Blog of the Society for Menstrual Cycle Research

#Making Menstruation Matter—For All the Wrong Reasons

April 15th, 2013 by Chris Bobel

Oops!

Somebody fell in it.

And by it I mean the tired old WomenCan’tDoStuffBecauseTheyAreWomen pit–a veritable snake hole crawling with misogynists, essentialists, and old school protectionists.

Image adapted from public domain photo // Design by Anne Bobel Zelek
[Actual menstrual status of shooter unknown. That's the point, people. You can't tell]

Terri Proud, a newly hired Administrative Assistant in the Arizona Department of Veterans’ Services, landed in the pit recently when she (allegedly) made comments about women’s menstrual cycles in combat. She was fired, and her boss, Colonel Joey Strickland, was asked by the Arizona governor to resign (apparently, Strickland hired Proud against the Governor’s wishes).

According to the Arizona-Sonora News Service, when asked about women serving on the front lines, Proud said “Women have certain things during the month I’m not sure they should be out there dealing with….”

Proud says she was misquoted. Was she or wasn’t she? Even if the quote is verbatim, I struggle to imagine a government official’s capacity  to register the absurdity of this comment, but maybe I am just cynical. Suffice it to say, there is surely more to this obviously political  here, but I’d like to focus on the menstrual dimension.

The assumptions about what women can and cannot do while menstruating make for a long and logic-defying list. The rationale for menstrual prohibitions is sometimes religious  (e.g., bans on menstruating women from religious rites, sex, and food preparation). There’s another category of no-nos beyond the menstrual taboo, though.  Women can’t do [fill in the blank] because their periods render them incapacitated or otherwise put them at risk. Many people still believe a woman should not camp or hike in bear infested woods because their menstrual odor will render them bear bait.  Not true. Often, women themselves are constructed as the predators during their PRE-menstrual period. You know….PMSing women are dangerous, even potentially homicidal. And women can’t be trusted to make decisions (or serve on the Supreme Court) because they are Out Of Control.

But we know differently. Women—during all phases of the menstrual cycle—can do all manner of things,  all the time, thank you very much, including jobs that are not, shall we say, menstrual management-friendly. They fight forest fires. They collect data in remote field sites. They orbit space. They are perform brain surgery.

Yet, PREJUDICE against women is often JUSTIFIED because they menstruate. The Disability Rights/Inclusion Movement has taught us that often, the most pernicious barriers to inclusion are perceptions, not the actual limits imposed by our disabilities. That’s certainly the case here. Let me go out on limb here: if women were respected, if women were valued, if women were seen as competent peers, then the fact of their menstruation would be less of a “disability” and more of a fact of a life.

But you know what? I want to give Terri Proud the benefit of the doubt for a minute. When pressed about her comment by The Arizona Daily Star, Proud said “I don’t have a problem with women being on the front line if that’s their choice….I’m not going to sit there and say, ‘No, you don’t have that right.” In the same story, Proud is described as harboring  a “curiosity”  about “how menstrual cycles are handled” and noted “that whether or not that hurdle is being addressed is a real issue, even if it isn’t talked about. Women are designed differently from men and need to have their needs met on the front lines.” And I say to that: well done Terri Proud, Menstrual Activist.

Because she is right. Menstruation is a reality, and menstruators need support and resources. Managing our menses can be tough when we don’t have access to facilities, or privacy, or both. Anybody that’s been camping while on their period can tell you that (bears notwithstanding) this IS a REAL issue. So she is right to ask (even if she is merely doing so to recover from blurting out something really dumb) What is the US military doing for women in combat? Now with the ban on women in (officially recognized) combat positions is no more, a change in policy that is expected to open 230,000 front-line positions to women, this question demands answers.

One answer: Suppress menstruation through the use of extended oral contraceptive pills. That is an option, yes, but it might not be the right one for every woman. Even beyond many menstrual cycle researchers discomfort with the one-size-fits-all approach to dosing cycle-stopping contraception (readers of re:Cycling are no stranger to concerns about this trend), there is a deeper concern about the implications of just making the menses go away.

