Blog of the Society for Menstrual Cycle Research

Women’s Reproductive Health journal explores postmenopausal hormone therapy

June 17th, 2015 by Laura Wershler

Free access to Women’s Reproductive Health, the journal launched by the Society for Menstrual Cycle Research in 2014, is available to all SMCR members. To become a member of the society or to obtain a subscription contact info@menstruationresearch.org.  For media, submission, and other inquires about the journal contact editor Joan C. Chrisler at jcchr@conncoll.edu.

 

Guest Post by Joan C. Chrisler

The spring 2015 issue of Women’s Reproductive Health contains our first special section: on postmenopausal hormone therapy. The section contains a thought-provoking anchor article by menopause expert, psychologist Paula Derry. It is followed by short commentaries by a multidisciplinary group of menopause experts–a physician, a sociologist, an anthropologist, and a nurse. This set of papers would make an excellent reading assignment for a women’s health course, and it is sure to generate class discussion. The issue also contains two other research reports: one on women’s experiences with gynecological examinations, and the other on the relative absence of mentions of menstruation in novels aimed at adolescent girls because publishers are worried about challenges by parents and school boards that could hurt sales. The issue is rounded out with three book reviews.

 

Women’s Reproductive Health

Volume 2, Number 1 (Spring 2015)

Special Section on Postmenopausal Hormone Therapy

Article
Evidence-based Medicine, Postmenopausal Hormone Therapy, and the Women’s Health Initiative – Paula Derry

Commentaries
The Science of Marketing: How Pharmaceutical Companies Manipulated Medical Discourse on Menopause – Adriane Fugh-Berman

Medicalization Survived the Women’s Health Initiative…but Has Discourse Opened up? – Heather Dillaway

Animal Models in Menopause Research – Lynette Leidy Sievert

Lost in Translation? – Nancy Fugate Woods

Articles
A Multi-method Approach to Women’s Experiences of Reproductive Health Screening – Arezou Ghane, Kate Sweeny, & William L. Dunlop

The Censoring of Menstruation in Adolescent Literature: A Growing Problem – Carissa Pokorny-Golden

Book Reviews
Investigating the Ubiquitous: The Everyday Use of Hormonal Contraceptives – Marie C. Hansen

Menstruation’s Cultural History – David Linton

WomanCode: Caveat Emptor – Elizabeth Rowe

Joan C. Chrisler is a professor of psychology at Connecticut College and the founding editor of Women’s Reproductive Health. Her special areas of interest include PMS, attitudes toward menstruation and menopause, sociocultural aspects of menstruation, and cognitive and behavioral changes across the menstrual cycle.

Exploring menstrual shame, embodiment, and the parameters of premenstrual distress

May 26th, 2015 by Laura Wershler

Concurrent sessions on Saturday, June 6th explore unique cultural experiences of menstruation and delve into the parameters of premenstrual distress at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.


Strekkja (stretch, flexible) Original artwork by Magdalena Margrét. Used with permission.

Culture and Embodiment: 

Menstruation and objectification in an Icelandic context
Herdís Sveinsdóttir, University of Iceland

The aim of the study is to describe objectification among Icelandic women and how it relates to menstrual attitudes, women´s body consciousness and health behavior. Participants were 320 women aged 20-40 years drawn from the Register of Iceland in fall 2013. Findings regarding disordered eating and objectification will be discussed.

Shame, secrecy, or celebration: Experiences and constructions of menstruation across cultures
Alexandra Hawkey, Centre for Health Research, University of Western Sydney 

Through qualitative interviews this study aims to reveal culturally specific experiences and constructions of menstruation with migrant women from a range of backgrounds, in Australia and Canada. Analysis of the data highlights a range of themes including, cultural silencing; celebration of the girl to women transition; and menstrual rules.

Black Women, Red Tent: Doing Blood Work and Recovery of Black Girlhood, Spirituality and Ritual Exclamations for Black Girl Periods
Sevonna Brown, Williams College

This project invites black women to explore their relationships to their menstruation and their bodies more holistically through a consideration of blood, spirituality, and monthly ritual. This conversation-making and interactive study anticipates collective issues of shame, survival, birth, infertility, sexuality and disease. The research inquiries desire to find Black women in their own Red Tent in celebration of their own bodies, reproductive mysteries, traumas and triumphs.

