Blog of the Society for Menstrual Cycle Research

No Snack, Just Tampons

April 24th, 2014 by Heather Dillaway

I was flipping through the May 2014 issue of Working Mother Magazine the other day and landed upon a small article about a working mother’s recent “faux pas”: on a “crazed morning” she accidentally packed her bag of tampons in her 7-year-old son’s camp bag and took her son’s snack to work with her. Not only did this mistake leave her son without a snack for the day but also with an “inappropriate” item in his camp bag. The article, titled “The Big Switch,” told of this mother’s horror when she realized that she packed tampons in her son’s camp bag. It told of the constant agony and mortification she felt in just thinking about what might happen at school if anyone found the tampons in her son’s bag. She called her friends and they laughed, offering no advice. She braced herself for the end of the day but, when the end of the day came, she found out that her son had received a special treat of Oreos at school because he had no snack. Her son arrived home happy and unphased. The story ends without us finding out whether the son ever even realized that he had tampons in his school bag. We are also left to think, “Phew, disaster averted.”

Mothers naturally make mistakes all of the time (indeed, it’s maybe one of the things we do best!). However, this mistake was high stakes because it challenged an important social norm: a concealment norm. Women should not let anyone know that they menstruate and they should definitely not involve and/or show kids the evidence. This mother worried for her son’s potential willingness to “share” his knowledge of the tampons in his bag among his friends. She envisioned moments within which everyone at camp would know that she had packed tampons in her son’s bag and was concerned about potential repercussions. This mother worried that camp counselors might even call Protective Services if they found out about the tampons in her son’s bag, and that other parents might find out and complain as well. She knew there could be real consequences….but there weren’t consequences. In fact, in the end, this mistake seemed trivial. Perhaps the son saw the tampons and didn’t think they were a big deal, or perhaps he never saw them.

When we go against concealment norms and “show” to others that women/moms menstruate, we realize exactly how powerful those concealment norms are. This mother spent an entire day on the edge of her seat, unable to engage in her paid work, worried about what would happen to her son and to her because of this mistake. She thought about all of the possible problems and solutions, and engaged in quite a bit of emotional work trying to deal with the fact that she had made this mistake. This illustrates exactly how much work women invest in the concealment of menstruation, how much time and energy it entails yet also how fragile concealment is over time. Women must continually engage in concealment (and also be ready to do damage control) to make certain that menstruation can remain hidden.

This is also a story about how working mothers are constantly negotiating whether they are “good” mothers. This mother provides lots of excuses for why the “big switch” happened – everything from having deadlines at work to being a single mother. Thus we see another set of social norms at work as well in this story: social norms about who is a “good” mother. According to our social norms, there is only one kind of good mother at the end of the day: the mother who does not make mistakes. How silly is that? The ending of the story even seems to suggest how silly these motherhood norms might be, because the son turned out just fine — tampons didn’t hurt him, nor did his lack of snack.

In the end, this small story is just one more representation of the tightropes that women walk, and the impossible demands that social norms place on women. Let it be known that women menstruate and that mothers make mistakes. No social norm has the power to discount those facts.

What’s In A Name?

March 27th, 2014 by Heather Dillaway

This month an important Sage research journal, Menopause International, “the flagship journal of the British Menopause Society (BMS),” changes its name to Post Reproductive Health. The Co-Editors of this journal are quoted in talking about this name change:

“Women’s healthcare has been changing dramatically over the past decade. No longer do we see menopause management only about the alleviation of menopausal symptomatology, we also deal with an enormous breadth of life-changing medical issues. As Editors of Menopause International, we felt that now is the time for the name and scope of the journal to change; thus moving firmly into a new, exciting and dynamic area. We wish to cover Post Reproductive Health in all its glory – we even hope to include some articles on ageing in men. Our name change is a reflection of this development in scope and focus.”

