Blog of the Society for Menstrual Cycle Research

How to menstruate while camping?

October 30th, 2012 by Alexandra Jacoby

A friend of mine is going camping soon, and getting her period then is the last thing she wants to think about!

Photo by Beth and Christian Bell // CC 2.0

Camping and menstruation…That reminded me about the bears-being-attracted-to-menstrual-blood question, and, in case she didn’t know,** I let her know that there is no evidence that bears are more attracted to menstrual smells more than any other smells…

That put a little space between me and her question of how to deal with it while camping.
I didn’t know what to tell her.

No, she didn’t know that about the bears.
That’s good to know.

Back to what to do about her period: what’s the ecologically-respectful way to handle it? I didn’t know what to tell her—other than ziploc bags. [my answer for most travel/packing questions].

I told her I’d look into it, and found my way back to the article on bears and menstruation, and forwarded it to her.

It’s not exactly en pointe, but I thought this part from the Precautions section — “Do not bury tampons or pads (pack it in – pack it out).” — the pack it in/pack it out part was useful.

It goes on with: “Place all used tampons, pads, and towelettes in double zip-loc baggies and store them unavailable to bears, just as you would store food.” [Ziplocs: I knew it!]

So, leaving nothing behind is good, but all that used product is still heading for landfill, right?
So maybe then: the cup?

She made a face.

I know. It’s sticky, wet. And you’re in the woods. Blood feels like more to deal with than pee…

But wait, is it ? –

If you’re staying put, you’ll be washing somewhere, right? Is this designated space actually different than using any shared bath”room”?

I realize you’ll be outdoors, but still it’s not much different than a public bathroom—that may or may not be in working order, and that will or won’t have products and plumbing organized for easily, privately and completely dealing with menstrual blood.

If you know where you’ll be washing up, then you’ll know if there’s going to be a water available for washing, or not. What you don’t expect to be provided there, you’ll have to bring with you. Just as you do with public bathrooms.

If you’re on the move, then it’s harder. There may or may not be water or privacy when you want it. And, the whatever that you’ll be taking with you, you’ll have to carry it.  And, water is heavy.

Again, come to think of it: this is the same situation as city travel.

I’m not saying that it won’t be harder, stickier, in the woods than in Manhattan, just that this camping story is highlighting the fact that we still need to figure this out for city life.

Bidets. I haven’t seen one in years, and never in the U.S.
Is that what we need? 

How did we do this before (our ill-equipped modern times)? she asked, still looking for what could work in the woods. — Again: I don’t know. Though, I’m reminded of the red tent. Logistically speaking — was that it? How it got addressed — menstrual hygiene?

Does it have to be like that? 

Can this be done without the isolation piece? 

Can the fact that we menstruate be included in a society where living goes on, where work continues, relationships, commitments, projects, gardening, raising children, caring for those who are ill or need help, first dates, parties and camping trips, it all keeps going.

And so do we. We, menstruators, keep going.

With varying experiences of bloating, pain, etc., living goes on. Varying experiences. I am not representing a group here, just myself—and thinking about others: wondering about your experiences and whether/how your needs are met.

Me — I would like it to be easy and normal to bleed. I also don’t want the world involved in when and how I do, so I don’t want to step off, and I don’t see a reason to stand out: it’s a normal experience, right? Our facilities should match that.

Voting with Your Ovaries, Pill Embarrassment, and More Weekend Links

October 27th, 2012 by Elizabeth Kissling

Source: EpicFail.com, Monday Oct 15, 2012.

  • Jezebel reports on an online study that found “almost 40% of women use their period as an excuse to get out of lame things“.
  • Sex or meditation? Why not both?
  • Have you seen Ruby Cup’s video response to the Bodyform video we posted and wrote about last week?
  • You may have seen on our Facebook page that CNN quickly removed their story about that sketchy study about how women’s voting decisions are driven by ovulation. But Kate Clancy’s blog at Scientific American has a great takedown of the original study. The tl;dr version is this: “I do not understand how it is ok to publish papers that are predicated on an assumption about ovulation and hormone concentrations, but not measure ovulation or hormones.”
  • Brown University student Cara Dorris has written a pointed and insightful column for her school newspaper about eating disorders and the far more common, even normalized, campus practice among young women of disordered eating. Dorris lists some of the consequences of habitual undernourishment (a.k.a., dieting):

    You develop a significantly higher miscarriage rate. You may become anemic. You may stop getting your period and become infertile. Your bones will stop strengthening and might actually atrophy. You are at risk for stress fractures and early onset osteoporosis. Your heart may weaken. You may literally get dumber from changes in cognitive function.

  • If you click on the “Advertising” or “FemCare Advertising” tag in the column on the right, you won’t have any trouble locating examples of magazine ads and television commercials that use shame to sell menstrual products. Yesterday, alert reader Melissa Doty sent me a link to a new ad for NuvaRing contraceptives that uses the old tried-and-true “it fell out of my purse and I was so embarrassed” trope. But this time it wasn’t a tampon but a packet of birth control pills that embarrassed the modern woman. Oh no! People might think she has health insurance! To see the ad for yourself, visit this page on the NuvaRing site, and select Oh!verheard at a Gym.
  • GOOD magazine reports on a study about how gynecologists talk about sex – and fail to talk about sex.

Footloose and Pharmaceutical-Free?

October 26th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

At the West Coast Catalyst Convention for sex-positive sex-educators I was listening to a talk on definitions of sexual health when the birth control pill was brought up. I’d spent much of the event feeling desperately vanilla and so was pleased to be discussing something other than strap-ons and lube. The most popular forms of contraception – the hormonal kind – had been notably absent from all discussion that weekend.