Premenstrual Distress:

Psychosocial factors associated with Premenstrual Syndrome
Ina Rosvall & Sandra Ekholm, University of Lund

Inspired by critical feminist research the association between PMS and psychosocial factors was studied using 1320 responses to a web survey. 33,9% of the total variance in PMS could be predicted, emphasizing the importance of social norms, family structure and relational factors over hormones in the understanding of premenstrual distress.

Sarafem Redux: PMDD, Antidepressants, and Big Pharma
Shannon M. Peters, Madeline Brodt & Lisa Cosgrove, University of Massachusetts 

Industry-facilitated approval of antidepressants was used to justify inclusion of PMDD in the DSM-5. We provide data on industry funding of clinical trials of antidepressants for the treatment of PMDD, discuss the consequences of these commercial ties, and discuss the role of implicit bias in psychiatric research.

Evaluation of the relative efficacy and mechanisms of a couple-based intervention for Premenstrual Syndrome through a randomised control trial
Janette Perz & Jane Ussher, Centre for Health Research, University of Western Sydney

120 women took part in a randomised controlled trial comparing one-to-one and couple psychological therapy for PMS, in comparison to a wait list control group. Whilst women in all three conditions reported reductions in premenstrual distress and improvements in coping, women in the couple condition reported significantly greater reductions in distress post-intervention.

Measuring the Syndrome: An Introduction to the Measurement of Premenstrual Distress Disorders
Marie Hansen, Long Island University Brooklyn

This presentation will cover the history of the scientific measurement of Premenstrual Disorders and will explore the way in which these disorders are measured by researchers today. Included will be an analysis of two widely used scales: Premenstrual Tension Syndrome Observer Scale/ Self-Rating Scale (PMTS-O/SR) and the Daily Record of Severity of Problems (DRSP).

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

State of Wonder–Part 1: Wondering about missing menstrual mentions in literature

January 22nd, 2015 by Laura Wershler

In her novel State of Wonder Ann Patchett explores, among many broad themes, the question: What if there were a drug women could take to extend menstruation and fertility into their seventies? Not evident on the dust jacket, this storyline grabbed the attention of this menstrual cycle advocate.

Set mainly in the jungle of Brazil, the novel revolves around the decades-long research of Dr. Annick Swenson who has kept the location and progression of her research secret from the drug company funding her work with the fictional Lakashi tribe. When a male scientist sent by the drug company to find Dr. Swenson and deliver a message is reported dead, Dr. Marina Singh, a research pharmacologist, becomes the second emissary charged with finding Dr. Swenson and assessing her progress towards the promised drug.

Finding Dr. Swenson is a formidable task, but when she does Marina eventually learns the complex botanical explanation for the Lakashi’s extended fertility, as well as the justifiable reasons why the research location has been so scrupulously protected.

This literary novel, a satisfying read, powerfully renders the mystique of the Amazon jungle, conveying both the wonder and trauma Marina experiences there. For an insightful review of State of Wonder I’d recommend Lydia Millet’s. This series of posts is not a review, but rather commentary on the niggling details related to the extended fertility storyline. Spoiler Alert: Some plot points will be revealed.

After a few weeks in the jungle—the timeline is fuzzy—Marina is invited by two other female researchers to the grove of Martin trees where she observes Lakashi women of all ages scraping tree bark with their teeth, a practices she is told that begins at menarche and is the key to their lifelong fertility.

Marina learns the women chew the bark every five days except when they are menstruating and when they’re pregnant; the bark repulses them from the moment of conception. She is told also that although the women don’t all come to the grove on the same five-day cycle, they’re menstrual periods are “pretty much” synchronous so the researchers “get a few days off every month.” That is, days off from observing them in the grove while taking pin-prick blood samples and collecting cervical mucus swabs to monitor estrogen levels that Dr. Swenson has taught the Lakashi to do themselves with Q-tips. Dr. Swenson’s research team charts and studies every cycle of every menstruating girl and woman.