This name change may seem very insignificant to most people but, for me, a change in name signifies major steps in conceptual thinking, research practice, and (potentially) everyday health care. While I have some problems with the new name (I’ll get to those in a minute), the idea that menopause researchers and practitioners are beginning to see menopause as part of a broader life course transition is phenomenal. It signifies the willingness of many in the business of studying and treating menopause to think more broadly about reproductive aging. It also indicates that many now understand that menopause is not necessarily the “endpoint” of or “final frontier” in one’s reproductive health care needs. Perhaps it also means that we might acknowledge that perimenopausal symptoms are more than single, isolated, “fixable” events and that they may be related to larger, long-term bodily changes. The very idea that “post reproductive health” is important is one that I support and advocate, and I see this as evidence of the realization that there is life after menstruating and having babies. What’s more, the re-branded journal seeks to include research on men’s health too, perhaps signifying that researchers and practitioners acknowledge the sometimes non-gendered aspects of “reproductive” or “post-reproductive” health. Everyone needs health attention, no matter what their life course stage.

What I can still critique about the name change, though, is that the new name of this journal suggests that menopause and other midlife or aging stages are thought of as “post”-reproductive. In my opinion, it is really that we live on a reproductive continuum, that we are never really “post” anything, that prior life stages always continue to affect us and that there are not strict endpoints to the menopausal transition in the way that the word “post-reproductive” might suggest. Reproductive aging as a transition could take as much as 30 years or more, and women report still having signs and symptoms of “menopause” into their 60s and beyond. According to existing research our “late” reproductive years begin in our 30s and don’t end until….what? our 60s? our 70s? The word “post-reproductive” suggests an “end” that maybe doesn’t really exist ever. Here is a link to an article I wrote on this idea of the elusive “end” to menopause, and I think it is important to think about how the word “post” may not be the best way to describe how we live our midlife and older years. We may still have “reproductive” health needs way into our 70s, 80s, and beyond, so how can we think of ourselves as “post” anything?

With this said, however, I still am very happy to see the current name change of the journal, Post Reproductive Health, because I believe it signifies a very important change in the right direction, and I hope to see many more moves like this as we contemplate what midlife and aging health really is.

We Need To Talk About Ovarian Cysts

February 27th, 2014 by Heather Dillaway

One of my PhD students and I are attempting to start a new research project on women’s experiences of ovarian cysts. Because this is a new project for us, we have spent a lot of time researching the topic to see what others have to say about it. What we’ve found is that there is a serious lack of information about this kind of reproductive difficulty and, as a result, there is a lot of confusion among doctors and women themselves about ovarian cysts. Here is what we have found so far:
-There are lots of different kinds of ovarian cysts. Thus, when someone has an ovarian cyst they can still have quite a range of experiences. Cysts can be of varying sizes and can be filled with fluid, gaseous substances, blood, or semi-solid tissues. The two main categories are “functional cysts” and “non-functional cysts”:

  • Functional cysts are typically fluid-filled and are tied to the ebbs and flows of the menstrual cycle. They can increase or decrease in size alongside different phases of the cycle. When women have problematic symptoms, doctors often just have them wait a few menstrual cycles to determine whether the cysts will decrease in size themselves or remain a problem. The other common solution is prescribing women birth control pills, to help prevent functional cysts from growing. Women often don’t know they have functional cysts however. It is possible that many of us have them but do not know, because there are often no signs or symptoms. If there are symptoms, then it’s often because the cyst has grown enough to put pressure on other organs or because the cyst has ruptured. Women in their 20s and 30s are often diagnosed with functional cysts, but women over 40 can still get small follicular cysts that fall in the “functional” category.
  • Non-functional cysts do not correspond to the menstrual cycle, and often are filled with tissue. There are lots of different kinds of non-functional cysts, which makes this type of cyst even more confusing for women and doctors. From what we read, this category of cysts is often confused with fibroids and laparoscopic or open abdominal surgery is often the answer (depending on the size of a cyst). Sometimes these types of cysts can be linked to endometriosis and ovarian cancer, but are not necessarily predictive of those conditions; that is, some women just get cysts and that’s it. When women over 40 are diagnosed with this type of cyst, doctors often recommend complete hysterectomies (even though women themselves might not want this solution).

-We’ve also found that there are a range of diagnostic tools that can detect cysts (e.g., pelvic exams, ultrasounds, MRIs, and CAT scans) and a range of treatment plans and procedures (e.g., just making women wait to see if the cyst decreases in size, birth control pills, laparoscopic surgery, open abdominal surgery to remove just the cyst, hysterectomy, oophorectomy).

