Blog of the Society for Menstrual Cycle Research

Yaz and Yasmin Back in the Spotlight

May 9th, 2013 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

Last year the FDA made the decision to keep the birth control pills Yaz, Yasmin, and Beyaz on the market despite controversy over corporate corruption of the review process.These drugs are back in the spotlight.

The French health minister has called for doctors to stop writing prescriptions, 2,000 lawsuits against Bayer launched in Canada last month, and Marie Claire Australia dedicated five pages to an in-depth feature about the side effects, instigating an investigation by the country’s top current affairs show Today Tonight.

Bayer has gone about settling the 13,000 lawsuits in the US out of court, likely with the hope of keeping the details of confidential files regarding marketing techniques and research out of the public eye. Unperturbed by mounting reports from women of the myriad health issues caused by their products, the company launched Yaz Flex in Australia at the end of 2012. The first oral contraceptive on the Australian market presented as being for the purpose of preventing periods, Yaz Flex comes in a digital dispenser that records how many pills have been taken and alerts the user when she’s missed a dose. There are enough tablets to allow for just three breaks a year. In the US in April the FDA, equally unperturbed, ruled that pharmaceutical company Activis can start selling generic versions of Yaz, providing a low-cost version of what has been the most expensive oral contraceptive of recent years.

The feature in Marie Claire Australia generated 300+ comments on the magazine and television show’s Facebook pages. Many of the commenters were women who had developed blood clots when taking these brands. Some had made the connection at the time and others made the link only as a result of the coverage after months or years of not knowing why they had endured the injuries. Some of the women were presently experiencing the symptoms of a blood clot mentioned in the show and made the decision to stop taking the pill as they typed.

The piece was written by a long-time member of the Yaz and Yasmin Survivors forum and balances interviews with women who suffered the serious physical side effects with those who have been victim to the serious psychological side effects. I’m among those who experienced a long list of negative physical and psychological effects when taking Yasmin for more than two years and it was this forum that prompted me to stop taking it.

Monash University in Australia is one of the few facilities to have undertaken research into the correlation between birth control pills and depression. Professor Jayashri Kulkarni found that women on the pill were twice as likely to experience depression, anxiety, and mental numbness (known as anhedonia). The Yale Daily News reports that in the wake of her research receiving a little media attention Dr Kulkarni received more than 300 emails from women “clearly describing when they went off the pill that they felt subjectively more happy. The anhedonia, for example, disappeared, the irritability disappeared, the sense of poor self esteem disappeared”.

She is now focusing her attention on researching what she believes to be the particular psychological impact of the Yaz brands, those pills containing the synthetic progesterone drospirenone and low-dose synthetic estrogen.  Continue reading...

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Posted in Birth Control, coming off the pill, Pharmaceutical | 1 Comment »

Stopping Depo-Provera: Why and what to do about adverse experiences

April 11th, 2013 by Laura Wershler

Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist

A screen shot of comments to Laura Wershler’s blog post of April 4, 2012: “Coming off Depo-Provera can be a woman’s worst nightmare.”

With 250 comments – and counting – to my year-old post Coming off Depo-Provera is a women’s worst nightmare (April 4, 2012) I thought it was time to revisit this topic.

That blog post has become a forum for women to share their negative experiences with stopping Depo-Provera (also called “the shot,” or Depo), the four-times-a-year contraceptive injection. (Commenters reporting positive experiences have been extremely rare.) Many women have experienced distressing effects either while taking Depo and/or after stopping it. They report that health-care professionals seem unable to explain their problems or to offer effective solutions. What is puzzling for many is why they are experiencing symptoms like sore breasts, heavy and ongoing bleeding (or not getting flow back at all), digestive problems, weight gain and mood issues when they stop Depo.

This post aims to briefly explain how Depo works to prevent pregnancy, its common side effects and, most importantly, why and what to do about adverse experiences when stopping it.

What follows is my interview with Dr. Jerilynn C. Prior, Society for Menstrual Cycle Research board member, professor of endocrinology at the University of British Columbia, and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) Section 1 explains how Depo-Provera works and what causes its side effects. Section 2  explains the symptoms women are experiencing after stopping the drug.

1) Taking Depo-Provera: How it works and established side effects

Laura Wershler (LW): Dr. Prior, what is Depo-Provera® and how does it prevent pregnancy?

Ask Jerilynn: The term, “depo” means a deposit or injection and Provera is a common brand name of the most frequently used synthetic progestin in North America, medroxyprogesterone acetate (MPA). Depo is a shot of MPA given every three months in the large dose of 150 mg. Depo prevents pregnancy by “drying up” the cervical mucus so sperm have trouble swimming, by thinning the endometrium (uterine lining) so a fertilized egg can’t implant and primarily by suppressing the hypothalamic and pituitary signals that coordinate the menstrual cycle. That means a woman’s own hormone levels become almost as low as in menopause, with very low progesterone and lowered estrogen levels.

