A HISTORY OF EARLY INTERVENTIONS IN THE US

From early Colonial times through the mid-nineteenth century, people took herbs or drank special teas to “regulate,” “induce” or “bring down” late periods when they did not want to be pregnant.  These efforts likely have a history thousands of years old; we know that in the US, such efforts were part of a traditional framework for thinking about early pregnancy and that they were  both legal and culturally acceptable up until “quickening” (about 14-16 weeks after a last menstrual period) when a pregnant person could feel a fetus moving inside them and could confirm their pregnancy.  

CHANGING IDEAS ABOUT BRINGING ON MENSTRUAL BLEEDING

Over time, several changes to culture and laws impacted this traditional way of thinking. 

 

THE 19TH CENTURY: DOCTORS, MIDWIVES, AND MORAL AUTHORITY

In the mid-nineteenth century, mostly male physicians became the respected authorities on pregnancy and childbirth.  They bolstered their moral authority by blaming midwives -- who were informally trained and mostly female -- for abortion, which physicians deemed unsafe and immoral. Midwives traditionally helped women give birth, regulate their menses, and end established pregnancies. For the first time, states began enacting laws regulating and banning abortion. 

THE 20TH CENTURY: NEW WAYS OF TESTING FOR PREGNANCY

In the twentieth century, technological advances enabled people to confirm pregnancy at earlier and earlier dates.  This continued to shift cultural frameworks away from uncertainty at the beginning of a potential pregnancy to one of supposed certainty --  where pregnancy was a yes/no question. 

 

A HISTORY OF EARLY INTERVENTIONS IN THE US

From early Colonial times through the mid-nineteenth century, people sometimes took herbs or drank special teas to “regulate” their menses when their periods were late and they did not want to be pregnant.  These efforts to induce menstrual bleeding likely have a history thousands of years old; we know that in the US, efforts to “bring down” a late period – or regulate menses [WS1] [CS2] were part of a traditional framework for thinking about early pregnancy.  These actions were both legal and culturally acceptable when people thought they might be pregnant and did not want to be. 

Bringing down late periods gave potentially pregnant people several months after their last menstrual period to try to ensure they were not pregnant.  These actions to induce menstrual bleeding were legal up until the “quickening” (about 14-16 weeks after a last menstrual period) when a pregnant person could feel a fetus moving inside them and could confirm their pregnancy. 

 

THE 21ST CENTURY: USING NEW TECHNOLOGIES TO REVIVE AN EMPOWERING TRADITION

The idea of taking action to bring down a period when someone doesn’t want to be pregnant is newly relevant today.  Recent medical advances have shown us that many early pregnancies are lost naturally – so that a very early positive pregnancy test may well indicate that someone may have a lasting pregnancy, or a very early pregnancy that will soon pass.  

And now, people with late periods can access safe, twenty-first century medications that will bring on menstrual bleeding and, if a person has an early pregnancy, they will end the  the pregnancy. People with late periods have a new (yet traditional!) feasible, effective option for bringing down a late period.

A SAFE, TESTED OPTION

Medications that induce menstrual bleeding or early pregnancy loss have now been used safely and successfully around the world for more than thirty years.  Research clearly shows that these medicines – misoprostol alone or with mifepristone – can be used when menses are just days late to induce cramping and bleeding, and to end any pregnancy that may be beginning.  These medicines give people new options to ensure they aren’t pregnant when their periods are late – without needing to test for pregnancy first.  Instead, people can choose – if they so desire – to be in a state of uncertainty, and to do something simple and at home to ensure a state of non-pregnancy. 

 

ONE FINAL NOTE: A NOD TO FEMINISTS IN THE 1970s

Interestingly, this is not the only time that modern health advocates have explored the potential of very early interventions to ensure non-pregnancy when periods are late. In the early 1970s, some providers in the US offered “menstrual extraction” to restore bleeding when menses were late.  Menstrual extraction – in which the uterus was evacuated using manual vacuum aspiration - was provided before pregnancy could be confirmed. However, most of this work mostly ended when Roe v. Wade legalized abortion in 1973.  

 

WHAT’S DIFFERENT ABOUT THIS IDEA TODAY 

Although abortion is now legal in the United States, it is once again becoming more difficult to access in many areas of the country. At the same time, we now have safe and effective medications that cause uterine cramping and bleeding and can be taken to bring back a period when it is late. 

Another important difference is that pregnancy tests can now identify the presence of pregnancy hormones like hCG around the time of a missed period. This is very different from the past, when pregnancy was not recognized until much later in the process.

Some people would not consider the initial presence of hCG as a pregnancy - and so may prefer to avoid early tests altogether and just take pills to bring back their period and ensure they are not pregnant. Others may simply prefer not to know if they have hCG in their urine.

This may be the moment in US history when traditional ideas about possibly early pregnancies return, in ways that empower possibly pregnant people with another safe, updated fertility option.