Women Receive Insufficient Reproductive Health Information

When it comes to knowledge and understanding of using a continuous Pill regimen to skip or eliminate the menstrual period it looks like women and their doctors are talking past each other.

From a survey of 500 women and 300 physicians:

• 63% of women reported being “somewhat” or “extremely” interested in not having a period, but only 17% of MDs reported that their patients indicated they did not want a period.

• Only 20% of women reported they “strongly agree” or “somewhat agree” that having their period is not medically necessary, while 97% of MDs reported that continuous OC use is medically acceptable.

• Few women (12%) reported talking to their MD about eliminating or reducing their periods; of these, 71% reported that they raised the topic. However, 80% of MDs reported mentioning continuous OC use when discussing contraceptive options; when continuous OC use was discussed, 77% of MDs reported that they raised the topic.

The study concludes that women and their MDs have different understandings of the medical implications of menses inhibition, and women may be receiving insufficient information. Gee, you think?

I'm not exactly sure why we're having this problem. I do think it has a lot to do with 1) the short duration of a well care visit and the inability to spend enough time on patient education, and 2) the assumption that this information is so basic that patients already know about it. [I must admit this is an easy trap to fall into occasionally. Just the other day I assumed a woman knew what lochia was just because she was a multip. Very bad form on my part.]

Spending more time with the patient would be ideal, but, unless we figure out how to be in two places at the same time, I don't think that's a feasible solution. So the best way to go about it is to insure that women receive, and are familiar with, most of the background information before they come in.

If you already know the basics about the menstrual cycle, the Pill's mechanism of action, and the Pill brands and regimens used to skip the period, you can use the office visit to fine tune, to tailor your options to best suit your particular needs.

Now all that remains to be done is to find a way to insure all women are up-to-date on the basics of reproductive health.

The New York Times Bars Facts From Op-Eds

And Karen Houppert's menstrual suppression op-ed is the perfect case study.

Here's how you, too, can strip your article of facts in 5 easy steps:

1. Don't bother to know what Lybrel is or how it works.

[Lybrel] is as effective at preventing pregnancy as the other pills already out there (about 98 percent) but boasts one advantage: Women who take it will never get their periods.

Incorrect. The one advantage Lybrel boasts isn't period suppression.

All [combination] birth control pills, from the first brands that were available in the 1960s to Lybrel have the exact same effect on the menstrual period: Women who take them never get their periods.

The difference between Lybrel and the other pills already out there is that women who take Lybrel will never induce an withdrawal bleeding episode. Lybrel does away with the monthly bleed by eliminating the placebo pills.

I've mentioned this before but one more time, exclusively for New York Times op-ed columnists: the menstrual period and withdrawal bleeding are not one and the same thing.

It's an important distinction to get, otherwise you run the risk of wasting an entire op-ed column attacking the wrong bogeyman. [When it comes to Lybrel, you want to misinform your readers about eliminating monthly withdrawal bleeds, not about menstrual suppression.]

2. Make sure you can't tell the difference between scientific research and opinion and propaganda.

Ms. Houppert goes on and on about the existence of scientific proof, rashes of studies and flurries of research, but when it comes time to be specific all she has to offer are the observations of a British doctor and a propaganda film. Personal opinions, even those of a physician, and government films are not scientific proof of anything to do with the menstrual period.

Ms. Houppert does have one reference to some actual studies (those from Wyeth showing that menstruating women feel less effective at work, take more sick days, don’t exercise and wear dark clothes more often) and a mention that premenstrual syndrome studies appeared in the medical literature in 1953. And still she manages to ignore the scientific method and relies instead on name calling and innuendo to support her assertions.

Studies on how menstruating women feel and what they wear tell us.....how menstruating women feel and what they wear. They're not part of the proof that Western civilization...hinges on our ability to wrangle our messy cycles to the ground and stomp ’em out once and for all. Also, describing PMS as an affliction and implying that the date of publication for the early studies on PMS somehow taints their validity, still not a valid method of scientific critique.

One more thing.

Someone cynical might suggest that research highlighting menstruation’s distressing consequences bubbles to the surface every time the public feels anxious over women’s expanding roles.

And someone cynical (oh, who are we kidding? That would be me.) might suggest that nebulously sourced innuendo bubbles to the op-ed pages of The New York Times every time a writer is too too lazy to look up data to support her assertions.

3. Avoid knowing the indications for menstrual suppression.

While [menstrual suppression] may be good news for the 8 percent of women who have debilitating periods (a constellation of symptoms known as premenstrual dysphoric disorder), the rest of us may be puzzled by the fuss.

And there will be none other more puzzled by the fuss, of course, than the 7.8 million teenage girls and women who suffer from iron deficiency, 3.3 million of which have a more severe form called iron-deficiency anemia. [The main cause of iron-deficiency anemia in premenopausal women is blood lost during menses.] Or those with heavy bleeding and pain (dysmenorrhea), endometriosis, or epilepsy.

Since menstrual disorders are the most common gynecologic problems suffered by women in the United States Ms. Houppert's ignorance of the routine indications for menstrual suppression is appalling.

What's also appalling is Ms. Houppert's cheery assumption that menstrual suppression may be good news only for women who suffer from period-related problem. 'Cause as we all know, if you're female, unless you're suffering or you're at death's door you're not worthy to take advantage of anything medicine has to offer.

If you are one of the millions of women who don't have bothersome periods, but who, for whatever reason, would like to suppress your period just to benefit your lifestyle, off with your head!

4. Be unaware of women's attitudes about the period.

Sure, getting our periods can be a bother sometimes, but after the traumatic moment of menarche — "How can this be happening to me when the sixth-grade pool party is tomorrow and I have no idea where that tampon goes?" — most of us get used to it.

It just is.

Actually what just is is presumptuousness. Assume your views of the period magically apply to most women, ignore all the available evidence and, presto, you're on the op-ed pages of The New York Times. Nice gig if you can tolerate it, but utterly unconnected to reality.

Studies, surveys and polls have consistently found that most of us don't, in fact, get used to getting a monthly period. The evidence shows that a majority of women would prefer not to bleed every month. [Interestingly, this finding holds true across decades, age groups and countries.]

5. Don't hesitate to make ignorant claims and wild accusations (the more, the better).

Lybrel is landing on pharmacy shelves this month. And now war has been declared on menstruation.

Ignore for a moment the grandiosity of the claim and the type of solid proof it would require. Note what's actually claimed--that a war on menstruation has been declared in support of Lybrel, a Pill brand that has no effect on the menstrual period (in that Pill users don't have periods). Good to know pharam is crafty enough to wage a propaganda war, but inept enough to not know what to indoctrinate us about.

Already the first few volleys in this battle have been exchanged. Gird yourselves, women, for a barrage of advertising and research highlighting the debilitating effects of periods and the joys of menstrual suppression.

Because, obviously, the second Lybrel becomes available, all research highlighting the debilitating effects of periods should cease immediately, and the subject of period-related problems is to became taboo. You know, just to be on the safe side and insure womenfolk are protected from undue influences on their pea-sized brains.

