Blog of the Society for Menstrual Cycle Research

Debating the Causes of Early Menarche

December 29th, 2009 by Elizabeth Kissling
Three of my young nieces.

Three of my young nieces, Labor Day Weekend 2009.

Janice Horowitiz’ “Dueling Docs” feature at Huffington Post today is about the issue of girls reaching puberty at increasingly earlier ages than previous generations. Both Dr. Alisan Goldfarb and Dr. Stephen Safe talk about endocrine disruptors such as BPA (bisphenol-A, a carcinogenic component of some plastics found in some baby bottles and water containers) and pesticides. Certainly both types of chemicals are likely to be a factor in early menarche, but I find it surprising that those are the only factors mentioned. There’s no discussion of the roles of psychosocial stressors, low birth weight, or formula feeding. Neither physician gives serious consideration to the endocrine disruptors that are the hormones used in raising beef and dairy cattle as well as chicken in this country; Dr. Safe acknowledges that “[a]lmost all foods have endocrine disruptors”, but qualifies that statement with, “particularly fruits and vegetables.” (Do you suppose the beef and dairy lobby advertise at Huffington Post?)

For a more thorough, nuanced analysis of this issue, see Sandra Steingraber’s report, The Falling Age of Puberty in U.S. Girls: What We Know, What We Need to Know, published in 2007 by the Breast Cancer Fund. Among other findings, Steingraber reports that new research has revealed that the amount of natural hormones a child’s body produces on its own is much lower than previously estimated; this means “safe levels” of exposure to synthetic hormones and endocrine disruptors must be recalibrated, and policy modified accordingly.

Adventures in Menstruating LIVE in New York!

December 29th, 2009 by Elizabeth Kissling

If you’re anywhere near NYC, don’t miss this opportunity to see our friend Chella Quint perform tonight at Bluestockings. She will be reading from Issue #5 of Adventures in Menstruating, her awesome period-powered zine, at 7pm on Tuesday, December 29th, at the Women’s/Trans’ Poetry Jam and Open Mike. Bluestockings Radical Books is located at 172 Allen St., New York, NY 10012.

Contraceptive Injections Increase Risk of Bone Loss

December 27th, 2009 by Elizabeth Kissling

DEXA scan of femur.New research from the University of Texas Medical Branch at Galveston finds that nearly half of women using depot medroxyprogesterone acetate (DMPA), commonly known as the birth control shot, will experience high bone mineral density (BMD) loss in the hip or lower spine within two years of beginning the contraceptive. Women who smoke, have inadequate calcium intake, and have never given birth are at higher risk of BMD loss.

The study, published in the January 2010 issue of Obstetrics and Gynecology, followed 95 DMPA users for two years. In that time, 45 women had at least five percent BMD loss in the lower back or hip. A total of 50 women had less than five percent bone loss at both sites during the same period. The researchers followed 27 of the women for an additional year and found that those who experienced significant BMD loss in the first two years continued to lose bone mass.

“These losses, especially among women using DMPA for many years, are likely to take an extended period of time to reverse,” says first author Dr. Mahburbur Rahman, assistant professor in the department of obstetrics and gynecology and Center for Interdisciplinary Research in Women’s Health.

The researchers note that while this study will help physicians counsel women with modifiable risk factors who wish to use DMPA, prevention of bone loss while using the contraceptive and reversibility of BMD loss are still not well understood and further research is needed.

DMPA, an injected contraceptive given every three months, is used by more than two million women in the U.S.; nearly one-quarter of them teens. DMPA is popular with young women because it is less expensive than many other forms of birth control, has a low failure rate, and does not require daily use.

[Via Red Tent Sisters]

Open Call: Medical Screening Procedures Unique to Women

December 27th, 2009 by Elizabeth Kissling

One of the reviewers for the forthcoming edition of Our Bodies, Ourselves, who blogs anonymously at Mom’s Tinfoil Hat, is seeking contributions for the chapter she is reviewing.

I am busy reviewing and contributing to the second chapter of Our Bodies, Ourselves that was assigned to me. It is called “Unique to Women” and is about screening tests and medical procedures. I am trying to get through the technical side of writing this: checking on new screening guidelines, new screening tools, and such scientific type things. But, I really want to take into account the needs and points of view of many women, including disabled women, women of color, women from different cultural and religious backgrounds, women who are trans, men who are trans, women who are survivors of sexual abuse and/or assault, women who work in the sex industry, women who are polyamorous, women who are gay, women with piercings and tattoos, women of size, etc.

