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?
A month ago I was musing about what it might be like to blog about fun stuff like food, fashion or travel – you know, topics not quite so “fraught” as the menstrual cycle. Sometimes it feels like just so much work sharing facts and opinions about why body literacy matters, why knowing how our cycles work and how ovulation impacts our health can lead us into meaningful, self-determined relationship with our bodies and ourselves.
But in the days leading up to Christmas, I was reminded by two young women, both of whom I’ve known since they were babies, daughters of friends, one in her late 20s, the other in her early 30s, why I do what I do.
The younger had contacted me last September, at the suggestion of her mother, with questions about switching birth control methods. She was fed up with the Pill, wanted to quit, was considering the Mirena IUD, told me about her history with ovarian cysts, irregular cycles. In a stable relationship, she hadn’t thought much about children. We talked about options. I assured her there were effective non-hormonal methods she could use, that by doing so she could assess her fertility, get her cycle functioning normally before making a decision about the Mirena. I sent her information about treatment – not involving hormonal contraceptives – for ovarian cysts; I asked a medical colleague questions on her behalf. She was thankful, emailing me that she had “some heavy thinking to do, including my actual timeline for children.”
I hoped to see her at her family’s annual Christmas party. We greeted each other briefly when I arrived, but not until the house was teeming with guests did we have the chance to talk privately amidst the holiday din. She told me she’d stopped the Pill three months before, could hardly believe how much better she felt, even though she’d yet to have a period. She thanked me, again, for validating her desire to quit the Pill. It so happened she had an appointment the next day with her family doctor; she knew what treatment she would request to help get her cycle started.
It did not go well. Her doctor, like so many I’ve heard about, was not interested in the menstrual cycle research she had done or the choices she wanted to make about her reproductive health. Quite the contrary: her doctor was hostile. It was disheartening for her, maddening to me, but not surprising.
A day later, at another holiday gathering, the other young woman stopped me in the hall to ask what I thought of the Mirena. She’d made the switch from the combined Pill (estrogen/progestin) to a progestin-only version to help with migraines. She offered that she and her partner had not yet decided about children, but she was concerned about leaving it too late. I told her the Mirena was intended as a five-year method, and if she was thinking she might want a child, it was a good time to stop hormonal contraception and assess her fertility before making a decision, either way.
I forwarded both women links to a naturopath skilled in menstrual cycle and fertility issues, and to a fertility awareness instructor who’d just announced her 2014 Eco-Contraception Program. The decision about what to do next, of course, will be theirs.
I sense both young women are searching for new, mindful connections to their bodies. Even if all I ever do is help a few such women find the support they need to make this connection, then to hell with food and fashion, I’ll keep writing about the menstrual cycle.
The recent death of writer Doris Lessing led me to revisit her work a bit. *
Author of more than 50 books as well as an opera, Lessing was brave. She spanned genres, refused to tow a singular ideological line and used her Nobel Prize moment to remind us that privilege shapes greatness as much, even more perhaps, than talent. And Lessing wrote about menstruation when few others dared.
In her 1962 novel The Golden Notebook, protagonist Anna Wulf journals on the first day of her period—chronicling every thought and feeling her menses produced for her. In the passage below, Wulf’s disgust with her body is hardly a menstrual-positive standpoint (and isn’t something off with her cycle if she detects such an offensive smell?). But there is an honesty, here. A broken silence. Lessing brought to the fore the reality of the fraught and conflicted menstruating body in the early 1960s, and that was a bold move.
I stuff my vagina with the tampon of cotton wool … I roll tampons into my handbag, concealing them under a handkerchief … The fact that I am having my period is no more than an entrance into an emotional state, recurring regularly, that is of no particular importance … A man said he would be revolted by the description of a woman defecating. I resented this … but he right … For instance, when Molly said to me … I‘ve got the curse; I have instantly to suppress distaste, even though we are both women; and I begin to be conscious of the possibility of bad smells … and I begin to worry: Am I smelling? It is the only smell that I know of that I dislike. … But the faintly dubious, essentially stale smell of menstrual blood, I hate. And resent. It is a smell that I feel as strange even to me, an imposition from outside. Not from me. Yet for two days I have to deal with this thing from outside—a bad smell, emanating from me. … So I shut the thoughts of my period out of my mind; making, however, a mental note that as soon as I get to the office I must go to the washroom to make sure there is no smell (pp. 339-340).
