Blog of the Society for Menstrual Cycle Research

The Eternal Feminine: Focused, Goal-Oriented, Practical, and Loving

April 30th, 2012 by Paula Derry

Visiting colleges became part of our repertoire of family trips back when my daughter was a senior in high school.   We visited many schools to get a sense of the range of possibilities that existed.   As was typical, Vassar offered a tour of the campus for groups of prospective students and their parents, led by tour-guides who were undergraduate students.  Vassar’s tour had one unique feature.  An original campus building, which dated to the post-civil war era, had an exceptionally wide hallway.  This, we were told, was because the all-woman student body needed to be able to walk back and forth repeatedly in the halls in their wide skirts, as part of a college program in physical fitness. Vassar, founded on the idea that the education of women should equal that of men, had a program of physical culture to offset criticisms that the school was endangering women’s health by educating them.

Sheila Rothman describes Vassar’s history in her book “Woman’s Proper Place,” published by Basic Books in 1978.  The common wisdom in the second half of the 19th century was that people have a limited amount of biological “vital energy.”  Rothman (p.24) quotes a contemporary physician:  ”Woman has a sum total of nervous force equivalent to a man’s” but the force is “distributed over a greater multiplicity of organs…The nervous force is therefore weakened in each organ…it is more sensitive, more liable to derangement.”  Menstruation and pregnancy were times of special danger, when the demands on her system were greater and the possibility of physical and mental disorder increased.  Menstruation was a time when women were irrational, even insane.  Caution, however, was always called for, as when intellectual activity or other exertion used up nervous energy.  Thus, when Vassar was founded, a program was put in place to overcome women’s predisposition to illness through a structured environment and programs of physical exercise.  Later, the Association of Collegiate Alumnae conducted a survey to provide research evidence as to whether female college graduates were normal.

Image by Thiophene_Guy // CC 2.0

Back in the Vassar of the present, our student tour guide wondered:  “How could anyone believe anything so silly?” It’s true that we no longer talk about a “vital force.”  Yet, broad generalizations about the nature of women and reproductive physiology continue to exist that have an air of plausibility, based today on a different scientific language, one of hormones, neurotransmitters, and other players.   Not very long ago, menopause was defined as an “estrogen deficiency disease” that had a uniquely powerful effect on health.  Heart disease was a disease of civilization for men and a disease of the ovaries for women.   The idea that the menstrual cycle destabilizes women’s minds, creating mood and intellectual changes, continues to exist.

One of my favorites is the idea that women are somehow receptive, loving, and self-denying because of their maternal role, which is somehow mediated by estrogen.  Thus menopause may be said to be a time that women regain the ability to focus more on themselves, liberated from a physiological preparedness for reproduction and its needs.   Pregnancy is a dreamy time when women are moody and unable to think clearly.

Sure, mothers are receptive, loving, self-denying, but they are also many other things.  I love being a mother.  My relationship with my daughter has been powerful, unique, and wonderful.  However, I know that a mother who is lost in a dreamy connectedness to her child or reflexively puts her child before herself can’t do everything she needs to do.   A mother is emotionally connected to her child but also must be an individual who perceives the child accurately, as a separate person, in terms of the child’s motivation and perspective, in order to provide both a sense of connection and the mirroring needed for a child’s emotional development.   Further, children misbehave, make mistakes, and must be taught all kinds of things; mothers must have clear-headed, pragmatic, problem-solving skills.

Understanding Research: Buyer Beware

April 2nd, 2012 by Paula Derry

xkcd.com // CC 2.5

I certainly believe that scientific research is important.  Research uncovers new knowledge and prunes away facts that are not accurate.  However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications.  If a scientific result can be invoked, we can believe that something is true. Is there an unconscious?  Freud said so, but he’s out of date.  Are we intrinsically social beings?  Evolutionary theorists argue. Does meditation really result in an altered state of consciousness?  If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.

What’s wrong with this? Isn’t this science doing its job of uncovering truth?  There are two things wrong with this. One is that not all knowledge is scientific knowledge.  The second is that scientific results are often portrayed inaccurately in our society.

With regard to the first point, I’ll just give a few examples.  von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow.   Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.

But what I really want to talk about here is the second point.  We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means.   However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context.  When I was a graduate student in psychology, every class included practice in critiquing research.

To understand research, certain mathematical ideas are important.  “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why?  That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased.  Why?  Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.

What is a hormone?

