Blog of the Society for Menstrual Cycle Research

We Bring Our Bodies to Work

May 23rd, 2014 by Heather Dillaway

“Woman Working,” courtesy of Open Clip Art

A recent study by researchers at La Trobe University and Monash University in Melbourne, Australia, suggests that working women “need more managerial support [while] going through menopause.” This “Women at Work” study explored the health and wellbeing of working women and women’s satisfaction at work, yet focused on working experiences in or around menopause. The lead researcher, Professor Gavin Jack, reports that “menstrual status did not affect work outcomes” but that “if a woman had one of the major symptoms associated with the menopause — for example weakness or fatigue, disturbed sleep or anxiety, then this did influence how they regarded work.” Jack is further quoted as saying: “What is really important is not the fact of going through the menopause in itself, but the frequency and severity of symptoms which women experience, and how these factors affect their work.”

This study has been described in several news sources over the past few weeks, such as the International Menopause Society, Science Daily, and IrishHealth.com. I have many reactions to this research, both positive and negative.

I’ll present my positive feelings first: I appreciate the fact that researchers are talking about the fact that menopausal women are a large part of the workforce and that menopausal experiences matter for individual women. I also applaud the attention given to the fact that workers are human beings with bodies, and that bodies matter. The idea that employers should recognize that paid workers have bodies and that paid workers may be affected by their bodies is an excellent one. I agree that employers should be educated to be more sensitive to menopause and other bodily experiences that their paid workers might have, and simple adjustments in work policies and work environments can go a long way in making employees happier and more productive (plenty of research has already shown this). Finally, and maybe most importantly, as one article in Science Daily notes, “Not enough attention is paid to the experiences which people go through at different stages of life — the workplace treats this very unevenly.” I couldn’t agree more. Especially when it comes to midlife and aging, we forget that paid workers are still dealing with bodily transitions. We forget the range of chronic illnesses that paid workers might have at midlife and beyond, as well as the many normal health transitions that any midlife or aging individual deals with. Anything from the acquisition of bifocals (and learning to see differently through bifocal lenses) to the hassles of dealing with back pain, neck pain, arthritis, hearing impairments, insomnia, etc., can affect one’s work. Not to mention menopause, prostate conditions, and other aging health concerns that can involve a range of different signs, symptoms, and stages. Starting at midlife, it is also much more common to deal with caregiving for elderly parents, divorces and remarriages, putting kids through college (or putting up with adult kids living at home), deaths of parents and spouses/partners,  and other social transitions, and all of these things will impact how a paid worker feels and acts on the job. There is much to pay attention to about paid workers in their 40s, 50s, 60s, and beyond, and I believe that this research is a good start on that. Middle-aged paid workers may be reaching the peaks of their careers and may be excellent at their jobs, but they’re still dealing with a multitude of other life circumstances at the same time. And if they’re not performing well on the job, it may well be because of these very same issues. Paid workers are people, with full lives and physical bodies that they can’t leave at home (no matter how much they try).

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.

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

Give the Gift of Body Literacy

December 16th, 2013 by Laura Wershler

Photo by Laura Wershler

This holiday season consider giving the women in your life the gift of body literacy. The books, resources and services compiled below support understanding and appreciation of our bodies.

Gifts for teenagers:

* To hold a Wondrous Vulva Puppet is to experience a loving representation of the female body. Dorrie Lane’s vulva puppets are used around the world to spark conversations about our bodies and our sexuality. To quote a testimonial on the website: “The sensual curves, velvety feel and beauty of these puppets seems to disarm people in a way that opens the door to real discussion about women’s sexuality.”

* Toni Weschler, widely known for her best-selling book on fertility awareness Taking Charge of Your Fertility, has also written a book for teenagers. Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body makes the perfect gift for your daughter or younger sister, neice or cousin. This book can transform a young teenager’s experience and understanding of her body as it teaches her the practical benefits of charting her menstrual cycles. Available in paperback and Kindle editions.

