

The drug Lybrel promises to free women from their monthly curse. But today it's a sales pitch that seems hopelessly outdated.

Topics: Medicine, Science,

A fabulously healthy woman stands barefoot in a field of grass trailed by a lime-green picnic blanket, her chest jutting forward, her hair and skirt lifted by a gentle breeze. She is beaming because she has postponed her period. Now she can exercise often, never miss work, travel and have sex whenever she wants to. Whom does she have to thank for her new carefree lifestyle? Lybrel, the first and only FDA-approved cycle-stopping contraceptive, which hit pharmacy shelves last summer.

To view the Lybrel Web site, you might think that women everywhere have been waiting desperately for the chance to postpone their periods. Clearly, Wyeth, the drug giant behind Lybrel, is banking on it. But it turns out that not all women want to cure the curse. Wyeth’s own research says so. Still, the ease with which women can now postpone their periods has sparked a new debate on menstruation. Teenage girls are wondering whether avoiding messy periods is as simple as taking a pill. Feminists see Big Pharma treating something natural and essentially feminine as an illness. Lybrel is the first drug to allow women to stop their period for good, and some scientists say its long-term effects are unknown.

Ever since Lybrel was released, new questions about menstruation have been turning up in newspaper Op-Eds and glossy women’s magazines and on TV news. Karen Houppert, author of “The Curse: Confronting the Last Unmentionable Taboo: Menstruation,” says it’s no coincidence that public debate over periods has surfaced at this particular cultural moment. “This conversation about periods gets recycled in times where there’s high anxiety about women’s role in society,” she says. Today, from the “mommy wars” to the possibility of a high-powered woman in the White House, there is plenty of anxiety over women’s changing roles. So it’s no wonder that Lybrel has cracked open the debate and has women asking: Is this the end of menstruation?

If you consider the entire history of menstruation as a 24-hour period, women have been menstruating regularly only for the last two minutes. In hunter-gatherer days, women had an average of 160 periods in their lifetime because they spent much of their lives breast-feeding or pregnant. Traces of that cultural history can be seen today, where some women can count the number of periods they’ve had on one hand. In some tribes, a big show is made of menstruation — women are secluded in menstrual huts because of beliefs that menstrual blood has magic or evil powers. Sometimes they are secluded as a way of publicly monitoring their cycles, and, consequently, maternity.

“It’s only been in very recent times, due to changes in the sociological pattern in how we live, that we’ve entered an era of menstruation,” says Sheldon J. Segal, author of “Is Menstruation Obsolete?” and a scientist at the Population Council. Along with those changes have come ways to deal with menstruation. For thousands of years, various cultures used everything from seaweed to lint to contain menstrual blood. It wasn’t until 1921 that Kotex produced its first menstrual pad, which was developed from a “sanitary absorbent” used as a bandage on wounded soldiers during World War I, and was attached to a belt worn around a woman’s waist. In the decades that followed came belt-free pads, pads with wings and, of course, thong-shaped pads. The first commercial tampons premiered in the late 1920s; in 1936, Tampax came out with the first tampon with an applicator and string.

But the most profound change to the culture of menstruation came with the Food and Drug Administration’s approval of the first oral birth control pills in 1960. The Pill’s creators worked a week of placebo pills into a monthly regimen because they believed women would find the “withdrawal bleeding” caused by the sudden drop in hormones a reassuring replication of their natural cycle. But more important, co-creator John Rock was a devoted Catholic and longed for the church’s approval of the Pill. The only way to guarantee that approval was to portray the Pill as the rhythm method’s next of kin in its mimicking of monthly menstruation.

Around the same time the Pill was approved, researchers discovered that Depo-Provera, an injectable drug that was given to women to treat endometriosis and prevent miscarriages, was also effective as contraception. But it wasn’t until 1992, after several applications, that the FDA approved Depo-Provera for use as a contraceptive. It causes many women’s periods to lighten or disappear completely, but the focus of its marketing campaign was the convenience of a contraceptive that was injected every three months; while on Depo-Provera, a woman doesn’t have to worry about remembering to take a daily pill.

Instead of being hailed as a liberator offering “freedom from the everyday,” Depo-Provera stirred an unrivaled public outcry. Activists questioned its safety after animal trials revealed an increased risk of breast and endometrial cancer, although the relevance of those findings to humans remains highly questionable. Civil rights activists also took issue with the drug’s trials in third-world countries among poor and illiterate women and suggested that those women were unaware of its risks and had been used unethically as guinea pigs. Depo-Provera remains in use today.

In 2003, the birth control pill Seasonale, which promises women only four periods a year, made a far more glamorous premiere on the contraceptive scene with former “Sex and the City” columnist Candace Bushnell as its spokeswoman. The icon of Fendi feminism declared, “When you think about what women have accomplished with 13 periods a year, think about what we can accomplish with only four.” Bushnell added: “We have come a long way, but we’ve only just begun.”

The pink pill, tag-lined “Fewer Periods. More Possibilities,” was promoted as a lifestyle choice. The drug’s current Web site offers a period planner allowing women to schedule their cycle around “vacations, business travel, romantic encounters, and family reunions.” In other words, there is no need for public premenstrual breakdowns, missing a meeting because of debilitating cramps or dampening a sexual flame by having to bashfully explain it’s “that time of the month.” The take-away marketing message: A woman in control has menstruation under control.

