Blog of the Society for Menstrual Cycle Research

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

I’d given up reading the comments on online articles for the good of my mental health when a small slip last week steeled my resolve. In response to an article exploring the arguments made by “birth control truthers” a concerned father decided to have his say, taking the defensive arguments put forward by those in opposition to these “truthers” to their only logical conclusion:

“Perhaps we should market contraceptive pills as hormonal supplements to reduce cancer risk instead of as “contraception”? After all, it is only in modern times that women have hundreds of menstrual cycles throughout their lives. Even up until 1800 it was common for women to be either pregnant or lactating throughout much of their short lives.

The body simply wasn’t built to handle so many menstrual cycles, which raises the risk for cancer.

Who could argue with taking supplements to prevent cancer?

This may sound strange, but I am seriously considering putting my 11 year-old daughter on the pill (with no placebo) just for the health benefits. I just have to convince my wife first who is a little shocked by the idea…”

I cannot count how many times I have heard that the birth control pill “prevents cancer” – specifically “preventing” ovarian and endometrial cancer.  In the last few months I have seen references to this benefit explained less and less so as a “lowered risk” and more and more so as a “preventative” action.  I think this is significant as the word “prevent” suggests that the pill guarantees you will not get these forms of cancer. And yet, to remark that the pill is counted as a carcinogenic substance by WHO – due on the increased the risk of breast and cervical cancers – will get you tagged as a “truther.”

What is interesting, of course, is that despite the “cancer protecting” benefits of pregnancy, and early pregnancy at that, we do not see women encouraged to get pregnant in order to lower their risk of ovarian cancer.  Criticism of child-free women does not generally include comments about their lax attitude towards their own health. The risk goes down further with every pregnancy and further still with breast feeding, especially breast feeding for a long period of time after birth. Women who have children young, and multiple children, have a lower risk of breast cancer than women who have no children or children after 30. Yet we see more talk of women having “too many” children at an age that is “too young” – in fact I was contacted via Twitter by someone who read this piece and who saw, in the comments, that one woman who uses natural family planning admitted to both liking the method and having 14 children. This admission disgusted the person who contacted me, even when I pointed out that it seemed the woman had very much chosen to have those 14 children.

It seems the people who are advocating prescription of the pill for cancer prevention purposes are not advocating women have children earlier, more children, or consider breast feeding for the good of their own health – in fact two of the loudest critics of my “birth control truther” book are vehemently against pregnancy and breast feeding being part of women’s lives (Amanda Marcotte and Lindsay Beyerstein). The risks of the pill are frequently compared to the health risks associated with pregnancy and child birth,  but we don’t often hear women say they are choosing to not have children to avoid putting their health at risk for nine or so months.

Which leads me to this article in the LA Times that suggested nuns should also be on the birth control pill for its cancer-protecting abilities:

“And are the pills really unnatural? Our hunter-gatherer ancestors had their babies four or five years apart, because of long intervals of breastfeeding. As a result of that and their shorter life spans, they had as few as 40 menstrual cycles in a lifetime, while a modern woman can have 400. Though we can’t claim that today’s pills are perfect, their use is certainly less unnatural than enduring the hormone turmoil of hundreds of menstrual cycles.

Lookin’ for them reds everywhere – on menstrual leave

January 14th, 2014 by Holly Grigg-Spall

By MichaelBueker (Own work) [CC-BY-3.0],
via Wikimedia Commons

Last year Russian lawmaker and LDPR party member Mikhail Degtyaryov proposed that women have two days paid leave from their work when they are menstruating.

“During that period [of menstruation], most women experience psychological and physiological discomfort,” said Degtyaryov.

He also argued that pain from menstruation causes heightened fatigue, reduced memory and efficiency at work, and emotional discomfort.

NBC, amongst other sources, reported this news as a sign of Russia’s move towards more conservative social politics.

“Scientists and gynecologists look on difficult menstruation not only as a medical, but also a social problem,” Degtyaryov explained.

Responses to this across feminist media and others ranged from shocked to outraged.

I argue in my book ‘Sweetening the Pill’ that the emphasis on constant and consistent productivity and on quantity over quality of work is hard on everyone, not just women, and not just when they’re menstruating. As technology makes it so we can be available at all times, we therefore have to be available at all times. Dave Eggers’ novel ‘The Circle’ satirizes this pressure to be “on” brilliantly, making for an exhausting read in itself.

Our desire to miss out on the time when we might be pre-disposed to slow down – our period – by taking drugs that let us keep up the consistency in all ways is symptomatic of a wider cultural emphasis on inhuman work expectations.