Toys in Babeland window display, Photo by Joaquin Uy // CC 2.0

The speaker told the group that the pill is the leading cause of low libido and pelvic pain. She explained that studies had suggested the impact on libido could be permanent. The reaction of the audience was immediate and urgent – questions were fired out and it became clear that this information was news to most. A number of audience members seemed genuinely shocked. “What’s the science behind that?” one woman asked, but the speaker said she didn’t know.

Although the convention’s attendees had an intimidating level of knowledge when it came to sexual technique and sex toys, I discovered that once I mentioned I was there to develop a book and a documentary on hormonal contraceptives, many repeated the usual disinformation about birth control methods.

The speaker was right – the birth control pill is a leading cause of lowered sexual desire and pelvic pain. It’s also known to cause loss of lubrication, vaginitis, and vulvodynia. Other hormonal contraceptives such as the Depo Provera injection, implant, ring and Mirena IUD have been seen to have similar consequences. In fact, Dr. Andrew Goldstein, director of the U.S.-based Centers for Vulvovaginal Disorders and one of the foremost vulvodynia experts in North America, blames an increase in complaints of this kind on third generation low-dose pills.

The study the speaker referred to was conducted by Dr. Claudia Panzer of Boston University and it did suggest some women may see a permanent effect on their testosterone levels, and so their level of desire. There have also been studies on these methods impact on frequency and intensity of orgasm, showing both to be decreased. Not to mention the 50% of women who will experience general negative mood effects that surely impact on their interest in sex. Many, many other studies have shown a clear negative effect on libido whilst using hormonal contraceptives. So many that it’s become something of a joke to roll eyes over the “irony” of prescribing a pill for pregnancy prevention that stops you wanting to have sex anyway.

At a convention dedicated to the celebration of sexual pleasure, I was surprised to see this information received with such confusion. A sex-positive attitude is becoming synonymous with “set it and forget it” long acting hormonal methods of contraception. But it struck me that sex-positive advocates should be the biggest fans of fertility awareness methods. Here’s why:

Is PMS Overblown? That’s What Research Shows

October 24th, 2012 by Elizabeth Kissling

If PMS is a myth, then what on earth can we blame for all the lady-rage?

Photo by Flickr user dearbarbie // CC 2.0

You may have seen the article in The Star or The Globe and Mail or The Atlantic about the recently published research review by a team of medical researchers who assert that “clear evidence for a specific premenstrual phase-related mood occurring in the general population is lacking.” Judging from the headlines and the online comments, this proposition is surprisingly controversial–probably because the headlines were frequently misleading, suggesting the findings are much broader than they are. Some online commenters are especially angry, insulting the intelligence and methods of the researchers, proclaiming that of course hormones affect moods, as does menstrual pain, citing examples of their own or their wives’ experience.

But Sarah Romans, MB, M.D.; Rose Clarkson, M.D.; Gillian Einstein, Ph.D.; Michele Petrovic, BSc and Donna Stewart, M.D., DPsych–the five medical scholars who reviewed all the extant studies of PMS based on prospective data–did not claim in the now-infamous Gender Medicine review study that PMS does not exist, or that hormones do not affect emotion or mood. The variety of research methods used in other studies prevented them from conducting a meta-analysis–a statistical technique that allows researchers to pool results of several studies, thus suggesting greater impact–so the authors instead looked at such study characteristics as sample size, whether the data was collected prospectively or retrospectively (that is, at the time of occurrence or recalled from memory), whether participants knew menstruation was the focus of the study and whether the study looked at only negative aspects of the menstrual cycle. Although their initial database searches yielded 646 research articles dealing with the menstrual cycle, PMS, emotions, mood and related keywords, only 47 studies met their criteria of daily prospective data collection for at least one full cycle.

When the authors scrutinized these studies, they found that, taken together, there is no basis for the widespread assumption in the U.S. that all (or even most) menstruating women experience PMS. In fact, only seven studies found “the classic premenstrual pattern” with negative mood symptoms experienced in the premenstrual phase only. Eighteen studies found no negative mood associations with any phase of the menstrual cycle at all, while another 18 found negative moods premenstrually and during another phase of the menstrual cycle. In other words, the symptoms these women experienced were not exclusively premenstrual, making the label inaccurate. Four other studies found negative moods only in the non-premenstrual phase of the cycle.

So let’s be fair, angry online commenters (and careless journalists): The researchers aren’t telling you menstrual pain is all in your head, or that your very real period pain won’t affect your mood. Sarah Romans did tell James Hamblin of The Atlantic,

The idea that any emotionality in women can be firstly attributed to their reproductive function—we’re skeptical about that.

Rightly so–feminists have been saying this for decades. Feminist critiques of PMS as a construct point to both the ever-increasing medicalization of women’s lives and the dismissal of women’s emotions, especially anger, by attributing them to biology.

Part of what makes PMS difficult to study, and difficult to talk about, is the multiple meanings of the term. In the research literature, there are more than 150 symptoms–ranging from psychological, cognitive and neurological to physical and behavioral–attributed to PMS. There is no medical or scientific consensus on its definition or its etiology, which also means there is no consensus on its treatment.

In everyday language, its meaning is even more amorphous. Some women and girls use PMS to mean any kind of menstrual pain or discomfort, as well as premenstrual moodiness. Some men and boys, as well as some girls and women, use it to diminish a woman’s or girl’s emotions when they disagree with her, or want to dismiss her opinions, or are embarrassed by her feelings.

