May 1st, 2013 by Laura Wershler
How do girls learn about menstruation today? Who talks to them? Who do they talk to? Or do most girls rely on the Internet for information about periods?
Take this article by Elizabeth (bylines are first names only) – What I Wish I Knew About My Period – posted last week at Rookie, an online magazine for teenage girls. Not a teenager but definitely a young woman, Elizabeth (Spiridakus) shares the wisdom she’s gained through her menstrual experience. Here’s her sum-up:
These are all the things I wish someone had told me before I got my first period, and in the couple of years that followed. Most of all, I wish I had FOUND SOMEONE TO TALK TO! I had so many questions and fears about the whole business, and I think I would have been so much less self-conscious, and so much HAPPIER, if I had only had access to some friendly advice. So, talk to your friends! Talk to your cool older cousin or aunt or sister or your best friend’s cool mom or your OWN cool mom. Leave your questions—and your good advice—in the comments, because I certainly haven’t been able to cover all the bases here.
Read this again: “Most of all, I wish I had FOUND SOMEONE TO TALK TO!”
Photo courtesy of Laura Wershler
Elizabeth urges readers to talk to their friends, cool older relatives, or their own – or somebody else’s – “cool mom.” Great advice, but I have to ask: Why aren’t cool moms and older relatives already talking to the girls in their lives about menstruation? Sharing friendly advice? Passing on wisdom from mother to daughter, woman to woman?
Suzan Hutchinson, menstrual activist, educator and founder of periodwise.com, a project dedicated to empowering girls and women to embrace the taboo subject of menstruation, has a few ideas about this. She thinks many moms don’t know when to begin “the period talk” or what to say, so they remain silent until their daughters start their periods, or they wait thinking their daughters will initiate period talk. She warns against this.
“We should all remember that when moms offer too little information or start providing information too late, girls often question their credibility and hesitate to return as new questions arise.”
Although Suzan’s mother talked to her about menstruation, she didn’t start early enough, before Suzan heard things from other girls that she didn’t understand. Her early menstrual experience included lying to her friends about getting her period long before she did at age 15. By then she was “too embarrassed to ask my much more experienced friends” and “too proud to turn to Mom.” She tried to deal with things on her own.
“I needed a period coach – someone to walk through things with me and instruct me…help me figure out what to do, when to do, how to do.”
A period coach. This is exactly what Elizabeth is for the girls at Rookie. Read the comments. Readers loved it.
She’s not the only one using the Internet to connect with girls about menstruation. Despite my reservations about a website operated by the company that sells Always and Tampax, the content of which deserves serious critique, I must acknowledge that thousands of girls are turning to beinggirl.com for period coaching, including tips on how to talk to their moms!
Moms shouldn’t be waiting for their daughters to talk to them. They need to find their own period coaches. Other mothers like Suzan Hutchinson and the mom who started bepreparedperiod.com.
The more information girls have the better. Brava to Elizabeth for What I Wish I Knew About My Period. But moms and cool older relatives have got to get in the game. Now. Don’t wait until the girls in your life come to you.
Tags: Activism, FemCare, Girls, Laura Wershler, Menarche, menstrual education, Menstruation, period talk, Procter & Gamble, rookiemag.com, tampons, What I Wish I Knew About My Period
Posted in Communication, Girls, magazines, Menarche, Menstruation | 6 Comments »
April 11th, 2013 by Laura Wershler
Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist
A screen shot of comments to Laura Wershler’s blog post of April 4, 2012: “Coming off Depo-Provera can be a woman’s worst nightmare.”
With 250 comments – and counting – to my year-old post Coming off Depo-Provera is a women’s worst nightmare (April 4, 2012) I thought it was time to revisit this topic.
That blog post has become a forum for women to share their negative experiences with stopping Depo-Provera (also called “the shot,” or Depo), the four-times-a-year contraceptive injection. (Commenters reporting positive experiences have been extremely rare.) Many women have experienced distressing effects either while taking Depo and/or after stopping it. They report that health-care professionals seem unable to explain their problems or to offer effective solutions. What is puzzling for many is why they are experiencing symptoms like sore breasts, heavy and ongoing bleeding (or not getting flow back at all), digestive problems, weight gain and mood issues when they stop Depo.
This post aims to briefly explain how Depo works to prevent pregnancy, its common side effects and, most importantly, why and what to do about adverse experiences when stopping it.
What follows is my interview with Dr. Jerilynn C. Prior, Society for Menstrual Cycle Research board member, professor of endocrinology at the University of British Columbia, and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) Section 1 explains how Depo-Provera works and what causes its side effects. Section 2 explains the symptoms women are experiencing after stopping the drug.
1) Taking Depo-Provera: How it works and established side effects
Laura Wershler (LW): Dr. Prior, what is Depo-Provera® and how does it prevent pregnancy?
