For many women, a birth control pill that eliminates monthly menstruation might seem a welcome milestone.
Would you consider taking this pill? Why or why not?
Ruth Fremson/The New York Times
Giovanna Chesler speaking before the showing of her documentary.
But others view their periods as fundamental symbols of fertility and health, researchers have found. Rather than loathing their periods, women evidently carry on complex love-hate relationships with them.
This ambivalence is one reason that a decision expected next month by the Food and Drug Administration has engendered controversy. The agency is expected to approve the first contraceptive pill that is designed to eliminate periods as long as a woman takes it. Doctors say they know of no extra risk to the new regimen, but some women are uneasy about the idea.
“My concern is that the menstrual cycle is an outward sign of something that’s going on hormonally in the body,” said Christine L. Hitchcock, a researcher at the University of British Columbia. Ms. Hitchcock said she worries about “the idea that you can turn your body on and off like a tap.”
That viewpoint is apparently one reason some already available birth control pills that can enable women to have only four periods a year have not captured a larger share of the oral contraceptive market.
“It’s not an easy decision for a woman to give up her monthly menses,” said Ronny Gal, an analyst at Sanford C. Bernstein & Company.
But if the new pill, called Lybrel, is approved, Mr. Gal predicts an onslaught of advertising meant to persuade women to do just that. The drug’s maker, Wyeth, said yesterday that it was expecting F.D.A. approval in May, but has declined to discuss its marketing plans.
The company’s research shows that nearly two-thirds of women it surveyed expressed an interest in giving up their periods. That dovetails with the findings of similar research conducted by Linda C. Andrist, a professor at MGH Institute of Health Professions in Boston.
“We don’t want to confront our bodily functions anymore,” Ms. Andrist said. “We’re too busy.” Doctors say they know of no medical reason women taking birth control pills need to have a period. The monthly bleeding that women on pills experience is not a real period, in fact.
And studies have found no extra health risks associated with pills that stop menstruation, although some doctors caution that little research has been conducted on long-term effects.
The topic has, however, inspired an hourlong documentary by Giovanna Chesler, “Period: The End of Menstruation?,” currently screening on college campuses and among feminist groups.
Ms. Chesler, who teaches documentary making at the University of California, San Diego, said she became concerned about efforts to eliminate menstruation when she first heard about the idea several years ago.
“Women are not sick,” she said. “They don’t need to control their periods for 30 or 40 years.”
The subject has also ignited a debate within the Society for Menstrual Cycle Research, a scientific organization that studies both the medical and social science of menses.
In 2003, the group issued a position statement saying that more research was needed before women could make an informed choice about using pills that suppress their periods. That statement could be revised at the group’s meeting scheduled for Vancouver, British Columbia, in June.
Ms. Hitchcock, a director of the organization, said that although some research has been comforting, she remained concerned that medical science did not fully understand the long-term implications of interrupting women’s periods. The same hormones that work on the menstrual cycles act in the brain, bones and the skin, she said.
“You need to think about whether there are consequences we don’t know about for the whole body,” said Ms. Hitchcock, who is with the Center for Menstrual Cycle and Ovulation Research.
There has also been a backlash among groups that celebrate the period as a spiritual or natural process, like the California-based Red Web Foundation. “The focus of our group is to create positive attitudes toward the menstrual cycle; suppressing it wouldn’t be positive,” said Anna C. Yang, a holistic nurse and executive director of the organization.
Eliminating menstruation is not a completely new concept. Women who take any kind of oral contraceptive do not have real periods.
Because the hormones in pills stop the monthly release of an egg and the buildup of the uterine lining, there is no need for the lining to shed — as occurs during true menstruation.
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Still, since the advent of oral contraceptives in 1960, birth control pills typically have been designed to mimic the natural 28-day menstrual cycle to assure women using the pill that their bodies were functioning normally. The pills are usually packaged as regimens of 21 days of hormone pills and 7 inactive pills. The interruption of hormone therapy during the inactive part of the regimen induces bleeding that resembles a mild period but is, in fact, caused by unstable hormone levels.
In recent years, drug makers have come out with new pill regimens that tinker with the 28-day cycle by increasing the number of hormone pills, creating a shorter span of bleeding.
The drug maker Barr caused a sensation in 2003 by introducing Seasonale, a contraceptive regimen packed as 84 hormone pills and 7 placebo pills. Users have “periods” once every three months.
