By Amelia Bucek
A Publication of the Population and Development Program at Hampshire College * No. 36 * Summer 2005
Since the first birth control pill was released to the American public in 1960, oral contraception has evolved considerably. Within today's burgeoning and increasingly specialized pharmaceutical industry there are dozens of varieties of birth control pills available. Many of these are advertised as offering more than just fertility control.
 Dubbed "designer contraceptives," these pills cater to specific issues completely detached from contraception. Whether the allure is convenience, acne treatment, or a reduction in water retention, focus on the gimmick attached to the pill overshadows all other concerns associated with the contraceptive. The niche marketing of these pills translates to an expanded customer base and increased profits for contraceptive manufacturers. The deregulation of prescription advertisements in 1997, which allows pharmaceutical companies to advertise alternative uses for the pill directly to consumers, hastened this practice. Media attention to designer contraceptives has also facilitated this growing market. One of the most celebrated and criticized pharmaceuticals in this field is Seasonale. What is Seasonale?
Seasonale is an extended cycle oral contraceptive pill, which differs from the standard pill in its method of prescription. Oral contraceptives are customarily dispensed in 28-day packs containing 21 active pills with hormones and 7 placebo sugar pills. The break in hormone intake for one week every month causes the body to think ovulation has occurred, resulting in the shedding of the uterine lining. This outcome is technically called a withdrawal bleed, but is also known as a period since it mimics the monthly occurrence of menstruation. Seasonale promises to limit this bleeding to just four times a year. Women prescribed Seasonale take active pills for 84 consecutive days, followed by 7 days of placebo. Periods are thereby reduced from an average of 13 a year to 4, creating the specialized purpose of Seasonale: menstrual suppression.Selling Doctors on Seasonale
After testing Seasonale on 1400 women in 47 cites nationwide, the FDA approved the pill in September 2003.
 In its initial marketing of the product, Barr Pharmaceuticals aggressively targeted physicians. Questionable mingling of reproductive health education and manufacturer profits was evident in audio conferences sold for $99 a piece to educate healthcare providers on extended use contraception. These corporate-sponsored listening sessions could also be used as credit toward professional nursing requirements.
 In early 2004, Barr unleashed a 250-person sales team that sought out 28,000 physicians (20 times the number of women they tested for the safety of their product) throughout the U.S. in order to spread the word on Seasonale.
 This profit-driven approach proved to be quite successful. In February 2004, 5000 prescriptions for Seasonale were written each week and by March sales totaled $17.7 million. Seasonale had become the fourth top selling oral contraceptive.
 Only eight months after its release, over 120,000 prescriptions had been written, with 7,000 being added weekly.
 After significant buzz had been created throughout the medical community and spread to the patient population, Barr launched a $50 million ad campaign in June 2004.
Advertising Seasonale to Consumers: PMS, Liberation, and Health
The Seasonale campaign included television spots, two-page ads in magazines as diverse as Vogue
and US News and World Report
, as well as a trendy website all promoting the Seasonale mantra, "Fewer Periods. More Possibilities."
 The overall theme of the ads is that it is fun and attractive to get fewer periods a year and the decision to suppress menses is easy and obvious. One television commercial pictures a woman in a bright white space, wearing a red polka dot dress, responding happily to a voice-over informing her that it is now possible to limit her monthly periods to just four a year. She then proceeds to spin around as all but four of the polka dots (representing menstruation) fly off her dress. Thus, menstruation is deemed as frivolous as a fashion decision. Some versions of this ad feature multiple women, all dressed in white, who pick up the red dots and throw them around like Frisbees. The ads try to equate Seasonale with a crisp and clean sense of carefree fun.
The marketing and media coverage of Seasonale paints a very negative picture of menstruation, which serves to further imply that the pill is a constructive addition to a woman?s life. In research sponsored by Barr on women's attitudes toward their periods, the company claimed that more than half of the women surveyed felt "messy, fat and unattractive" during their periods. However, as the National Women's Health Network (NWHN) points out, this data was misconstrued. In actuality, only one third of the women reported menstruation made them feel unattractive and Barr neglected to disclose the 68% of respondents who experience a positive sense of health during menses.
Such faulty reporting on the negative effects of menstruation is eerily similar to the wave of media attention given to premenstrual syndrome in the 1980s. In fact, PMS is widely cited as a reason to take Seasonale, and as was the case in the late 20th
century, the alleged problems caused by menstruation are often overblown and quite dubious. For example, one Boston Globe
piece on extended cycle pills was titled, "No Chocolate Cravings\ No PMS or Bloating\ No Fatigue or Moodiness\ What if Having Your Period Was a Choice?"
 Readers are led to presume that all menstruating women experience these symptoms and that even chocolate cravings necessitate pharmaceutical treatment. Journalists writing about Seasonale also claim that the menstrual cycle causes women to miss professional, social, or family-oriented events,
 keeps them from participating in summer activities,
 and makes them ineffective leaders.
Even more troubling is the way these damaging, broadly applied stereotypes are used to depict menstrual suppression as the road to feminist liberation. Candace Bushnell, creator of the HBO series Sex and the City
and Seasonale's celebrity spokeswoman, summed up this idea by saying, "When you think about what women can accomplish with 13 periods a year, think about what we can accomplish with only four. We have come a long way, but we've only just begun."