Cycle stopping contraception, Liz Kissling has argued, enables a particularly new manifestation of the docile neoliberal subject. The feminine non-mensturating body, is not, as popularly believed, liberated, but rather, one held even tighter to the hegemonic male standard. Place this compliant amenorrheaic body in the context of the military and a curious paradox is revealed. The submissive soldier? The docile woman packing an assault rifle? Really? Seems both oxymoronic, and hardly like a gain in the fight for women’s equality.

Instead, can we imagine an expanded universe of menstrual management options?

  • Reusable cups and sponges provided for free (with eww-effect reduction training included) ?
  • Cycle stopping contraception offered as an option (not a mandate)—including an honest discussion of risks and benefits?
  • Quality reproductive health care in which menstrual health is a part of a comprehensive whole?
  • Work cultures, even remote ones, that acknowledge cyclical and variable human needs of all sorts?

Otherwise, if women must alter their very bodies to “fit in” and be taken seriously in their jobs, show me the ground we have gained. Cuz when I look down, all I see is the bottom of the same ole stinky pit.

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Posted in Communication, FemCare, Health Care, Humor, Media, Menstruation | 6 Comments »

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 »

Understanding Research: Media Reports of Research

April 1st, 2013 by Paula Derry

The Huffington Post published a story last week titled “Last Menstrual Cycle Could Be Predicted With New Model”. The story stated that a research study had just been published about a new method for predicting the end of menstruation in which researchers developed a formula for using the levels of two hormones, estradiol and follicle stimulating hormone (abbreviated FSH), to make this estimate. This “new method for predicting a woman’s last menstrual cycle could have broader implications for menopausal women’s health”. Since “in the year leading up to the final menstrual period, women are met with faster bone loss and a greater risk of heart disease”, if the end of menstruation could be predicted, medical monitoring and interventions would become possibilities. The research was also reported as news on the medical website Medscape.

Research results are often reported as news stories, as though these results are facts. However, “dog bites man” and “man bites dog” are facts, but research results are not facts in the same way. They are “evidence” that most often must be evaluated, understood, and put into the context of many other studies. There could very well be disagreement about whether a study’s methods really did accurately make a point, or whether the conclusions the researchers drew from their work were justified. Sadly, it happens all too often that research does not make the point that the headlines claim.

Photo by clarita // morgueFile

Here, we have a study by a respected researcher at a major institution, UCLA, funded by a grant from the National Institutes of Health and other prestigious grantors. However, we do not have the information with which to understand what the researchers actually did. UCLA issued a press release which states that the study “suggests” a way to predict the final period. The Medscape article states that “A new model MAY [my emphasis] help physicians determine how far a woman is from her final menstrual period”.

Suggests? May? I have no idea what this means. As a researcher, I want to look at the published article to see what was actually done. However, the publisher does not make a free copy of the article available. Anyone who wants to look at the published article—a researcher or an informed consumer—would need to pay the publisher $37.00 to access this 20-page article for one day. Predicting the last menstrual period from hormone levels, which is what is claimed, is something other researchers have tried but failed to do, so how these researchers worked with the difficult problems is an important question.

Assume for a moment that the model was a big success, and it did predict the last menstrual period. The idea that this has important implications for women’s health is stated as though it were another fact. However, this is not a fact; this is a complicated and controversial area. Bone density does decrease in the years surrounding menopause, but professionals disagree about how big an effect this has on bone disease. For example, current guidelines recommend testing bone density beginning at age 65, 15 years after the average age of menopause, because this is when the fracture rate has significantly increased. Heart disease risk factors may increase on average in the years surrounding menopause, but professionals disagree about whether menopause is important compared with other factors associated with aging.

Assume for a moment that bone disease really is an important negative health consequence of menopause. Whether interventions would be found that must be started in the year or two before menopause is another speculation. Such interventions might be found or might not. Predicting the last menstrual period, even if the claim is valid that a method to do so has been found, is a long way from preventing disease.

The medical satirist Andrew Vickers wrote an article called “News On Cancer Drug Fails to Raise False Hopes”, which begins: “A recent article on a novel cancer therapy has rocked the newspaper industry by giving a balanced and cautious review of an early-phase trial”. Satirists make extreme statements to make a point. Media reports are often written to sound definite and to portray a study as really important. A cautious approach to medical news is to withhold judgment unless the methodology of the study is clear and the context of the study is understood.

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Posted in Health Care, Hormones, Media, Menopause, New Research | No Comments »

March is Endometriosis Awareness Month

March 20th, 2013 by Elizabeth Kissling

You’re busy celebrating Women’s History Month, the Ides of March, Pi(e) Day, St. Patrick’s Day, not to mention Spring Break and numerous lesser known awareness days and months. But don’t let Endometriosis Awareness Month slip away.

Endometriosis — when the uterine lining or endometrium grows outside of the uterus,  most commonly elsewhere in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity — affects at least 6.3 million women and girls in the U.S., 1 million in Canada, and millions more worldwide, according to the Endometriosis Association. It frequently results in very painful menstrual cramps and other symptoms, and is notoriously hard to diagnose. There is no known cause, and while there are many treatments, there is no real cure.

Adapted from a photo by Ben Werdmuller // Creative Commons 2.0
http://www.flickr.com/photos/benwerd/3976375987/

So what can you do this month? Just talking about endometriosis — acknowledging it exists or sharing your own story might help a teenage girl realize that those gut-stabbing cramps aren’t normal or another woman to know that it’s not all in her head.

If you have endometriosis and have found a physician or other health care practitioner who is compassionate and has helped you find ways of coping, tell others — refer your friends. Many doctors don’t know that endometriosis often presents as, or with, gastrointestinal symptoms.

Does your local library have up-to-date books about endometriosis? Recommend materials that have helped you.

Share this post on Facebook, Twitter, and other social networks. (The little buttons at the bottom make it easy.)

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Posted in Girls, Health Care, Menstruation | 2 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 »

Herpes Is The New Black

March 12th, 2013 by Kati Bicknell

Okay, the title of this post may have thrown you off, but hopefully it also lured you in so that you can hear me out.

What’s the story here? Just that herpes is way more common than most people realize, and that you can get it from people who may or may not even know that they have it.

 

Micrograph showing the changes of herpes simplex virus (HSV) – Photo by Nephron // Creative Commons 3.0

Herpes is a virus that causes outbreaks of blister-like lesions on the skin. Many people have had these on their mouth, where they are known as cold sores. When these same lesions appear on the genitals they are known as genital herpes. Technically they are two different versions of the same virus. HSV-1 is usually found in oral herpes cases. HSV-2 is usually found in genital herpes cases, but either virus can cause outbreaks in either location. Upstairs can go downstairs, and downstairs can go upstairs, as it were. Ahem.

According to the American Sexual Health Association, it’s estimated that about 50% of the adult population have had a cold sore on their mouth at some point in their life, meaning they have HSV-1. Half the population! That means that half the population could potentially give you genital herpes if they performed unprotected oral sex on you, so use protection, ask for your partner’s STI status well BEFORE you engage in any hanky panky, and don’t forget to ask if they’ve ever had a cold sore. If they have, you may be at risk to contract herpes. Unfortunately, most people who are infected with the herpes virus never show any symptoms, so even if they’ve never had an outbreak, they could STILL give you herpes.

According to the Center for Disease Control, around one in six people aged 14 to 49 in the United States have the HSV-2 virus, AKA genital herpes. One in six. That’s a lot. Same deal here, they may have never had an outbreak, but they can still give it to you, and YOU can have an outbreak! If you have one outbreak, you’ll likely have more, as the herpes virus will stay with you forever.The good news though is that the outbreaks tend to decrease in frequency and severity over time.

The best way to minimize your risk of getting herpes is to know the STI status of all your partners, and to know your own. You can (and should) be one of those awesome responsible people who doesn’t give their partners the surprise gift that nobody wants. Routine STI screenings won’t check for the herpes virus, so you have to ask for it specifically.

To get a test for herpes, ask for an IGG-type specific blood test. It will show if you have antibodies to either of the two viruses, and tell you which one, if either, you have. This test will only pick up the antibodies though, which take about three to four months after the initial outbreak to show up, so it isn’t 100% accurate. Just do the best you can. And always practice safer sex (no sex is totally “safe”).

Use protection when your partner’s STI status is unknown. That means dental dams for cunnalingus and analingus, and condoms for anal sex, vaginal sex, sex toys if shared between partners, fellatio, etc. And even if you DO use condoms every time, herpes has an asymptomatic shedding period, when the virus can be passed even if there are no sores, and only the part of the body that the condom is covering is protected, and herpes can be spread from scrotum to vulva.  Continue reading...

