The abolition of menstruation.

The abolition of menstruation.

The abolition of menstruation.

Science, technology, and life.
May 26 2007 7:02 AM

Bloodless Revolution

The abolition of menstruation.

Illustration by Robert Neubecker. Click image to expand.

Say goodbye to another curse of nature. Menstruation just became optional.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

We've been tampering with periods for years. But on Tuesday, we made it official. The Food and Drug Administration approved Lybrel, the first birth-control pill explicitly designed to abolish monthly bleeding.

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Since the dawn of hormonal contraception, women have debated the wisdom of suppressing their periods. Crunchy feminists think it's unnatural. Techno-feminists think it's liberating. I'm a guy, so I'll stay out of the fight over womanhood. But I'll say one thing about nature and liberation: Pharmacology is dissolving them. Menstruation as we know it isn't exactly natural. And for some women, abolishing it isn't exactly liberating.

Officially, the case against "continuous contraception" is about safety. Studies show no more risk from Lybrel than from other birth-control pills, but critics say this one needs more research because it's so radical. The safety question, in other words, boils down to the nature question. And on that question, menstruation advocates are passionate. As one sociologist puts it, "Menstrual manipulation appears to be another in a long line of attempts to medicalize women's natural biological life events."

It's true that we've manipulated women's biology for a long time. So long, in fact, that we've confused the manipulation with nature. Primitive women seldom menstruated, since they were pregnant or breastfeeding. For them, menstrual suppression was natural. What we call natural, the monthly period, was largely a byproduct of early contraceptive methods, which blocked pregnancy but not ovulation.

Then, about 50 years ago, we invented the pill. It prevented ovulation by mimicking the hormones that told a woman's body she was already gestating a baby. In short, it faked pregnancy. But that didn't bother people. What bothered them was the idea of disrupting the monthly cycle, particularly "natural" menstruation every fourth week. So drug makers replicated the cycle. They sold pills in packs of 28, the last seven of which were dummy pills. The dummy pills allowed hormone levels to sink, causing the uterine lining to decay and bleed as though the woman were losing an egg. In fact, there was no egg. That was the whole point of the previous 21 pills. Fake pregnancy, fake period.

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The other reason for the dummy pills was to reassure women that they weren't pregnant. Never mind that the "pill period" wasn't real. If you bled, you'd feel safe. At the time, this was understandable, since pregnancy tests were elaborate and hard to get. Today, however, you can buy a test at any drug store for less than $10. You don't have to bleed.

For special occasions—weddings, honeymoons, vacations—women learned to skip the dummy pills and open the next batch of real ones. And for patients with unusually bad menstrual symptoms—endometriosis, fibroids, extreme pain—doctors scrapped the dummy pills completely. But that required a special prescription. Meanwhile, thanks to free samples from drug companies, female doctors were taking the real pills year-round. They knew it was safe, and they didn't want periods disrupting their work schedules.

Gradually, the hypocrisy gave way. Four years ago, the FDA approved Seasonale, a pill designed to be taken for three months, with a week off. Next came Seasonique, which added estrogen to the dummy pills, softening the fake period. Last year, the FDA approved Yaz and Loestrin 24, which cut the number of dummy pills to four per cycle. Other devices—implants, injections, IUDs—eliminated periods altogether. Women began to replace patches and vaginal rings every three weeks instead of every four. Now, with Lybrel, it's official: PMS, R.I.P.

To the techno-feminists, that's the end of the story. The "natural" case for periods is a fraud, so menstrual suppression is a blow for liberation. But the story isn't over. Technology doesn't stop with the confounding of nature. It confounds freedom, too.

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For women with severe physical symptoms—cramps, migraines, nausea—banishing periods is a no-brainer. But for many others, menstrual discomfort is more psychological. At a conference four years ago, researchers presented evidence that women's interest in menstrual suppression correlated more strongly with their attitudes toward menstruation than with their symptoms. Last year, when Lybrel's manufacturer, Wyeth, asked women what bothered them most about their periods, most picked pain or inconvenience. But one in four cited mood swings, weight gain, overeating, clothing anxiety, or feeling dirty.

The danger, from a standpoint of emancipation, is that some of these women won't shut off the bleeding to satisfy themselves. They'll do it to satisfy others. On menstrual-suppression Web sites, you can find testimonies from women who hate their periods for making them too moody for their boyfriends or too tired to go to the office. Their menses are getting in the way of their men. Even a gender-studies major, effusing over Lybrel, told ABC News, "Maybe men would respect women more if they didn't have periods."

Drug companies play on these insecurities. Bayer advertises Yaz as the only birth-control pill approved by the FDA to treat "Premenstrual Dysphoric Disorder," which can impair "your work, daily activities or relationships." The pill's Web site lists symptoms to watch out for: "Irritability. Moodiness. Feeling Anxious. Bloating. Increased Appetite." Last fall, a Wyeth executive told investors that women might buy $250 million worth of Lybrel a year, in part because periods threatened their job attendance or performance.

Pills can liberate you from old burdens. They can also impose new ones. I'm glad women are free to take Lybrel. I hope, in the future, they'll also feel free not to.

A version of this article also appears in the Outlook section of the Sunday Washington Post.