By Karen Gullo
We’ve all been there. And it’s not fun.
You’re about to give a major presentation, or sitting on pins and needles before taking an important exam, or seeing your kids off to camp for the first time, and bam! You get your period. Or it’s the night before you leave on vacation when you suddenly realize you forgot to run by the drug store to pick up birth control pills.
Such are the trials of womanhood. Women in the U.S. begin having their periods at 12 years of age on average, and have monthly periods (except during pregnancy and breast feeding) 12 times a year until menopause, which occurs, on average, around age 51. For someone who has two kids and breast feeds a few months for each, that adds up to about 440 periods. That’s a lot of bleeding, and a lot of trips to the drug store. And for some women it means monthly cramps, fatigue, depression, and mood swings.
Photo by nensuria/iStock / Getty Images
The Curse. Aunt Flo. It’s just part of what we have to put up with as women.
Or is it?
Dr. Sophia Yen, CEO and co-founder of the doctor-led birth control delivery service Pandia Health, says no. Unless you’re trying to get pregnant, periods are optional, she says. Fewer periods, and birth control pills delivered to your door, would make life a lot easier for millions of women.
“If we don’t want to get pregnant, why the hell are we bleeding so much?” Yen asks in an authoritative and incredulous voice that has you asking yourself: yea, why the hell are we bleeding so much?
Yen began thinking seriously about this back in the mid 2000s. An adolescent medicine specialist and expert in reproductive health, Yen has been studying, teaching, and counseling patients about menstrual health for two decades. At Physicians for Reproductive Health, a New York-based organization focused on improving women’s access to comprehensive reproductive healthcare, Yen was on the faculty of its Adolescent Reproductive Health Education Project for more than a decade. A graduate of MIT, UCSF School of Medicine, and UC Berkeley School of Public Health, Yen teaches and speaks frequently to physicians, educators, and young women about menstruation, birth control, emergency contraception, and pregnancy prevention. In addition to running Pandia Health, Dr. Yen is a Clinical Associate Professor at Stanford Medical School, where she’s worked for over 17 years.
Dr. Sophia Yen, CEO and co-founder of the doctor-led birth control delivery service Pandia Health.
Photo source: Sophia Yen
It was during a talk to a group of doctors that she was asked why women miss taking their birth control pills. Researchers estimate that as many as 40 percent of oral contraceptive pill users don’t keep up with the daily pill-taking regimen, partly because of the inconvenience of having to make frequent visits to the drug store for refills. Women have busy lives, Yen told the doctors.
“You’re chained to the pharmacy, you’re freaking out about getting your prescription filled,” she said. “It’s another micro-aggression stressor in women’s lives.”
Pandia Health delivers birth control pills by mail.
Photo source: Sophia Yen
It was a desire to make women’s lives easier, and give them the opportunity to break free of monthly periods, that led Yen to start Pandia Health in 2016 with friend and entrepreneur Perla Ni. Pandia, based in Sunnyvale, California, is an online telemedicine service where women can get birth control pills, whether or not they have insurance, delivered to their home by mail. No trips to the pharmacy, and for most women, there’s no trip to the doctor required.
Pandia is unique among birth control home delivery services in that it was founded by women, run by women, and led by female doctors. Yen raised money from her family and friends to launch the service, and later raised $2 million from investors through startup accelerators Springboard Enterprises, StartX, and Women’s Startup Lab. The elevator pitch for Pandia Health was: telemedicine meets Amazon Prime for birth control or the Dollar Shave Club for Women but with birth control.
The service is fairly simple. Women without a prescription fill out an online questionnaire about their general health and menstrual history and provide a blood pressure measurement from the past year. This is examined by one of Pandia’s six female doctors. The customer pays $20 for this. If everything looks good, you get a prescription, which is filled by Pandia Health’s partner pharmacies. Patients without insurance pay about $20 a month for one pack of birth control pills, or $15 each for a three-pack. Pandia Health can currently provide online doctor visits for customers needing new prescriptions in California, Florida and Texas. It can deliver to all 50 states, so if you already have a prescription, Pandia can move it from your current pharmacy to theirs and provide free delivery with automatic refills and some goodies like Hi-Chew, tea, and chocolate.
