Seasonal periods, brought to you by Big Pharma

Following the trend toward inventing diseases and conditions that can be treated by new drugs on the market, the pharmaceutical world has presented women with a new condition that it can conveniently cure: too many periods. I discovered the condition on the back of the May/June issue of “Nurse Practitioner World News” sticking out of my mailbox.

I didn’t know we wanted this before now, but maybe we do? Seasonique, an oral contraceptive offering “fewer periods and, now, more savings” features in its new advertisement a healthy, happy, Patagonia-clad woman enjoying a fresh walk down the beach. She’s probably not having her period!

THIS IS AN INDUSTRY TRADE MAGAZINE ADVERTISEMENT. What’s so disturbing about this new birth control pill is not that it is available, but that the pharmaceutical industry has decided it can — and should — attempt to convince physicians, nurse-practitioners and midwives that it knows what women want. Big pharma understands fifth-wave feminist desires. It can provide us with the means to control and limit our monthly menses to seasonal inconveniences……until Annuelle™ comes on the market.

Personally I’ve used the pill (also called OCPS, or “oral contraceptives”) a few times in my teens and twenties. Back then OCPs seemed like the best fit for me. They weren’t messy, they weren’t scary in the way that IUDs or injections were, or freaky the way implants were. The pill appeared benign enough that one could practically forget they were taking a daily dose of synthetic hormones. Ultimately I became uneasy about the daily dose of hormones I was consuming. I began to recognize that some of the side-effects I was experiencing were the result of the additional hormone load. I remember feeling like some other entity had come in and taken up residence in my body.

While I am not a fan of increasing our exogenous hormone load, I am all for choices in contraception and I accept that the pill is the preferred method for many women. I wish, however, the trade-off for preventing unwanted pregnancies was not an increased risk of certain cancers. In my clinical life, I have had very few clients interested in hormonal birth control methods either because they are nursing mothers, they want to avoid exogenous hormones, or they hope to become pregnant soon.  Until now I’ve only been peripherally aware of the new option to have 4 periods per year instead of the regular 13 or so

Is this really what women want? Seasonal periods? The concept is alluringly pseduo-natural. Maybe this is your body…. in harmony with the four seasons?

There were times when toting along tampons or sponges or whatever was awkward, but I never found myself thinking “How can I get out of having these periods?” And I was one of those women who spent an entire day doubled over with severe cramping every month.(Perhaps my Catholic guilt played a role here). Are women so burdened by their monthly periods that a drug company felt compelled to save us all from our suffering by creating a new brand of birth control pill that “empowers” us to have fewer periods? Perhaps for women already committed to the pill, switching to one that eliminates most of their periods is not a significant stretch.

Suppose this product was created in response to consumer demand, and not the other way around?  What price will we pay for “seasonal” periods?  In an article about these kinds of OCPs, the Mayo Clinic counsels “you may notice bleeding or spotting between periods (breakthrough bleeding) when you extend the number of days between periods.” Spotting is casually presented as the only noteworthy side effect of these extended cycle OCPs.

In reality, we don’t have any long-term studies (more than a few years) on using OCPs this way. Decades of research on traditional OCPs however is clear about some major risks including heart disease, stroke, and blood clots. And what about cancer?  Research has shown that birth control pills slightly decreases the risk of ovarian and uterine cancer, while potentially increasing the risk of breast and liver cancer in some women. In 2006, the Mayo Clinic determined that women who used the pill before their first pregnancies had a 44% higher risk of breast cancer over women who had not used the pill.

The possibility of more breast cancer, even if the research flip-flops on the subject, is a big deal to me.  As an American woman I have a 1 in 8 chance of developing breast cancer in my lifetime — much higher odds than having ovarian or uterine cancer. Pills like Seasonique expose women to an additional 13 weeks of exogenous hormones over the regular combined OCPs.

While digging around for information on Seasonique I learned that the pharmaceutical industry in 2004 is estimated to have spent spend $57.5 BILLION dollars on advertising. The industry spent TWICE as much on advertising  as it spends researching and developing existing and new medications. I also learned that maker of Seasonique, Teva Pharmaceuticals, along with 12 other pharmaceutical companies, were sued by the state of Massachusetts in 2003 for Medicaid fraud.  These companies allegedly inflated the prices of their medications to their industry’s price reporting services, which in turn caused Medicaid to waste tens of millions of dollars in inflated reimbursements to recipients of the medications made by these companies. Your grandmother has to choose between food and medications while the folks at Teva are raking in obscene profits. All 13 companies in the Mass Medicaid fraud suit settled, returning roughly $23 million dollars back to the state’s Medicaid program.