Also, yeepee, the joys of menstrual suppression; just dreamy! Seriously, what is this, an op-ed in the kindergarten newsletter? Does anyone seriously think this level of condescension works on actual women?

So what’s a poor company to do? Re-conceptualize menstruation as a disease in need of treatment.

Let's make this very easy. If Ms. Houppert produces one single instance of a legitimate medical or pharma source equating the normal menstrual period with a disease I'm prepared to eat her hat.

And what’s a poor menstruating woman to do? Get cranky with the prophets who offer to cure us of menstruation; who minimize the complex interplay of hormones and their many roles in our bodies; who gloss over the still unknown long-term effects of menstrual suppression; who promise that cycle-free women are better lovers, mothers, workers.

If you want to be taken seriously, don't project your odd fantasies--prophets who offer to cure us of menstruation, really?--on pharma, or make wild, misguided accusations.

Questioning, for example, the effect of the extra weeks of estrogen exposure with Lybrel shows you've bothered to familiarize yourself with the topic you are venturing an opinion on. Throwing complex interplay of hormones and their many roles in our body around and hoping it will stick only denotes your ignorance of facts.

As does the accusation that the long-term effects of menstrual suppression are still unknown. They're not. [See, this is where knowing what you're talking about comes in handy.]

The effects of menstrual suppression and the effects of eliminating the monthly withdrawal bleed are two distinct issues.

We know that suppressing your period long term is not detrimental (actually, there's evidence it's beneficial, but I digress). And how do we know that? From decades of observing the effects of menstrual suppression in women who, you know, don't menstruate for extended intervals: Pill users, pregnant women, breastfeeding women.

But what about the effects of eliminating the monthly withdrawal bleed? Unlike the menstrual period, withdrawal bleeding is an artificial manipulation. The bleeding frequency isn't intrinsic; it's arbitrarily set (monthly by the Pill's inventors; every 3 months by Seasonale's manufacturer; never by Lybrel's manufacturer).

Briefly, the correct question is, will the shift in bleeding frequency (prolonged hormone exposure) negatively impact, for example, the risk of uterine cancer or cardiovascular side effects? Based on all the available evidence--clinical (long-term) and studies (short-term)--the answer is no. Eliminating the monthly withdrawal bleed is safe.

Bottom line: The menstrual period is a normal body function, not an affliction. You suppress your period to improve your health, if having a period is a health concern, or to benefit your lifestyle, if the period is a simple inconvenience. And you eliminate withdrawal bleeding because there's no reason to bleed monthly while on the Pill.

Now if only The New York Times and its columnists could figure out that, even for op-ed articles about the menstrual period, accuracy still matters, I could.....

You know, I had a few clever endings for that phrase, but if you really think about it, there's nothing funny about this much misinformation, relentlessly repeated and prominently displayed.

Skipping Your Period, The International Edition

Studies suggest you have a greater tolerance for long intervals of skipping your period if you're a woman residing in Western Europe rather than in Asia or Africa.

Prefer never to have a period

Netherlands, Germany and Scotland - over 35%

Hong Kong, Nigeria and Shanghai - 6%, 13% and 15%

South Africa - 29% (white), 9% (black)

From a social survey of 1207 healthy women from Campinas (Brazil), Heidelberg (Germany) and Ann Arbor (USA) (~400 women from each country):

Prefer never to have a period

- one-third of USA and Brazilian women [about 38% and 33%, respectively]

- less than 10% of German women

Prefer to have a monthly period

- 15% of USA women

- 25% of Brazilian women

- 30% of German women

Prefer to have a period every six months

- ~ 15% of women in all three countries

In response to the question “if you could change the way you menstruate, what single change would be most valuable to you?”, half of all German women and one-third of USA women listed “having more precise control over the timing of menses” as their highest priority. “Having less pain” was the highest priority for a quarter of Brazilian women.

German women, on average, mentioned three times more positive features of menstruation compared to USA or Brazilian women.

Most positive features of menstruation

- being assured of not being pregnant; feeling healthier; and feeling lighter.

Most common negative features of menstruation (across all three countries)

- inconvenience; cramps; bad mood and premenstrual syndrome.

The Demise of the Placebo Week

Instructive editorial by Dr. Sulak in support of altering the current 21/7-day (placebo week) Pill regimen:

Oral contraceptives are the most common method of reversible contraception, with the majority of women using them sometime during their reproductive life. Modifications have primarily involved lowering hormone content and utilizing new progestin components.

The 21/7-day OC regimen (21 days active/7 days hormone-free) was arbitrarily created to mimic the average spontaneous menstrual cycle of 28 days. After more than 40 years of use, the traditional 21/7-day OC regimen is undergoing necessary, overdue changes in design. Numerous studies over the last decade have documented that lowering the doses of hormones in OCs without altering the standard 7-day hormone-free interval (HFI) compromises suppression effects and can induce hormone withdrawal symptoms.

Although today's low-dose OCs are very effective in preventing pregnancy, studies have confirmed incomplete inhibition of pituitary-ovarian function with follicular growth and resultant endogenous hormone production and potential for follicular cysts and ovulation. With a standard 7-day HFI, follicle-stimulating hormone begins to increase on day 3–4 of the HFI, allowing follicular recruitment and estradiol production. While uncommon, pregnancy can occur because of this escape ovulation, even in perfect users. Low-dose OCs have also been shown to provide little to no protection from the development of functional ovarian cysts because of the 7-day HFI. Unfortunately, most of our patients do not take their pills perfectly, increasing the chance of ovarian cysts and pregnancy.

Today's standard low-dose 21/7-day OCs have also been responsible for the occurrence of nuisance side effects in many patients. Published data document an increased incidence of menstruation-related symptoms during the 7-day HFI in patients on standard 21/7-day low-dose OCs, with increases reported in headache, pelvic pain, bloating/swelling, breast tenderness, and use of pain medication during this placebo interval. Menstruation-related symptoms including headache, mood swings, abdominal cramping, bloating, and breast tenderness are long-recognized side effects associated with OCs and often lead to untimely discontinuation and resultant unintended pregnancy.

The question is not "Should the current 21/7-day OC be altered?" but instead "How is the 21/7-day OC to be altered?" Modifications are necessary to address the issues of increased symptomatology and follicular development. We need to set women up for success rather than failure.

Currently, several approaches alter the typical 21/7-day OC regimen. Shortening the 7-day hormone-free interval of today's low-dose OCs can provide greater pituitary-ovarian inhibition, reducing the risk of ovulation, ovarian cyst formation, and common hormone withdrawal symptoms. Two OC products that utilize 24 days of active hormones and a 4-day HFI (24/4) have been approved by the FDA in 2006: ethinyl estradiol 20 mcg/drospirenone 3 mg (Yaz, Berlex) and ethinyl estradiol 20 mcg/norethindrone acetate 1 mg (Loestrin 24 Fe, Warner Chilcott).

Extending the number of active pills beyond the standard 3 weeks to 6, 9, 12, or more weeks is also common practice. A recent survey of health care providers in the United States revealed that the majority thought extended regimens should be offered to women who desired elimination of monthly withdrawal bleeding and associated symptoms.

