Blog of the Society for Menstrual Cycle Research

State of Wonder–Part 2: Wondering about missing femcare products and birth control references

March 6th, 2015 by Laura Wershler

In State of Wonder–Part 1, I mused as to why, in a novel revolving around the extended menstruation and fertility of the Lakashi tribe, only the menstrual cycles of the Brazilian women being studied are made visible to the reader. Why does author Ann Patchett ignore the menstrual cycles of the novel’s protagonist, Marina Singh, or the other female research scientists? If they are eating the tree bark responsible for the Lakashi’s extended fertility, their menstrual responses should be of interest to the author.

Failure to mention the scientist’s cycles points to another puzzling omission. There is no reference to menstrual-care products the women would have required while living in the rainforest for years at a time. There was opportunity to do so because a few key scenes are set in the store where research leader Dr. Annick Swenson buys all the provisions for the camp.

Marina must visit the store immediately upon landing in Manaus because the airline has lost her luggage. She has no clothing, no toiletries, none of the necessities for daily living. Why does she not purchase, visibly to the reader, tampons or pads? If not on her first trip to the store, then on her second as she prepares to leave for the remote research camp with Dr. Swenson? She obviously will need such supplies as her weeks in Brazil progress, and the timing of her cycle, as deduced by this reader, suggests she needed them while in Manaus or shortly after arriving at the camp.

I think Patchett’s reason for leaving out this menstrual-related information was not literary, but rather socio-cultural in nature. She tastefully shares the intimate details of the Lakashi women’s menstrual cycles, but can’t find a way—with even a few sentences—to convey this aspect of other female character’s lives? (Exception: Dr. Swenson, whose experiences I avoid mentioning to prevent plot spoilers.) Did she try? Did she resist? If so, why? What a missed opportunity. Marina’s interior dialogue makes it clear she is a still-menstruating woman wondering if motherhood will be in her future. How easy it would have been to use Marina’s need for tampons as a segue to consideration of her fertility.

Which brings me to another menstrual-related omission in the book. There is no reference to the birth control methods used by Marina and one of the female scientists who lives in the research camp with her husband.

Drs. Nancy and Alan Saturn are part of the research team in Brazil. Nancy is eating the bark, enhancing her fertility. Pregnancy is not an objective for this couple; they must be using contraception. The pill would be contra-indicated—a double whammy of exogenous estrogen provided by the pill and the Martin tree bark could have negative consequences. Condoms would break down in the heat. A Mirena IUD might not be at odds with the estrogenic bark, which has another critical medicinal effect the researchers are eager to access. Maybe a copper IUD? A diaphragm? Abstinence? Does it matter? Perhaps not, but why not be daring and tell the reader anyway? Surely the author must have asked herself these questions.

And what about Marina’s choice of birth control? At 42 she is in an intimate relationship with a much older colleague, the man who sent her to Brazil. Contraceptive use is implied but the method is, yet again, invisible. One can assume it was non-hormonal and not an IUD because of what happens at the end of the novel. But why not write one or two sentences along the way to convey this information? Isn’t this what good writers do, litter clues as a novel progresses to set up what happens later?

Ann Patchett chose not to mention the femcare products and birth control methods her characters used in her novel State of Wonder. I can’t help wondering: why?

Continued in State of Wonder—Part 3: Wondering about menstrual cycle misconceptions in postulating a theory of extended fertility

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.”

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.

‘Yuck’-busting conversations about menstruation

July 22nd, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

In my line of work, I talk and write a lot about the female reproductive system. It’s no secret…I’m pretty vag-savvy. I don’t randomly walk up to strangers and start talking lady parts, but I certainly don’t hesitate to share repro info when the topic arises or when people ask me what I do for a living.

While some people constantly look like they are secretly planning an escape from the conversation, more often than not, the folks I’ve encountered are genuinely very curious and inquisitive about female reproduction. After all, it’s something that most of us have never really been taught. One big thing I’ve noticed is that talking about the topic like it’s no big deal makes people a lot more likely to truly engage. Having frank conversations rather than ones riddled with “ewws” and “yucks” goes a long way toward helping people break down internal menstrual stigmas, and it’s an awesome thing to be part of.

I recently spent some time in Chicago visiting a friend, and while I was there, we went out to dinner with her friends. Then comes the obligatory question about what I do for a living. To this day, when someone asks me this question, I still have moments of mild internal panic, wondering how they will react. I would imagine that when most of us ask this question, we’re not expecting to be faced with a deeply personal, and often polarizing, subject. So, in some ways, I can totally understand the initial shock-factor that some people experience. But I somehow always manage to answer very matter-of-factly, and on this particular day, it couldn’t have gone better.

 

One of the women in the group, after hearing that I specialize in lady parts and natural fertility management, mentioned that she was really struggling with the birth control pill and had been thinking for a while about stopping. And she asked for my advice. I’m always very careful not to say “this is what you should do,” because autonomy is incredibly important and I’ll never claim to know the best birth control option for someone…especially someone I just met. So, instead, I opened up about my personal experience with the pill, my hesitation in deciding to stop, my work with Groove and fertility awareness, and what it has all meant for my life. I wasn’t surprised that she was interested in my story (it’s always nice to know you aren’t alone), but I start to get pretty giddy when others jump into the conversation, too. Which is precisely what happened.