LW: Could you explain the hormonal changes behind the several established side effects of Depo? Let’s start with bleeding issues including spotting, unpredictable or non-stop bleeding that can last for several months before, in most women, leading to amenorrhea (no menstrual period).

Ask Jerilynn: It is not entirely clear, but probably the initial unpredictable bleeding relates to how long it takes for this big hormone injection to suppress women’s own estrogen levels. The other reason is that where the endometrium has gotten thin it is more likely to break down and bleed. These unpredictable flow side-effects of Depo are something that women should expect and plan for since they occur in the early days of use for every woman. After the first year of Depo (depending on the age and weight of the woman) about a third of women will have no more bleeding.

LW: What about headaches and depression?

Ask Jerilynn: It is not clear why headaches increase on Depo—they tend not to be serious migraine headaches but are more stress type. Perhaps they are related to the higher stress hormones the body makes whenever estrogen levels drop. Unfortunately, headaches tend to increase over time, rather than getting better as the not-so-funny bleeding does.  Continue reading...

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Posted in Amenorrhea, Birth Control, coming off the pill, Dysmenorrhea, Health Care, Hormones, Menorrhagia, Menstruation, Ovulation, Perimenopause | 20 Comments »

Little Girls! Just Say Yes to Your Dreams!

March 18th, 2013 by Chris Bobel

Seen this one yet? (or the (eerily) related “Birth Control on the Bottom“?)

We posted “Sassy Girlz Candy Birth Control Pills” (written by Carissa Leone in 2011) in our regular installment Weekend Links on Feb 2. I had a mixed reaction. And when a couple re:Cycling readers described the video as “nasty,” I knew we needed to dig in a bit.

Let’s discuss.

There’s something very absurdly funny about eating birth control, even if the women are still tweens and the birth control is merely mulit- colored jelly beans intended to get young girls in the pill-popping groove before they are saddled with a baby and an half-finished high school education.

First of all, women CAN eat their birth control, donchaknow… Warner Chilcott brought to market their chewable, spearmint flavor oral contraceptive, Femcon Fe, for women who have difficulty swallowing pills and apparently, find stopping for 30 seconds to swallow water.

But I digress (I guess I just want to be clear that we are ALREADY munching our pills).

It is hard not to love how this sketch takes down the pandering to the girl tween market. Oh lordy. There’s so much potential there! (one estimate figures that kids aged 8-12 years are spending $30 billion OF THEIR OWN MONEY and nagging their parents to spend another $150 billion annually!) Little girls quickly move from Disney to diets, from fingerpaint to fake eyelashes, from tutus to belly shirts…..I have seen it with my own girls and it feels, frankly, like an inexorable force.

Viral sketch writer Carissa Leone graciously replied to my questions regarding the piece. When I asked her what inspired her, she channeled her Women’s Studies training (go team!) and supplied her two main reasons:

(1) “I saw a little girl on the subway,holding a baby doll in one of those pretend baby slings…and I thought, “If only she really knew what motherhood was like. I wonder if anyone has explained the authentic experience. I wish she were carrying a briefcase and reading a teeny issue of Ms. magazine instead… “

AND

(2) “The idea that women can/should have it all, in terms of relationships and families and career still seems to be put forth as a tangible (and”correct”) goal in Western culture. It’s a pressure I and many other peers feel, and one that I don’t think is truly possible, or necessarily awesome.”

And Big Pharma takes a hit, too, per the spot’s director, Brian Goetz, who offered this when I asked him about what led to the sketch:

“I wanted to do the video because the script spoke so well to the branding of pharmaceutical commercials, where no matter what the product, as long as you say there’s a problem and that you have the solution, throw some happy people and fun b-roll in it, you’ve got a successful campaign. On top of that, it’s always fun to legitimize terrible ideas in sketch comedy. And if that means having multi-colored jelly bean birth control pills, all the better.”

But I think there’s more to it that that.

Why do I find myself laughing and crying at the same time? Well, I just finished my advance copy of Holly Grigg-Spall’s forthcoming Sweetening the Pill  or How We Became Hooked on Hormonal Birth Control (out this Spring with Zero Books). In it (and here as well, on this blog), Grigg-Spall makes the case the hormonal contraceptives have become so normative that we, as consumers, permit an imperfect (at best) product to flourish even while other options may be more appropriate. The one-pill-fits-all mindset is so pervasive and bores in so deep, so young, Grigg-Spall argues, that when someone says, ‘hey! I don’t want to be on the pill,’ these—what she calls “pill refugees” — are hastily branded as irresponsible, antifeminist, or just plain dumb. That is, the pill gets constructed as our savior, our liberator, our saving grace, even when its not.

