Blog of the Society for Menstrual Cycle Research

Depo-Provera and Fifty Shades of Grey—The Movie

February 13th, 2015 by Laura Wershler

Dear Readers: The following post first appeared on July 25, 2012, during the media think-piece flurry over the soaring popularity of E.L James’s Fifty Shades of Grey trilogy. With the movie opening on Valentine’s Day, 2015, I can’t wait to find out if or how Depo-Provera is referenced as the contraceptive choice made for heroine Anastasia Steele by ob-gyn Dr. Greene, a character I have confirmed via IMDb is in the movie. I argued in the post that Depo-Provera as Ana’s birth control method was an unrealistic plot device. Commentary on Fifty Shades has again started to snowball, but I doubt anyone besides myself will have the slightest interest in this facet of the story. I invite readers who get to the theater before I do to report back in the comments section.

Menstrual Considerations in Fifty Shades of Grey

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.”

State of Wonder–Part 1: Wondering about missing menstrual mentions in literature

January 22nd, 2015 by Laura Wershler

In her novel State of Wonder Ann Patchett explores, among many broad themes, the question: What if there were a drug women could take to extend menstruation and fertility into their seventies? Not evident on the dust jacket, this storyline grabbed the attention of this menstrual cycle advocate.

Set mainly in the jungle of Brazil, the novel revolves around the decades-long research of Dr. Annick Swenson who has kept the location and progression of her research secret from the drug company funding her work with the fictional Lakashi tribe. When a male scientist sent by the drug company to find Dr. Swenson and deliver a message is reported dead, Dr. Marina Singh, a research pharmacologist, becomes the second emissary charged with finding Dr. Swenson and assessing her progress towards the promised drug.

Finding Dr. Swenson is a formidable task, but when she does Marina eventually learns the complex botanical explanation for the Lakashi’s extended fertility, as well as the justifiable reasons why the research location has been so scrupulously protected.

This literary novel, a satisfying read, powerfully renders the mystique of the Amazon jungle, conveying both the wonder and trauma Marina experiences there. For an insightful review of State of Wonder I’d recommend Lydia Millet’s. This series of posts is not a review, but rather commentary on the niggling details related to the extended fertility storyline. Spoiler Alert: Some plot points will be revealed.

After a few weeks in the jungle—the timeline is fuzzy—Marina is invited by two other female researchers to the grove of Martin trees where she observes Lakashi women of all ages scraping tree bark with their teeth, a practices she is told that begins at menarche and is the key to their lifelong fertility.

Marina learns the women chew the bark every five days except when they are menstruating and when they’re pregnant; the bark repulses them from the moment of conception. She is told also that although the women don’t all come to the grove on the same five-day cycle, they’re menstrual periods are “pretty much” synchronous so the researchers “get a few days off every month.” That is, days off from observing them in the grove while taking pin-prick blood samples and collecting cervical mucus swabs to monitor estrogen levels that Dr. Swenson has taught the Lakashi to do themselves with Q-tips. Dr. Swenson’s research team charts and studies every cycle of every menstruating girl and woman.

The researchers tell Marina they also chew the bark and invite her to try it. Here is where, in a story that speaks intimately about the tribal women’s menstrual cycles, I wondered why Patchett did not include even one sentence to acknowledge when Marina had her last period. (At 42 she has thought about her fertility and her prospect of having a child someday.) Because she scrapes the bark one assumes she isn’t menstruating, and she’s been in Brazil long enough–weeks spent in Manaus before getting to the jungle–to have had at least one period. Where is she in her cycle? This matters because of what happens later in the story. So, since menstruation is integral to the novel, why not mention it? And why don’t the other female researchers mention whether their cycles, too, have synchronized with the Lakashi’s?

In most novels, probably too many, the menstrual cycles of female characters are invisible unless they figure prominently in the plot. It made no sense to me that Patchett chose to make Marina’s cycle invisible. Even if readers can deduce this missing information, surely this is the wrong novel in which to require us to do so. Again, I ask, “Why?”