Lessing is not alone among the brave who dare to Speak a Menstrual Language. In honor of Thanksgiving in the US, I offer this shout out to a short list of the courageous who inspire. Thank you menstrual champions.
Rachel Horn, of Sustainable Cycles, who cycled coast to coast this summer, promoting menstrual literacy and menstrual cup awareness.
Holly Grigg-Spall, who has put herself on the line with her new book Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control. Grigg-Spall has been challenged, sometimes pretty nastily, for suggesting that one can use a feminist reproductive justice lens to be critical of the pill.
And how about radical feminist pioneer of queer cinema, Barbara Hammer. Her 1974 expeimental film Menses playfully interprets, though a group of women enacting their own individual fantasies, what menstruation means to them. 1974!
Menarchists Jaqueline J. Gonzalez and Stephanie Robinson, who founded the Menstrual Activist Research Collective (M.A.R.C) in 2011, and just released their line of menstrual gear (http://www.etsy.com/shop/menarchists) at cost so you can help them spread the good word, or as they put, leave your MARC! We bleed. It is okay. We bleed.
Then there’s Arunachalam Muruganantham, the self described “school dropout” (and now the subject of a new documentary) who developed a table top machine that rural Indian women can use to produce and sell low cost single use menstrual pads. He wants to make life easier for Indian women (and he is not interested in getting rich). Yes, there are sustainability issues, here, but there’s also a widening of options for women.
Every teenager who, on the way to the school toilet, ever dared to walk down the hall with femcare-product-of-choice in open view.
Every menstruator who hangs cloth pads on the clothesline with the rest of the laundry.
Questioning and quitting the pill are current hot topics, fueled in no small part by Holly Grigg-Spall’s recently released Sweetening the Pill Or How We Got Hooked on Hormonal Birth Control. Her book has drawn ample backlash, brilliantly addressed by re:Cycling blogger Elizabeth Kissling.
Adding to the media clamour was Ann Friedman’s New York Magazine online piece No Pill? No Prob. Meet the Pullout Generation which explores how and why women she knows are ditching hormones and depending on withdrawal and period tracking apps for birth control.
Both writers, along with Toronto freelancer Kate Carraway, recently discussed the topic Rebelling against the pill: ‘Pulling-Out’ of conventional birth control on CBC Radio-Canada’s The Current.
Listening to Grigg-Spall, Friedman, and Carraway discuss the pill rebellion affirms that while many young women are through with hormonal birth control, their transition off the pill, etc., is not without risk-taking and pushback.
Grigg-Spall nailed the pivotal point when she said “It’s a provider issue.”
The rise of the “pullout generation” is proof that sexual health-care providers and educators, among whom I count myself, have failed on two counts:
1) We’ve failed to address a key aspect of contraceptive use: how to transition successfully between method groups, in this case from hormonal to non-hormonal methods. We’d rather present the so-called “latest and greatest” hormonal methods and say – earnestly, pleadingly – try this! The CBC panelists provided strong anecdotal evidence that more and more women are having none of it.
2) We’ve failed to adequately acknowledge and serve women who can’t, won’t or don’t want to use hormonal methods. We are NOT providing across-the-board support and programs that include easy access to diaphragms or certified training in fertility awareness based methods (FABM), either onsite or through collaborative referral strategies.
For over 25 years I’ve advocated for increased access to information, support and services for women who want to use non-hormonal methods of birth control. It’s self-evident such services must include access to qualified instruction to learn FABM that have effectiveness rates over 99%. This is not to say there isn’t a place for withdrawal as an effective back-up. Check out this confessional how-to post by fertility awareness instructor Amy Sedgewick.