And that’s where this spoof enters….since the pill IS all these things, let’s get those girlies on board NOW! Why wait? Good habits start young, after all. And product loyalty is not just for toothpaste and laundry detergent….

And so, “Sassy Girlz Candy Birth Control Pills” is super smart feminist critique. It calls out the enduring wrongheadnessness of romanticizing motherhood and co-opting what I would call a tragically hollowed-out pseudo feminism harnessed to push product:

  • Little girls playing Mommy is cute, and kinda bullshit!
  • Its never too early to teach little girls about options!
  • She’ll know that birth control means winning a college scholarship

Yup. There’s lots of problems with that. Thanks to the feminist satirists to help us see.

But I have to say one more thing.

Leone and I discussed (what I consider) the unfortunate below-the-belt invocation of gender dysphoria to as she put it, “most absurd, heightening beat” in the sketch (here’s another, more recent example of same, on SNL). I don’t think trans or gender queer or otherwise gender variant people should ever serve as punchlines, as I told Leone so in our email exchange. When I inquired about this moment in an otherwise spot-on sketch, she said that is was never intended it as a negative perception of transgendered kids. But still  it is, and I think it points with a big fat finger at how much work we still need to do to move trans issues from margin to center.

Let’s push forward without leaving anyone behind. Let’s laugh at feminist satire that avoids (even unintended) transphobia. Let’s keep our targets clear and our allies clearer. Let’s say YES to that dream, for real.

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Posted in Advertising, Birth Control, Communication, Film, Girls, Health Care, Humor, Independent Film, Internet, Language, Media, Pharmaceutical, Pregnancy, Reproduction | 4 Comments »

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.

It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).

Hormonal contraceptives clearly act as EDCs according to the definition used in this report:

An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.

Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.

The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and  progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”

The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.

How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?

Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.

Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”

Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors.  Continue reading...

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Posted in Birth Control, Fertility, Hormones, Menstruation, Pharmaceutical, Reproduction | 25 Comments »

How to Check Your Cervical Fluid When You Feel Like You Just Don’t Have Any

February 12th, 2013 by Kati Bicknell

In an older post I wrote, I talked about how to check your cervical fluid with a folded piece of toilet paper or your clean fingers.

BUT! What if you’re doing that and not finding anything? What if you, like many women I talk to, think that they don’t have any cervical fluid?

Well, you’re in luck, because I’m about to explain how to measure your cervical fluid, even if it seems like you don’t have any! Are you ready for this? You’re so ready.

Adapted from a photo by Lamerie // Creative Commons 2.0

Things you’ll need:

  • Hand mirror
  • Clean towel
  • Soap and water

So … it goes a little something like this — CRAM YOUR FINGERS IN YOUR VAGINA! Just kidding. Not really. Kind of. Kidding about the “cramming” thing, but not about the “in your vagina” thing.

First things first, wash your hands. You don’t want to introduce any foreign bacteria into the vagina — it’s got a whole host of its own friendly bacteria that keeps things running smoothly, and you don’t want to upset the balance.

Now that your hands are clean … wait a minute! Okay, a lot of you reading this are probably very familiar with your vagina, where it is, how it looks, and every little nook and cranny inside and out. But some of you may not be. For those of you in the second camp, there is an extra step.

Grab a hand mirror!

Okay, was that hand mirror very dirty? Did you take it out of the woodshed or something? Is it your husband’s shaving mirror? If any of the above are true, wash your hands again.

Now get naked from the waist down — think gynecologist’s office, but significantly less unpleasant. You can leave your socks on. No cold stirrups (hopefully). Now sit or squat on a clean towel on the floor, and hold the hand mirror between your legs so you can actually get a good look at your vulva (external genitalia). As women, our genitals are positioned in such a way that they are very hard to get a clear look at without the aid of a hand mirror, so unless you’ve done this before, you may be surprised at what you see. Look at how beautiful you are! So many little folds of soft delicate skin, so many different shades of color. Vulvas come in all shapes and sizes and colors, and each are perfect and beautiful and packed with nerve endings, so don’t you even dare consider labiaplasty, even if the vulva you see in the mirror doesn’t look like the ones you may have seen in certain adult movies (or Canadian strip clubs). Yours is perfect. I promise.

Have a look and a feel around! Gently spread your inner labia apart and take a peek at what’s in there. You’ll see your clitoris, vaginal opening, and, if you have keen eyesight, the urethral opening. Neat, huh? You may even see some cervical fluid at the vaginal opening.

Now see where your vaginal opening is? Gently slide one clean finger inside, see how that feels? Okay, now you know WHERE to stick your finger when checking your cervical fluid internally.

Crouch in a squatting position, and place one or two (if they fit) fingers in your vagina, until you feel something like the tip of a nose (if you are fertile it might be much softer). This is your cervix! The place from whence all cervical fluid hails! The motherland!