Ask Jerilynn: The term, “depo” means a deposit or injection and Provera is a common brand name of the most frequently used synthetic progestin in North America, medroxyprogesterone acetate (MPA). Depo is a shot of MPA given every three months in the large dose of 150 mg. Depo prevents pregnancy by “drying up” the cervical mucus so sperm have trouble swimming, by thinning the endometrium (uterine lining) so a fertilized egg can’t implant and primarily by suppressing the hypothalamic and pituitary signals that coordinate the menstrual cycle. That means a woman’s own hormone levels become almost as low as in menopause, with very low progesterone and lowered estrogen levels.
LW: Could you explain the hormonal changes behind the several established side effects of Depo? Let’s start with bleeding issues including spotting, unpredictable or non-stop bleeding that can last for several months before, in most women, leading to amenorrhea (no menstrual period).
Ask Jerilynn: It is not entirely clear, but probably the initial unpredictable bleeding relates to how long it takes for this big hormone injection to suppress women’s own estrogen levels. The other reason is that where the endometrium has gotten thin it is more likely to break down and bleed. These unpredictable flow side-effects of Depo are something that women should expect and plan for since they occur in the early days of use for every woman. After the first year of Depo (depending on the age and weight of the woman) about a third of women will have no more bleeding.
LW: What about headaches and depression?
Ask Jerilynn: It is not clear why headaches increase on Depo—they tend not to be serious migraine headaches but are more stress type. Perhaps they are related to the higher stress hormones the body makes whenever estrogen levels drop. Unfortunately, headaches tend to increase over time, rather than getting better as the not-so-funny bleeding does. Continue reading...
Tags: CeMCOR, coming off Depo-Provera, cyclic progesterone therapy, Depo-Provera, Dr. Jerilynn C. Prior, estrogen, hormonal imbalance, hormones, Laura Wershler, menstrual suppression, Menstruation
Posted in Amenorrhea, Birth Control, coming off the pill, Dysmenorrhea, Health Care, Hormones, Menorrhagia, Menstruation, Ovulation, Perimenopause | 20 Comments »
March 6th, 2013 by Laura Wershler
I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.
It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).
Hormonal contraceptives clearly act as EDCs according to the definition used in this report:
An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.
Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.
The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”
The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.
How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?
Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.
Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”
Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors. Continue reading...
Tags: Birth Control, birth control pill, breast cancer, endocrine disrupting chemicals, estrogen, fertility, hormones, Laura Wershler
Posted in Birth Control, Fertility, Hormones, Menstruation, Pharmaceutical, Reproduction | 25 Comments »
February 6th, 2013 by Laura Wershler
Author’s Update, February 14, 2013: As clarified by Bedsider.org in the comments section below, the Works Like A Charm Contest mentioned in this post is not current but ended in 2011. The contest website pages are now inactive.
If
Bedsider.org sponsored a contest called Why I Hate My LARC, there would be no shortage of contest entrants. But I expect it will be a long time before the nay-sayers get as much attention as the yeah-sayers.
Composite illustration by Laura Wershler
Bedsider has jumped on the LARC bandwagon. The online birth control support network for women 18-29 has launched the Works Like a Charm contest encouraging “the awesome women and couples” who use long-acting reversible contraception to share why they love their LARCs for the chance to win up to $2000. This is a variation of the Why I Love my LARC video campaign sponsored by the California Family Health Council last November, only with prizes!
To quote my blog post about the earlier campaign: “Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.”
One long-acting, not-so-reversible contraceptive in particular – Depo-Provera – is causing grief for many women. Yet “the shot” is front and center in the graphic on the contest website.
Considering the rah-rah tone of the Works-Like-a-Charm campaign messages, it seems that bedsider.org, a project of the National Campaign to Prevent Teen and Unplanned Pregnancy, is oblivious to the misery caused by this contraceptive. Often, Depo works like a curse.
I acknowledge that Bedsider is doing good work: The website provides youth-friendly, accessible information about the full range of birth control methods. But, in my opinion, any organization that promotes Depo-Provera as a contraceptive method should be totally transparent about the ill effects many women experience both while taking and after stopping the drug.
Depo-Provera, to put it bluntly, fucks with a woman’s endocrine system.
The long list of ill effects while on or after stopping this drug includes: continual bleeding (from spotting to heavy), mood disorders, severe anxiety, depression, digestive issues, loss of sex drive, extreme weight gain (often without change to exercise or eating habits), lingering post-shot amenorrhea, intensely sore breasts, nausea, and ongoing fear of pregnancy leading to repeated pregnancy tests. (Not to mention its documented negative effect on bone density.)
These effects are why the continuation rate of Depo-Provera is only 40-60% after one year of use, and why women are filling online comment pages with stories of their struggles coming off this drug.
