Read women's comments about stopping menstruation.
In March and April, 2000, several articles and comments appeared
(including in the New Yorker magazine
- read that whole
article for free - The Lancet medical journal, and the Guardian (U.K.)
newspaper, and in many places since then) about the benefits of stopping
menstruation. The inspiration is mainly the book Is
Menstruation Obsolete? (read some excerpts),
by Brazilian Dr. Elsimar Coutinho, with Dr. Sheldon Segal (Oxford University
Press, 1999), which argues that the benefits far outweigh any problems.
The work of Beverly Strassmann, of the University of Michigan [U.S.A.],
who has studied the menstrual customs of the Dogon people of Africa for
years - they use menstrual huts - also supports the argument for fewer periods.
Read two opposing opinions:
by the Brazilian
physician who is the author of Is
Menstruation Obsolete? (Oxford University Press,
1999) and by an American physician
at Texas A&M University
Uninterrupted use of hormonal contraceptives for menstrual
suppression:
why I do not recommend it
Dr. Nelson Soucasaux, Brazilian gynecologist
(personal details and more of his articles at the bottom of this page)
Though the subject is controversial, new and arouses great discussion,
personally I am not in favor of the continuous use of hormonal contraceptives
for preventing the coming of menstruation. To my way of thinking, this method
is valid only in exceptional cases, in the presence of important medical
indications - but always as an exception. (The only gynecologic problem
that always demands menstrual suppression as an essential condition for
the success of the treatment is endometriosis.) I do not mean that the continuous
administration of hormonal contraceptives, without the usual seven-day interval
between one series and the other, is especially problematic - it is too
early for affirming that. I simply cannot see reasons that, in most of the
cases, can justify the adoption of such atypical way of taking these medicines.
Nevertheless, some debatable reasons for menstrual suppression have
been announced by those who defend the administration of hormonal contraceptives
without the usual seven day interval between each series of 21 days of treatment.
The medical conditions more frequently presented for justifying the
hormonal suppression of menstruation are premenstrual syndrome and dysmenorrhea.
However, we must remark that almost all premenstrual symptoms usually are
successfully treated by means of several available therapeutic methods,
without any need for abolishing the coming of the menses. In many cases,
the dysmenorrhea is considerably reduced or even disappear with the use
of the oral contraceptives in their habitual mode of administration. Another
highly effective treatment for dysmenorrhea consists of the use, during
the menstrual period, of the modern anti-inflammatory drugs that inhibit
the synthesis of prostaglandins.
Regardless of all of this, there is a very old non-medical reason that
is also being used for reinforcing this new "fashion" of abolishing
menstruation through the continuous use of oral contraceptives or the subcutaneous
implant of devices that release progestogens continuously: I am talking
about the psychological rejection that many women manifest in relation to
this cyclical uterine bleeding that is menstruation - even when asymptomatic
and entirely normal from the medical point of view. Behind this attitude
lies a defective adaptation of these women to one of the most characteristic
features of the female physiology, a feature that is the main external manifestation
of the typical cyclical pattern of woman's nature. In my point of view,
the ideal approach to this feeling of rejection to menstruation is psychotherapy.
I perfectly understand that, from the physical point of view, the menstrual
bleeding in itself is not pleasant. Even so, I believe this should not constitute
a reason for intending to suppress the menses.
Now, some explanations about the functioning of the oral contraceptives
become necessary. The oral contraceptives - the best and the safest of all
contraceptive methods - work by creating a reversible inhibition of the
ovarian function, due to an interference on the physiology of the hypothalamus-hypophysis-ovaries
axis. The resulting inhibition of this functional axis is due to the effect
of the hormonal association contained in the oral contraceptives. The menses
that come after each series of 21 days of taking the hormonal contraceptives
are not natural menstruations, since the ovarian cycle is inhibited during
their use. They are artificial and due to the habitual interruption in the
ingestion of these products at the end of each series of 21 days. This interruption
causes a sudden fall in the blood levels of the synthetic estrogens and
progestogens contained in the oral contraceptives, imitating what happens
with the natural ovarian hormones at the end of each physiologic cycle.