Gifts for those who want to learn fertility awareness:



* Justisse Method: Fertility Awareness and Body Literacy A User’s Guide by Justisse founder Geraldine Matus is a helpful gift for anyone wanting to learn about fertility awareness based methods (FABM) of birth control. It is “a primer for body literacy, and a guide for instructing women how to observe, chart and interpret their menstrual cycle events.”

For someone who wants to learn fertility awareness to prevent or achieve pregnancy, or to fix menstrual problems, finding a certified practitioner is getting easier. Technology can connect women with skilled instructors who may live thousands of miles away. Check out the practitioners below online and on Facebook.

*   *    *   *   *   *

* Flowers Fertility (Colleen Flowers, Colorado): Facebook.

* Grace of the Moon (Sarah Bly, Oregon): Facebook.

* Holistic Hormonal Health (Hannah Ransom, California): Facebook.

* Justisse Healthworks for Women provides a directory of Justisse-trained Holistic Reproductive Health Practitioners (Worldwide): Facebook.

* Red Coral Fertility (Justina Thompson): Facebook

* Red Tent Sisters (Amy Sedgwick, Ontario, Canada): Facebook

I invite other certified instructors who work locally to leave their contact information in comments.

Gifts for women in midlife

* For women who are in the perimenopausal transition – which can last from six to 10 years for most women, ending one year after the final menstrual period – give the gift of information. Connect friends and family with the website of the Centre for Menstrual Cycle and Ovulation Research where they’ll find many free resources that offer explanations and treatment suggestions for the symptoms they may experience throughout this transition including night sweats, hot flushes, heavy and/or longer flow, migraines, and sore, swollen breasts.

* To those who love fiction, consider giving Estrogen’s Storm Season, a fictionalized account of eight women’s journey through perimenopause written by CeMCOR’s Scientific Director, endocrinologist Dr. Jerilynn Prior:

They are as different as women can be—yet they share the mysterious experiences of perimenopause, night sweats, flooding periods or mood swings. We follow these women as they consult Dr. Madrona, learn the surprising hormonal changes explaining their symptoms, get better or worse, and try or refuse therapies. As each woman lives through her particular challenge, we begin to see how we, too, can survive perimenopause!

Proceeds from book sales support ongoing research.

From menarche to menopause, it is never too early or too late to acquire body literacy. I invite readers to share other gift ideas that promote menstrual cycle comfort and support body literacy.

What Menopausal Women Want to Hear

November 7th, 2013 by Heather Dillaway

 

Photo Courtesy of Heather Dillaway

I’ve been thinking a lot about the messages that women do or don’t get at menopause.

Because of this, I decided to come up with a list of things that women would love to hear at menopause (or perimenopause, if we are talking about when women experience the majority of their signs and symptoms).

I’ve divided my list into things that they might want to hear that are true, and things that they might want to hear but might not be true yet (but should be). I’d love to hear reader comments on this division and any ideas about what I’ve forgotten that should be on my lists!

 

Things Menopausal Women Would Love to Hear That ARE True:

1. It’s okay to be glad to be done with menstruation, the threat of pregnancy, the burdens of contraception, etc. It’s also okay to use the menopausal transition to question whether you really wanted kids, whether you had the number of kids you wanted, and whether you’ve been satisfied with your reproductive life in general. It’s normal to have all of these thoughts and feelings.

2. You’re entering the best, most free part of your life! But, it’s okay if it doesn’t feel like that yet.

3. Menopause does not mean you are old. In fact, potentially you are only half way through your life.

4. You are not alone. Lots of people have the experiences you do. You are normal!

5. I understand what you’re going through. (Or, alternatively, I don’t completely understand what you’re going through but I’m willing to listen.)

6. It’s okay to be confused and frustrated at this time of life, or in any other time of life!

7. You’ve had an entire lifetime of reproductive experiences, and this is simply one more. How you feel about menopause is probably related to how you’ve felt about other reproductive experiences over time, however. It might be helpful to reflect back on all of the reproductive experiences you’ve had to sort out how you feel about menopause.

8.  Talk to other women you know. Talking about menopause helps everybody.

9. Menopause and midlife can be as significant or insignificant as you’d like them to be. For some women, these transitions mean very important things but, for others, they mean little. Whatever it means to you is okay.

