Blog of the Society for Menstrual Cycle Research

Misogyny, Medicine, or Menstrual Madness?

February 29th, 2012 by Elizabeth Kissling

Guest Post by Lydia Aponte — Marymount Manhattan College

In Professor David Linton’s Social Construction and Images of Menstruation course, our class watched two documentaries involving menstruation and menstrual suppression. Both Period: The End of Menstruation? and Red Moon addressed what is becoming an increasingly concerning topic: now that menstrual suppression in the form of birth control is becoming more and more readily available – and is even being promoted to specifically stop or slow the menstrual cycle – is menstruation necessary?

Many women, including myself, have asked themselves this very question – some because of the monthly cramps that have reduced us to a fetal position, some because of the awkward situations that menstrual stigma has put us in. Yet, many women still do not question it because menstruation is believed to be a natural occurrence that must happen because, well, that’s just life. What happens, on the other hand, when a man questions the necessity of menstruation? Or even further, does something about it? Meet Dr. Elsimar Coutinho.

From São Paulo, Brazil, Dr. Coutinho appeared briefly in Red Moon avidly disputing the necessity of menstruation. He believes that it is not necessary, because “what is the use of an ovulation if it does not result in a pregnancy?” I was initially stunned by his intensity when it came to the subject, not only because of his stance against menstruation, but because of the role he seemed to be playing. It seemed as if Dr. Coutinho were playing the “mad scientist,” distributing birth control to women and spreading the word that menstruation was “unnecessary” and “unnatural.” So I decided to look up this “character,” and came upon Dr. Coutinho’s biography page. Of course, the first paragraph of his bio was nothing but praise: “Dr. Elsimar Coutinho is, unquestionably, a man born to make history. For more than 50 years, his research and discoveries in the fields of human health and reproduction have broken paradigms and brought down millenary concepts.” (For a man who made history, I had never heard his name before Red Moon.)

Yet, I was more taken aback by how he had been quoted regarding menstruation. “My greatest contribution to humanity was to realize that menstruation was unnecessary, a disposable phenomena.” (Coutinho, E.M.) Not only is a doctor refuting the biological necessity of menstruation, which alone is jarring, but a man is refuting the necessity of a cycle highly regarded by many women, including myself, as a symbol of womanhood and deeming it “disposable.” Not only is Dr. Coutinho refuting it, he is actively taking measures to suppress menstruation through his research and practices.

If menstruation equals womanhood to so many, and Dr. Coutinho believes that menstruation is unnecessary, what is he saying about the beliefs and values that many people hold in regards to femininity? According to his philosophy, those,too, would be disposable. Dr. Coutinho’s suggestions — although questionable — have caused me to ask these questions: has something I regarded a natural part of my female biology been unnecessary this entire time? Is the human body wrong, and is Coutinho seeking to correct it with medicine? Or is misogyny still a key player in the menstrual realm?

Margaret Atwood’s Menstrual Dystopia

February 27th, 2012 by David Linton

The menstrual cycle has been of interest to novelists from time to time and some of their work has received critical attention by scholars, most notably in Dana Medoro’s Bleeding in America, a seminal study that assesses the menstrual elements in the novels of Faulkner, Pynchon, and Morrison (previously reviewed here).  But perhaps the novel that is devoted most completely to the social, political, religious, cultural and economic impact of disruptions in the healthy functioning of the menstrual cycle is Margaret Atwood’s 1985 depiction of a menstrual dystopia, The Handmaid’s Tale.

Now, 27 years after its publication, the novel resonates with relevance to the current circumstances of our lives.  As such, it deserves recognition along with those other prescient novels of a dysfunctional future, Fahrenheit 451, Brave New World, and 1984.