As Friedman said on The Current, women are intimidated by the idea of learning fertility awareness. I believe this is mostly because mainstream sexual health-care providers have never fully educated themselves about FABM or fully committed to presenting these methods as viable options to drugs and devises. Do they think that most women can’t or don’t want to learn fertility awareness skills? That would be like thinking most girls can’t or don’t want to learn to read.
As I’ve written elsewhere: “Fertility awareness, like riding a bicycle, is a life skill.”
If you can learn to swim, ski or snowboard, knit a sweater, read a balance sheet or master Adobe InDesign, you can learn to observe, chart and interpret your menstrual cycle events. We can all acquire body literacy.
Until sexual health educators and care providers develop programs to fully serve women who won’t use or want to stop using drugs and devises for birth control, we will continue failing to meet the growing “unmet need” for effective non-hormonal contraceptive methods.
The reign of hormonal birth control as the top-of-the-contraceptive-hierarchy gold standard appears to be coming to an end. The pullout generation represents just one thread in this transition. The questions is: Are sexual health educators and care providers paying attention and, if so, what are they going to do about it?
I had the privilege of writing the foreword for Holly Grigg-Spall’s recently published book Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control. It’s astounding to me that more than 30 years ago, before Holly was born, I was asking some of the same questions she explores in her book. I thought we’d have more answers by now, but one thing is certain: Holly’s book has prompted long-overdue discussion and debate about issues related to hormonal birth control. Below is my foreword to Sweetening the Pill.
In a letter dated March 22, 1980, I proposed to the editor of an American woman’s magazine that they consider my enclosed article: The Contraceptive Dilemma – A Subjective Appraisal of the Status of Birth Control.
“Recent articles (about birth control) deal almost exclusively with the basic pros, cons, and how-tos of the various contraceptives available – matter-of-fact discussions that reduce birth control to a mere pragmatic decision. If only that were the case.
Contraception, like the sexual interaction that necessitates it, involves our emotions as much as it does the facts. Yet the subjective, personal aspect of contraception is so often ignored. In this age of scientific research we are expected to (subjugate) our emotional reactions to significant probabilities, our anger to logic. Very real fears and earnest questions are dismissed as irrelevant….”
Although today I wouldn’t use the phrase “emotional reactions,” it’s hard to believe that three decades later, the status of birth control and women’s relationship to it has not much changed. Websites, not magazines, now host information about the basic pros, cons and how-tos of available birth control methods. And it is writers like Holly, half my age, who honour women’s real fears and ask earnest questions that are still being dismissed as mostly irrelevant.
Just as my personal story with the pill – including over a year of distressing post-pill amenorrhea – set me on a course of research and advocacy, so too has Holly’s personal experience. Sweetening the Pill explores and challenges the ways in which the pill and other drug-based contraceptives damage women’s health, threaten our autonomy and thwart body literacy. What we don’t know about our bodies helps pharmaceutical companies “sell” their contraceptive drugs, and keeps us “addicted” to them.
At some point between my first attempt at non-hormonal contraceptive advocacy and Holly’s exploration of how we’ve become hooked on hormonal birth control, something disturbing transpired. Prescribing the pill, or other forms of hormonal contraception, has become, in the minds of most health-care providers, the “standard of care” for being a girl. It is all too common to subjugate a girl’s menstrual cycle to synthetic hormones that superficially “regulate,” but actually suspend the maturation of her reproductive system. And for many girls, the use of hormonal contraception continues well into their 20s, without awareness of what might be or has been sacrificed.
There are many women like Holly who are fed up with hormonal birth control. I’ve met scores of them during my 30 years involvement within the mainstream pro-choice sexual and reproductive health community, the one that prides itself on inclusion and diversity. Yet I’ve been unsuccessful in my constant advocacy for this community to accommodate a more inclusive, diverse approach to contraception, to provide acknowledgement, support and services to women who cannot or do not want to use drug- or devised-based methods. We pay lip service to the idea, but the message we convey is: “You’re on your own.”