Even before Seasonale secured FDA approval, though, the Society for Menstrual Cycle Research, a nonprofit research organization, released a cautionary statement, noting that related media discussions presented monthly menstruation “as bothersome and even unhealthy.” The statement warned: “Women are not getting accurate, balanced information, rendering an informed decision about this health care option difficult if not impossible.”

Regardless, the menstrual suppression movement gained speed. In 2006, the FDA approved three new forms of period-suppressing oral birth control. Seasonique, a similar formulation to Seasonale also made by Barr Pharmaceuticals, gives women four periods a year. Its marketing took a no-nonsense approach. In one commercial, two women, “Logical” and “Emotional,” discuss the possibility of suppressing periods; with the help of Seasonique, the two alter personas merge into one.

Yaz, which promises shorter and lighter periods, took a more aggressive approach: The campaign’s theme song is a pop version of Twisted Sister’s “We’re Not Gonna Take It.” The drug’s Web site features a peppy, sun-kissed young woman — the kind surely conquering A.P. calculus while serving as captain of the girls varsity soccer team — giving a one-two punch to a jumble of block-lettered words: bloating, acne, moodiness and fatigue.

Then there’s Loestrin 24, which created a spunky redheaded (and fictional) spokeswoman, Cammie. She is “an aspiring textile designer in her mid-twenties” who has everything: a “chic funk” apartment in Alphabet City, a boyfriend who fronts an alternative-rock band, a closet full of hip vintage clothing and a period that lasts only three days.

That same year, Dr. Susan Rako, an outspoken opponent of the “antimenstrual” movement, sounded an alarm about the dangers of menstrual suppression. In her book, “The Blessings of the Curse,” she wrote: “Tampering with the hormonal climate of healthy, menstruating women, including teenage girls, whose lives stretch ahead for decades, for the purpose of doing away with their periods, is, in a word, reckless.”

Feminists note that cycle-suppressing contraception is being marketed to young girls as a way to avoid the angst of teenage transition. “It’s infantilizing, [the message that] you don’t have to go to that next stage of maturation, you can hover in this liminal state between childhood and mature adulthood,” says professor Mary Vavrus, who teaches courses in feminist communications at the University of Minnesota. Period suppression is being sold as a cosmetic fix, a way for women to avoid bloating, feel bikini-ready and be able to slip into skinny jeans. “Just like getting breast implants or doing different cosmetic surgeries, you’re objectifying your body in some troubling ways,” Vavrus says.

With all the good press for period suppression, observers worry it will be hard to persuade young teens to welcome menstruation as an entry into womanhood. “The problem is the ‘welcome to womanhood’ idea is not such a welcome thought to them,” Houppert says. “It’s viewed as a restrictive role. It means girls who are 12 and 13 are leaving their childhood aside for other concerns that have to do with appearance, boys and weight.” It’s hard to imagine menstruation no longer being the cultural cornerstone of girlhood, or reading Seventeen magazine without its TraumaRama feature of menstruation horror stories. But, Houppert says with a sigh, “if you can get rid of menstruation the same way you can with acne, we’re going to go for it.”

To Vavrus, drugs like Lybrel medicalize a normal bodily function. “This means having to give over that thing that makes us uniquely female to a big pharmaceutical company that has no problem flooding our bodies with hormones,” she says. “A lot of women are concerned that after the silicone breast implant disaster and the estrogen therapy disaster, there’s a well-founded fear that pharmaceutical companies are willing to sacrifice women’s health for their own profits.” Houppert adds: “It recasts menstruation as a disease, and I don’t think most women see it as that.”

On the medical front, Lybrel still faces skeptics. Although many doctors say the drug is safe — and similar to the type of period suppression women have experienced for the past 40-plus years on the standard Pill — some, like Dr. Rako, say long-term studies are still needed. “Manipulating women’s hormonal chemistry for the purpose of menstrual suppression threatens to be the largest uncontrolled experiment in the history of medical science,” she says. Her chief concern is that constant use of hormonal birth control cuts testosterone levels, which influence a woman’s bone and cardiovascular health, mood and sex drive. There are other side effects “we may not know about until it’s too late,” she says.

Lybrel and related drugs are prescribed to plenty of women with menstrual-related medical problems, like severe PMS and endometriosis. But today it’s difficult to see that Big Pharma is winning the cultural battle against period suppression. Women may complain about the curse, but they don’t all want to give it up. Most basically, some look to their period as a sign that they aren’t pregnant. Still others value the rhythm of change, like shifting sleep patterns or creativity and intense contemplation inspired by hormonal changes. Then there are the more prosaic benefits of having your period, like an excuse to take a break from housework or even arrive late to work.

Vavrus says her female students often tell her they are greatly reluctant to suppress their periods. She adds that having a period is a powerful form of female solidarity, one that can’t be broken by even the most high-powered marketing campaign. “Even though we have been socialized to detest our period and to really dread its onset, it still is one of those things that bind us together as women,” she says. “It’s the only thing we really have in common in a very fractured and splintered world. It’s one thing you can always count on other women to understand.”

Ultimately, the availability of Lybrel, with its potential to stop periods, only reminds women of how important that time of the month is. “The way we experience our bodies is profoundly yet invisibly shaped by cultural norms of which we’re often unaware until they’re challenged,” says Alma Gottlieb, author of “Blood Magic: The Anthropology of Menstruation.” For many women, monthly menstruation — and the associated doses of Midol, hot-water bottle applications and trips to the feminine hygiene aisle — is the gateway to and foundation of womanhood. “It’s just too bizarre,” says Gottlieb, “to imagine our bodies otherwise.”

Tracy Clark-Flory

Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter and Facebook.

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