Blog of the Society for Menstrual Cycle Research

Why Women Menstruate, Yeast Infection Myths, and Other Weekend Links

December 31st, 2011 by Elizabeth Kissling

On Menopause Definitions

December 28th, 2011 by Paula Derry

Guest Post by Paula S. Derry, Ph.D.

In a recent blog post, Heather Dillaway commented on the uncertainty, confusion, and frustration she felt as a menopause researcher, given the lack of consensus about the most basic aspects of the menopause transition. Researchers don’t agree about their definitions, and can’t even agree on what needs to be defined. She asked for reactions to her entry; I’ve found that my reaction has grown into this separate post.

Fire in the Head by Beate Knappe // CC 2.0

I, unlike Heather, am not a sociologist. I’m a health psychologist. My training and current work include analyzing, critiquing, and making sense of experimental research and theories. I have also developed workshops for community women and for professionals whose aim is to provide health-promoting information and decision-making heuristics. I have given a lot of thought to the issues that Heather raises, and this is as far as I’ve gotten with them.

To me, there are many layers of issues involved. The first is the fact that the science — about the physiology of menopause and the processes leading up to it — is limited and incomplete. Part of the reason that professionals disagree about whether the life course of menstruation has five stages or seven, or why women have hot flashes, or even why women have a menopause, is that we don’t actually know. We simply do not have the scientific facts. We don’t understand what the underlying process is or how it works. Given this uncertainty, professionals must make judgments about how to define terms and what their hypotheses (or best guesses) are about underlying processes. A second fact, along with our limited real knowledge, is the tenacity with which professionals assert their judgments and argue against competing views. People disagree and they hold strongly to their positions—about language and the facts. To me, it makes sense to have definitions of stages of menstrual life that are objective and easily measurable (like the STRAW staging system) for researchers who need to compare results with each other. It doesn’t make sense to assert that this system, based on expert opinion and not on experimental facts, actually defines when a particular stage really “begins.” It makes sense to say that experimental research supports the idea that changes in the thermoregulatory center of the hypothalamus are important processes if you’re trying to understand hot flashes.  It does not make sense to conclude that these brain changes in themselves explain hot flashes; other factors must also be involved.

I think another source of confusion is that menopause is not one thing, but many. It is a circumscribed biological change (lack of periods and what leads up to them physiologically) and also a psychosociocultural matter. We have a term for when girls begin to menstruate (menarche), a separate term for the larger biological changes of which menarche is a part (puberty), and another term for the biopsychosociocultural changes of which puberty is a part (adolescence). I think these kinds of distinctions are confused with regard to understanding menopause in part because there is cultural confusion about midlife (or mature adulthood or whatever term you use) as a life stage.  There is no cultural consensus about this stage of life.  And, indeed, this isn’t surprising.  Some women are planning retirement while others are training for a new job or career.  Some are grandmothers while others are raising a young child.  My opinion, also, is that we as a culture have a paucity of concepts of mature, responsible adulthood and what it means.

Finally, I think another source of confusion has been relying on biomedical information to understand menopause. Biomedical information is important. A woman who is experiencing odd changes in her periods, clots or frequent bleeding or whatever, should be able to get information about whether this is a health problem. And so on. However, research has shown that the kinds of questions that interest women are often not the questions that interest physicians. What does this stage of life mean to me? What are good ways of coping with uncomfortable or distressing experiences? All too often, biomedical information has encouraged a negative view that menopause is the gateway to old age or a body that is vulnerable to illness, a view that goes far beyond the facts. The biomedical perspective has thus often encouraged a view that menopause is extremely important, a watershed experience that must be vigilantly attended to and worried about, while not providing information about how to effectively deal with the changes ascribed to menopause.  Biomedical perspectives have even encouraged a passivity in the face of physiological changes, a pessimism that anything other than medical care can be effective in alleviating problems.

Everything you need to know about the menstrual cycle in less than 3000 words

December 26th, 2011 by Chris Bobel

The Research Pile by Krista Kennedy // CC 2.0

What happens when get a bunch of interdisciplinary menstrual cycle researchers together and give them each a topic or two and a word count?

 

You get a pithy document called “The Menstrual Cycle: A Feminist Lifespan Perspective” available to anyone who needs to put their finger on the state of menstrual cycle research today. Readers of re:Cycling know there is deep complexity swirling around the menstrual cycle (indeed, that’s why this blog exists!)  so it sure is helpful to have a resource that collects the key info in one tidy place.