The first approved extended regimen became available in the United States in 2003 (Seasonale, Barr Laboratories), and consists of 84 days of 150 mcg of levonorgestrel and 30 mcg of ethinyl estradiol followed by a 7-day HFI. But, a 7-day HFI with an extended regimen can lead to the same problems seen with a 21/7-day regimen.

A new OC approved in May 2006 both extends combination active therapy to 84 days and adds low-dose estrogen to the usual 7-day HFI (ethinyl estradiol 30 mcg/levonorgestrel 150 mcg for 84 days plus ethinyl estradiol 10 mcg for 7 days; Seasonique, Barr Laboratories). By doing so, it becomes the first approved OC to completely eliminate the HFI. Addition of low-dose ethinyl estradiol during the HFI provides greater pituitary-ovarian suppression, preventing an increase in follicle-stimulating hormone, follicular development, and endogenous estradiol production.

Continuous OC regimens that entirely eliminate the HFI are being extensively studied. While these extended, continuous regimens decrease scheduled bleeding, they can cause irregular, nuisance bleeding or spotting. Breakthrough bleeding with continuous OCs has been shown to be effectively managed by institution of an abbreviated 3-day HFI.

As more modifications of the 21/7 regimen are approved, it is important to ascertain from each patient her desired menstrual frequency. As in the movie, we must find out “What Do Women Want?” Whether she wants to bleed once a month, once every 3 months, or never will determine what regimen we should recommend. Today, we can give women what they want and decrease side effects, increase compliance, and decrease unintended pregnancy. No matter what the menstrual frequency, the 7-day HFI needs to be eliminated.

Today's low-dose 21/7-day contraceptive regimens have documented design flaws that can result in discontinuation and unintended pregnancy. Modifications of the standard 21/7-day design seen in today's vaginal contraceptive ring, transdermal patch, and OCs can greatly improve the side effect profile and continuation rates. Shortening the HFI, adding estrogen to the standard HFI, and extending the active component are all effective improvements that provide greater ovarian suppression, and will eventually lead to the demise of low-dose 21/7-day regimens. The sooner, the better.

Continuous Pill Use; A Review

From a review discussing the impact of menstrual disorders, symptoms and associated conditions on women and the evidence in support of the safe induction of amenorrhea with continuous OC use:

Menstruation has an important impact on quality of life for many women, ranging from a simple inconvenience to a major health concern for those suffering from menstrual disorders and conditions that are aggravated during menstruation. Up to 80% of reproductive-aged women experience physical changes associated with menstruation, and 20% to 40% experience menstrual-cycle-related symptoms. Recognized menstrual-cycle-related disorders affect approximately 2.5 million women between the ages of 18 and 50 years in the United States alone.

...

Menstruation and menstrual disorders have a broader economic impact on women and society, which is a direct result of time lost from work and decreased productivity. Texas Instruments noted a 25% reduction in the productivity of female workers during menses as one example. The total economic cost of menstrual disorders in the United States is estimated to be 8% of total wages, with dysmenorrhea alone estimated at US$2 billion annually and menorrhagia estimated at US$1692.00 annually per woman.

...

While not life-threatening, primary dysmenorrhea [painful period] is the most common reason for absenteeism from work and/or school among women younger than 30 years.

...

There appears to be a relationship between epilepsy and the menstrual cycle. It has been apparent for over 100 years that menstruation can increase the occurrence of epileptic seizures, referred to as catamenial epilepsy....A large retrospective study of 265 women with epilepsy and 142 control subjects recently confirmed previous smaller reports that women with epilepsy have an increased frequency of menstrual disorders.

...

Menstruation has a single biological purpose: to allow the endometrium to be reprogrammed for implantation of a fertilized ovum.

...

Hormonal contraceptives were originally developed, employing a regimen of 21 days of active drug followed by 7 drug-free days, in an effort to mitigate the perception that they would interfere with the normal menstrual cycle and to make the concept of hormonal contraception more acceptable to women, clinicians and the Roman Catholic Church. There were practical reasons for the 21-day/7-day regimen as well. While women today have easy access to accurate and affordable pregnancy tests, the majority of women relied on the occurrence of regular menstrual bleeding to determine if they were not pregnant before the pill was originally designed and marketed. The traditional OC regimen is an artifact of that bygone era, rather than a scientifically established truth. Clinicians realized from the beginning that OCs could prevent bleeding as long as they are taken, producing a cycle or interval of any desired length.

...

Women 100 years ago began menstruating at the age of 16 years, had their first child at 19.5 years of age and gave birth six times between the ages of 20 and 34 years. As a consequence, they only experienced an average of 160 menstrual cycles during their lives. Modern women begin menstruating much earlier, at an average age of 12.5 years, and have fewer children (two children on average in the United States), which translates into more than 450 menstrual cycles over their lifetime.

...

Since the early days of OC use, studies about reducing the number of pill-free periods have shown that it is a safe and effective option for many women.

...

A recent review evaluated the differences between cyclic (21-day) and continuous use (>28 days) of OCs. Due to the significant differences between published studies, the authors were unable to perform a meta-analysis; however, the authors concluded that the available evidence suggests that continuous use of OCs offers comparable contraceptive efficacy and safety to cyclic OC regimens. Bleeding patterns were either similar or improved with continuous OC use. Where evaluated, the incidence of cycle-related symptoms (such as headaches, tiredness and menstrual pain) was reduced with continuous OC regimens.

...

When women are allowed to choose their cycle length and duration of pill-free interval, they clearly prefer extended cycles and shorter pill-free periods. Among women who were permitted to set their own hormone-free intervals (n=220), most (60%) continued using extended cycles for more than 2 years, with 88% choosing a hormone-free interval of ≤4 days, with no serious sequelae or pregnancy.

...

Furthermore, women using continuous OC regimens miss fewer pills, particularly during the first day and first week of the cycle. Current low-dose OCs contain the minimum hormone doses required to prevent ovulation; if the pill-free period is extended by even 1 day, follicular development may occur and the risk of ovulation increases. Similarly, missed or delayed pills affect cycle control, and a single missed pill can result in breakthrough bleeding. A retrospective analysis of data from large multicenter trials found that inconsistent OC use is associated with a 60% to 70% increase in the risk of intermenstrual bleeding. Continuous use of OCs may improve compliance and thereby increase both contraceptive effectiveness and patient satisfaction.

...

Many women derive health and quality-of-life benefits by eliminating their menstrual cycle, which may reduce the occurrence of menstrual-cycle-related disorders such as menorrhagia, dysmenorrhea and anemia.

...

OC use [on a regular, 21/7 regimen] is associated with a reduced incidence of ovarian and endometrial cancers, benign breast disease, pelvic inflammatory disease, ectopic pregnancy and anemia. Links to OC use to increase bone mineral density and decreases in uterine leiomyomas, toxic shock syndrome and colorectal cancer are currently being investigated.

...

