Question marks in debate over (menstrual) periods
Question marks in debate over periods
By Sue Ellen Christian
Copyright © 2006, Chicago Tribune
Published August 6, 2006
Although the debate over a controversial birth-control pill that would stop menstruation is well under way in regulatory circles, doctors' offices and in the media, American women are likely no closer to making an informed decision about whether to halt a function so seemingly integral to their bodies.
Most women, research shows, have never heard of menstrual suppression. To make up her mind about the concept, a woman has to sift through a lot of rhetoric--and she may still come away scratching her head.
Who is to blame for the lack of good information? The media, which has provided biased coverage of a similar pill already in use. Doctors, many of whom don't know enough about the risks and benefits of menstrual suppression to counsel patients.
Researchers, too, many of whom are more interested in fighting for their point of view in a medical journal than providing balanced information to the public. And then drugmakers, who are adept at promoting only the data that will help them sell their products.
The current debate, one that has veered into social, historical and economic issues, is prompted by the pending Food and Drug Administration approval of drugmaker Wyeth's Lybrel, an oral contraceptive that suppresses menstruation as long as a woman takes it.
Historically, women had no more than a few dozen periods during their lifetime; they were busy having babies or breastfeeding. So say researchers who use this perspective to argue that what is "natural" for women is to have far fewer than the average 450 menstrual cycles in a lifetime.
Economics come into play too. The creators of the pill theorized correctly that women would more readily accept the contraceptive if it mimicked the normal menstrual cycle. The researchers also reasoned--incorrectly -- that the Catholic Church might more readily accept the drug based on such a natural rhythm, said Dr. Sheldon Segal, co-author of the book, "Is Menstruation Obsolete?" and a scientist at the Population Council, a non-profit organization that conducts health research.
So for decades the typical birth-control regimen of 21 days of dosing with seven days of placebo pills has been followed largely for non-medical reasons.
Further complicating a woman's decision is the fact that society gives mixed messages about menstruation and how women should view it. Teenage girls are taught to see menstruation as a rite of passage into womanhood. But at the same time they are taught to hide their tampons and employ euphemisms to avoid saying aloud that they are having their period.
Also confusing to women is whether continuously suppressing menstruation is safe. Researchers and physicians who support menstrual suppression say it allows women to avoid cramps, premenstrual syndrome and other side effects, and that it does away with an unnecessary bleed that may hinder a woman's overall quality of life and even career advancement.
Heavy menstrual flow, they say, contributes to anemia. And diseases associated with menstruation, such as endometriosis, would improve under a continuous-use hormonal contraceptive.
Experts cautious about the concept say that there is not enough research about many aspects of the effects of menstrual suppression on a woman's body. Because the estrogen and progesterone found in birth control play a role in bone physiology, it is an open question how lengthening oral contraceptive use affects bone density.
Other medical concerns include the effect on the development of adolescents' reproductive systems, and the loss of a pill-free interval that mimics the "hormonal pause" that normally happens around menstrual flow.
"You can have freedom from bleeding," said Dr. David Grimes, vice president of biomedical affairs for Family Health International, a non-profit organization active in international public health.
"It costs a great deal of human suffering," Grimes said. "Women often feel bad when they are menstruating. They may have diarrhea, cramps. A large amount of time is lost from work and school, which translates into millions of dollars in lost productivity annually."
Other experts don't see monthly bleeding as a burdensome medical problem.
"Menstruation is not a disease," said Christine Hitchcock, a researcher at The Center for Menstrual Cycle and Ovulation Research at the University of British Columbia in Vancouver, which studies women's menstrual cycles, hormonal patterns and ovulatory characteristics.
News coverage isn't helping women make an informed decision either. The coverage of Barr's Seasonale, a birth-control pill intended to limit bleeding to just once every three months, was resoundingly biased in favor of menstrual suppression, with proponents quoted far more than those against, according to a study by psychologist Ingrid Johnston-Robledo of State University of New York-Fredonia.
Also, many physicians just don't know enough about the concept to talk to reporters or counsel their patients on it one way or another, experts said.
Johnston-Robledo's research also found that young women she surveyed were curious about menstrual suppression but not necessarily in support of it.
"They wanted more information and research," Johnston-Robledo said. "We need more data before we can argue that all women in North America don't want to menstruate."
Women can only hope that a public meeting of contraceptive experts planned by the FDA for later this year will help settle some of the questions about Wyeth's drug. The FDA also has asked the company to submit more information on manufacturing methods and more analyses of clinical data to help make its decision on whether to approve the drug.
Maybe then women across the country will have enough clear, cogent information to make their own decisions.
----------
Sue Ellen Christian is an assistant professor of journalism at Western Michigan University.