The researchers tell Marina they also chew the bark and invite her to try it. Here is where, in a story that speaks intimately about the tribal women’s menstrual cycles, I wondered why Patchett did not include even one sentence to acknowledge when Marina had her last period. (At 42 she has thought about her fertility and her prospect of having a child someday.) Because she scrapes the bark one assumes she isn’t menstruating, and she’s been in Brazil long enough–weeks spent in Manaus before getting to the jungle–to have had at least one period. Where is she in her cycle? This matters because of what happens later in the story. So, since menstruation is integral to the novel, why not mention it? And why don’t the other female researchers mention whether their cycles, too, have synchronized with the Lakashi’s?

In most novels, probably too many, the menstrual cycles of female characters are invisible unless they figure prominently in the plot. It made no sense to me that Patchett chose to make Marina’s cycle invisible. Even if readers can deduce this missing information, surely this is the wrong novel in which to require us to do so. Again, I ask, “Why?”

Continued in State of Wonder—Part 2: Wondering about missing menstrual femcare products and birth control references

 

Menstrual Marking

November 18th, 2014 by David Linton

The idea that animals (male animals, that is) mark territories with urine streams is well established, particularly in the case of dogs, wolves, and other similar breeds. It seems that men too (notably adolescent boys) engage in some sort of marking practices when it comes to failure to flush urinals or toilets in public (and sometimes domestic) facilities.

A story by Haruki Murakami in a recent New Yorker magazine (Oct. 13, 2014; pg. 100+) depicts a teenage girl who uses a menstrual product as a way of marking territory as well. Murakami’s character is a middle-aged woman in a story titled “Scheherazade” who, in the course of a string of post-coital sharing moments, confides to the narrator a time in her adolescence when she was obsessed with a boy in her high school. Too shy to approach him personally, she would occasionally sneak into his home and peruse the contents of his bedroom. Eventually she stole several of his personal objects – a pencil, soccer insignia, sweaty tee shirt – and leaves something of her own hidden in the back of a drawer or under some old notebooks. In addition to a few strands of her hair, she hides the most personal object she can think of:

“Finally, I decided to leave a tampon behind. An unused one, of course, still in its plastic wrapper. . . . I hid it at the very back of the bottom drawer, where it would be difficult to find. That really turned me on. The fact that a tampon of mine was stashed away in his desk drawer. Maybe it was because I was so turned on that my period started almost immediately after that.”

When she returns to the house on several later trips she always checks to see that the tampon is still in place and delights that it has remained in the boy’s drawer. The tampon comes to be described as “a token” that represents her unrequited crush on the boy who is barely aware of her existence. Eventually she comes to associate her erotic attraction with her menstrual cycle, even thinking about the boy’s masturbation as being compared to her period, “All those sperm had to go somewhere, just as girls had to have periods.” Finally, the boy’s parents discover that someone has been invading their home and change the locks so that her trespasses are ended. But the story’s exploration of the erotic associations of menstrual details is fascinating and fairly rare.

Furthermore, the fact that this is a male author’s take on the topic probably makes it somewhat unreliable even though it claims to be told through the words of a woman’s reminiscences. Readers are invited to respond with mention of other stories that explore both the erotic and territorial marking potential of menstrual products and blood.

Coming off Depo-Provera can be a woman’s worst nightmare

August 28th, 2014 by Laura Wershler

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Laura Wershler originally appeared April 4, 2012, and has received nearly 600 comments. To avoid confusion, we have closed comments on this re-post.

 

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies OurselvesQuestions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.

Male Menopause, Andropause and now “Manopause”?

August 22nd, 2014 by Heather Dillaway

August 18, 2014 cover of TIME magazine

By now, everyone has probably seen this week’s TIME cover story. The magazine’s August 18th cover photo showed a topless, seemingly frumpy, middle-aged man worried about his loss of testosterone and (therefore) manhood under the title, “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry”. The cover story details the booming testosterone (“Low-T”) industry in the U.S., describing the reasons why middle-aged men might go to the growing number of Low-T clinics for treatment. While the article draws some interesting parallels to the hormone therapy industries that have targeted women and highlights some of the important risks and unknowns about Low-T treatments, there are some interesting gaps and missteps in the article that are worth detailing.

First, if we are going to talk about a male menopause, can we please pick one term? This author of this article refers to male menopause, andropause, and then titles his article “manopause.” So, which is it? Having all of these terms floating around is just confusing. As we know from research on women’s menopause, having more than one term or having vague terms for a health condition just leads to confusion. This article adds to the confusion over terminology.