As the hormonal contraceptives inhibit the ovarian function, it is advisable
that, at least once a year, their users stay one or two cycles without taking
the "Pill," in order to avoid a prolonged inhibition of the already
mentioned hypothalamus-hypophysis-ovaries axis. The usual seven day interval
between each series of 21 days taking the oral contraceptives is intended
to make women menstruate, simulating the menstrual cyclical pattern of the
natural cycles. At the same time, these intervals may also function for
allowing a seven day interruption in the inhibition of the hypothalamus-hypophysis-ovaries
axis. Though this pause of seven days in the active inhibition of the system
that controls the ovarian function is too short, even so I believe we should
not deny its importance. We must remember that the hormonal contraceptives
were always administered in this way, and that a seven day interval between
each series of 21 days of taking these products is better than the absence
of any interval.
The uninterrupted, continuous use of the hormonal contraceptives intending
to suppress the menses eliminates this short but possibly important period
of rest between each 21 days using these products. This results in keeping
a continuous inhibition of the intricate system that controls the ovarian
function. Moreover, the continuous administration of the hormonal contraceptives
impedes the monthly cyclical fall of the hormonal levels which the female
organism is used to. One of my main objections to the continuous use of
hormonal contraceptives, without the usual pause of seven days between the
series, is based mostly on this fact. My other objection is that the endometrium
(the tissue that covers the interior of the cavity of the uterine corpus)
was designed by nature to being constantly renewed, by means of its periodic
menstrual desquamation and reconstruction along the next cycle. This is
a fundamental feature of the endometrial physiology.
The artificial menstruations ("fake" menstruations) that purposefully
occur during the seven days interval between each series of 21 days taking
the hormonal oral contraceptives are the most practical way women usually
have to know that the contraceptive is working - that is, that they did
not get pregnant during the use of the "Pill" (though, of course,
there are rare exceptions). Taking this into consideration, if these "fake"
menstruations are abolished by the uninterrupted use of the contraceptives,
a crucial question arises: what will provide women the usual and most practical
control they have regarding the efficacy of the method? If there are no
menstruations, which early "information" will women have indicating
that the contraceptive may have failed?
Finally, I also would like to emphasize that the present attempts of
stimulating women to artificially suppressing menstruation for reasons of
minor importance do not seem to reveal a healthy attitude with regard to
this typical aspect of woman's nature. From the point of view of psychosomatic
gynecology, I believe that this new and debatable idea that menstruation
is "useless" and "superfluous" will certainly contribute
to reinforcing the old-fashioned female negative attitudes in relation to
menstruation, and now hidden under the name of science. I think this is
not good for women's psycho-physical health.
© Nelson Soucasaux 2001
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive
and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina
da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several
articles published in medical journals and of the books "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology") and "Os
Órgãos Sexuais Femininos: Forma, Função, Símbolo
e Arquétipo" ("The Female Sexual Organs: Shape, Function,
Symbol and Archetype"), published by Imago Ed., 1990, 1993.
Read two opposing opinions:
by the Brazilian
physician who is the author of Is
Menstruation Obsolete? (Oxford University Press,
1999) and by an American physician
at Texas A&M University
Read women's comments about stopping menstruation.
In March and April, 2000, several articles and comments appeared
(including in the New Yorker magazine
- read that whole
article for free - The Lancet medical journal, and the Guardian (U.K.)
newspaper, and in many places since then) about the benefits of stopping
menstruation. The inspiration is mainly the book Is
Menstruation Obsolete? (read some excerpts),
by Brazilian Dr. Elsimar Coutinho, with Dr. Sheldon Segal (Oxford University
Press, 1999), which argues that the benefits far outweigh any problems.
The work of Beverly Strassmann, of the University of Michigan [U.S.A.],
who has studied the menstrual customs of the Dogon people of Africa for
years - they use menstrual huts - also supports the argument for fewer periods.
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