The Pill, periods and the Catholic church

Medical legend has it that when scientists were developing the first contraceptive pill, they developed it so that women taking the pill would have the reassurance of a monthly bleed. No matter that the bleed had no other purpose (it doesn’t even tell you you’re not pregnant as if you happen to fall pregnant on the pill, you will still bleed during your pill free week) – these guys thought that most women liked having periods, and morever, they hoped that the Catholic Church would find their new contraceptive more acceptable if women experienced a regular bleed.  We don’t need to bleed, of course. If we’re on the pill we can quite happily take it two or three packets at a time, or even indefinitely with breaks for your bleed tailored exactly to you and your physiology. I tell my patients that if we were living a traditional lifestyle (starting intercourse young, having babies and breastfeeding them for a few years) we might have only a couple of dozen periods in our lifetimes – as the breastfeeding and pregnancies happening back to back would suppress ovulation and lead women to have on average ten children over a reproductive lifetime. It’s contraception, in fact, together with reduced rates of breastfeeding, that have given women the “reassurance” of a monthly period for years on end.

Can you tell I find this fascinating? One of the reasons for my temporary break from blogging has been because I have been doing a bit of extra training, so that I can get a postgraduate qualification in Family Planning. Yes, even though I am thirty-cough, I am still studying. It’s never ending. But one of the joys of general practice, is that you can develop a special interest, and mine is family planning and sexual health. I am fiercely in favour of women being able to take control over their sexual and reproductive health, and mine is the perfect profession to advise and counsel. I never fail to be amazed at how few women really appreciate the range of options available to them. The Family Planning Association (who have now wisely rebranded as “FPA”) publish a fantastic leaflet that I use with my patients, to show them just how many forms of contraception we have available to us. So when my patients come in and say, “I want to go on the pill” I can say, “No problem, shall we go through all the options, so we can see whether the pill is the right contraceptive for you?” – then I unfurl this huge leaflet which details all twelve (yes twelve) commonly used contraceptive methods.

To recap: the pill, the progesterone only pill, the contraceptive patch, the contraceptive ring, the coil, the Mirena coil, the injection, the implant, male and female condoms, a cap or diaphragm, male and female sterilisation, natural family planning methods. All bona fide, and all have their place. Impressive, isn’t it? And my patients, without fail, are suprised just how many options they have. (Sadly, the Catholic church only approves of one of them.) It takes more than ten minutes to discuss the real pros and cons of each of these methods with my patients, of course, but I do my best. One of the most satisfying aspects of these contraceptive consultations is knowing that if I do my job correctly, the implications could be huge. I could and should be preventing unwanted pregnancies. I could and should be helping a women or a couple plan when and how often they become pregnant; I could and should be helping my patient take advantage of medical technology to control her cycles, prevent PMS, minimise the physical and psychological impact of endometriosis or heavy painful periods. And the bigger picture:  I could and should be having an impact on the environment by helping prevent overpopulation; I could and should be helping women have unnecessary abortions.

Marie Stopes tells us that one in five pregnancies in the UK will end in abortion. Their fascinating leaflet on why UK women find themselves with an unwanted pregnancy is well worth a read. Whilst I remain a strong supporter of easy access to abortion for my patients, I, like most people, wish there were fewer of them. If I can, in my small way, give my patients a proper choice of contraception – education, support, and practical help – all this extra work will be well worth it.

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18 Comments

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18 responses to “The Pill, periods and the Catholic church

  1. You’re back; a real post. And very interesting it was too. Only a man could think that women enjoyed having periods.

  2. You could and should promote NFP as the safest and healthiest method for family planning…not prescribing abortion by pill, or risking a higher chance of female cancers.

    There are even better alternatives for treating ailments like endometriosis and infertility with NaProTechnology (try a search engine). You couldn’t ask for a more satisfying education in reproductive technologies or family planning.

    Just a suggestion.

    …Oh, and don’t be “sad” for the Catholic Church. We’re doing just fine 🙂

  3. Vicky P

    Hello Nice Lady Doctor,

    I have subscribed to your blog because, I hope one day to also become a nice lady doctor (even though I’m already 30-cough and only now applying to medical school).

    Any thoughts for a woman who will be breastfeeding and uses the ‘mooncup’ so has had problems with the coil before? Just your thoughts seeing as you mentioned it, I will of course, be going to my own GP when I’ve given birth.

    Cheers
    Vicky

  4. Not sure if you have seen this, but your post brought it to my mind. (Oh, and I too and thirty-cough and still studying! It keeps us fresh, apparently)

    Have a Happy Period!

