When hormonal birth control pills were first introduced to the public in 1960, they were initially packaged in a bottle, like other medications. A few years later, Ortho-Novum was the first to create the circular dispenser many of us are familiar with: 21 days on, seven days off. This dispenser gave periods a sense of temporality, as they occurred on a regular basis every few weeks. Pharmaceutical companies designed the “off” week to create a menstrual period because they felt that patients, pharmaceutical executives, and religious officials would find hormonal contraception more acceptable in this way. Experiencing a somewhat regular period is also an important way that people know they are not pregnant. Although menstruating people have been hacking their own contraceptives for decades to avoid periods around certain life events, like vacations or sports competitions, it wasn’t until the early 21st century that pharmaceutical companies began selling hormonal birth control pills that explicitly they omitted the placebo. weeks to decrease the frequency of menstruation.
Chemical menstrual suppression, like hormonal contraception, represents the next step in what historian Sharra Vostral calls “transitional technologies.” Menstrual control products were the first “gait technology” in that they allow a menstruating person to move through the world as if she were not menstruating. Tampons allow you to wear bathing suits and go swimming; All forms of menstrual control products reduce the risk of staining clothing, furniture, and bedding. Menstrual suppression technologies are the next logical step in pharmaceutical executives’ quest to win customers, but it also seems like a good idea for those looking to survive in busy, productive cultures that leave less and less room for experiences like menstruation, not to mention those for whom eliminating menstruation would help to affirm their gender. While the acceptance of menstrual suppression technologies was initially quite low, acceptability has increased dramatically in recent decades, largely due to advertising by pharmaceutical companies and advocacy by physicians. And the increased accessibility of menstrual suppression technologies is part of what we need in our future with a period (or for some without a period).
Suppressions and Menstrual Manipulations
Most menstrual suppression technologies are different types of hormonal contraceptives, which are not as well tolerated by menstruating bodies as most of us believe. In multiple studies, about half of people taking hormonal birth control discontinue it. Even those who adhere to hormonal contraception often experience unwanted side effects, which they bear as an acceptable cost to avoid becoming pregnant or menstruating. Many groups are committed to people who are menstruating and still taking hormonal contraceptives, including pharmaceutical companies, those who fear teen pregnancy, and those with an interest in world population control. But menstruating people may not always be as involved, at least in the management and suppression technologies that currently exist. According to a recent Cochrane review, indeed, the gold standard in health care if you’re trying to assess the quality of the evidence, face-to-face counselling, the most common intervention to improve hormonal contraceptive continuation, it does not increase the rate at which people choose to remain on hormonal contraception. In the articles they sampled, between a quarter and a half of those on a given hormonal contraceptive regimen discontinued its use during the study period. A recent study comparing self-reported continuation rates with actual claims from pharmacies suggests that people may overestimate how continuously they use hormonal contraception. People skip a month here or there because they forget to get their prescription on time, because the prescription is expensive, because they don’t have potentially contraceptive sex, or because they don’t like how hormonal birth control makes them feel and need a break from it.
Hormonal contraceptives, especially the shorter-acting forms like pills, rings, patches, and injections, are a hassle, and users often report side effects, including loss of libido, weight gain, vomiting, dizziness, and depression, as well as amenorrhea. irregular bleeding and heavy bleeding. Two studies reported some improvement in continuation among users with adverse side effects receiving counselling, but the certainty of the finding was weak. Keep in mind that the goal of these studies was to find out how people with severe effects could continue to take hormonal birth control. Fear of pregnancy, particularly the fear of the wrong person getting pregnant (for example, a teenage girl or a brown or black woman), motivates the continued use of hormonal contraceptives that harm approximately half of the people who try them. .
Significant side effects and high discontinuation rates also affect the levonorgestrel-containing intrauterine device or hormonal IUD. A study examining the experiences of 161 women who had hormonal IUDs inserted at a UK hospital found that almost half of them had their IUDs removed because of side effects, including “swelling, headaches, head, weight gain, depression, breast tenderness. , excessive hair growth, oily skin, acne and sexual disinterest”. This finding is particularly surprising as these women were excellent candidates for the hormonal IUD: they had undergone a gynecological examination prior to insertion and, in most cases, had also had a hysteroscopic evaluation of the uterine cavity to ensure that they did not have fibroids or other injuries that could complicate their experience.
In a study interviewing physicians who administer hormonal contraceptives, respondents did not understand when patients requested early IUD removal. Clinicians in this sample were often frustrated when patients were dissatisfied with their IUDs for whatever reason. In an effort to get as many people as possible to use them, one study doctor confessed: “I don’t try to influence women’s decisions, but I try. I don’t want me to be the person making the decision, but I want to guide them in making a good decision for themselves. But I usually say that it is my favorite method. … And I often say that it is our most effective method, and it is very easy to implement”. When patients asked to have their IUD removed, doctors often discouraged them by asking them to keep it in for a few more months to see if symptoms changed. While many clinicians emphasized the importance of patient decision-making, others only reluctantly conceded to patient autonomy. Others expressed disappointment or disagreement with their patients. These coercive stances run counter to the broader goals of reproductive justice.