At Our Bodies, Ourselves, the blog post Questions About Side Effects of Stopping Contraceptive Injections has been attracting comments since November 3, 2009, with no end in sight.
On my April 4, 2012 re:Cycling post – Coming off Depo-Provera can be a woman’s worst nightmare - there are over 130 comments. All but six were posted since mid-November when the post caught fire. Not more than a day or two goes by before another women shares her story of distress, confusion or frustration. I read each one and respond occasionally. Rarely, a positive experience appears; one criticized other commenters for complaining.
It’s one thing to read or hear about potential ill effects while trying to decide whether or not to use Depo-Provera. It’s quite another to experience some or many of them for months on end without acknowledgement or health-care support from those who promote or provide this drug.
The Works Like a Charm contest website says about LARCS:
Reversible = not permanent. If and when you’re ready to get pregnant, simply part ways with your LARC and off you go.
“Off you go?” Tell that to the thousands of women who are waiting, months post-Depo, to get their bodies and their menstrual cycles back to normal. Most of them still aren’t ready to get pregnant.
Tags: bedsider.org, Birth Control, blogs, coming off Depo, Depo-Provera, Health Care, Laura Wershler, menstrual suppression, Works Like a Charm
Posted in Activism, Amenorrhea, Birth Control, coming off the pill, Health Care, Hormones, Menstruation, Pharmaceutical | 10 Comments »
January 9th, 2013 by Laura Wershler
As 2013 begins, I give thanks to each and every one of my colleagues at the Society for Menstrual Cycle Research and all my blogging buddies at re:Cycling. Without them I’d feel left out in the cold.
Are menstrual cycle advocates left out in the cold? Photo by Laura Wershler
I’ve been a menstrual cycle advocate since 1979 when, during a year of post-pill amenorrhea that totally freaked me out, I began to research the ill effects of hormonal contraception. It is not an understatement to say that reading Barbara Seaman’s national bestseller Women and The Crisis in Sex Hormones changed my life. It started me on a path of self-discovery, and commitment to the idea that healthy, ovulatory menstruation is integral to women’s health and well-being. If you don’t know about Barbara Seaman and her work in women’s health activism, please read about her.
My menstrual cycle advocacy took what could be considered a counter-intuitive path. I aligned myself with the pro-choice sexual health community, committed to comprehensive access to sexual and reproductive health information, education and services. I’ve been as much a contraception and abortion rights advocate over the last three decades as I’ve been a menstrual cycle advocate. But I was a successful user and ardent advocate of the fertility awareness method long before I became a board director at the pro-choice Calgary Birth Control Association in 1986. I went on to serve 10 years on the board of Planned Parenthood Federation of Canada and worked for six years as executive director of Planned Parenthood Alberta, which became Sexual Health Access Alberta in 2006. I’m currently on the board of Canadian Federation for Sexual Health, the former PPFC.
I stress my pro-choice credentials because I think I’m often suspected of being anti-choice. Surely any woman who advocates for healthy, ovulatory menstruation and speaks out against the health concerns inherent in hormonal birth control methods must be anti-contraception and anti-choice. I am neither. More broadly, I’ve written and talked a lot about the value of body literacy for women’s health and well-being.
I wonder sometimes why I’ve stuck it out with the pro-choice sexual health community. While many have been open to my ideas, I have seen little effort to learn about the health benefits of ovulatory menstruation or acknowledge the need – let alone act – to better serve women who want to use non-hormonal contraception. It’s frustrating to be a lone voice, but I keep talking.
It took me over 20 years to find the community that serves and appreciates my menstrual cycle advocacy. I attended my first Society for Menstrual Cycle Research conference in 2005, and that’s how I came to belong to this diverse group of academics, medical professionals, researchers, activists and artists committed to advancing knowledge and awareness of the menstrual cycle. We come from different perspectives, we ask different questions and we focus on different aspects of women’s menstrual lives. But we all hold true to the same idea: #menstruationmatters.
Menstrual cycle advocacy can be lonely and oh so frustrating. Chris Bobel’s recent post about how difficult it can be to help others make the menstrual connection included this quote from me:
Caring about menstruation and the menstrual cycle makes me almost a freak in the pro-choice world. I get ignored or criticized a lot because people don’t want to ask or answer some of the questions I keep trying to pose about choice around non-hormonal contraceptive methods.
Thanks to SMCR and re:Cycling, I’m not going to stop asking hard questions, or challenging the ignorance and avoidance that many in the mainstream sexual health-care community demonstrate when it comes to ovulation, the menstrual cycle and fertility awareness. I’ll keep chirping and chipping away. Continue reading...
