Ann Althouse blogs about this — apparently the pill just got approved — and the discussion in her comments is very interesting.
My thought: It's perfectly sensible to be concerned about the pill's safety, even despite the approval. But some of the other concerns strike me as entirely misguided. Here's one comment (from commenter "galvanized"), which exemplifies this:
[M]enstruation, like childbirth, is just part of being a woman. If another woman would want to escape it, then sure, she should go for it. But, not being punny, it just wouldn't feel right to sidestep it.
Secondly, we're a pill culture. We now have yet another pill for another condition. I think we're way too dependent on medications. The further one goes from what is natural then the more chance for negative effects. Also, just doesn't feel right to pop a pill for this reason....
It seems that superfluous medicating is right up there with cosmetic surgery. I think that this pill is really a byproduct of our culture's quest to be aesthetically perfect, a spillover from magazine covers and television. So, yes, I do consider this a feminist issue, a suppression of sorts even if it is women doing it to themselves. I don't want my daughter to think that anything that occurs in association with being female is disgusting and should be eradicated. It's negating a not-so-pretty part of femininity. Maybe androgyny is what we're after?
The third is that there, as always, could be longterm effects that aren't known yet. Plus, it's more money for big pharm companies. That's all I need to know. Big business has made our culture pill-dependent, and we buy it up....
Again, concerns about long-term health effects are quite sensible. But I don't see any justification for the feeling that it's not "right to sidestep" something that's "part of being a woman." I suppose it could be some esthetic judgment that argument won't much drive; but setting aside esthetics, why on earth should we want to accept natural but painful or unpleasant things?
Disease is a part of being a human. Headaches are part of being a human. Excruciating pain in childbirth is part of being a woman. They are bad parts.
A good part of being a human is being able to prevent disease and to ease pain. Why embrace the harmful, painful, or uncomfortable parts of human nature, and reject those parts of human nature — our species' intelligence and resulting scientific acumen — that diminish harm, pain, and discomfort?
The cosmetic surgery analogy seems quite flawed, too. I have nothing against cosmetic surgery myself, so long as the health risks don't outweigh the benefits. At least, however, I can see the argument that instead of changing our appearance we should change our mentality, and stop caring as much about appearances.
But menstruation isn't about appearance. Women don't dislike it chiefly because it "occurs in association with being female," because it's "disgusting," or because it's "not-so-pretty." They dislike because of the cramps, because of the mood swings, because of the hassle. (I suppose that the desire not to get blood on one's clothes, and the concomitant need to use various products to prevent that, can be cast as a question about what's "disgusting" or "pretty," but both men and women generally and understandably don't like bloodstains of whatever sort. And in any case, as I understand it the physical discomfort associated with menstruation is a much greater concern for most women than just the universal desire not to get blood on things.)
And, of course, "it's more money for big pharm companies. That's all I need to know." Of course, what more would anyone need to know? If you want to decide whether some product is good, don't ask whether it eases your pain, protects your health, or whatever else. Ask whether some business you don't like will make money from your buying the product. Have cramps, and when you do, feel good about it: "I'm in pain, but at least Big Pharma is making less of a profit." Brilliant.
Thanks to InstaPundit for the pointer.
Related Posts (on one page):
Oh, Eugene, you really underestimate how important the pains and unpleasantries associated with childbirth are to many women's identity.
If your statement were true, then wouldn't most women willingly pass up natural child birth for cesarean sections? Yet it amazes me how women who have had elective c-sections are shunned by the sisterhood. And plenty of women who had to have emergency c-sections end up making themselves miserable because they were denied a natural experience. It boggles my mind, but it is very real.
By contrast, the modern American woman doesn't start pumping out babies at the age of 16. She might not marry until her late 20s or have her first (or only child) until past 30. So she goes through hundreds of ovulation/menstruation cycles between the ages of 16 and 30 that she simply wouldn't be going through had she been born 2500 years earlier. There's nothing particularly "natural" about this.
