- 20 Minutes conducted, in partnership with the School of Advanced Studies in Social Sciences (EHESS), a survey, on the rules under the pill, in three parts and a podcast.
- The rules on the pill are false rules, which have no real medical utility, and one can just as easily take the pill continuously, say the doctors in chorus. But then who invented them, these useless rules, and why? Is it dangerous to delete them? Why don't women do it more?
- In this first part, we look at the invention of these “false rules”, going back to the 1960s, in the footsteps of the inventors of the pill, Gregory Pincus and John Rock.
How many women know this? Bleeding under the pill is not real rules. Called “withdrawal hemorrhages”, blood loss under the pill is induced by the drop in the levels of estrogen-progestin hormones in the blood, which leads to a detachment of the endometrium without there being any menstrual cycle, nor ovulation. They are triggered in the classic schemes after twenty-one days of active tablets during the seven-day pill stop period, or placebo period (some pills contain placebo tablets).
"We fooled the women"
There is no medical utility in triggering these false rules, says most of the specialists we interviewed in unison. So much so that in the UK, the FSRH (Faculty of Sexual and Reproductive Healthcare), the French equivalent of the National Council of Gynecologists-Obstetricians (CNGOF), has updated its recommendations, which state that women can totally skip this seven-day stop and do without "menstruation", or opt for pills that reduce the number of cycles or the duration of bleeding. "There is no medical reason for the stop," said Jane Dickson, its vice-president.
Worse: stopping taking the pill for several days could even increase the risk of getting pregnant, as demonstrated by the recent study by Professors MacGregor and Guillebaud.
But then why did you create these false rules? For Brigitte Letombe, professor at the Lille University Hospital and member of the CNGOF Orthogeny, Contraception and Sexual Health Commission, these are societal reasons that historically presided over this choice, because "women must have rules": "We have fooled women, "she sums up. A little dive into the history of the pill suggests that the truth is not far from that.
A devout Catholic
To understand it, we have to go back to the 1960s, and to the fathers who designed the famous tablets: Gregory Pincus and John Rock. The first was an unsuccessful biologist, rejected by Harvard and who had nothing to lose. The second was an eminent gynecologist, respected by his peers and adored by his patients, who had tested an alliance of estrogen and progesterone on women with unexplained infertility. The first went to get the second, and they launched a series of contraceptive pill tests, which Gregory Pincus had previously tested only on animals.
You have to imagine a society that is much more conservative than ours, where the idea of offering women the possibility of controlling their sexuality was not well received by everyone. John Rock was also a devout Catholic, and he wanted to convince religious authorities to authorize the pill. Among the reasons he invokes to justify the pill with the Church, there is this one: the pill does not change the "natural" cycle of women. This is what he explains in a book published in 1963, The time has come: a Catholic doctor's proposals to end the battle over birth control , where he speaks of hormonal contraception as a "complement" to nature.
Seven days off to limit hormone use
False rules only to please the Church? This myth, says John Rock biographer, historian Margaret Marsh, is hard-pressed, and continues to spread through the press. “When Rock accepted Pincus' idea of trying to simulate the monthly cycle, the Catholic Church had nothing to do with it. Nothing at all, ”she explains. If the idea of "mimicking" the cycle of nature pleased John Rock, and that he used it later to plead his cause with the Pope, other reasons explain this initial choice, as does that the doses of hormones were at the time much higher, which was not without consequence on the users, who complained of various symptoms close to the state of pregnancy. No wonder, when you know that the pill "makes believe" to the body that it is already pregnant ... Providing these false rules was therefore a way for the designers of the pill to limit the intake of hormones and the associated symptoms. And above all to reassure users worried about being pregnant when faced with its symptoms.
The fact remains that this is an illusion, which should not even reassure, since it is still possible to be pregnant on the pill and to have bleeding that is taken - wrongly - for rules. "We thought they were too stupid to understand" sums up the doctor and writer Martin Winckler. It was only then, confirms Jonathan Eig, author of Libre as a man: the great story of the pill , that John Rock used the argument of false rules to convince the Church, and the Pope in particular.
Anyway, the only slightly medical argument at the time - limiting the intake of hormones - seems to have fallen into the water for years, the dosage being 100 to 1000 times less important today. It is even so low in mini doses, that it justifies a continuous intake to ensure good efficiency…
To complete our dossier “What if we do without it? », Find two other articles in the EHESS PLACES project notebook.
Culture
How to represent menstruation in the rules of the art?
Health
Contraceptive implants: the ANSM wants to prevent the risks of passage into the lungs
20 seconds of context
This series of articles is part of the PLACES project, a collaborative research project between journalists and researchers, initiated by the School of Advanced Studies in Social Sciences (EHESS) and coordinated by the OpenEdition Center. The ambition, according to Alessia Smaniotto, research engineer at EHESS and coordinator of the project, is "to offer a way out of the dead ends of a current situation, which positions the figures of the journalist and the researcher in two compartmentalized worlds".
To this end, three pilot projects have been selected in partnership with three media: research on young Alzheimer's patients, with Binge Audio, work on what migration does to border towns with Café Babel and the survey of 20 Minutes on hormonal contraception, conducted with sociologist Julie Ancian, post-doctoral fellow at EHESS, today at Inserm. Through these three binomials, themselves observed during their work, the idea is to constitute a toolbox facilitating this type of collaboration, in order, ultimately, to create a larger platform for joint work.
The PLACES project is funded by the Ministry of Culture and Communication, coordinated by Pierre Mounier and Alessia Smaniotto, research engineer and study engineer at EHESS respectively. Alexandra Caria and Jonathan Chibois, post-doctoral researchers at EHESS for the PLACES project, studied communication and socio-professional practices as well as the digital uses of pairs of journalists and researchers, through observations and interviews.
- Rules
- Contraceptive pill
- Contraception
- Health