It’s been in the works for a while now, but the FDA has finally approved Lybrel, the pill that skips menstration. This has involved a lot of discussion that has, in my mind, completely missed the biggest issue: pregnancy that is not discovered until well into the pregnancy. Whatever else it does, menstration tells a woman whether or not she needs to find out if she’s pregnant.

William Saletan of Slate gives this a rather short nod:

The other reason for the dummy pills was to reassure women that they weren’t pregnant. Never mind that the “pill period” wasn’t real. If you bled, you’d feel safe. At the time, this was understandable, since pregnancy tests were elaborate and hard to get. Today, however, you can buy a test at any drug store for less than $10. You don’t have to bleed.

Well yeah, but the problem is that without menstration a woman doesn’t know if she needs to take the test or not. Technically she should know if she missed the pill and had sex again before she should, but if she’s not paranoid about pregnancy it’s pretty easy for her to ask herself “What are the odds?” and skip it altogether.

I brought up the issue with Clancy, who announced that we’re not going to have a child in eight months just a few days ago, and she said that the news had hit the email circuit at her work. The fear there is that there will likely be an uptick in misdiagnosis of abdominal pain in women because the doctors won’t know that the woman is pregnant because the patient won’t know (theoretically doctors are supposed to check any time there are abdominal pains, but they often don’t). She mentioned a specific problem about the baby being in some tube instead of where it’s supposed to be and that there is the fear that this will go unnoticed and untreated.

(yeah, this post would be a lot better if I were the doctor instead of my wife, but if I were the doctor I wouldn’t have time to blog)

In any case, I think what ought to happen is that the pill ought to automatically come with a pregnancy test. If the woman has the pregnancy test anyway there’s no doubt that she would use it. It’s the act of actually going to the store and buying one that’s the big disincentive when a woman doesn’t have any particular reason to believe that she’s pregnant.

Meanwhile, I’m not sure that Lybrel will be taken advantage of in the Truman household. The status quo is unpleasant and inconvenient once a month, but she does seem reassured by the monthly reminder that she’s not pregnant. It’s actually a non-issue at the moment, though, since uses an alternative form of birth control from The Pill.