This byzantine and slightly confusing belief matters because one of the scientists who helped develop the birth control pill, John Rock, was a devout Catholic. He was convinced, however naively, that the church would accept the pill as a form of "natural" contraception if it were presented in the right light. (Because the pill contains progestin—a hormone naturally released after ovulation, during the "safe period"—Rock considered it a sort of scientific extension of the rhythm method.)But in order for it to be palatable to the church, he knew that it had to seem natural. And if women took the pill consistently, with no withdrawal periods, they'd potentially go months without any menstrual bleeding—which would freak pretty much everyone out. Rock and his collaborator Gregory Pincus thus decided that the pill should be subscribed in four-week cycles consisting of "three weeks on the pill and the fourth week off the drug (or on a placebo), to allow for [withdrawal bleeding]," Malcolm Gladwell writes in a 2000 New Yorker story. "There was and is no medical reason for this."
In their marketing campaigns, both companies highlighted the freedom that fewer periods a year would give women. Seasonale ads featured women dancing, traveling, and biking in all-white outfits, with slogans like "Let's hear it for four periods a year," and "Fewer periods, More possibilities." (Critics, however, said that these companies downplayed the fact that many women taking the pill experienced heavy breakthrough spotting, and in 2005 the FDA sent the pharmaceutal company behind Seasonale a warning letter condemning their ads for understating this side effect.)
Why should women have to go through 400 menstrual cycles?
Today, the science is more settled, though there hasn't been a long-term study on the continuous use of oral contraceptives yet. But based on data from the long-term use of non-extended cycle birth control pills, which are chemically the same as extended cycle contraceptives, gynecologists have largely reached the conclusion that the practice is safe. "At this point, I can't think of any OB/GYNs that would have a problem with [extended cycle oral contraception]," says Dr. Lauren Naliboff, a fellow at the American Congress of Obstetricians and Gynecologists.A study by the Cochrane organization found that women on extended cycle pills "fared better in terms of headaches, genital irritation, tiredness, bloating, and menstrual pain" than those on pills with monthly bleeding. A peer-reviewed article by Acta Obstetricia et Gynecologica Scandinavica acknowledged that long-term studies are lacking, but ultimately concluded that continuous use oral contraceptives showed no unique side effects beyond increased spotting, and still resulted in less "bleeding days" than non-continuous birth control pills.Philosophical and scientific debates aside, perhaps the largest barrier between women and their right to decide whether or not they want to bleed is a lack of information. Many women are unaware that consistently skipping withdrawal bleeding is an option, let alone that extended cycle pills exist, or that menstrual suppression can also be accomplished with hormonal IUDs, NuvaRing, birth control injections, and contraceptive patches.
The invention of the pill was one of the most significant advancements in the fight for reproductive agency; it allowed us, as a society, to dramatically reconceptualize sexuality and gender relations. At the same time, our relationship to this groundbreaking medical technology has been shaped and constrained by our own conceptions of what's "natural" and what defines a woman. Similar reproductive and sexually liberating advancements that target men—Viagra, for instance—have not led to similar debates on what it means to be a man, or to have an "unnatural" hard-on. And while Viagra is covered by insurance, Dr. Naliboff says that most insurance companies do not cover extended cycle birth control to this day, even in cases where patients are on the pill for medical issues like primary ovarian insufficiency or endometriosis.The discrepancy in education and affordable access is telling: The normalization of placebo pills and subsequent withdrawal bleeding means that even in 2017, many women do not know that extended cycle pills exist, let alone that menstrual suppression is a safe option. Combined with the fact that the percentage of schools teaching students about contraception has declined drastically since 2000, this means that many women are likely to stay in the dark about their options when it comes to choosing whether or not they want to bleed once a month.