The inventors of the Pill decided women should still bleed every month
Menstruation marketing
At some point, the scientists who invented hormonal contraception decided that women still needed a period every month. And it wasn’t entirely for medical reasons, but also so everyone felt a little more comfortable. But for women on the Pill, though, they aren’t exactly real “periods” anyway.
“Regular and recurrent menstruation throughout most of a woman’s reproductive years is a fairly recent phenomenon,” wrote authors Elsimar M. Coutinho and Sheldon J. Segal in Is Menstruation Obsolete? (1999). Our hunter-gatherer ancestors menstruated as few as 50 times, due to shorter lifespan, malnutrition, disease, later puberty, and more years spent pregnant and nursing.
By comparison, today’s average woman has closer to 450 periods over her fertile years. And the daily contraceptive pill, which revolutionized Western medicine, improved women’s agency over their bodies, and offered alternative family planning, is partly responsible.
The FDA first approved the Pill in 1957 — at first, only for menstrual disorders and infertility. It was neither marketed nor professionally sanctioned as a contraceptive for preventing pregnancy. However, each box featured a warning about “contraceptive activity.” In other words, birth control was a side effect. By 1959, half a million women were using the Pill.
An FDA approval for Enovid, specifically designed for use as an oral contraceptive, came the following year.
Upon its release, Catholic clergy uproariously denounced the Pill for contraceptive use. They argued that the practice directly contradicted the church’s “rhythm method” planning guidelines, which instructed women to count backwards 14 days from the first day of menstruation to determine when they had ovulated. That information would predict her fertility the following month, which could ostensibly help her avoid unintended pregnancy via abstinence.
The practice was unreliable enough to be sometimes referred to as “Vatican roulette.” So, many devout women suddenly complained of menstrual disorders and secretly got on the Pill.
In order to pacify the Church, John Rock, one of the Pill’s inventors and a Catholic, devised a plan. He proposed designing a three-week pack of hormonal pills followed by a one-week stretch of placebo pills, a course that would mimic the presence and appearance of a real period. A woman on hormonal birth control does not ovulate at all, and uterine lining is drastically reduced. Even so, by cutting off hormones progestin and estrogen after the third week, women would shed what uterine lining did exist.
“There was and is no medical reason for this,” wrote Malcolm Gladwell in a 2000 New Yorker piece. Rock and colleagues believed women would feel more comfortable with a reliable monthly bleed, even if their periods weren’t as regular beforehand. Bonus if the church liked it. His argument was that a woman on the Pill could regulate her period in order to more effectively practice the rhythm method. Attention turned to the Vatican. In a 1964 cover story, Newsweek wrote, “Not since the Copernicans suggested in the 16th Century that the sun was the center of the planetary system has the Roman Catholic Church found itself on such a perilous collision course with a new body of knowledge.”
Rock and colleagues continued to double down on messaging, appealing to women who wanted more predictable cycles without eliminating their periods entirely. They argued the Pill upheld the natural process of menstruation.
“Marketers at the manufacturing company which developed the pill felt at the time that an oral contraceptive might or might not be accepted by the public,” biochemist and inventor of the first implantable birth control Sheldon Segal told NPR in 2006. “These were very different times.”
Rather than take on one of the biggest social and political issues of the day, Pope Paul VI delayed an official stance for years. In July 1968, he finally declared “artificial” contraceptives against church doctrine. It mattered little.
In 1965, the U.S. Supreme Court protected the constitutional right for married couples to use birth control. And by 2012, 99 percent of sexually active American women aged 15–44 had used at least one contraceptive method; 16 percent were taking the Pill, the most widespread contraceptive method; only 2 percent of Catholic women at risk of unintended pregnancy relied on natural family planning.
After the Pill’s release, women experienced more regular bleeding than ever. Yet over time, some health professionals expressed both concern over the Pill’s high levels of hormones, and after levels were decreased in 1988, indifference toward the placebo pills all together. Female doctors and nurses were some of the first to skip their periods and start a new pack of pills after the third week, according to Susan Wysocki, former head of the National Association of Nurse Practitioners in Women’s Health.
Decades later, pharmaceutical companies inverted John Rock’s marketing strategy: In November 2003, Seasonale came out with a pill that could be taken over 12 weeks, with a bleeding break every three months. The company hadn’t reinvented the wheel; it simply made women feel more at ease with fewer periods. By 2006, sales had reached $110 million.
The fourth-week placebo pills, originally intended to reassure women with regular menses, risked demise. Surveys show many women are receptive to the idea of fewer periods, or none at all; 77 percent view menstruation as “just something they have to put up with.” But while many are open to the idea of skipping periods via hormonal contraceptive, they remain concerned about the potential risks involved.
Menstrual suppression has a relatively short medical history. Long-term effects of the practice are unknown, though some recent findings suggest irregular cycles pose an increased threat of ovarian cancer. Some doctors believe suppression is no riskier than long-term birth control use. In 2013, the CDC listed menstrual suppression via certain forms of birth control as a non-contraceptive benefit, a lifestyle improvement.
That said, the Pill has always been about choice, even when its inventors decided for us.