Tags: Activism, birth control pill, blogging, FAM, fertility awareness method, Health Care, Menstruation, oral contraceptive pills, pro-choice
Posted in Activism, Amenorrhea, Birth Control, Communication, Health Care, Menstruation, Ovulation | 15 Comments »
December 12th, 2012 by Laura Wershler
Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.
Nov. 25 to Dec. 1, 2012, was LARC Awareness Week, billed by the California Family Health Council as “a chance to increase awareness about LARCs as a safe, effective, and long-acting birth control method.” Women were invited to contribute video messages on the theme Why I Love My LARC.
This catchy acronym stands for long-acting reversible contraceptive, and the push is on for many more women to choose this form of birth control. Make no mistake, it’s all about control: What the doctor puts in, only the doctor can take out. Ergo, it’s 99% effective. You can quit taking your pills, rip off your patch, or NOT show up for your next Depo-Provera shot. But if you hate the side effects caused by your IUD or implant, you’ve gotta go see a health-care provider to have it removed.
I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week.
According to the awareness campaign, LARCs include the ParaGard (copper) IUD, Mirena (progestin) IUD and Implanon, a non-biodegradable flexible rod, also containing progestin, that is inserted under the skin and left for up to three years. (Here’s a story about the rods going missing in women’s bodies.) Read the patient information about Implanon. Would you agree to have it inserted into your body?
Women who hate Implanon are speaking out. So are women who don’t love their ParaGard or Mirena IUDs. On YouTube, a video by a women with Mirena issues has over 6000 views; Why I Love My LARC, posted 8 days earlier, has about 100.
The old-school LARC – Depo-Provera – is not on the campaign’s list of LARCs, though it is heavily used in the United States. Holly Grigg-Spall recently reported that “one in five African American teens are on the Depo shot, far more than white teens.” Hmm. Will they all be switched to other LARCs when, or if, they come back for their next shot? Perhaps Depo is not on the list because women can discontinue this contraceptive without clinician intervention. But it’s probably because Depo causes bone density loss – and because this LARC is not a lark. Women are sharing their Depo stories on another re:Cycling post: Coming off Depo-Provera can be a women’s worst nightmare. You can find more bad news about this LARC than any other.
What about getting your LARC removed if you hate it instead of love it? One re:Cycling blogger shared what happened when she wanted her ParaGard IUD removed:
I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like ‘”Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.”
This is not the only reason why women who end up hating their LARCs will be discouraged from rejecting them. The Affordable Care Act requires all health plans issued on or after August 1, 2012 to provide no-charge access to FDA-approved LARCs. What’s it going to take to convince health-care providers to remove an expensive contraceptive – provided for free – that was supposed to last for three to 10 years?
Maybe a YouTube video about Why I Hate My LARC will help make it as easy to get rid of one as it now is to get one.
Tags: Activism, Birth Control, Depo-Provera, hormones, implanon, LARCs, Long-acting reversible contraceptives, Mirena, ParaGard
Posted in Activism, Birth Control, coming off the pill, Girls, Health Care, Hormones, politics | 6 Comments »
November 14th, 2012 by Laura Wershler
Bloggers at re:Cycling often challenge and invite readers to open up and talk about our menstrual experiences.
In a September post, Heather Dillaway asked : “Why don’t we talk about the important variations in our menstrual cycles?” In another, she wrote about the “second talk” Poise ads that encourage women to share their perimenopause experiences.
Chris Bobel wrote in defense of hating her period, sparking a lively discussion and much support for both her honesty and her call for “a more (not less) pluralistic menstrual discourse.”
Alexandra Jacoby has been writing a series of posts exploring things about our bodies we tend not to talk about. From Tell me again why we can’t talk about body stuff to her last post asking readers for suggestions on How to menstruate while camping , she is opening the door ever wider to menstrual cycle conversations.
We do our bit at re: Cycling to get people thinking and talking about menstruation from a broad range of perspectives, including the personal. And, happily, we are not alone in bringing “period talk” out in the open.
Last Friday, I participated in a #periodtalk Tweet Chat, a monthly event hosted by Be Prepared Period, a website dedicated to providing accurate, helpful information about menstruation to girls, women and parents. One of Friday’s guests was Suzan Hutchinson (@periodwise), the Director of Connectivity for You Are Loved, a non-profit organization “focused on raising awareness about tampon related Toxic Shock Syndrome and providing factual information about menstruation.” You Are Loved has been an ongoing #periodtalk participant. Suzan, a self-described “menstrual cycle activist since youth,” herself experienced TSS.
Suzan’s topic was menstrual understanding; her introductory Tweets shared some of her story:
I began my menstrual journey at age 15 with a belted pad & knowledge that a week each month my body would betray me.
No one talked about periods. I thought my experience was unique – that I was odd. Embarrassment kept me silent.