Now draw your finger(s) gently out of your vagina and have a look at them. They will be slightly damp, because the vagina is a mucus membrane, like the inside of your mouth, so wetness is a given. Other than that, is there any “substance” on them? Anything that looks like grade school paste, or hand lotion, or raw egg whites? If so … there is your cervical fluid!!!! You found it! Hooray!

If not, you may be a) on the pill, b) in the pre-ovulatory infertile phase of your cycle, before you’ve started to make cervical fluid, or c) in the post-ovulatory infertile phase of your cycle, after ovulation, and your body may have stopped making cervical fluid for the remainder of your cycle.

If you don’t notice any, check again later in the day, and several times tomorrow, and every day after that! Soon you’ll have something to record on your chart!  :-)

Now you can stand up, wash your hands (again), pull up your pants (this step is critical), and go about your day!

Wheeee!!! Any questions on that? Ask me in the comments.

Cross-posted at Kindara, February 5, 2013

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Posted in anatomy, Birth Control, DIY, Fertility | 6 Comments »

Does Depo-Provera work like a charm or a curse?

February 6th, 2013 by Laura Wershler
Author’s Update, February 14, 2013: As clarified by Bedsider.org in the comments section below, the Works Like A Charm Contest mentioned in this post is not current but ended in 2011. The contest website pages are now inactive.

If Bedsider.org sponsored a contest called Why I Hate My LARC, there would be no shortage of contest entrants. But I expect it will be a long time before the nay-sayers get as much attention as the yeah-sayers.

Composite illustration by Laura Wershler

Bedsider has jumped on the LARC bandwagon. The online birth control support network for women 18-29 has launched the Works Like a Charm contest encouraging “the awesome women and couples” who use long-acting reversible contraception to share why they love their LARCs for the chance to win up to $2000. This is a variation of the Why I Love my LARC video campaign sponsored by the California Family Health Council last November, only with prizes!

To quote my blog post about the earlier campaign: “Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.”

One long-acting, not-so-reversible contraceptive in particular – Depo-Provera – is causing grief for many women. Yet “the shot” is front and center in the graphic on the contest website.

Considering the rah-rah tone of the Works-Like-a-Charm campaign messages, it seems that bedsider.org, a project of the National Campaign to Prevent Teen and Unplanned Pregnancy, is oblivious to the misery caused by this contraceptive. Often, Depo works like a curse.

I acknowledge that Bedsider is doing good work: The website provides youth-friendly, accessible information about the full range of birth control methods. But, in my opinion, any organization that promotes Depo-Provera as a contraceptive method should be totally transparent about the ill effects many women experience both while taking and after stopping the drug.

Depo-Provera, to put it bluntly, fucks with a woman’s endocrine system.

The long list of ill effects while on or after stopping this drug includes: continual bleeding (from spotting to heavy), mood disorders, severe anxiety, depression, digestive issues, loss of sex drive, extreme weight gain (often without change to exercise or eating habits), lingering post-shot amenorrhea, intensely sore breasts, nausea, and ongoing fear of pregnancy leading to repeated pregnancy tests. (Not to mention its documented negative effect on bone density.)

These effects are why the continuation rate of Depo-Provera is only 40-60% after one year of use, and why women are filling online comment pages with stories of their struggles coming off this drug.

At Our Bodies, Ourselves, the blog post Questions About Side Effects of Stopping Contraceptive Injections has been attracting comments since November 3, 2009, with no end in sight.

On my April 4, 2012 re:Cycling post – Coming off Depo-Provera can be a woman’s worst nightmare - there are over 130 comments. All but six were posted since mid-November when the post caught fire. Not more than a day or two goes by before another women shares her story of distress, confusion or frustration. I read each one and respond occasionally. Rarely, a positive experience appears; one criticized other commenters for complaining.

It’s one thing to read or hear about potential ill effects while trying to decide whether or not to use Depo-Provera. It’s quite another to experience some or many of them for months on end without acknowledgement or health-care support from those who promote or provide this drug.

The Works Like a Charm contest website says about LARCS:

Reversible = not permanent. If and when you’re ready to get pregnant, simply part ways with your LARC and off you go.

“Off you go?” Tell that to the thousands of women who are waiting, months post-Depo, to get their bodies and their menstrual cycles back to normal. Most of them still aren’t ready to get pregnant.

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Posted in Activism, Amenorrhea, Birth Control, coming off the pill, Health Care, Hormones, Menstruation, Pharmaceutical | 10 Comments »

Getting Over The Pill

January 15th, 2013 by Kati Bicknell

Here’s a notion: Birth control pills are not the only way manage your reproductive health.