Atwood envisions a world in which, due to a combination of environmental disasters, most women have become incapable of conceiving, leading to the creation of a cadre of “handmaids” who still have normal menstrual cycles and who are assigned to the leaders (“Commanders”) of the nation to bear them children who are immediately turned over to their infertile wives.  They enact a weird form of surrogacy patterned after the story in Genesis of Rachel’s handmaid having sex with Jacob so that Rachel can have a child.  The handmaids (who do not have names of their own but instead are referred to as possessions of their Commanders with the prefix “of,” as in OfFred) have sex by lying between the legs of the Commander’s wife so as to pretend that the congress is “normal.”  The fiction is continued when a birth occurs with the wife simulating labor surrounded by other wives while the handmaid delivers the child elsewhere.

The novel is prescient on many levels.  Our own concerns with the potential effects of environmental contamination on reproduction are strikingly anticipated:

“The air got too full, once, of chemicals, rays, radiation, the water swarmed with toxic molecules, all of that takes years to clean up, and meanwhile they creep into your body, camp out in your fatty cells. . . . Women took medicines, pills, men sprayed trees, cows ate grass, all that souped-up piss flowed into the rivers.  Not to mention the exploding atomic power plants. . . and the mutant strain of syphilis no mold could touch.” (143-144)

As a result, the birth rate plummets far below replacement level, schools are closed for lack of children and fertility becomes a rare commodity that is carefully controlled as women still capable of conceiving are doled out as special benefits to the rulers of the state.  All of this occurs in the context of a culture of religious fanaticism with a full complement of hypocrisy and brutality common to extremes of any stripe.

Key scenes are built around gynecological exams, menstrual anxiety, failed attempts at impregnation: all aspects of cycle management.  Every moment of the narrator’s life centers on her identity as a potential producer: “Each month I watch for blood, fearfully, for when it comes it means failure. I have failed once again to fulfill the expectations of others, which have become my own.” (95)

As we experience today’s resurgence of efforts to control or limit women’s reproductive options and the tangled skein of regulations, insurance restrictions, religious assertions, and political posturing, The Handmaid’s Tale makes for timely reading.

History of Pill Packaging, Outrageous Remarks about Birth Control, and Other Weekend Links

February 25th, 2012 by Elizabeth Kissling

Sex Ed for Teens: Where’s the Mucus?

February 24th, 2012 by Laura Wershler

Guest Post by Lisa Leger

Teen girls are getting pregnant, in part, because they don’t understand their menstrual cycles. It’s time for sexual health educators to step up and teach girls the primary sign of fertility.

A recent report by The Centers for Disease Control and Prevention (CDC) on teen pregnancy in the U.S., based on a survey of close to 5,000 young mothers who got pregnant unintentionally, found that half of them had not used birth control.  When questioned further, a third of those said that they didn’t think they could get pregnant. Their reasoning ties in with previous research findings that girls who get pregnant in their teens have misconceptions about their menstrual cycles. They don’t seem to understand how ovulation works and are failing to correctly identify the fertile days in their monthly cycles.

Photo by Acaparadora // CC-BY-SA-2.5

My colleagues in sexual and reproductive health education should take notice. These findings reveal a knowledge gap in sex education: Teens don’t know about the easy-to-spot sign of fertility that precedes ovulation – cervical mucus secretions. Let’s fix it by adding one simple phrase to our sex ed classes: “When you have mucus, you can get pregnant.”

We would also need to explain the ovarian cycle, how estrogen promotes cervical mucus production, the role of mucus in sperm survival and how to check for it. This is arguably among the most useful information young women and men could receive before leaving high school.

If girls had this knowledge then I believe that at least some of them would more accurately identify fertile days in their cycles and at least some unintended pregnancies would be prevented. When a girl knows that mucus on the toilet tissue means she is fertile and able to get pregnant, she may be empowered to avoid intercourse, insist on a condom if she has sex, or know if she needs to seek out emergency contraception. Or she may decide to just hang out with her girl friends. I’m not saying that fertility awareness is a magic wand. Of course, many factors influence our decision-making. But teens are capable of making wise choices when they have accurate information on which to base them.