Her deadline is New Year’s Eve, so please contact her ASAP if you can contribute.

The cure for all things menstrual?

December 24th, 2009 by Chris Hitchcock

A recent press release from the American College of Obstetricians and Gynecologists announces that Hormonal Contraceptives Offer Benefits Beyond Pregnancy Prevention. This is in the same vein as similar articles published over the years about “non-contraceptive benefits of the pill” – a laundry list of the many benefits women may obtain by using hormonal contraception. It’s not clear how they should be used by practicing obgyn’s. One use is certainly as additional talking points to convince women who are cautious or reluctant to replace their body’s own menstrual physiology with a pharmaceutical product.

I haven’t been able to read the full document (for some reason my university access seems to only find the first page of the full document), but it appears that, like previous reviews I have read, it is a biased list, including benefits but not risks. Perhaps what is most in common is the sense that a spontaneous menstrual cycle is somehow suspect, that fluctuations over time are unnatural, and that pharmaceutical control is a good solution.

I can understand why the pharmaceutical industry might want to publish a long list of off-label uses (although they would be quickly stopped by the US’s FDA and regulatory bodies in other countries). But it is a curious thing to find a professional group extolling the many off-label benefits of a class of pharmaceutical drugs. Do cardiologists publish practice bulletins about the non-cardiovascular benefits of statins?

There are other perspectives about how one might treat painful periods or heavy menstrual flow. The published Cochrane Reviews (well-respected summaries of published studies) about cramps suggest that the evidence for non-steroidal anti-inflammatories (NSAIDS, such as ibuprofen) is more solid and clear than that for combined oral contraceptives, and that, to date, no studies have compared them head-to-head. Moreover, NSAIDs also have been shown to reduce menstrual flow.

The press release notes the protective effects against endometrial, ovarian and colorectal cancer, but fails to note the increased risk of sexually transmitted infections. Being on the pill is the most important risk factor for not using condoms.

And when absent or long periods occur, inducing regular and predictable flow will reduce the risk of endometrial cancer, but otherwise primarily serves to mask the underlying issue. In that case, going on the pill can be like hitting snooze on your smoke alarm.

 

Season’s Greetings

December 23rd, 2009 by Elizabeth Kissling

Three unidentified men wearing hideous Christmas sweaters.Merry Christmas to those who celebrate. To commemorate the holiday, here is an mp3 download of the only known Christmas song that mentions tampons: Robert Earl Keen’s “Merry Christmas from the Family”.


Flow (of new posts) will be light at re:Cycling over the next few days. Enjoy the season, and thanks for reading!

Pills and Soap: Birth Control Now Available without Prescription in London Pharmacies

December 23rd, 2009 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, freelance writer (“Sweetening the Pill“)

NHS poster announcing availability of The Pill without prescription.In the summer of this year, I was researching for a feature for Easy Living magazine on the potential side effects of the birth control pill and when searching for a news hook for the piece, I found out about the preparation of a NHS scheme which would allow oral contraceptives to be distributed from pharmacies without a prescription. At that time, all of the doctors I interviewed expressed concerns about this development, even the most conservative GPs who stubbornly dismissed my concerns about side effects.

Then last week it hit British newspapers that this scheme had recently launched in the areas of London that have the highest rates of teenage pregnancy. Bold, bright posters in the style of laundry soap adverts exclaiming that the Pill is now available without prescription are up in pharmacy windows of Lambeth and Southwark. According to the news reports the pharmacists involved were given three weeks of training in order to provide consultations for young women looking to start taking oral contraceptives or wanting to move from the Pill to long acting methods like the injection, the implant or the hormonal IUS. The implication was also there that if young women came to the pharmacy for the emergency contraceptive pill then their consultation would involve the suggestion that they start on the Pill or a long-acting method.

The British government can’t seem to figure out how to handle their teenage pregnancy problem. They are looking for a quick, effective, wide-reaching fix that doesn’t cost much – certainly not as much as working with individual teenage girls to discuss their attitudes towards relationships and definitely not as much as providing holistic sex education that covers both the technical and emotional aspects. The NHS as a countrywide health service can be brilliant at organizing awareness campaigns – such as their quit smoking scheme – but providing the Pill without prescription is a step in the wrong direction.

Aside from the fact that this proposal will, without a doubt, devalue the Pill as a drug, a medication, and thus make it appear harmless, and therefore keep women ignorant of its potential impact on their health and wellbeing and prevent them from seeing the signs of side effects – any ‘consultations’ provided by pharmacists are very unlikely to be comprehensive or cautious. We already know how most doctors deal with doling out the Pill – many simply do not tell the truth about how it works, and do not talk about the potential problems it might cause, particularly in terms of mood and emotions.