The Fact Sheet –four pages of content and two pages of must-have references—was collaboratively written by a team of members of the Society for Menstrual Research. It is available for download here [pdf]. Sections include menstrual attitudes and representations, menarche, peri/menopause, menstrual care, problems associated with menstruation and more. Something for everybody.

 

The Fact Sheet is commissioned and published by Sociologists for Women and Society (SWS), who, since 2002, has been publishing several fact sheets each year on topics ranging from Women & Size to Title IX to Women, Poverty and Welfare Reform. These resources are immensely helpful to scores of folks—teachers, activists, clinicians, the interminably curious—anyone , really, who needs concise accurate info.

 

Impress your friends. Go grab the Fact Sheet!

Margaret Cho’s Period Musings, Bad Tampon Ads and other Weekend Links

December 24th, 2011 by Elizabeth Kissling

 

What I told the girl in my life about menstruation

December 22nd, 2011 by Alexandra Jacoby

Last month I wrote about what I would tell the ten-year-old girl in my life about menstruation. This would be my first conversation about it with her.

I really appreciated the supportive responses that I received in the comments and offline! 
I was nervous about it. Your participation helped me to move forward.

Some of you asked me to tell you how it went…

I’m not going to.

Maybe it went well. Maybe it didn’t. Maybe it was a long talk, and kind of delicious to get that time with her, or maybe it ended abruptly. Maybe we hugged, suffered long silences, or laughed each other silly. Maybe I drew diagrams and she was the art director. Maybe she’s avoiding me now.

It doesn’t matter.

Because the point is – even more than to start talking – to keep talking. Not to look for done. Not to hope for done.

Just to say what you have to say; ask questions, reveal what matters to you, and stay.

Knowing that it’s not over. If it didn’t go “well”, that’s just a moment in time.

Remember why you wanted to have this talk – why you wanted her to have this information – why you wanted her to trust you with her questions and opinions.

If it went well, that’s just a moment in time. You don’t know what will happen next.

Her body-experiences, social experiences, ideas, needs and wants are going to change change change.

Done doesn’t exist in our world of human bodies.

Maybe I gave a really “good” talk and it still sucked for her. Maybe my girl’s poised reception of my seriously-delivered speech is not a possibility for either of you. Don’t worry about that.

I’m not telling you how it went because I don’t want our story leading to dos and don’ts, cues to take, and pitfalls to avoid. All that is useful, but I want to stay general for a moment, and, in the absence of specifics, to appreciate on the ongoing, evolving nature of

talking about, 
and being, 
a human body.

A Whole New Meaning to DIY Menstrual Pads

December 21st, 2011 by Elizabeth Kissling

When Arunachalam Muruganantham discovered that his wife was using old rags for menstrual pads to save their family the cost of pre-manufactured sanitary napkins (paying Indian prices for sanitary napkins “meant no milk for the family” that week), he decided to create a low-cost napkin. Read his amazing story of how he did it: It includes teaching himself English and pretending to be a millionaire to get U.S. manufacturers to send him samples of their raw material, and testing his pads by wearing them himself — while also wearing women’s underwear and his own homemade menstruating uterus, consisting of a bladder filled with goat’s blood.

It’s hard to imagine a high school dropout in the U.S. pushing this as far as Muruganantham did with the obstacles he faced — but only because we can take cheap pads and tampons for granted.

Thanks to Khalil for sending me this story.

Food insecurity is associated with later puberty

December 20th, 2011 by Chris Hitchcock

Many girls in Africa have insecure access to food, that is, they worry about getting enough food, and they sometimes eat less than they want, or go without food. There are two theories about how this might affect the onset of menstruation (menarche). One is that the limitations in energy and nutrition might slow development, resulting in a later menarcheal age. The other evolutionary theory is that early life stressors trigger a shift in so-called life history strategy, leading to accelerated development and an earlier menarche. In a recent article in the journal Reproductive Biology and Endocrinology, researchers from Ethiopia, Belgium and the USA presented data from the first two years of the Jimma Longitudinal Family Survey of Youth to contrast these two theories. The survey was conducted in southwest Ethiopia, sampling across rural, urban and small town areas and including boys and girls. Data about the household and the girls’ experience of food insecurity were assessed by questionnaire in the first year, and in the second year girls were asked whether and how old they were when they first menstruated. 900 girls, with an average age of 14.8 at baseline, participated in both of the first two years of the five year study.