March 5th, 2012 by Paula Derry

All too often, hormones are portrayed in the media, and even in professional articles, as strangers inside our bodies that control us.   Sometimes hormones are personified as bosses that order our bodies around.  Sometimes they are portrayed as akin in function to gasoline or motor oil, needed to keep the machinery of our body moving or smoothly gliding.  Hormone levels that oscillate rather than maintaining a reassuring stability might be especially suspicious or even uncanny.

Take oxytocin.  According to the website ScienceDaily.com, which summarizes recent scientific studies, the hormone oxytocin is the “cuddle chemical”, promoting positive feelings, especially between mothers and infants, but it also has a “dark side,” promoting envy and gloating.  An oxytocin nasal spray might help shy people behave in a less introverted manner, and can make “surly monkeys treat each other a little more kindly”.

Or, take estrogen.  Teenagers are at the mercy of their “raging hormones.”   Premenstrual syndromes, perimenopausal mood changes, menstrual migraines, and hot flashes have all been attributed to hormones that oscillate (i.e., go up and down), dip, or are present in the wrong amount; thus, the orders barked out by the hormones go awry.   Perimenopausal estrogen changes are feared to destabilize the brain, creating preconditions for cognitive decline, or to increase risks for bone or heart disease.   A recent article (2010, vol. 1204) published by the Annals of the N Y Academy of Sciences was titled  “Estrogen and the aging brain:  An elixir for the weary cortical network?”.  A Science Daily report on estrogen and menopause (Oct. 4, 2011) was entitled “This is your brain on estrogen”.  Of course, not all hormones have this mythic status.  Important as diabetes is as a public health problem, I don’t recall seeing an article entitled “This is your liver on insulin.”

Here’s another view of hormones:  Most introductory science textbooks define them as chemical messengers, typically released from special tissues called glands, into the bloodstream.  In order for a hormone to affect a cell, the cell must have a receptor for the hormone. If there is no receptor, the hormone does not affect the cell.  If there is a receptor, the hormone changes the rate at which cells work, it does not make cells do things they would not otherwise do.  Hormones are chemical messengers that are involved in coordinating physiology, behavior, and development.

Consider a simple case, a person who is sitting in a chair and wants to stand up.  The muscles in a variety of parts of her body have to work together.  She can’t, for example, lift her buttocks before her feet push down on the ground, or lean so far forward that she falls.  Other parts of the body have to get into the act, also.  For example, her blood pressure must go up before she starts to stand; otherwise she would become dizzy since as she rises less blood reaches her head. Mind and body work together; blood pressure rises in response to her mere intention to get up.  In a similar manner, purposiveness is typically coordinated by hormones, the nervous system, and other players.

The way I think about it is that hormones are team players in complex, multi-determined systems that have a purpose. Hormones help to coordinate what happens in the body, but in normal functioning they do not act alone; they are part of a larger whole. They are more like telephone wires than the content of the conversation.

Menopause Tales

February 6th, 2012 by Paula Derry

The philosopher of science Mary Midgley (1995) doesn’t mince words.  She tells us:  “The theory of evolution is not just an inert piece of theoretical science.  It is, and cannot help being, also a powerful folk-tale about human origins.”  Along these lines, stories about reproductive physiology are important folk-tales about what’s natural for women and what their life course should be.

What are the stories about menopause?  One is that living beyond menopause is a biological puzzle. The argument goes like this: Most animals reproduce up until, or close to, the end of their natural life span.  This makes sense, because theoretical biology tells us that animals reproduce as much as possible to leave as many offspring as they can.   Why women live beyond menopause is therefore a puzzle.  One answer is that we can expect to live thirty years past menopause because technological innovations have resulted in the conquest of infectious disease, the generation of great food stores, and other advances. As recently as the turn of the century, the average woman lived 47 years.  Far longer, probably, than our prehistoric forebears:  prehistoric hunter-gatherers were probably old at thirty.  Living many years past menopause is therefore a recent historical development.  Not surprisingly, if aging women are “outliving their ovaries,” menopause is associated with a variety of unpleasant experiences and health problems.

What are some facts relevant to this story?  First, is living past menopause a new historical development?  Well, ….No.  Old age is not an invention of the twentieth century.  Betsy Ross died when she was eighty-four.  Classic Greek and Roman medical writers (including Hippocrates himself) and traditional Eastern medical systems all discuss menopause. In the Old Testament, Sarah laughed when God said she would bear a child even though it had “ceased to be with her after the manner of women.”  Might the Bible have been referring to menopause?

Sign from The Musée Mécanique, a for-profit interactive museum consisting of 20th-century penny arcade games and artifacts located at Fisherman's Wharf in San Francisco, California.