By Sue Ellen Christian
Copyright © 2006, Chicago Tribune
Published August 6, 2006
Although the debate over a controversial birth-control pill that would stop menstruation is well under way in regulatory circles, doctors' offices and in the media, American women are likely no closer to making an informed decision about whether to halt a function so seemingly integral to their bodies.
Most women, research shows, have never heard of menstrual suppression. To make up her mind about the concept, a woman has to sift through a lot of rhetoric--and she may still come away scratching her head.
Who is to blame for the lack of good information? The media, which has provided biased coverage of a similar pill already in use. Doctors, many of whom don't know enough about the risks and benefits of menstrual suppression to counsel patients.
Researchers, too, many of whom are more interested in fighting for their point of view in a medical journal than providing balanced information to the public. And then drugmakers, who are adept at promoting only the data that will help them sell their products.
The current debate, one that has veered into social, historical and economic issues, is prompted by the pending Food and Drug Administration approval of drugmaker Wyeth's Lybrel, an oral contraceptive that suppresses menstruation as long as a woman takes it.
Historically, women had no more than a few dozen periods during their lifetime; they were busy having babies or breastfeeding. So say researchers who use this perspective to argue that what is "natural" for women is to have far fewer than the average 450 menstrual cycles in a lifetime.
Economics come into play too. The creators of the pill theorized correctly that women would more readily accept the contraceptive if it mimicked the normal menstrual cycle. The researchers also reasoned--incorrectly -- that the Catholic Church might more readily accept the drug based on such a natural rhythm, said Dr. Sheldon Segal, co-author of the book, "Is Menstruation Obsolete?" and a scientist at the Population Council, a non-profit organization that conducts health research.
So for decades the typical birth-control regimen of 21 days of dosing with seven days of placebo pills has been followed largely for non-medical reasons.
Further complicating a woman's decision is the fact that society gives mixed messages about menstruation and how women should view it. Teenage girls are taught to see menstruation as a rite of passage into womanhood. But at the same time they are taught to hide their tampons and employ euphemisms to avoid saying aloud that they are having their period.
Also confusing to women is whether continuously suppressing menstruation is safe. Researchers and physicians who support menstrual suppression say it allows women to avoid cramps, premenstrual syndrome and other side effects, and that it does away with an unnecessary bleed that may hinder a woman's overall quality of life and even career advancement.
Heavy menstrual flow, they say, contributes to anemia. And diseases associated with menstruation, such as endometriosis, would improve under a continuous-use hormonal contraceptive.
Experts cautious about the concept say that there is not enough research about many aspects of the effects of menstrual suppression on a woman's body. Because the estrogen and progesterone found in birth control play a role in bone physiology, it is an open question how lengthening oral contraceptive use affects bone density.
Other medical concerns include the effect on the development of adolescents' reproductive systems, and the loss of a pill-free interval that mimics the "hormonal pause" that normally happens around menstrual flow.
"You can have freedom from bleeding," said Dr. David Grimes, vice president of biomedical affairs for Family Health International, a non-profit organization active in international public health.
"It costs a great deal of human suffering," Grimes said. "Women often feel bad when they are menstruating. They may have diarrhea, cramps. A large amount of time is lost from work and school, which translates into millions of dollars in lost productivity annually."
Other experts don't see monthly bleeding as a burdensome medical problem.
"Menstruation is not a disease," said Christine Hitchcock, a researcher at The Center for Menstrual Cycle and Ovulation Research at the University of British Columbia in Vancouver, which studies women's menstrual cycles, hormonal patterns and ovulatory characteristics.
News coverage isn't helping women make an informed decision either. The coverage of Barr's Seasonale, a birth-control pill intended to limit bleeding to just once every three months, was resoundingly biased in favor of menstrual suppression, with proponents quoted far more than those against, according to a study by psychologist Ingrid Johnston-Robledo of State University of New York-Fredonia.
Also, many physicians just don't know enough about the concept to talk to reporters or counsel their patients on it one way or another, experts said.
Johnston-Robledo's research also found that young women she surveyed were curious about menstrual suppression but not necessarily in support of it.
"They wanted more information and research," Johnston-Robledo said. "We need more data before we can argue that all women in North America don't want to menstruate."
Women can only hope that a public meeting of contraceptive experts planned by the FDA for later this year will help settle some of the questions about Wyeth's drug. The FDA also has asked the company to submit more information on manufacturing methods and more analyses of clinical data to help make its decision on whether to approve the drug.
Maybe then women across the country will have enough clear, cogent information to make their own decisions.
----------
Sue Ellen Christian is an assistant professor of journalism at Western Michigan University.
posted by Carlos T Mock at 10:55 AM
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