-We have read up on women’s experiences on online support forums, however, and realize that women typically experience misdiagnosis at first. When they present a problem for women, cysts have symptoms that are commonly associated with pregnancy, indigestion and IBS, menopause, PMS, PID, PCOS, gallstone or kidney problems, hernias, cancer, etc. As a result, women are told they are pregnant, fat, need new shoes, are just postpartum, eating badly, etc. It is often months before diagnosis, and months or years before treatment, unless a doctor knows to look for cysts. If women go to the ER or a family practitioner with signs and symptoms, they are often misdiagnosed more quickly; OBGYNs seem to be able to diagnose more quickly but still may be unsure as to what the solution is.

-In our quick perusal of online forums about ovarian cysts, we can see that it is not just women in the U.S. who are desperately searching for answers about ovarian cysts. It is women in many other countries as well. Women report the long waits until diagnosis and treatment, the worries about whether cysts will reoccur, their worries about the appropriate diagnoses and treatments, their distrust of doctors (who seem to be just as confused as women themselves most of the time), and the constant conflation of ovarian cysts with other reproductive and non-reproductive difficulties as well as with normal reproductive experiences. Everyone is confused and the common experiences seem to be confusion, worry, second-guessing, misdiagnosis, and long waits for answers.

Symptoms are Demeaning….and Feminine?

January 31st, 2014 by Heather Dillaway

According to a recent piece in The Times, a reputable English newspaper, symptoms are demeaning AND feminine. More specifically, the article reports on the prostate cancer experiences of Sir Michael Parkinson, or “Parky,” a famous British talkshow host. Parkinson reveals his harrowing experience of getting prostate cancer treatment and its “grueling” side-effects. While the treatments worked, they apparently produced menopause-like symptoms (hot flushes and weight gain) that reminded him of “how women feel when they are going through menopause.” Parkinson is quoted directly as saying, “In a sense you become a woman. I’m getting fitted for a bra next week!” The reporter goes on to say “he’s joking but he’s also deadly serious.” The “menopausal” symptoms that Parkinson had during his prostate cancer treatments are also described as “demeaning” in the same paragraph.

Parkinson is a major public figure in the UK, with significant media influence. I’m certain that this article was read by many as a result, and it makes me wonder about the far-reaching impact of the negative characterizations made about both women and bodily symptoms in this article. When I read this article, I find the equation of symptoms and femininity problematic, for lots of health conditions that produce bodily changes and sensations are not only experienced by women. Experiencing a hot flush or hot flash, while often attributed to menopause, is not menopause-specific all of the time. You can have hot flushes from exercising hard, from the flu, from medications that treat a range of diseases, or when you’re embarrassed. You can have weight gain at midlife (or any time of life for that matter) for a variety of reasons unrelated to menopause. Both the equation of women with symptoms and the definitions of symptoms as negative and “demeaning” show exactly how little progress we have made in eradicating gendered ideologies that harm us. Women are equated with their bodies and seen as lesser than men because of this equation. Men are supposed to be able to rise above their bodily functions, signs, and symptoms and live the life of the mind. Thus, when men experience a symptom they must rid themselves of it because, oh, the horror, they might be “like women” if they have to pay attention to their bodies at all. Research studies show quite often that women are ignored by doctors when they report a long list of symptoms and are not given the treatments they need to ease those symptoms as much as men are, because doctors learn to assume that women are just overreacting. Symptoms are not real if reported by women, studies suggest. Yet, when men experience symptoms and report them they are treated for them more often, especially when they report things such as pain. I interviewed a woman once who told me that “symptoms are always negative” and I wonder if that is partially because of the equation of symptoms with femininity and women’s bodies.

I am certain that it was difficult for Parkinson to undergo treatments for his prostate cancer. I also know that hot flushes and weight gain are never comfortable for people, especially when they seem uncontrollable. BUT, when we go on to support the characterization of symptoms as “what women feel” and then in the next breath say that those symptoms are “demeaning,” we head right into reifying gender ideologies that harm every single one of us. Men should be able to notice changes in their bodies without feeling “feminine.” We should recognize bodily symptoms as part of both health and illness that everyone experiences. And women should not have to be defined only by the fact that they go through certain reproductive transitions that include symptoms. I know Parkinson is perhaps from a generation that might still be holding tightly to gender ideologies that do not make much sense for the contemporary world, but I hold the reporter responsible for some of the characterizations made in this article, too. It is 2014, and aren’t we supposed to be more progressive than this? Because you experience a hot flush you should be fitted for a bra? In the YouTube video that appears along with this post, Parkinson himself admits “men are silly about their health.” I’ll say. But comments reported in the recent Times article go way past being silly.