I’ve talked to many public health nurses throughout my 20-year career as a fertility awareness instructor. They usually quibble about the effectiveness of fertility awareness as a birth control method and seem reluctant to mention the existence of cervical mucus for fear that “a little bit of knowledge is a dangerous thing.” They worry that some students, if taught fertility awareness, might screw it up, thinking they were “safe” when they were not. But the CDC report tells us that garbled understanding about how ovulation works is doing more harm than good.

I hasten to reassure my public health colleagues that I am not proposing we teach teenagers natural birth control. What I’m proposing is the awareness part, that we correct this critical gap in teenagers’ knowledge by explaining that mucus is an obvious sign of fertility.

I won over my local sex educator to this idea by showing her the evidence-based Justisse Method of Fertility Awareness User’s Guide. She now teaches the meaning of mucus in her ovulation lessons.I predict her students will benefit. When they feel that slippery wetness when wiping, they will remember that it has something to do with being fertile. When they see clear, stretchy mucus on the tissue, they will know it’s a fertile day. It seems obvious that reducing confusion about the fertile phase would result in fewer unplanned pregnancies among girls who are currently confused about when they’re safe and when they’re fertile.

Instead of withholding useful information about what cervical mucus means, let’s tell teens that avoiding sex when they observe mucus can prevent pregnancy.

SMCR member Lisa Leger teaches the Justisse Method of Fertility Awareness & Body Literacy and is a Natural Health Consultant on Vancouver Island.

What’s missing from Mother Jones’ birth control calculator?

February 22nd, 2012 by Elizabeth Kissling

Source: Public Domain

In response to Rick Santorum’s recent assertion that birth control only costs “a few dollars” and therefore there shouldn’t be such a big fuss about denying insurance coverage, Mother Jones published a birth control calculator this week that estimates your lifetime costs for birth control, based on your current age. The calculator asks you to enter your age and then select your preferred method. Options include the pill, IUDs, Implanon, injections, the patch, the vaginal ring, and surgical sterilization. (It doesn’t specify sterilization for women or for men, but given the context of the current debates, I’m assuming the calculator estimates only the cost of female sterilization.) It also fails to take into account that, in reality, most women use more than one method throughout their reproductive years.

Now, I know that aside from the cost of reference books, charting supplies, and perhaps a course or two to get started, using Fertility Awareness Methods is free, but condoms and spermicide aren’t. And as NPR reported on Tuesday, it can be difficult or inconvenient to get those methods covered by health insurance. Diaphragms and cervical caps aren’t cheap either, and they both require physician visits to be properly fitted. Diaphragms last a long time, but they do need to be replaced every few years. It’s been a while since I needed one, but I’m pretty sure that my health insurance covered the cost of my diaphragm, although I had to pay out-of-pocket for the accompanying spermicide gel. In my student days, I got both at my school’s Student Health Center, covered by the student health insurance fees that we were required to pay whether we used the student health center or remained on parental insurance.

I’ve written before about my bewilderment at the diaphragm’s disappearance, but I’m increasingly frustrated that the current political debates about the pill are contributing to the apparent erasure of all non-hormonal methods of birth control. The pill has become synonymous with birth control in some quarters, without consideration of the profound implications of that swap for women’s health.

I am not opposed to the pill, by the way. I want it to be available, I think it should be covered by health insurance, and I want it to be safe. But I also want women to have complete, accurate, accessible information about all of their birth control options. And let’s get all of them covered by health insurance.

All Wrapped Up

February 20th, 2012 by Elizabeth Kissling

Guest Post by Saniya Ghanoui

Photo by Jennifer Gaillard // CC BY-NC-SA 2.0

I always felt that airline travel involves building many short-lasting friendships where people bond over delayed flights, weather problems and luggage issues. Recently I was traveling and had to make a connection in the Dallas/Ft. Worth airport. I was using the restroom and I could hear the lady in the stall next to me change her sanitary napkin. She dropped the plastic wrapping from the new pad and it floated into my stall. Without hesitation, I picked up the wrapper and disposed of it. We both exited our stalls around the same time and as we approached the sinks she turned to me and said quickly but firmly, “Thank you so much for doing that.” I was a bit taken aback but responded “Oh, no problem,” we washed our hands and we bid each other farewell as we left the restroom.