Although they are different phenomena, the symptomatology of menstruation is similar to what many women experience during the hormone withdrawal period (Fig. 2). Nausea, breast tenderness, headaches, bloating and cramping occurred significantly more often (p<.001) during the pill-free week than while taking active drug when evaluated over several 28-day cycles in 262 OC users. These symptoms are frequent reasons for discontinuing OCs and may be alleviated by eliminating the pill-free interval. With continuous OC use, the total number of bleeding days is dramatically decreased, as well as other symptoms including headache, cramps and bloating. ... There are many groups of women who may particularly benefit from reduced or eliminated menstrual cycles. Many women in the military (>60%) report that menstrual or premenstrual symptoms have affected their ability to perform physical tasks and have created problems with regard to changing, obtaining and disposing of hygiene products. Female athletes commonly take OCs to protect bone health, to eliminate or postpone bleeding and to control menstrual symptoms. Virtually all perimenopausal women experience cycle irregularity, and OCs regulate menses and suppress other perimenopausal symptoms such as hot flashes, which worsen during the pill-free period. In the United States, tubal sterilization is the most common form of contraception; this large group of sterile women continue to menstruate with no possibility of pregnancy. For all of these women, amenorrhea through continuous OC use could improve their quality of life.

Last, but not least:

The physiological purpose of menstruation is to prepare the uterus for pregnancy; however, monthly hormone withdrawal bleeding in women taking OCs to prevent pregnancy cannot be considered to have a physiological or biological purpose, and it is not a physiological requirement. Current cyclic OC regimens were not designed based on empirical scientific evidence but out of a desire to suit the needs and allay the fears of both women and society. Effective contraception is no longer the radical concept that it once was, and women clearly want more options for both contraception and cycle control. The availability of a continuous use of orally active estrogen and progestin combination used to eliminate or reduce menstruation would offer improved quality of life and provide greater lifestyle convenience for many women. Use of this regimen could be dissociated from the need for contraception and is indicated for alleviating menstrual-cycle-related symptoms.

Extended Pill Regimen Decreases PMS

A study looking at the incidence and severity of premenstrual-type symptoms in patients converted from a 21/7 Pill regimen to an extended regimen found that the extended regimen (168-day one) led to a decrease in symptoms compared with the 21/7-day regimen. From the comment section:

The present study confirms that many women experience a multitude of premenstrual type symptoms while utilizing standard 21/7 OCs. Regardless of the progestin content of the pill, symptoms worsen during the last week of active pills, peaking in intensity during the 7-day HFI [placebo week]. The occurrence and severity of symptoms interestingly coincides with the decline in endogenous estradiol levels during the last week of active pills into the beginning of the HFI....

Elimination of the 7-day HFI with the extended 168-day DRSP/EE [Yasmin] OC regimen resulted in a statistically significant reduction (P < .001) in premenstrual type symptoms.... ... Since many patients discontinue OCs because of premenstrual type symptoms including breast tenderness, bloating, headaches, and mood swings, warning patients of their possible occurrence and management options can be crucial in OC continuation. Our study along with others confirms that 21/7 regimens can induce PMS type symptoms. Extended regimens may reduce these problems. Knowing this, 2 issues need to be addressed. First, patients currently on 21/7 OCs need to be questioned regarding symptoms occurring during the end of the active pills into the HFI. Our experience with a simple 0-10 scale for rating mood on a daily basis during 1 or more 21/7 cycles can assist with this documentation in a clinical setting where detailed daily symptom logs are often not practical. Those with significant cyclic variation in symptomatology can be offered the option of an extended regimen. Patients initiating a 21/7 regimen also need to be informed of the documented increase in symptoms associated with the HFI and instructed to report their occurrence. Second, these results provide further evidence of the need to redesign OCs with modification of the standard monthly 7-day HFI.

Menstrual Suppression Interactive Tool

Just noticed that the Association of Reproductive Health Professionals has a new interactive menstrual suppression tool:

You've heard about stopping your period (temporarily or long-term) by using certain types of birth control. Perhaps you have a friend who's done it, or you've seen reports in the media.

This tool will give you the facts about your period and stopping your period. It covers:

* Your menstrual cycle (monthly periods)

* Your menstrual cycle on hormonal birth control (monthly "withdrawal bleeding" – no true periods)

* Suppressing your menstrual period with hormonal birth control ("withdrawal bleeding" only if/when you want it)

* How different birth control methods suppress menstruation

Seasonale Proves the Earth is Flat--Part IV

In the last 4 paragraphs of the Seasonale: A Eugenicist's Dream article any pretense of logic is abandoned. No attempt is made to show us the alleged link between Seasonale and eugenics. Instead, we are "treated" to, and I'm searching for an accurate description here, utter nonsense.

One of the main goals of the Population Council, an international nonprofit "research" institution, is to "help achieve a humane, equitable, and sustainable balance between people and resources," i.e., to "stop those Third World people from procreating!"

The Population Council's stated mission is:

. . . to improve the well-being and reproductive health of current and future generations and to help achieve a humane, equitable, and sustainable balance between people and resources.

What does the Population Council do? It:

-- Develops contraceptives and other products to improve reproductive health;

-- Improves the quality and outreach of family planning and reproductive health services;

-- Conducts research on reproductive health and behavior, family structure and function, gender issues, and the causes and consequences of population growth;

-- Strengthens professional resources in developing countries through collaborative research, awards, fellowships, and training;

-- Provides a forum for publication of innovative research in peer-reviewed journals, books, working papers, and regional monographs.

Contrary to what the article says, the Population Council doesn't "stop those Third World people from procreating!" Oh, and isn't it telling that an article which purports to be concerned with the well-being of people everywhere would use the term "those Third World people"? Just because some people in this world, due to an accident of birth, are poor and live in the Third World doesn't give anyone the right to be condescending towards them, and even racist. "Those" people are not inferior to us! We just got geographically lucky and, if there is anything we can do to help out, we do it, simply because they are our equals, in need of help.

It all boils down to the old fallacy that the planet will implode if we don't slash how many people live on it, which has long since been proven untrue. But they continue to dupe the public into believing that we must use abortion and birth control to save ourselves.

I know, this is almost too easy to bother with! How exactly does the activity of the Population Council boil "down to the old fallacy that the planet will implode if we don't slash how many people live on it"? Based on all the available evidence, the Population Council is concerned with reproductive health and research on the causes and consequences of population growth. Why is a concern about overpopulation a fallacy? Has it been proven untrue? When? By whom? How does the Population Council "dupe the public"? What evidence is there that this is a continuing practice on their part? Most importantly, why is the assumption made that the public consists of a bunch of boobs (as in dolt, not bosom) which are easily duped? And how exactly does projecting the article's core belief "that we must use abortion and birth control to save ourselves" on to the Population Council make sense?

In keeping with this mission, the Population Council is a leader in the development of new contraceptives. The notion that long-term contraceptive regimens should be used to stifle menstruation was originally the brainchild of Population Council researchers; in particular, former council vice president and endocrinologist Sheldon J. Segal, who co-authored the book, Is Menstruation Obsolete? with Elismar Coutinho, a Brazilian gynecologist. Segal is also a member of a council division known as the International Committee for Contraceptive Research.

