An Argument for Menstrual Suppression?

I’m aware that the standard feminist position is to cast a jaded eye on medicine extending its authority over the female body. (In my academic life, I’ve spent hundreds of pages doing just this, with enough footnotes to sink the Queen Mary.) Versions of the birth control pill such as Seasonale (which allows for four periods per year) and Lybrel (which eliminates them entirely) represent further medicalization of women’s bodies. I agree with the assessment of the National Women’s Health Network: Women should have the option of menstrual suppression, but the drug companies need to knock off shaming women about their periods.

However, the standard birth control pill also offers some real health benefits beyond preventing unwanted pregnancy, which raises the question of whether menstrual suppression could confer additional benefits. Previous research has shown that the pill offers very substantial protection against the development of ovarian cancer. Now, a new study finds that women who have fewer periods, over a lifetime, are more likely to survive ovarian cancer:

Women whose menstrual periods start at a young age are less likely to survive ovarian cancer than their peers whose periods start later, new research shows. Similarly, women who have more menstrual cycles over their lifetime also have worse survival.

“Although we have relatively good knowledge about the influence of reproductive factors on the risk of developing ovarian cancer, knowledge is rather limited regarding the reproductive factors that may influence survival after diagnosis with this serious disease,” Dr. Cheryl L. Robbins said in a statement.

As reported in the journal Cancer Epidemiology, Biomarkers, and Prevention, Robbins’ group analyzed data from 410 women with ovarian cancer who were enrolled in the Cancer and Steroid Hormone study (1980 to 1982). During 9 years of follow-up, 212 women died.

Menstrual period onset before 12 years of age increased the risk of death by 51 percent relative to periods beginning at age 14 or older.

The results also indicate that patients with the highest number of lifetime menstrual cycles were 67 percent more likely to die during follow-up than were those with the lowest number of cycles.

The 15-year survival rates for women with the most lifetime menstrual cycles and those with the fewest were 33.3 and 56.7 percent, respectively.

(Source: Reuters)

To me, this raises questions about whether Seasonale and Lybrel might reduce the deadliness of ovarian cancer, and not just its likelihood of developing. This study didn’t look at menstrual suppression (I peeked at the original article, which isn’t freely available on the web). The researchers found no statistically significant relationship between use of oral contraception and survival. They thought this was surprising:

We were particularly puzzled by the lack of associations with parity or use of oral contraceptive in adjusted analyses because they accounted for the majority of anovulatory cycles in our cases. However, in unadjusted Kaplan-Meier survival analyses, oral contraceptive use was associated with improved survival, and although not statistically significant, it is noteworthy that HRs [hazard rations] for parity, oral contraceptive use, and breast-feeding were in the protective direction, as expected. It may be that power was limited to detect modest associations due to sample size. Alternatively, it is feasible that combined, the LOC [lifetime ovulatory cycles] component variables become statistically significant in the composite measure. Yet, another possibility is that age at menarche is driving the association between LOC and ovarian cancer survival, but because the HR of high LOC is greater than the HR of younger age at menarche, we find the synergistic explanation more compelling. Finally, we considered what effect additional survival data might have on the observed associations, and because of the lethality of this disease, we think it is unlikely that increasing follow-up would yield very different results from 15-year survival results.

(Cheryl L. Robbins, et al., “Influence of Reproductive Factors on Mortality after Epithelial Ovarian Cancer Diagnosis,” Cancer Epidemiology Biomarkers & Prevention 18, 2035, July 1, 2009)

So further research would be required to determine whether artificially stopping periods confers the same protection as late menarche and fewer lifetime menstrual cycles. It’s unlikely that many women in the study would have had a history of menstrual suppression, since the pills promoted for this purpose are still relatively new. (Of course, it’s long been possible to use regular birth control pills to stop periods, too, but it was never a common practice.)

Let’s posit, for the sake of argument, that future studies show that artifical suppresion of periods conferred better survival odds. Wouldn’t this be just one more step toward greater medicalization of women’s bodies? Not inevitably. There’s little reason to force women to get a prescription for the pill. Few drugs have been more closely scrutinized, by now. It’s safety profile is good enough that it could be an over-the-counter product. In Great Britain, the Lancet has called for the pill to be sold without prescription.

Here in the U.S., some ob/gyns might oppose an OTC pill. Birth control prescriptions are one of the main levers for getting women to show up for an annual exam. But by the same reasoning, you could make Tylenol and Advil prescription-only to ensure that everyone gets their check-ups.