Pandia Health operates a nonprofit, the Pandia Health Birth Control Fund, which provides financial assistance to patients who need it for the doctor screening, the medication, or both.
Those with insurance and an existing prescription fill out the questionnaire, provide a blood pressure test, a copy of a government ID, and a selfie. Pandia bills the patient’s insurance, and makes money from the difference between the reimbursement and the price it pays to source the birth control pills.
Patients have absolute control over the frequency of their periods—they can have a period every month, every three months, every six months, or even once a year. This is accomplished by skipping the week of placebo sugar pills, or the ring-free week if you’re using a birth control ring, and just go right onto the next pack or ring. The primary side effect is spotting.
Typical use of birth control pills includes a week of taking placebo pills, which reduces hormones in the body, causing menstrual bleeding. Birth control pill inventor Dr. John Rock, a devout Catholic, designed the contraceptive that way—some say he wanted the pill, which was approved by the FDA in 1960, to be seen as a better way to practice the “rhythm method.” That was the only form of contraception approved by the Catholic Church, and Rock was seeking the Vatican’s approval for his invention (he lost that battle).
About a quarter of Pandia’s customers skip their periods. Dr. Yen and other reproductive health experts say that for most women it’s safe; period cessation slightly increases the risk of breast cancer, but lowers the risk of anemia, ovarian cancer, endometrial cancer, and colorectal cancer, and helps those with endometriosis and ovarian cysts.
Erin Macguire, a 20-year-old college student in Los Gatos, California, heard about Pandia from a friend. She’s been taking birth control pills since around age 15, when her doctor prescribed them to control frequent heavy periods that had caused her to become anemic. She started using Pandia last September and has opted for having periods every three to four months.
“It’s so easy and it saves money,” Macguire says. “If I don’t have to have periods, why do it?”
The average women spends between $150 to $300 a year on feminine hygiene products. Because tampons and panty liners aren’t considered a necessity, like medical devices or food (or Viagra—untaxed as a prescription drug), they are subject to state taxes, aka the “tampon tax.” California passed a law last year to end the tampon tax, but only for two years.
Kelsey Ricketts, another Pandia customer, uses a specific type of birth control pill that not all pharmacies carry. She looked online and contacted Pandia, which said it could supply the pill she needed. An office manager at a chiropractic office in El Dorado Hills, California, Ricketts, 27, doesn’t have health insurance, and said the physician screening process at Pandia was much easier than trying to get a doctor’s appointment. “It’s made a huge difference,” she said. “It’s all done through text messaging, and someone gets back to me within five to 10 minutes.”
Fewer periods can be life-changing in more ways than one. Not having to deal with cramps and mood swings every 28 days can help woman perform better in school and in the work force, Yen says. Studies show that one in five women miss school or university due to period pain. Two in five report that menstrual pain affected their concentration or performance in class. Yen says she’s seen teens in her clinic miss two days of school each month because of their periods—that’s 10 percent of their educational opportunities at a crucial time in their academic lives lost because of menstruation.
Yen remembers getting her period the day she had to take a biochemistry final as a pre-med student at MIT. “I am flipping out, and I’m looking to my left and right,” she says. Sitting next to her on both sides were male classmates—they’ll never have to deal with this, she thought.
“Now that I have two daughters, I don’t want them to be in the middle of a test, or a performance, or doing a sport and have to worry about blood trickling down their leg,” says Yen. “This is personal, for me and for my daughters.”
Karen Gullo is a freelance writer and former Associated Press and Bloomberg News reporter covering technology, law, and public policy. She is currently an analyst and senior media relations specialist at Electronic Frontier Foundation (EFF) in San Francisco.