Drug companies’ influence over physicians’ prescription pads is also obscene. In 2000 the drug companies spent over $20 BILLION dollars on private sales meetings between drug reps and physicians. The industry can afford to spend this amount of money on promotional meetings with physicians because it knows from experience that targeting susceptible physicians will ensure humongous profits. A former drug rep for Eli Lilly describes the nature of the drug rep/physician relationship:

It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange.

—Shahram Ahari

What does this mean for the physician-patient relationship in discussing birth control options? I want to believe that providers would place their obligation to provide true informed choice about the risks and benefits of contraception options over cozy relationships with drug reps. But I recall my own experiences and  I fear for the women in their teens and twenties going in for their first yearly well-woman exams, and coming home with packs of pills, completely unaware of the money, advertising, and schmoozing efforts involved in getting those pill packs to the providers desk.

Some women might want these pills, and that’s OK. What do I want?

Instead of insurance fraud and a misrepresentation of these medications’ risks, I want transparency. I want the pharmaceutical industry to adopt a shred of decency and stop inventing and selling made-up conditions to women, and start spending more money on making its products safer than on advertising them to us. I want honest discussion about the possible risks. I want more choices and safer choices. What do you want?

10 thoughts on “Seasonal periods, brought to you by Big Pharma

  1. Welllll…I enjoy pregnancy & nursing so very MUCH b/c part of it means I am NOT having a period! 🙂 In fact…the longer I breast feed (even if I’ve weaned) the longer it takes for my period to come back! 28 months of nursing, 11 months post nursing, plus 18 months total of pregnancy means in the last 8 years I have missed periods for almost FIVE YEARS. I am also overweight right now…And for me, that means no periods. I enjoy not having a period, but I do not enjoy being FAT!

    I have never used a hormonal birth control…I prefer non-hormonal options & currently use a diaphragm. I feel like…If my body is naturally having (or not having) periods…I should not interrupt that. My body “knows best” and if being fat means my body thinks I should not be having babies (and therefore not ovulating)…then I will believe it. 🙂

    I don’t know about big pharma or making up conditions (I know my sister would get rid of her periods if she could)…but I know that I read a study…many many many years ago that talked about “modern” women and the rise in cancers. And that many women in the past would have many babies…and breastfeed their babies…And this meant they had many less periods than today’s woman. And maybe less periods is okay. (Although I doubt that means less periods by way of a hormone pill!) But I am not a scientist…or a doctor…Just a woman who enjoys not having her periods. Pre-kids my period was not terrible, and just a minor inconvenience. Post-kids I sit at home & gush for 3 days…and then it lightens for the last 4.

  2. There’s also a societal element, totally supported (created?) by advertising from pharma companies and general feminine hygiene” products that encourages women to see their periods as bad, dirty, and inconvenient. And I get that it’s not always a pleasant thing, but what if we shifted how we think about it? I have a friend who recently told me that her period was her favorite time of the month, because she feels connected to her body, she feels cleansed, she feels beautiful. It was like a revelation for me to think of my period as a vital, beautiful part of me instead of some outside force–the way its presented in advertisements like the one you tak about here–that is inflicted on me.

    • I love the comment that your friend made. I had a similar experience when I read Taking Charge of Your Fertility. That book opened my eyes to how AWESOME our bodies are, and how everything is so in sync and perfect.

      I tried to take hormonal BC when I was younger, before I got married. It messed with me…no matter what type I used. I threw up (like morning sickness) every month, for at least a week. I was moody and not a happy person to be around. I tried the NuvaRing, and that had all those side effects, plus making my vagina feel like an oil spill all month. I gave up on all those crazy things, and I chart now. I feel so connected to my body, since I know what is happening inside it now at any given time.

  3. When I first started my period at the age of 12, it became my nemisis. I would hurt so bad on the second day that I could barely concentrate and I was physically exhausted. Every fourth month, that second day would be so bad, I would spend all day in the bathroom sicking up all day – even if that meant missing school, work, or other important events. This went on for six years and finally my mom took me to the gyno. Did they recommend a natural remedy, a way to treat my symptoms? No, my doctor immediately put me on Seasonal – which is just a weaker version of Seasonique. After several months, I got sick (unrelated) and I had gone back for a check up to see how I was doing on the birth control. Since I was still having a period every month (though, like Seasonique, I wasn’t supposed to) she switched me to the higher dose Seasonique and told me to stop taking the period week pills, in effect completely removing my monthly period! When asked if that was okay, she said no problem.