The reason I was taken aback was because I felt she had nothing to thank me for. I simply picked up a piece of wrapping and threw it away. However, the serious tone of her voice told me that she was grateful for what I did. Perhaps it saved her what she deemed the embarrassment of picking it up herself? Or maybe she was just thanking me for a kind gesture. It wasn’t as if I gave her something (like a pad or tampon) that she could thank me for and the act in no way inconvenienced me. I wonder if she would have felt inclined to thank me if she had dropped a candy wrapper or tissue instead.

While there has always been this overall social need to conceal the period, it seems lately that there has been a surge in the desire to conceal menstrual products. Procter and Gamble has a site, Being Girl, that gives the Dos and Don’ts of tampon usage, including practicing at home to “see how quiet you can be when making a quick change.” And silence is one aspect that P&G tends to advertise, especially with its Tampax Pearl product. The wrapper becomes a selling point for Tampax Pearl because of its quiet and easy-to-open tabs that allow for utmost discretion.

I’m sure most re:Cycling readers have seen the U by Kotex line of menstrual products. This line is aimed at a younger crowd, the website has a section for tweens, and takes the idea of concealing in a different direction. Instead of making the products discreet and quiet the company advertises “hot new colors and wrappers.” However, changing the color or design of a tampon wrapper is still missing the point and is just as damaging as advertising products with quiet wrappers. The period is still being hidden. If a woman drops a bright green tampon wrapper on the floor is she now going to be less embarrassed because of the color? It doesn’t matter if the wrapper is white, pastel or a bright color, she shouldn’t be embarrassed at all. That is what needs to change — the embarrassment factor women have about their periods, not the colors of the products used.

Abortion, Birth Control, and U.S. Politicians — and Weekend Links

February 18th, 2012 by Elizabeth Kissling

Am I losing friends when I post menstrual cycle stuff on my Facebook page?

February 16th, 2012 by Alexandra Jacoby

Am I losing friends when I post menstrual cycle stuff on my Facebook page?

I wonder about that.

Actually, I worry about that. But I post anyway.

When someone “likes” a cycle post, every cell in my body tingles with glee, and sighs a little relief.

The other day, a particularly good post (that I learned about on Liz’s Weekend Links, written by Yashar Ali, “If Men Had Periods, Women Would Know All About It”) prompted a friend of mine to initiate a pre-yoga class period talk; we talked about the article – her thoughts on it and her boyfriend’s, and then she told me that she’d started using the Diva Cup. She liked it better than tampons, and was so happy to use a product that was not adding waste to the environment, and  and  and …how come she didn’t already know about this!!

Yeah. I know.

I’ve thought about this many times —

  1. how we don’t talk to each other as much as we could about body stuff in general, and cycle stuff in particular, because we’re embarrassed or ashamed…and how life-changing just getting to ask a question can be
  2. how information isn’t easy to find or understand, and so most of us are just not body literate…and what a difference to our quality of life increasing our body literacy would bring us
  3. as would menstrual products that fit well into our lifestyles, are good for our bodies and the environment improve our lives…and yet most of us don’t know what our options are or expect to have a say in them

I was thinking about that, all that, again, thinking…and then I realized that it was time. Time to take a significant step forward into that space that I worry about, where you can see me and hear what I’m thinking about. Time for me to choose among these three menstrual cycle subjects:

  1. stuff about our bodies we don’t talk about
  2. body literacy
  3. products

and to commit to exploring and writing about one of them for the next year.

Ok. I’m in. (eek)

Only…

I can’t decide on which one (a lifelong condition – I find everything to be interesting!) — so I’m asking you to choose for me.

Vote in the comments, or email me if you want privacy. In addition to your vote, I’d love to hear what prompts your choice, if there is anything in particular you’d like to read about, to better understand it, or change it, improve it… I will keep that in mind as I go forward.