Even researchers are influenced by entrenched cultural meanings. Romans and her colleagues observed that none of the 47 studies analyzed variability in positive mood changes, which they attribute to biases of the researchers. Many women have reported anecdotally that they feel more energetic, more inspired or other positive feelings during their premenstrual phase, but this is seldom studied or regarded as a “syndrome.” Romans and colleagues note that most measures of menstrual mood changes only assess negative changes, so even if positive changes are occurring, researchers are missing them. They also cite research indicating that both women and men tend to attribute negative experiences to the menstrual cycle, especially the premenstrual phase, and positive experiences during the premenstrual phase to external sources.

Romans and her colleagues do not deny the existence of menstrual pain, or even the existence of PMS. What their study shows is that very few women experience cyclic negative mood changes associated with the premenstrual phase of their ovulatory cycle. PMS is not widespread, and the authors are careful to distinguish it from premenstrual dysphoric disorder (PMDD), which is rarer still. As Gillian Einstein, one of the researchers, told the Toronto Star, “We have a menstrual cycle and we have moods, but they don’t necessarily correlate.” She did not add, but I will, that it it is unfair and unreasonable to assume that every woman’s moods should be attributed to her menstrual cycle and to refuse to take her feelings seriously.

Cross-posted at Ms. blog.

Happiness Is in the Eye of the Beholder

October 22nd, 2012 by Elizabeth Kissling

Guest Post by Chella Quint, Adventures in Menstruating

When periods hit the news, and they do every now and again (no, not once a month – that’d actually be nice, and proof that it was a normal, neutral topic of conversation), my friends have me on speed dial. I’ve been hanging with my Off the Shelf Festival pals this week, though, and was apparently experiencing some kind of menses media blackout, because I was none the wiser about the latest Bodyform brouhaha until I got a Facebook message from my friend Bill that said ‘Quite remarkable’ with a link to a New Statesman article entitled Fighting Snark With Snark: Bodyform viral video destroys commenter.

So I clicked the link.

Nutshell: a guy recycled an old joke about femcare ads being unrealistic (This was at the expense of his girlfriend, whose period apparently resembles scenes from the Exorcist. Nice work. You’re a real charmer.) to made a tongue-in-cheek jab at the company, posted it on their facebook page, a zillion people ‘liked’ it (although there is this ‘fake likes’ issue so I do wonder a little – genuinely – not a lot, but a little), and the brand replied with a viral video, which only took a week to turn around.

Check it out:

Analysis: First thoughts? I did say I like a two-way conversation, but damn. There’s nothing more two-way than a brand adbusting an adbuster. He’s hardly destroyed though. He’s made rather a lot of, addressed repeatedly by name, and given an awful lot of attention. They put the response together in a week, which is only a few days longer than I’ve taken with some of my ad parodies, and they made a whole film with acceptable production values and neat touches. (Right at the end, the mobile phone rings with the classic Bodyform ad as a ringtone, and then the correct part of the song picks up to carry on as non-diagetic sound for the outro. Classy.) The guy in question was an easy target, though, and commented in a way that amusingly got under the skin of a femcare company with the following message: periods are horrible, women on their period are out of control, and Bodyform were terrible for pretending it was all sunshine and flowers. So in the clever-clever video, Bodyform duly apologise for pretending periods were about unrelated lovely fun things, etc., but – here’s the kicker – then agreed that periods are totally horrible – so horrible that nothing to do with them can be shown on screen, and the truth makes grown men cry.

By the time I’d watched it, though, my pal Seonaid over on the west coast of the US had caught up and sent me a link from an ad website, with simply ‘Awesome’ written above it. Huh. Seonaid is a hip cool lady and knows her stuff. She thought it was awesome, thought of me, and sent it straight over. So I watched it again. The (FAKE! TOTALLY FAKE! A DUDE OWNS THAT!) CEO pouring out some blue liquid from a pitcher into a glass and then the recall of her drinking it at the end, that was pretty funny – really sound visual comedy, and the fart was a great afterthought (Teasing a guy for thinking women are classical and not grotesque? That’s a good gag. Oh yeah – playing by the rules of signers in femcare ads, though, she totally drank from a big old pitcher of blood. But I digress.) The original post is a riff on an old joke that people throw around all the time about unrealistic femcare ads of the ’80s, but this time someone actually told the joke to the brand itself using social media, which many people found refreshing.

It was a tweet from my Sheffield buddy Saul that I’d most like to respond to:

Saul Cozens ‏@saulcozens: @chellaquint is this a step in the right direction http://www.youtube.com/watch?feature=player_embedded&v=Bpy75q2DDow … it still feels a bit too coy but it isn’t trying to hide anything

Good shout, Saul. I wasn’t sure either. Incidentally – I met Saul after he saw my TEDx Sheffield talk, which is a potted history of femcare advert messages. So if you add my femcare research background, my fanzine shenanigans, my natural skepticism, and my initial reactions to the Bodyform video, when I read this tweet I went back and watched the video again, not with the surprise and glee expressed by most of the people who’ve analysied this story for articles that are now cropping up in feminist blogs, ad industry press and in the mainstream media, but with a need to work out why everybody seemed to love it, and I was left with a bad taste in my mouth.

I hate to be a killjoy. I love joy. I’d be joy’s EMT, do joy CPR…heck – I’d even take a bullet for joy. But this facebook commenter’s post and the response, while funny on the surface, and clearly a lesson for all the advertisers and quite a few filmmakers, isn’t all it seems.