Suzan eventually came to view her period as just one part of her menstrual cycle, and she brought this cycle perspective to the Tweet Chat. In a post-chat phone conversation, Suzan told me that she has seen how #periodtalk has helped others lose their embarrassment in talking about periods. “I’ve watched women who started out not being able to contribute become menstrual activists, bringing other women to the chats.”
She also told me about the day #periodtalk trended worldwide on Twitter. It was September 14, 2012 and the topic was Back to School: Periods101. A blog post at Lunapads.com describes what happened:
Today #PeriodTalk had it’s big moment when it reached trending topic status worldwide. A pretty big accomplishment for a bunch of folks chatting about a topic which is usually so “hush-hush”. Of course the taboo-nature of the topic brought the trolls out of the woodwork and some pretty nasty things were said by a few crass individuals. Participants in #PeriodTalk were admonished for talking openly about something, which was in their opinion, not appropriate for the internet….seriously? Not appropriate for the internet? Have these people *seen* the internet?
Too bad for the trolls. Talking openly about our menstrual cycles is here to stay. We’ll keep doing it at re:Cycling and #periodtalk is thriving at Be Prepared Period. They have also launched an online Period Talk forum where girls and parents can ask questions and get answers about anything related to menstruation and puberty.
The next #periodtalk Tweet Chat – on the topic of Non-Profits and Menstruation – is on Friday, December 14, 2012. Check it out. Continue reading...
Tags: Activism, blood, Communication, FemCare, Girls, Menarche, Menopause, Menstruation, Social media and menstruation, toxic shock syndrome, Twitter and menstruation, weekend links
Posted in Activism, Communication, FemCare, Girls, Internet, Menarche, Menopause, Menstruation, Perimenopause, Reusable menstrual products, Toxic Shock Syndrome | 2 Comments »
October 17th, 2012 by Laura Wershler
Birth control in the U.S. has become synonymous with drugs and devices. The pill, patch, or ring; Depo-Provera or hormonal implant; copper IUD or Mirena IUD; traditional hormonal birth control or long-acting reversible contraceptives. All impact the function of the menstrual cycle; some suppress it completely. As a pro-choice menstrual cycle advocate I take issue with the fact that keeping your cycle and contracepting effectively are now considered mutually exclusive.
A widely published Associated Press story tells us that the American College of Obstetricians and Gynecologists now recommends hormonal implants and IUDs as the best birth control methods for teenagers. The research this recommendation is based on did not even study pregnancy outcomes for women using condoms, barriers, or fertility awareness methods. These methods were not among the free contraceptives offered to study participants. Another story reported that ”the new guidelines say that physicians should talk about (implants and IUDs) with sexually active teens at every doctor visit.” This sounds like a hardcore sales pitch to me. I expressed my concerns about pushing LARCs on teenagers in a previous re:Cycling post.
Drugs and devices also figure prominently in Switching Contraceptives Effectively. New York Times health writer Jane E. Brody writes about the mistakes women make when switching between birth control methods that can result in unintended pregnancies. The reasons women switch are explored and a link to a resource on how to switch methods successfully is provided.
The Reproductive Health Access Project developed the pamphlet to help women prevent gaps in contraception when they change methods. The premise is a good one:
What’s the best way to switch from one birth control method to another? To lower the chance of getting pregnant, avoid a gap between methods. Go straight from one method to the next, with no gaps between methods.
But the pamphlet developers made the huge false assumption that all women just need or want to try another drug or devise. It focuses ONLY on these method — how to switch from the pill to Depe-Provera or the copper IUD, or how to switch from the Mirena IUD to the progestin implant. Condoms and barrier methods are considered useful ONLY for the transition period between drugs and devices. Fertility Awareness Methods are ignored completely. The resource comes across as propaganda for drug- and device-based birth control methods.
Neither Brody nor those behind the Reproductive Health Access Project seem to understand that this approach contributes to the unplanned pregnancy rate by failing to acknowledge that many women are fed up with contraceptive drugs and devices. These women want support and information to switch away from these methods. They are falling though the contraceptive gap created by this failure.
Is it any wonder that some women stop using their contraceptives without talking to their physicians? Maybe they are fed up with doctors like Ruth Lesnewski, education director of the Reproductive Health Access Project, who offers trite admonishment that side effects ”will go away with time” and insists that caution about using long-acting methods like the IUD or hormonal implant is “outdated.” Real health issues are associated with all these methods. I guess Dr. Lesnewski doesn’t read health blogs where women document their frustration about side effects and dismissive health-care providers.
This article places blame for contraceptive failure on women not knowing how birth control works, instead of where the blame really belongs — on the blind spot that keeps sexual and reproductive health-care providers from seeing, and serving, women who are sick and tired of drugs and devices.