    Then, two and a half years later – after years of clean bills of health and settling down into a monogamous relationship – I got a bad result on my pap smear. Over the next year, I had to undergo a series of uterine biopsies, electro/cryo treatments to remove dysplasia from my uterus, and the Gardasil vaccine. Only to be told that it’s likely caused by my active sex life or possibly my body producing too many hormones. So I asked my doctor if my birth control could be the problem, and she dismissed my fears with a laugh and the shake of her head. I still don’t know if the huge amounts of hormones – with no break for my body to do what comes naturally – is what caused it since I hadn’t been promiscuous since well before my last pap, which had come up clean.

    And then, after seven years on Seasonal/Seasonique, I started having mood swings – violent, terrifying mood swings that included suicidal thoughts and near misses. It was after a night where my husband and to wrestle me to the floor until I calmed down that we decided that enough was enough. I was tired of sitting outside my body and watching in horror as I lashed out at my husband and myself for no reason. Two months after I stopped taking the birth control, I leveled out and I haven’t had a mood swing like it in the last year and a half. All because my doctor would rather subscribe this new “wonder drug” that look at what was really going on in my body.

    Women’s health needs to stop being a fashion plate for the most “trendy” treatments to be sold to women with the dangers in fine print that we can’t see. The worst part about this whole thing, was this wasn’t subscribed by a man who would never have to worry about what the effects of what I was being given would have on him – I was given this, without warning or seeming knowledge about the dangerous side effects, by my WOMAN gyno. Thank you for passing this important information on!

  4. I think I would fall into the “market demand” portion of this, long before this was an option offered by big pharma my ob/gyn had me using regular birth control and extending time between periods. On both ortho tricycline and yaz I was able to go from 3-4 months without periods just by skipping over the inert tablets and continuing on with the active tablets. I never had a problem with the doctor providing additional sample packets as I would exceed what insurance would cover by skipping those weeks of pills and thus consuming more birth control than prescribed.

    My issue wasn’t totally convenience related. I am one of the unlucky women who suffer with PMDD and I also have IBS and the periods wreaked havoc on my system so skipping them gave me much desired relief. I did this for five years from 18-23 until I had a Mirena IUD placed which completely knocks out the periods.

    My first Mirena was inserted due to taking medications that would have had horrible affects on a developing child had I become pregnant during that time, after it expired with the thought of wanting to get pregnant sooner than five years I switched to birth control and that is when I felt the hormone affects and when I re-discovered that periods still were not good for my system. I was only on birth control for 8 months and when I went in to have my next Mirena placed I was going into my fourth month of continuous birth control which was yaz and not designed for this. So it seems that all birth control really has this ability and has the ability to do it quickly (well for me at least). I wish that companies like this wouldn’t act as though they are the only option for extending or postponing periods – you can do this with pretty much any pill.

    Sensonique and Seasonale are simply a different brand of birth control in my opinion and for women who don’t have health providers like mine that tried to match the birth control that worked best for me with what I needed then support my intentions to avoid periods by providing adequate samples it does give that option to women. What I learned during my break from the IUD is that the only reason for the new formula of this brand is that the old one expired and is now available as a generic so they are marketing the new one more aggressively to avoid market loss.

    It is all sales and hype in some ways, but then I am a woman who really struggles with periods and various options of birth control have given me the ability to alleviate that. Now that I am scheduling to have my IUD removed and planning for TTC I am finding more about women having trouble conceiving after the IUD so I have another hurdle.

    It really does seem like there should be a better option for birth control out there and I just can’t wrap my head around the lack of it.

  5. I was a rep at Teva and sold this product – it just went generic – but the issue I had when I sold it and still have is that it is just a repackaged older birth control pill. It seemed wrong to charge people a ridiculous amount of money for a gimmic. Doc’s could extend your cycle with any pill on the market – just don’t take the placebo week. All Teva (well actually Duramed) did was package it all in one box. Pharma sales is a game and the clinicians that are smart know how to leverage the reps info and resources – those are the smart ones. Unfortunately there are a lot out there that are not very savy.

  6. What about the idea that we modern women actually experience negative health consequences from having so many menstrual cycles? Women throughout history have been pregnant or lactating for much greater portions of their fertile years than women today, and although I don’t have the citations, there have been studies done to this effect. From an evolutionary perspective, it would make sense that we would have evolved to be healthy with numbers of ovulatory cycles similar to women of the past as compared to monthly. Not to mention that ANY of the “periods” you have with OCPs are not real periods but rather artificial withdraw bleeds anyhow.

  7. I love the idea of no period. I started Seasonique about 3 years ago to turn it off. I loved the pill. However, over that same period I’ve lost about 50% of my hair. After researching the ‘net I found that many other people have had this same experience – or worse. I really hate having to go back to bleeding all the time but I really don’t want to be bald. I can’t believe how much hair I’ve lost. 😦

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