Recursiveness

January 3rd, 2014 by Heather Dillaway

A few years ago, in response to an article of mine on menopause, an editor encouraged me to think of women’s reproductive lives as “recursive”. Little did he know how much his comment would affect my thinking about women’s lives and life in general. Recursiveness is a common sense concept, but something we don’t often think about. But, especially in light of the “new” year and the sense that we all hold that we are beginning 2014 as if we have a clean slate, I decided to blog here about recursiveness. This is very relevant for anyone thinking about menstruation and menopause, which is why I write about it here.

If you look up the word “recursive” in a dictionary, you find this as one of several definitions:
“of, relating to, or constituting a procedure that can repeat itself indefinitely…”
— re•cur•sive•ly adverb
— re•cur•sive•ness noun

If you think about reproductive events like menstruation, menopause, pregnancy, childbirth or anything else, we often think of them one at a time, almost in isolation. But, they’re not isolated at all and many of them have a tendency to repeat because of the cyclical nature of all life processes. In addition, reproductive events are tied to each other in meaning and we think of them only in relation to what comes before and they only mean things in relation to what other events meant to us in the past or what situations we are dealing with in the present. Thus, potentially when two menstrual periods or other reproductive events occur, we might tend to think of them similarly, approach them similarly, and/or compare them even when they could be very different, because the first experience colors the second and beyond. To think that we might approach each reproductive event as it comes as something new and unrelated to past events or experiences is almost silly, for the past always colors our perceptions of things even if it shouldn’t. Likewise, if we think of 2014 as a brand “new” chunk of time that represents a blank slate, we are also fooling ourselves (perhaps we do so knowingly though). We can make different decisions or act somewhat differently if we’d like, but we approach 2014 with our past in mind and potentially may repeat our attitudes and behaviors in the future automatically. Even if we live different experiences in the new year and very purposely separate ourselves from past attitudes and behaviors, we might think of our new attitudes and experiences in relation to other past experiences, making attitudes and behaviors recursive in meaning at least (even if our newer experiences are not the same as in the past).

I have written here about similar themes in the past, and I do really like thinking about the recursiveness of our experiences. My brother is a forester and farmer and always talks about nature’s cycles and tendency towards repetition, but I think we can think about recursiveness in much broader terms than that too. Recursiveness is a powerful idea and it makes a lot make sense in the world. It doesn’t mean we can’t experience things differently over time. Thinking about transitions like menopause makes us realize that things (like menstruation or fertility) are definitely not the same over time and maybe stop repeating and cycling. But, in our minds, we might expect things to repeat indefinitely (and therefore emotionally wrestle with the physiological changes we experience because we don’t expect change). Previous experiences might repeat in the identities we continue to hold dear or in the ways in which we think about reproductive transitions or any other changes in our lives, even when the experiences themselves change.
As we approach this new year, I propose we acknowledge recursiveness as a real thing.

Happy new year, everyone.

What Menopausal Women Want to Hear

November 7th, 2013 by Heather Dillaway

 

Photo Courtesy of Heather Dillaway

I’ve been thinking a lot about the messages that women do or don’t get at menopause.

Because of this, I decided to come up with a list of things that women would love to hear at menopause (or perimenopause, if we are talking about when women experience the majority of their signs and symptoms).

I’ve divided my list into things that they might want to hear that are true, and things that they might want to hear but might not be true yet (but should be). I’d love to hear reader comments on this division and any ideas about what I’ve forgotten that should be on my lists!

 

Things Menopausal Women Would Love to Hear That ARE True:

1. It’s okay to be glad to be done with menstruation, the threat of pregnancy, the burdens of contraception, etc. It’s also okay to use the menopausal transition to question whether you really wanted kids, whether you had the number of kids you wanted, and whether you’ve been satisfied with your reproductive life in general. It’s normal to have all of these thoughts and feelings.

2. You’re entering the best, most free part of your life! But, it’s okay if it doesn’t feel like that yet.

3. Menopause does not mean you are old. In fact, potentially you are only half way through your life.

4. You are not alone. Lots of people have the experiences you do. You are normal!

5. I understand what you’re going through. (Or, alternatively, I don’t completely understand what you’re going through but I’m willing to listen.)

