To Bleed or Not to Bleed

Laura Wershler

Laura Wershler offers an alternative perspective on menstrual suppression and argues for more research and education on cycle-stopping contraceptives like Lybrel.

I am not a fan of cycle-stopping contraceptives. My refusal to accept menstrual suppression drugs, like the recently approved Lybrel, as just another reproductive choice is based on over 20 years of personal and professional experience.

This stance in no way compromises my pro-choice beliefs. As a veteran sexual and reproductive health advocate, all of it spent with Planned Parenthood affiliated organizations, I also happen to be a student of the menstrual cycle. I've observed, charted and interpreted my own menstrual cycle events since I was 27. At 53, this life skill now informs my passage towards menopause. I call the knowledge that comes with menstrual cycle charting "body literacy" (PDF). Literacy, in any form, is empowering.

I also belong to the Society for Menstrual Cycle Research (SMCR), a nonprofit, interdisciplinary research organization. Members are researchers in the social and health sciences, humanities scholars, health care providers, policy makers, and students with interests in the role of the menstrual cycle in women's health and well-being. And no, SMCR is not a hotbed of anti-choice advocacy.

That more of my colleagues are not active members of SMCR surprises me. After all, we've spent the last 50 years manipulating women's menstrual cycles with contraceptive drugs. You'd think we, as stewards of women's reproductive health, would be interested in learning everything we can about menstruation.

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But maybe this is changing. In recent conversations with journalists and sexual health educators, I'm constantly asked, "What else should women know about the menstrual cycle?" If we were to believe the many gynecologists and drug executives who've been quoted in the Lybrel coverage, the answer would be, "nothing." Their comments suggest that menstruation is irrelevant, unneccesary and, possibly, even dangerous to our health.

Yet in September of 2004, the SMCR presented a scientific forum to the New York Academy of Sciences proposing that the menstrual cycle be considered the fifth vital sign of women's health. "The menstrual cycle is a window into the general health and well-being of women, and not just a reproductive event," said Paula Hillard, M.D., professor of obstetrics & gynecology and pediatrics at the University of Cincinnati College of Medicine. "It can indicate the status of bone health, heart disease, and ovarian failure, as well as long-term fertility."

So who's right? The doctors who champion menstrual suppression by telling us we don't need to bleed? Or the similarly respected medical professionals and researchers who present sound scientific reasons why normal ovulatory menstruation is important to women's health and well-being?

Consider this contradiction. If a woman not using hormonal birth control showed up at her doctor's office with amenorrhea of one year's duration she would be considered to have a serious endocrine disorder. Yet the same condition induced by a drug like Lybrel is considered safe, healthy, and comes highly recommended by many doctors.

In June 2007, the SMCR updated its position statement on menstrual suppression. It urges caution and clearly states that "menstruation is not a disease."

Neither is menstruation just about reproduction.

Maybe it's time we all become students of the menstrual cycle and start talking about its broader meaning in our lives. Maybe then we can exercise authentic informed choice and decide for ourselves if menstruation matters.

Here are some suggestions on how to do this:

1. Check out the Centre for Menstrual Cycle and Ovulation Research.

2. Arrange public or private screenings of the documentary Period: The End of Menstruation?, by Giovanna Chesler. Follow up with a panel or group discussion about what menstruation means in our lives.

3. Read a book that challenges menstrual suppression, such as No More Periods?, by Dr. Susan Rako.

4. Read books, articles and websites that promote body literacy:

5. Share information with friends and colleagues. Debate and discuss.

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