As we saw earlier in the summer, Facebook posts on femcare pages do garner attention, and Bodyform were right to respond (although if Femfresh had responded saying anything other than ‘You’re right, our stuff is pointless, possibly harmful, and we are slowly learning how to say the words vulva and vagina in pubic. PUBLIC. We mean public. Dammit.’ their product would have tanked immediately, which would have made lots of extra space on the shelf for reusable femcare products like menstrual cups, but been rather bad for their business). Femfresh should have responded this way, but either didn’t have the brand knowhow, or knew they had something to hide, and sarcasm couldn’t make it better. I made a spoof ad in response to that Femfresh campaign, you know. Not to go into a sulk or anything, but I’m a little disappointed they didn’t make me my own movie. I’m not in it for the attention – I do this because I want people to engage with their media environment – but at least after that case and this one we know for sure that femcare companies are hanging on our every word. It’s too bad that so far they only respond when there’s an easy target who’s comment plays right into theirh hands. Because this guy’s post and the ‘you asked for it, buddy’ reply both play up the same stereotypes of ‘all periods suck’, ‘all women are hormonal and out of control’ and ‘all men have to either deal with it or be shielded from this horror’ which is not very period positive, and throws in some mental health and physical disability stuff right in there with the sexism. I think the way to explain period positive to people is: the woman is not the butt of the joke.

Here’s his comment (sic):

Hi , as a man I must ask why you have lied to us for all these years . As a child I watched your advertisements with interest as to how at this wonderful time of the month that the female gets to enjoy so many things ,I felt a little jealous. I mean bike riding , rollercoasters, dancing, parachuting, why couldn’t I get to enjoy this time of joy and ‘blue water’ and wings !! Dam my penis!! Then I got a girlfriend, was so happy and couldn’t wait for this joyous adventurous time of the month to happen …..you lied !! There was no joy , no extreme sports , no blue water spilling over wings and no rocking soundtrack oh no no no. Instead I had to fight against every male urge I had to resist screaming wooaaahhhhh bodddyyyyyyfooorrrmmm bodyformed for youuuuuuu as my lady changed from the loving , gentle, normal skin coloured lady to the little girl from the exorcist with added venom and extra 360 degree head spin. Thanks for setting me up for a fall bodyform , you crafty bugger.

Bodyform were eating this stuff up though. It follows the classic advertising technique where the company has to convince you that you have a problem, before they can solve it for you. If you think periods are ok, you probably won’t have a lot of time for people who seem afraid to talk about it. But if you are a company that targets people who think periods are gross, this is right up their menstrual street. Which is why their response video intro on their page says:

We loved Richard’s wicked sense of humour. We are always grateful for input from our users, but his comment was particularly poignant. If Facebook had a “love” button, we’d have clicked it. But it doesn’t. So we’ve made Richard a video instead. Unfortunately Bodyform doesn’t have a CEO. But if it did she’d be called Caroline Williams. And she’d say this.

See what I mean about the totally fake CEO? She’s a made up character. Which reminds me – Richard’s girlfriend is a nameless, faceless possessed child. There are no women in the fake focus group (the fake-us group? the faux-cus group?). There are no real women anywhere in this exchange, with no real voice – they’re simply spoken about. Yet loads of women enjoyed watching it all unfold. I’d imagine the ‘battle of the sexes’ trope provides for a satisfying ‘smug male’ smackdown. I suspect some women who really do have horrendous periods caused by underlying medical conditions may have felt vindicated to finally see their take on things put across on screen. It’s definitely funny that the only graphic description of periods in the ad is accompanied by a subtle zoom out that takes in a conveniently placed plate of red jelly (that’s Jell-o or generic gelatin dessert, for speakers of US English). The eating and drinking menstrual blood metaphors are a little surreal – I’m not sure if they were going for vampire or cannibal, but these bits add a quiet menace that keeps up the horror movie theme running through the whole thing, just in time for Halloween.

Bodyform could have taken this opportunity to tell the real truth: that periods are part of a bigger cycle, can be anything from painful to annoying to no big deal to an exuberant turn up for the ‘not pregnant!’ books, or just, you know, a sign that you are in good reproductive health and everything’s ticking over nicely, like your pulse, and your blood pressure and your peak flow and stuff like that.

For some people, it’s just fine, you know. Periods are a part of life – like every other bodily function. We call them bodily functions because most of the time, they’re functional. Stuff works. And when it doesn’t work, like with this awful cough and head cold combo that is sweeping the UK right now (I hope this makes it into some professor’s pandemic prediction algorithm, but I’m nerdy like that…), you get cranky and irritable and may feel short tempered, like my wife does right now. I don’t think she’s acting like a character from The Exorcist, though. I think she has a head cold, and I will probably buy her some ginger ale to sip and try not to bug her too much. Like I said, this guy sounds like a real charmer. Bodyform is his target, but it’s at his girlfriend’s expense, and she’s not the only one on the receiving end of the putdowns.

The original post is at a woman’s expense. It’s written in a patronisingly innocent tone toward Bodyform, and the butt of the joke is the man’s girlfriend – a woman whose period causes her to become, quote, “the little girl from the exorcist with added venom and extra 360 degree head spin”. He does call out their outrageous adverts, but not for implying that women’s real bodily functions are normal. He says (and Bodyform sticks with this view in its response) that women lose it during their periods, which are unmentionably horrible, and men are the real victims.

I’m not the only one who’s noticed. There are a number of dissenting voices in the comments on the Facebook page, calling this stuff out, but many of these commenters are dismissed with replies that are patronising or accuse the poster of, charmingly, not being able to take a joke because they are currently on their period.