SMCR’s own Margaret Stubbs pointed out in an interview with Yahoo! Shine – why can’t women just take sick days when they’re menstruating, if they want?

However, most US employers do not provide paid sick days, and those that do limit the number significantly. A sick day often needs to be used for a doctor’s appointment, a family emergency, or just to catch up on myriad other duties. A policy that attributes additional sick days (and if we’re talking two days per month that means A LOT of additional sick days) doesn’t seem such a bad idea to me at this point.

There was something of an echo of the Cold War in the reaction to this news. It was partly America’s faith in work as a cure-all that positioned it in opposition to the communists.

Yes, menstrual leave is not entirely unproblematic as a proposal, within the context. Apparently, according to Wikipedia at least, the LDPR party is worryingly nationalistic (any Russian readers please feel free to correct me on this). But some of the reactions suggested a pride in the American way of long hours and little vacation time. As I find myself saying at least once a week as a British person living in Los Angeles – take a look at the economically solid, recession-surviving countries like Germany and Australia for some good reasons why that pride is misplaced.

Sometimes it seems many women are so busy establishing the lack of difference between themselves and men that they find it hard to be truly honest about the experience – possibly painful, possibly tiring – that they are going through when they get their period. See Chris Bobel’s great post about suffering in silence for more on this. She suggests that discomfort during menstruation should indeed be a “social problem” of a kind.

If we are only valued for our productive output then menstrual leave will always be seen as dead time. It will then be more about getting women out of the office when their productivity is low and they may become a burden, than it is about valuing the potential benefits of the leave for the woman.

I admit that this is old news, and well-discussed elsewhere, but what prompted me to write a post is the desire to share more widely this great piece of writing over at the Irish Feminist Network by Barbara Scully. She discusses a BBC documentary that showed a British woman’s experience of a menstrual hut in a tribal community. Just as the capitalists saw the communists as backward, we sometimes too willingly believe our way of organizing things is the most progressive, most modern, most sophisticated. Perhaps we’re not always right.

Etiquette for menstruation

November 19th, 2013 by Holly Grigg-Spall

Photo courtesy of sweeteningthepill.com

Recently I was fortunate enough to be asked to lend an excerpt of my recently released book to the UK Sunday Times Style magazine. The mostly fashion-centric Style magazine is not really known for its edginess or risk-taking (except perhaps in the realm of shoe and make-up choices) and so I was happily surprised when the editor told me that the subject matter discussed in my book that she happened to find most interesting was, in fact, menstruation. I had expected her to want to focus on condoms perhaps, or just my personal story, but no, she was keenly interested in what I wrote about periods.

The argument I make in my book is that how we feel about hormonal birth control is inextricably linked to how we feel about menstruation. In a sense, many of the newer methods of hormonal birth control, as well as the newer uses (running packets of pills together, prescriptions for cramps or heavy bleeding) show an effort to get rid of the period completely, rather than just hide it away. I also discuss in the book, briefly, menstruation activism. However, I do defer to the far better work done by the likes of SMCR’s own Chris Bobel who writes on this topic with far more knowledge (not to mention wit).

You can read the feature in full here at my website (it’s otherwise behind an online pay wall and frankly I’m pleased to rob Rupert Murdoch of a few pounds by making it freely available).

In the end, the feature was not exactly an excerpt from my book – more so it was quotes from the book mixed with quotes from a long interview with the editor. Therefore I didn’t quite know what would be published in the magazine. The finished piece covered a range of controversial topics seen here at re:Cycling regularly – menstrual outing, reusable femcare products, the potential health benefits of ovulation…

If the high point of my career was getting the word “patriarchy” into the notoriously right-wing British tabloid The Daily Mail, I think I had another peak seeing this sentence in the Style (notorious for its high priced designer fashion spreads) – “This movement believes the act of stopping and hiding our periods with hormonal contraceptives and sanitary products is a mark of corporate ownership of our bodies.” I take great pride in also getting a discussion of menstrual extraction on to Style’s pages, and therefore onto the breakfast table of approximately one million British people – “an entire period’s worth of menstrual blood could be removed in a few hours instead of being experienced over days.” Well, if we can have Page 3, why not menstrual extraction?

The editor who did such a great job on this piece was Fleur Britten and in a funny twist of fate I realized, during our conversations, that in my first full time working position after college, at the publishing company Debrett’s in London, I worked as a production assistant on one of her books – Etiquette for Girls. At that time controversy surrounded Fleur’s section on the proper etiquette for one-night stands (I think it was something about getting out quickly, quietly, but leaving a nice handwritten note). So, it made me smile to see her skewer the etiquette of menstruation in the opening paragraph of this piece: “Many women are bored with having to take a whole handbag into the ladies rather than carry a tampon in their hand. Men say “I’m going to take a dump,” but we don’t say, “I’m just going to change my tampon.””