The pharmacists have probably been told to check the teenagers weight and blood pressure on their first visit – but what about scheduling follow up appointments? Will the teenage girl go back every six months and check in with the pharmacist for another consultation? How many packets of the Pill will they be given to start? It can be assumed busy pharmacies aren’t going to want to have a constant round of check ups and would be more inclined to hand out Pills literally over-the-counter after an initial talk. This goes against even the loose policies presently in place for obtaining prescriptions. Women must return to their GP every three or six months to check for problems such as the increased blood pressure, migraines or breathing difficulties that might suggest a blood clot formation.

Most women get the Pill from their GP, but often family planning clinics are much more interested, at least in the UK, in the side effects a woman might suffer from on different brands. This new scheme appears to stem from the root idea that teenage girls are secretive about taking the Pill and therefore want to avoid their family GP. The spokespeople for the scheme have said teenagers go into, say, the Boots pharmacy to buy cosmetics, so they can pick up the Pill easily and inconspicuously. It seems very doubtful that teenage girls really have this problem with people knowing they are on the Pill. Would these consultations, like those available at a family planning clinic, involve discussion of condoms and the necessity that they are used for casual sex at all times? If teenage girls are using condoms properly then they wouldn’t need to take the Pill, and they definitely need to use condoms to prevent getting or passing on STIs.

The “standard of care” for being a girl?

December 22nd, 2009 by Laura Wershler

In a December 21, 2009 news release the American College of Obstetricians and Gynecologists (ACOG) proclaimed that “hormonal contraceptives offer benefits beyond pregnancy prevention“.

You’d have to be an ostrich with her head in the sand not to have heard this message before.  Just open any woman’s magazine to any ad for the pill, or any of the myriad varieties of drug-based birth control, and you’ll find the litany (a prolonged and tedious account) of non-contraceptive benefits used as marketing messages to “sell” birth control to girls and women.  So the news release begs the question: why now?

Maybe the pharmaceutical companies are putting pressure on the gynies to protect their funding and the drug companies profits.  Maybe this news release is damage control.  A recent article in Maclean’s magazine proclaimed a trend towards ”ditching the pill for good“.

[O]ral contraceptive prescriptions in Canada levelled off in 2008, reports pharmaceutical industry analyst IMS Health Canada. Health care workers are seeing a growing demand for non-hormonal methods. Spurred by concerns about their health, the environment, or even frustration with family doctors, who sometimes seem to push the pill as a modern-day cure-all, Canadian women are looking for other options.

Are declining prescriptions for hormonal contraceptives a growing trend in North America?  Is there a backlash brewing against the pill, the patch and the ring?  One can only hope that the days when your gynecologist could convince you that taking the pill is a panacea for everything that, supposedly, is “wrong” with women’s bodies are coming to an end.

Hormonal contraceptives are drugs that disrupt a woman’s normally functioning endocrine system with synthetic versions of estrogen (ethinyl estradiol) and progesterone (progestin) to induce infertility.  [Do not be fooled by the language used in the press release.]  These drugs have a time and place.  But precribing the pill must never become the “standard of care” for being a girl.  Mothers everywhere, take note.




MANopause; or, Hello, God, It’s me, Mel Gibson

December 22nd, 2009 by Elizabeth Kissling
Mel Gibson claims his work has suffered due to male menopause.

Mel Gibson claims his work has suffered due to male menopause.

Guest Post by David Linton, Marymount Manhattan College

An earlier re: Cycling post about a clever viral marketing strategy that exploited the notion of male cramps reminded me of some other ways that men have tried to appropriate aspects of the menstrual mythos for their own interests.

Gender jealousy was spelled out by Freud with his concept of “penis envy” and rebutted by Karen Horney who claimed that “womb envy” was an even stronger psychosocial phenomenon that expressed male anxiety at their inability to give birth.  Then the term “menstrual envy” came along in an attempt to explain a variety of male attractions to behaviors including sports and war.

Recently there has been a rise in use of the term “male menopause,” probably a reflection of demographic shifts and concern for the well being of the aging American male.  An early advocate of this syndrome was Jed Diamond whose 1998 book, Male Menopause, claims that the purpose of the hypothesized phenomenon (also called viropause or andropause) “is to signal the end of First Adulthood and prepare men for Second Adulthood.”