The problem is (as I recall from Gladwell's article), every time the woman ovulates, the ovum has to punch a hole in her ovary to reach the fallopian tubes. These holes heal, but each new hole/regrowth has the potential to result in mutated cells as part of the regrowth. Such mutations can lead to ovarian cancer. So the unnaturally large number of ovulations a modern woman undergoes in her lifetime contribute to ovarian cancer. By preventing ovulation and menstruation, this risk is reduced (among the other benefits of the new pill).
Again, I'm not saying that any of this is correct--just what I recall reading in an article 7-8 years ago.
The article is available here:
http://www.gladwell.com/2000/2000_03_10_a_rock.htm
-dk
It's been amazing seeing my wife and other women deal with her first pregnancy. Immediately upon announcing to the world she's pregnant, my wife was part of the "in crowd." Every mother--whether she knew my wife well or not--could smile and talk about morning sickness, or finding out the baby's gender, or feeling bloated, etc.
So, it is not aesthetic. Humanity derives meaning from shared experiences, and deleting one of the most universal and central of all female experiences can subtract perceived meaning from people's lives. In that regard it is very important.
As a soon-to-be-doctor, I would never recommend such birth control without bringing up and discussing the social and emotional ramifications in addition to the physiological ones.
Apoorva Mandavilli over at Nature's Spoonful of Medicine posted a little on it about two weeks ago.
The blog post links to Mandavilli's good article on pros and cons in Women's Health. Check it out too.
If you can't martyr yourself on the cross of womanhood, what is there in life? ;)
You mention C-sections. C-sections aren't half of it! Real women don't even get epidurals. After all, how can you guilt your kids for years if you didn't suffer?
(To be serious, many women avoid c-sections because there is an increased risk of infection and complications. Furthermore, the recovery time is significantly longer and, after all, those scars aren't very aesthetically pleasing. Avoiding an epidural is, however, just madness.)
Back on topic.
Don't forget endometriosis (often, women with that disease are prescribed the Pill off-label to use so that they never menstruate), polycystic ovaries, nausea, anemia, and the possibility of various diseases (I believe that the risk of breast cancer and uterine cancer increases with early menarche and/or delayed menopause).
No one really has problems with women who would take a pill to treat what is essentially a disease (endo, PCO, etc) - and all the better if a medication is designed specifically for that abnormality, instead of using others off-label; what we object to is the idea that normal menstruation is a disease - and one that should be treated not via pain relief but by eradicating it in its entirety.
16 to start menstruation? Maybe hundreds of years ago, but not now. 12 was the average age back in the 1950's-60's, and I believe it's lower now.
Agreed on the health risks of c-section. But I was working from Eugene's premise, which is that health risks are a valid concern, but the other reasons not to take the pill are not valid. And the risks don't explain why women that had a c-section without complication would later regret it.
Anyway, women's suspicion of big pharma is nothing new. Look at Mary Baker Eddy. As some tell the story of Christian Science, Eddy pioneered a whole religion based on her (then correct) concerns that women were being exploited by the male health establishment.
so speaks someone extremely unlikely to die of smallpox, yellow fever, cholera, whooping cough, sepsis, influenza...
This time in the form of Connie Willis' humorous short story, "Even the Queen", which won the Nebula Award.
Here's an excerpt from a spoiler-laden review:
I almost included this in the request for SF with a legal theme; this second temptation is too much.
For that matter, in her short story series "Fire Watch" there are several interesting legal stories, not the least Samaritan, about a sentient orangutan and the question of what his rights are. Also, The Sidon in the Mirror, a really confusing story (it took me 3 or 4 reads to get what was going on) about vigilante justice and the question of accomplices, entrapment, and identifying perpetrators.
Again, this is just my uneducated, non-medical, layperson's reaction.
Funny how my perspective has sharpened on this issue. I suspect that these self-absorbed latte-swilling Big Pharma bashers don't have too much to offer to my 9-year-old, who has cancer. Big Pharma, on the other hand -- no doubt driven by terrible greed for evil profits -- has invested enormous sums, taking great risks, to develop the complex drugs that have saved his life.
I hope Big Pharma makes a LOT of money. Hell, I hope their chief executives make enough money to take treasure baths.