When I was carrying the proofs of Fleur’s book to the printers back some seven years ago, little did I know we would be conspiring to get the British public to say “I am menstruating” today over tea and toast.

Essentialism and experience

August 26th, 2013 by Holly Grigg-Spall

My forthcoming book ‘Sweetening the Pill or How We Got Hooked on Hormonal Birth Control’ began to take shape on the pages of this blog and much of the process of its development was spurred on by the work of members of SMCR. As such, it seems only fitting, with the release date of September 7th soon here, to share for my post this month an excerpt and to say thank you for the support of this community. I hope to have added something of interest and value to this on-going conversation.

……

Women often discuss menstruation and birth as happening to them, rather than as part of them and their experience. Emily Martin remarks in ‘The Woman in the Body’ that women often see their self as separate to their body. Women’s central image is that “your body is something your self has to adjust to or cope with” and therefore, Martin concludes,“your body needs to be controlled by your self.”

Martin explores the idea that women did not fit into the structure of the jobs that were open to them in industrialized society. These jobs most often required monotony, routine and repetition. Although in reality no more suited to men than they were women, it was women that were judged as innately unable to succeed in such positions due on the constantly changing and supposedly unpredictable nature of their physical state.

As Martin states, “Women were perceived as malfunctioning and their hormones out of balance,” especially when experiencing PMS and menstruation, “rather than the organization of society and work perceived as in need of transformation to demand less constant discipline and productivity.”

The rigidity of society was forcefully imposed on women as it was on men. For all, both men and women, it is inhumane but it was women that were required to adapt in a more dramatic and overt way. Men are viewed as naturally given to the industrious and disciplined way of life demanded of them and the structure of society is built on these assumed capabilities.

If we admit that women do change through the month, that we do menstruate, experience PMS, have differing moods week to week, we fear that this admission will be used as justification for negative judgment.

Martin counters the feminist refrain of “biology is not destiny”; “I think the way out of this bind is to focus on women’s experiential statements – that they function differently during certain days. We could then perhaps hear these statements not as warnings of the flaws inside women that need to be fixed, but as insights into flaws in society that need to be addressed.”

The idea that men are otherwise unchanging is falsified. Men also experience hormonal changes with studies suggesting they experience a cycle daily that is equivalent to the monthly cycle of women as well as changes in hormone levels across their lifetimes.

Women’s “experiential statements” as Martin describes them are often silenced in the discourse surrounding hormonal contraceptives. It is a betrayal of the feminist cause to speak out with openness about the side effects of the pill.

When Yaz and Yasmin were released the marketing strategy co-opted the idea of word of mouth. In a commercial women were seen passing along the “secret” of these new drugs with their host of beneficial yet superficial side effects. Receiving messages of increased physical attractiveness as the result of a drug that many women were using anyway, only a different brand, increased the transference of this experience from one woman to the next.

In the face of such powerful manipulation, what place does a skillfully worded informational insert have in women’s decision making process? The time of the Nelson Pill Hearings was a very different to today.

Naomi Wolf mentions the pill briefly in ‘The Beauty Myth.’ She remarks that it was originally marketed as a drug to keep women “young, beautiful and sexy,” concepts parallel to those promoted by Bayer through its contemporary advertising. Wolf quotes, in the context of the beauty industry, John Galbraith, “Behavior that is essential for economic reasons is transformed into social virtue.”

Giving birth in ditches

July 30th, 2013 by Holly Grigg-Spall

The second week of July began with a post at The Daily Beast titled ‘Are Tampons Anti-Feminist’ and ended with my own post for Dame ‘5 Facts About Menstrual Suppression.’ In between there was ‘Not Everything is a Feminist Issue for Chissakes,’ and ‘I Do Not Think Tampons Are Anti-Feminist, for Chrissakes.’ Meanwhile, towards the end of that week, women were having their tampons and pads confiscated by security guards at the Texas Senate as they entered to protest the proposed ban on abortions after 20 weeks. It was a perfect storm for a debate around menstrual shame.

With notable foresight the first article mentioned ends with, “For women who can’t break the silence, there are other ways to protest. Just ask DiFranco. “I didn’t really have much to say/the whole time I was there,” she sings in “Blood in the Boardroom,” “so I just left a big brown bloodstain/on their white chair.”” Later, women at the Texas Senate shared responses that were similar to this statement (“No tampons allowed? Guess we’ll just have to bleed all over the seats” and “Maybe it’s time for a bleed-in”), although there were an equal number remarking on their feelings of humiliation and horror at having their tampons and pads exposed in public.