As for the ACOG recommendation on the best birth control methods for teens? It’s just a step away from coercive, patriarchal decision-making by doctors for teenage girls, and a threat to the sexual agency of many young women.
Tags: Activism, Birth Control, birth control pill, Health Care, LARCs, Long-acting reversible contraceptives, oral contraceptive pills
Posted in Activism, Birth Control, coming off the pill, Health Care, Menstruation, Pharmaceutical | 25 Comments »
September 21st, 2012 by Laura Wershler
I was fuming. My Twitter feed had alerted me to a free online course called Contraception: Choices, Culture and Consequences. I opened the link to find this course syllabus:
- Week One: Introduction to Contraceptive Care
- Week Two: The Menstrual Cycle
- Week Three: Long Acting Reversible Methods
- Week Four: Hormonal Methods
- Week Five: Barrier Methods
Regular readers will know what I think is missing from the syllabus: Fertility Awareness Methods. I emailed course instructor Jerusalem Makonnen from University of California–San Francisco to ask about this omission. I was delighted by her response. She will be including information on Fertility Awareness Methods in Week 5, with Barrier Methods. It was an oversight. Makonnen wrote, “I have been teaching a Contraception course at UCSF School of Nursing for the past five years and it has been a topic that is fully integrated and taught to nurse practitioners and midwives.”
I wish I could say that Fertility Awareness Methods of birth control are “fully integrated” in all sexual and reproductive health clinics and organizations across North America. I have advocated for their inclusion throughout my volunteer and work career in this field, including 19 years on the boards of Planned Parenthood affiliated organizations in Canada, and as a writer on women’s health issues. I believe that full contraceptive choice must include information, support, and training to use Fertility Awareness Methods effectively and confidently.
For more than 25 years I’ve been urging the mainstream sexual and reproductive health community to include FAM in their service delivery. While it might be discussed as an option, with some helpful information provided, the means to learn and use the method is rarely made available to clients. I consider this to be a serious error of omission, an unacceptable failure to provide access to an effective birth control method.
The facts are these: FAM works and many women want to learn how to use it. They buy books and seek out skilled instructors to learn from. They share information online. Thousands are downloading apps to their smartphones to track their menstrual cycles. You could almost say FAM is trending. So why are women who don’t want to take drugs or insert devices to prevent pregnancy receiving such little support and service from established providers of contraceptive care?
There are no valid excuses for sexual and reproductive health clinics and educational organizations NOT to offer FAM instruction to clients, either through trained in-house staff or in collaboration with certified FAM instructors. At the very least, they should have referral programs – regularly evaluated – for women seeking instruction in the method.
To return to the course syllabus above, I can’t help but suggest that Fertility Awareness Methods should follow Week 2: The Menstrual Cycle, since FAM is all about learning how to observe, chart, and interpret menstrual cycle events. This would be the logical progression. But for now, I’ve stopped fuming and am just relieved to know that the free online course Contraception: Choices, Culture and Consequences is going to include instruction on FAM. This means more women will have access to accurate information about these methods.
In the video explaining the course, instructor Makonnen notes that half of all pregnancies in the United States are unplanned. It’s quite likely this percentage could be lowered just by teaching girls and women the key principles of fertility awareness. When it comes to women’s sexual and reproductive health, body literacy is a good place to start.
Tags: Activism, Birth Control, contraception education, Menstruation
Posted in Activism, Birth Control, Menstruation | 6 Comments »
August 22nd, 2012 by Laura Wershler
Your fertility is not a deep, dark mystery only your doctor can unravel. It’s yours to own, understand and manage. Forget the ticking biological clock, it’s the wrong metaphor. Fertility ebbs and flows, like the phases of the moon. It’s about the cycle – not the clock.
Are you wondering about your fertility status? Will you be able to have a baby when you want to?
Seems these questions are on the rise for 20- and 30-something women who are finally getting the message that putting off motherhood may not be a good idea. Recent news stories report that young adults don’t know the facts of fertility decline and overestimate the success of reproductive technologies.
But as the message gets through, the response makes my eyes roll.
Judith Timsom, one of my favorite columnists, recently pondered the fertility fears many young women are having. Among them:
A third woman, turning 30, with a committed partner and a great job, made fertility sound like the new “f” word as she glumly remarked to a friend ,“My doctor told told me my fertility just dropped 50 per cent. Crap.”
This is crap. It misrepresents how fertility works. Timson writes that “young women – and men – are crying out for more factual, emotionally neutral information on how their fertility works.” Forgive me if I, and at least 700,000 others – the number of people who have purchased Toni Weschler’s Taking Charge of Your Fertility since it was first published in 1995 - shake our heads in frustration.