I’ve found enthusiasm in other realms for my menstrual cycle advocacy and my belief that many women want to, and can, learn to use non-hormonal methods effectively and confidently. I’ve found scientific evidence of the value of ovulation to women’s health and well-being.
I’ve read, met or worked with several of the sources included in this book. Many have devoted their careers to understanding women’s bodies and our relationships with our bodies in ways the medical mainstream typically ignores and barely comprehends. They have made contributions that help us imagine a different way of thinking about fertility, contraception and our menstrual cycles in relation to our sexual, reproductive and overall health.
It’s been more than 20 years since Susan Faludi first published Backlash (with the provocative subtitle, The Undeclared War Against American Women), her thorough documentation of the ways women and feminism were under attack in the U.S. The War Against Women has been now been openly declared in American politics, and there is a backlash among women in online feminism.
I’m referring to discussions of hormonal birth control; specifically, how and with whom we can criticize the birth control pill. Before she joined the re:Cycling team, Holly Grigg-Spall wrote a guest post for us titled, Why Can’t We Criticize the Pill? At the time, the title may have seemed a little overwrought, but now that her book criticizing the pill has reached the market and been reviewed in several online publications (including by some reviewers who refused to even read it), the question is more than apt. Lindsay Beyerstein’s review for Slate prompted some readers to start a petition asking the publisher to cease publication. Amanda Marcotte has written two posts on her blog slamming the book without reading it, and refused offers of a free copy so that she could respond accurately. Dr. Jen Gunter is also uninterested in reading it, labeling the book “that atrocious pill book” on Twitter and suspecting “a pro-life agenda”.
The criticisms of the book are many and inconsistent: (1) an assertion that Grigg-Spall claims the pill is bad because it is not ‘natural’, (2) since the pill was bad for Grgg-Spall, no one should take it; (3) the pill is sexist and therefore dangerous; (4) the pill is anti-feminist; and furthermore, (5) Holly advances all of these claims in service of a anti-feminist, anti-woman, anti-choice, pro-life, Christian right-wing agenda. That last one is particularly galling, as every time she speaks or writes about these issues, Holly prefaces her talk or mentions in her writing that she is atheist, feminist, and pro-choice. (She often also mentions that she’s British, and was raised with a very different health care system than those of us in the U.S., and thus held different assumptions about access.)
All of these criticisms are either factually incorrect, or exaggerated or deliberate misinterpretations of Holly’s actual arguments. For instance, while she does question what ‘natural’ cycles would be like if women didn’t take the pill, she does not assert that pill = unnatural = bad. Nor does she advocate banning or restricting the pill. She does locate the pill in a complex matrix of capitalist and patriarchal social structures that do not benefit women, which is not exactly the same as saying “the pill is sexist”.
As a feminist, a scholar, and as a reader of books, I’m both fascinated and frustrated by the criticism Sweetening the Pill has received. I’m appalled that reviewers would write and publish reviews completely panning a book they haven’t read, and then refuse to read it. As a feminist, I’m frustrated by apparent efforts to shut down dissent. The pill has never been more politicized in American life, and as I’ve asserted elsewhere, we cannot be so focused on preserving access that we’re willing to ignore questions of safety. Furthermore, it is not anti-feminist to disagree with one another. Feminism has a long history of proliferating and becoming more powerful by listening to dissent from within. Anyone remember the “Lavender Menace“? The emergence of intersectionality? As a commenter on one of the hack pieces eloquently put it,
The feminist critique of reproductive technology (including the pill’s discontents) are well established going back before the existence of the pill itself as debates with Sanger and colleagues. I’m sure this is widely taught in the Women’s Studies programmes you mention, it was to us even in A-level sociology.
I just don’t understand why you are pretending this is a new thing or that anyone taking these positions is a non-feminist. Are genuinely unaware of the history of your own movement or is this a crude rhetorical move against people you don’t agree with? Feminists (Seaman and Wolfson) provided critical testimony in the 1970 Senate Hearings, this is not some sort of obscure or secret fact, Wolfson’s outburst as to the constitution of the hearings and why drug companies were better represented than women is surely famous?