Long-term contraceptive (birth control) regimens, which have existed for decades, have never been used to "stifle menstruation". They have been used to treat a wide range of medical problems (painful periods, seizures, migraine headaches, bleeding disorders, ovarian cysts, endometriosis, etc.). Using them is considered the standard of care, and it's approved by the FDA. Drs. Segal and Cautinho's brains do not put forth the "notion that long-term contraceptive regimens should be used to stifle menstruation" in their book (Is Menstruation Obsolete?). I know this because I've read the book. But you don't have to take my word for it. This is part of Amazon.com's editorial review:

Is Menstruation Obsolete? argues that regular monthly bleeding is not the "natural" state of women, and that it actually places them at risk of several medical conditions of varying severity. The authors maintain that while menstruation may be culturally significant, it is not medically meaningful. Moreover, they propose that suppressing menstruation has remarkable health advantages.

The article continues:

Almost all of the latest propaganda used to promote Seasonale comes directly from Segal and Coutinho's book. The Population Council further pushes the concept through a plethora of recent pro-Seasonale articles from other council members, such as "reproductive health" researcher Charlotte Ellertson and Sarah L. Thompson, both quoted earlier in this article.

Contrary to the article's allegation that propaganda is used to promote Seasonale, the FDA's rules concerning approval and promotion of new drugs specifically require scientific evidence, rather than information that is spread for the purpose of promoting some cause, aka propaganda. Again, there's no need to take my word for this. If you want to see the medical evidence used for the promotion of Seasonale, contact Barr Laboratories, the maker of Seasonale, and request a copy of the Seasonale randomized, open-label, multi-center trial.

Also, if you're interested, take a look at Dr. Sulak's excellent review article: Should your patients be on extended-use OCs?

Oh, and one more thing. Dr. Charlotte Ellertson is a reproductive health researcher because she earned a M.P.A. and Ph.D. from Princeton University, and because she has, and is conducting research intended to promote reproductive health for women around the world. Again, using scare quotes around words does not magically cause reality to disappear.

Quotes from these "authorities" have helped clinch public support of Seasonale and everything it stands for. Barr and friends hope to see FDA approval of Seasonale within the year; their expectation is not far-fetched. It seems that the population control agenda is more important than the fact that long-term effects of a constant influx of synthetic hormones has barely been studied, much less proven to be safe and natural.

I am a patient person, so I'll say it again: just using scare quotes ("authorities") doesn't prove anything. (Well, OK, it does indicate one is ignorant and/or lazy, but it still doesn't refute facts.) What is the evidence that the FDA approved Seasonale because "the population control agenda is more important"? A PubMed search returns 1,956 studies on the long-term effects (and safety) of a constant influx of synthetic hormones. As to the "natural=as seen in nature" issue: it is natural for women not to have a monthly period, and the "long-term effects of a constant influx of synthetic hormones" causes women not to have a monthly period.

Finally, the article concludes:

If we really want to get to the root of what is "normal", i.e. what nature intended, it's not going to be what the feminists and population control elitists want to hear: Nature designed most women to be wives and mothers in the traditional sense; fulltime moms--not fulltime executives--who often have more than the politically correct 2.2 children. Sorry, that's just the way it is. And popping a hormonally loaded pill will never take the place of what nature truly intended.

Ah, let us, indeed, get to the root of "what nature intended"! (Please pardon my use of boldface, but this can't be emphasized strongly enough.) To determine "what nature intended" you have to look at what happens in the "wild", over an evolutionary significant (tens of thousands of years) period of time.

You have to look at what happens in the "wild" because humans are social creatures. This means the frequency of our menstrual period is influenced by both nature and nurture. The only way to separate nurture's (society's) influence is to look at our study subjects in the wild. Also, you have to look at what happens over a long period of time because humans aren't fruit flies (Drosophila melanogaster). For humans, we need to look at roughly 1000-10,000 generations (that's about 20,000-200,000 years). I'll go into more details in a future post, but for now the bottom line is this:

-- There is an established scientific method which is used to determine "what nature intended".

-- "What nature intended" is completely independent of what the article's authors want to hear (or, for that matter, of "what the feminists and population control elitists want to hear").

-- Nature designed most women (and men) to insure survival of the species. It didn't design women to be "wives", "fulltime" moms, or "executives" since such things aren't natural (all are social constructs).

-- The replacement fertility level (the level needed to ensure the long-term replacement of a country's population) of 2.1 children per woman is a well-established, scientific fact, completely unrelated to political correctness. "Sorry, that's just the way it is", indeed.

The idea of being able to "induce" a natural state is silly, at best.

Why is the idea of being able to "induce" a natural state silly? The very concept of medicine is based on this idea-- once a natural state is disrupted (you fall and break your arm, your cholesterol level is sky-high, etc.), you/your physician induce a natural state (by applying a cast on the arm, taking drugs to lower the cholesterol, etc.).

The notion that is being promoted--that women must engage in the artificial practice of oral contraception in order to return to the "natural" physiology of infrequent menstruation--should be recognized as the quack medicine that it is.

Besides the unsubstantiated allegation that a "notion...is being promoted", this section also reveals a complete ignorance of the subject being discussed. Artificial fertility control (i.e., taking oral contraceptives to prevent a pregnancy) has nothing to do with using Seasonale for menstrual management. (I will elaborate in a future post.) You can not, credibly, judge something to be "quack medicine" if you lack even a basic understanding of it.

Unfortunately, many women are falling for it.

Actually, despite the article's implied conclusion that women are feeble-minded idiots, all the scientific evidence (to say nothing of common sense!) points to the fact that women, given the correct and complete information, are quite capable of judging the quality of the available health information, and making sound decisions on their own.

Hmm, what a scary and alienating concept this must be for people who write articles entitled "Seasonale: A Eugenicist's Dream"!

Seasonale Proves the Earth Is Flat--Part III

Looking at the second part of the factually-challenged article Seasonale: A Eugenicist's Dream I realized something: not only isn't the connection between Seasonale and eugenics revealed (since no logical case for such a connection can be made), but the medical misinformation contained in this section is appalling. This is simply unacceptable.

It's one thing to pretend logic doesn't exists--a poorly constructed argument doesn't kill. If it did, most of our politicians would be in need of serious medical care (sorry, but I couldn't resist the gratuitous dig). It's an entirely different thing to ignore or distort (knowingly or out of ignorance) medical facts--this has real-life, dangerous consequences. So, in order to correct the many factual mistakes in the article, I will devote a separate entry/s to that task. For now, let's just have fun with logic (or, rather, the lack of it).

The good news is that the second section of the article starts of with a statement of fact (finally, some facts):

"Yes, periods and all that go with them can be annoying and inconvenient."

The bad news is that the facts don't last...:

But so are many other natural bodily functions. I doubt there are many among the average population who would assert that the body's process of waste elimination is a convenient or somehow pleasant bodily function. Yet, it is completely normal, natural and necessary.