What women need is body literacy, the know-how to observe, chart and interpret our menstrual cycle events so that we – not the doctor, not the lab tech – can confirm our fertility status. Yes, it’s called fertility awareness, and, since the late 60s, millions of women world-wide, including me – a bonafide pro-choice feminist, have used this life skill to both avoid and achieve pregnancy.
If you’re worried about your fertility, here are five things you need to know:
- You can learn to observe and chart three key signs of fertility: a) fertile cervical mucus b) basal body temperature shift c) adequate luteal phase, or number of days from ovulation to next period.
- If you use hormonal contraception (HC), you have been infertile for as long as you’ve been using it. When you stop HC, your body has to establish healthy ovulatory menstrual cycles before you become fertile. Health and environmental factors may impact this process. Factor recovery time into your baby plans.
- If you began using HC as a teenager for heavy bleeding, painful periods or irregular cycles chances are your reproductive system has not fully matured. When you quit HC this maturation process will resume. Depending on the method you used, it could take months before you have ovulatory, fertile cycles. Be patient. Holistic Reproductive Health Practitioners can assist in recovering fertility.
- If you began using HC for PCOS or endometriosis, expect symptoms to resume when you stop. The Centre for Menstruation and Ovulation Research describes treatments that manage PCOS and endometriosis while helping to preserve fertility.
- Fertility is individually, not statistically, determined. It can ebb and flow from cycle to cycle. Diet, stress, travel and trauma can result in anovulatory, or infertile, cycles. When it comes to getting pregnant, the more you know about your own menstrual cycle, the better.
Fertility awareness is empowering, but Toni Weschler says that in her decades long experience she has repeatedly seen the sense of excitement that women feel evolve into anger. “Women want to know why they weren’t taught this when they were teenagers.”
The young women Judith Timson writes about have yet to acquire this knowledge. When they do, will they be angry enough to teach their own daughters? Weschler has a book for them, too - Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body. Fertility isn’t a mystery if you know where to look for the clues.
Tags: Activism, biological clock, Birth Control, CeMCOR, delayed motherhood, fertility, fertility awareness, fertility charting, Fertility fears, infertility, Justisse Method of Fertility Awareness, Menstruation, Taking Charge of Your Fertility, Toni Weschler
Posted in Birth Control, Fertility, Menstruation, Ovulation, Pregnancy, Reproduction | 2 Comments »
July 25th, 2012 by Laura Wershler
SPOILER ALERT: Plot details in the Fifty Shades of Grey trilogy are revealed in this post.
Second book in the Fifty Shades of Grey trilogy.
Fine literary fiction it is not, but the Fifty Shades of Grey trilogy by E.L. James can certainly claim to be libido-boosting storytelling. Deirdre Donahue at USA Today summarized the books’ appeal in 10 reasons ‘Fifty Shades of Grey’ has shackled readers. She pretty much nailed it. And she’s read the books, which is more than can be said for other writers, including this one who implied that heroine Anastasia (Ana) Steele signs a contract to become hero Christian Grey’s submissive in a BDSM relationship. She doesn’t.
Until he meets Ana, Christian’s sexual history has included only BDSM relationships, those involving bondage, discipline, dominance, submission and sadomasochism. BDSM plays a role in their love story, but the most sadistic thing that Ana submits to is a shot of Depo-Provera. re:Cycling readers know what I think of this contraceptive: I. Am. Not. A. Fan.
As a menstrual cycle advocate, I pay attention to menstrual mentions wherever they appear. It was impossible for me NOT to hone in on how James handles menstruation and birth control.
Christian quickly ascertains that Ana, a virgin when he meets her, is not using birth control. (His unflinching communication about sexuality is one of the books’ most appealing aspects.) As their sexual affair begins, he uses condoms. Within a week or so he asks when her period is due and says, “You need to sort out some contraception”. But our hero is a rich control freak, so he arranges for “the best ob-gyn in Seattle” to come to his home on a Sunday afternoon. Ana, the narrator:
“After a thorough examination and lengthy discussion, Dr. Greene and I decide on the mini pill. She writes me a prepaid prescription and instructs me to pick the pills up tomorrow. I love her no-nonsense attitude — she has lectured me until she’s as blue as her dress about taking it at the same time every day.”
Alas, Anastasia, just 21, is the perfect example for why researchers with the Contraceptive CHOICE Project are recommending that women under 21 use long-acting reversible contraceptive methods. She forgets to keep taking her pills when she and Christian briefly break up. It’s back to condoms for this couple, until Dr. Greene reappears, confirms Ana is not pregnant, and, after Depo-Provera’s side effects are dismissed as irrelevant because “the side effects of a child are far-reaching and go on for years”, gives her the shot. I almost had to stop reading.
