Blog of the Society for Menstrual Cycle Research

Napping is Good for You!

April 28th, 2010 by Elizabeth Kissling
The Importance of Nap Time by Age, graph by cmoney345

The Importance of Nap Time by Age, graph by cmoney345

This is a very small study, but I don’t need much encouragement for an afternoon nap. Researchers wanted to test whether a mid-afternoon nap during the late-luteal phase of the menstrual cycle (commonly known as the premenstrual period) would improve symptoms of sleepiness, mood, and cognitive performance without negatively impacting subsequent nocturnal sleep. They tested this hypothesis on ten women with significant premenstrual symptoms and a control group of nine women with minimal or no symptoms, and found that napping made both groups feel better. More precisely,

Napping improved sleepiness, alertness, mood, and some aspects of cognitive performance. Improvements were maintained for at least 30 minutes and up to 6 hours after napping. An afternoon nap benefited both groups of women, but those with significant symptoms had a slightly greater improvement in intensity of mood 30 minutes after the nap.

Napping – it’s not just for kindergarteners. Wouldn’t the world be a better place if everyone could have a Fig Newton and a blankie at about 2:30 pm?

Menstruation Myths PSA

April 26th, 2010 by Elizabeth Kissling

Menstruation is DANGEROUS!!!The Jamaica Observer has published a list of menstrual myths, apparently as a public service to its readers. Among the fallacies:

  • Do not go to a funeral and look at the dead while having your period as this will cause your bones to rot.
  • If a menstruating woman cans fruits or vegetables, the fruits will spoil in the can.
  • Dentist visits should not be done during the menses, because fillings put in during this time will fall out.
  • During menstruation a woman should not go hunting as the animals will smell her blood, which will drive them away.

And if you happen to be from New Jersey and of Italian descent, stay away from the tomatoes.

Extreme Fem-Care

April 26th, 2010 by Chris Hitchcock
Found on the web

Found on the web

The Pill in the News

April 25th, 2010 by Chris Hitchcock

This week was a big one for media coverage of the 50th anniversary of the Pill. And it looks like this is also being taken as an opportunity to reflect on women’s history over the past 50 years, which will also be a good thing. Women often lose our history, and those of us who are 70 now grew up in a very different reality than those of us who are 20. I am 45, smack in the middle of that span, and it’s very interesting to me to look both forward and back. We are living through incredible changes in social history, and we need to know this to understand what is going on today and what will happen tomorrow.

The pill made the front cover of Time magazine. The author, Nancy Gibb, makes some very good points about how the existence of the pill changed young women’s ideas about the possibility of planning a career path that included being sexually active (probably in the context of marriage) but with control over the timing of pregnancy.

There’s a Time editorial here.

And there are a few interviews with Nancy Gibb, the author of the Time article, on Time’s own web page, on CNN, and NPR (

In the Huffington Post, Christianne Northrup discusses important social and medical context for decision-making about contraception, including the Pill.

Katrina Onstad wrote about the pill’s birthday in Chatelaine magazine.

Books and book reviews on the anniversary of the pill:

Michelle Goldberg reviews a new book about the pill in the American Prospect.

Saturday Surfing: Linkalicious Reading

April 24th, 2010 by Elizabeth Kissling

In case you missed these stories of the week:

Neurology and steroid hormones – where is progesterone in this discussion?

April 23rd, 2010 by Chris Hitchcock

Recently the New York Times published a long article entitled the Estrogen Dilemma. It’s an article rich with many issues, and previous blogs have critiqued its uncritical acceptance of the timing hypothesis, and its failure to distinguish between the transient symptoms of perimenopause, early menopause, and the rest of your long, healthy, post-menopausal life.