Somehow, along the way, these threads of discussion were merged – if we’re considering tampons as anti-feminist, or menstrual shame culture as anti-feminist more accurately, then surely what we’re saying is that women should just bleed all over their furniture and clothing, right? Right?

Texas native and high-profile feminist writer Amanda Marcotte weighed in on the debate: “I used to joke that anti-choicers would start considering bans on menstruation,” she wrote.

I would argue that between menstrual shame culture and the pharmaceutical industry we have a “ban on menstruation” of a kind already.

When asked why it was necessary to keep tampons and pads “private” anyway and why it was that confiscating them in public was being discussed as a power move on the part of the Senate employees, she responded with:

“I’m not afraid to be a urinating human being, but I also don’t just go pee on the street corner. One can want to go about without blood on their clothes and not be ashamed of being female. I promise.”

And then, after some attempts at reasoning, “Convinced. I am going to pee freely now, and anyone who says no is just down on me for having a urethra.”

Never mind that they weren’t confiscating toilet paper, available and publicly displayed in the Senate bathrooms.

Elsewhere she suggested that those who were questioning our acceptance of the menstrual hygiene industry’s messages were just “weirdos.”

Marcotte: “I just want once to make a tampon joke without the weirdos who think women should bleed freely for “feminism” coming at me.”

Response: “Do these people have jobs? Or couches?”

Marcotte: “I have no idea. I just assume it’s part of that crunchy fake feminism that thinks women should give birth in ditches, too.”

I don’t think many women are going to argue that we bleed on our couches and clothes because, considering the statistics on division of housework, it’s definitely women who are going to have to clean that up. And if doing laundry isn’t anti-feminist, well, I don’t know what is.

Elsewhere the writer of ‘Not Everything is a Feminist Issue…’ Erin Gloria Ryan, another high-profile feminist writer, when directed to re:Cycling as a source of knowledge on the issue responded with “Ill read it (the blog) aloud at my next fun social gathering filled with normal people.”

Whether it’s from lack of awareness of the history of oppression of women via their bodies or whether it’s just another symptom of the corporate/capitalist feminism that dominates the mainstream, these are the women considered to be representative of the whole.

I relay the details of this interesting week not to depress, but to galvanize.

I, for one, am proud to be a weirdo, an abnormal person, a crunchy feminist, a fake feminist, oh and a miserable enemy of uteri everywhere, a bitch, and a…err…fish.

The Other Dangers of Yasmin and Yaz

July 2nd, 2013 by Holly Grigg-Spall

Recently, in a piece for the Ms. Magazine blog, re:Cycling’s Elizabeth Kissling remarked on the lack of media coverage of serious safety issues with the popular birth control pill brands Yaz and Yasmin. Of the coverage there has been, little has looked beyond the significant number of injuries and deaths caused by blood clots to the potential dangers held in the negative psychological impact of these drugs, an impact that it appears a large number of women may have experienced.

As I read the stories of women who had suffered strokes or gone blind, I wondered how many women using Yaz or Yasmin had also been driven close to death, or perhaps even died, due to the depression the pills can provoke.

I decided to interview Dr Jayashri Kulkarni at Australia’s Monash University, one of the few people researching into this area, to find out more. As a practicing psychiatrist Dr Kulkarni treats women with mental health issues as well as leading research studies into this possible root cause of psychological problems.

Of the potential for these pills to create suicidal tendencies in users Dr Kulkarni says, “We have seen amongst women using these oral contraceptives a profound lowered self-esteem which causes them to lose perspective, misinterpret comments, and feel like no one would notice, or the world would be better off, if they weren’t around anymore. We’ve seen suicide attempts.

Dr Kulkarni is undertaking both a large-scale national and international survey of women’s subjective experiences with Yaz, Yasmin, as well as the Mirena IUD, Depo Provera shot, and Implanon implant and a smaller scale in-clinic study of the impact of oral contraceptives like Yaz and Yasmin on women over a three month period. The psychological impact is not what she calls “major depression” but instead a “sub-clinical depression” wherein women experience a mood change that impacts their relationships, work, and overall happiness.

“This depressive syndrome has a spectrum of symptoms. We tend to think depression just means sadness, but it can present as fuzzy headedness, inability to multitask, guilt, irritability, anxiety, and in behavioral changes like the development of obsessive compulsive disorders. Women experience a change in perspective that makes them magnify issues that occur in their lives, be that a slight weight gain or an argument with a partner, into feelings of worthlessness. It can also cause impulsivity, making the woman suicidal.”

