The end of menstruation

Feb. 4, 2008 | 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.

Next page: On the medical front, Lybrel still faces skeptics