The pill came out more than 50 years ago, and at the time, it was a symbol of liberation and freedom for women. Suddenly, they no longer had to worry about unplanned pregnancy. It was great. But now that 50-year-old technology is starting to lose much of the appeal it once had.

Adapted from a photo by Jess Hamilton // Creative Commons A-NC-SA 2.0

Today many women get on the pill as teenagers to “regulate” irregular cycles, and they get off the pill in their late 20s or early 30s when they want to get pregnant. The unfortunate reality is many women find it’s not as easy as they thought it would be to get pregnant. Ten or fifteen years of being on oral contraceptives doesn’t “fix” an irregular cycle; it just kind of pushes the pause button on your reproductive system.

When you come off the pill in your late 20s or early 30s because you finally want kids, your body has to pick up where it left off when you were a teenager. Often women at this stage of their lives find it takes longer than expected to conceive and wind up on the assisted reproductive technology track — reproductive endocrinologists, expensive and annoying tests, procedures, hormone injections ,and all that jazz. And, heartbreakingly, after several years and thousands of dollars, that doesn’t always work.

The side effects of the pill are a real pain in the ass for many women, too. Weight gain, depression, loss of libido, and “not feeling like myself” (AKA “I seem to have gone insane”) are some of the more common complaints cited. In fact, a CDC report on contraceptive use states that 10.3 million women have stopped taking the pill due to side effects, or fear of side effects.

All women need a way to have children when they want them, and to not have children when they don’t. And they need to feel good about the whole thing — not freaked out, bloated and crazy. Imagine how the world would be different if this was a reality.

This reality is possible thanks to the wonderful simplicity of the Fertility Awareness Method — the technology behind Kindara. Instead of women’s reproductive reality being like this:  “Oh my god,  I don’t want to get pregnant” during her twenties, followed by “Oh my god,  I want to get pregnant NOW!” in her thirties, the Symptothermal Method makes it one question: “When do I want to get pregnant?”

Charting your cycle using the Fertility Awareness Method can help you achieve your reproductive goals without pills, side effects, or stress, whether you want to have kids in the next few years, in 10 years, or never. By charting your cycle, you will see if and when you are ovulating, and you will know when you are fertile, which is the trick to knowing when you can or cannot pregnant. Charting your cycle could help clarify issues that need to be remedied before you can get pregnant too. You can even confirm pregnancy with your chart. Exciting!

If women were taught the basics of Fertility Awareness as soon as they entered their reproductive years and knew that they could avoid or plan for pregnancy by charting their primary fertility signs (temperature and cervical fluid), they would save a lot of time, money, and stress.

What a different world we would all be living in if each woman shifted her thinking from “I need this pill so I don’t have unplanned pregnancies, and I need my doctor to prescribe this pill” to “I know just what is going on with my cycle at all times. I am calm, confident, and empowered. I manage my own fertility thank you very much, and I don’t need pills to do it.”

Now I’m not saying that oral contraceptives have no place in the world. They are a wonderful invention. Thanks to the pill, women today can take it as fact that pregnancy can be prevented easily and effectively. But because this is now a forgone conclusion, we are free to look for even better options — options like the Fertility Awareness Method that can prevent pregnancy easily, effectively, autonomously and without side effects.

Originally published at Kindara.com on December 15th, 2012

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Posted in Birth Control, Fertility, Menstruation | 4 Comments »

I am a pro-choice menstrual cycle advocate

January 9th, 2013 by Laura Wershler

As 2013 begins, I give thanks to each and every one of my colleagues at the Society for Menstrual Cycle Research and all my blogging buddies at re:Cycling. Without them I’d feel left out in the cold.  

Are menstrual cycle advocates left out in the cold? Photo by Laura Wershler

I’ve been a menstrual cycle advocate since 1979 when, during a year of post-pill amenorrhea that totally freaked me out, I began to research the ill effects of hormonal contraception. It is not an understatement to say that reading  Barbara Seaman’s national bestseller Women and The Crisis in Sex Hormones changed my life. It started me on a path of self-discovery, and commitment to the idea that healthy, ovulatory menstruation is integral to women’s health and well-being. If you don’t know about Barbara Seaman and her work in women’s health activism, please read about her.

My menstrual cycle advocacy took what could be considered a counter-intuitive path. I aligned myself with the pro-choice sexual health community, committed to comprehensive access to sexual and reproductive health information, education and services. I’ve been as much a contraception and abortion rights advocate over the last three decades as I’ve been a menstrual cycle advocate. But I was a successful user and ardent advocate of the fertility awareness method long before I became a board director at the pro-choice Calgary Birth Control Association in 1986. I went on to serve 10 years on the board of Planned Parenthood Federation of Canada and worked for six years as executive director of Planned Parenthood Alberta, which became Sexual Health Access Alberta in 2006. I’m currently on the board of Canadian Federation for Sexual Health, the former PPFC.