Right from the start, we have a red herring--of the fallacy, not fish variety. If you're trying to establish what's natural when it comes to the menstrual period, it is completely irrelevant what other body functions are, or are not. Oh, and in the interest of scientific accuracy: waste elimination is necessary; the period isn't. If your kidneys fail, you die. If you don't have a period, not only do you not die, but you're also not necessarily infertile--you can still become pregnant.

As the piece continues, again a statement of fact--certain women experience more extreme symptoms and are more than a little inconvenienced by the monthly period--is followed by misinformation:

But are women really healthier on the pill? If side effects are the main indicator of health, I think the answer is a hands-down NO. Here's what the "cure all" pill can cause:...

First of all, side effects are never an indicator of health, but rather of risk. The end-result of the balance between benefit and risk is the health indicator. For example, if you decide the benefits of having a baby outweigh the risks, and if, after delivery (post-partum) you're fine, you're in good health. Same with taking drugs--if the benefits of using a drug are greater than the risks, the end result is a healthier you.

Second of all, women are, in fact, healthier on the pill as we've already discussed. And last, but not least (run, run for the hills as fast as you can--the scare quotes are a-comin') the claim that the birth control pill is a "cure all" has never been made by any competent medical professional, any pill manufacturer, or any legitimate scientific publication at any time, anywhere. Quotation marks do not magically transform fantasy into reality.

And while we're on the subject, I am officially unveiling a new Public Service Announcement campaign:

Just Say No to Scare Quotes!

All kidding aside, this next section contains dangerous medical misinformation:

...nausea, bloating, moodiness, breast tenderness, breakthrough bleeding, weight gain, headaches/migraines, depression, decreased libido, vaginitis, urinary tract infections, skin problems, gum inflammation, aggravated asthma, increased incidence of contracting viral illnesses. More dangerous side effects include: severe pain or swelling in the legs, dizziness, weakness, numbness, blurred vision (or loss of sight), speech problems, chest pain or shortness of breath, abdominal pain, high blood pressure, blood clots, stroke, and whether they want to admit it or not, studies DO show that there is an increased risk of breast cancer. Oh yeah, iron-poor blood is WAY worse than all that.

I'll address the specific medical issues in a separate post, but allow me to vent for a moment. As I mentioned before, this lack of professionalism is unacceptable. After all, it's not like this piece appeared in a blog, where, as we all know, [sarcasm] everything goes since there are no editors [/sarcasm]. There is no excuse--basic information about the pill is easily available just by doing a simple search, or talking to a medical professional. Again, just because one has an opinion doesn't mean the facts can be ignored. If I have an opinion about, say, mine safety work procedures, doesn't mean I can just write about it off the top of my head, seeing how I've never even been close to a mine entrance. Either I do my due diligence, research the subject, and come up with an informed opinion, or I clearly state, at the start of the piece, that I don't actually know the facts about working in a mine and I'll be making them up as I go along, in support of my opinion.

Moving on, we stumble upon a few more fallacies (you know, if the word fallacy didn't signal a break in logic, one could enjoy encountering it--I could certainly make a case that this word just sounds vaguely naughty):

All the medical rhetoric aside, the propagation of the myth that the natural functions of women's bodies are abnormal and must be "fixed" comes from an old nemesis:...

This is a typical begging the question fallacy: just because you state that there's a myth, which is being propagated, is not enough to establish that, indeed, such a myth exists, or that it's being spread around. If you state something as fact you need to provide some supporting evidence (any evidence, an iota, a teensy-weensy bit, or maybe even...gasp...a link). And, if all the medical rhetoric is set aside, the word nemesis is used because...? Let me venture an answer: because some people are under the mistaken impression that fancy, out-of-context words can substitute for a lack of facts.

Well, even if the article doesn't make it clear why the word nemesis is used, at least it does tell us who the nemesis is: ...the population control movement (which by default includes the feminists, eugenicists and the like).

I am going to completely ignoring the lack of logic in this statement, just because I am trembling with anticipation. Finally, it looks like the reason for linking Seasonale and eugenics is going to be revealed:

These are the people who are obsessed with reducing the world's population just to ease their own irrational fears or to achieve their own insidious agendas. Not surprisingly, these operations have their fingers buried deeply in the contraceptive cookie jar. For example, Barr Laboratories and Eastern Virginia Medical School aren't the original public advocates of Seasonale. As mentioned earlier, there exists another conspirator: the Population Council.

Wait a minute! What just happened here? There isn't even a perfunctory attempt to offer an explanation. We go directly from illogical statements to conspiracy theory. I must confess, this is a let down. I was looking forward to seeing how the article would explain the connection between menstrual management, something which doesn't involve sexual intercourse and which has to do with controlling the menstrual period, and eugenics, something which, by definition, must involve sexual intercourse and which has to do with genetic traits control.

The best (and I use the term "best" loosely) the article can do in its attempt to establish a link between Seasonale and eugenics is this:

--it asserts that there is a myth that the natural functions of women's bodies are abnormal and must be "fixed" (What evidence is there that such a myth actually exists?)

--it also asserts that there is a propagation of the myth (What evidence is there that this alleged myth is being propagated? What is the meaning of "propagated" in this particular context?)

--that this alleged propagation is done by an old nemesis (What is the evidence that, if the myth is true and if it is being propagated, the "old nemesis" is doing the propagation?)

--that the "old nemesis" is the population control movement (What is the evidence which establishes that the "old nemesis" is made up of the population control movement?)

--and, finally, that the population control movement by default includes the feminists, eugenicists and the like (What is the evidence for this inclusion?)

To sum up: myth that the natural functions of women's bodies are abnormal and must be "fixed"-->propagated-->old nemesis (population control movement)-->eugenicists

You still don't get the connection between Seasonale and eugenics? Not to worry, especially since there isn't one.

Seasonale/menstrual management is based on the fact that the natural functions of women's bodies are, in fact, normal. The natural (as seen in nature) pattern for the menstrual period (a woman's body function) is one period every few years, for a lifetime total of 100 to 150 periods. Since women today have a period every month, for a lifetime total of 400 to 450, Seasonale/menstrual management offers women the option to have a natural, normal period pattern. Thus, even assuming that all the unproven assertions in the article (myth, propagation, eugenicists connection) are true, since Seasonale has nothing to do with the myth, any connection between the myth and eugenics is irrelevant.

Returning to the article, we get a bit more "information" (read unsubstantiated assertions) about the "old nemesis", aka the population control movement:

These are the people who are obsessed with reducing the world's population just to ease their own irrational fears or to achieve their own insidious agendas. Not surprisingly, these operations have their fingers buried deeply in the contraceptive cookie jar. For example, Barr Laboratories and Eastern Virginia Medical School aren't the original public advocates of Seasonale. As mentioned earlier, there exists another conspirator: the Population Council.

Oh, where, oh where to begin? Again, just because words like "obsessed", "irrational fears", "insidious agendas", and "conspirator" are used, the need for facts/evidence doesn't magically disappear.