I was in mixed company and everyone in the group was actively engaging in a conversation about periods, birth control, and cervical fluid. Not a single person murmured an “ew,” and I (of course) was thrilled. There were a lot of wonderful questions asked, a lot of great dialogue about how the female reproductive system works, and even some thoughtful critiques of modern birth control methods. In the end, the woman who initially asked for my advice said that she found my experience both validating and reassuring, and she mentioned that she planned to stop the pill. But even if this hadn’t been her decision, the conversation was still a wild success.

Any initial hesitation felt by the individuals in our group quickly dissipated after the conversation began. In the end, there was no shame, no embarrassment, no stigma. This is precisely why I do what I do. If I can help even one person overcome female reproductive stigmas, then I consider my work a success. On this day, I felt enormously successful.

Women’s Need for Accurate Information About Birth Control Gets Lost in Controversy over Zimbabwe Official’s Speech About Dangers of Birth Control

July 18th, 2014 by Saniya Lee Ghanoui

Guest Post by Carol Downer

One side of the population controller establishment, the “pro-natalist”, says they’re concerned about our health, when, in reality, they just want us to have more babies; the other side, the “anti-natalists”, says they’re concerned about our health when, in reality, they want us to have fewer babies. Who’s “facts” do we believe?  Or, whether we believe their facts or not, do we believe they’re concerned about our health, or that they’re cloaking their national and international policy debates about the impact of birth rates on national aspirations or economic growth in the neutral garb of a discussion about women’s health.

A recent flurry of supposedly neutral health discussions and commentary was provoked when a pro-natalist Zimbabwean official told his countrywomen “to multiply” in order to be a “superpower” and warns that birth control can cause cancer, a supposedly objective “fact checker group”, Africa Check, rushed to allay women’s fears about oral contraceptives and cancer, and Bustle.Com chimes in support.

Africa Check wrote a critical article about two main assertions by Zimbabwe Official Tobaiwa Mudede on May 25 at the celebration of Africa Day. It ignored his first assertion that the promotion of birth control is a ploy by western nations to retard population growth in Africa, and then it found that when he says that contraceptives can cause cancer, his facts are right, however his advice to women to stop using contraceptives were “misleading and alarmist”.

They rely on WHO’s cancer and research agency, the International Agency for Research on Cancer (IARC), who confirmed that there can be a link between the use of oral and injectable hormonal contraceptives and particular types of cancer, increasing the risk in some cases and lowering it in others. Dr. Elvira Singh of IARC concluded that Mudede’s comments are “alarmist”.

Shortly thereafter, Abby Johnston of Bustle.com, sums up the WHO’s position as “the benefit far exceeds the risks” with contraceptive use, and mis-quotes Africa Check in saying that “the higher the birth rate in a country, the higher the maternal mortality rate”. Fact? Africa Check said that the UN only said the dangers of having more children could result in increased mortality rate. Johnston reveals her true concern, which is that African women are having too many babies in her statement, “Access and education on birth control is particularly important in areas facing overpopulation.”  She presumably means Africa. African women, just as much as other women, need to have an unbiased comparison of all methods of birth control; www.birth-control-comparison.info

Methinks that the reason that Africa Check didn’t check the facts concerning Mudede’s allegation that “there are those in the West that push birth control is because they fear population growth in Africa” is based on fact, as the Bustle.com article reveals.

There isn’t much written about or by the population control establishment for the general reader. (There is an extensive scientific literature published by demographers -demography is the study of populations, including birth control, migration and immigration). I urge supporters of women’s reproductive rights to read “Quiverfull” by Kathryn Joyce, a contributing reporter for Nation Magazine. Joyce gives a road map to the Christian Patriarchy Movement” in America that forms the popular base for the pro-natalist politicians. Given the tidal wave of T.R.A.P. laws (Targeting Abortion Regulation Providers) in various states, and the recent Supreme Court decisions that promise to sharply restrict accessibility of abortion, I think it is important for us to face the influence of the growing pro-natalist movement in the United States. At the same time, I think we need similar research and analysis of the antinatalist movement, both national and international, who oppose it. My review of Quiverfull is at femwords.blogspot.com.

Obvious Child: The Other Taboo

June 18th, 2014 by Holly Grigg-Spall

cervical mucus

 The recently released rom-com ‘Obvious Child’ has been discussed far and wide for its mature, sensitive and funny approach to the topic of abortion and yet I have not seen one comment on the fact that this movie also makes mainstream (and yes, funny) the topic of cervical mucus.

In the opening scene stand-up comedian Donna (played by real-life comedian Jenny Slate) is performing on stage at her local open mic night. She wraps up with a joke about the state of her underwear and how, she describes, her underpants sometimes look like they have “crawled out of a tub of cream cheese.”

She claims that they often embarrass her by looking as such during sexual encounters, something she feels is not sexy.

Of course, by “cream cheese” I immediately assumed Donna meant cervical mucus. Unless she is supposed to have a vaginal infection – which seeing as it is not discussed amongst the other myriad bodily function-centric conversations in the movie, I doubt to be the case – then it’s clear she is detailing her experience of cervical mucus.