Agreed - hence my snarkiness about real women avoiding epidurals, let alone C-sections. (Nevertheless, "complications" of C-sections aren't all of it - the scarring, longer recovery period, and, often, the necessity of delivering via C-section during a subsequent birth make the entire process difficult. Unless, of course, you're a guy....)
Women embrace the suffering because it validates them and makes them feel like they are somehow better than those who do not suffer. I'm not kidding about the epidural thing -- some women think they are better (or better mothers) if they go through childbirth with the maximum amount of pain possible. There is no distinction between suffering for some greater good and suffering for its own sake.
The latter is, objectively, ridiculous, but there are people who assume that some greater good is automatically conferred upon those who suffer (or feel avoidable pain).
~Theo (I have zero clue what an "obromo" is and don't really want to find out!)
Somewhat more seriously, at least some portion of women will be on this pill because their men will be strongly encouraging them to be on it. Just like men encourage women to be on the pill so they don't have to use condoms, and encourage women to have abortions, so they don't have to raise children.
I'm not trying to get all Jerry Falwell on everyone, but it is a consequence.
Amber is completely right - many women have been skipping periods by skipping the sugar pills for years with off-label BCP usage. For several years, I was one (for reasons beyond simple convenience). Skipping your period makes you no less of a woman - I guarantee you with the average onset of mestruation at age 12, most women will have a few years before they're on this magic pill and they can enjoy the "community of womanhood" then. Gag. There is far more to womanhood than mentruation - just like a woman is still a woman after a mastectomy. So what if someone wants to take a pill because they view their period as a hassle?
There are tons of things that aren't "natural" - glasses, circumsizion, Viagra, birth control.
You're definitely not kidding. I have met such women and they have told me that they have this view. They seem to think it's perfectly rational. I think it's about as rational as refusing novacain during a root canal. Can anyone explain this?!?
Well sure, there's someone who fits into any category you might define, but it's pretty silly to think there will be a significant number of women who don't mind having their period at all, yet are browbeaten into taking the pill by the men in their lives. Implicit in this speculation is that the real victims of menstruation are the men who have to put up with cranky women once a month.
<blockquote>
Implicit in this speculation is that the real victims of menstruation are the men who have to put up with cranky women once a month.
</blockquote>
Not really. Men may <i>view </i><i>themselves </i>as victims, or just collateral damage, and that is enough for them to harass their girlfriends.
My iron levels are fantastic, I never get cramps, and I'm chaste, but had a doctor who all but force-fed me the Pill. The assumption is that you need a reason to not take it, rather than an affirmative reason to use it. Given that this drug will have a recognisable, generally positive effect for every woman who takes it, why won't doctors (and boyfriends) be pressuring women into it, when they already do so with the Pill?
Of course, such is not a reason to not manufacture it (benefits to women with chronic problems being enough justification), nor to delay or inhibit its pre-market approval, but is a legitimate concern about it's post-market use.
However, on a broader level this whole "it isn't natural" argument is a bunch of hooey. It is another variant of the same argument that crops up whenever people are confronted with change to the institutions they are used to and find comforting and reassuring. There have been Luddites who have railed against any change in the human condition, be it the loss of connection with the land when we don't grow our own vegetables, to the unnaturalness of man going at any speed over that of a galloping horse.
Most particularly though we see this tendency with respect to aspects of the human condition that are painful. It isn't so much that the painful experiences (walking to school uphill both ways) are actually deeply important and meaningful but that we imbue them with importance to lessen the pain. Going through the pain of childbirth or just the annoyance of doing some kind of labor would be a lot worse if you thought 'damn't I only have to do this because technology is insufficiently advanced' than if you credited it real significance. Especially when we look back on them retrospectively in light of the knowledge that those pains are now optional there is the strong temptation to tell ourselves we derived great benefits from our pain then to admit we were just born too early to avoid them.
I mean everyone hears earlier generations complain that the old, more painful/unpleasant ways of doing things were better and disagrees with them. So any rational person should be suspect when they notice those same feelings in themselves.
None of the problems cited above should preclude the use of menstruation blockers, but women using these drugs need to be informed and need to be alert to early signs of problems. They may also want to take a small aspirin daily to lower the risk of clotting.