Here are a couple:

I estimate about 25% of the female responses on here are very aggressive towards Richard, even though he was clearly just making a joke. Hmmm what on earth could be currently causing about a quarter of women to act like psychos, lacking any form of reason or logic? – Chris Dubuis

Lol, seems like half the woman on this post have their monthly friend. Good thing Richard is on their mind! – Paul Antoniuk

Here’s one from a woman who wanted those who were not amused to shut up:

Very clever Richard and I like the companies come back……. both VERY clever……… LIGHTEN UP LADIES…….. it’s a joke, a HA HA, a giggle, snicker and or snort…… it’s all for fun……. I found it amuzing, thank you for writing this Richard. it was a hoot – Linda-Lee Bosma

Wow. Effective reinforcing of negative messages, Bodyform. But here are a couple of commenters who do a better job than Bodyform in terms of injecting some fair representation and role reversal into your humour:

Richard, sometimes a man just needs a little more game in order to get a date with a skydiver, dancer, biker, surfer or rock musician. Keep trying, buddy, and good luck. – Liisa Pine Schoonmaker

@Richard…I train at a MMA gym..I train in Muay Thai Kickboxing, regular boxing, and BJJ. I do it while my “Happy Period” is in session. I don’t let it slow ME down. I also do the fun stuff like dancing and amusement parks. So, I guess they must have made the advertisement about me… – Lorelle Massageworks

They did have a particular target in mind for their advert, but it’s not the person above, it’s not Richard specifically, or men generally, or women who have painful periods. The whole thing’s a smokescreen. The truth rocks up 45 seconds into the viral video, when the C.E.FAUX (That works, right?) says:

“I’m sorry to tell you this, but there’s no such thing as a happy period.”

She looks straight into the camera, delivering a direct hit to the Always ‘Have a Happy Period’ campaign. (This tagline was in use in the US, more recently in the UK, and is still around in other European countries. It’s most well known for, ironically, a fake viral campaign that started out as a McSweeney’s article, and coincidentally namechecked another fake exec, but this one was male.) It’s not ok to pretend all periods are a walk (rollerblade?) in the park, but the reverse is also true. It’s not all doom and gloom, and it’s irresponsible to insist it is. Even their focus group fake out (The voice over: “We ran a series of focus groups to gauge the public’s reaction to periods.” is run with clips of men crying while watching a screen we ca’t see.) Playing up the negative maintains the taboo even while trying to pretend to break it down. It may seem funny on the surface, but look below the blue liquid for a minute and things do get scary.

This ad isn’t just a coy game with Richard, though, and it’s not just complicit in supporting men’s negative feelings about periods and the people who have them, or even those annoying old ads. It’s a big ‘up yours’ (as it were) to Always, a coded message to potential customers to laugh along with them at the international maxi-pad market leader’s catchphrase, and a bit of (nearly) subliminal encouragement to jump ship and declare new brand loyalty with cheeky old Bodyform (which many Facebook page posters have now done, including one lady from Canada, who went so far as to say that she had never heard of Bodyform before, but should she ever be in the UK and have her period, she would seek their products out specially, in some new kind of uber-brand-loyalty I have never before seen, except in my head where I covet Smeg fridges and they populate my fantasy dreamhouse).

But back to the ad. Fakety-fake-faker Caroline ‘Fake’ Williams continues: “The reality is, some peopele simply can’t handle the truth.”

One perceptive Facebook commenter seems to reply directly to this:

Finally, at last, we have found value in the truth. By the way, just when was it that man first became incapable of handling the truth? Speaking of the truth, when did we stop telling the truth? Ah! There in lay the rub, If we don’t tell the truth, how on Earth are we going to be able to handle the truth, let alone ever know it when we hear it? – Bradley Acopulos

A good point. Simply saying you’re telling the truth doesn’t mean you actually are.

Bodyform uses a clever ploy but it just reminds me of Nick Clegg. (I guess at this point, Bodyform would say, ‘It’s called a metaphor, Richard.’) At 18 seconds in, the actor hired to impersonate a pretend CEO says: “We lied to you Richard, and I want to say sorry. Sorry.” At the Lib Dem party conference, Nick Clegg apololgised for promising he wouldn’t raise university tuition fees, when he should have been apologising for raising university tuition fees. Bodyform apologises to a guy for making periods look like fun, but they should be apologising to women for playing up to the stereotype that periods turn women into possessed little girls.

So. It was remarkable, Bill. I have felt the urge to remark upon it at lengt. It was awesome Seonaid. I am in awe at the irresponsible and seemingly irrepressible force behind age-old period stereotypes, propagated by people who do their research and should know better. And Saul, it was not a step in the right direction, they were being coy, and unless advertising changes radically, they’ve probably got plenty to hide.

Cross-posted at Adventures in Menstruating

Bodyform’s adbusting response, new PMS research, and more Weekend Links

October 20th, 2012 by Elizabeth Kissling
  • Bodyform’s response to ‘Richard’ in the form of the video at right has been getting a lot of play — I’ve lost track of how many times it’s been sent to me. We’ll have more to say about it on Monday, with celebrity period blogger, Chella Quint.
  • The Atlantic published a summary of a new review of studies of PMS with prospective data of moods from Gender Medicine. The researchers concluded that the articles, in aggregate, “failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome.” We’ll have more to say about this next week as well.
  • Remember when everyone was panicking that the HPV vaccine would induce wild promiscuity in teen girls? A new study has found that the HPV vaccines have no effect on the likelihood of girls becoming sexually active. Now that the vaccine is recommended for boys as well, we’re still waiting for the public outcry about how it will encourage them to want to have sex . . .
  • In other news about Gardasil, the vaccine has been reported to be the cause of infertility in a 16-year-old three years after menarche.
  • A report about women in China switching from disposable pads to re-usable cloth pads cites a presentation at the Pittsburgh meeting of the Society for Menstrual Cycle Research. (We are everywhere!)

Is Hormonal Literacy Important in a Counseling Session?