At her clinic Dr Kulkarni describes treating a mother who found it difficult to let her children go to school for fear something would happen to them and another who became transfixed with the idea that her partner was cheating, and so called his phone repetitively to check on him. She believes that the provoked anxiety can display itself clearly as panic attacks, but it can also appear as paranoia and agoraphobia. When taken off Yasmin and Yaz these women returned to their previous state with a healthy perspective.

The Depo Provera shot and Implanon implant have shown in the research to also cause particularly profound depression. For women who have a history of mental health issues or have environmental factors that make them more vulnerable to mental health issues, these methods have been seen to provoke serious negative changes in mood.

Dr Kulkarni’s hypothesis is this: “Low estrogen pills and progesterone-only methods seem to cause depression at the highest rate. In our research we’ve seen women respond better to higher dose estrogen and natural progesterones. Clinical studies on animals have shown progesterone in a low dose causes increased anxiety, but conversely in a high dose it alleviates anxiety.” Her findings will be published later this year in full.

At present Dr Kulkarni treats her patients by changing their hormonal birth control method with her research in mind, a practice she believes to be generally successful. She prescribes new pill Zoely to patients who have responded badly to other brands. Zoely (which contains 2.5 mg of nomegestrol acetate and 1.5 mg of 17-beta-estradiol) was refused approval by the FDA for the US in 2011.

The Truth About Skyla

June 4th, 2013 by Holly Grigg-Spall

Mirena Intra-uterine Device
Public domain image

Do women using the Mirena hormonal IUD have their period?

Does it suppress the hormone cycle for all women or just some?

How does it work to prevent pregnancy exactly?

It seems these questions can’t be answered even by the assumed experts. We are told the Mirena “partially” suppresses ovulation and that some women will bleed and some won’t bleed at all. Mostly we hear that the impact must be limited to the reproductive organs because the level of synthetic hormone used is so low.

In an article entitled ‘Mirena: The Other Side of the Story’, AAA Ewies, a consultant gynaecologist at a UK NHS hospital wrote, “The argument used that serum concentration of LNG is extremely low and that its influence on ovarian function is limited has been disputed recently by many investigators. Xiao et al. found that Mirena was associated with substantial systemic absorption of the synthetic progesterone and recorded levels equivalent to two synthetic progesterone-containing ‘minipills’ taken daily on a continuous basis. A study documented that 21% of Mirena users experienced progestogenic adverse effects. Wahab and Al-Azzawi reported that Mirena suppresses oestrogen production, inducing a clinical situation similar to a premature menopause in at least 50% of treated women”.

In an effort to cut through the confusion, Bayer Pharmaceuticals went ahead and released the Skyla hormonal IUD in February of this year. Skyla is smaller than the Mirena, lasts three instead of five years, but contains the same synthetic progesterone and is also 99% effective at preventing pregnancy.

It was interesting timing, considering the American Congress of Obstetricians and Gynecologists (ACOG) almost simultaneously released a recommendation that doctors provide the IUD (it didn’t specify if they meant the hormonal or copper device in the statement) as “first-line contraceptive options for sexually active adolescents”. Teens often struggle with heavier or painful periods and are far more likely to be offered the Skyla, which is said to lighten bleeding, than the Paragard copper IUD, which is thought to increase bleeding. Not to mention the Skyla costs significantly more, has a shorter span of use, and is backed by a Bayer’s marketing department. The Mirena has been advertised heavily since its release in 2001 and the aggressiveness of the campaign – with television commercials proclaiming Mirena would make a woman “look and feel great” – was reprimanded by the FDA.

As a consequence of this combination of the ACOG recommendation and the release of Skyla we have seen articles in recent weeks with headlines such as ‘Could New Skyla Contraception Help Women Reach For The Stars’ and yet more that worry over the lack of knowledge that is preventing doctors from providing the IUD to young women or preventing young women from asking for an IUD. There was a time when IUDs were only given to women who had already had children – in part because of concerns regarding the devices causing damage that led to infertility. The tone is always the same – why are they keeping this near-perfect sounding birth control choice from us? If it is an undercover marketing technique to get women riled up about their access to hormonal IUDs then that department of Bayer deserves a raise.