I stress my pro-choice credentials because I think I’m often suspected of being anti-choice. Surely any woman who advocates for healthy, ovulatory menstruation and speaks out against the health concerns inherent in hormonal birth control methods must be anti-contraception and anti-choice. I am neither. More broadly, I’ve written and talked a lot about the value of body literacy for women’s health and well-being.

I wonder sometimes why I’ve stuck it out with the pro-choice sexual health community. While many have been open to my ideas, I have seen little effort to learn about the health benefits of ovulatory menstruation or acknowledge the need – let alone act – to better serve women who want to use non-hormonal contraception. It’s frustrating to be a lone voice, but I keep talking.

It took me over 20 years to find the community that serves and appreciates my menstrual cycle advocacy. I attended my first Society for Menstrual Cycle Research conference in 2005, and that’s how I came to belong to this diverse group of academics, medical professionals, researchers, activists and artists committed to advancing knowledge and awareness of the menstrual cycle. We come from different perspectives, we ask different questions and we focus on different aspects of women’s menstrual lives. But we all hold true to the same idea: #menstruationmatters.

Menstrual cycle advocacy can be lonely and oh so frustrating. Chris Bobel’s recent post about how difficult it can be to help others make the menstrual connection included this quote from me:

Caring about menstruation and the menstrual cycle makes me almost a freak in the pro-choice world. I get ignored or criticized a lot because people don’t want to ask or answer some of the questions I keep trying to pose about choice around non-hormonal contraceptive methods. 

Thanks to SMCR and re:Cycling, I’m not going to stop asking hard questions, or challenging the ignorance and avoidance that many in the mainstream sexual health-care community demonstrate when it comes to ovulation, the menstrual cycle and fertility awareness. I’ll keep chirping and chipping away.  Continue reading...

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Posted in Activism, Amenorrhea, Birth Control, Communication, Health Care, Menstruation, Ovulation | 15 Comments »

Do you love your LARC?

December 12th, 2012 by Laura Wershler

Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.

Nov. 25 to Dec. 1, 2012, was LARC Awareness Week, billed by the California Family Health Council as “a chance to increase awareness about LARCs as a safe, effective, and long-acting birth control method.” Women were invited to contribute video messages on the theme Why I Love My LARC.

This catchy acronym stands for long-acting reversible contraceptive, and the push is on for many more women to choose this form of birth control. Make no mistake, it’s all about control: What the doctor puts in, only the doctor can take out. Ergo, it’s 99% effective. You can quit taking your pills, rip off your patch, or NOT show up for your next Depo-Provera shot. But if you hate the side effects caused by your IUD or implant, you’ve gotta go see a health-care provider to have it removed.

I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week.

According to the awareness campaign, LARCs include the ParaGard (copper) IUD, Mirena (progestin) IUD and Implanon, a non-biodegradable flexible rod, also containing progestin, that is inserted under the skin and left for up to three years. (Here’s a story about the rods going missing in women’s bodies.) Read the patient information about Implanon. Would you agree to have it inserted into your body?

Women who hate Implanon are speaking out. So are women who don’t love their ParaGard or Mirena IUDs. On YouTube, a video by a women with Mirena issues has over 6000 views;  Why I Love My LARC, posted 8 days earlier, has about 100.

The old-school LARC – Depo-Provera – is not on the campaign’s list of LARCs, though it is heavily used in the United States. Holly Grigg-Spall recently reported that “one in five African American teens are on the Depo shot, far more than white teens.” Hmm. Will they all be switched to other LARCs when, or if, they come back for their next shot? Perhaps Depo is not on the list because women can discontinue this contraceptive without clinician intervention. But it’s probably because Depo causes bone density loss – and because this LARC is not a lark. Women are sharing their Depo stories on another re:Cycling post:  Coming off Depo-Provera can be a women’s worst nightmare. You can find more bad news about this LARC than any other.

What about getting your LARC removed if you hate it instead of love it? One re:Cycling blogger shared what happened when she wanted her ParaGard IUD removed:

I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like ‘”Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.”

This is not the only reason why women who end up hating their LARCs will be discouraged from rejecting them. The Affordable Care Act requires all health plans issued on or after August 1, 2012 to provide no-charge access to FDA-approved LARCs. What’s it going to take to convince health-care providers to remove an expensive contraceptive – provided for free – that was supposed to last for three to 10 years?

Maybe a YouTube video about Why I Hate My LARC will help make it as easy to get rid of one as it now is to get one.

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Posted in Activism, Birth Control, coming off the pill, Girls, Health Care, Hormones, politics | 6 Comments »

“Here is the thing that is really driving me crazy about my goddamned IUD”

November 1st, 2012 by Kati Bicknell

“Population Bomb” by Jairus Khan // CC 2.0

Who among us wants to invite a T-shaped piece of plastic or metal to live in our uterus for the next 5 to 10 years, just for fun? No one! But if it’s to prevent pregnancy that’s a different story. IUDs may be uncomfortable and annoying but women still use them because they are so dang effective.