6. It’s okay to be confused and frustrated at this time of life, or in any other time of life!

7. You’ve had an entire lifetime of reproductive experiences, and this is simply one more. How you feel about menopause is probably related to how you’ve felt about other reproductive experiences over time, however. It might be helpful to reflect back on all of the reproductive experiences you’ve had to sort out how you feel about menopause.

8.  Talk to other women you know. Talking about menopause helps everybody.

9. Menopause and midlife can be as significant or insignificant as you’d like them to be. For some women, these transitions mean very important things but, for others, they mean little. Whatever it means to you is okay.

10. Researchers are working hard to understand this reproductive transition more fully.

 

Things Menopausal Women Would Love to Hear But Might NOT Be True:

1. This is guaranteed to be your last menstrual period. You are done! (Or, a related one: You’ve already had the worst signs and symptoms. It gets better from here on out!

2. Signs and symptoms of menopause will be predictable and will not interrupt your life.

3. No one will think negatively of you or differently about you if you tell them you’re menopausal.

4. There are no major side effects to hormone therapies or any other medical treatments you might be considering.

5. Doctors will be able to help you, and will understand your signs and symptoms, if you need relief.

6. Leaky bodies are no problem! No one will care if your body does what it wants whenever it wants.

7. Partners, children, coworkers, and others will completely understand what you’re going through.

8. Middle-aged women are respected in this society, and it is truly a benefit to be at this life stage.

9. There is a clear beginning and a clear end to this transition.

10. Clinical researchers are researching the parts of menopause that you care about.

 

In my opinion, things that menopausal women would love to hear but might not be true speak to many of our societal norms and biases. Menopausal women are in a tough spot when it comes to norms about bodies, aging, gender, etc. Items on this second list also speak to menopausal women’s difficulties in accessing quality health care or getting safe relief from symptoms when needed. The latter list also notes the potential disconnects between research findings and women’s true needs during this transition. The first list represents what we should probably tell women and represents the kinds of supportive comments they might want to hear while going through perimenopause in particular.

Powerful Red

October 10th, 2013 by Heather Dillaway

Photo Courtesy of Heather Dillaway

Red is my favorite color by far. Autumn is my favorite season. Autumn brings out the true essence of red. As I watch the leaves start to turn it’s hard not to think about the true power of the color.

 

It symbolizes transitions and cycles, regardless of whether we are talking about seasons or menstruation or anything else. It is a marker of change in that way.

It is warm and inviting but also dangerous sometimes.

It incites action (as in making bulls charge).

It can make people stop (as in red lights and stop signs).

It can instill caution (as in, “Caution, HOT!” or “Please use this product as directed” or “Do Not Enter”).

It can mark mistakes (as in grading incorrect responses) or stand in for punishment (as in the Scarlett Letter).

It can be representative of leaks (as in menstrual accidents) and first sexual activity (as in spotting because of the breaking of a hymen).

It is emotion (as in anger, embarrassment).

It is exertion (as in flushed, sweaty skin after a workout).

It is representative of symptoms (as in rashes or infected spots).

It signifies ideal feminine beauty (as in red lipstick or red nail polish), even sexiness and/or sexual desire (as in red high heels).

It symbolizes fertility (as in the Handmaid’s tale).

It can mean exclusion and celebration simultaneously (as in the red tent).

It symbolizes vulnerability (as in Red Riding Hood).

It can mean death (as in bloodshed).

It can represent life (as there is nothing more vital than blood itself).

It can mean fun (as in the Red Hat Society).

It stands in for love (as in hearts and roses for Valentine’s Day).

It can mean something is ripe or mature (as in a red apple or red strawberry).

It can stand in for communism or particular countries (as in China, for example).

It can mean drug prevention (as in the Red Ribbon campaign).

The list could go on and on….what am I missing?

As I live in my favorite season with my favorite color all around me, it is hard to miss the true power of red.