This is why my wife didn't resume using the Pill after our child was born. She doesn't enjoy her periods, which tend to be a little debilitating, but she likes the effects of the Pill even less.
So rather than go to Big Pharma, this person's preference is for the money to go to Tampax (i.e., Procter &Gamble), or one of the many other large corporations who produce virtually all of the feminine hygiene products. Well that's okay: you pays your money and you takes your choice. Doesn't seem to me that one is any better or worse than the other, though.
You're so naive. Aren't you aware that P&G is affiliated with the Church of, oh, I dunno, maybe....
SATAN?!?!?
Only if you're under the mistaken impression that there's any difference between Lybrel's effect on the menses and that of any other combined oral contraceptive (COC) known to human beings.
All COC brands suppress the period for as long as the woman uses it. The regimen--regular, extended, continuous (Lybrel)--is utterly irrelevant.
Again, if a woman uses a 21/7 brand or Lybrel for, say, 5 years, she does not have menstrual periods for 5 years.
The only difference between a 21/7 regimen and Lybrel is that Lybrel eliminates the monthly withdrawal bleed. The monthly period and the monthly withdrawal bleed are not one and the same thing. [See Amber's link above for details.]
Getting back to the concerns about long-term health effects, according to the FDA, over the years, more studies have been done on the pill to look for serious side effects than have been done on any other medicine in history.... We have over 40 years of data on the effects of suppressing a period for extended intervals.
The proper question is, does eliminating the monthly withdrawal bleed cause any long-term health effects? Based on the fact that this bleed is a designer artifice, and on the available data, the answer is "No."
Dr. T,
The first risk (which is the same as for oral contraceptives) is that the dosage will be too high for some women.
What do you mean? Lybrel is a very LD brand [20 mcg ethinyl estradiol/90 mcg levonorgestrel]. In other words, if you use a low-dose regimen like Lybrel to eliminate your monthly withdrawal bleed, the total amount of Pill hormones your body is exposed to is actually less than if you used a higher-dose 21/7 regimen and had a monthly bleed.
High levels of estrogenic drugs increase the risks of spontaneous thromboses (blood clots), certain types of breast cancers, and endometrial cancers (which are rare).
Um, Lybrel is a very LD COC, not an estrogen-only one. [COCs have been shown to significantly decrease the risk of endometrial cancer--50% reduction, with the protective effect lasting ~15-20 years after you stop using the Pill.]
Estrogenic drugs promote thickening of the endometrium (uterine lining). Preventing the endometrium from shedding for many months or even for years may cause problems directly or if the endometrium gets infected.
Pardon me, but WHAT?!? All Pill brands prevent thickening of the endomentrium. [That's why you don't menstruate; thin endometrium, nothing to shed.] Do you have any data to support your assertion that preventing a thin, suppressed endometrium from shedding for may months/years may cause problems? Or, for that matter any data showing that COC user are susceptible to endometritis?
They may also want to take a small aspirin daily to lower the risk of clotting.
Not unless you're advising pregnant women to take a daily aspirin to lower their risk of clotting [of course, I'm kidding. This is not an actual recommendation.]
As a future physician and current med student, i would have no problems prescribing this pill (assuming that when I'm able to write prescriptions there is no negative research about the pill). It is not my place to tell the patient what she should feel or what she should do to "fit in".
My period tells the man that lives with me, "Please. Go get a life. Go smoke cigars and gamble with the guys. Go to a titty bar. GET OUT OF THE HOUSE!!" I swear, if I didn't menstruate, I'd go all psycho on his ass.
The only problem I have with the pill (regardless of the "period" interval) is its affect on my sex drive. I really only have a sex drive for the week around ovulation. Taking the pill prevents you from ovulating.
It took me years to realize this. All I knew was that sometime after my period something would change and for a few days almost any healthy young man would seem insanely attractive, and then it would pass. It wasn't until I took the pill for a few years and then stopped that I realized what was causing it. This has to be the same for at least some other women. I can't understand why no one talks about it. Surely guys (at least) would be interested in this "other period", but it doesn't even have a name. Perhaps we should call it the "exclamation mark".