There are many ways to prevent pregnancy. Abstinence, Condoms, the Fertility Awareness Method, Birth Control Pills…and more. One form of contraception that has grown in popularity in recent years is the Intra-Uterine Device (IUD). One study found that teenagers who use long-acting reversible contraception (LARC) had fewer unplanned pregnancies. IUDs and sub-dermal implants are two LARCs. In light of this study, doctors have been recommending IUDs to teenagers as the most effective form of contraception. In the past, it was commonly held that only women who had already had children would be good candidates for IUDs, but today they are recommended for women regardless of whether or not they’ve had children. These devices are very effective at preventing pregnancy, and some even work without hormones. For many women, the IUD is a great option, effective contraception that they rarely have to think about.

But IUDs are not all butterflies and rainbows. I had one briefly, even after knowing my mom’s horror story with the Dalkon Shield in the late 60s. At the age of 27, I was done with the pill and all hormonal contraception, and as I didn’t have a history of heavy periods, my doctor said that the Paragard would be a good choice for me. So I got one. And…I freaking hated it! For the first three weeks after it was inserted, I had cramps so severe that even with intense pain killers, I found it hard to go about my life without thinking I was dying and/or wishing I was dead. My light 3-day periods turned into heavy 10-day affairs with crippling cramps the entire time. An additional unexpected and unpleasant side effect was a sudden inability to reach orgasm during sex. (Anyone else ever have this side effect?)

The one good thing about having the IUD was that one time when I sneezed while on my new heavier period and blood exploded out of my vagina like a gunshot wound, which I found HILARIOUS! But I digress…

A friend of mine says this about her Paragard:

“Here is the thing that is really driving me crazy about my goddamned IUD — my crotch has no idea what it’s doing anymore, and hence neither do I.”

Her cervical fluid is all out of whack, there is no longer any discernable pattern, so she doesn’t know where she is in her cycle. So, while she is using the IUD for contraception, and doesn’t need to chart her fertility for contraceptive purposes, the monthly cues her cervical fluid usually gives her about where she is in her cycle are no longer there.

She also brought up a study that found elevated levels of Mast Cells in the endometrium of women with IUDs. Mast Cells are what your body produces when it’s having an allergic reaction, like if you get hives after eating shellfish. So, are IUDs actually producing allergic reactions in women’s uteruses? That would probably help prevent pregnancy, but what about the woman who has to live with this every day?

Ultimately, I had my IUD removed after four months because I couldn’t stand it any more. All that blood and pain, and lack of orgasms, in a word, sucked! I really feel for women who have periods like this normally, it’s the worst! I was not going to subject myself to this if I didn’t have to.

Thinking I had fully exhausted all medical contraceptive options, I was resigned to using condoms or other barrier methods for the rest of my life. Luckily I didn’t have to do that! I soon found out about the Fertility Awareness Method and started charting my fertility. I can now have unprotected sex with my husband when I’m not fertile, and use barrier methods only when I am fertile.  It’s the best possible solution for us.

IUDs are very effective, but as my story shows, having one in your uterus can be pretty gnarly. In general, I am very glad that IUDs exist. The side effects of today’s IUDs are minimal when compared to the ones in the 60s and 70s, but that doesn’t mean that they are the magic bullet of contraception (see a recent post by Laura Wershler expressing some overlapping views). For me and many other women, the Fertility Awareness Method is a wonderful contraceptive. I want more women to hear about it so it can be brought to light as a serious contender for mainstream contraceptive use.

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Posted in Birth Control | 16 Comments »

Footloose and Pharmaceutical-Free?

October 26th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

At the West Coast Catalyst Convention for sex-positive sex-educators I was listening to a talk on definitions of sexual health when the birth control pill was brought up. I’d spent much of the event feeling desperately vanilla and so was pleased to be discussing something other than strap-ons and lube. The most popular forms of contraception – the hormonal kind – had been notably absent from all discussion that weekend.

Toys in Babeland window display, Photo by Joaquin Uy // CC 2.0

The speaker told the group that the pill is the leading cause of low libido and pelvic pain. She explained that studies had suggested the impact on libido could be permanent. The reaction of the audience was immediate and urgent – questions were fired out and it became clear that this information was news to most. A number of audience members seemed genuinely shocked. “What’s the science behind that?” one woman asked, but the speaker said she didn’t know.

Although the convention’s attendees had an intimidating level of knowledge when it came to sexual technique and sex toys, I discovered that once I mentioned I was there to develop a book and a documentary on hormonal contraceptives, many repeated the usual disinformation about birth control methods.