To be continued in State of Wonder—Part 2: Wondering about missing menstrual femcare products and birth control references

 

Coming off Depo-Provera can be a woman’s worst nightmare

August 28th, 2014 by Laura Wershler

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Laura Wershler originally appeared April 4, 2012, and has received nearly 600 comments. To avoid confusion, we have closed comments on this re-post.

 

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies OurselvesQuestions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.

Choice, Fertility, and Menstrual Cycle Awareness

April 2nd, 2014 by Laura Wershler

Guest Post by Lisa Leger

Photos courtesy Lisa Leger

Posing while pregnant in my pro-choice T-shirt in 1993 was a political statement, one I made with a huge sassy grin on my face. When I recreated the pose recently on my daughter’s 21st birthday, I found it easy to reprise the grin. First take, in fact. My choice tee is well worn; it’s a house/jammy shirt that my daughter has seen me in her whole life. Little does she know that she’s had her nose wiped by a piece of Canadian history.

I bought the choice tee at a fundraiser in Toronto when the Ontario Coalition for Abortion Clinics was helping Canadian abortion rights crusader Dr. Henry Morgentaler with legal expenses when he was forced to defend in court his practice of providing safe abortions in a free-standing clinic. At the time, abortion was legal in Canada, but only if approved by a Therapeutic Abortion Committee and performed in a hospital. I was 27 years old, fresh from university, and a legal abortion had allowed me to finish my degree unburdened by an unplanned pregnancy, but I supported fewer restrictions to access.

Like most twenty-somethings, I had a long history of contraceptive use. I’d tried the pill, an IUD, and even the rhythm method, a fuzzy grasp of which I probably had picked up in a public school health class. I had a rotten attitude about my fertility, saw it as a huge hassle, and had no interest whatsoever in becoming a mother. My social and political opinions about the right to reproductive choice were fully formed when I bought this T-shirt for the cause I so ardently supported.

I was 32 years old when I posed in it while pregnant. By then I’d been charting my menstrual cycles for enough years to have improved my attitude about fertility dramatically. I’d met Geraldine Matus in the late 80s and learned to use the Justisse Method for Fertility Awareness that she developed. It changed my life forever; not only did I gain body literacy, develop a healthy relationship with my cycling body, and break free from contraceptive drugs and devices forever, I also gained a cherished mentor in Geraldine, and a career path as a Justisse fertility awareness educator that has sustained and gratified me for the past 25 years.

I took that picture in my choice T-shirt in 1993 because, for me, it says “I’m choosing to be pregnant.” I grinned because it was my choice to have Clair; I wasn’t scared or forced or coerced into that pregnancy. It was entirely my free will to lend my body to the great task of having a child and I made that choice because of the healing that had gone on over the years of charting, coming into relationship with my body, and learning to appreciate the awesomeness of my pro-creative power. Now that my daughter is 21 years old, I think about the freedom and choices she has as a Canadian woman in 2014, and feel sadness for those who don’t have that choice. I reflect on what a shame it is that these battles over reproductive choice, human rights, access to birth control, stigma, and power seem never to be put to rest. On Clair’s birthday, I posed in my choice T-shirt for my family archives and for those who still do not have choice.

Lisa Leger is a Holistic Reproductive Health Practitioner (HRHP) and women’s health activist on Vancouver Island. She serves on the board of the Society for Menstrual Cycle Research.

The Big, Fat, Menstrual Untruth in Cameron Diaz’s The Body Book

February 5th, 2014 by Laura Wershler

I was curious. If Cameron Diaz’s purpose in writing  The Body Book: The Law of Hunger, the Science of Strength, and Other Ways to Love Your Amazing Body was empowerment, helping women to understand how their bodies work, would she include information about the menstrual cycle?

There was no way of knowing from her Jan. 22, 2014 radio interview with Jian Ghomeshi on CBC’s Q. I listened to Diaz explain that conversations she’d had and overheard in the last few years made it clear to her that women are completely confused about their bodies. She said this had her thinking, “Wow, that’s such a crazy thing that after so many years of living in your body that you actually don’t have an understanding of it.”

