Excerpt: 'No More Periods'

In her new book, No More Periods?, Dr. Susan Rako argues that manipulating women's menstrual cycles so that they no longer have periods is dangerous. Though widely covered in the media, it needs a more careful look from experts, she says.

Chapter One

No More Periods?

— The Washington Post, September 7, 2000, A Pill to Uncramp Women's Style — Libby Copeland, Staff Writer

I think we have to disabuse health professionals and women of the idea that monthly menstruation is natural, normal and healthy. — Dr. David Grimes University of North Carolina Professor of Gynecology

We're into the era of medicine making life more convenient. — Dr. Charlotte Ellertson

The Lancet March 11, 2000

Nuisance or natural and healthy: should monthly menstruation be optional for women?

Continuous use of ordinary oral contraceptives safely lets women control … whether and when they choose to bleed.

When such a safe, simple, and inexpensive treatment is already so widely available, women should not have to be driven loony by their lunar cycles if they prefer not to bleed each month. — Charlotte Ellertson, Ph.D. Population Council, Latin America and the Caribbean "thanks to Elsimar Coutinho for ideas and suggestions"

Chicago Daily Herald December 11, 2000

No More Period. Period. — Lorilyn Rackl, Daily Herald Health Writer

Unless you're trying to get pregnant, there's no physiological reason to have a monthly period.

The drum beat for fewer periods definitely is getting louder, leaving some experts to predict the feminine hygiene aisles at Wal-Mart will one day be a lot less crowded.

I know the tampon and pad people don't want to hear this. I routinely put women on birth control pills and have them not take their last week's pills to suppress their periods. A lot of them love it. — Dr. Teresa Ann Hoffman, Gynecologist Mercy Medical Center, Baltimore

I have this box of tampons in my cupboard and I told my sister the other day, "God, I gotta throw these out, because they're so old they'd probably be dangerous."

The longer you go without a period, the more you realize you didn't need it. There's a certain freedom to not having to plan Kotex in your luggage. — Leslie Miller, M.D., Assistant Professor Obstetrics/Gynecology University of Washington

And from the "Health Science" section of my hometown newspaper — full page:

The Boston Globe August 22, 2000, Megan Scott, Globe Correspondent

NO chocolate cravings No PMS or bloating No fatigue or moodiness What if having your period was a choice?

It's up to you.

This article goes on to quote Dr. Freedolph Anderson, director of clinical research at the Institute for Reproductive Medicine of Eastern Virginia Medical School:

There's really no good medical reason for menstruation.

The Wall Street Journal June 25, 2002

Doctors Push New Efforts to Eliminate Women's Periods.

Tara Parker-Pope, in "Health Journal"

If we're not offering it [period suppression] routinely to women, they don't know this is an option. They don't know how healthy it can be for them. — Anita Nelson, M.D. Professor of Obstetrics and Gynecology University of California at Los Angeles

The Boston Globe article describes Dr. Anderson as "one of the leaders of the anti-period movement, overseeing a nationwide test of a form of birth-control pill that would reduce the number of periods a woman has each year from 13 to 4."

"Anti-period movement?"

For years I have been sickened by the irresponsibility of media-coined "official" categories. One particular bizarre or obscene event can be neutralized of its impact when it is referred to as just another example of a created "category." Naming is a form of tacit acceptance of the unacceptable.

"Car-jacking." "Drive-by shooting." "Ethnic cleansing."

By comparison, "anti-period movement" sounds, but is not, innocuous. Disturbing, too, for women's natural lunar cycle to be considered an appropriate subject for social-economic-political positioning. When first I read the words, I thought, What's next-an "anti-high tide/low tide movement? Not much is safe from "improvement." Since my research and teaching about the physiology and function of testosterone in women's physiology, and following the publication of my book The Hormone of Desire: The Truth About Testosterone, Sexuality, and Menopause, I have had several reorienting experiences.

One, in particular, stands out. June 1998. Washington, D.C. I am preparing to speak at the Congress on Women's Health. In the lobby, I am introduced to a physician who consults to the Food and Drug Administration. The first words he says to me: "I hear that we are on different sides of the coin." He knows that I see the need for FDA-approved, properly dosed pharmaceutical preparations of testosterone for women suffering symptoms of testosterone deficiency — and his comment implies that he holds some opposing position. "I am concerned with the whole coin," I tell him levelly. And I mean it.

Interesting metaphor, though: coin. I am a realist. Our democratic and capitalist society, which I honor and choose over any other on earth, benefits from pharmaceutical companies' investment in research and development of new drugs. However, the fact that drug companies fund a significant percentage of research projects (and the scientific papers that they generate) creates a potential for bias and manipulation of publications in medical journals.