10. Researchers are working hard to understand this reproductive transition more fully.

 

Things Menopausal Women Would Love to Hear But Might NOT Be True:

1. This is guaranteed to be your last menstrual period. You are done! (Or, a related one: You’ve already had the worst signs and symptoms. It gets better from here on out!

2. Signs and symptoms of menopause will be predictable and will not interrupt your life.

3. No one will think negatively of you or differently about you if you tell them you’re menopausal.

4. There are no major side effects to hormone therapies or any other medical treatments you might be considering.

5. Doctors will be able to help you, and will understand your signs and symptoms, if you need relief.

6. Leaky bodies are no problem! No one will care if your body does what it wants whenever it wants.

7. Partners, children, coworkers, and others will completely understand what you’re going through.

8. Middle-aged women are respected in this society, and it is truly a benefit to be at this life stage.

9. There is a clear beginning and a clear end to this transition.

10. Clinical researchers are researching the parts of menopause that you care about.

 

In my opinion, things that menopausal women would love to hear but might not be true speak to many of our societal norms and biases. Menopausal women are in a tough spot when it comes to norms about bodies, aging, gender, etc. Items on this second list also speak to menopausal women’s difficulties in accessing quality health care or getting safe relief from symptoms when needed. The latter list also notes the potential disconnects between research findings and women’s true needs during this transition. The first list represents what we should probably tell women and represents the kinds of supportive comments they might want to hear while going through perimenopause in particular.

Complicated Emotions

September 4th, 2013 by Heather Dillaway

Rocky emotions at menopause? // Photo courtesy of Heather Dillaway

Anyone who has ever loved anyone and existed in any kind of intimate relationship, or raised a kid, or negotiated with their parent as their parent ages knows that you can both love someone and also be very frustrated — even feel like hating them — at the very same time. You can love someone while simultaneously being extremely frustrated by her or him.
These same complicated love-hate emotions seem very present at perimenopause and menopause. The more I listen to middle-aged women talk and the more I see the media around menopause, the more I realize this. Feminist scholars have often stressed that menopause is not solely a negative transition and that women can find the transition positive at times. At the very least we’ve found that women feel indifferent or mixed about menopause, even if they don’t feel positive about the transition. BUT feeling positive or indifferent about reaching menopause (i.e., being happy to reach a certain period of life) is completely different from living with perimenopause. The signs and symptoms of perimenopause and menopause (e.g., hot flashes, night sweats, insomnia, irregular bleeding, etc.) can be grueling, and to discount that means telling women that their everyday feelings are not real. Especially when one thinks about the uncertainty women feel when they don’t know how long perimenopause will last (and when menopause will finally arrive), it is important to think about the very real and very negative feelings women might have even if they are happy overall about making this reproductive transition. Feelings of negativity might also come from women’s thoughts about what menopause means for their fertility if they’ve had trouble conceiving (“After all I’ve been through, now I have to go through this?”) or what menopause means about aging (“Should I worry about aging now? What is coming next for me?”). Even if women are glad to be done with monthly periods, they might still be fearful of aging or mourn their fertility in some way. Women who have decided not to have kids might feel that it’s unfair to have to go through menopause when they didn’t even use their reproductive capacities, even if they are glad to finally be rid of periods. To not acknowledge these complicated emotions is to discount the complicated life courses that women lead. At any life stage we think about what has happened before and what will happen next, and our thoughts about both the past and the future affect how positive we can be about the present. Automatically this means we will have complicated emotions as we make life stage transitions.
Thinking about the road ahead, I know that I’m going to be like every other middle-aged woman. I’m going to love and hate perimenopause and menopause. Just like I’ve loved and hated all other reproductive events in my life. It’s too bad we don’t talk about this stuff more openly, because complicated emotions are actually fairly commonplace. At home. At work. In all of the arenas of everyday life. If we acknowledged this more fully ahead of time, we might be better off as we go through our life stage transitions. Transitions might still be rocky and rough, but at least we’d know it’s normal to have these emotions.

Reclaiming “The Change”

May 31st, 2013 by Ashley Ross

The Change.