Some of the doctors may have not received the memo but others may be concerned about the mounting lawsuits regarding the serious physical side effects of the Mirena, or at least they should be. The production of Skyla appears to be a deliberate effort by Bayer to reach the teens and twenty-somethings market. Even Bitch magazine got in on the advertorial action last week linking through their website to a suspicious looking post that seemed much like a marketing placement. Most of the media coverage does not flag the difference between the hormonal IUD and the copper, blithely using the term “IUD” in the same way the phrase “birth control” is now synonymous with “hormonal birth control.”

Professor at the University of California at Riverside Chikako Takeshita outlines in her book, The Global Biopolitics of the IUD, the history of the IUD, from its coercive use in developing countries to its presentation as a convenient method for the modern woman in the US and Europe. “The ACOG recommendation and release of Skyla is clearly going to expand the market for these devices”, she states, “This normalizes the use of long-acting contraceptives. Such normalization makes the use of the devices a technological imperative. The idea is that if a solution, a technological fix, to the problem of unintended pregnancy exists then you must take it. It silences other ways to approach the problem. The IUD doesn’t fix the fundamental issue which is the lack of sex education for teenagers”.

Rather than seizing the ACOG recommendation as simply a victory in the war against the teen pregnancy “epidemic” we must look critically at the potential result. This may seem like the easy answer, but is it the right one?

Pill-pushers

January 19th, 2011 by Holly Grigg-Spall

yaz

In the LA Times earlier this month, under the banner ‘oddities, musings and news from the health world,’ came a rewritten press release masquerading as one of the above that stated ‘Birth control pills using 24-day regimen may be more effective.’ Firstly, just from the headline, it is clear that this is one of those tell-us-what-we-already-know stories that only serve to reveal the amount of money wasted on research that concludes the obvious. If a woman takes a pill more days a month than she does not, then she’s less likely to forget to take that pill. Plus the more pills you take, the more days of the year, the less likely your body will find an opportunity to ovulate. The article, and the study on which it is based, attempts to suggest that 24-day regimen pills are more effective for other reasons. Other reasons like those pills – or should we say pill, as there’s only one this is referring to, without actually being named as Yaz – contain drospirenone.

Bayer, the pharmaceutical company behind Yaz, has long implemented an aggressive marketing campaign in the promotion of its now number-one selling product. However, it has never before been able to claim that Yaz was more effective as birth control than any other pill on the market. This is one reason why the adverts emphasize other benefits – that Yaz is acne-clearing, reduces bloat. Originally Yaz was also suggested to improve a woman’s mood all-round, and reduce PMS-related anxiety and depression. The FDA had Bayer change that message, so that now Yaz can only be said to improve symptoms of PMDD, although the definition and existence of this syndrome is still in controversy. Birth control pills are hard to market when, until now, they could all only be said to be as effective at their primary objective – preventing pregnancy – as each other. There was no way to differentiate. It’s similar to the way bottled waters must strive to stand out from the crowd. Different pills do use different progestins, and these cause different side effects, and so women are often encouraged to swap from one to the next in avoidance of problems from breakthrough bleeding to depression. The synthetic oestrogen used is the same for all, but at different levels. A study that suggests Yaz is better at doing its actual job – aside from all the other suggested benefits, many of which have been overturned over time – is a boon for Bayer.

And an important boon, considering sales of Yaz have dropped since drospirenone was linked to the deaths and injuries of many young women, and has become the centre of hundreds of court cases against the company. Not to mention the web-based uproar over the negative impact Yaz has had on many women’s emotional and mental well-being.

That the study, or at least its promotion, leans heavily on the drospirenone as the cause of this effectiveness, and not just that the pill is taken for 24 days out of the 28 day cycle, and inactive pills are taken during the break thus producing more of a ritual and habit to pill-taking, than those brands that have a longer break, or no inactive pills, suggests that either this study was funded by Bayer – it was undertaken in Germany, and Bayer is a German company – or that Bayer is manipulating the study and paying off the researchers. That the statistics state that Yaz has a 2.1% failure rate after one year in comparison to a norm of 3.5%, and a 4.7% failure rate after four years in comparison to the 6.7% norm concretes that this difference is down to the method of pill-taking and not the drospirenone. After four years a woman is more likely to forget to take a pill here or there, the drospirenone level and impact remains the same and so cannot be the cause of the change in rate from one to four years. Only the method can be taken into account here.

Long Live The Difference

December 5th, 2010 by Holly Grigg-Spall

toiletcorbis The UK Daily Mail newspaper last week reported that a company in Norway required that its female employees wear a red bracelet when menstruating as a way to monitor the extra toilet breaks it is assumed they need at that time. Firstly, and aside from all the historical context for such stigmatization, it isn’t obvious why it would be assumed women having their period would need to visit the bathroom more often than normal. It certainly sounds like a thought from an ignorant male manager. Perhaps it is necessary to have one extra toilet break within the eight hours, two at most. Anyone who has worked in an office job knows that the bathroom is used for all manner of purposes other than for that it was designed – for taking a break from the monotony of office work, to take a break from the computer, to chat with a friend in private, to make a phone call, to organize a night out after work – by men and women.


