Sarah Boseley
BODY LANGUAGE
Some things in life are immutable. There is a rhythm to the seasons, night follows day, tides ebb and flood, and a woman’s body goes through a menstrual cycle every 28 days or so until the menopause sets in. That is the way it has always been and we assume it will for ever stay.
But does it have to be so? Or are women needlessly imprisoned by our assumptions about what is natural? Modern woman has nearly three times as many periods as her forebears, and evidence is accumulating that the toll of all this menstruation may not only be nuisance and distressing mood swings, but also an increased propensity to some diseases.
The first myth is that modern menstruation patterns are natural. In a recent article in Lancet, Charlotte Ellertson and Sarah Thomas, based in the Mexico office of the United States Population Council, write that times have changed: “Women in pre-historic times, as estimated by research among contemporary hunter-gatherer populations, probably had far fewer periods (about 160 ovulations over their lifetime) than modern women.”
Women living in industrialised countries today begin menstruating at an earlier age and go through menopause later. They limit their families to two or three children and scarcely breastfeed. So their bodies get very little break from menstruation, with its hormonal surges and the physical stress on the ovary each time a ripe egg bursts through the wall. Modern woman can expect to go through about 450 periods in her life.
So it can be argued that women are living an unnatural life – a sophisticated life of our own choosing, thanks to modern contraception, but one that leads to an unnatural number of periods. Some women are relatively undisturbed by their monthly bleed. Some welcome it as a sign of their fertility or as proof that they are not pregnant. But for some, periods are painful and debilitating – the “curse” of generations of women.
The Lancet article argues that “there is plenty of modern evidence that amenhorrhoea (the absence of periods) is often healthier than the alternative”. A woman who is not ovulating would escapes the sharp changes in hormone levels that can lead to mood swings. Arthritis, epilepsy and other conditions that worsen with the cycle would remain stable. Menstruation can cause endometriosis and anaemia.
But most alarming is probably the link with ovarian cancer, explored in a recent issue of New Yorker magazine which, coincidentally with the Lancet, has taken a radical look at menstruation and the Pill. Ovulation, it points out, encourages cell division as the breach in the ovary wall caused by the release of the egg is healed. Studies have shown that a woman’s lifetime risk of ovarian cancer drops by 10% every time she has a child.
“Why? Possibly because, between nine months of pregnancy and the suppression of ovulation associated with breastfeeding, she stops ovulating for 12 months and saves her ovarian walls from 12 bouts of cell division,” says the article.
The same argument applies to the changes in the lining of the womb, potentially increasing the chances of endometrial cancer, which, as with ovarian cancer, is a characteristically modern disease, the consequence, in part, “of a century in which women have come to menstruate 400 times a lifetime”, it continues.
Dr Sheldon Segal, a distinguished endocrinologist, well-known contraceptive researcher and co-author of Is Menstruation Obsolete?, agrees with this scenario. “The evidence is very clear”, he says, for the impact of menstruation on ovarian and endometrial cancer, although the jury is still out on the possibility that it might be implicated in breast cancer. “Among women who take oral contraceptives, they reduce their risk of ovarian cancer by one- seventh,” he said.
But they still have periods, don’t they? No, they don’t. Not a menstrual period in the proper sense. What they have is a superficial bleed, which is not the same thing. There is no ovulation. This is the irony that the New Yorker hooks into – that for women on the Pill, that bleed
is not necessary.
It was devised by a pioneer of the Pill, John Rock, who thought that if women took 21 pills and then seven placebos, enabling them to have this non-functional bleed that seemed like a period, then the Roman Catholic Church might approve the Pill as a “natural” form of contraception which did not interfere with the normal rhythms of life.
Of course, the argument was kicked into touch by the church. But the Pill continued to be made and marketed in the pseudo- natural way he had devised. It may be that many women feel better about taking the Pill knowing that their body has a week’s break, but in fact, argue today’s scientists, it makes very little difference.
For all that he, and the Lancet writers, are challenging the orthodoxy, Segal says he is not urging all women to take the Pill continually and give up periods for good. “I do see it as a possibility that women will want to have fewer periods as a lifestyle choice, but I’m not really urging women to do this if they have no problem with their menstruation. But when it stands in the way of their normal functioning, women should be given the opportunity to decide for themselves.”
Ellertson and Thomas think that women should be given the information so that they can decide which menstrual pattern suits them.
“Health professionals and women ought to view menstruation as they would any other naturally occurring but frequently undesirable condition,” they write in the Lancet. “This means providing those women who want it with safe and effective means to eliminate their menstrual cycles, contributing to happier, less encumbered lives and helping women individually and society as a whole.”