Bioethics, healthcare policy, and related issues.
The AP is carrying a story on the increasing popularity of hormonal birth-control regimens that provide round-the-cycle protection and do away with monthly menstruation. Women love them, and nobody understands why The Pill hasn’t always been this way.
In particular, the AP article makes no mention whatsoever, and the author is apparently completely unaware of, the reason a monthly period is built into birth control pills. The answer has nothing to do with women’s health or with increased contraceptive effectiveness. The answer, as with so many forms of interference in women’s sexual health, is the Catholic church.
Strange but true: One of the major forces behind the first hormonal birth control – Dr. John Rock – was a devout Catholic. Development of hormonal contraceptives began in the middle of the Vatican’s drawn-out process of establishing official dogma on birth control, in the 1950s – 60s. Rock believed that if hormonal birth control mimicked a natural menstrual cycle as much as possible, then using the pills would be indistinguishable from using the rhythm method – in both cases, contraception is achieved by having sex during the woman’s infertible period, the only difference being that with the Pill the non-fertile period would be extended to cover the entire menstrual cycle. Rock thought he could sell it to the Pope that way, and by some accounts he almost succeeded, but the Church reverted to type by choosing against women’s health and liberty.
It was John Rock and Gregory Pincus who decided that the Pill ought to be taken over a four-week cycle–a woman would spend three weeks on the Pill and the fourth week off the drug (or on a placebo), to allow for menstruation. There was and is no medical reason for this. . . . Pincus and Rock knew that the effect of the Pill’s hormones on the endometrium was so modest that women could conceivably go for months without having to menstruate. “In view of the ability of this compound to prevent menstrual bleeding as long as it is taken,” Pincus acknowledged in 1958, “a cycle of any desired length could presumably be produced.” But he and Rock decided to cut the hormones off after three weeks and trigger a menstrual period because they believed that women would find the continuation of their monthly bleeding reassuring. More to the point, if Rock wanted to demonstrate that the Pill was no more than a natural variant of the rhythm method, he couldn’t very well do away with the monthly menses. Rhythm required “regularity,” and so the Pill had to produce regularity as well.
I must say I have some sympathy for Rock’s attempt. If the Catholic Church had been slightly more progressive when they were asked to be, tens of millions of women, at least, would have had access to effective birth control who instead have suffered – in many cases, died – from the burden and consequences of uncontrolled fertility. If Rock’s vision had panned out, how much good would have been done! – and if kowtowing to Catholic notions of what is “natural” was what it took to boot some sense into their sexual politics, it was obviously the right thing to do. The tragedy is that even that wasn’t enough, and uncountably many women the world over have suffered ever since. Even women who were on the Pill did not get as effective a medication as they needed, and in many cases became pregnant due to the complexity of a medication regimen delivered in pills deliberately designed not to work 1/4 of the time, solely to cajole a Pope who in the end turned against them anyway.
Over 40 years later, women are now being given access to consistent, uninterrupted forms of the most effective birth control ever devised – as they should have been from the beginning.
Using the pill or other contraceptives to block periods is becoming more popular, particularly among young women and those entering menopause, doctors say.
“I have a ton of young girls in college who are doing this,” says Dr. Mindy Wiser-Estin, a gynecologist in Little Silver, N.J., who did it herself for years. “There’s no reason you need a period.”
Such medical jury-rigging soon will be unnecessary. Already, the Seasonale birth-control pill limits periods to four a year. The first continuous-use birth-control pill, Lybrel, is expected to be on the U.S. market soon, and drug companies are lining up other ways to limit or eliminate menstrual periods.
The article lists six different no-cycle or long-acting hormonal birth control products – pills, implants, and hormone-impregnated IUDs – either recently approved or expecting FDA approval within two months. (It will be interesting to see if the FDA acts to block these products as they have done with emergency contraception.) Now women have direct control over their fertility cycle on their own terms, for the first time. That’s certainly good news – but the reason they haven’t had that control until now is old news of a very different kind.
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