    This is an actual letter from an Austin woman sent to American company Proctor and Gamble regarding their feminine products. She really gets rolling after the first paragraph. It’s PC Magazine’s 2007 editors’ choice for best webmail-award-winning letter…

    Dear Mr. Thatcher,

    I have been a loyal user of your ‘Always’ maxi pads for over 20 years and I appreciate many of their features. Why, without the
    LeakGuard Core or Dri-Weave absorbency, I’d probably never go horseback riding or salsa dancing, and I’d certainly steer clear of running up and down the beach in tight, white shorts. But my favorite feature has to be your revolutionary Flexi-Wings. Kudos on being the only company smart enough to realize how crucial it is that maxi pads be aerodynamic. I can’t tell you how safe and secure I feel each month knowing there’s a little F-16 in my pants.

    Have you ever had a menstrual period, Mr. Thatcher? Ever suffered from the curse’? I’m guessing you haven’t. Well, my time of the month is starting right now. As I type, I can already feel hormonal forces violently surging through my body. Just a few minutes from now, my body will adjust and I’ll be transformed into what my husband likes to call ‘an inbred hillbilly with knife skills.’ Isn’t the human body amazing?

    As Brand Manager in the Feminine-Hygiene Division, you’ve no doubt seen quite a bit of research on what exactly happens during your customers’ monthly visits from ‘Aunt Flo’. Therefore, you must know about the bloating, puffiness, and cramping we endure, and about our intense mood swings, crying jags, and out-of-control behavior. You surely realize it’s a tough time for most women. In fact, only last week, my friend Jennifer fought the violent urge to shove her boyfriend’s testicles into a George Foreman Grill just because he told her he thought Grey’s Anatomy was written by drunken chimps. Crazy!

    The point is, sir, you of all people must realize that America is just crawling with homicidal maniacs in Capri pants… Which brings me to the reason for my letter. Last month, while in the throes of cramping so painful I wanted to reach inside my body and yank out my uterus, I opened an Always maxi-pad, and there, printed on the adhesive backing, were these words: ‘Have a Happy Period.

    Are you fu*%ing kidding me? What I mean is, does any part of your tiny middle-manager brain really think happiness – actual smiling, laughing happiness is possible during a menstrual period? Did anything mentioned above sound the least bit pleasurable? Well, did it, James? FYI, unless you’re some kind of sick S&M freak girl, there will never be anything ‘happy’ about a day in which you have to jack yourself up on Motrin and Kahlua and lock yourself in your house just so you don’t march down to the local Walgreen’s armed with a hunting rifle and a sketchy plan to end your life in a blaze of glory.

    For the love of God, pull your head out, man! If you just have to slap a moronic message on a maxi pad, wouldn’t it make more sense to say something that’s actually pertinent, like ‘Put down the Hammer’ or ‘Vehicular Manslaughter is Wrong’, or are you just picking on us? Sir, please inform your Accounting Department that, effective immediately, there will be an $8 drop in monthly profits, for I have chosen to take my maxi-pad business elsewhere. And though I will certainly miss your Flex-Wings, I will not for one minute miss your brand of condescending bull sh*t. And that’s a promise I will keep. Always!

    Best,
    Wendi Aarons
    Austin , TX

  5. Laurie

    We definitely need more people like you around. I’ve used Depo-Provera on and off for about 10 years, using several different family planning clinics, and have encountered some surprising responses from medical staff there. I once told the nurse that my libido had reduced to nothing since starting Depo, and was patronisingly told “don’t worry dear, when you meet the right man it’ll come back”. I also asked how the normal monthly cycle of hormones changes after receiving the Depo and they were unable to tell me.

    Of course there have been exceptions and I’m so grateful to have free contraception available to me, but I have been treated quite dismissively, especially when I was younger (let’s say under 21). If you take young women seriously and treat them like intelligent adults, it makes so much difference.

    So I admire your attitude and your patients are lucky to have someone like you on their side.

    • NiceLadyDoctor

      Yes, I had a complete lack of libido on Depo too, but others seem to love it, so it remains in my armoury.

  6. NiceLadyDoctor

    Hi madasagirl – nice to hear from you.

    Pamela – thanks for the comment on my blog – welcome. As a GP I don’t “promote” one method over another – I discuss the pros and cons of each method taking into account the woman’s own needs and indeed ethics and religion. Fertility Awareness/ Natural Family Planning is probably underused – but for some couples it’s the right thing for them. It’s particularly good for spacing children if another pregnancy wouldn’t be a complete disaster – indeed I used the Lactational Amenorrhoea Method between my own children.