Another web site identifies eight “symptoms of male menopause,” but reading the list reveals that what is now being called male menopause used to be called simply “getting old,” as it includes items such as declining sex drive, forgetfulness, weight gain, and irritability.


FOX News "SEXpert"The Fox news network has also gotten behind the idea with testimony from the “Foxsexpert,” Yvonne Fulbright, who sports a sexy pose to support her title under a headline that reads, “NOT SUCH A MYTH: MALE MENOPAUSE”  The Sexpert goes on to state, “He’s feeling hot flashes — and they have nothing to do with desire. Like a woman, his body is letting him know it’s going through “male menopause.” Far from being a myth, this hotly debated experience really does exist. Yet few people know about the condition more formally known as andropause.”

Actually, once the article turns its attention to the medical circumstances surrounding andropause, it raises some very important issues that men would be well advised to know about.



(more…)

Every Vulva Is Different

December 19th, 2009 by Elizabeth Kissling

Guest Post by Therese Shechter, filmmaker (Trixie Films)

Alert: Links are Not Safe for Work
Photo of woman wearing only underpants, superimposed with words, "Jede Vulva ist Anders" (Deutsch for "every vulva is different")German teen magazine Bravo, known for it’s explicit information on sexuality and sexual health has done it again with their feature: Vulva-Galerie: Schau, welche Unterschiede es gibt! which according to my Google translator means”Vulva Gallery: Look, what are the differences?”

The text says: The vulva is the externally visible part of the vagina. Do you want to finally know what it looks like on other girls? We show you the variations! If you click on Hier siehst du, welche Vulva-Variationen es gibt! (Here are the vulva variations!), you get a gallery of photographs of female genitals, photographed from the front. Some are pierced, some are hairy, some are shaved, some have larger labia…but unfortunately, they’re all white and none of the women seem to be on the larger side.

That’s too bad, because the underlying message is a good one: Stop comparing your ladyparts to women in mainstream porn. This is what we look like when we’re not being seen through the male gaze. Every vulva is different and special in its own way. Again, I wish there had been some diversity in race and size. Is Germany really such a homogeneous society? I don’t think so. The photo series ends with a more explicit photo of the inner vulva, complete with labels.

Not only would this never fly in the US, it reminds me of an interview we did with CosmoGirl! editor Susan Schulz who told us about an illustration of a vulva they commissioned in order to acquaint their readers with their own ladyparts. The title was ‘Vulva Love’ and it was done in a fun folksy way and totally non-pervy. Susan told us they got more hate mail from parents about that item than anything else they ever ran. The illustrator didn’t even want their name on the piece. I’ve searched online for the image but can’t find it, so I’ll post it and our interview with Susan in when I’m back in the USA.

By the way, the Bravo vulva item is part of a regular feature called Dr. Sommer which includes topics for teen boys and girls like vaginal health, penile pain, “Are You Really Ready for Sex?” and “Love School”(if you are ready, I guess). My knowledge of the German language is now exhausted, but if anyone wants to translate other items, please leave it in the comments!

Cross-posted at The American Virgin.

Who Lacks Health Literacy?

December 18th, 2009 by Elizabeth Kissling

You may have heard the news that 23 hormone replacement therapy lawsuits filed by women diagnosed with breast cancer were dismissed by a New York judge this week. Judge Martin Shulman granted Pfizer’s motion to dismiss for two reasons: the plaintiff’s delayed filing exceeded the the three-year statute of limitations in New York, and that “the potential risk of contracting breast cancer from taking HRT medication was well known at all times out there in the stream of public information.” Oddly, Judge Shulman simultaneously asserted “that the debate over HRT health problems has not yet been settled.”

I can’t argue about exceeding the statute of limitations, but it’s difficult for a judge to assert that breast cancer risk of hormone therapy is well known public information. The Lancet reported today that up to half of US adults have trouble interpreting medical information, displaying low levels of health literacy. Health literacy, according to The Lancet, is the ability to comprehend and use medical information that can affect access to and use of the health-care system. Health literacy is more than reading and comprehending news reports of medical issues (which are often of poor quality – see Health News Review for sharp analysis of health news); one must also know how to navigate the complexities of the health care system, including knowing how and when to question one’s physicians and pharmacists.