Then she revealed her intention in writing the book – to empower women to make “informed decisions about their nutrition and their physical activity.” Judging from this comment, the book’s subtitle, and the fact she did not mention menstruation during the interview, I wondered if the menstrual cycle would even be mentioned.

I sought out The Body Book at my local bookstore and quickly scanned the table of contents and index. I found myself smiling, thinking about Betty Dodson, author of Sex for One: The Joy of Selfloving, and how she revealed in Chapter 1 that whenever she gets a new sex book she “immediately” looks up “‘masturbation’ to see where the author really stands on sex.” Whenever I see a new book about women’s health I look up “menstruation” to see what the author really knows about the menstrual cycle. Turns out Diaz, and/or her co-author Sandra Bark, know both a lot and not so much.

In Chapter 21, Your Lady Body (the book’s introduction starts with the salutation Hello, Lady!), she presents a fairly accurate endocrinological description of the three phases of the menstrual cycle: follicular, ovulatory, luteal. So far so good. But then, in the last paragraph of the luteal phase section, comes the big, fat menstrual untruth, the implication that whether you use hormonal birth control or not, this is how your menstrual cycle unfolds. It’s an absolute falsehood, and one that many women in this age of burgeoning body literacy are sure to see through.

Photo Illustration by Laura Wershler
Note: This is the only reference to contraception in The Body Book

The last paragraph of this luteal phase description (page 182) is ridiculously misleading. If a woman’s birth control method is the pill, patch, ring, implant or (Depo-) Provera shot, the synthetic hormones each contains will shut down her normal menstrual cycle function. She most definitely will not experience a cycle with follicular, ovulatory and luteal phases. Hormonal contraception does not “protect” her eggs. She will not ovulate, therefore the egg will not die. She may have a “withdrawal bleed” but it is not a true period. This is the truth.

I can understand, possibly, why Diaz made this egregious implication. What were her choices? Open a can of worms? State categorically, as every description of menstrual cycle function should, that you don’t ovulate or experience a normal menstrural cycle while taking hormonal contraception? 
Maybe something like this?

Hey Lady! If you use hormonal birth control none of this fascinating menstrual information applies to you. Wish I could tell you what this means for your health and fitness but, sorry, that’s beyond my area of expertise.

If Diaz’s intention for this book is to empower women to better understand their bodies, then she failed when it comes to the menstrual cycle. I hope she’ll correct this big mistake in any future editions.

Food. Fashion. Blood?

January 10th, 2014 by Laura Wershler

A month ago I was musing about what it might be like to blog about fun stuff like food, fashion or travel – you know, topics not quite so “fraught” as the menstrual cycle. Sometimes it feels like just so much work sharing facts and opinions about why body literacy matters, why knowing how our cycles work and how ovulation impacts our health can lead us into meaningful, self-determined relationship with our bodies and ourselves.

But in the days leading up to Christmas, I was reminded by two young women, both of whom I’ve known since they were babies, daughters of friends, one in her late 20s, the other in her early 30s, why I do what I do.

Photo by Laura Wershler

The younger had contacted me last September, at the suggestion of her mother, with questions about switching birth control methods. She was fed up with the Pill, wanted to quit, was considering the Mirena IUD, told me about her history with ovarian cysts, irregular cycles. In a stable relationship, she hadn’t thought much about children. We talked about options. I assured her there were effective non-hormonal methods she could use, that by doing so she could assess her fertility, get her cycle functioning normally before making a decision about the Mirena. I sent her information about treatment – not involving hormonal contraceptives – for ovarian cysts; I asked a medical colleague questions on her behalf. She was thankful, emailing me that she had “some heavy thinking to do, including my actual timeline for children.”

I hoped to see her at her family’s annual Christmas party. We greeted each other briefly when I arrived, but not until the house was teeming with guests did we have the chance to talk privately amidst the holiday din. She told me she’d stopped the Pill three months before, could hardly believe how much better she felt, even though she’d yet to have a period. She thanked me, again, for validating her desire to quit the Pill. It so happened she had an appointment the next day with her family doctor; she knew what treatment she would request to help get her cycle started.