    Re: the combined pill and breast and cervical cancer – the “cons” of the combined pill should be counterbalanced with its “pros”, particuarly its protective effect in reducing the incidence of ovarian, endometrial and bowel cancers, and its contraceptive effects prevent against pregnancy and birth related morbidity too.

    Re “abortion by pill” – I’m assuming you’re referring to emergency contraception – we’ll have to disagree on that one – you will know that a UK Judicial Review in 2002 deemed that human life begins at implantation rather than at fertilisation (http://www.ffprhc.org.uk/admin/uploads/449_EmergencyContraceptionCEUguidance.pdf) and I agree. I feel that adequate contraception (in all its guises) is the best way to reduce abortion rates.

    Vicky – the mooncup shouldn’t affect things at all – it can be used with the coil in situ. Your options as a breastfeeding mother are: progesterone only pill, progesterone injection (but might not be appropriate if you’re planning another baby due to the delay in fertility), the Implanon contraceptive implant, barrier methods (condoms/cap/diaphragm), natural family planning (lactational awareness method, and then fertility awareness or Persona), the Mirena coil, the copper coil, and sterilisation. Everything bar combined methods (pill, patch, nuvaring).

    • Vicky P

      Cheers NLD.

      I tried the coil last time and it came out with using the Mooncup… I don’t think it’s that common for it to happen but it happened to me so probably wouldn’t try that again.

      The progesterone injection sounds like a possible option as I don’t plan on having any other children but sterilisation seems a step too far (and hubby doesn’t want to go that far either).

      Will look into it… in the meantime, back to study!

      Cheers
      Vicky P

      P.S. Post more often, I really enjoy your blog!

  7. Emergancy contraception yes, but also your run of the mill Pill. However you wouldn’t see that as abortifacient either, I guess.

    By the way, thank you for at least acknowledging NFP has a viable option.

    The U.S. has not (yet) declared when life begins. And I was not aware the UK had (though not surprised). So if my government says Life begins at fertilization who will be right?

    Hmmmm…

  8. Scribbler

    Pamela said: “The U.S. has not (yet) declared when life begins. And I was not aware the UK had (though not surprised). So if my government says Life begins at fertilization who will be right?”

    You, I imagine.

  9. dutchdoctor

    What advice do you give patients who have moodswings/ depressive mood around menstruation? I have not figured it out myself, but would love to know what other doctors say.

    • NiceLadyDoctor

      It’s worth trying to bi-cycle or tri-cycle the combined pill – but Mirena and Implanon are also worth a try. Anything that obliterates the cycle by inhibiting ovulation, basically. For a while there was the (theoretically implausible) suggestion that premenstrual SSRIs might work but that seems to have gone out of fashion – but for serious PMS an SSRI (any SSRI) seems to work well.

      • stefafra

        I have migraine around my periods, nothing else unpleasant but having an imp with a hammer in your skull 7 days a month is not funny…
        Now I “tricycle” with nuvaring and I’m very happy, it has cut 2 thirds of the headaches, I can’t do longer otherwise I start spotting.
        It works better if I keep the ring 4 weeks instead of 3 when I’m going without pause, I don’t know why, with 3 weeks and a new ring I was getting mini-periods with, yes, the migraines again, those not mini at all.
        I read that they were marketing a “new”, combined pill with a name reminding the seasons (how romantic) for those who want to avoid the mess of periods, it was promoted as something special and innovative!
        Power of marketing, I guess.
        I get strange looks from people when I explain what I do, they think it is unnatural not to have periods. I think it is very handy, and my slight anemia has disappeared too.

  10. Elaine

    Addressing the two prev. comments…

    I found “Women’s Moods” by Sichel and Driscoll interesting (from a layperson-with-an-interest-in-menopause/moods perspective).

    http://www.harpercollins.com/book/index.aspx?isbn=9780380728527

    Has anyone else read it? If so, what did you think of it?

    E

  11. dutchdoctor

    Thanks, fluoxetine seemed to be the best one for severe PMS. But I’m still a bit stuck what to advice patients when they have moodswings around menstruation but they are already using antidepressants. I will have a look at it again.

    • DocJock

      9 months after your post I have stumbled on it! I have found that pyridoxine 50mg per day is often helpful for women with hormone related mood swings/short temper/depression. I suggest they try it for 2 months and stop then if it hasn’t helped. If it helps they can just continue. Seems especially effective in those who get mood swings on the combined pill.

  12. helen

    I wish I had a GP like you 😦

  13. noya

    Got my first Implanon when I was 16, never looked back. Haven’t had a period for 7 years and don’t miss the blasted things one tiny bit

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