If toilet breaks are such a hindrance to companies then the next logical step is statutory Seasonique for every new female employee.

Monitoring bathroom breaks has historical links to the monitoring of women in the workplace specifically. Emily Martin discusses in her book The Woman In The Body how women were thought incapable of working alongside men exactly because they menstruate – and their menstruation was the central example of their difference, and inferiority – and so the necessity for extra bathroom breaks once a month was said to be detrimental to the productivity of the factory – as opposed to the modern-day version, the office. But Martin points out that bathrooms were also the only space in which the women workers could be away from men and speak in private. This made bathroom breaks times for women to establish their own identity outside of the male-created, male-ruled environment and to connect with each other. I have written about this in more detail for my own blog, Sweetening The Pill.

In The Daily Mail article although ostensibly the source of outrage is the red bracelets, menstruation is lumped in with all the other bodily functions reserved for the toilet. It is interesting to see the difficulty the media has in placing menstruation within its understanding of human experience. That it is said women feel ‘justifiably humiliated’ and ‘insulted’ is not explored in any of the coverage, it is only accepted that it is right they feel this way because menstruation is private, and by private it is meant dirty, disgusting and needing to be hidden away. When people use the bathroom for urinating they don’t pretend they are only going in there to have a glass of water or sit down. Or in a way actually, they do and perhaps shame and the need for women to be disassociated from their bodies is the source of the mythology that has built up around women’s bathroom breaks – that they always go in pairs, that they stay in their a long time, that they are doing other things, anything other than urinating.

Miranda Gray writes in The Optimized Woman that menstruation should set women apart from men in a positive way, that women’s menstrual cycles and the changes that occur in their skills and talents across the month could be used to reinvent the work environment and the structure of the 9-5 working week to be more humane, and therefore more productive. She sees that the male-created working world needs to be made better for the sake of women and men, and that the cycle might present an alternative that allows humans to be human and does not expect them to behave as machines.

The Don’t Do Drugs

November 24th, 2010 by Holly Grigg-Spall

15 Dangerous Drugs Big Pharma Shoves Down Our Throats

best-diet-pills1

Alternet recently posted a list of the drugs most likely to make you sick. Writer Martha Rosenberg’s ’15 Dangerous Drugs Big Pharma Shoves Down Our Throats’ contained some startling choices.

Yaz is there, described as a “too good to be true” birth control pill that purported to do away with acne, bloating and PMS but ended up causing the deaths of many young women from blood clots and gall bladder disease. Interestingly, she points out that although the pharmaceutical company Bayer has seen a sales slump of late this has been attributed to the appearance of a generic, cheaper version of the pill, and not women’s suspicion of its side effects. This is a testament to the power of the company’s aggressive marketing campaign, and the pull of Yaz’s promise.  I have written at length on my blog, Sweetening the Pill, about the impact Yaz had on my health – from the UTIs to the paranoia – but still when I saw Bayer would be releasing a rebranded version of the drug – Beyaz, with added vitamin B – I still felt tempted to try it. My life has been entirely transformed since ditching the Pill after ten years and looking back I can see very clearly how Yaz destroyed my body and mind, but I am still a woman living in a Pill-pushing culture just trying to avoid the self-doubt I’m sold on every day.

The birth control pill was the first drug created for and prescribed to healthy people. Its release was a catalyst for the industry, showing that although pills for sick people could make a profit, pills for healthy people could make millions. The Pill had a massive potential market of fertile women, and soon became a cure-all for any ailment seen as specific to them. This paved the way for another medicine on Alternet’s list – Lipitor – the heart-attack preventer drug, on which Martha Rosenberg writes:

“”My older patients literally do without food so that they can buy these medicines that make them sicker, feel bad, and do nothing to improve life,” says an ophthalmologist web poster from Tennessee. “There is no scientific basis for treating older folks with $300+/month meds that have serious side-effects and largely unknown multiple drug interactions.” What kinds of side effects? All statins can cause muscle breakdown but combining them with antibiotics, protease inhibitors drugs and anti-fungals increases your risks. In fact, Crestor is so highly linked to muscle breakdown it is double dissed: Public Citizen calls it a Do Not Use and the FDA’s David Graham named it one of the five most dangerous drugs before Congress.”