But it is quite remarkable to me that, when speculating about potential hormonal treatment for poor memory and issues of staying on task, the only steroid hormone that seemed to be on anyone’s radar was estrogen. The writer had a lot of space (7600 words) and gave the scientist a lot of freedom to speculate, so I’m guessing that the absence of progesterone in the article is a true representation of her conceptual blind-spot. Progesterone was mentioned a few times, in the context of protection from uterine cancer, and in the context of using MPA (a synthetic relative) as a possible scapegoat in interpreting the WHI randomized hormone therapy trial data. But never did I see any suggestion that progesterone might be anything other than a necessary evil.

In fact, there are some intriguing new research areas that look at progesterone as therapy in neurological domains.

So, in a free-wheeling article about how scientists are exploring possibilities, it’s interesting that the possibilities seem to be limited by a cultural bias towards estrogen.

More on life-giving female fluids

April 23rd, 2010 by Chris Hitchcock

When I was pregnant and then learning to breast-feed my daughter, my doula told me that breast milk had great anti-biotic properties, and that it was good to use on eye-infections and cuts. Turns out that there is science behind that. Not only that, but now scientists have shown that breast milk contains substances that may kill cancerous cells. They’re calling the extracted substance HAMLET – not sure why a substance extracted from lactating women would be named after a grieving, tortured young man struggling with suicidal and homicidal thoughts, but I’ll leave more thoughts on that to those who are better at post-modern analysis.

It reminds me of the idea of harvesting stem-cells from menstrual blood. And also some questions about that. Like, is this one of the cases where it matters what produced the menstrual blood? Not all episodes of menstrual bleeding are the same. So how does stem cell quality differ among these different sources of uterine blood?

  • a normal ovulatory cycle
  • normal-length but anovulatory cycle
  • very long or irregular cycles, which tend to be anovulatory
  • withdrawal bleed when you are on the pill
  • or even a post-menopausal vaginal bleed from taking sequential hormone therapy

I don’t even know if anyone is asking these questions, because there is relatively little interest or appreciation in the varieties of sources of menstrual blood and how it might change its quality.

What do vaginal rings and tampons have in common?

April 22nd, 2010 by Elizabeth Kissling

Vaginal ring held up for display in gloved right hand.

So here’s an odd little study: when women are given a choice between oral contraceptives and the contraceptive vaginal ring, what characteristic is most highly correlated with a slightly greater interest in using the vaginal ring? If you said “tampon use”, you’re right!

Among contraceptive vaginal ring and OCP users, 247 (79%) reported using tampons. Contraceptive vaginal ring users were not significantly different from OCP users in terms of age, race or ethnicity, marital status, insurance, body mass index, or parity. Adjusted analysis indicated that tampon users were more likely to choose the contraceptive vaginal ring instead of OCPs.

The study was published this month in Obstetrics & Gynecology. The researchers conclude, “but all women should be offered the contraceptive vaginal ring regardless of experience with tampon use”. No kidding. Sadly, they don’t appear to be offered any non-hormonal contraceptive options, as this research was conducted in conjunction with The Contraceptive Choice Project, described in the research report as “a longitudinal study of 10,000 St. Louis area women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction for all reversible methods.”

It seems to me that the researchers want to predict contraceptive choices based on how willing contraceptive users are to touch their own genitals, but apparently they can’t directly ask them. They might accidentally discover an interest in using a diaphragm or cervical cap!

Riddle me this: What’s wrong with birth control?

April 20th, 2010 by Laura Wershler

I read The Birth-Control Riddle by Melinda Beck, published today in The Wall Street Journal with interest and frustration.  As a veteran pro-choice sexual and reproductive health advocate, I’ve spent decades contemplating this ”riddle”. I have two specific comments in response to the piece, and a few suggestions for potential follow-up stories.
 1) I find it discouraging, but understandable, that the article failed even to mention fertility awareness based methods (FABM) of birth control, which when taught so that women/couples can use the method effectively and confidently have a 99.4% effectiveness rate. Don’t take my word for it. The German study called: The effectiveness of a fertility awareness based methods to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study was published in the prestigious journal Human Reproduction in late 2007. 