It did not go well. Her doctor, like so many I’ve heard about, was not interested in the menstrual cycle research she had done or the choices she wanted to make about her reproductive health. Quite the contrary: her doctor was hostile. It was disheartening for her, maddening to me, but not surprising.

A day later, at another holiday gathering, the other young woman stopped me in the hall to ask what I thought of the Mirena. She’d made the switch from the combined Pill (estrogen/progestin) to a progestin-only version to help with migraines. She offered that she and her partner had not yet decided about children, but she was concerned about leaving it too late. I told her the Mirena was intended as a five-year method, and if she was thinking she might want a child, it was a good time to stop hormonal contraception and assess her fertility before making a decision, either way.

I forwarded both women links to a naturopath skilled in menstrual cycle and fertility issues, and to a fertility awareness instructor who’d just announced her 2014 Eco-Contraception Program. The decision about what to do next, of course, will be theirs.

I sense both young women are searching for new, mindful connections to their bodies. Even if all I ever do is help a few such women find the support they need to make this connection, then to hell with food and fashion, I’ll keep writing about the menstrual cycle.

Give the Gift of Body Literacy

December 16th, 2013 by Laura Wershler

Photo by Laura Wershler

This holiday season consider giving the women in your life the gift of body literacy. The books, resources and services compiled below support understanding and appreciation of our bodies.

Gifts for teenagers:

* To hold a Wondrous Vulva Puppet is to experience a loving representation of the female body. Dorrie Lane’s vulva puppets are used around the world to spark conversations about our bodies and our sexuality. To quote a testimonial on the website: “The sensual curves, velvety feel and beauty of these puppets seems to disarm people in a way that opens the door to real discussion about women’s sexuality.”

* Toni Weschler, widely known for her best-selling book on fertility awareness Taking Charge of Your Fertility, has also written a book for teenagers. Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body makes the perfect gift for your daughter or younger sister, neice or cousin. This book can transform a young teenager’s experience and understanding of her body as it teaches her the practical benefits of charting her menstrual cycles. Available in paperback and Kindle editions.

Gifts for those who want to learn fertility awareness:



* Justisse Method: Fertility Awareness and Body Literacy A User’s Guide by Justisse founder Geraldine Matus is a helpful gift for anyone wanting to learn about fertility awareness based methods (FABM) of birth control. It is “a primer for body literacy, and a guide for instructing women how to observe, chart and interpret their menstrual cycle events.”

For someone who wants to learn fertility awareness to prevent or achieve pregnancy, or to fix menstrual problems, finding a certified practitioner is getting easier. Technology can connect women with skilled instructors who may live thousands of miles away. Check out the practitioners below online and on Facebook.

*   *    *   *   *   *

* Flowers Fertility (Colleen Flowers, Colorado): Facebook.

* Grace of the Moon (Sarah Bly, Oregon): Facebook.

* Holistic Hormonal Health (Hannah Ransom, California): Facebook.

* Justisse Healthworks for Women provides a directory of Justisse-trained Holistic Reproductive Health Practitioners (Worldwide): Facebook.

* Red Coral Fertility (Justina Thompson): Facebook

* Red Tent Sisters (Amy Sedgwick, Ontario, Canada): Facebook

I invite other certified instructors who work locally to leave their contact information in comments.

Gifts for women in midlife

* For women who are in the perimenopausal transition – which can last from six to 10 years for most women, ending one year after the final menstrual period – give the gift of information. Connect friends and family with the website of the Centre for Menstrual Cycle and Ovulation Research where they’ll find many free resources that offer explanations and treatment suggestions for the symptoms they may experience throughout this transition including night sweats, hot flushes, heavy and/or longer flow, migraines, and sore, swollen breasts.

* To those who love fiction, consider giving Estrogen’s Storm Season, a fictionalized account of eight women’s journey through perimenopause written by CeMCOR’s Scientific Director, endocrinologist Dr. Jerilynn Prior:

They are as different as women can be—yet they share the mysterious experiences of perimenopause, night sweats, flooding periods or mood swings. We follow these women as they consult Dr. Madrona, learn the surprising hormonal changes explaining their symptoms, get better or worse, and try or refuse therapies. As each woman lives through her particular challenge, we begin to see how we, too, can survive perimenopause!