Let’s say I’ll start on Feb. 29th, and you have until then to vote. In March, you can read my first installment in this to-be-named series here at Re: cycling.

Totally posting this on my Facebook page!

 

 

Advertise Your Period Dot Com

February 15th, 2012 by Elizabeth Kissling

Today, in vintage femcare advertising, we bring you Tampax’s idea of menstrual shaming, 1990s style:

 

But Tampax doesn’t understand menstruation as well as they think they do. Sure, it might be a little tiresome to have a Mariachi band follow you around everywhere for most of a week, but as I’ve indicated before, I love the idea of a musical celebration of my monthly miracle.

Why Can’t We Criticize the Pill?

February 13th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall

On February 10th, the Washington Post published an op-ed piece by Rachel Maddow. In this she outlines how there are Republicans who don’t want birth control covered by insurance, they don’t want Planned Parenthood receiving federal funding, and they want an embryo to be considered as a person with rights. She highlights that this last issue threatens the legality of hormonal birth control. In the final paragraph she states:

“Time will tell on the political impact of this fight, but the relevant political context here is more than just a 2012 measure of Catholic bishops’ influence on moral issues. It’s also this year’s mainstream Republican embrace of an antiabortion movement that no longer just marches on the anniversary of Roe v. Wade to criminalize abortion; it now marches on the anniversary of Griswold v. Connecticut, holding signs that say “The Pill Kills.”

Discarded Pill Package Photo by Beatrice Murch // CC-BY-SA 2.0

I was somewhat perturbed by Rachel’s slightly misleading description of how hormonal birth control works which suggested she has no more of an understanding than the Republicans she is railing against. However, I like her and I am loathe to criticize her — but I must. The thing is — the pill does kill. I’m not talking unborn children, I’m talking teen and adult women who are definitely considered persons.

As I wrote about for Ms. magazine last week, the FDA recently ruled to keep the oral contraceptives Yaz and Yasmin on the market despite the fact that it was discovered these drugs hold a 50% to 75% increased risk of causing blood clots than other birth control pills. Even though they are only as effective as other pills in preventing pregnancy, an FDA advisory board weighted with people with financial ties to Bayer Pharmaceuticals decided the benefits outweighed the risks. There are 10,000 lawsuits against Bayer — women who have been seriously injured by the embolism, stroke, or heart attack that resulted from a blood clot and the families of women who have died. I spoke to a lawyer working on many of these cases who told me one of his clients is a 20-year-old young woman who was training to be an Olympic skier when she started taking Yaz. She developed a blood clot, had a stroke, and is now permanently injured.

Now, I’m British and so where I’m from birth control is free under the National Health System. If you want to use the pill for contraception the doctor draws a little ‘female’ sign on your prescription and the pill is given to you, any brand and as often as you need it, for free. If you want it for, say, acne or endometriosis treatment, you pay the same prescription rate as you would any other drug — around $12. The NHS has even piloted schemes to make the Pill available over-the-counter. So, I’m coming from a very different background and therefore when I started criticizing Yasmin — and then the pill as a whole — through my blog, Sweetening the Pill, I was perplexed to find I was accused of siding with the far and religious Right. I’m pro-choice. I used the pill for a decade. Now I use a combination of condoms and spermicide together and the fertility awareness method. I don’t want children. I have no problem with abortion. I’m not Christian. Somewhere around half of the British population do not see themselves as part of an organized religion, significantly more than in the US.

From this standpoint, to me it seems as though the fight over sustaining access to birth control is preventing women speaking honestly about the pill, and hormonal contraceptives in general. In the US women seem too scared to criticize the pill as they think anything less than zealous enthusiasm will be seized upon by the Right and used as fodder in their bid to ban birth control. This situation means there is very little accurate information getting through to women about the risks of hormonal contraceptives — from the quality-of-life-threatening to the truly life-threatening. Those on the Right that are looking to ban birth control or limit access (like Mr. Rick Santorum) are manipulating information, this is true, but so are those who claim to be working for women, who claim to have women’s best interests at heart – feminists, activists for reproductive rights and the women’s health movement. The silencing of honest discussion is letting many women suffer unnecessarily as a result of using the Pill.