Second, the article is titled “Manopause” but really has little to do with this supposed testosterone “deficiency” condition. The article is mostly about the growing Low-T industry and men’s search to remain youthful. It is more about potential treatments for testosterone deficiency than anything else. Anyone looking for information on what “manopause” is would be misled by the title and would not find any answers in this article. At most, readers learn that men who are worried about aging might have low testosterone. Readers will not gather comprehensive information about manopause, andropause, male menopause, or male aging.

Third, this article only addresses research on testosterone “deficiency” in a cursory manner. Readers looking for actual evidence of decreasing testosterone in midlife or the need for Low-T treatment should make sure to consult scientific studies of such things. Since this is TIME magazine, this is not a source of any real information on these subjects. As another commenter reports, the author’s reference to “foggy science” is also misplaced; while we do not have complete answers, there are real studies to be found on this subject.

Fourth, there are comparisons made to women’s menopause, hormone therapy for women, and how women handle their midlife transitions in this article. While it makes sense to compare endocrinological changes in women’s and men’s bodies and burgeoning hormone replacement industries for midlife women and men, comparisons about how women and men “handle” their midlife transitions are a bit misplaced and subjective here. The author states that “women handle their [bodily] betrayal more matter-of-factly – a nip, a tuck, a tint, maybe, but not a Vegas condo”. The author argues that, “judging by the demographic profile of sports-car buyers,” men don’t deal well with testosterone deficiency and bodily change. As someone who has studied women’s bodies and women’s menopause for almost 20 years, I think this comparison masks the variation in how women or men might experience these transitions and reifies gender dichotomies that help no one in the long run. Women DO have trouble with bodily change at times. And the majority of men still forgo Low-T treatments. The author would have done better if he had steered away from these gendered generalizations about how individuals “handle” midlife.

A commenter at HealthNewsReview.Org asks, Does Manopause Really Warrant one of TIME’s 52 Covers This Year? This is a great question. The power of pharmaceutical industries in this country means that topics like this get more press than is probably warranted (especially in light of all of the topics that could have had this front page, such as Ebola, Ferguson, Parkinson’s or ALS disease, foreign conflicts, etc.). Some scholars argue that we are experiencing the “pharmaceuticalization” of society, which puts industries like the Low-T industry front and center and makes us think in terms of “deficiency”, “disease”, and “replacement”. Pharmaceuticalization reinforces ideas about the importance of youthfulness and unchanging bodies and makes the onset of midlife problematic in general. We are actively urged to fight bodily change (here termed bodily “betrayal”) despite how normal it is.

Lately I’ve also seen a lot of press on men and masculinity. NPR has been running an “All Things Considered” series on boys and men this summer, detailing the hardships and unique experiences that boys and men have. I also read that a group of middle aged men recently got together to create a play called “Four Play” to combat the hype around Menopause: The Musical – to make sure that men have their stage too. In Detroit this summer we’ve also been tangoing with groups of Men’s Rights Activists who feel that feminists are taking over the world. To me, the “Manopause” cover of TIME magazine falls right in line with other recent attention to “men’s issues”. To me, this is all a backlash against attention given to women’s issues. In some cases I don’t even think it’s a conscious or calculated backlash but it still presents as one.

Overall, I’m indifferent about this TIME story. I don’t think it warrants the cover photo or the cover story but it is interesting to find out about a growing testosterone industry. Nonetheless the hype around the story concerns me because I keep thinking about what’s lurking behind the hype. For instance, we have to think about the gendered dynamics behind these stories and media portrayals, for gender forms an important backdrop here and can hinder the pursuit of real knowledge about these midlife transitions. Gender ideologies are what make testosterone (and estrogen) important in the first place. In addition, I do think we need to settle on one term for male menopause/andropause/manopause and why it might be important for us to think about. Finally, we really need to think about what pharmaceuticalization means for all of us.

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

A Letter to My Mom: I am Sorry I Was A Brat

February 17th, 2014 by Chris Bobel

Photo courtesy someecards.com

Dear Mom,

I owe you an apology.

Remember when you were perimenopausal (or as we called it, “going through menopause”)? Remember when you experienced hot flashes? And remember when you did, how we, your loving family, either 1) ignored 2) trivialized or 3) mocked you? Your hot flashes were a constant source of humor around our house and I recall you joining the fun.