Proceeds from book sales support ongoing research.

From menarche to menopause, it is never too early or too late to acquire body literacy. I invite readers to share other gift ideas that promote menstrual cycle comfort and support body literacy.

Why the “pullout generation” is a sex ed fail

November 13th, 2013 by Laura Wershler

Questioning and quitting the pill are current hot topics, fueled in no small part by Holly Grigg-Spall’s recently released Sweetening the Pill Or How We Got Hooked on Hormonal Birth Control. Her book has drawn ample backlash, brilliantly addressed by re:Cycling blogger Elizabeth Kissling.

Adding to the media clamour was Ann Friedman’s New York Magazine online piece No Pill? No Prob. Meet the Pullout Generation which explores how and why women she knows are ditching hormones and depending on withdrawal and period tracking apps for birth control.

Black Iris by Georgia O’Keeffe, photographed by Laura Wershler
at The Metropolitan Museum of Art

Both writers, along with Toronto freelancer Kate Carraway, recently discussed the topic Rebelling against the pill: ‘Pulling-Out’ of conventional birth control on CBC Radio-Canada’s The Current.

Listening to Grigg-Spall, Friedman, and Carraway discuss the pill rebellion affirms that while many young women are through with hormonal birth control, their transition off the pill, etc., is not without risk-taking and pushback.

Grigg-Spall nailed the pivotal point when she said “It’s a provider issue.”

The rise of the “pullout generation” is proof that sexual health-care providers and educators, among whom I count myself, have failed on two counts:

1) We’ve failed to address a key aspect of contraceptive use: how to transition successfully between method groups, in this case from hormonal to non-hormonal methods. We’d rather present the so-called “latest and greatest” hormonal methods and say – earnestly, pleadingly – try this! The CBC panelists provided strong anecdotal evidence that more and more women are having none of it.

2) We’ve failed to adequately acknowledge and serve women who can’t, won’t or don’t want to use hormonal methods. We are NOT providing across-the-board support and programs that include easy access to diaphragms or certified training in fertility awareness based methods (FABM), either onsite or through collaborative referral strategies.

For over 25 years I’ve advocated for increased access to information, support and services for women who want to use non-hormonal methods of birth control. It’s self-evident such services must include access to qualified instruction to learn FABM that have effectiveness rates over 99%. This is not to say there isn’t a place for withdrawal as an effective back-up. Check out this confessional how-to post by fertility awareness instructor Amy Sedgewick.

As Friedman said on The Current, women are intimidated by the idea of learning fertility awareness. I believe this is mostly because mainstream sexual health-care providers have never fully educated themselves about FABM or fully committed to presenting these methods as viable options to drugs and devises. Do they think that most women can’t or don’t want to learn fertility awareness skills? That would be like thinking most girls can’t or don’t want to learn to read.

As I’ve written elsewhere: “Fertility awareness, like riding a bicycle, is a life skill.”

If you can learn to swim, ski or snowboard, knit a sweater, read a balance sheet or master Adobe InDesign, you can learn to observe, chart and interpret your menstrual cycle events. We can all acquire body literacy.

Until sexual health educators and care providers develop programs to fully serve women who won’t use or want to stop using drugs and devises for birth control, we will continue failing to meet the growing “unmet need” for effective non-hormonal contraceptive methods.

The reign of hormonal birth control as the top-of-the-contraceptive-hierarchy gold standard appears to be coming to an end. The pullout generation represents just one thread in this transition. The questions is: Are sexual health educators and care providers paying attention and, if so, what are they going to do about it?

“Prescribing the pill has become ‘standard-of-care’ for being a girl”

October 16th, 2013 by Laura Wershler

I had the privilege of writing the foreword for Holly Grigg-Spall’s recently published book Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control. It’s astounding to me that more than 30 years ago, before Holly was born, I was asking some of the same questions she explores in her book. I thought we’d have more answers by now, but one thing is certain: Holly’s book has prompted long-overdue discussion and debate about issues related to hormonal birth control. Below is my foreword to Sweetening the Pill.