Later on that night, when Donna meets and goes home with a guy, has sex and then wakes up in bed with him the following morning, she sees that her underwear is laying next to the guy’s head on the pillow. Not only that, but this is one of those situations she finds embarrassing as the underwear is actually covered in the aforementioned “cream cheese” or cervical mucus. She cringes, retrieves the underwear and hastily puts it back on under the covers.

At this scene we can assume that the presence of visible cervical mucus indicates that the character is in fact fertile at this time during the movie. Even if we didn’t know this movie was about unplanned pregnancy, perhaps we would know now. Apparently Donna is not on hormonal birth control, and she’s not sure if, in their drunkenness, they used a condom properly. So, I speculate, if Donna had known she was fertile and that the “cream cheese” in her underwear was actually one of the handy signs of fertility her body provides, then she may have taken Plan B and not had to worry about an abortion. But, then, of course, we wouldn’t have had the rest of this movie. We would have had a very different movie – a movie someone should also make.

But it goes to show how some body literacy might go a long way in helping women make more informed choices. The abortion sets her back $500 and causes some emotional turmoil. A dose of Plan B is cheaper and easier to obtain, although not without some side effects. Maybe even, we can speculate, if Donna had known she was fertile she might have avoided PIV sex that night.

It’s great to see a movie approach the choice of abortion as though it really were, well, a choice. But isn’t it interesting that in doing so it shows how women can be hampered in their choices by a lack of body literacy?

We often see women in movies discussing their “fertile time” in regards to wanting to get pregnant – and so meeting their husbands to have sex at the optimum time in usually funny, crazy scenarios. Sometimes we have seen women taking their temperature or using ovulation tests and calendars to figure this out. However, I think this might be the first mention of cervical mucus in cinema.

I had the honor of seeing this movie with longtime abortion rights and women’s health activist Carol Downer and getting to discuss it with her after. Carol pioneered the self-help movement and self-examination, adding much to our collective knowledge of our bodies.  

This is what she had to say:

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

There seems to be a growing disconnect in recent years between physicians and their patients, and women are especially susceptible to this given our reliance on doctors for information about contraception. When compared to the questions many of us ask our doctors, the information we receive isn’t always up to snuff.

Patient autonomy, as defined by medical dictionaries, is “the right of patients to make decisions about their medical care without their healthcare provider trying to influence the decision.” Based on many conversations with other women, in addition to my own personal experiences, patient autonomy often does not exist for women seeking information about contraception. And this is a huge problem. Deadly (and rare) birth control side effects have become a hot-topic in the news as of late – which is likely contributing to this physician–patient disconnect – but the growing patient interest in control and autonomy means that this cannot simply be dismissed as a side effect of the media.

A recent study, published in the Journal of Contraception, asked both women and healthcare providers to rank the importance of 34 questions relating to contraceptive options. They found that the things that are most important to women are often not as important to their healthcare providers. For example, knowing exactly how a method works to prevent pregnancy was ranked by women as the most important piece of information, whereas how to use a method correctly topped the list for providers. Effectiveness, while still important, was ranked fifth by women, which is a stark inconsistency if you consider just how central a method’s effectiveness is in ads and in the media. The study also found that questions regarding potential side effects ranked in the top three for 26% of women, but only 16% of providers.

These stats may seem inconsequential – after all, physicians should be educating patients about proper use of contraceptive methods. But here’s the problem: the methods suggested by physicians don’t always align with a woman’s stated preferences. I’m certain I’m not the only woman who has been pressured to use a hormonal method (despite my voiced concerns) simply because these methods are considered to be easy and effective. While it seems like a logical solution for physicians to advocate for hormonal methods over methods with higher typical-use failure rates, this approach is ultimately a detriment to women.

A growing number of women seem to be turning to withdrawal, and while this isn’t inherently bad, it becomes bad when a patient isn’t educated on how to properly use it simply because her physician is hesitant to discuss “unreliable” methods. This means that women are turning to potentially unreliable internet sources (or, worse, misinformed friends) for this information. The same can be said for diaphragms, cervical caps, and fertility awareness-based methods. If we want to continue to drive down unintended pregnancy rates, dismissing patient concerns and eliminating patient autonomy isn’t the route we should take. Contraceptive methods aren’t one-size-fits-all, which should be obvious by the huge differences in side effects experienced from person to person. So why do so many contraceptive consultations continue to be carried out in this one-size-fits-all fashion?

Empowering women through family planning is more complex than simply prescribing the most effective methods. It must be coupled with engagement in an open dialogue, including acknowledgement of patient concerns and a respect for patient autonomy. Patients are increasingly demanding autonomy, and if healthcare providers wish to remain a respected part of a woman’s health, it’s time to set aside contraceptive biases and listen.

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

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

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

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

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

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

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

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

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

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

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

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

Who could argue with taking supplements to prevent cancer?

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

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

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

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

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

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

We Need To Talk About Ovarian Cysts

February 27th, 2014 by Heather Dillaway

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

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

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

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

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

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.

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.