Contraceptive pills have been used by countless women around the world to control menstrual cycles since the U.S. Food and Drug Administration first approved them in 1960.

But World Health Organization statistics show that only 1.1 percent of Japanese women aged between 15 and 49 used oral contraceptives in 2015 — far below the rates of 40 percent seen in France, 37 percent in Germany, and 16 percent in the United States.

The low rate has been attributed to misconceptions about using such pills, including excessive worries over side effects and a long-standing belief among many Japanese women that controlling menstrual cycles via medication is unnatural and harmful.

Gynecologists say that because of their reluctance to take such pills, many Japanese women suffer from severe problems related to menstruation that degrade their quality of life as well as their work performance.

One problem that can be treated with contraceptive pills is endometriosis. The condition makes tissues that usually form only the lining of the uterus, or womb, spread to other organs inside the body, causing intense lower abdominal pain during menstruation or sexual intercourse. In severe cases, it can even result in infertility. While the mechanisms that cause endometriosis remain unclear, its symptoms have been found to be triggered by menstruation.

According to a study by the Japan Enlightenment Committee In Endometriosis (JECIE), around 8 million women in the nation were estimated to have been suffering from dysmenorrhea — the medical term for severe menstrual pain — in 2014, up from some 7.83 million in 2004, and only 10 percent were being treated. More than 2.6 million Japanese women were estimated to have endometriosis in 2014.

Mikio Momoeda, vice president of St. Luke’s International Hospital, said at a seminar in May that the main cause of the increase lies in the fact that women today menstruate around 10 times more than women in the Meiji Era (1868-1912), primarily due to changes in their lifestyles.

According to Momoeda, women in the Meiji Era gave birth to an average of four to five children. With menstrual cycles interrupted before and after childbirth, they experienced a total of between 40 and 50 menstrual periods over the course of their lifetimes. In contrast, the majority of women in modern-day Japan go through pregnancy just once on average. Furthermore, they tend to have their first menstrual period earlier and undergo menopause later than women in the past, which means they can expect to have around 450 menstrual periods in their lifetimes.

“People seldom realize that the risk of developing endometriosis is intertwined with the number of periods they have, and many are prone to misattribute the cause to environmental factors alone,” said Momoeda.

He said women who suffer from severe menstrual pain have a high risk of developing endometriosis but that properly prescribed contraceptive pills would allow them to control and shorten menstrual periods, providing at least one way to prevent them from developing the symptoms.

Yet many tend to think that feeling such pain is natural, and endure it every month while taking painkillers to manage the worst of the discomfort.

According to a survey of 1,035 Japanese women aged between 20 and 39 conducted by pharmaceutical company Bayer AG in February, around 40 percent of those who responded said they were reluctant to take pills to control their menstrual cycles. The two major reasons they cited were potential side effects and a sense that menstruation is a natural process that should not be controlled by medication. The main side effects of contraceptive pills are related to the fact that they contain two hormones, estrogen and progestin, which have been known to increase the chance of developing blood clots.

In the survey, 61.5 percent of the respondents said they took painkillers and tried to rest when they suffered severe pain, whereas only 7.5 percent said that they took oral contraceptives to ease menstrual pain.

“Obtaining a prescription and taking contraceptive pills when early symptoms of dysmenorrhea first appear can help prevent women from developing several menstruation-related conditions that might cause infertility later in life,” Momoeda said. “Parents need to understand the realities about both menstruation and contraceptive pills, and must take their children to clinics as soon as they begin suffering pain during their menses.”

Momoeda said that tackling misconceptions about oral contraceptives would also open up more choices for women who feel their capability to perform well at work fluctuates due to the often debilitating pain they experience during menstruation.

In a survey of 2,000 Japanese full-time or part-time working women aged between 18 and 49, conducted by the nonprofit organization Health and Global Policy Institute in February, 45 percent reported that they felt their capacity to work dropped by 50 percent or more due to physical and mental discomfort related to menstruation. Only 6 percent said that their performance and productivity in the workplace were not affected by menstruation.

“Getting rid of the misconceptions that exist around menstruation and oral contraceptive pills is crucial in order to secure Japanese women’s health and their lifestyles,” said Momoeda. “Doctors, media, and parents each have a role to play in disseminating accurate information about (contraceptive) pills and menstruation.”

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