October 19th, 2012 by Ashley Ross

When we sit with our clients – whether it’s a medical consultation, a therapy session, a group program or even spiritual guidance – what happens when we include a woman’s cyclic nature in the conversation?

As a holistic reproductive health coach using the Hakomi somatic counseling method, this question is not only unavoidable but inevitable.

Hakomi is a therapeutic method that uses mindfulness in our present time experience to discover unconscious beliefs that either resource or limit us. Put another way, we bring a woman’s awareness to what is happening in her body as we’re consulting with her. This is done with the understanding that our bodies are as much a part of our experience as our cognitive experience (how we make meaning) but they have a less perfected filtering and editing capacity, making them a wonderfully effective access route to our unconscious – our experience outside our awareness.

Many of my clients come to me for help with their emotional hormonal symptoms (perimenopause, PMS). Below are a few different ways I work in this hormone/psyche/somatic interface. I thought this might be a place for us to share what we’ve discovered.

Knowing Where She’s At

I begin each session by establishing which phase of her monthly cycle and/or life-cycle she’s in. We explore how she experiences these phases (which initially requires teaching tracking and observation skills). I also find it extremely helpful to find out what birth control she uses to ascertain whether she is using endocrine disruptors.

Her Relationship to Her Cycle

We get to know what beliefs she has about her cycle and her body. Many core beliefs about the Self reside in her relationship with her body and can show up in how she experiences her period, her birth control choices, how she inhabits different parts of her body – specifically her reproductive organs and pelvis, etc. (I like the work of Tami Kent on this last point). Many issues of self-regard, self-compassion and agency might also be expressed through this relationship.

Menarche

We explore her first period experience; for example, how old she was, what was happening in her life at that time and the messages she got leading up to and including her first period. These might include difficulty in accepting her sexuality; anger and resentment towards the masculine, or the feminine; shame, confusion, disappointment or rage about her menstruating body; relief and excitement about being a woman; etc. We also explore her significant relationships at that time – with mother, father, sisters, brothers, grandmother etc. We note whether she experienced any loss of relationships because of her menarche. We offer her the “missed experience” of acceptance of her womanhood, fertility and sexuality (with gender-identity appropriateness).

Normalizing the Fluctuations

We discuss variations in energy, temperament, sexuality, mood, “liminal” state (see Alexandra Pope’s Wild Genie), etc. through her cycle. She learns to recognize her unique patterns. We explore any fears/judgments/beliefs about being “unpredictable” or “inconsistent”, specifically in relation to expectations she might have for herself.

The Resource of Hormonal Literacy

We point out new signs and beliefs as she begins to integrate her hormonal experience. for example, moments of self-compassion, nonjudgmental, embodiment, empowerment, etc. We work somatically to create new neural pathways that integrate her developing hormonal literacy.

These are a few areas that I feel warrant further discussion and examination in how we include a woman’s hormonal experience in our interactions with her in a session. There are more, of course, like the counselor’s relationship to hormones and menstruation (counter-transference) as well as bringing hormone awareness to treatment with addiction or trauma. Rich stuff.

What I’ve noticed by including this interplay between hormones, psyche, and the body is the phenomenon of how awareness changes a woman’s experience. When she connects the dots between her hormonal cycle and her experience, it not only empowers her but shifts her hormonal experience itself.

I know we all look forward to the day when our hormonal and somatic awareness are so integrated, they become the water we swim in – that great day when we are not appreciated and valued regardless of our hormones but because of them. Until then, I believe we can best serve women by including hormonal literacy in our work together.

I’m fed up with birth control propaganda

October 17th, 2012 by Laura Wershler

Birth control in the U.S. has become synonymous with drugs and devices. The pill, patch, or ring; Depo-Provera or hormonal implant; copper IUD or Mirena IUD; traditional hormonal birth control or long-acting reversible contraceptives. All impact the function of the menstrual cycle; some suppress it completely. As a pro-choice menstrual cycle advocate I take issue with the fact that keeping your cycle and contracepting effectively are now considered mutually exclusive.

A widely published Associated Press story tells us that the American College of Obstetricians and Gynecologists now recommends hormonal implants and IUDs as the best birth control methods for teenagers. The research this recommendation is based on did not even study pregnancy outcomes for women using condoms, barriers, or fertility awareness methods. These methods were not among the free contraceptives offered to study participants. Another story reported that ”the new guidelines say that physicians should talk about (implants and IUDs) with sexually active teens at every doctor visit.” This sounds like a hardcore sales pitch to me. I expressed my concerns about pushing LARCs on teenagers in a previous re:Cycling post.

Drugs and devices also figure prominently in Switching Contraceptives EffectivelyNew York Times health writer Jane E. Brody writes about the mistakes women make when switching between birth control methods that can result in unintended pregnancies. The reasons women switch are explored and a link to a resource on how to switch methods successfully is provided.

The Reproductive Health Access Project developed the pamphlet to help women prevent gaps in contraception when they change methods. The premise is a good one:

What’s the best way to switch from one birth control method to another? To lower the chance of getting pregnant, avoid a gap between methods. Go straight from one method to the next, with no gaps between methods.

But the pamphlet developers made the huge false assumption that all women just need or want to try another drug or devise. It focuses ONLY on these method — how to switch from the pill to Depe-Provera or the copper IUD, or how to switch from the Mirena IUD to the progestin implant. Condoms and barrier methods are considered useful ONLY for the transition period between drugs and devices. Fertility Awareness Methods are ignored completely. The resource comes across as propaganda for drug- and device-based birth control methods.

Neither Brody nor those behind the Reproductive Health Access Project seem to understand that this approach contributes to the unplanned pregnancy rate by failing to acknowledge that many women are fed up with contraceptive drugs and devices. These women want support and information to switch away from these methods. They are falling though the contraceptive gap created by this failure.