But I am betting that while you were yukking it up, you felt lonely and misunderstood. I think you were just ‘being a good sport’ because what choice did you have?

You deserved better.

I admit that until recently, until I began hotflashing myself, I forgot about your transition and how we responded to it. But now that I am living with my own body thermostat on the fritz, I get it.

Now that I am consumed by cycles of heat and chill with no warning, I am having a major A HA ! moment. Now that I find myself waking in the night, my pillow wet, my face wetter, my sleep disrupted, I am time traveling to our sunny kitchen on 2nd Street—you: flapping your blouse, face flushed. Me: rolling my eyes.

I feel badly that I did not appreciate that this process is HARD. I feel badly that I made fun of you, thinking you just a silly old woman whining about something meaningless.

In short, I was a total brat.

Sure. I did not have models for compassionate support. It seems that the discourse of peri/menopausel has two nodes 1) joking  2) patholgizing—another distorted binary that fails to capture the complexity of human experience.

I know that today, struggling through my own perimenopause, I need some simple understanding. I am normal. This is normal. AND this normal reproductive transition can suck to high heaven.

While, we don’t need to stop the clocks or call the midwife, I would like some acknowledgement (minus the sexist aging jokes, please) that doesn’t make me  (or my body) the butt of a joke.

You deserved better when it was your time, Mom, and I am so sorry you didn’t get it.

Love, Chrisi

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.

Symptoms are Demeaning….and Feminine?

January 31st, 2014 by Heather Dillaway

According to a recent piece in The Times, a reputable English newspaper, symptoms are demeaning AND feminine. More specifically, the article reports on the prostate cancer experiences of Sir Michael Parkinson, or “Parky,” a famous British talkshow host. Parkinson reveals his harrowing experience of getting prostate cancer treatment and its “grueling” side-effects. While the treatments worked, they apparently produced menopause-like symptoms (hot flushes and weight gain) that reminded him of “how women feel when they are going through menopause.” Parkinson is quoted directly as saying, “In a sense you become a woman. I’m getting fitted for a bra next week!” The reporter goes on to say “he’s joking but he’s also deadly serious.” The “menopausal” symptoms that Parkinson had during his prostate cancer treatments are also described as “demeaning” in the same paragraph.

Parkinson is a major public figure in the UK, with significant media influence. I’m certain that this article was read by many as a result, and it makes me wonder about the far-reaching impact of the negative characterizations made about both women and bodily symptoms in this article. When I read this article, I find the equation of symptoms and femininity problematic, for lots of health conditions that produce bodily changes and sensations are not only experienced by women. Experiencing a hot flush or hot flash, while often attributed to menopause, is not menopause-specific all of the time. You can have hot flushes from exercising hard, from the flu, from medications that treat a range of diseases, or when you’re embarrassed. You can have weight gain at midlife (or any time of life for that matter) for a variety of reasons unrelated to menopause. Both the equation of women with symptoms and the definitions of symptoms as negative and “demeaning” show exactly how little progress we have made in eradicating gendered ideologies that harm us. Women are equated with their bodies and seen as lesser than men because of this equation. Men are supposed to be able to rise above their bodily functions, signs, and symptoms and live the life of the mind. Thus, when men experience a symptom they must rid themselves of it because, oh, the horror, they might be “like women” if they have to pay attention to their bodies at all. Research studies show quite often that women are ignored by doctors when they report a long list of symptoms and are not given the treatments they need to ease those symptoms as much as men are, because doctors learn to assume that women are just overreacting. Symptoms are not real if reported by women, studies suggest. Yet, when men experience symptoms and report them they are treated for them more often, especially when they report things such as pain. I interviewed a woman once who told me that “symptoms are always negative” and I wonder if that is partially because of the equation of symptoms with femininity and women’s bodies.

I am certain that it was difficult for Parkinson to undergo treatments for his prostate cancer. I also know that hot flushes and weight gain are never comfortable for people, especially when they seem uncontrollable. BUT, when we go on to support the characterization of symptoms as “what women feel” and then in the next breath say that those symptoms are “demeaning,” we head right into reifying gender ideologies that harm every single one of us. Men should be able to notice changes in their bodies without feeling “feminine.” We should recognize bodily symptoms as part of both health and illness that everyone experiences. And women should not have to be defined only by the fact that they go through certain reproductive transitions that include symptoms. I know Parkinson is perhaps from a generation that might still be holding tightly to gender ideologies that do not make much sense for the contemporary world, but I hold the reporter responsible for some of the characterizations made in this article, too. It is 2014, and aren’t we supposed to be more progressive than this? Because you experience a hot flush you should be fitted for a bra? In the YouTube video that appears along with this post, Parkinson himself admits “men are silly about their health.” I’ll say. But comments reported in the recent Times article go way past being silly.

