In the past 10 years, the rate of U.S. women using long-acting, reversible birth control devices such as IUDs has nearly doubled, as doctors and patients come to recognize them as one of the safest and most effective forms of birth control.
Now, a paper in the journal npj Microgravity suggests a new arena for IUDs and similar devices: space.
Although pregnancy in space — or during pre-flight training — would be problematic, that’s not really the issue at hand. While we don’t know for sure, it’s pretty unlikely that astronauts are having sex in space. Privacy is at a premium in shuttles and on the International Space Station, and physically, zero gravity can induce nausea, sweating, and reduced blood flow. None of which would be good for sexy space times, despite decades of kinky sci-fi scenes.
Instead, female astronauts often turn to birth control as a way to suppress their periods for convenience — which, by the way, is completely medically safe. In the past, many female astronauts on long-duration missions have simply continually taken birth control pills.
As NASA prepares for long-term space flight like that required for a manned mission to Mars, however, the study’s authors argue that long-term devices like IUDs may be a better option.
For one, a three-year flight would require a woman to bring 1,100 pills with her into space. That would add packaging weight, every bit of which counts in space flight (though perhaps this consideration could be offset considering women are usually smaller and lighter than men anyways.)
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— NASA (@NASA) January 7, 2016
IUDs don’t require taking a daily pill, don’t add any bulk, and are proven to be safe and effective. The study’s authors, space gynecologist Varsha Jain and Virginia Wotring, assistant professor at the Center for Space Medicine, Baylor College, assure readers that no reports show that the G-forces of spaceflight would cause an IUD or a subdermal implant to shift while its in the woman’s body.
They do, however, say that it could be a concern that the implant or device could rub or catch on specialist equipment or attire — though seeing as this is not a problem for birth control implant users on the ground, who usually don’t notice it’s even notice it’s there, it’s pretty unlikely to be a problem in space.
From a health perspective, though, the authors argue that more research needs to be done on the hormonal impacts of long-term birth control use. On Earth, some methods of birth control can cause loss of bone mineral density — which could be compounded by zero-gravity related bone changes. And, implants and birth control pills can increase the risk of blood clots.
The main problem, however, appears to be that there simply aren’t enough active female astronauts for studies to be done. There hasn’t been an IUD in space yet to study — probably because the proportion of female astronauts remains low, despite recent gains. (Perhaps if gendered unknowns remain a big consideration, a female astronaut ought to spend a year in space like fellow NASA astronaut Scott Kelly.)
In the meantime, the authors suggest combining data from Earth with spaceflight data in order to answer some of the remaining questions. “Offering female astronauts up-to-date, evidence-based, comprehensive education, in view of the environment in which they work, would empower them to make informed decisions regarding menstrual suppression while respecting their autonomy,” the paper concludes.
Considering that long-acting devices like IUDs and implants are becoming the birth control of choice for terrestrial women, it makes sense to ensure those options are safe and available for lady astronauts as well — especially considering that for the first time, 50 percent of the NASA’s latest astronaut class is female, and they’re all candidates for a mission to Mars.
The choice of whether to menstruate or not is completely up to the astronaut — and all the amenities are available should they choose to stay on their cycle. However, many astronauts on long space flights have chosen to suppress in the past for practicalities’ sake: it means that they don’t have to deal with the hassle of using pads or tampons in microgravity, or the decreased availability of wash water. And, for long-distance flight it may be recommended, because it means they won’t have to take on board pads and tampons, which take up space and add weight — and in a mission to Mars, for example, every bit of payload will count.
But the question of periods in space carries a lot of historical baggage — and is part of the reason there have been so few women in space to begin with.
Space Periods: A Loaded Question
Periods have long been used as an argument against women’s participation: Aunt Flo has been cited as a reason against military women being allowed to enter combat jobs, against women being president, and generally, been trotted out time and time again to dismiss or undermine women’s strength, dependability, and authority in the public sphere — particularly as they try to take on roles that have been traditionally male.
The pattern holds true with the space program. NASA first began exploring putting women into space in the 1960s, putting 19 women through the same battery of physical and psychological tests that male astronauts had to surpass. In fact, in some ways the women endured an even more difficult ordeal than the male candidates — they took their tests alone or with one partner, in contrast to the men, who had a group to rely on, and underwent a far more strenuous sensory deprivation test. Despite this, 68 percent of the women passed with “no medical reservations.” Fifty-six percent of the men did.
Yet, despite the fact that women had proven they were as physically and mentally capable as the men (if not more so) — and that women are smaller, lighter, and consume less food — America didn’t put a woman into space until Sally Ride in 1983, decades after the Soviets.
Instead, the 1960s program was shut down. The most prominently offered reason by study’s (male) authors was: “the intricacies of matching a temperamental psychophysiologic human and the complicated machine are many and, obviously, both need to be ready at the same time.”
In other words, despite the fact that women had passed a battery of psychological testing, NASA was concerned that once a month women would be too hormonal to be trusted around complex machines.
(This stereotype about women being controlled by their hormones still lingers, and is still a focus of scientific research — though a 2014 meta-analysis of period studies that showed that in fact, many studies finding differences in women’s preferences based on her cycle are false and use problematic research methods.)
Once NASA got over this misconception and finally did send a woman to the stars, engineers were still confused about the mechanics of the menstrual: Engineers reportedly tried to send Sally Ride on a 7-day trip to space with 100 tampons, and then tied them together by the strings like sausages so they wouldn’t float away.
As recently as 2015 space periods remained a topic of obsession. When NPR interviewed three female astronauts and NASA’s (female) chief scientist, the most commonly submitted question was: “What happens if you get your period in space?”
What Actually Happens When You Get Your Period In Space
Although periods in space did (and so some extent, still do) present an unknown, so did many aspects of early space travel — the male-dominated space program proceeded anyway. Once women were afforded the same opportunity, the question was answered: Periods in space are nothing out of the ordinary.
As Astronaut Rhea Seddon, who was part of the first group of female NASA astronauts, said in her oral history: “I’m not totally sure who had the first period in space, but they came back and said, ‘Period in space, just like period on the ground. Don’t worry about it.’”
And, although most female astronauts now make the choice to suppress their periods aboard the ISS for practical reasons, generally it’s a non-issue.
“If you decide instead of having a regular menstrual cycle on board, it’s not a problem. There are stocks of sanitary products onboard and the ‘bother’ is really a minor one,” said Italian Astronaut Samantha Cristoforetti in a 2015 blog post.