Is it any wonder that some women stop using their contraceptives without talking to their physicians? Maybe they are fed up with doctors like Ruth Lesnewski, education director of the Reproductive Health Access Project, who offers trite admonishment that side effects ”will go away with time” and insists that caution about using long-acting methods like the IUD or hormonal implant is “outdated.” Real health issues are associated with all these methods. I guess Dr. Lesnewski doesn’t read health blogs where women document their frustration about side effects and dismissive health-care providers.

This article places blame for contraceptive failure on women not knowing how birth control works, instead of where the blame really belongs — on the blind spot that keeps sexual and reproductive health-care providers from seeing, and serving, women who are sick and tired of drugs and devices.

As for the ACOG recommendation on the best birth control methods for teens? It’s just a step away from coercive, patriarchal decision-making by doctors for teenage girls, and a threat to the sexual agency of many young women.

Understanding Research: Expert Opinion Isn’t Enough

October 15th, 2012 by Paula Derry

Many of us do our own health research, either because we have a specific question or simply to keep up with the news. If we don’t read the original scientific articles, we rely on experts to provide summaries in newspapers, magazines, or on a variety of websites. It seems as though by choosing sources judiciously we should be able to count on finding information that is accurate. However, relying on authority, whether this authority derives from a writer having scientific or medical training, or the writer being a professional journalist, or some other reason, is not enough.

I thought about this recently when I saw an article on Medscape, a website for health professionals, especially physicians, called “Early menopause doubles CVD risk regardless of race.” A summary of a new journal article, it was highlighted on the Medscape home page for many days. It began: “Women who experience early menopause–before their 46th birthday–are twice as likely to suffer from coronary heart disease and stroke as women who don’t enter menopause prematurely, and this finding is independent of traditional risk factors.”  Johns Hopkins University, where one of the authors is employed, issued a press release entitled “Early Menopause Associated With Increased Risk Of Heart Disease, Stroke” which also begins:  “Women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke, new Johns Hopkins-led research suggests.” Similar articles appeared in Medline+ (a National Institutes of Health and National Library of Medicine website), a Blue Cross Blue Shield healthcare news website, and many print newspapers.

So, what was in the original scientific article? The article was published in Menopause, which, like many journals, does not post its articles free online for non-subscribers. Many academic libraries do not carry this journal. However, if a reader does get the original article, these are some of the details: The women in this research were studied for a number of years. The researchers collected information about many predictors of circulatory problems (smoking, diabetes, etc.). The women were also asked at what age they had reached menopause. If this was when they were younger than 46, they were classified as having an “early menopause” whether menopause was caused by surgery (ovaries removed) or occurred naturally. The researchers looked at whether the women developed heart problems or strokes, and created mathematical models to study which predictors of these problems were important.

Twice the number of women with “early menopause” had heart problems compared with women who reached menopause later. This is what is called “relative risk.” The “absolute risk” numbers were: 3% of the women with early menopause had heart problems compared with 1.4% of those who did not; for stroke, the numbers were 2.6% vs. 1%. This is still a difference, but not as dramatic as a twofold increase. In addition, the way the strength of the association was mathematically computed was to first predict heart problems and stroke with more usual predictors: age, risk factors like diabetes. The difference in risk due to menopause was in the uncertainty left after all these other factors had already been taken into account. Further, we don’t know whether the “early menopause” group had other associated characteristics leading to a health difference—if they were unhealthy in other ways. The authors, for example, state that if a woman had a family history of heart problems, and if this was mathematically taken into account before looking at menopause, then early menopause was no longer a predictor of her having a problem. In accounting for results, the article cannot distinguish between surgical and natural menopause, which differ in many ways.

It is true that, in the media accounts of this research, if a reader reads the entire article, qualifiers do appear embedded in the article in some of the sources. Some do say that the number of women in the study who developed heart problems or strokes was small; that this was a correlation, not a cause-and-effect association; or that when family history of cardiovascular disease was taken into account the relationship disappeared (although in Medscape, the author of the study was quoted as saying that “the pattern was still similar”). A piece of misinformation that reappeared in some of the sources was that the increased risk was similar whether the women had early menopause naturally or because their ovaries had been surgically removed. The research article clearly states that the authors did not have sufficient power (in research this means, basically, enough subjects to get an accurate answer to the question) to determine this.

I was puzzled why so much publicity was given to this study.  In my opinion, it did provide some interesting, suggestive results and contributed information about women from a range of ethnic groups (who have been understudied in the past), but the study’s results were modest and inconclusive.  However, what the article did do was to claim to support the underlying assumption that menopause and heart disease are related, an idea that keeps re-occurring in the professional literature, even stated as though it is a fact, although the evidence for it has been at the very best arguable and weak.  A recent SMCR blog post by Chris Hitchcock analyzed media misreporting of the results of another research project intended to test this relationship. In the study I am discussing, highlighting weak data that seems to suggest a relationship between menopause and ill health, blurring the distinction between natural and surgical menopause, contribute to this meta-message.  Ages 40 to 45 would be considered within the normal age range for menopause by many professionals, but is here defined as creating health risks.  I would hate to think that meta-messages promoting ideas that menopause is unhealthy and causes risk of heart disease contributed to the perceived importance of the article.

Reference

Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis.  Melissa Wellons, MD, NCMP, Pamela Ouyang, MBBS, Pamela J. Schreiner, PhD, David M. Herrington, MD, and Dhananjay Vaidya, PhD, Menopause: The Journal of The North American Menopause Society, 2012.  Vol. 19, pp. 1081-1087

Running, Pap Smears, Menstrual Release, and More Weekend Links

October 13th, 2012 by Elizabeth Kissling

When Can We Write the Obituary for the Critical Timing Hypothesis?

