Messing with Mother Nature
By Lindsay Heintz

OTTAWA — For Lori Tarbett, Depo-Provera seemed like a wonder drug.

The 21-year-old was in a committed relationship and looking for a low-maintenance birth control method. Like other young women, she was attracted to the idea of a birth control injection every three months and the sexual freedom the drug promised. She also liked the idea of not getting her period, a symptom of the injection that most women experience, which could alleviate painful side effects of menstruation.

Depo-Provera, an injectable for of birth control.

“I started taking it because I was having problems with the Pill — having chest pains,” she said. “I’d always had really bad [period] cramps, to the point that I would have to leave school sometimes.”

Almost immediately, the drug started to lose its appeal. Beside weight gain, major mood swings and decreased sexual libido, Tarbett suffered from continuous bleeding when she expected her periods to stop. After three injections, she called it quits.

“I took it because I wanted to make my relationship better; I could have sex whenever I wanted, and I thought, ‘that’s great — a shot every three months,’” she said. “But I didn’t even want to have sex, and when you’re bleeding all the time it’s not the most attractive thing.”

Eliminating the inconvenience

Drugs like Depo-Provera, an injection of progesterone given every three months, and Seasonale, an oral contraceptive designed so women only menstruate four times per year, are the primary methods of suppressing menses. Some women are advised by their physicians to take their 28-day cycle oral contraceptives continually, without taking a break each month for their period.

Dr. Christine Hitchcock, a research associate at the University of British Columbia, said she feels convenience is the main reason women choose to suppress their periods.

“People isolate menstruation from the female body - they think it only has to do with fertility, and if you’re not trying to get pregnant what’s the big deal?” said Hitchcock. “Hormones are a whole part of our health as women; it’s a lot more than bleeding and babies.”

Dr. David Pfeiffer, director of Health and Counselling Services at Carleton University, says there are circumstances when women should look at menstruation suppression as an alternative to getting their period every month.

“Certainly if you’re travelling somewhere where it’s not convenient, it‘s not really a problem,” said Pfeiffer. “But if you’re a woman who’s having major problems with your period, it’s something that should be looked at.”

Pfeiffer said some conditions are triggered by menstruation, including menstrual migraines, certain forms of epilepsy and endometriosis — where tissue formed along the uterus lining binds to other organs, causing extreme pain. For women suffering from these ailments, Pfeiffer said not having a period could be an alternative.

“I don’t think there’s any evidence that it’s harmful to a woman,” said Pfeiffer. “But it’s kind of fiddling with things — and you have to wonder if it’s a good idea to be adding pharmaceuticals to our bodies for convenience rather than necessity.”

The medical evidence

Research shows there may be dangerous side effects of menstruation suppression drugs. Besides decreased libido, weight gain, and breakthrough bleeding cautioned by drug manufacturers of Depo-Provera and various oral contraceptives, there is also evidence of an increased risk for osteoporosis.

Ortho Tri-Cyclen, a birth control pill.

A study published in the British Medical Journal found that women aged 18 to 33 taking Depo-Provera, oral contraceptives or non-hormonal birth control, those on Depo-Provera for two years experienced an average bone density loss of 5.7 per cent. Similarly, a study in the Canadian Medical Association Journal found that women who were taking oral contraceptives had an overall lower spinal and neck bone density than those on non-hormonal forms of birth control. The CMAJ report concluded that the lower bone density values in oral contraception users could translate to an increase in fracture risks of 20 to 30 per cent, in relative terms.

Dr. Hasnain Khandwala, an endocrinologist at the University of Saskatchewan, said suppressing menstruation causes a decrease or elimination in the production of estrogen. Drugs like Depo-Provera suppress the production of ovarian estrogen. He said bone formation, reaching a peak in production when women are in their late 20s and early 30s, is dependent on estrogen, which stimulates bone cells. Khandwala said while it may be possible for women who suppress menstruation to regain their bone density, it is not guaranteed.

There may also be a possible link between suppressing menstruation and an increased risk for heart disease. According to the medical journal Heart, women have a lower incidence and death rate from coronary heart disease than men — and the medical community has never been able to explain the difference. While it has been theorized that female estrogen production protects women from heart disease, a controversial iron hypothesis explains the difference another way.

Dr. Jerome Sullivan developed the hypothesis which suggests that iron lost through menstruation protects women from heart disease. Sullivan proposes that increased iron in the blood increases the levels of low-density-lipoprotein (LDL) cholesterol, which can increase one’s risk for heart disease. Sullivan also points out that menopausal women accumulate iron levels in their blood roughly equal to men; therefore he theorizes that menstruating women are protected by their periods.

Hitchcock said while there may be risks associated with an absence of menstruation, she is more concerned with a lack of data proving the practice is safe.

Intra Uterine Device

“When you’re looking at the studies and data on this, it’s amazing what people aren’t looking for,” she said. “It’s quite possible there are no risks associated with not having a period, but I don’t think we have enough data to say if this is a good practice.”

A woman's choice?

Doctors like Dr. Roger Pierson, a professor of obstetrics and gynecology at the University of Saskatchewan, feel the choice of contraception is a decision best left to women.

“I’ve never had a period, nor do I plan on getting one, so we as doctors need to provide women the information so they can make the best choice for themselves,” said Pierson. “However the notion that we need to have a period every month is more of a sociological, rather than biological belief - if you’re not trying to get pregnant, you don’t really need to get it.”

Dr. Ingrid Johnston-Robledo, a professor of psychology at the State University of New York at Fredonia, said the practice is part of a trend to treat menstruation as a medical problem.

“We’re viewing menstruation as if it needs to be cured, and we’re appealing to women by focusing on all the negative aspects of having a period,” she said. “Women’s reproduction is being pathologized, and made to seem like menstruation is a burden with work, academics, our social life.”

Condoms, a non-hormonal birth control.

Hitchcock said women aren’t being informed about the risks of suppressing menstruation. Until the medical community can prove there aren’t major health risks, she said it shouldn’t be promoted to women.

“We have a history of medical interventions in women’s health that have been applauded and lauded, and have turned out to be disastrous,” she said. “Medicine has gotten it wrong in significant ways.”