In addition to the typical North American dismissiveness (by healthcare providers) of FABM as ineffective, is the dismissive response given to North American women who express an interest in learning FABM.  A quick google search or a week’s hits on a google news alert for “Fertility Awareness” (the secular, pro-choice variation of the religiously contextualized Natural Family Planning) quickly establishes the burgeoning interest and use of these methods by young American women. Why is this so readily ignored by the mainstream sexual and reproductive health community (of which I am a part)? I have been mulling over this question for years. I have arrived at several answers. How I would love to see a journalist, any journalist, start asking this question.

 2) My second comment is that this article is a missed opportunity. It is useless merely to list (yet again) the birth control “choices” available to women, as if just knowing about these methods of contraception should make the problem of unintended pregnancy go away. Of one thing we can all be certain: it can’t and it won’t. What this piece lacks is any attempt to explore in depth the writer’s accurate but unexamined statement – Why are the numbers so high? The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors.  Why not make an effort to get to the bottom of the so-called birth control riddle?  

Should Beck be interested in continuing to write about this issue, one angle she might consider exploring is barriers to access to information, support and services for women seeking to use non-hormonal methods of birth control effectively and confidently, including diaphragms, cervical caps and fertility awareness based methods. This is a huge issue of concern to me and the many women who can’t, won’t or don’t want to use hormonal birth control.

I have a theory that a good number of unintended pregnancies happen because women are finding little or no support to access and effectively use non-hormonal methods. Yet this lack of support is not enough to keep them on the pill, patch or ring, or to agree to submit to invasive shots or implants.  Therefore, care providers’ dismissal of young women’s requests for non-hormonal methods may actually be the cause of some of the unintended pregnancies we seem to be so puzzled by. Another issue not being talked about is that some women are getting pregnant while using the pill, patch or ring. These unintended pregnancies, which oddly don’t seem to pull down the “typical use” effectiveness rate of these methods, is partly behind the growing interest in IUDs.  The other reason IUDs are growing in popularity is backlash against traditional hormonal methods.

Another story idea is to question the hierarchy with which contraceptive methods are presented. As illustrated by Beck’s contraceptive method list, hormonal methods are always at the top, suggesting that these methods are always superior choices (that is how they are usually presented – to young women especially) even if for many women they are not. What if we presented birth control methods as three distinct sets of choices that all women and sexual health care providers should be equally knowledgeable about, and – in the case of the healthcare provider – supportive of? These method groups – alphabetically identified as barrier, hormonal and natural methods – could be presented as equally valid choices based on what suits best a woman’s needs, health concerns and values. After all, the old adage states that the best kind of birth control is one that you will use.

I am always amazed at young women’s perception that only hormonal methods are truly effective, and anything else is second best. Wherever did they get this idea? And with this impression, how possibly can they hope to be successful using other methods?  The challenge is that if we present these method groups as equally effective and worthy of choice, then we are going to have to find better ways to provide information, training and support so that women and their partners can use all of them with confidence.  

Attention, U by Kotex: We have a message for you

April 20th, 2010 by Elizabeth Kissling

Guest Post by Chella Quint, Adventures in Menstruating


Okay, Kotex? Here’s the deal: We’re only gonna stop feeling the shame when we take ownership of our periods. And we’re taking it back from you, dude. So you can’t reclaim our periods for us. You’re some of the people we’re reclaiming them from. Got it?

Does your birth control method stop your cycle?

April 20th, 2010 by Chris Hitchcock

It’s starting. With the approaching 50th anniversary of the birth control pill, there will be a flood of anniversary celebrations and reviews of birth control methods. Which is good. We should have those discussions more often. Just say “no” (on the part of parents who don’t want to hear about it) is a big contributor to unwanted teen pregnancy.

Today’s Wall Street Journal is running an article called The Birth-Control Riddle. The riddle is apparently the high rate of unwanted pregnancy, despite the availability of a range of effective birth control methods. And, as befits the Wall Street Journal, each birth control method is accompanied by a price tag, so you can make an informed consumer decision.