Photo by Thomas Hawk // CC-BY-SA 3.0

What about the idea that prehistoric humans died before menopause? Studies by anthropologists suggest that modern hunter-gatherers do live to old age.  Therefore, perhaps our prehistoric hunter-gatherer forebears did so as well.  Richard Lee (1985), for example, studied the !Kung San in Botswana.  About 10% of the population were over sixty years old, and it was not unusual to find !Kung aged 70 or 80.   Lancaster and King (1985) found, when twenty-four hunter-gatherer and horticulturalist groups were examined, that 53% of the women who lived to age fifteen could expect to still be alive at age 45.

If a small number of older people are found in simpler societies, is this important?   Is ten percent survival so small that for all intents and purposes fifty years is the real limit on lifespan?  Older people, as described by anthropologists, are not viewed by the members of their own societies as oddities.  That is, if living into middle-age and beyond were an anomaly, it is unlikely that people in a society would have expectations about what role an older person should play.  Older people might be viewed as curiosities.  However, older people more typically have important places in their societies.  At least through their fifties and sixties, they are relied on to do important things.  It is relatively common in nonindustrial societies for women to experience positive changes in status when they become middle-aged (Brown, 1985).  In cultures without written legal systems or CEOs, older people often have authority over younger people.  They can be decision-makers about the distribution of property, allocation of jobs, and other social behaviors.  Among the !Kung, for example, older women assign younger relatives what jobs they need to do, arrange marriages, decide on kinship classifications.  In cultures that don’t have books or the internet, older people may be sources of stored and accumulated knowledge, like the location of a watering hole that hasn’t been needed since the last drought thirty years ago (Diamond, 1996), or social and technical skills (Kaplan et al., 2010).

On Menopause Definitions

December 28th, 2011 by Paula Derry

Guest Post by Paula S. Derry, Ph.D.

In a recent blog post, Heather Dillaway commented on the uncertainty, confusion, and frustration she felt as a menopause researcher, given the lack of consensus about the most basic aspects of the menopause transition. Researchers don’t agree about their definitions, and can’t even agree on what needs to be defined. She asked for reactions to her entry; I’ve found that my reaction has grown into this separate post.

Fire in the Head by Beate Knappe // CC 2.0

I, unlike Heather, am not a sociologist. I’m a health psychologist. My training and current work include analyzing, critiquing, and making sense of experimental research and theories. I have also developed workshops for community women and for professionals whose aim is to provide health-promoting information and decision-making heuristics. I have given a lot of thought to the issues that Heather raises, and this is as far as I’ve gotten with them.

To me, there are many layers of issues involved. The first is the fact that the science — about the physiology of menopause and the processes leading up to it — is limited and incomplete. Part of the reason that professionals disagree about whether the life course of menstruation has five stages or seven, or why women have hot flashes, or even why women have a menopause, is that we don’t actually know. We simply do not have the scientific facts. We don’t understand what the underlying process is or how it works. Given this uncertainty, professionals must make judgments about how to define terms and what their hypotheses (or best guesses) are about underlying processes. A second fact, along with our limited real knowledge, is the tenacity with which professionals assert their judgments and argue against competing views. People disagree and they hold strongly to their positions—about language and the facts. To me, it makes sense to have definitions of stages of menstrual life that are objective and easily measurable (like the STRAW staging system) for researchers who need to compare results with each other. It doesn’t make sense to assert that this system, based on expert opinion and not on experimental facts, actually defines when a particular stage really “begins.” It makes sense to say that experimental research supports the idea that changes in the thermoregulatory center of the hypothalamus are important processes if you’re trying to understand hot flashes.  It does not make sense to conclude that these brain changes in themselves explain hot flashes; other factors must also be involved.

I think another source of confusion is that menopause is not one thing, but many. It is a circumscribed biological change (lack of periods and what leads up to them physiologically) and also a psychosociocultural matter. We have a term for when girls begin to menstruate (menarche), a separate term for the larger biological changes of which menarche is a part (puberty), and another term for the biopsychosociocultural changes of which puberty is a part (adolescence). I think these kinds of distinctions are confused with regard to understanding menopause in part because there is cultural confusion about midlife (or mature adulthood or whatever term you use) as a life stage.  There is no cultural consensus about this stage of life.  And, indeed, this isn’t surprising.  Some women are planning retirement while others are training for a new job or career.  Some are grandmothers while others are raising a young child.  My opinion, also, is that we as a culture have a paucity of concepts of mature, responsible adulthood and what it means.

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.