Stormy skies above Bagnor (UK)
Photo by Andrew Smith // Creative Commons 2.0

This name for peri/menopause has appeared in many cultures and has been passed down through the eons, generation to generation. I, myself, really like calling it The Change, as it describes the awe and magnitude of peri/menopause. The Change honors the call to attention, the rupture from the known, the reflective incubation, the life choices and the leap of faith that a conscious, mindful passage through peri/menopause requires. The Change encapsulates the seismic shifts, the unexpected turns, the disturbing reorientations, the annoying distractions, the unsummoned losses, and the depth of self-discovery that is available to every woman willing to answer the call and step into the initiatory potential of this passage to Eldership.

As I prepare my workshop (The Chrysalis and the Crone: A Conscious Menopause) to bring to the SMCR Conference next week, I find myself deeper and deeper in the reality of our contemporary, global culture and the crisis of the absence of rites and initiations. Specifically, how does it affect each and every one of us, that our experience is being defined only by our ‘symptoms’? What does it mean for us and our planet if we pay attention to the attempts of the psyche to guide us out of our work-a-day-lives and into discovering what else might be possible? What if we choose not to be thwarted by the unimaginative beliefs that the soul’s needs are unquantifiable and thus unimportant?

Marion Woodman describes this vacuum:

“The doors that were once opened through initiation rites are still crucial thresholds in the human psyche, and when those doors do not open, or when they are not recognized for what they are, life shrinks into a series of rejections. Torschlusspanik [a German word connoting the terror of disconnection] is now part of our culture because there are so few rites to which individuals will submit in order to transcend their own selfish drives. Without the broader perspective, they see no meaning in rejection. The door thuds, leaving them bitter or resigned. If, instead, they could temper themselves to a point of total concentration, a bursting point where they could either pass over or fall back as in a rite of passage, then they could test who they are.  Their passion would be spent in an all-out positive effort, instead of deteriorating into disillusionment and despair“. (from Richard A. Heckler’s Crossing: Everyday People, Unexpected Events and Life Affirming Change, p. 134)

If this is true, then instead of suffering ‘symptoms’ and struggling, each of us, to suppress or get rid of these symptoms, we might consider peri/menopause as a collective imperative to initiate and embody change – in ourselves and our society. Peri/menopause might be the catalyst to shake us awake from our collective trance, to step away from our habituated notions of who we are and how our world is supposed to work.

Here’s the rub: change is pain. We are, for the most part, creatures of comfort. We like, for the most part, to be lulled. But our souls long for more, and at peri/menopause we can no longer ignore the small whisper, deep in our psyches, asking: “Is this it?  Is this all there is?”

