You Are [Not] Your Uterine Lining

Recently, Rachel's Well, Inc., a non-profit aim[ing] to improve access to preventative health services for uninsured women and develop a model of healthcare delivery for all Americans, and the Society for Menstrual Cycle Research, a nonprofit whose mission is to be the source of guidance, expertise, and ethical considerations for researchers, practitioners, policy makers and funding resources interested in the menstrual cycle, co-sponsored a discussion, The Menstrual Cycle is a Vital Sign, designed to raise awareness about the role of menstruation as a unique indicator of a woman's overall physical health. Proctor & Gamble supported the meeting via an unrestricted educational grant. Here is the press release, and you can listen to the webcast here (free registration required).

I wasn't able to listen to the webcast, but I did read the press release and I have a few comments.

First, what is a vital sign? A vital sign is a physical sign that indicates an individual is alive. Respiratory rate, temperature, and pulse are vital signs (often, blood pressure is also included). The menstrual period is not a vital sign.

Moreover, the period isn't even a very specific indicator of your overall health. In other words, if you no longer have a pulse you're dead. In contrast, if you no longer have a period you could be healthy (just a shift in cycle, or you're pregnant, or maybe breastfeeding, or using hormonal drugs), or there might be a problem, ranging from stress, to a brain tumor. [Actually, the most common cause of missed periods in reproductive age women is a pregnancy. This is why, before you worry about this or that disease, it's important to always rule it out first.] For a different opinion about the importance of the period as a health sign [the loss of period regularity as the first sign of everything from pregnancy, to autoimmune adrenal insufficiency, to drug abuse, and then some more], please go here. (Just based on the name, I think the author is the founder of Rachel's Well Inc., but I'm not sure.)

Interestingly, one poll found that more than two-thirds of the women surveyed did not rely on their period as a "health" sign. [scroll down to question #3]

Practical tip: If you do rely on your period to let you know if you are/aren't healthy and you are considering using hormonal birth control, like the Pill, for birth control, remember that you will no longer have a menstrual period for as long as you use the Pill. So, while there's nothing unhealthy about deliberately suppressing your period, you should consider that whatever "health" signs you might have drawn from the period will no longer be present. A barrier method, like the sponge, or the Oves cap, might be a better alternative for you.

Returning to the press release:

Doctors and scientists also discussed the long- and short-term effects of irregular or interrupted periods (amenorrhea) brought on by over-training of female athletes and excessive dieting and exercise, as well as oral contraceptives designed to suppress the monthly cycle. The experts called for more research to determine the impact of menstrual suppression and its potential side effects on future fertility and long-range health.

Let's look at this passage one step at a time:

Interrupted periods brought on by over-training and excessive dieting and exercise (functional amenorrhea)

What happens during an interrupted period brought on by over-training or excessive dieting and exercise? Briefly, the menstrual cycle is shut down and with it, so is the body's production of estrogen and progesterone.

What is the net effect of this type of period interruption? You become hormonally deficient (in particular, estrogen).

How does this type of period interruption affect fertility and long-range health (for example, bone density)? There's an overall negative impact. If whatever problem causing the period interruption isn't treated, fertility will be impaired. Also, the lack of hormones (estrogen, in particular) causes brittle bones.

Interesting aside: Women who suffer from interrupted periods brought on by over-training or excessive dieting and exercise experience bone loss. Taking the Pill helps these women improve bone strength.*

Bottom line: This is an abnormal state. There is an absence of menstruation when menstruation should occur. There's also a hormonal deficiency (low estrogen, or hypoestrogenism). Overall, the impact is negative.

Interrupted periods brought on by oral contraceptives designed to suppress the monthly cycle (elective menstrual suppression)

What happens during an interrupted period brought on by oral contraceptives? Again, briefly, the menstrual cycle is paused and with it, so is the body's production of estrogen and progesterone. At the same time the oral contraceptive's estrogen and progesterone are introduced into the body; the body "thinks" the hormones are "home made" and uses them as it would its own.

What is the net effect of this type of period interruption? The hormones produced by the body are replaced by the hormones in the oral contraceptive. No hormonal deficiency.

How does this type of period interruption affect fertility and long-range health (for example, bone density)? There's an overall positive impact. Over 30 years of studies have determined that the Pill doesn't have a negative impact on your fertility (it takes on average 1 month for fertility to retun). Actually, it appears quite the contrary is true: using the Pill enhances your fertility. A recent study of over 8,000 women found that women who had used the Pill had an increased ability to become pregnant (compared to nonusers). As for bone density, it's been determined that Pill use does not have a negative effect on bone density. Moreover, it appears the Pill has a positive effect on bone mass--estrogen helps with strengthening the bone (mineralization). For example, long-term use of the Pill, and taking calcium in later reproductive years, is a highly effective way to strengthen the bones and halt midlife bone loss.*

Bottom line: This is a normal state. There is an absence of menstruation when menstruation should not occur. There's no hormonal deficiency, and the overall impact is positive.

Also in the press release:

"The most important thing to emphasize about menstrual suppression is that the long-term effects are simply unknown," said Jerilynn Prior, M.D., professor of endocrinology and metabolism at the University of British Columbia in Vancouver, and board member for the Society for Menstrual Cycle Research.

Actually, the long-term effects of abnormal period interruption (functional amenorrhea) are not only known, they are well established (e.g., brittle bones). Similarly, the long-term effects of the elective, normal menstrual suppression achieved by using the Pill are known from over 30 years of studies and clinical experience. 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.

Continuing with the release:

"Whether a woman is electing to do so [suppress the period] with new birth control products, or it results from excessive dieting or exercise, we as a society are allowing the one vital sign unique to women to go unmonitored, which could ultimately lead to an enormous uncontrolled experiment with a woman's health."

Mentioning elective menstrual suppression and exercise- or diet-induced amenorrhea in the same sentence does not magically make these two unrelated processes one and the same thing. Unfortunately, all it does is create confusion. Again, menstrual suppression--normal, and no hormone deficiency; amenorrhea resulting from excessive dieting or exercise--abnormal, and accompanied by hormone deficiency.

Moreover:

the one vital sign unique to women

Infusing the menstrual period with all sorts of meanings does not serve a useful purpose. The menstrual period is not a vital sign; just like in men, women's vital status is determined by assessing respiratory rate, temperature, and pulse, not some special, feminine indicator.

we as a society are allowing the one vital sign unique to women to go unmonitored

It's possible that this is just a rhetorical flourish, but just in case it's not: Women don't need society to monitor their menstrual periods. It doesn't take a village to figure out menstrual happenings. How about we allow society to monitor, say the state of the roads or the equipment of military troops, and we entrust women with monitoring their own bodily functions.

an enormous uncontrolled experiment with a woman's health

Last, but not least, conspiracy theories--what are they good for? A more useful approach would be to either state the facts, if you have any, or refrain from conspiratorial insinuations.

The release concludes:

The clear message of today's forum was the importance of the relationship between women and their menstrual cycles.

It is important for women to have complete and correct information about their menstrual cycle. It is detrimental and presumptuous to define women by their menstrual cycle; there's more to a woman than the state of her uterine lining. And it is unfortunate to have a discussion about the menstrual period that confuses and misleads.

The menstrual period is not something to be ignored, nor is it of outmost importance; it's just a body function.

*Speroff L. Bone Mineral Density and Hormonal Contraception. In: Dialogues in Contraception. 2002;7(5):1-3,8. [sorry, not online]