It seems to be the case you want to retro-actively kick Barbara Seaman out of feminism. You know, the woman that Gloria Steinem said was the prophet of the women’s health movement… with respect I don’t think you have the power and you don’t have an argument.
Feminism has always supported counter-intuitive critiques given that problems are multi-valenced. While Sanger held that reproductive control was an essential pre-condition of liberation, “who controls the control”, why and how are far more provocative questions.
Agree or disagree with Sweetening the Pill, or any other book, but read it for yourself, and form an opinion based on what the book actually says — not what a reviewer says or a 140-character criticism on Twitter suspects it might say. And think very carefully, and perhaps read it again, before you decide that it’s not feminism just because it doesn’t match exactly your feminism.
My forthcoming book ‘Sweetening the Pill or How We Got Hooked on Hormonal Birth Control’ began to take shape on the pages of this blog and much of the process of its development was spurred on by the work of members of SMCR. As such, it seems only fitting, with the release date of September 7th soon here, to share for my post this month an excerpt and to say thank you for the support of this community. I hope to have added something of interest and value to this on-going conversation.
Women often discuss menstruation and birth as happening to them, rather than as part of them and their experience. Emily Martin remarks in ‘The Woman in the Body’ that women often see their self as separate to their body. Women’s central image is that “your body is something your self has to adjust to or cope with” and therefore, Martin concludes,“your body needs to be controlled by your self.”
Martin explores the idea that women did not fit into the structure of the jobs that were open to them in industrialized society. These jobs most often required monotony, routine and repetition. Although in reality no more suited to men than they were women, it was women that were judged as innately unable to succeed in such positions due on the constantly changing and supposedly unpredictable nature of their physical state.
As Martin states, “Women were perceived as malfunctioning and their hormones out of balance,” especially when experiencing PMS and menstruation, “rather than the organization of society and work perceived as in need of transformation to demand less constant discipline and productivity.”
The rigidity of society was forcefully imposed on women as it was on men. For all, both men and women, it is inhumane but it was women that were required to adapt in a more dramatic and overt way. Men are viewed as naturally given to the industrious and disciplined way of life demanded of them and the structure of society is built on these assumed capabilities.
If we admit that women do change through the month, that we do menstruate, experience PMS, have differing moods week to week, we fear that this admission will be used as justification for negative judgment.
Martin counters the feminist refrain of “biology is not destiny”; “I think the way out of this bind is to focus on women’s experiential statements – that they function differently during certain days. We could then perhaps hear these statements not as warnings of the flaws inside women that need to be fixed, but as insights into flaws in society that need to be addressed.”
The idea that men are otherwise unchanging is falsified. Men also experience hormonal changes with studies suggesting they experience a cycle daily that is equivalent to the monthly cycle of women as well as changes in hormone levels across their lifetimes.
Women’s “experiential statements” as Martin describes them are often silenced in the discourse surrounding hormonal contraceptives. It is a betrayal of the feminist cause to speak out with openness about the side effects of the pill.
When Yaz and Yasmin were released the marketing strategy co-opted the idea of word of mouth. In a commercial women were seen passing along the “secret” of these new drugs with their host of beneficial yet superficial side effects. Receiving messages of increased physical attractiveness as the result of a drug that many women were using anyway, only a different brand, increased the transference of this experience from one woman to the next.
In the face of such powerful manipulation, what place does a skillfully worded informational insert have in women’s decision making process? The time of the Nelson Pill Hearings was a very different to today.
Naomi Wolf mentions the pill briefly in ‘The Beauty Myth.’ She remarks that it was originally marketed as a drug to keep women “young, beautiful and sexy,” concepts parallel to those promoted by Bayer through its contemporary advertising. Wolf quotes, in the context of the beauty industry, John Galbraith, “Behavior that is essential for economic reasons is transformed into social virtue.”