Complicated Emotions

September 4th, 2013 by Heather Dillaway

Rocky emotions at menopause? // Photo courtesy of Heather Dillaway

Anyone who has ever loved anyone and existed in any kind of intimate relationship, or raised a kid, or negotiated with their parent as their parent ages knows that you can both love someone and also be very frustrated — even feel like hating them — at the very same time. You can love someone while simultaneously being extremely frustrated by her or him.
These same complicated love-hate emotions seem very present at perimenopause and menopause. The more I listen to middle-aged women talk and the more I see the media around menopause, the more I realize this. Feminist scholars have often stressed that menopause is not solely a negative transition and that women can find the transition positive at times. At the very least we’ve found that women feel indifferent or mixed about menopause, even if they don’t feel positive about the transition. BUT feeling positive or indifferent about reaching menopause (i.e., being happy to reach a certain period of life) is completely different from living with perimenopause. The signs and symptoms of perimenopause and menopause (e.g., hot flashes, night sweats, insomnia, irregular bleeding, etc.) can be grueling, and to discount that means telling women that their everyday feelings are not real. Especially when one thinks about the uncertainty women feel when they don’t know how long perimenopause will last (and when menopause will finally arrive), it is important to think about the very real and very negative feelings women might have even if they are happy overall about making this reproductive transition. Feelings of negativity might also come from women’s thoughts about what menopause means for their fertility if they’ve had trouble conceiving (“After all I’ve been through, now I have to go through this?”) or what menopause means about aging (“Should I worry about aging now? What is coming next for me?”). Even if women are glad to be done with monthly periods, they might still be fearful of aging or mourn their fertility in some way. Women who have decided not to have kids might feel that it’s unfair to have to go through menopause when they didn’t even use their reproductive capacities, even if they are glad to finally be rid of periods. To not acknowledge these complicated emotions is to discount the complicated life courses that women lead. At any life stage we think about what has happened before and what will happen next, and our thoughts about both the past and the future affect how positive we can be about the present. Automatically this means we will have complicated emotions as we make life stage transitions.
Thinking about the road ahead, I know that I’m going to be like every other middle-aged woman. I’m going to love and hate perimenopause and menopause. Just like I’ve loved and hated all other reproductive events in my life. It’s too bad we don’t talk about this stuff more openly, because complicated emotions are actually fairly commonplace. At home. At work. In all of the arenas of everyday life. If we acknowledged this more fully ahead of time, we might be better off as we go through our life stage transitions. Transitions might still be rocky and rough, but at least we’d know it’s normal to have these emotions.

Room for a New Line of Kids’ Books . . .

July 18th, 2013 by Heather Dillaway

Picture taken by me in Wall, South Dakota

I am doing a last minute switch of topic for my blog post this time. I had another post all planned out but I am on a cross-country trip this week and am open to new ideas. I am in South Dakota today (at Wall Drug of all places).

I found myself staring at yet one more kids’ book on poop (see picture). Yes, it was fun and funny, and I thought about buying it for my kids. Then I realized they already own books on poop and farts and do not need another book on this subject. I took a picture of the front cover of the book to show to my kids instead. Now I’m also sharing it with you—enjoy!

But, fun aside, then I got to thinking: what we really need is more kids’ books on all of the other ways our bodies leak. Even the mysterious ways that bodies leak. Like menstruation. Sure, there are kids’ books for teaching about how babies are born and for teaching kids about sex. I’ve seen a book for kids on farts that also included information on burping. So there has been headway made on getting the word out to kids (“Yes, bodies leak!”). But I’ve never seen a real kids’ book on menstruation.

What would be so wrong about a menstruation book for kids—one that made menstruation interesting and fun for kids to learn about?
Why can’t we write this book? Is it that we are scared to really come out and write about this subject? Is it because we ourselves still think it is taboo and gross? I know that many people have tried to put together educational information for girls who are about to reach menarche but that is not what I’m talking about. I’m talking about the need for a book that makes a mysterious subject fun (or at least interesting) for kids to learn about. I’d like to see a book on menstruation that I could read to my kids and they could both walk away knowing more about women’s bodies and be less fearful of menstruation.

I might be living a dream but I’d like to think kids are curious about menstruation just like they are curious about poop.

Medical Training for Menopause? Wishful Thinking.

May 23rd, 2013 by Heather Dillaway
Medical Training for Menopause?

Photo by Ctorrear via Wikimedia Commons

OB-GYNS receive little to no medical training about menopause. Or at least that’s what recent research results show. Results of a web-based survey of 258 OB-GYN residency training directors across the country suggest that about one in five doctors receive any training on menopause, but that as many as seven in ten would like to receive that training. Residency training directors were asked to forward the survey to their residents, leading to a sample of 510 residents responding to the survey. Of the residents who responded, only 20% (100) reported any formal curriculum on menopause and only 78 residents reported participating in a hands-on “menopause clinic” as part of their residency. News articles reporting on this study suggest that this is a major problem considering how many women (as many as 50 million by the year 2020) are entering menopause in recent years.

