For many a woman across the world, the recent US Food and Drug Administration (FDA) approval for Implanon - a contraceptive that could stop menstruation for up to three years - seems like the answer to many of her problems. She must strive to outperform her male colleagues at work to be recognized at par with them. There is no slack at home either, where running the home is primarily her job, as is taking care of the elderly or the ailing. And, let's face it, almost every woman has wished at some point that she could do away with menstruation.
For quite some time now, women have been popping the Pill to keep pregnancy at bay. Many have, in the process, discovered the joys of doing away with the menstrual cycle after the prolonged use of these hormonal contraceptive pills. Implanon, though, is something of a revolution. It is a single-rod contraceptive that is inserted under the skin in the upper arm and is effective for up to three years. No more popping the Pill or using barriers like condoms! A trained doctor inserts the rod five days after the onset of a monthly menstruation, and it is effective immediately.
Implanon is not yet available in India, but doctors in India are far from happy with this new development. In the US as well, Implanon has sparked off a debate on whether women should resort to menstruation suppression at all, especially for prolonged periods.
"For the past three years - after my marriage - I have been using oral contraceptives. Initially, there was some nausea and general weakness, but then it subsided. After about 18 months, I just stopped menstruating. My doctor said it is a side-effect of prolonged contraceptive pill use, and advised me to stop using the Pill for some time. But, frankly, I started enjoying the no-periods life," says Amol Bindra*, 32, a resident of Lajpat Nagar, New Delhi.
Doing away with menstruation for specific events - marriages, festivals or an activity - or to deal with the various demands at work and home is also an increasingly common phenomenon. "I had to go trekking once, and my gynecologist recommended a drug to alter the date of my periods. She also told me about contraceptives that, if taken regularly, can stop the menstruation cycle completely. After that, it sort of became a habit. I have now been using the Pill for almost two years and have not menstruated for almost a year. Of course, I have been told to stop using the Pill and not mess with my system, but it is too tempting, especially because I travel a lot," says Meenal Joshi, 27, a media professional in Delhi.
The medical fraternity, though, stresses that menstrual suppression has significant side-effects. "The most obvious side-effect of these contraceptives is that the lining of the uterus becomes thin. Many women experience nausea, weight gain and irritability. A number of studies also suggest that prolonged use of contraceptives could also lead to temporary infertility," says Dr Lalita Badhwar, gynecologist at Indraprastha Apollo Hospital, New Delhi.
She also cautions against another risk associated with implants: "Inserting implants in your body involves a minor surgical procedure. However, the implant may not agree with your system. This means you would have to go through another surgical procedure to remove it from your body. Implants are best avoided, and we do not recommend them in any circumstances."
Implanon is not currently available in India, but other implants - like Norplant, which works like Implanon and is also surgically implanted in the arm - were available until recently in government and other major private hospitals.
Norplant has also been surrounded by controversy ever since its launch. It has been available for trial in India since the 1980s, but many rural women reported side-effects like excessive bleeding and headaches. According to the website of the feminist organization 'INCITE! Women of Color Against Violence', about 3,500 Indian women were administered Norplant without screening to determine whether they were suitable candidates for the study. The study was finally stopped due to concerns about 'teratogenicity' and 'carcinogenicity'. The website also suggests that Norplant was disproportionately promoted among women of color, indigenous women and women with disabilities. It was withdrawn from the UK in 2001, and later from government hospitals in India as well. In any case, the reluctance of the medical fraternity to prescribe these implants ensured that they never became popular.
Leslie Botha - a US-based activist, author, women's health educator and radio and television talk show host, who campaigns against the increasing use of contraceptives to stop the menstruation cycle - says, "A major fallout of suppressing the endocrine system with the use of synthetic hormones for long periods of time is infertility. An increasing number of women are actually going into menopause in their 30s because they are unable to ovulate naturally. Their bodies are no longer able to produce natural hormones."
Botha also believes that often, the side-effects that women consider significant are deemed insignificant by the industry. She cites the example of birth control pill Enovid, which was introduced in the 1960s. "For Enovid, women in Puerto Rico, who were experimented on, had so many problems that the health officials were concerned about the pill. However, these concerns were ignored and the pill was pushed through the FDA," says Botha. Also, many products - like Norplant - are launched in the market without adequate research into the side-effects. "The industry is exploiting women in the name of 'choice'," she says.
An often-asked question is: Why this aversion to menstruation, a natural body process? There are no easy answers. Culturally, menstruation is construed as a negative - a messy process that needs to be hidden away. Even today, in several Indian families, menstruating women are not allowed to enter the kitchen, go to the temple or participate in certain festivals. Even for those not bound by tradition, menstruation does get in the way of many activities at work and home. In an ideal world, women would have a choice. But if it is not safe, it is not a choice.
"We have two fundamental concerns with extended and continuous combined hormonal contraceptives: the hype surrounding these new ways of taking hormonal contraceptives is focusing negative ideas about women by making normal menstruation into a problem; and the health implications of these more continuous ways of administering higher doses of estrogen and progestin are not yet known," says Jerilynn C Prior of the Centre for Menstrual Cycle and Ovulation Research, Vancouver, Canada on the Centre's website.
Prior even asks, "Have periods have become the latest of women's 'deficiencies'? Is having regular menstrual flow a 'Pill deficiency disease'?!"