Why are media-based discussions about menstrual cycle advocacy vs. menstrual suppression, or hormonal birth control (HBC) vs. non-hormonal birth control (NHBC), so often fraught with conflict, suspicion and untested assumptions?
Because the opposing frames of reference are often considered to be an either/or dilemma, with “right” and “wrong” solutions according to our preferred position, rather than two ends of a polarity between which a dynamic range of positions fluctuate. We live with many common sense polarities, like rain and sunshine, knowing the right combination of both is in our best interests.
Please Don’t Judge Me for Skipping My Period, a recent post by Sarah Fazeli at Xojane illustrates the challenges in managing polarities. The title suggests the writer expects to be or has already been judged for her “wrong” decision, yet many of the 427 comments demonstrate the range of positions held on the issue.
At one end of the menstrual cycle polarity is my preferred position – based on experience, research and evidence-based medicine - that consistent ovulatory menstruation supports women’s bone, breast, heart, reproductive, sexual, psychological and overall health. HBC disrupts endocrine function and stops ovulation, impacting many physiological systems. Many women are choosing NHBC because they are HBC-intolerant and/or want to experience healthy menstrual cycles. I advocate for improved access to information, support and services to help them use NHBC effectively and confidently.
I understand how my position might be construed as an either/or dilemma, but in no way am I demanding HBC be banned, bullying women to stop taking their pills or alluding to anti-abortion views. Yet others make and act on untested assumptions that I and others who hold this position are doing some or all of these things.
So how might we all – advocates, health professionals, educators, journalists, bloggers and the public – talk about the menstrual cycle polarity in ways that create opportunities and commitment to work together to meet all women’s needs?
For answers I revisited my training manual in Contemplative Dialogue. In 2009, I took a four-day intensive workshop to learn about this process of engaging collective awareness to create “a deep experience of community where division or separation may have been the felt starting point.”
Contemplative means taking a long, compassionate look at the real; dialogue is the practice of creating shared meaning. Compassion is a key element because “it helps us get past the kind of guarded and defended reactions that undercut us doing things together.”
I refreshed my memory on how to avoid acting on untested assumptions. I thought about how I might become skilled enough to back not just myself but other people down Chris Argyris’s “ladder of inference” in a non-threatening way to resolve misunderstandings and create shared meaning.
Contemplative Dialogue also incorporates into its process Barry Johnson’s work in managing polarities. In emotional debates it helps if we can learn to speak across polar values.
This process calls for me to identify both my preferred value and the opposite value. In dialogue I first acknowledge the upside of the opposite value followed by the potential downside of my preferred value. Keeping my language fair and non-pejorative, I then speak of the downside of the opposite value that I fear. Finally, I get to talk about the upside outcomes to my preferred value that I’m striving for.
I want to keep talking about these issues, but I’m not up for a range war, a spilling of metaphorical menstrual blood to determine who holds the higher ground or owns the greater truth. I’m committed to practicing contemplative dialogue to bridge the divisions between the two ends of the menstrual cycle polarity.
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.
Although there is no direct-to-consumer advertising in Australia these brands of pill gained popularity there just as they did in Europe and Canada. It is interesting to note that Marie Claire US ran an article in 2011 titled ‘The New Super Pill’ that named Yaz and Yasmin as the latest, greatest “no-acne, no-bloat and pms-be-gone” pills that also allow you to “shorten your period”. The pages of magazines such as Marie Claire in the US are usually scattered with adverts for Yaz and Yasmin, the NuvaRing, Nexplanon impant, and Mirena IUD. The print and television commercials often play on the same insecurities reflected and bolstered by the majority of the women’s magazine articles.
Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist
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.
The reasons for depression are mysterious to me but this is an important adverse effect. I believe that anyone who has previously had an episode of depression (whether diagnosed or not, but sufficient to interfere with life and work) should avoid Depo.
LW: Although there has been little discussion about bone health concerns on the previous blog post, I think we should address the fact that Depo causes bone loss. How does it do this?
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.