Lipitor is the best-selling drug in the world because its market is huge – healthy people holding any risk of heart attack, or just holding the fear of a heart attack are the demographic. Whereas the Pill is confined to female parameters, Lipitor also hooks men. Those behind the Pill had to first convince women that stopping ovulation is okay, then that menstruation is at best bothersome and unattractive, and at worst dangerous. Lipitor had a lost less work to do.

Since moving from the UK to the US I have been shocked by the casual use of Ambien that I’ve seen here. This drug also seems to be gathering cure-all status despite actually only reducing the get-to-sleep time by 18 minutes. Despite high profile cases of Ambien inducing users to act – drive, make phone calls, have sex – in their sleep, it is taken with an easy, carefree attitude. Martha Rosenberg remarks increased uptake has been linked to higher rates of traffic accidents and national overweight statistics – as users find themselves crashing cars and eating junk food whilst under the influence. The sleep cycle can usefully be considered alongside the menstrual cycle as important fixtures of a life led at optimum wellness – a topic I have written on previously. Lack of sleep impacts on hormone levels with a range of negative consequences. As we see more magazine articles advocating eight hour a night sleep routines people have been reaching for the Ambien, rather than the relaxation techniques.

Don’t Just Take Yaz, Be Yaz

November 17th, 2010 by Holly Grigg-Spall

yaz-tv-commercial-300x168Despite facing ever-rising numbers of lawsuits over their top-selling drug – birth control pill Yaz – the Bayer pharmaceutical company has released a rebranded version, with added vitamin B. Despite, or perhaps as a result of, the mounting claims for compensation made by those who believe Yaz, or more specifically the synthetic progesterone component of Yaz – drospirenone, caused their stroke, blood clot or heart attack or that of their now dead or disabled loved one, the company has seen fit to produce a modified alternative to improve on the risk of other, lesser known side effects.

Bayer suggests that Beyaz, with its added levomefolate calcium – a form of folic acid, which is a B vitamin – will alleviate the possibility of pregnancy complications and birth defects produced by the original Yaz pill. Yaz causes folate deficiency which creates problems if a woman falls pregnant whilst taking the drug, or soon after stopping. In the press release sent out by Bayer last week, the company stated that Beyaz would provide ‘folate supplementation’ – admitting in subtext that Yaz causes this deficiency and that the millions of women taking Yaz as the most popular birth control pill in the US and Europe have therefore experienced deficiency in a type of vitamin B seen as vital enough to necessitate the creation of a new drug.

Just as it seemed possible Yaz might be taken off the market, here is Yaz, new and improved. Except Beyaz still contains drospirenone, the claimed cause of not only serious physical side effects – but also a negative mental and emotional impact documented by women across the Internet.

Bayer is focusing on the effect of folate deficiency on pregnancy and the unborn. This choice suggests Bayer’s marketing department is aware that most women taking the Pill aren’t wanting to get pregnant, aren’t planning on getting pregnant soon and therefore will dismiss folate deficiency as nothing to worry over, yet. Although some women may be alarmed at their suggestion that you can get pregnant when on the Pill. A little research reveals folate supplementation has been linked in studies to a decrease in stroke and thrombosis risk – a subtext Bayer could not print without admitting blame and accepting the law suit claims.

The production of pharmaceuticals is a billion dollar industry and it is, unfortunately, necessary to assume moves are made for money and the market and not in the hope of improving the lives of women. The less sick, or deceased women, the less lawsuits, and the more money to be made for Bayer. The creation of Beyaz suggests Bayer cares, and has the interests of women at heart, but essentially it is a cynical ploy to win back the loyalty of the many women who have become suspicious of Yaz, and consequently the Pill as a whole, due on the controversies and, most importantly, their own experiences.

Bayer has created a product that will solve a problem caused by one of its products, and make money from this. Even more ludicrous than that, it is ‘solving’ a problem by making an addition to a Pill that is causing the problem, in the hope the negative impact on the body will be balanced out. Bayer could have told its customers that they need to take a folic acid supplement when using Yaz, or eat foods rich in folic acid, instead of creating Beyaz.

Folate deficiency holds more issues than those stated by the company – sufferers can experience weakness, fatigue, irritability and difficulty concentrating – to name just a few. If Yaz produces a folate deficiency, it is also right to assume it is producing deficiency in other B vitamins, and other vitamins generally. By highlighting the issue, Bayer is revealing a more profound concern. There has been speculation that Yaz also creates a B12 deficiency – and it is logical speculation – and this can lead to psychosis, depression and personality changes. Intake of B vitamins of any kind is inextricably linked to good mental and emotional health.

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.