This problem of potential bias in scientific publications has become of such substantial concern that editors-in-chief of thirteen of the most prominent medical journals authored, in one voice, an extraordinary and comprehensive editorial published in the autumn of 2001 in the Journal of the American Medical Association, the Lancet, the British Medical Journal, Obstetrics and Gynecology, and half a dozen others. Their notable effort addressed the wide range of potential conflict of interest — political, personal, economic, and other on the part of contributing authors, "peer reviewers" (who have the power to accept or reject a paper for publication), and of editors themselves. The editorial said:

If a study is funded by an agency with a proprietary or financial interest in the outcome, editors may ask authors to sign a statement such as, "I had full access to all of the data in this study and I take complete responsibility for the integrity of the data and the accuracy of the data analysis." Editors should be encouraged to review copies of the protocol and/or contracts associated with project-specific studies before accepting such studies for publication. Editors may choose not to consider an article if a sponsor has asserted control over the authors' right to publish.

These reasonable suggestions are not yet universal rules. The arena of scientific publications today has a way to go toward dependable integrity. When we read or hear in the media a report of the findings of some recent study, it might be helpful if we were told who sponsored the research.

Obviously, scientists and clinicians work and publish papers on subjects of special interest to them. In promoting a particular theory or pharmaceutical approach, researchers sometimes focus on the drawbacks of competing theories or pharmaceuticals. Sometimes that's a good thing. When conducted and reported with integrity, studies motivated by an intention to expose the shortcomings and risks of competing theories and pharmaceuticals can contribute important information to understanding the whole picture.

While the knowledge and ethical standards of vigilant editors of scientific journals can help to protect that arena from distorting bias, the media's communication of news about medical-scientific subjects presents a different challenge. News articles regularly report breaking developments in medical science. However, at times a particular feature is mistaken in emphasis or significantly incomplete. Part of the job of journalists (and their editors) is to draw our attention, of course. And news writers — even the best ones — cannot be authorities on every one of the subjects they report. The dramatic headlines and the slant of news stories featuring "no more periods" is a solid example of this limitation.

My first contact with "the anti-period movement" was the Gladwell article mentioned in the Foreword, whose subtitle, "Menstruation Can Be Dangerous to a Woman's Health," is arresting and, with an emphasis on the qualifying verb, technically accurate. It certainly got my attention. The implication of this message is that women can be better off NOT menstruating. Women can also be worse off. Menstrual suppression can be dangerous to a woman's health.

The consequences of manipulating a woman's natural, complex hormonal chemistry by dosing her more or less nonstop with birth control pills — a method of menstrual suppression that is in active development — concerns me greatly. While I was reading the New Yorker piece, I had a visceral response: nausea and fear. My female nature shouted an intuitive "NO" as my brain began to spin with what I knew to be some of the implications for our intricate physiological chemistry. In some "thought-form shorthand" version, this is what raced through my mind (it is technical language that probably won't mean much without the translation that will come later, but may give a flavor of what got me going on this subject):

How can anyone believe that disrupting the menstrual cycle is innocuous? Constant estrogen stimulation decreases ACTH and increases binding proteins, leading to lowered DHEAS levels and lowered available testosterone levels. Disrupting the normal menstrual cycle eliminates a natural mechanism that lowers blood pressure. These changes are bad for our immune system and our response to stress, increase our risk of heart attacks and strokes, and decrease our sexual desire, sensitivity, and pleasure.

Manipulating women's natural hormonal chemistry messes with the basis of sexual attraction and partner choice between women and men, with consequences that are linked to and can even detrimentally affect the genetic inheritance of immune mechanisms for our human species.

Motivating women to use oral contraceptives for the purpose of menstrual suppression puts increased numbers of sexually active women-including very young women-at risk for potentially lethal sexually transmitted diseases. It's not just the AIDS virus that's threatening us. Women are dying from cancer of the cervix caused by high-risk strains of the Humanpapilloma Virus (HPV).

The title of a book by Brazilian gynecologist Dr. Elsimar Coutinho, Is Menstruation Obsolete?, homes in on menstrual bleeding — as though that part of the female hormonal cycle can be isolated from the whole and simply done away with. Of course it cannot. "No more periods" is where the folks on the bandwagon of "the anti-period movement" want the spotlight. What they are actually proposing (and presenting as though it were an innocuous manipulation) is NO MORE MENSTRUAL CYCLE.

What is at issue here is not only the monthly bleed, but the whole of the natural female reproductive cycle. The intricate interplay of hormones that rise and fall in a monthly pattern have remarkable effects on every organ system in the body and are at the foundation of natural and sexual selection in the human species.

Imagine the television ads for one of the new pharmaceuticals: images of carefree and happy women active in sports intercut with scenes of romance. Voice-over: "No more periods." And then, very small print at the bottom of the screen and very, very fast voice-over:

This medication has been shown to increase the risk of blood clots, heart attacks, and strokes, to interfere with sexual desire and pleasure, to increase the user's risk of cancer of the cervix, to expose the user to infection with sexually transmitted diseases, to alter the chemistry of male-female attraction.

We need more than a voice-over to understand the hazards of menstrual suppression. We need a careful, knowledgeable, balanced, responsible, unhurried voice.

Excerpted from No More Periods? by Susan Rako, M.D. Copyright 2003 by Susan Rako, M.D.. Excerpted by permission of Harmony, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.