It’s also hard to argue that HT risks are well known when gynecologists, the primary prescribers of HT, refuse to believe the scientific evidence. In 2000 – well after 1990s publication of data from the Heart and Estrogen/Progestin Replacement Study (HERS), a prospective, randomized, double-blind study of 2,763 women with coronary disease which found no benefit of hormones in preventing heart disease – 94.6% of American gynecologists surveyed recommended HT during menopause. Denial continued even after the Women’s Health Initiative (WHI) study – a large, prospective, randomized placebo-controlled trial of estrogen (with and without progestin) in healthy menopausal women – was stopped early in July 2002, because the treated group experienced higher rates of breast cancer, cardiovascular disease, as well as other risks of harm.

WHI was a large, primary prevention trial that contained enough subjects (more than 27,000) to answer the research question; used a design widely acknowledged to be the standard in testing therapeutic efficacy; tested Prempro, the most popular hormone combination; and was monitored by a data safety monitoring board using pre-established criteria. Practitioners should have been satisfied that the question of estrogen as a health-protecting drug had been resolved. Instead, a storm of protest erupted from physicians who could not, or would not, believe the results. Objections to the WHI results (almost exclusively from gynecologists) were so widespread that the media characterized the WHI results as confusing and controversial.

In truth, there was no confusion about the data, which were monotonously consistent with HERS and other randomized controlled studies. [Fugh-Berman & Scialli, 2006]

Why do gynecologists, judges, and others still regard this question as unsettled? Scholars offer several explanations. Paula Derry (board member of the Society for Menstrual Cycle Research) proposed in a 2008 article that faulty decision-making criteria are in play, such as

not valuing rigorous scientific thinking (e.g., ignoring normal rules for judging what counts as scientific evidence, sometimes while claiming to be scientific); not placing a primary value on avoiding harm (e.g., considering heart disease outcomes while not simultaneously considering other risks such as stroke); and basing judgments on a preconception about menopause (i.e., that menopause is an estrogen deficiency disease that causes health problems). [Derry, 2008]

Adriane Fugh-Berman and Anthony Scialli also say the perception of menopause as an estrogen deficiency disease still influences doctors. They speculate that certain features of the unique culture of obstetrician-gynecologists are involved in the continuing promotion of HT. For example, gynecologists are one of few medical specialties that see mostly healthy patients.

Managing medications in healthy women gives a doctor something to do and ensures a continuing relationship with women no longer in need of obstetric expertise.The promise of eternal youth ensures the patients’ consent and gratitude. Healthy women require little or no monitoring and are resilient enough to survive most prescriptions.

The Cosmetetical* Potential of Menstruation

December 18th, 2009 by Elizabeth Kissling

C'ELLE Collection Kit
*(I really did type “cosmetetical”. Readers under the age of 40 and/or outside the U.S. can find the origin of the term here.)

Guest Post by David Linton, Marymount Manhattan College

Here’s where exploitation and menstrual activism crash into each other.  While activists have been diligently working to reduce the “Ewww” factor so that women are not treated with disgust when (and because!) they menstruate, commercial interests have been just as diligently striving to find new ways to cash in on the period.

One of the newest gambits is found at an online beauty products site called M.S. Apothecary promoting a service that been around for a few years, C’ELLE®.  C’ELLE® offers to cryogenically freeze the stem cells found in menstrual blood for future use.  Originally the pitch for C’ELLE® focused mostly on the potential of stem cells to yield material that can be used to treat diseases, once medical science discovers a way to use them.  Meanwhile, the material is judiciously stored away in one’s “portfolio.”  The initial cost is described as a “special introductory rate for new clients” of $499, although the price hasn’t changed in more than a year.  Following the first year there is a yearly storage charge of $99 that is subject to later increases.

The connection between a menstrual blood collection service and a beauty store comes in the way the service is described in the link that is posted on the M.S. Apothecary site:

Begin your beauty from the inside out. C’ELLE®, a revolutionary service that empowers women to take charge of their future health and beauty, allows for the collection and preservation of their precious stem cells. With C’ELLE’s® exclusive process and step-by-step instructions, any woman experiencing menstruation can easily and painlessly gather her own stem cells in the comfort of her own home. In the future, these cells may be the basis of medical treatments for threatening diseases, personalized cosmeceuticals and regenerative medical procedures, providing the potential for living a longer, healthier life.

It remains to be seen if menstruation will eventually come to be seen widely as a source of beauty “from the inside out,” but this is not the first time that menses and fashion have been linked.  In the early 1990’s the sketch comedy series In Living Color ran several skits featuring menstruation.  The fashion statement depicted in this one might be compatible with the pitch for menstrual blood collection.

*I really did type “cosmetetical”. Readers under the age of 40 and/or outside the U.S. can find the origin of the term here.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.