………………..

In a letter dated March 22, 1980, I proposed to the editor of an American woman’s magazine that they consider my enclosed article: The Contraceptive Dilemma – A Subjective Appraisal of the Status of Birth Control.

I wrote:

“Recent articles (about birth control) deal almost exclusively with the basic pros, cons, and how-tos of the various contraceptives available – matter-of-fact discussions that reduce birth control to a mere pragmatic decision. If only that were the case. 

Contraception, like the sexual interaction that necessitates it, involves our emotions as much as it does the facts. Yet the subjective, personal aspect of contraception is so often ignored. In this age of scientific research we are expected to (subjugate) our emotional reactions to significant probabilities, our anger to logic. Very real fears and earnest questions are dismissed as irrelevant….”

Although today I wouldn’t use the phrase “emotional reactions,” it’s hard to believe that three decades later, the status of birth control and women’s relationship to it has not much changed. Websites, not magazines, now host information about the basic pros, cons and how-tos of available birth control methods. And it is writers like Holly, half my age, who honour women’s real fears and ask earnest questions that are still being dismissed as mostly irrelevant.

Just as my personal story with the pill – including over a year of distressing post-pill amenorrhea – set me on a course of research and advocacy, so too has Holly’s personal experience. Sweetening the Pill explores and challenges the ways in which the pill and other drug-based contraceptives damage women’s health, threaten our autonomy and thwart body literacy. What we don’t know about our bodies helps pharmaceutical companies “sell” their contraceptive drugs, and keeps us “addicted” to them.

At some point between my first attempt at non-hormonal contraceptive advocacy and Holly’s exploration of how we’ve become hooked on hormonal birth control, something disturbing transpired. Prescribing the pill, or other forms of hormonal contraception, has become, in the minds of most health-care providers, the “standard of care” for being a girl. It is all too common to subjugate a girl’s menstrual cycle to synthetic hormones that superficially “regulate,” but actually suspend the maturation of her reproductive system. And for many girls, the use of hormonal contraception continues well into their 20s, without awareness of what might be or has been sacrificed.

There are many women like Holly who are fed up with hormonal birth control. I’ve met scores of them during my 30 years involvement within the mainstream pro-choice sexual and reproductive health community, the one that prides itself on inclusion and diversity. Yet I’ve been unsuccessful in my constant advocacy for this community to accommodate a more inclusive, diverse approach to contraception, to provide acknowledgement, support and services to women who cannot or do not want to use drug- or devised-based methods. We pay lip service to the idea, but the message we convey is: “You’re on your own.”

I’ve found enthusiasm in other realms for my menstrual cycle advocacy and my belief that many women want to, and can, learn to use non-hormonal methods effectively and confidently. I’ve found scientific evidence of the value of ovulation to women’s health and well-being.

I’ve read, met or worked with several of the sources included in this book. Many have devoted their careers to understanding women’s bodies and our relationships with our bodies in ways the medical mainstream typically ignores and barely comprehends. They have made contributions that help us imagine a different way of thinking about fertility, contraception and our menstrual cycles in relation to our sexual, reproductive and overall health.

Who is using menstrual cycle charting apps and why?

September 18th, 2013 by Laura Wershler

Screenshot of Selene app // Photo courtesy of daringplan.com/selene

Hanging out (mostly virtually) with so many researchers at the Society for Menstrual Cycle Research, I find myself thinking of research topics I’m curious to see explored. Here are just two that have crossed my mind recently:

1. Who is using menstrual cycle tracking apps and why?

There are so many on the market that this period technology recently garnered it’s own story at The Cut. The story notes that Period Plus “claims more than a million users.” Kati Bicknell, co-founder of Kindara has blogged at re:Cycling , and Amy Sedgewick reviewed another new charting app, Selene, just a few weeks ago.  Now, Justisse Healthworks for Women has launched their app to support women using the Justisse fertility awareness charting method.

So why and how are women using these cycle tracking apps? For pregnancy achievement, avoidance or both? For fun?