True, it's easier to assume your audience is a bunch of idiots, and to throw some nonsensical words at them. But, really, in this age of Google how hard is it to show a minimum of respect for your readership by giving them the facts and allowing them to reach their own conclusions? For example, why is someone who believes in reducing the world's population "obsessed"? What are their fears and in what way are they "irrational"? What are these people's agendas and why are they "insidious"? What is the meaning of the term "conspirator" in this context? Are all the many public advocates of women's health issues--numerous churches and charities, the government, the medical community--"conspirators" because they care about women's health? Or do the public advocates become "conspirators" only when they inform women about Seasonale? And if yes, why? I could go on, and on.

Speaking of going on, and on, the last 4 paragraphs of the article contain so much misinformation that I simply must end this post here, and dedicate a whole new one just to those last paragraphs. And, mind you, I haven't even gotten around to addressing the medical mistakes! I wonder, are there many articles like this one out there, purely devoid of facts, or did I just stumble on the one exception to the rule?

Seasonale Proves the Earth Is Flat--Part II

As promised, let's take a closer look today at Seasonale: A Eugenicist's Dream, an opinion piece, dated August 8, 2003, from The Washington Dispatch site. I'm not at all familiar with this site, however I did note their prominently displayed motto: "Your Source for Reliable News and Unbridled Opinion".

First, just so we're all clear on what the meaning of "is", is:

Eugenics = The study of hereditary improvement of the human race by controlled selective breeding./ n: the study of methods of improving genetic qualities by selective breeding (especially as applied to human mating).

So, presumably, when eugenicists dream, visions of DNA and selective breeding dance through their heads. This doesn't, however, explain the linkage in the title between Seasonale and eugenics. What's the connection? Seasonale = Eugenics? Seasonale is the main feature in an eugenicist's dream? What?

Seasonale, is a drug intended for period control (menstrual management), not pregnancy control--selective, or otherwise. Period control allows a woman to choose when to have a period and how many periods to have, regardless if she is, or isn't sexually active. Since you can't have eugenics without sex, the question remains: what's the connection between menstrual management and eugenics? Well, maybe if we're patient, somewhere in the article the connection will be revealed to us. So, let's look at the first half of the article today.

The article opens with a straw man set-up:

-- menstrual management is the "latest bit of medical scientific 'progress'"

Actually, menstrual management has been used for over 40 years and is considered the standard of care by the medical community.

-- menstrual management is based on the fact that "It's NOT normal to have a regularly functioning menstrual cycle."

There isn't a single article in any peer reviewed medical journal, nor any record of a competent physician stating that it's not normal to have a regularly functioning menstrual cycle. Even the makers of Seasonale clearly state on their site that:

...monthly periods are normal...

-- and, finally, the way menstrual management works is you "pop a new contraceptive pill called Seasonale, and eliminate menstruation almost entirely."

In reality, menstrual management can be used to skip only one period, like, for example, when you're going on your honeymoon (a once-in-a-lifetime event, hopefully), or it can be used to decrease the number of periods from 13 (one every month) to 4 (one every 3 months), like when you're using Seasonale for an entire year.

Next, medical fact and the article start to diverge:

"Medical 'progress' has already technically abolished menstruation in women who are on the pill...But it appears that the manipulation of women's bodies won't end there."

Medical progress hasn't, technically or otherwise, abolished anything. Women who are on the pill do not have menstrual periods because of the pill's mechanism of action. Also, menstrual management involves manipulation of the pill's hormone regimen, not of the woman's body. And, no, the two are not the same since, in a woman who isn't using the pill, the hormone levels produced by the body are also manipulated (they fluctuate periodically), by the body itself.

The article continues, and so does the break from reality:

"The researchers hired by those who stand to make a good deal of money from Seasonale are already force feeding women the notion that having a monthly period is an unnatural, unhealthy medical disorder that they need relief from."

The manufacturer of a product (Barr Labs, the maker of Seasonale) spends years and millions of dollars, employing hundreds of people and paying millions in taxes in the process, to develop a product and bring it to market. Once the product, the result of its labor, investment, and risk, finally reaches the market, it stands to make money. This is logical and reasonable (unless, of course, you think it's OK to walk into the corner bagel store, grab some bagels, and walk out without paying, or if you think Barr Labs' business model should be to sell their products for less than the cost of production, to insure that they do, in fact, lose money). At the same time, all this is also completely irrelevant when it comes to evaluating the quality of information women get from researchers. The researchers' information is either valid, or not, based on scientific facts, not based on their employment history.

As to the researchers "...force feeding women..."--I have yet to see any reports on the hoards of menacing, lab-coated researchers accosting women in the streets, or breaking into their homes and subjecting them to PowerPoint presentations. Not to mention the fact that no researcher involved with Seasonale has stated that having a monthly period is an "unhealthy medical disorder". And the "unnatural" trick is just that, a trick. In medicine, unnatural simply means not seen in nature (it's unnatural for humans to fly unaided--you know, seeing how we have no wings and all). The term doesn't have a negative, or positive, connotation: it's neither unhealthy that humans don't have wings, nor is it healthy.

Moving on, this is just plain silly:

"The medical 'evidence' they base this opinion on?"

OK, repeat after me: using scare quotes for the word evidence is nonsensical. Evidence, especially medical evidence, is either valid, or invalid. If you think the evidence is caca, great. Use facts to refute it or have a hissy fit--whatever. Just don't use quotation marks--they are meaningless in this context.

And the silliness continues:

"That cavewomen and members of primitive tribal cultures did not menstruate as often as we American women. This somehow makes us abnormal. I can't help but wonder at what point we began basing our modern health norms on what was normal for cavewomen. And I wasn't aware that cavewomen kept detailed records of their menstrual cycles."

The reason we have to look at cavewomen and women of primitive tribes is because humans are social animals. This means a lot of our traits (how often we have a period, our weight, our intellect, etc.) are influenced partly by nature and partly by nurture (societal/cultural factors). In order to determine what's normal in nature (what nature intended), we have to separate nature from nurture. The only way to eliminate nurture's influence is to look at women living in the wild, so to speak--hence cavewomen and primitive tribes. This is called the scientific method of study, and it's the reason we study cavewomen. No strange desire to start a retro-cave trend is involved (as if any sane person would yearn for the good old...cave dwelling).

Oh, and one more thing. The fact that we menstruate more than the famed cavewomen means our menstrual pattern is not what nature intended. In other words, the cavewoman's period frequency is determined only by nature, which makes it the natural pattern. In contrast, our period's frequency is influenced by both nature and nurture (time at first period, life expectancy, infant mortality, breastfeeding, and the ability to choose infertility). This dual influence doesn't mean us, modern women are "abnormal". All it means is that we have a period pattern which isn't seen in nature.

Here we go again:

"Medical authorities are using this overwhelming scientific 'discovery' to convince women that they will be healthier if they take the pill. They are enamored with reminding women that with menstruation comes a plethora of dangerous side effects: headaches, bloating, moodiness, cramps, and the worse culprit of all, inconvenience."