Why the “pullout generation” is a sex ed fail

November 13th, 2013 by Laura Wershler

Questioning and quitting the pill are current hot topics, fueled in no small part by Holly Grigg-Spall’s recently released Sweetening the Pill Or How We Got Hooked on Hormonal Birth Control. Her book has drawn ample backlash, brilliantly addressed by re:Cycling blogger Elizabeth Kissling.

Adding to the media clamour was Ann Friedman’s New York Magazine online piece No Pill? No Prob. Meet the Pullout Generation which explores how and why women she knows are ditching hormones and depending on withdrawal and period tracking apps for birth control.

Black Iris by Georgia O’Keeffe, photographed by Laura Wershler
at The Metropolitan Museum of Art

Both writers, along with Toronto freelancer Kate Carraway, recently discussed the topic Rebelling against the pill: ‘Pulling-Out’ of conventional birth control on CBC Radio-Canada’s The Current.

Listening to Grigg-Spall, Friedman, and Carraway discuss the pill rebellion affirms that while many young women are through with hormonal birth control, their transition off the pill, etc., is not without risk-taking and pushback.

Grigg-Spall nailed the pivotal point when she said “It’s a provider issue.”

The rise of the “pullout generation” is proof that sexual health-care providers and educators, among whom I count myself, have failed on two counts:

1) We’ve failed to address a key aspect of contraceptive use: how to transition successfully between method groups, in this case from hormonal to non-hormonal methods. We’d rather present the so-called “latest and greatest” hormonal methods and say – earnestly, pleadingly – try this! The CBC panelists provided strong anecdotal evidence that more and more women are having none of it.

2) We’ve failed to adequately acknowledge and serve women who can’t, won’t or don’t want to use hormonal methods. We are NOT providing across-the-board support and programs that include easy access to diaphragms or certified training in fertility awareness based methods (FABM), either onsite or through collaborative referral strategies.

For over 25 years I’ve advocated for increased access to information, support and services for women who want to use non-hormonal methods of birth control. It’s self-evident such services must include access to qualified instruction to learn FABM that have effectiveness rates over 99%. This is not to say there isn’t a place for withdrawal as an effective back-up. Check out this confessional how-to post by fertility awareness instructor Amy Sedgewick.

As Friedman said on The Current, women are intimidated by the idea of learning fertility awareness. I believe this is mostly because mainstream sexual health-care providers have never fully educated themselves about FABM or fully committed to presenting these methods as viable options to drugs and devises. Do they think that most women can’t or don’t want to learn fertility awareness skills? That would be like thinking most girls can’t or don’t want to learn to read.

As I’ve written elsewhere: “Fertility awareness, like riding a bicycle, is a life skill.”

If you can learn to swim, ski or snowboard, knit a sweater, read a balance sheet or master Adobe InDesign, you can learn to observe, chart and interpret your menstrual cycle events. We can all acquire body literacy.

Until sexual health educators and care providers develop programs to fully serve women who won’t use or want to stop using drugs and devises for birth control, we will continue failing to meet the growing “unmet need” for effective non-hormonal contraceptive methods.

The reign of hormonal birth control as the top-of-the-contraceptive-hierarchy gold standard appears to be coming to an end. The pullout generation represents just one thread in this transition. The questions is: Are sexual health educators and care providers paying attention and, if so, what are they going to do about it?

“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.

I like to think that all of our work provides the framework, reason and evidence to support the decision Holly made personally and that hundreds of thousands of women have made or are considering making – saying no to hormonal birth control.

Sweetening the Pill is an important book because it speaks to young women who intuitively, subconsciously, or actively are leaning in this direction. It offers a contemporary perspective on the pill and its influence on our bodies and our lives, as well as evidence that affirms and confirms we make sacrifices – large and small – to live under its influence. It remains for readers to decide what to do about it.

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.