 By alluding to the feminist movement in her speech, Bushnell places menstruation as an obstacle on par with institutional forms of sexism that hinder women?s possible achievements. Instead of offering a critique of the social structures that impede women's progress, the blame is turned inward and placed on the menstruating body. She implies that if only women could stop menstruating, they could achieve so much more. Barr Laboratories also hired a doctor to attend a media briefing on Seasonale to make similar claims, asserting that the drug could improve high school girls' test scores.
 Although there is no proof of the accuracy of this statement, the message is clear: if women want to excel in school, employment, and life in general, they should limit their periods.
An interesting component of the "feminist" argument for Seasonale is the hypothesized role of menstrual suppression in maintaining women's health. There is a school of thought, led by Dr. Elsimar Coutinho and Dr. Sheldon Segal, authors of Is Menstruation Obsolete?
that firmly believes women are becoming ill due to regular menstruation. Simply put, the rationale is that historically, Western women's main function in society was to procreate. Consequently, they were pregnant or breast-feeding, in other words not menstruating, for the majority of their reproductive lives. The conclusion is then drawn that the woman who experiences infrequent menstrual cycles is more natural and healthy than the woman whose menstrual cycle occurs monthly. Regular menstruation is deemed unnatural and a threat to women?s wellbeing.
Menstrual suppression is offered as a compromise to fix this biologically unnatural turn of events. It is hailed as a "radical rescuing [of] the ovaries and endometrium from modernity."
 This approach simultaneously argues that women's bodies were designed for a life of serial pregnancy, and not much else, as it also alleges that if women try to exceed these roles, their reproductive health will falter. Thus, the only way to be a successful modern woman and retain your health is to suppress your menstrual cycle. In a New Yorker
article, Malcolm Pike of the University of Southern California illustrates this rationale by claiming that:
The modern way of living represents extraordinary change in female biology. Women are going out and becoming lawyers, doctors, presidents of countries - the world is not the world it was. And some of the risks that go with the benefits of a woman getting educated and not getting pregnant all the time are breast cancer and ovarian cancer, and we need to deal with it.
Although women's health advocates firmly deny any reduction in cancer risk due to menstrual suppression,
 Seasonale is offered as a means of returning women to a more biologically natural state of infrequent menses that will allow them to lead healthier, more enriching lives. However, such assumptions about women's nature are far from empowering. They frame the female body that does not participate in compulsive procreation as pathological, and rely on the notion that women's bodies are most healthy when symbolizing a social function focused on reproduction. Therefore, even though Seasonale is marketed as an aid to women's empowerment, it also frames women's liberation as biologically unnatural and unhealthy.10 Health Concerns You Should Be Aware of Before Taking Seasonale
While proponents of menstrual suppression advocate on behalf of Seasonale for its health benefits, there are several health issues related to the pill that paint a far less optimistic picture of extended cycle contraception.
1. Seasonale does not protect against STDs. The focus on the designer purpose of menstrual suppression relegates Seasonale's role in fertility control to the back burner, rendering promotion of safe sex while taking Seasonale all but forgotten.
- The extended cycle regimen of Seasonale exposes women to a 23% increase in annual hormone intake. This may translate to an increased risk of side effects already attributed to the birth control pill, such as stroke and heart attack.
- There has been no long-term research undertaken to study the effects of extended cycle oral contraception. Physicians and journalists attempt to downplay this fact by referencing women who have skipped the placebo pills to manipulate their periods for years. However, personal experimentation is no substitute for scientific study and has no effect on the safety of this practice.
- The research conducted to test Seasonale was only conducted on women over the age of 18. Even though 1.2 million girls aged 15-19 currently use oral contraceptives, the effects of an extended cycle pill are unknown for this age group.
- Seasonale was only tested on women who had previously been using 28- day oral contraceptives. No research on the effects of Seasonale has been performed on women who have never used birth control pills before.
- Significant breakthrough bleeding can occur between scheduled periods while taking Seasonale. In December of 2004, the FDA took action and officially admonished Barr for excluding information about the possibility of substantial breakthrough bleeding in their advertisements in order to make Seasonale appear safer.
- Abnormal changes in menstrual flow are often early warning signs of other physiological problems. Suppression of this function can mask symptoms and delay attention to a variety of disorders.
- The expected loss of monthly menstruation would also remove a common marker of pregnancy. Women who become pregnant while taking Seasonale may not become aware of their condition until much later than the average woman, thereby reducing their options for abortion.
- Promotion of menstrual suppression may cause or promote a negative view of the menstruating body. The National Women's Health Network warns that if menstrual suppression is aggressively advertised as the preferred and natural way for the female body to function, young girls especially will acquire a negative body image.
- Positive physical effects linked to monthly menstruation such as lowered risk of heart disease, bone health, sexual desire, increased immunity, and a cyclic reduction in blood pressure, would be lessened with the use of an extended cycle pill. 
Despite the health concerns and the media manipulations associated with menstrual suppression, an extended cycle oral contraceptive may be the right choice for some women. Those who experience extremely painful periods or women who have conditions exacerbated by the onset of monthly menstruation might find Seasonale to be the relief they have been looking for. Others may simply prefer to bleed less frequently for their own personal reasons. Regardless of the impetus to use Seasonale, it is pertinent that both physicians and manufacturers ensure that women have access to all of the health information necessary to make an informed decision. Women also deserve new contraceptive methods that are developed in an environment that places their needs and safety above the profit margins of pharmaceutical giants.
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