One more time: using scare quotes, for the word discovery this time, is nonsensical. Something either is, or isn't a scientific discovery. If you don't think it's a discovery, use facts to refute the evidence or throw a temper tantrum. Either way, stay away from, you know...quotation marks. Also, using at least one actual fact sure would help a lot. No authorities, medical or otherwise, are using the fact that cavewomen had less periods to convince women of anything. The reason women are healthier if they take the pill is because the pill is a medication which:

1. treats a variety of medical problems (migraine headaches, heavy bleeding, ovarian or breast cysts, etc.), in women who suffer from period-related health problems

and

2. considerably lowers the risk of cancer (ovarian, uterine), protects against Pelvic Inflammatory Disease, or PID (an infection of the upper part of a woman's reproductive tract), etc., in women who don't experience any period-related problems

And how exactly does the fact that medical authorities are doing their duty, by educating women about the side effects of the menstrual period, demonstrate that said authorities are "enamored" (of what exactly, it's not entirely clear)? It is one of the basic principles of the Hippocratic Oath that a physician: first has to watch (to learn), second has to do (to practice), and third has to teach (to educate). Should we perhaps ask medical authorities to stop reminding us about the side effects of pregnancy, or AIDS, or heart diseases, least they appear "enamored"?

Also, what medical authority, ever, anywhere has stated that the worst side effect associated with the menstrual period is "inconvenience"? If this matter wasn't so serious--period-related health problems can, and do kill women--the fabrications in this article would be mildly amusing. Let's look at this "inconvenience" issue for a moment. Clearly, this aspect of the period can be highly subjective: your slightly annoying period cramps and week and a half of bleeding can be your best friend's week and a half spent in the middle of the desert in Iraq, fighting the enemy while cramping and worrying about where to get a tampon. So, just because the period is less inconvenient for some women, is no justification to be patronizing and dismissive of the women who do find the period inconvenient.

Finally, remember how I said the fantasies which pass as facts in this article would be mildly amusing, were it not for the serious matter of period-related health problems? Here's the last example for today:

"One article I read even stated that the rare side effect of anemia (iron-poor blood) is one of the world's worst medical maladies. I would have voted for something like cancer or heart disease."

Let's go to...reality, and check the facts:

-- The World Health Organization considers iron deficiency the number one nutritional disorder in the world . It affects more than 30% of the world's population.

-- Just in the U.S. alone 7.8 million teenage girls and women suffer from iron deficiency, of which 3.3 million have a more severe form called iron deficiency anemia.

Source: The Journal of the American Medical Association, 1997;277(12):973-976. (sorry, couldn’t find a link to this article)

-- Iron deficiency anaemia affects over 2 billion people, particularly women of reproductive age and pre-school children.

-- Iron deficiency is the most prevalent single deficiency state on a worldwide basis. It is important economically because it diminishes the capability of individuals who are affected to perform physical labor, and it diminishes both growth and learning in children.

-- There are several kinds of anemia produced by a variety of underlying causes, but the most common and most severe type of anemia, iron-deficiency anemia (IDA). Just as the name implies, this form of anemia is due to insufficient iron. In the United States, 20% of all women of childbearing age have iron-deficiency anemia, compared with only 2% of adult men. The principal cause of iron-deficiency anemia in premenopausal women is blood lost during menses.

Before I go, a final note. Perhaps I went a bit overboard with the number of examples, but this can not be emphasized strongly enough: just because one writes an opinion piece, doesn't mean that reality and facts can be ignored. For example, if you think the millions and millions of women who suffer from iron deficiency anemia are insignificant and deserve to be mocked, just grand! This is a free country and you are entitle to your opinion. But what you're not entitled to is pretending reality doesn't exists, and/or distorting said reality.

Seasonale Proves the Earth Is Flat--Part I

By now I expect you've all heard the news. No, I'm not talking about the President's speech on Sunday, or about the 7 consecutive days in Iraq without any U.S. combat deaths. I am talking, of course, about the really important news: the FDA has approved Seasonale! And, please, no e-mail about how dare I mention the war in Iraq and Seasonale in the same paragraph--keep on reading, and you'll see that there is, indeed, a connection.

Seasonale, manufactured by Barr Laboratories, is the first drug on the market specifically packaged for use in menstrual management. In really (really) general terms: women can use Seasonale to cut down the number of yearly menstrual periods from 13 (once a month), to 4 (once every three months). Taking control of your period and deciding when to have a period, and how many periods to have = menstrual management.

But, just because this drug was approved, I didn't have to: 1) start a blog, 2) name it The Well-Timed Period, and 3) dedicate it to discussing menstrual management. No, what actually motivated me to do all this was stumbling upon an article, titled Seasonale: A Eugenicist's Dream while Googling, you guessed it, Seasonale. This article is number 4, out of about 7,580 results. For shame!

Most women, the media, and, unfortunately, quite a number of medical professionals, don't have accurate information about menstrual management as it is. For example, the September 5, 2003 AP news wire (picked up by most media outlets) announcing the approval of Seasonale, contains the following telling phrase:

"The big safety question is whether four periods a year are enough to allow the uterus to shed any tissue that builds up."

This is wrong--there is no tissue build up in the uterus while a woman uses hormonal birth control. The mistake stems from confusing the actual period with the fake one (medical term = withdrawal bleeding). A common mistake, but a mistake nonetheless. Add to this baseline confusion the medical fiction in an article like the eugenics one and you have a recipe for disaster.

Yes, I said disaster. Because, contrary to the patronizing and dismissive tone of the eugenics article, period-related problems are serious and can even kill. Since this is my first post ever, I won't go into the really depressing statistics. I'll just touch upon a few of the "minor" ones.

Just in the U.S.:

-- Period-related disorders "are the most common gynecological complaint, affecting nearly 2.5 million women aged 18 to 50. Two-thirds of these women contact a doctor regarding menstrual problems each year, and 31% report spending a mean of 9.6 days in bed annually."

-- Among women under the age of 25 painful periods (medical term for painful period = dysmenorrhea) are the most common cause of time lost from work or school.

-- The costs of period-related disorders to US industry have been estimated to be 8% of the total wage bill.

-- The impact is particularly acute in industries that employ predominantly women. For example, Texas Instruments noted a 25% decrease in productivity among female workers around the time of menses.

And if you think it's not so easy to be a soldier, on active duty, in the middle of the desert, in 130 degrees heat, think how "easy" it is to be a soldier, on active duty, in the middle of the desert, in 130 degrees heat, while having your period. [See, I told you there was a link between the war in Iraq and Seasonale.]

So, all this introduction (sorry, but I haven't yet achieved the Professor's succinctness), just to say that:

-- I found an article full of medical fiction

-- medical misinformation is dangerous

-- I started a blog to set the record straight and inform the public [Well, doesn't that sound official!]

Actually, I really wanted to use "administer a medical fisking" somewhere in the mission statement, but it just sounded too much like a, slightly unpleasant, minor outpatient medical procedure.

In any case, since I also can't claim anything resembling Mr. Den Beste's craftiness with long, but brilliantly informative posts, I'll end this entry here and dedicate my next post to the promised debunking of the eugenics article. Oh, and the fact that it took me over 4 hours to create this site and publish this entry has nothing, nothing I tell you, to do with my ending this post here.