My reaction to this is simple: of course there is little to no medical training on menopause. Of course. Anyone who has ever been to the doctor (for a simple cold, for a reproductive reason, or anything else) knows that doctors are easily stumped and that their training is often surface-level. If you present anything besides a “normal” case, the likelihood is that doctors will not have in-depth knowledge of your condition (regardless of whether that condition means you’re “healthy” or “sick”). In addition, if your body or your reproductive system represents something besides the norm then you should just brace yourself for doctors’ lack of knowledge about your body. Individual doctors are not necessarily at fault for this since they do not get training on aging bodies, disabled bodies, reproductive bodies that do not behave according to textbook info —  let alone the fact that the male body is really the norm and so women are already at a disadvantage since their reproductive bodies already represent an abnormal case. I’ve interviewed menopausal women who’ve talked about going to the doctor and having those doctors not really know much about their symptoms. I’ve also interviewed women who have had hysterectomies but then are not told anything about what effect that hysterectomy might have on long-term health or menopause. I have a student who just completed a dissertation on the reproductive experiences of women with sickle cell disease, and it is clear from her study that doctors have no idea how to deal with the reproductive needs of women with a congenital disease. I’m also working on a project about women with spinal cord injuries who can’t even find a doctor who will give them a proper pelvic exam because doctors have no idea how to handle a body that does not neatly fit on an exam table.

Women who really want answers learn to strategize about how to cobble together knowledge about their health or illness by seeing multiple doctors, going to alternative doctors as well as mainstream doctors, consulting others who have the same health or illness, doing their own research outside of medical institutions, and to some extent just putting up with their bodies and life stages without medical help. Women learn these strategies over time as doctors remain unable to help them. This is not a new situation by any means, rather it is just what women have learned (or have to learn) to expect over time. As much as biomedicine would like to declare doctors as the experts on women’s health and health or illness in general, in practice we know that doctors are not these experts. They are probably trying the best they can most of the time, but just have little training and knowledge in anything specific. Unless an individual doctor becomes extremely proactive and wants to seek out extra knowledge by themselves, the likelihood is that they will only have cursory knowledge of specific women’s health conditions or life stages. This means that women have to be ready to be their own experts and know their own “normal” in any life stage, because we cannot rely on doctors to have any training that might help us. Yes, on one level, this is a serious problem but, on another level, this is just reality.