I get it that James uses Depo-Provera as a plot device, as becomes apparent. But the author’s decision to give Ana Depo-Provera is not in keeping with either Dr. Greene’s or Christian’s characters. I don’t believe for one minute that the best ob-gyn in Seattle would give Depo-Provera to any patient; she’d recommend a Mirena IUD. As for control-freak Christian, he is adamantly committed to Anastasia’s safety, evidenced in many ways. He would never consent to her taking a drug with these potential side effects: weight gain, digestive problems, depression, loss of bone density, vaginal dryness, and — especially — loss of sexual sensitivity and desire. Never! And he’s too smart not to know this.
Christian’s occasionally expressed distaste for condoms also seems to be a plot device considering he uses them so skillfully, and without obvious diminishment to either his or Ana’s pleasure, through 986 pages of the 1594-page trilogy. The tearing of foil condom packets is a leitmotif that in no way hinders this man’s exceptional “sexing skills”.
But James gets full marks for this: Christian Grey is not afraid of blood. While making love in a spacious hotel bathroom, he gently removes Ana’s tampon and tosses it in the toilet. Later, sitting on the bathroom floor, Ana remembers she has her period:
“I’m bleeding,” I murmur.
“Doesn’t bother me,” he breathes.
Tags: BDSM, Birth Control, blood, book, book reviews, Depo-Provera, erotica, Fifty Shades of Grey, menstrual sex, period sex, pop culture
Posted in Birth Control, books, Literature, Menstruation, Sex, Virginity | 6 Comments »
June 28th, 2012 by Laura Wershler
Body Literacy. It’s cool to see a phrase I championed infiltrate the language, be taken up and used by others. Not always referenced, but used. And that’s okay by me. I want #bodyliteracy to become a flourishing Twitter hashtag.
I first used the term in June 2005, just as I arrived at my first Society for Menstrual Cycle Research conference in Boulder, Colorado. A few months later, the origins of this first usage, by myself and colleagues Geraldine Matus and Megan Lalonde, were documented in Femme Fertile, a newsletter published by Justisse Healthworks for Women. I wrote at the time:
The concept of body literacy occurred to me after I read a novel illustrating the disempowering impact of illiteracy. The inability to read diminishes self esteem and opportunities to participate in the exchange of ideas. The connection to the lives of girls and women is obvious — the education of girls is a key strategy in all international development work. It struck me that most educated women in developed countries live with another kind of illiteracy — (we) are not taught to“read” or understand (our) own bodies. On the contrary, (we) are taught to distrust (our) bodies and accept various artificial means to“manage” them.
By my definition, body literacy is acquired by learning to observe, chart and interpret our menstrual cycle events. This life skill (as I call it) helps us understand how our sexual, reproductive and general health and well-being are connected to our menstrual cycles. Body literacy supports, if not compels, our fully informed participation in health-care decision making.
My Femme Fertile colleagues and I continued to write about body literacy, telling personal stories in Stuck in a Body Literacy Gap (Winter 2006) and sharing professional experiences in Body Literacy at Work in the Community. Our presentation at the 2007 SMCR conference was called Menstrual Cycle Charting: A Path to Body Literacy.
Since then, the phrase has been spreading thanks to SMCR members. Geraldine Matus, who helped develop the concept, incorporated the phrase in the title when she updated her Justisse Method Fertility Awareness and Body Literacy: A User’s Guide, first published in 1989. Research scientist Annie Harvey uses the phrase in her women’s health work at Via Christi Hospitals in Wichita, Kansas. Jerilynn Prior at the Centre for Menstrual Cycle and Ovulation Research says body literacy is ‘as important as reading, writing and arithmetic!‘ Chris Bobel, associate professor of women’s studies, mentioned body literacy in her book ‘New Blood: Third Wave Feminism and the Politics of Menstruation‘ (2010).
Chris’s mention was noted and used in a Psychology Today blog title by Molly Castelloe, The Last Taboo: Menstruation and Body Literacy. It was re-posted on Tumblr.
A recent Google search found other mentions, one of which predates my use of the phrase. I love that the Tathapi Trust Women and Health Resource Development has been advancing the concept in India since 2000.
Sexuality and Fertility Awareness (FA) education as part of ‘body literacy’ is a core area of Tathapi’s work, involving not only bodily experience of the reproductive system but also the socio-cultural and political experience of women’s health.
The PUKAR Youth Fellowship Program in India has used body literacy in its work with teenage girls, while the Institute for Reproductive Health at Georgetown University has a youth initiative focusing on fertility awareness and body literacy.
Body Literacy: Now in a book title, a fledging hashtag on Twitter and, perhaps, soon to be an Internet meme? I hope so. The word meme, coined by evolutionary biologist and author Richard Dawkins, comes from the Greek word ‘mimeisthai’ meaning to imitate or copy. Please, go for it! Continue reading...
Posted in Menstruation | 5 Comments »
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.