Change is afoot …

The Last Snowflake

April 24th, 2013 by Heather Dillaway

Photo by Heather Dillaway, April 2013

My kids and I read a book about “the last snowflake” a few years ago. The book was a story about how the last snowflake felt as it hit the ground each winter – lonely because his friends were ahead of him and probably melted already, or maybe carefree and floating on the wind to say the last goodbye to winter. This year my kids and I keep trying to wonder when that last snowflake would fall. Was it a few weeks ago? No. Was it last weekend? No. Well, here it is snowing again today so will I see the last snowflake tonight? At some point this snow has to end – it’s late April! When WILL that last flake fall?
Plenty of people have written and sang about the “last snowflake” (do a web search and you’ll see). It’s a great thing to philosophize about: when will it come, what will it look like, will I miss it, am I ready for what comes after it, and, in general, how do I feel about the transition it represents? Am I glad to see that last snowflake of the season, or am I melancholy about it? Am I ready for the warmer weather, or did I like wearing warm sweaters and fleece pajamas? Do I like winter after all, even though it’s hard and long and seemingly never-ending, until it’s over? I like spring a lot but it’s always so short in Michigan and we head right into hot weather, there’s really not much in-between. Plus spring and summer mean the ramping up of activities and a busier schedule – am I ready for that? A part of me is already missing that last snowflake even though I don’t know if I have seen it yet….but then again, I’m pretty ready for winter to be over. Can I feel two things at once? Can I be sad and glad to see that last snowflake?
Why am I writing about snowflakes? Because I read a piece on the Red Hot Mamas website the other day about a menopausal woman’s last period that reminded me that of my thoughts about last snowflakes. In “A Gentle Good-bye,” Christine Merser talks about how she did not get to say goodbye to her last period at age 42, that it came too fast and she mourns (at least in part) the idea that she’ll never menstruate again. She acknowledges the hardships menstruation sometimes caused and the hassles that were part and parcel of it, but also reminisces in its life-giving qualities and feels a sense of loss. She feels her last period was a “benchmark moment” and suggests that in not knowing that her last period was indeed her last, she did not get to say that “gentle goodbye” that she wanted to say. She also talks about menopause as representing the “October” of her life, signifying ends rather than beginnings, but at the same time wants it to mean new and better things. The idea that the last period cannot be predicted but is hoped for, but then may be bittersweet when it’s finally reached is something that I’ve heard from so many women. Menstruation is hard, especially when it is unpredictable in perimenopause or before, but a part of it is also safe and representative of a kind of stability and identity that is hard to give up. Merser proposes that cessation of menstruation is the “first thing she can’t fix” about her body. Regardless of the freedoms that you might get when it’s over for good or the things about it that you will gladly give up, women aren’t always quite sure they really want to be done with menstruation forever once they sit back and think about its meanings. So they ask, Am I glad to see that last period, or am I melancholy about its passing? Am I ready for the midlife and beyond, or did I like being younger? Am I ready to give up my monthly reminders of womanhood? Do I like menstruation after all, even though it’s hard and long and seemingly never-ending until it’s over? I might like midlife a lot but it seems like it might be short and it might head me right into aging for real, so how long will I really be in this good midlife stage? Does a part of me miss my period before I’ve seen my last one?
Like snow, menstruation can be unpredictable, uncertain, burdensome, and a hassle, and we might all be very happy to say goodbye. BUT, for those of accustomed to the seasons and the good parts of each season, we might also be somewhat sad to see snow and menstruation leave us. Especially if we don’t get to say a chance to say goodbye.
Disclaimer: This analogy probably only works for those who live in Northern climates and are used to the good and bad things that come with snow. And yes, I’m sort of making light of menstruation here, but my feelings about the last snowflake this year are noticeable to me and I thought it might be fun to play with this analogy.

Menstruation, Consciously?

April 17th, 2013 by Ashley Ross

In Heather Dillaway’s re:Cycling post of March 28, “The Physical Body and the Lived Body”, she invited a conversation about the importance of understanding the “lived bodily experience” when we examine menstruation. She suggests that “we cannot comprehend menstruation until we separate the physical body from the lived body”. Her inquiry reflects the dilemma many of us face when we attempt to enter the female experience through our cognition. Inevitably we rely on what we’ve heard repetitively and from many sources; what we’ve been taught, cajoled, shamed, brainwashed, and had whispered to us. In this way our experience has been formed from the outside in. This is what Dillaway delightfully (albeit cognitively) calls the “governmentality” of (our) bodies – that is, all the rules that surround bodies, all the norms that suggest exactly how our bodies should be and behave”.

If we agree reframing and embodying our own experience is called for, the logical question is no longer WHAT is our lived experience (that would still keep us in our heads) but HOW do we experience our bodies to discover our experience from the inside out? What are we called to do, or perhaps more relevantly, to BE, to develop the ability to fine-tune our inner attention, to deepen our listening and to familiarize ourselves with the terrain of our interiority?

How we chose to do this — how we each bypass the machinations, the loops, the highly developed editing abilities of our minds, the habituation of needing more, more, more information — is as personal and varied as the individuality of each inner landscape. However, I would like to suggest the following three components as a place to start:

Photo by Ashley Ross

“Going inward” only can happen when we slow down. This is a timeless realm, where attention will only settle on our experience, like a butterfly on a flower, when the air is still.

We also need to bring our curiosity to the unknown. We won’t free ourselves from the tyranny of imposed meaning until we are willing to enter into our experience and be willing to not know what we will find. Not even think we might know. Simply not expect to know.