The speaker was right – the birth control pill is a leading cause of lowered sexual desire and pelvic pain. It’s also known to cause loss of lubrication, vaginitis, and vulvodynia. Other hormonal contraceptives such as the Depo Provera injection, implant, ring and Mirena IUD have been seen to have similar consequences. In fact, Dr. Andrew Goldstein, director of the U.S.-based Centers for Vulvovaginal Disorders and one of the foremost vulvodynia experts in North America, blames an increase in complaints of this kind on third generation low-dose pills.

The study the speaker referred to was conducted by Dr. Claudia Panzer of Boston University and it did suggest some women may see a permanent effect on their testosterone levels, and so their level of desire. There have also been studies on these methods impact on frequency and intensity of orgasm, showing both to be decreased. Not to mention the 50% of women who will experience general negative mood effects that surely impact on their interest in sex. Many, many other studies have shown a clear negative effect on libido whilst using hormonal contraceptives. So many that it’s become something of a joke to roll eyes over the “irony” of prescribing a pill for pregnancy prevention that stops you wanting to have sex anyway.

At a convention dedicated to the celebration of sexual pleasure, I was surprised to see this information received with such confusion. A sex-positive attitude is becoming synonymous with “set it and forget it” long acting hormonal methods of contraception. But it struck me that sex-positive advocates should be the biggest fans of fertility awareness methods. Here’s why:  Continue reading...

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Posted in Birth Control, DIY, Sex | 4 Comments »

I’m fed up with birth control propaganda

October 17th, 2012 by Laura Wershler

Birth control in the U.S. has become synonymous with drugs and devices. The pill, patch, or ring; Depo-Provera or hormonal implant; copper IUD or Mirena IUD; traditional hormonal birth control or long-acting reversible contraceptives. All impact the function of the menstrual cycle; some suppress it completely. As a pro-choice menstrual cycle advocate I take issue with the fact that keeping your cycle and contracepting effectively are now considered mutually exclusive.

A widely published Associated Press story tells us that the American College of Obstetricians and Gynecologists now recommends hormonal implants and IUDs as the best birth control methods for teenagers. The research this recommendation is based on did not even study pregnancy outcomes for women using condoms, barriers, or fertility awareness methods. These methods were not among the free contraceptives offered to study participants. Another story reported that ”the new guidelines say that physicians should talk about (implants and IUDs) with sexually active teens at every doctor visit.” This sounds like a hardcore sales pitch to me. I expressed my concerns about pushing LARCs on teenagers in a previous re:Cycling post.

Drugs and devices also figure prominently in Switching Contraceptives Effectively. New York Times health writer Jane E. Brody writes about the mistakes women make when switching between birth control methods that can result in unintended pregnancies. The reasons women switch are explored and a link to a resource on how to switch methods successfully is provided.

The Reproductive Health Access Project developed the pamphlet to help women prevent gaps in contraception when they change methods. The premise is a good one:

What’s the best way to switch from one birth control method to another? To lower the chance of getting pregnant, avoid a gap between methods. Go straight from one method to the next, with no gaps between methods.

But the pamphlet developers made the huge false assumption that all women just need or want to try another drug or devise. It focuses ONLY on these method — how to switch from the pill to Depe-Provera or the copper IUD, or how to switch from the Mirena IUD to the progestin implant. Condoms and barrier methods are considered useful ONLY for the transition period between drugs and devices. Fertility Awareness Methods are ignored completely. The resource comes across as propaganda for drug- and device-based birth control methods.

Neither Brody nor those behind the Reproductive Health Access Project seem to understand that this approach contributes to the unplanned pregnancy rate by failing to acknowledge that many women are fed up with contraceptive drugs and devices. These women want support and information to switch away from these methods. They are falling though the contraceptive gap created by this failure.

Is it any wonder that some women stop using their contraceptives without talking to their physicians? Maybe they are fed up with doctors like Ruth Lesnewski, education director of the Reproductive Health Access Project, who offers trite admonishment that side effects ”will go away with time” and insists that caution about using long-acting methods like the IUD or hormonal implant is “outdated.” Real health issues are associated with all these methods. I guess Dr. Lesnewski doesn’t read health blogs where women document their frustration about side effects and dismissive health-care providers.

This article places blame for contraceptive failure on women not knowing how birth control works, instead of where the blame really belongs — on the blind spot that keeps sexual and reproductive health-care providers from seeing, and serving, women who are sick and tired of drugs and devices.

As for the ACOG recommendation on the best birth control methods for teens? It’s just a step away from coercive, patriarchal decision-making by doctors for teenage girls, and a threat to the sexual agency of many young women.

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Posted in Activism, Birth Control, coming off the pill, Health Care, Menstruation, Pharmaceutical | 25 Comments »

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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.