Overall, girls who reported some degree of food insecurity (n=225/900) were similar in age, region (urban, semi-urban, rural), and nutritional status (whether they were short for age). However, they were more likely to be in a male-headed household, tended to be in middle income rather than high income households, and reported more domestic work than those reporting food security. Overall, girls with moderate to severe food insecurity were significantly less likely to have undergone menarche. The estimate of the age at menarche was one year older for Ethiopian girls who have insecure access to food.

Girls in the developing world experience menarche at an older age than those in the developed world, and, with development, other countries are experiencing the secular change of earlier age at menarche. In this study, the estimated age at menarche was younger in urban centres (14) than in semi-urban or urban areas (15), and girls in high income households had an earlier menarche, suggesting that improved food security may be part of the puzzle explaining these changes.

Nuns on the Pill, a Menstrual Cycle Primer, and other Weekend Links

December 17th, 2011 by Elizabeth Kissling

Endometriosis and the Mysteries of Pelvic Pain

December 16th, 2011 by Elizabeth Kissling
Endometrial tissue embedded in abdominal wall

Endometriosis in abdominal wall. Photo by Ed Uthman, MD. Public domain.

I’ve recently developed a whole new understanding of why it takes so long for women to receive a diagnosis of and treatment for endometriosis. It’s not just the constraints of menstrual etiquette or the belief that painful periods are normal, especially for young women.

 

It’s about poop. No one wants to talk about that, least of all me.

 

I have endometriosis, and I’ve known it known for years. My doctors know it, too. It was seen through the laparoscope during a procedure for something else when I was about 35. But I’m still having trouble getting a diagnosis and treatment.

 

A flare-up of pain began two months ago, and I went to the clinic for relief and told the responding physician, “I think it might be my endometriosis”, pointing to the low area on my pelvis where it hurts. He asked a lot of questions about my bowels — I’ll spare you the grisly details — and ordered blood tests and an abdominal x-ray. After studying the results, he prescribed treatment for constipation, and urged me to call or return if my pain was not soon resolved.

 

Since that October afternoon, I’ve seen three additional physicians and continue to experience daily pelvic pain. I’ve had more blood tests, another x-ray, and a contrast CT scan, which showed normal bowel function. Perhaps because I had a hysterectomy a few years ago for adenomyosis, my doctors* continued to focus their attention on my ‘bowel problem’, rather than reproductive health issues, even though I retain healthy, functioning ovaries.

 

Until this week, when I finally saw the gastroenterologist. He listened to my description of the pain and its location, and more detail about my bowel habits than I’ve ever had to report since my mother toilet-trained me. And after a brief examination, he referred me back to the gynecologist who performed my hysterectomy. That’s right — he found nothing wrong with my bowels. My appointment with the gynecologist is early next week, and I’m optimistic that I will finally have an answer about the source of my pain, and even better, a means to resolve it.

 

For me, a well-educated, 48-year-old ciswoman with good health insurance who already knows she has endometriosis, this has been only two months of dealing with pain and the annoyance of waiting and medical bureaucracy. I can only imagine what kind of torment this might be for women with more severe symptoms without these resources, and without the knowledge that endometriosis frequently presents as, or with, gastrointestinal symptoms. Doctors who don’t specialize in women’s reproductive health may not even know this. Frequently, the symptoms of endometriosis are bowel symptoms:

  • Painful bowel movements
  • Constipation
  • Diarrhea
  • Alternating constipation and diarrhea
  • Intestinal cramping
  • Nausea and/or vomiting
  • Abdominal pain
  • Rectal pain
  • Rectal bleeding

I’m reminded again of my friend and colleague Laura Wershler’s frequent calls for body literacy; we need to know our own bodies, and know how to talk about them. I can talk about menstrual cycles until the cows come home, but it has been a real challenge to observe and talk about the details of bowel habits, even with my trusted physician.

 

Good health requires good communication.

 

P.S. I’m still in pain, and it’s really hard to say this in public, but thank you, Dr. S., for recommending the daily dose of MiraLax.