Bears, Vagina Vérité, Profiting from Periods, and more Weekend Links

February 11th, 2012 by Elizabeth Kissling

“Death Loves Menopause”: Heart and Stroke Foundation Sends Wrong Message

February 8th, 2012 by Laura Wershler

The Heart and Stroke Foundation of Canada has inaccurately branded menopause as a killer of women. I will not be sending them a donation.

Last October, the foundation launched a fundraising campaign called Make Death Wait. Magazine and TV ads personify death as a man with a disembodied voice (he sounds like a stalker) who says he loves women (and men) and is coming to get them.

Eileen Melnick McCarthy, director of communications for the foundation, wrote to me in an email that the intent of the campaign is to “wake up Canadians to the threat of heart disease and stroke.” The campaign – urging viewers to “make death wait” by making a donation – has drawn both support and criticism.

Note the stereotypical hot flash reference: The thermostat is set at 15 C (60 F) but reads 23 C (73 F).

Photos of the ad by Laura Wershler

I think the TV ads are creepy, but what disturbed me more was the Death Loves Menopause message in the December issue of Chatelaine, Canada’s oldest women’s magazine. The small print reads: “He loves that menopause makes women more vulnerable to heart disease and stroke.” But is this statement defendable?

Dr. Jerilynn Prior, endocrinologist and scientific director of the Centre for Menstrual Cycle and Ovulation Research, wrote in an article about women’s risk for cardiovascular disease that the assumption heart disease in women is caused by estrogen deficiency associated with menopause  is a myth:

The reasoning behind this notion goes like this—young women have lots of estrogen and don’t get heart attacks. Older menopausal women are “estrogen deficient” and get heart attacks. Therefore, lack of estrogen causes women’s heart disease. That is like saying that headache is an aspirin-deficiency disease!

 

It is true that heart disease and stroke is the #1 killer of women, but the ad’s assertion that it is menopause that makes women more vulnerable raised the ire of women’s health experts I asked for comment.

Joan Starker, a PhD clinical social worker specializing in midlife, menopause, and aging issues, called it “an appalling and shocking advertisement.” Starker says she and her colleagues have “worked hard to shatter negative conceptualizations of menopause and aging. When I viewed this ad, I was left with only one horrifyingly toxic message – menopause equals death – which is ageist and sexist.”

Barbara Mintzes, assistant professor at the University of British Columbia, calls the ad “misleading and inaccurate” and says “there is no sudden shift in the rate of heart disease post- versus pre-menopause (or around age 50), as would be expected if menopause was a major risk factor for heart disease.  As women age our risks of heart disease gradually increase, similarly to ageing in men.”

My fellow blogger, Paula Derry, is a PhD health psychologist who critiques, analyzes, and theorizes about menstruation research/theory, with menopause being one of her specialties. “The idea that women’s risk of heart disease increases after menopause is a common one, yet there is little evidence for any increase in risk, much less that menopause is a key cause of heart disease and death,” she says.

Derry cites a 2011 paper in the British Medical Journal - Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States – that concluded aging rather than menopause was key: “Heart disease mortality in women increased exponentially throughout all ages, with no special step increase at menopausal ages.”

Last March, the American Heart Association issued the Effectiveness-based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update. These guidelines present a long list of risk factors such as obesity, poor diet, physical inactivity, high cholesterol, hypertension and diabetes. Menopause is not included as a risk factor and is mentioned in just one sentence in the document.

As Derry says, “If I were going to donate money to an organization it would not be to one that tried to scare me with what I understand to be inaccurate facts.”

The Heart and Stroke Foundation of Canada should “wake up” to the truth about heart disease and menopause.

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.