October 12th, 2012 by Chris Hitchcock

What Happened?

The highlight of last week’s meeting of the North American Menopause Society (NAMS) meeting was a presentation of the primary results of the KEEPS study (Kronos Early Estrogen Prevention Study). A press release describing the findings, along with a list of FAQ (frequently asked questions), is available on the Kronos website. KEEPS was designed to confirm the critical timing hypothesis by looking at the use of menopausal hormone therapy in healthy women who were 6-36 months from their last menstrual period. Primary outcomes were progression of two atherosclerosis markers: carotid artery wall thickness (cIMT) and coronary artery calcification (CAC). In both cases, there were no statistically significant differences among the three groups (two hormone therapy formulations and a placebo group). The study failed to meet the stated goals by the stated criteria. Medical and popular coverage of these preliminary, non-peer-reviewed results have been almost uniformly positive, advocating renewed use of estrogen as menopausal therapy to women, provided they are young and healthy.

The timing hypothesis1 was born out of the collective cognitive dissonance following the unexpected findings of the Women’s Health Initiative, which failed to confirm the widespread belief that menopausal hormone therapy (specifically, estrogen) would protect menopausal women from cardiovascular disease.

The birth of KEEPS

Soon after the results of the Women’s Health Initiative were published, the discredited idea of menopausal hormone therapy for the prevention of cardiovascular disease was resurrected in the form of the critical timing hypothesis. In 2005, the KEEPS study was launched with much fanfare in the popular press and the medical literature. The lead editorial2 in the journal Climacteric heralded it as a move “[t]owards safer women, safer doses, safer routes and safer timing of administration of safer menopausal therapies,” and the journal invited an article describing the study design3.

Study Design

KEEPS is a “prospective, randomized, controlled trial designed, using findings from basic science studies, to test the hypothesis that MHT when initiated early in menopause reduces progression of atherosclerosis. KEEPS participants are younger, healthier, and within 3 years of menopause thus matching more closely demographics of women in prior observational and epidemiological studies than women in the Women’s Health Initiative hormone trials. KEEPS will provide information relevant to the critical timing hypothesis for MHT use in reducing risk for CVD.”4 The target sample size was 450 women completing the study, with a goal of at least 150 women in each arm. The recruitment goal was 720 women.

Rather than using the synthetic hormones (conjugated equine estrogen, CEE and medroxyprogesterone acetate, MPA) from the WHI, KEEPS included more “natural” hormonal products, comparing oral conjugated equine estrogen (o-CEE, derived from pregnant mares’ urine, and taken as a pill – Premarin, 0.45 mg) with transdermal estradiol (t-E2, taken by patch – Climara, 50 mcg). Estrogen taken alone causes endometrial cancer; KEEPS added oral micronized progesterone (OMP, 200 mg for 12 days per month), which is identical to the human hormone molecule.

The three arms were:

  1. PLACEBO – placebo pill, placebo patch, placebo OMP
  2. o-CEE + OMP – active pill, placebo patch, active OMP
  3. t-E2 + OMP – placebo pill, active patch, active OMP

The purpose of KEEPS was to test the critical timing hypothesis, that is, to answer the question:

Does estrogen therapy, when administered during the critical timing period, protect women from cardiovascular decline?

A study of this size and duration in healthy young(er) women cannot hope to address clinical outcomes, such as stroke, heart attack and the like. Therefore the study had two surrogate markers of atherosclerosis (a part of cardiovascular health) as primary outcomes:

  1. Rate of change in the thickness of the wall of the carotid artery (CIMT)
  2. Amount of arterial calcification of the coronary artery (CAC)

Both measures have strong evidence linking them to future cardiovascular disease.

Recruitment and Retention 4, 5

KEEPS met recruitment targets (727 randomized women at 8 centres) and exceeded retention targets (466 women completed all 4 years of the trial, and an additional 118 women discontinued study medication but continued to be followed for 4 years).

Applauding the “Second Talk”

October 11th, 2012 by Heather Dillaway

In an effort to continue positive conversations about menopause, this blog entry is about Poise’s new “2nd talk” campaign. I was watching TV the other night and an advertisement for Poise’s menstrual pad came on. For once, I was actually happy to see a TV ad on menopause. The ad featured a video of a woman talking about how confusing menopausal symptoms are and what menopausal symptoms can be like, and how women need to talk about them. Menopause talk, then, is the “2nd talk” to which Poise ads are referring. Poise has developed an entire collection of “unscripted” stories from women experiences perimenopause, and it is well worth watching them. Visit the website! The premise is that while we do talk about menstruation (apparently the “1st talk”), we do not talk about menopause and we should. We should share, and we should inform, and this will make women feel better at menopause. Poise is trying to fill the gap by creating a forum for “2nd talk” on their website and in TV ads.

What a wonderful idea. Research has already shown that talking and sharing makes menopause (and any other reproductive health experience for that matter) better, and I’ve blogged about this before. We could debate Poise’s stance that the “1st talk” (menstrual talk) actually happens, but I think we do need to praise the writers of this ad campaign for prioritizing “2nd talk.” It reminds me somewhat of the Dove campaign on what women like about their bodies and while we can find plenty of ways to critique the writers of these campaigns, we can’t deny that they are moving in the right direction.

I hope we see more of this Poise ad campaign! Perhaps we ourselves can also all try to encourage “1st talk” and “2nd talk.” Lately it seems like a lot of the entries on re:Cycling are about opening doors for talking and sharing, and Poise may not be that far behind us.

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.