In No Pill? No Prob. Meet the Pullout Generation , also at The Cut, Ann Friedman says that some women are quitting the pill and relying on period-tracker apps, condoms, and the pullout method for birth control.

Are others downloading the apps to learn fertility awareness or were they already charting their cycles before using an app? Are app users more or less inclined to seek out a qualified fertility awareness instructor? And how are women’s attitudes about their periods influenced by cycle tracking apps?

2. Who is quitting hormonal birth control and why?

The popularity of cycle tracking apps suggests some kind of trend away from hormonal methods, and dissatisfaction with side effects prompts many women to look for alternatives. As Friedman wrote in the “pull-out generation” piece mentioned above:

“But I know a dozen women in their late twenties and thirties who, after years of jumping from brand to brand and always feeling crazy or depressed, or after years of nagging health concerns about taking hormones, finally said ‘enough’ and told their partners to put on a condom and deal with it.”

Are there common factors that prompt women to stop using hormonal birth control (HBC)? What kind of support are they finding from health-care providers, partners, friends and family for this decision? Are their identifiable barriers to accessing information, support and services to use non-hormonal contraceptive methods? What do women consider to be their alternatives? Condoms? Cycle tracking apps? Diaphragm? Copper IUD? Fertility Awareness Based Methods? Where are they finding services? Are they finding services? What is positive about quitting HBC? What is negative about the experience?

Wouldn’t it be interesting to see research papers on these topics presented at the next SMCR conference in Boston, June 2015?

Contemplative Dialogue and the Menstrual Cycle Polarity

August 21st, 2013 by Laura Wershler

Why are media-based discussions about menstrual cycle advocacy vs. menstrual suppression, or hormonal birth control (HBC) vs. non-hormonal birth control (NHBC), so often fraught with conflict, suspicion and untested assumptions?

Because the opposing frames of reference are often considered to be an either/or dilemma, with “right” and “wrong” solutions according to our preferred position, rather than two ends of a polarity between which a dynamic range of positions fluctuate. We live with many common sense polarities, like rain and sunshine, knowing the right combination of both is in our best interests.

Please Don’t Judge Me for Skipping My Period, a recent post by Sarah Fazeli at Xojane illustrates the challenges in managing polarities. The title suggests the writer expects to be or has already been judged for her “wrong” decision, yet many of the 427 comments demonstrate the range of positions held on the issue.

At one end of the menstrual cycle polarity is my preferred position – based on experience, research and evidence-based medicine - that consistent ovulatory menstruation supports women’s bone, breast, heart, reproductive, sexual, psychological and overall health. HBC disrupts endocrine function and stops ovulation, impacting many physiological systems. Many women are choosing NHBC because they are HBC-intolerant and/or want to experience healthy menstrual cycles. I advocate for improved access to information, support and services to help them use NHBC effectively and confidently.

I understand how my position might be construed as an either/or dilemma, but in no way am I demanding HBC be banned, bullying women to stop taking their pills or alluding to anti-abortion views. Yet others make and act on untested assumptions that I and others who hold this position are doing some or all of these things.

So how might we all – advocates, health professionals, educators, journalists, bloggers and the public – talk about the menstrual cycle polarity in ways that create opportunities and commitment to work together to meet all women’s needs?

For answers I revisited my training manual in Contemplative Dialogue. In 2009, I  took a four-day intensive workshop to learn about this process of engaging collective awareness to create “a deep experience of community where division or separation may have been the felt starting point.”

Contemplative means taking a long, compassionate look at the real; dialogue is the practice of creating shared meaning. Compassion is a key element because “it helps us get past the kind of guarded and defended reactions that undercut us doing things together.”

I refreshed my memory on how to avoid acting on untested assumptions. I thought about how I might become skilled enough to back not just myself but other people down Chris Argyris’s “ladder of inference” in a non-threatening way to resolve misunderstandings and create shared meaning.

Contemplative Dialogue also incorporates into its process Barry Johnson’s work in managing polarities. In emotional debates it helps if we can learn to speak across polar values.

This process calls for me to identify both my preferred value and the opposite value. In dialogue I first acknowledge the upside of the opposite value followed by the potential downside of my preferred value. Keeping my language fair and non-pejorative, I then speak of the downside of the opposite value that I fear. Finally, I get to talk about the upside outcomes to my preferred value that I’m striving for.