We also need to build up the courage, the resources, the terra firma, the self-esteem, nay, the self-respect to go in and gently, lovingly touch those uncomfortable, painful, and often vulnerable parts of ourselves. These wary parts might even back away from us at first, but in truth, have been waiting for us to arrive for a long time. As the poet Mary Oliver says, “you only have to let the soft animal of your body love what it loves”.

These three mindfulness-based practices are at the foundation of a conscious embodiment of our menstruation, hormones and peri/menopause. They offer a way into our experience that allows understanding to bubble up from the experience itself. If we can BE in our bodies, if we can sit quietly and notice who we are when we menstruate, when we ovulate, and the tempo of our own monthly cycle, in this way we permit ourselves the experience of knowing ourselves from the inside out.

Who knows, something unexpected and remarkable might happen. By bringing consciousness into our experience, it might shift the experience itself…

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

April 11th, 2013 by Laura Wershler

Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist

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

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

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

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

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

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

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

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

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

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

LW: What about headaches and depression?

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

The reasons for depression are mysterious to me but this is an important adverse effect. I believe that anyone who has previously had an episode of depression (whether diagnosed or not, but sufficient to interfere with life and work) should avoid Depo.

LW: Although there has been little discussion about bone health concerns on the previous blog post, I think we should address the fact that Depo causes bone loss. How does it do this?

House of (Menopausal) Cards

March 26th, 2013 by David Linton

(Spoiler alert: if you haven’t finished or intend to watch the show discussed here, you might wait to read this post until later.)

The premises of the much-discussed new series House of Cards hosted on Netflix, are that no one in the world of politics can be trusted, that alliances are fragile, and that disaster looms at every moment. Beneath the surface of beautiful buildings, attractive people, glamorous receptions, and rousing rhetoric lie depths of deception and betrayal.

At the heart of the intrigue are the central power couple, US Congressman Frank Underwood and his wife, Claire, who heads a non-profit NGO dedicated to providing clean water to impoverished African villages. They appear to be well matched and unified in their ambitions for both personal power and their pet projects while expressing benign neglect toward each other’s outside sexual pursuits.

All is well in the Underwood cacoon until perimenopause makes its destabilizing entrance. There’s a concept that’s sometimes referred to as “Chekhof’s Gun” that goes something like this, “If you show a shotgun on the wall in an early scene, someone better use it before the play is over.” Well, the menstrual shotgun first appears in an early episode when Claire is seen standing before an open refrigerator door and she’s not looking for a quart of milk. Frank notices, says little, and the moment passes. Four or five episodes later Claire makes a deal to accomplish one of her goals, knowing it will undercut a grand scheme he is working on. When he learns of the betrayal, he employs the deadly menstrual shotgun, “Is it the hot flashes?” Whereupon she throws him out of her office and departs for New York to be with a long-time lover.

But this is only the first season of what promises to be an ongoing saga, so following yet another political crisis, she returns to Washington. But something has changed. She has been having dreams about saving a child who is being choked by vines and, in a final scene, visits an ob/gyn to discuss having a baby, despite the fact that she has had three prior abortions. Perimenopause has suddenly altered her perspective. As viewers have already learned that her husband hates children, the set up for next season’s drama is well established.

Menopausal Junk

February 28th, 2013 by Heather Dillaway

In response to my last blog entry about Helena Bonham Carter, Paula Derry commented that we treat menopause as a “junk category,” tossing in any symptom we can’t explain or don’t want to attribute to anything else. So true. In fact, Anne Fausto-Sterling said this long ago about menopause – that tons of symptoms were attributed to menopause when in fact only hot flashes really had a link to this life stage. BUT, we keep on attributing anything and everything to menopause.

    Photo by Flickr user Caterina // Creative Commons 2.0

  • Gaining weight at midlife? Must be menopause.
  • Sad or angry at midlife? Must be menopause.
  • Hairy at midlife? Must be menopause.
  • Dry at midlife? Must be menopause.
  • Blurry eyes at midlife? Must be menopause.
  • Headaches at midlife? Must be menopause.
  • Big boobs at midlife? Must be menopause.
  • