Blog of the Society for Menstrual Cycle Research

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

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

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

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

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

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

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

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

What’s In A Name?

March 27th, 2014 by Heather Dillaway

This month an important Sage research journal, Menopause International, “the flagship journal of the British Menopause Society (BMS),” changes its name to Post Reproductive Health. The Co-Editors of this journal are quoted in talking about this name change:

“Women’s healthcare has been changing dramatically over the past decade. No longer do we see menopause management only about the alleviation of menopausal symptomatology, we also deal with an enormous breadth of life-changing medical issues. As Editors of Menopause International, we felt that now is the time for the name and scope of the journal to change; thus moving firmly into a new, exciting and dynamic area. We wish to cover Post Reproductive Health in all its glory – we even hope to include some articles on ageing in men. Our name change is a reflection of this development in scope and focus.”

This name change may seem very insignificant to most people but, for me, a change in name signifies major steps in conceptual thinking, research practice, and (potentially) everyday health care. While I have some problems with the new name (I’ll get to those in a minute), the idea that menopause researchers and practitioners are beginning to see menopause as part of a broader life course transition is phenomenal. It signifies the willingness of many in the business of studying and treating menopause to think more broadly about reproductive aging. It also indicates that many now understand that menopause is not necessarily the “endpoint” of or “final frontier” in one’s reproductive health care needs. Perhaps it also means that we might acknowledge that perimenopausal symptoms are more than single, isolated, “fixable” events and that they may be related to larger, long-term bodily changes. The very idea that “post reproductive health” is important is one that I support and advocate, and I see this as evidence of the realization that there is life after menstruating and having babies. What’s more, the re-branded journal seeks to include research on men’s health too, perhaps signifying that researchers and practitioners acknowledge the sometimes non-gendered aspects of “reproductive” or “post-reproductive” health. Everyone needs health attention, no matter what their life course stage.

What I can still critique about the name change, though, is that the new name of this journal suggests that menopause and other midlife or aging stages are thought of as “post”-reproductive. In my opinion, it is really that we live on a reproductive continuum, that we are never really “post” anything, that prior life stages always continue to affect us and that there are not strict endpoints to the menopausal transition in the way that the word “post-reproductive” might suggest. Reproductive aging as a transition could take as much as 30 years or more, and women report still having signs and symptoms of “menopause” into their 60s and beyond. According to existing research our “late” reproductive years begin in our 30s and don’t end until….what? our 60s? our 70s? The word “post-reproductive” suggests an “end” that maybe doesn’t really exist ever. Here is a link to an article I wrote on this idea of the elusive “end” to menopause, and I think it is important to think about how the word “post” may not be the best way to describe how we live our midlife and older years. We may still have “reproductive” health needs way into our 70s, 80s, and beyond, so how can we think of ourselves as “post” anything?

With this said, however, I still am very happy to see the current name change of the journal, Post Reproductive Health, because I believe it signifies a very important change in the right direction, and I hope to see many more moves like this as we contemplate what midlife and aging health really is.

An Uncharted Territory: Marriage Manual and Menstrual Sex

March 26th, 2014 by David Linton

A previous post, The Subject of Sneers or Jests: Menstrual Education in the Service of Racism, examined the confluence of eugenic notions that conflated the effects of environmental factors like clothing, alcohol, and masturbation with heredity and health as expressed in a 1913 sexual health manual sponsored by the Women’s Christian Temperance Union, What Every Young Woman Ought to Know. It is important to note that not every book about sexuality that emerged early in the century was as misguided and misinformed as that one.

Just 13 years later, in 1926, another guide to sex and marriage was published, Ideal Marriage: Its Physiology and Technique, by Th. H. Van de Velde, M.D., that went on to its 44th printing at Random House by 1963. Though not much is actually known about its reception or the uses its readers put it to, its longevity suggests both popularity and impact. And in tone and content it is remarkably different from the previously discussed volume from 1913. It suggests that the sexual/menstrual ecology was in flux (perhaps it always is) but also that the earlier work did not fully reflect the spirit of its times.

In those sections of the book dealing with anatomy and physiology the information is mostly sound and presented in a straightforward manner. However, Ideal Marriage also contains an ample amount of less than thorough information about lots of topics, not the least of which is just what constitutes an “ideal marriage!” Of special interest to readers of re:Cycling are the portions that set out to explain and describe the workings of the menstrual cycle.

Though there are a few caveats or cautionary asides such as, “I am fully aware that we are here in an uncharted territory, full of traps and pitfalls. . .”(106) and that it is “. . . peculiarly difficult to sift the possible kernel of fact from the fantastic sheaf of tradition and superstition. . . ,” (107) none-the-less the author proceeds to paint a picture of the effects of menstruation as worthy of a Hitchcock thriller. Just before and during menstrual bleeding women have, “a lesser degree of bodily endurance, activity and dexterity; a tendency to exhaustion and malaise,” (100); “Temper, hypersensitiviteness, caprice, resentment, rapid changes of mood, liability to take offense unnecessarily appear, in women who are otherwise very free from these manifestations.” (100) And, women must take special care about “resolutely mastering their tongues and tempers. . .” (100) Naturally, these unfortunate flare ups create a special challenge for men: “For the husband, there are two occasions . . . in which tact, sympathy and self-control are urgently needed if he is to be an expert in love and life. Namely, in the first days of married life, and in the first days of the monthly vital ebb. The second is much the harder test—because it perpetually recurs!—but surely not any less important than the first.” (101)

In addition to these disturbances of mood, there are other physical defects that appear: “nausea and inclination to vomit, bad breath, increase of intestinal gas. . . a tendency to varicose veins, cold feet . . the vocal apparatus is impaired . . . the voice becomes easily tired and changes its quality. . .an appreciable narrowing of the field of vision, and less acute differentiation of colors. . . facial pallor, a tendency to blush easily, and blue rings under the eyes. . .[in effect] she is partly an invalid.” (104-105) Whew! Yet there is a saving moment. After a lengthy catalog of miseries and flaws we learn that, “Fortunately no one woman has to endure all the sufferings and disabilities described above. . . .And, I repeat, that fortunately, there are quite a number of women who do not suffer any of these things.” (105)

Despite the bleak depictions of what many menstruating women are believed to experience and what their husbands must endure, the author then goes on to confront and mostly refute the most deeply rooted sexual taboo of all. A full chapter is devoted to a discussion of sexual intercourse during menstruation and pregnancy. Beginning with acknowledging and identifying the wide range of historical religious and cultural prohibitions and traditions, the chapter then proceeds to describe how some women and men are not only indifferent to the prohibitions but, in fact, find menstrual sex more exciting:

The Subject of Sneers or Jests: Menstrual Education in the Service of Racism

March 20th, 2014 by David Linton

Title page of What a Young Woman Ought to Know

Sometimes, when it seems that progress toward the elimination of harmful menstrual stereotypes, myths, and misinformation is slow or even stalled, it is bracing to take a look back at the kinds of educational materials, marriage manuals, and sources of advice that women were offered in the past in order to be reminded that progress does actually exist. Consider, for instance, an effort to enlighten women about sex, marriage, and the menstrual cycle from the early 20th Century.

One hundred years ago, in 1913, a book appeared in the “Self and Sex Series” titled, What a Young Woman Ought to Know by an author identified as Mrs. Mary Wood-Allen, MD. Her credentials, displayed on the title page, include the following: “National Superintendent of the Purity Department Woman’s Christian Temperance Union,” and she is credited with having written six other books, including Almost a Man and Almost a Woman.

To get a hint of the direction the book takes in its effort to instruct young women in what they ought to know a glance at some of the chapter titles may suffice:

Ch. V – “Breathing”
Ch. VI – “Hindrances to Breathing”
Ch. VII – “Added Injuries from Tight Clothing”
Ch. XVI – “Some Causes of Painful Menstruation”
Ch. XVII – “Care During Menstruation”
Ch. XIX – “Solitary Vice”
Ch. XXVII – “”The Law of Heredity”
Ch. XXXIV – “Effects of Immorality on the Race”
Ch. XXX – “The Gospel of Heredity”

As these titles suggest, the book manages to link menstrual education with some of the most virulent eugenic nonsense that had gained widespread acceptance in American science and politics of the time, the same sham-science that led to sterilization of disabled people and African-Americans in the U.S. and found a welcome home in Nazi Germany in the following decades.

Perhaps the best way to communicate the stupidity of the book’s content is to allow it to speak for itself. Consider the explanations of menstrual discomfort and the effects of bad reading habits:

“Whenever there is actual pain at any stage of the monthly period, it is because something is wrong, either in the dress, or the diet, or the personal and social habits of the individual.” (119)

“Romance-reading by young girls will, by this excitement of the bodily organs, tend to create their premature development, and the child becomes physically a woman months, or even years, before she should.” (124)

“…if girls from earliest childhood were dressed loosely, with no clothing suspended on the hips, if their muscles were well developed through judicious exercise, they would seldom find it necessary to be semi-invalids at any time.” (146)

The underlying disdain or fear of sexual pleasure is expressed in the chapter about masturbation, titled “Solitary Vice,” in which it states, “the reading of sensational love stories is most detrimental…This stimulation sometimes leads to the formation of an evil habit, known as self-abuse….The results of self-abuse are most disastrous. It destroys mental power and memory, it blotches the complexion, dulls the eye, takes away the strength, and may even cause insanity.”

As if these dire consequences were not bad enough, it turns out that once one has inflicted these conditions on one’s self, they can enter the girl’s genetic code and be passed along to future generations. Even a girl’s clothing choices can have long term, disastrous effects: “The dress of women is not merely an unimportant matter, to be made the subject of sneers or jests. Fashions often create deformities, and are therefore worthy of most philosophical consideration, especially when we know that the effects of these deformities may be transmitted.” (223)

The author minces no words as to the effects on the children of such a careless mother: “The tightly-compressed waist of the girl displaces her internal organs, weakens her digestion, and deprives her children of their rightful inheritance. They are born with lessened vitality, with diminished nerve power, and are less likely to live, or, living, are more liable not only to grow up physically weak, but also lacking in mental and moral stamina.”

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

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

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

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

Who could argue with taking supplements to prevent cancer?

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

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

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

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

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

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

We Need To Talk About Ovarian Cysts

February 27th, 2014 by Heather Dillaway

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

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

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

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

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

The Big, Fat, Menstrual Untruth in Cameron Diaz’s The Body Book

February 5th, 2014 by Laura Wershler

I was curious. If Cameron Diaz’s purpose in writing  The Body Book: The Law of Hunger, the Science of Strength, and Other Ways to Love Your Amazing Body was empowerment, helping women to understand how their bodies work, would she include information about the menstrual cycle?

There was no way of knowing from her Jan. 22, 2014 radio interview with Jian Ghomeshi on CBC’s Q. I listened to Diaz explain that conversations she’d had and overheard in the last few years made it clear to her that women are completely confused about their bodies. She said this had her thinking, “Wow, that’s such a crazy thing that after so many years of living in your body that you actually don’t have an understanding of it.”

Then she revealed her intention in writing the book – to empower women to make “informed decisions about their nutrition and their physical activity.” Judging from this comment, the book’s subtitle, and the fact she did not mention menstruation during the interview, I wondered if the menstrual cycle would even be mentioned.

I sought out The Body Book at my local bookstore and quickly scanned the table of contents and index. I found myself smiling, thinking about Betty Dodson, author of Sex for One: The Joy of Selfloving, and how she revealed in Chapter 1 that whenever she gets a new sex book she “immediately” looks up “‘masturbation’ to see where the author really stands on sex.” Whenever I see a new book about women’s health I look up “menstruation” to see what the author really knows about the menstrual cycle. Turns out Diaz, and/or her co-author Sandra Bark, know both a lot and not so much.

In Chapter 21, Your Lady Body (the book’s introduction starts with the salutation Hello, Lady!), she presents a fairly accurate endocrinological description of the three phases of the menstrual cycle: follicular, ovulatory, luteal. So far so good. But then, in the last paragraph of the luteal phase section, comes the big, fat menstrual untruth, the implication that whether you use hormonal birth control or not, this is how your menstrual cycle unfolds. It’s an absolute falsehood, and one that many women in this age of burgeoning body literacy are sure to see through.

Photo Illustration by Laura Wershler
Note: This is the only reference to contraception in The Body Book

The last paragraph of this luteal phase description (page 182) is ridiculously misleading. If a woman’s birth control method is the pill, patch, ring, implant or (Depo-) Provera shot, the synthetic hormones each contains will shut down her normal menstrual cycle function. She most definitely will not experience a cycle with follicular, ovulatory and luteal phases. Hormonal contraception does not “protect” her eggs. She will not ovulate, therefore the egg will not die. She may have a “withdrawal bleed” but it is not a true period. This is the truth.

I can understand, possibly, why Diaz made this egregious implication. What were her choices? Open a can of worms? State categorically, as every description of menstrual cycle function should, that you don’t ovulate or experience a normal menstrural cycle while taking hormonal contraception? 
Maybe something like this?

Hey Lady! If you use hormonal birth control none of this fascinating menstrual information applies to you. Wish I could tell you what this means for your health and fitness but, sorry, that’s beyond my area of expertise.

If Diaz’s intention for this book is to empower women to better understand their bodies, then she failed when it comes to the menstrual cycle. I hope she’ll correct this big mistake in any future editions.

Lookin’ for them reds everywhere – on menstrual leave

January 14th, 2014 by Holly Grigg-Spall

By MichaelBueker (Own work) [CC-BY-3.0],
via Wikimedia Commons

Last year Russian lawmaker and LDPR party member Mikhail Degtyaryov proposed that women have two days paid leave from their work when they are menstruating.

“During that period [of menstruation], most women experience psychological and physiological discomfort,” said Degtyaryov.

He also argued that pain from menstruation causes heightened fatigue, reduced memory and efficiency at work, and emotional discomfort.

NBC, amongst other sources, reported this news as a sign of Russia’s move towards more conservative social politics.

“Scientists and gynecologists look on difficult menstruation not only as a medical, but also a social problem,” Degtyaryov explained.

Responses to this across feminist media and others ranged from shocked to outraged.

I argue in my book ‘Sweetening the Pill’ that the emphasis on constant and consistent productivity and on quantity over quality of work is hard on everyone, not just women, and not just when they’re menstruating. As technology makes it so we can be available at all times, we therefore have to be available at all times. Dave Eggers’ novel ‘The Circle’ satirizes this pressure to be “on” brilliantly, making for an exhausting read in itself.

Our desire to miss out on the time when we might be pre-disposed to slow down – our period – by taking drugs that let us keep up the consistency in all ways is symptomatic of a wider cultural emphasis on inhuman work expectations.

SMCR’s own Margaret Stubbs pointed out in an interview with Yahoo! Shine – why can’t women just take sick days when they’re menstruating, if they want?

However, most US employers do not provide paid sick days, and those that do limit the number significantly. A sick day often needs to be used for a doctor’s appointment, a family emergency, or just to catch up on myriad other duties. A policy that attributes additional sick days (and if we’re talking two days per month that means A LOT of additional sick days) doesn’t seem such a bad idea to me at this point.

There was something of an echo of the Cold War in the reaction to this news. It was partly America’s faith in work as a cure-all that positioned it in opposition to the communists.

Yes, menstrual leave is not entirely unproblematic as a proposal, within the context. Apparently, according to Wikipedia at least, the LDPR party is worryingly nationalistic (any Russian readers please feel free to correct me on this). But some of the reactions suggested a pride in the American way of long hours and little vacation time. As I find myself saying at least once a week as a British person living in Los Angeles – take a look at the economically solid, recession-surviving countries like Germany and Australia for some good reasons why that pride is misplaced.

Sometimes it seems many women are so busy establishing the lack of difference between themselves and men that they find it hard to be truly honest about the experience – possibly painful, possibly tiring – that they are going through when they get their period. See Chris Bobel’s great post about suffering in silence for more on this. She suggests that discomfort during menstruation should indeed be a “social problem” of a kind.

If we are only valued for our productive output then menstrual leave will always be seen as dead time. It will then be more about getting women out of the office when their productivity is low and they may become a burden, than it is about valuing the potential benefits of the leave for the woman.

I admit that this is old news, and well-discussed elsewhere, but what prompted me to write a post is the desire to share more widely this great piece of writing over at the Irish Feminist Network by Barbara Scully. She discusses a BBC documentary that showed a British woman’s experience of a menstrual hut in a tribal community. Just as the capitalists saw the communists as backward, we sometimes too willingly believe our way of organizing things is the most progressive, most modern, most sophisticated. Perhaps we’re not always right.

Silent Suffering: In 3 Scenes

December 23rd, 2013 by Chris Bobel

In PMS jokes the punchline is often a bitchy, out of control woman // someecards.com

Scene 1 10: 45 am:

A quiet Sunday morning, sunny and bright. Brunch on the patio.  I sat with my daughter, my partner, and my niece. Over pastries and coffee, I experienced waves of menstrual contractions, coming steadily every 15 minutes. And I winced, swallowing my moans.

While my niece spoke of her back pain, and my partner lamented his brief but powerful bout of the flu, I offered no comment about the vice grip around my uterus, the attention-grabbing cramping that hit me again and again. Through these cramping spells, I coached myself to  “tough it out” though I noticed that when I was alone, I audibly groaned. I hurt, but I said nothing.

And interestingly, later, while chatting with my stepson and his boyfriend, I kept the cramps entirely to myself. I chose to suffer in silence.

Why?

I hurt and yet, it seemed, my menstrual pain was not worth mentioning. It was mundane, even nearly universal. It was not the type of thing you sit around and whine about. I was aware, at some level, that an occasional mention of my pain would garner some sympathy, but beyond that, let the eye rolling begin. And in some company, it might be too-much-information, too private, too gross, even, to mention.

Scene 2  4:30 pm: Returning home after a 10-day road trip. The house, showing the wear of a place overrun by two cats with little human intervention, needed to be restored to order. Piles of mail. Bags to unpack.

But the very first thing I did when I walked through the door was take a shower and then do laundry. I had leaked badly during the last leg of the trip and I was a mess. My partner and daughter, alternatively, immediately settled on the (cat hair-encrusted) couch and reconnected to their wired worlds. While I, 21st century pioneer wife, scrubbed blood stains out of my clothes and hung another pair of “ruined” panties on the clothesline.

I walked past my family several times during my emergency clean up operation. With each glance, I felt envy rise up, and if i am honest,  resentment, too. But I did not complain. My body, my period, my mess. My problem.

But is it? Should it?

During menstrual moments like these,  (and now I will generalize) we often experience an acute embodied awareness that arrests our attention. At times, the experiences are painful or messy or both. Sometimes these ‘invasions’ are significant ,and we could benefit from some company. And yet, it is the rare menstruator who is NOT  socialized to  ‘buck up’ and ‘just deal with it.’ There is a persistent voice in our heads:  ‘No body wants to hear about your period…. Cramps are boring. And stain stories? Nobody wants to hear about THAT!”

I’ve argued this point before;  it seems the only acceptable menstrual discourse is PMS jokes (in which the punchline is a bitchy, out of control woman [see image above].

When it comes to expressing the reality of our menstrual lives—wherever our experiences fall on the continuum from menstrual joy to menstrual misery—we do so in a veritable sound chamber that CAN hurt us. For many of us, our menstrual experiences are uneventful, at least most of the time. But for the rest, they can be catastrophic. Or they may be normal, ho-hum, TODAY until they are NOT, a day later. Things change. Needs change. But the silence persists.

My concern is this: if we don’t open spaces for menstrual discourse, how can we find the support to discern the normal from the NOT normal? How can we get the info and support we need when we need it?

Scene: 3 3:24 am. I slowly came to consciousness and as I did, I instinctively reached between my legs. Yes. I was wet. Yes. My pad had shifted. And yes, so had the “insurance towel” I placed beneath me to protect the sheets. Damn. I didn’t want to get up and change my pad and underwear, but if I did not, I would have an even bigger stain on my sheet, maybe one that would  soak through the mattress pad and onto my mattress. Ugh.

Cause and Effect

November 11th, 2013 by Paula Derry

Does menopause cause an increase in health problems ranging from heart disease to bone disease to psychological depression? One issue is that many of these claims have been criticized as being overblown both by professionals within the medical community and by critics outside it. Another issue is that when problems are linked to menopause, the suggested solution has often been estrogen supplements (postmenopausal hormone therapy)—since after menopause a woman’s body produces far less estrogen—rather than seeking more complex causes, solutions, and mechanisms.

For example, although heart disease has many causes, during the 1990s many professionals recommended hormone therapy as being uniquely effective at preventing heart disease. At one time, a middle-aged woman who was depressed ran the risk of a professional assuming that she was suffering from a hormone imbalance without a careful evaluation of her distress.

While there is more attention today to looking at what causes problems and the best way to solve them, there is still a fundamental lack of understanding of basic processes. Even if menopause is linked to a problem, that doesn’t in itself tell us the mechanism by which this happens, or the best way of solving the problem. Suppose, for example, it had turned out that research established (it hasn’t, but suppose it had) that a woman’s risk of heart disease increases because of menopause. If this was because changes in estrogen levels result in changes in a woman’s metabolism, then lifestyle changes might solve the problem by revving up her metabolism even though a hormonal change caused it. Further, some other cause might be present. Perhaps some women who feel old or are busy become less physically active at midlife. Or perhaps some women who are depressed start eating more dessert. Or perhaps (as seems to be the case) heart disease risk simply increases as people get older.

For a wide variety of problems related to menopause, it would be great if more research looked at basic causes, complex mechanisms, and individual differences.

“Prescribing the pill has become ‘standard-of-care’ for being a girl”

October 16th, 2013 by Laura Wershler

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.

I wrote:

“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.

What Is Holistic Health?

September 16th, 2013 by Paula Derry

What is a holistic approach to health? To me, this is something different than using bio-identical hormones, practicing yoga, or seeking help from an acupuncturist. Sometimes, practitioners using complementary/alternative or integrative-medicine methods have as entrenched a disease model of the reproductive system as anyone else. For example, some practitioners talk about “treating” menopause itself, especially about treating “hormone imbalances” caused by the “shutdown” of the ovaries, accepting a theory that menopause is a disease or intrinsically unhealthy. A similar idea may be applied to normal changes through the menstrual cycle or premenstrual changes that are distressing.

To me, a holistic or integrative approach involves attitudes or understandings about what health is. Feeling healthy is the baseline against which dis-ease or disease contrasts. Sometimes disease results from just-one-thing (like a hormone imbalance), but, more typically, many factors are involved. For example, menopause isn’t unhealthy in and of itself, but sometimes unhealthy or distressing complications of menopause develop based on many factors. For example, treatments for menopause-related, premenstrual, or other reproductive issues often involve lifestyle changes (in diet, activity, etc.) in addition to whatever other approaches are used.

Here is a copy of a handout I use to provide an introductory overview of holistic health:

What Is Holistic Health?
Paula S. Derry, Ph.D.

Health is more than not having any diseases.

The World Health Organization defines health as “complete physical, mental and   social well-being and not merely the absence of disease or infirmity.”

Feeling healthy is an actual experience.

This may include a feeling of well-being; feeling solid, whole, at home in our bodies; feeling like we can move forward to accomplish our personal aims and goals, feeling physically strong and energetic, etc.

We feel healthy in the here-and-now.

Health involves being able to maintain our balance in the face of adversity.

Being able to cope, being resilient, being adaptable, asking for help when it is needed, etc.

Health involves the whole person and a balance among all our parts.

Physical health, mental well-being, and spiritual needs are all interconnected and play a role in overall health.

There is a natural vital energy in all living things.

Health also involves our relationship to all that is around us.

For example, relationships with other people and the physical environment. Some would put spiritual experience here.

Understanding illness involves understanding the whole person.

A person recovering from illness is restored spiritually, psychologically, and physically.

Maintaining health may mean getting help from a health professional or healer; engaging in activities for the purpose of preventing illnesses (like a diet to prevent diabetes); or having a satisfying lifestyle that is healthy and as a side-product maintains health (like if you practice yoga because you enjoy it, and it ends up helping to reduce stress).

What are basic needs, and what is a healthy lifestyle? It’s individual, but can include:

Activity (including exercise)

Nutrition

Touch

Social Relations

Meaningful existence

Relaxation

Spiritual Connectedness

Etc.

With regard to illness:
The body wants to heal itself.

Sometimes it needs a push in the right direction or other help restoring the ability to heal.

Holistic practitioners help the body regain its ability to heal itself. Sometimes this is not what is needed or enough, as when cancer or other illnesses require different kinds of help.

Some important parts of healing:

Restoring conditions so the body can heal itself; restoring balance to the body/mind/spirit; using the natural vital energy to help the body heal itself; attending to lifestyle; the relationship between a practitioner/giver and the client is important. Some methods:  herbs, acupuncture, touch, breathing, talk, etc.

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.