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?


This post originally appeared on midwife Erin Ellis's blog, where you can find loads of great information. Check it out!