The Last Snowflake

April 24th, 2013 by Heather Dillaway

Photo by Heather Dillaway, April 2013

My kids and I read a book about “the last snowflake” a few years ago. The book was a story about how the last snowflake felt as it hit the ground each winter – lonely because his friends were ahead of him and probably melted already, or maybe carefree and floating on the wind to say the last goodbye to winter. This year my kids and I keep trying to wonder when that last snowflake would fall. Was it a few weeks ago? No. Was it last weekend? No. Well, here it is snowing again today so will I see the last snowflake tonight? At some point this snow has to end – it’s late April! When WILL that last flake fall?
Plenty of people have written and sang about the “last snowflake” (do a web search and you’ll see). It’s a great thing to philosophize about: when will it come, what will it look like, will I miss it, am I ready for what comes after it, and, in general, how do I feel about the transition it represents? Am I glad to see that last snowflake of the season, or am I melancholy about it? Am I ready for the warmer weather, or did I like wearing warm sweaters and fleece pajamas? Do I like winter after all, even though it’s hard and long and seemingly never-ending, until it’s over? I like spring a lot but it’s always so short in Michigan and we head right into hot weather, there’s really not much in-between. Plus spring and summer mean the ramping up of activities and a busier schedule – am I ready for that? A part of me is already missing that last snowflake even though I don’t know if I have seen it yet….but then again, I’m pretty ready for winter to be over. Can I feel two things at once? Can I be sad and glad to see that last snowflake?
Why am I writing about snowflakes? Because I read a piece on the Red Hot Mamas website the other day about a menopausal woman’s last period that reminded me that of my thoughts about last snowflakes. In “A Gentle Good-bye,” Christine Merser talks about how she did not get to say goodbye to her last period at age 42, that it came too fast and she mourns (at least in part) the idea that she’ll never menstruate again. She acknowledges the hardships menstruation sometimes caused and the hassles that were part and parcel of it, but also reminisces in its life-giving qualities and feels a sense of loss. She feels her last period was a “benchmark moment” and suggests that in not knowing that her last period was indeed her last, she did not get to say that “gentle goodbye” that she wanted to say. She also talks about menopause as representing the “October” of her life, signifying ends rather than beginnings, but at the same time wants it to mean new and better things. The idea that the last period cannot be predicted but is hoped for, but then may be bittersweet when it’s finally reached is something that I’ve heard from so many women. Menstruation is hard, especially when it is unpredictable in perimenopause or before, but a part of it is also safe and representative of a kind of stability and identity that is hard to give up. Merser proposes that cessation of menstruation is the “first thing she can’t fix” about her body. Regardless of the freedoms that you might get when it’s over for good or the things about it that you will gladly give up, women aren’t always quite sure they really want to be done with menstruation forever once they sit back and think about its meanings. So they ask, Am I glad to see that last period, or am I melancholy about its passing? Am I ready for the midlife and beyond, or did I like being younger? Am I ready to give up my monthly reminders of womanhood? Do I like menstruation after all, even though it’s hard and long and seemingly never-ending until it’s over? I might like midlife a lot but it seems like it might be short and it might head me right into aging for real, so how long will I really be in this good midlife stage? Does a part of me miss my period before I’ve seen my last one?
Like snow, menstruation can be unpredictable, uncertain, burdensome, and a hassle, and we might all be very happy to say goodbye. BUT, for those of accustomed to the seasons and the good parts of each season, we might also be somewhat sad to see snow and menstruation leave us. Especially if we don’t get to say a chance to say goodbye.
Disclaimer: This analogy probably only works for those who live in Northern climates and are used to the good and bad things that come with snow. And yes, I’m sort of making light of menstruation here, but my feelings about the last snowflake this year are noticeable to me and I thought it might be fun to play with this analogy.

The Physical Body and the Lived Body

March 28th, 2013 by Heather Dillaway

I’ve been writing about disabled women who engage in reproductive experiences, and have been inspired by some of the ideas in the disability literature and literature on the sociology of the body in the past few weeks. Some scholars of the body argue that we should pay attention not only to the physical body and its functions, but also we should pay attention to the “lived body”. That is, we are in the world through our bodies, and therefore our bodies are what allow us to engage in the world and make sense of the world. Thus, the more subjective body, the one that forms our personal experience, is as important as any physical body or bodily function we may have. (For example, what does our first or last menstrual period mean to us?) We can also look at the “governmentality” of bodies – that is, all the rules that surround bodies, all the norms that suggest exactly how our bodies should be and behave. We can think about how those rules affect our experience of our own bodies. (For instance, what if we have a hot flash in public and people see us sweat, or we leak during our menstrual cycle and people see the leak? What happens to us in those instances, and how do we respond to these bodily happenings in the face of societal rules?)

Photo by Matt Wootton // Creative Commons 2.0
http://www.flickr.com/photos/mattwootton

Disability scholars suggest similar things, arguing that to truly understand disability we must separate out physical impairment from the “subjectivity of disability” or the actual experience of living with an impaired body and society’s rules about which bodies are “normal” and “abnormal”. To truly understand something like menstruation then, we would need to separate out the natural, normal bodily function from the actual lived experience of menstruation and the societal rules that affect menstrual experience. We cannot comprehend menstruation until we separate the physical body from the lived body and also pay attention to the social constraints that shape physical and lived bodies.

All of this makes me think that we have a long way to go before understanding menstruation, or any other reproductive process for that matter. Not only do we need to understand the physical body but, even more importantly, we need to understand the lived bodily experience. What’s it like to live with menstruation? What are the issues that arise day to day? What are the rules that really conflict with women’s day to day experiences? What are the parts of the physical experience that take on meaning? What are the meanings that are created? And then how do women live in the world through menstruating bodies? How do women make sense of menstruating bodies as both physical and lived entities?

This blog entry is more conceptual, and it really is just me thinking out loud. I’d love comments though on how readers think about their physical versus lived bodies. When we really think about it our physical body is only one dimension of our much more comprehensive and complicated bodily experience.

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.