But what I noticed was that there is no real awareness of what we at SMCR feel is an important consideration: Does your birth control method stop your cycle?

Some methods do – they deliver progestins and/or estradiol in high enough doses to act on the parts of the brain that normally make the hormones that talk to the ovaries that stimulate growth of a follicle, then trigger its release. This is a complex, whole body system, that normally we only notice because of uterine effects (that would be menstrual bleeding or pregnancy). And as a culture we have fairly casually accepted the idea that it is optional, and perhaps even optimally replaced by a pill made by a drug company.

When addressing the (no longer so) new extended use cycle-stopping contraceptive options, the WSJ glibly explains that “Experts say there is no health reason that women need to have a period if they are not ovulating or building up uterine lining each month.” In other words, so long as your uterus is not endangered (by pregnancy or endometrial cancer), there is no worry. Never mind that both estrogen and progesterone act on receptors throughout the body (bone, skin, blood vessels, brain, gut, breast), or that the synthetic estrogens and progestins don’t quite act in the same way, and we don’t quite completely understand how yet. And it’s just a change of schedule, so what difference can it make that your tissues are stimulated for 12 (or 52) weeks at a time instead of 3 before they get a break?

The problem is, with changes in the schedule of delivery and the reduction in hormone-free time, we really won’t know whether there are any consequences for a while. Oral contraceptives are taken by healthy young women, so the base rate of problems is low, and you need large numbers to measure the rates of serious side effects. I haven’t heard any further about the post-marketing surveillance studies for blood clots (venous thromboembolism) that the FDA asked Lybrel to conduct following its 2007 approval. But those 5-year followup data should be out around 2013. It will be interesting to see whether they are published, or just submitted as a report to the FDA. I’m guessing that will depend on whether the company likes the story they tell.

In addition, there’s increasing evidence that the effects of the pill vary with your age and the maturity of your hormonal system. So, for young women, it is looking more and more as though the pill is bad for bones, slowing or stopping the accumulation of bone mineral during teens and twenties. And maybe you can make that up after you come off. But many women never come off, replace their hormonal cycle with a pharmaceutical cycle for literally decades. And shouldn’t we be a bit concerned about that? At the other end of the reproductive life cycle, it’s important to know that the large safety trials exclude older women. Regulators want contraceptives tested on fertile women (which makes sense), but that means that safety trials usually cut off at 35 or 40. And as you get older, your chances of blood clots and strokes goes up anyway, so even if the relative risk were the same, the absolute risk (the number of new events) is going to go up with age. We do know that smokers who are over 35 are at very high risk.

Not only that, but the non-hormonal options are getting harder. To use a diaphragm, you need to also use a spermicidal jelly. Here in Canada, the company that has the rights has decided to stop distributing it, because the market is too small. I’ve just learned that there is a local clinic in my hometown (Willow Women’s Clinic in Vancouver) who are importing it. And those who want to use natural family planning methods (fertility awareness) need to look for educators to support them; most GP’s don’t have the knowledge or the time to support this choice.

The Great Perimenopause Cover-Up

April 19th, 2010 by Elizabeth Kissling

Guest Post by Jerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research

I just read “The Estrogen Dilemma” in Sunday’s New York Times Magazine,  and I feel like weeping—in sorrow and deep sadness. This article by Cynthia Gorney is about energetic, intelligent women who feel they must take estrogen in order to survive perimenopause yet have deep worries about its risks. I know personally the anguishing changes that erupt during perimenopause. “The Estrogen Dilemma” also evoked my frustration and even rage. It is wrong that symptomatic women in the midst of the long and stormy midlife transition have to face a conundrum—to take estrogen or not. It arises from a Nixonian-style cover-up of three proven and important-for-women truths: 1)    Perimenopause causes higher and not lower estrogen levels. (By perimenopause I mean the transition from fertile menstrual cycles to menopause, or the life phase beginning one year beyond the final menstrual flow.) 2)    Progesterone, estrogen’s essential partner hormone, in contrast to estrogen, truly is lower in perimenopause. 3)    Women survive perimenopause and “graduate” into a less symptomatic menopause.