I want to keep talking about these issues, but I’m not up for a range war, a spilling of metaphorical menstrual blood to determine who holds the higher ground or owns the greater truth. I’m committed to practicing contemplative dialogue to bridge the divisions between the two ends of the menstrual cycle polarity.

Two stupid ideas about menopause, and one that makes sense

July 3rd, 2013 by Laura Wershler

Two new suppositions about menopause have been tossed around the media in recent weeks. They make for racy headlines but both, unfortunately, perpetuate the myth that menopause is a disease women need to be protected from.

Most recent was the assertion by researchers from McMaster University in Hamilton, Ontario, Canada, that menopause in women is the unintended consequence of men’s preference for younger mates.

Men to blame for menopause

The writer with her mother Erna Sawyer who turns 95 on July 20, 2013. Is menopause an “age-related disease” that science must figure out how to prevent or an evolutionary adaptation for longevity?

Evolutionary biologist Rama Singh, co-author of the study published in the journal PLOS Computational Biology, gave this explanation in a CBC news story: “What we’re saying is that menopause will occur if there is preferential mating with younger women and older women are not reproducing.”

The study used computer modelling to arrive at this hypothesis. Singh said that this “very simple theory”…”demystifies menopause…It becomes a simple age-related disease, if you can call it that.”

Well, no Mr. Singh, you can can’t call menopause a disease. I challenged this idea in response to the Canadian Heart and Stroke Foundation’s Death Loves Menopause ads in February 2012.

Yet there he is, hoping his work will prompt research on how to prevent menopause in women, helping us to maintain better health as we age. What does he really know about menopause anyway?

Another stupid idea about menopause surfaced in late May with headlines like: Women could evolve out of menopause ‘because it is no benefit to them.’

Women could evolve out of menopause

The story, covered by media everywhere, was based on comments by biologist and science writer Aarthi Prasad at the 2013 Telegraph Hay Festival, Britain’s leading festival of ideas.

The Daily Mail reported that if women evolve out of menopause we could then have children well into our 50s (But how many women want to?), and that “targeted gene therapies will be developed to treat the condition.”

We’ve been fighting the assumption that menopause is a “condition” that needs to be treated for decades, with members of the Society for Menstrual Cycle Research at the forefront of this assumption-busting.

Quoted in The Telegraph, Prasad also said, “What we think is normal is not normal for nature. If it is something not in all mammals, is it something necessary or beneficial for us? I do not see any benefits.”

Wow! Menopause is not “normal for nature.” But what about the argument made by doctors like Elsimar Coutinho who promote menstrual cycle suppression, who assert incessant ovulation (i.e. reproductive capacity) is not natural, normal or healthy in humans, therefore we should take drugs to stop it?

These doctors and scientists need to get on the same page. Which is it? Do we ovulate too much or do we not ovulate enough?

As for “no benefits” to menopause consider this: What if menopause is an evolutionary adaptation that works in women’s favor?

Do women live longer, healthier lives because of menopause?

An October 2010 story in The Calgary Herald - Why don’t monkeys go through menopause? - discussed the research of University of Calgary anthropologists Mary Pavelka and Linda Fedigan who’ve spent years documenting the aging and reproductive histories of Japanese female macaques.

Few study subjects lived past their reproductive capacity, about age 25, and those that did showed signs of serious physical deterioration. For these primates, retaining the ability to reproduce until late in life did not make them healthier. Fedigan noted that they were “crippled up with arthritis, their face is all wrinkled and their fur is falling out.”

The question, they noted, was why would human females lose their ability to reproduce in healthy middle age?

“One hypothesis is that it’s a byproduct of evolution for longevity in humans,” Pavelka said.

Now here’s an idea that makes sense. Think about it. Men produce sperm – albeit of dwindling quantity and quality – until they die; women transition to menopause and can live healthy lives for decades after. Women live significantly longer than men. Therefore, it’s reasonable to hypothesize that menopause supports longevity in women.

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.