 

 

*I’m compelled to note that, Dr. S., my primary care physician, or ‘PCP’, as my health insurance plan refers to him, is a wonderful doctor. I really don’t have complaints about his care, and I have pretty good health insurance, and I’m lucky to have both.

Yaz, Yasmin and Ortho Evra patch increase risk of blood clots

December 14th, 2011 by Laura Wershler

Blood clots are a serious, if rare, side-effect of hormonal contraceptives. If left untreated, clots can lead to debilitating, or fatal, strokes. The increased risk of blood clots in users of some hormonal birth control brands has been the subject of several recent news stories.

In early December, Health Canada asked Bayer Inc. to change the labels on Yaz and Yasmin, two of the most popular birth control pills, because use of the drugs is linked to higher rates of blood clots.

According to a November 2011 story at cbc.ca/news, health problems associated with these two drugs include stroke, deep vein thrombosis, pulmonary embolism and heart attack.

The concern surrounds the progestin – drospirenone –  used in Yaz and Yasmin. Although promoted as being associated with less bloating and clearer skin than other progestins, drospirenone is also associated with a “1.5-to-three fold increased risk of experiencing a clot compared to women using other birth control drugs.

What this means in real terms varies from study to study, but one study led by Susan Jick of Boston University found the rate of non-fatal blood clots to be 30.8 per 100,000 among women taking Yaz or Yasmin (the only drugs containing drospirenone) compared to 12.5 per 100,00 among those taking pills containing the older, more common progestin levonorgestrel.

In related news this past week, advisers to the FDA recommended that Johnson and Johnson revise the label on its Ortho Evra birth control patch to better explain the risk of blood clots. Use of the patch has been associated with a higher rate of blood clots for several years. Publicity about the clot risk has no doubt contributed to a 50% decline in sales in the last five years. The formulary problem with the patch is its higher dose of estrogen compared to other pills.

The FDA advisers also recommended more detailed description of blood clot risks for Yaz and Yasmin.

What caught my eye in both stories were the take home messages from those requiring these label changes to women using these drugs.

Health Canada said women should talk with their doctors about the risks and benefits of taking drospirenone-containing oral contraceptives but did not urge women to stop using Yaz and Yasmin.

The FDA’s reproductive health advisers “voted 19-5 that the benefits of the weekly Ortho Evra patch outweigh its risks, including a potentially higher risk of dangerous blood clots that can cause heart attack, stroke and other life-threatening problems.”

I want to know why the five FDA panelists opposed to this decision think the benefits of the patch DO NOT outweigh the risks.

These news stories beg the question:  Should women be concerned enough about the increased blood clot risk associated with Yaz, Yasmin and the Ortho Evra patch to stop using these brands?  If you take these drugs, are you concerned?

If adverse publicity about blood clots resulted in a sharp decline in sales of the Ortho Evra patch, we should expect to see a similar decline in sales of Yaz and Yasmin.

The cbc.ca article reports that the family of a Toronto woman, who died of a large pulmonary embolism after taking Yasmin, has filed the first individual civil suit against Bayer Inc. in Canada. It also states that “more than 10,400 individual lawsuits related to the two pills have been filed in the U.S.”  Not to mention the class action suits related to these drugs currently in progress in both countries.

One thing is certain, the litany of stories about the adverse effects of hormonal contraceptives is not about to end anytime soon. Stay tuned.

Weekend Links

December 10th, 2011 by Elizabeth Kissling

A personal apology for us from o.b. tampons

Pfizer to pay $72 Million in Philadelphia PremPro Case

December 9th, 2011 by Chris Hitchcock

Three women who developed breast cancer after their use of combination hormone therapy have been initially awarded $72 million by a jury in Philadelphia, with further judgement about punitive damages still to come. The case concerns the use of PremPro, a combination of conjugated equine estrogen and medroxyprogesterone made by Wyeth. Wyeth has since been purchased by Pfizer. Women’s Health Initiative trial results released in 2002 found an increased risk of breast cancer in those randomized to estrogen + progestin compared with placebo. Earlier this year, Pfizer announced that it has set aside $772 million in its budget for settling PremPro lawsuits.

Prior to 2002, hormone replacement therapy was often recommended to otherwise healthy women as a health-enhancing preventative therapy. SMCR has long held that menopause is a natural stage in women’s lives, rather than a condition to be treated. Hormone therapy is no longer recommended for the prevention of disease in healthy women.

 

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.