Are estrogen levels low in perimenopause? No. Taking all perimenopausal women together (a meta-analysis of published levels comparing within-center young with perimenopausal women) estrogen levels are 26 percent higher (1). For symptomatic perimenopausal women like Cynthia Gormley and myself, estrogen swings to Everest-like peaks and may intermittently be a 1000-fold greater. Perimenopause, for some of us, is estrogen’s storm season (2).

Despite that, ever since estrogen was first discovered in 1926, anything ailing women has been deemed “estrogen deficiency.” And often inappropriately so treated. Thus, estrogen levels must be dropping and low in perimenopause when women become symptomatic—it makes sense because we know that perimenopausal women are running out of their store of ovarian follicles that, after all, make estrogen. That perimenopause-dropping-estrogen idea fits with the fact that perimenopausal women begin to have night sweats. But it doesn’t fit with the reality that night sweats begin while women are still having regular menstrual cycles (3) and thus still have adequate estrogen levels (but the misunderstanding of what causes hot flushes is yet another story).

The evidence that perimenopausal estrogen levels are higher than in the sexiest 20-something is strong and consistent (1;4-9). Why are media articles, consensus documents and authorized definitions still talking about dropping estrogen levels? A cover-up. The first clear evidence for higher estrogen was published from a Melbourne epidemiology study in 1995 (10). The back-story here is telling—the authors measured estrogen levels that were variable but at least a quarter of them were much higher than expected. However, their interpretation was that estrogen levels were dropping. That’s because levels in the 45-55 year old women with regular cycles (whom they wrongly called premenopausal) were higher than in those who’d been without flow for three to 12 months (10). That illustrates the power of what I call “the estrogen myth.” I, who at the time was suffering with puzzling sore breasts, heavy but regular flow and mood swings, was ecstatic to see data that explained my experiences. However, I was horrified at the erroneous interpretation—my colleagues and I wrote an impassioned letter to the editor demanding that the authors “let the data speak” (11).

Now to the second cover-up—lower perimenopausal progesterone. If this were a world where women’s health was guided by science rather than by power-over-women, we would all know that perimenopause, besides being a time of higher estrogen, is a life phase in which progesterone is too low. You ask, “Why are lower progesterone levels important? I thought it causes PMS and breast cancer.” This ignoring or blaming of progesterone is the second major cover-up, and not just for 15 years, but since estrogen’s discovery in the 1920s. Framing women’s reproduction only in terms of estrogen creates the postulate that “Estrogen’s what makes a girl, a girl.” The estrogen myth further asserts that estrogen is the female hormone, much as testosterone is the only important male hormone.

Progesterone, however, is the second essential hormone for women, one that makes egg implantation and pregnancy possible. But progesterone’s job is much bigger than that—progesterone halts the exuberant growth that estrogen stimulates (12), and counterbalances and complements estrogen’s actions in every tissue of our bodies. If women’s health is a jetliner and one wing is estrogen, progesterone is the other wing. Women’s health literally doesn’t fly without both estrogen and progesterone.

You haven’t heard about progesterone’s essential role in women’s health because of the power-driven “estrogen myth.” As Susan Baxter and I wrote in The Estrogen Errors—Why Progesterone is Better for Women’s Health (13), there is a broad and consistent conspiracy to frame estrogen as the source of women’s allure and youthful health. The manufacturers of Premarin (the popular conjugated horse estrogen prescribed for and taken by millions of women) have cleverly crafted this erroneous notion by slogans such as  “estrogen deficiency” and “hormone replacement therapy,” and by their support for North American academic gynecology. It isn’t rational, but gynecologists love estrogen (14); their backlash after the Women’s Health Initiative results is further evidence of both the love affair and its illogic.

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.