Do we need to menstruate?

PatriciaMoraleda via Pixabay

Contraception is not a new idea. As far back as Ancient Egyptian times, spermicidal concoctions were mixed by women with the intention to prevent pregnancy. Both the Bible and Koran refer to coitus interruptus, the rhythm method, by which a woman tracks her menstrual cycle to avoid having sex during ovulation. The 1800s saw the modernisation and popularisation of condoms. Our story, however, begins in the 1950s when a new wave of sexual freedom rolled in, putting the power in the hands of women: the first contraceptive pill was released.

The pill works by keeping hormone levels steady throughout the month so that ovulation does not occur. Three weeks of hormone tablets are taken, followed by a week of placebo pills during which a withdrawal bleed occurs. Although it is not physiologically the same as a period, the experience is very similar with side effects such as cramping and headaches. So, what exactly is the purpose of the placebo pill? What prevents people from taking back to back hormone tablets and just skipping periods altogether?

The short answer to this question is, there is no reason. The long answer requires a little history.

The root of the placebo pill lies in John Rock, one of the developers of the first pill, and a devout Catholic. Rock believed this was the secret to the pill being granted approval from the pope himself. Catholicism accepts ‘natural’ forms of conception, like the rhythm method, and so John thought that if women maintained the monthly cycle of menstruation, the contraceptive would be considered natural. The pill was therefore instructed to be taken for three weeks, with one week off, allowing for a withdrawal bleed. Placebo pills were later introduced to maintain a routine, even though there was no medical reasoning for it. The bad news for Rock and all the people on the pill having apparently pointless periods is that the Catholic church rejected the pill regardless of the seeming naturality.

The pill flourished even without the blessing of the church, but the religious influence remains. Over time, non-specific ‘medical grounds’ for the placebo pill came into circulation, but is there any truth behind the recommendations? A normal period occurs because the fluctuations in hormones orchestrate the building up of the uterine lining, ready to support a pregnancy. If no embryo implants, the uterus sloughs away as a period. However, the stable hormone levels created by the pill mean there is no build up in the uterine lining, and therefore no need for it to slough away as a period. This is the reason that withdrawal bleeds on the pill are (typically) lighter than periods. These ‘medical grounds’ were unfounded, a shared imagination to conveniently cover up the influence of religion in the invention of the pill.

Despite many studies confirming the safety of it, people remain hesitant: skipping periods is an appealing but a somewhat unnerving idea. So perhaps some faith that there is no need for such frequent menstruation can be taken from our ancestors.

A typical uterus today will shed its lining around 400 times over a lifetime; hunter-gatherer women would typically do so less than 50 times. There are multiple factors underlying this difference. Due to lower body fat content, hunter-gatherer women began menstruating later in life. Lack of contraception meant that pregnancy would follow soon after. After giving birth, a mother would breastfeed for three or four years and at more frequent intervals than modern day, allowing lactational amenorrhea to occur. Lactational amenorrhea is a natural form of contraception, a phenomenon that occurs when the hormones produced by breastfeeding suppress the menstrual cycle. When breastfeeding stops and the cycle eventually restarts, pregnancy soon follows, halting the cycle once again. Interestingly, this is thought to be the reason that we are now more prone to reproductive cancers – such regular tissue trauma increases the risk of cancerous cells arising because the cells have to work incredibly fast to keep repairing the damage,  and with each cell division there is a risk that something goes wrong. Fewer periods means less stress, not just on people but on their cells. Considering this, period suppression is not only possible but may even be a healthy alternative.

For years, continuous hormone pills have been prescribed to people with endometriosis and PCOS to save them the pain of menstruation. It’s time to let the rest of the population know. White jeans every day of the month.

 

Disclaimer

Follow your doctor’s advice when taking any medication. Although studies show that long term period suppression is safe, and the underlying science would suggest the same, few lifelong-term studies have been published yet.

If taking continuous hormone tablets, although menstruation won’t occur, there is a chance of spotting or breakthrough bleeding – these are not signs of something being wrong but can be inconvenient if unexpected.

Some people like to have a withdrawal bleed as confirmation that they are not pregnant, but it is important to remember that bleeding can occur during the first trimester of pregnancy so a withdrawal bleed is not necessarily proof.

 

This post was written by Ailie McWhinnie (She/her) and edited by Karolina Zieba (She/her).

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