Should Menstrual Suppression Be A Lifestyle Choice?
Menstrual suppression has been recommended for medical conditions such as endometriosis, but it is also being proposed as a lifestyle choice for women who dislike menstruation or find it inconvenient.
But is menstrual suppression safe and is it a reasonable lifestyle choice, asks Paula Derry, a Health Psychologist in this week's BMJ?
Birth control options that reduce or eliminate periods are being developed, she writes. The oral contraceptive Seasonale, for example, combines 84 days of active pills with seven days of placebo, reducing the number of pill-induced periods from 13 to four annually.
Seasonale has been approved by the US Food and Drug Administration, but long term research was not required for approval and the long term safety of menstrual suppression remains uncertain, she warns.
Some proponents have argued that menstrual suppression is safe, even beneficial, because monthly menstruation is unnecessary, even unhealthy. They believe that monthly menstruation throughout adulthood is a modern development and is at odds with what female bodies were designed to do.
But if it is more common today to have monthly menstrual cycles throughout adult life, this does not in itself mean that monthly menstruation is unnatural, much less that it is a medical problem, argues Derry. In this case, as in so many others, a wide range of situations may be "normal."
Further, why women menstruate is unknown. We do know that a menstruating woman is a healthy, probably fertile, woman, while unhealthy, malnourished, or massively stressed women are more likely to skip periods.
Even if prolonged monthly menstruation were unnatural and unhealthy, this would not prove that suppressing menstruation is better, she adds. Menstrual suppression itself is unnatural; a drug chronically overrides the physiological changes associated with the menstrual cycle, thereby creating an underlying hormonal environment that is not found in nature.
The argument that menstruation is obsolete is illogical and unscientific, she says.
The important questions are these: is there evidence that medications are safe and effective? what are the known benefits and risks, and what uncertainties exist with regard to future benefit and harm? who should be using such medications? are women provided with accurate information to make informed choices?