Many women in my patient population here in Brazil are poor and undernourished and are often anemic as a general condition. We tried to improve their anemic state by reducing menstrual-blood loss. I then began to notice women who had a long menstruation-free interval were healthier and happier.

They no longer complained of symptoms related to their ovulatory and menstrual cycles-premenstrual cramps, bloating, endometriosis, etc.

The treatment was beneficial, so I began to expand it to include the treatment of endometriosis, of excessive bleeding, and of uterine fibroids.

A number of women specifically asked if I could stop their monthly bleeding. By the late 1970s I was convinced that repeated bleeding is unnecessary and often prejudicial.

The belief that menstruation is beneficial goes back to Galen and Hippocrates-and their ancient defenses of bloodletting as a therapeutic modality.

But nature intended for women to bear children biennually throughout their reproductive years and to breast-feed ad libitum. In my experience, women who do so haven't the constellation of symptoms associated with menstruation.

Menstruation is a social phenomenon, created by the idea that women shouldn't bear children every two years. I believe we'll soon see women opt for periods of amenorrhea that last as long as a pregnancy.

Women who are using oral contraceptives in the traditional manner are intermittently reassured that they are not pregnant. Monthly bleeding, as a result of one week of placebo pills, confirm that, in fact, the contraceptive is working. People do forget to take their pills sometimes. No woman wants to worry every month if she has accidentally become pregnant. This small reason assumes a larger importance when it is applied to large populations of patients.

It is true that a certain number of women have terrible problems associated with their menses-pain, emotional turmoil, and hemorrhage. These complaints can and should be addressed specifically. In these cases patients can often be given relief from their symptoms by using continuous oral contraceptives.

This is very different, how-ever, from asserting that the pharmacologic suppression of
ovulation and menstruation is appropriate for everyone.

Women who take oral contraceptives usually have a light, painless period each month.

For some women this is a positive experience. Patients have told me they associate this period with a sense of well-being.

Yet, in cases of menorrhagia, PMS, or endometriosis, proper care for these women may include skipping their menses altogether.