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Posted in Health Care, Sex | No 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 »

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 »

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 »

Could use of the pill be linked to insulin resistance?

October 3rd, 2012 by Elizabeth Kissling

Adapted from a photo by anna marie-grace // CC 2.0

The pill is one of the most intensely studied drugs in history, and believed to be among the safest – safer than aspirin, as an editorial in the American Journal of Public Health noted twenty years ago. Yet young women seem to be quitting in droves, for a variety of reasons: to restore feelings of psychological and emotional health, regain lost libido, relieve cardiovascular symptoms and disorders, or ease anxiety about these or other health issues.

When women report these side effects of birth control pills, physicians often recommend they try another brand, but many of these side effects are common to hormonal birth control, especially oral contraceptives. A new study published this month in Human Reproduction suggests there may be yet another common side effect: Researchers in Finland found that oral contraceptives may worsen insulin sensitivity and are associated with increased levels of circulating inflammatory markers.

The study was very small and ran only for a short time, so drawing conclusions is premature, but since the beginning of the year, I’ve been following several online discussions of young women quitting the pill. Although I have yet to see development of Type 2 diabetes or insulin resistance cited as a reason to quit the pill, I have seen such a variety of health issues and medical problems described that this study caught my eye immediately. Current estimates indicate that 12.6 million, or 10.8 percent, of all U.S. women ages 20 years or older have diabetes (diagnosed and undiagnosed). Could it be related to their birth control? Perhaps in those already genetically predisposed.

Research from the Guttmacher Institute indicates nearly 60% of pill users take it for non-contraceptive reasons, such as for cramps or other menstrual pain, menstrual regulation, acne, endometriosis, as well as for prevention of unintended pregnancy. Fourteen per cent of US pill users (more than 1.5 million women) take birth control pills solely for non-contraceptive reasons. If the Finland study proves to hold true for larger groups over extended periods, there’s another reason to be more cautious prescribing the pill.

 

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Posted in Birth Control, coming off the pill, Health Care, New Research | 10 Comments »

I’m sick of being special.

August 2nd, 2012 by Alexandra Jacoby

I’m sick of being special. I am.

I want to be ordinary.


What brought this on? ​

I was clicking through some of the July 28th Weekend Links (thank you, Liz!), and the article about birth control advice for women over 40 caught my eye, and while reading it, I became curious about the source quoted there, Jennifer McCullen, a physician at Ob/Gyn Women’s Centre of Lakewood Ranch. That led me to the Lakewood Ranch Medical Center, The Women’s Center:

“Caring for the special needs of women at every stage of life is the focus of The Women’s Center at Lakewood Ranch Medical Center. Separate from the main hospital. Private and with easily-accessible parking, the center’s experienced team of medical professionals coordinate care in areas of obstetrics and gynecology, labor and delivery and urology, with special attention to childbirth and breast care.”

 

Special needs just stopped me in my tracks.
​Really? 

As far as I know, human reproduction has been happening more or less the same way forever.

In whatever way the moments of conception and birth were reached, whatever the stories of the people involved, they did include a fertile woman’s body ready to hold, to carry, and to nourish through all its phases a zygote, embryo to a fetus, and to eventually deliver, a human baby.

So, why are body-experiences as relate to reproduction, or to the menstrual cycle, considered special situations like in the quote above describing The Women’s Center’s services, or “special” in another way — embarrassing, inappropriate to mention, to-be-hidden, as Fit Chick reminds us is more often than not the case, in her blog post, Breaking the Curse?

​Actually, today, I don’t care so much about the whys – but go ahead and add to the comments: because that could help us to understand ourselves, our collective story of how we got here, and that may help us to move beyond this space where our common body-experiences as potentially child-bearing, menstruating humans is treated as other​, rather than ordinary.

Deeply and widely quality-of-life​ affecting, ordinary.

And yet, managing our experiences, just talking about them….these are still special situations.

Special situations – at every stage of our lives?

​​I’m sick of being special.

I want to be ordinary.

 

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Posted in Birth Control, Health Care, Menstruation | 3 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.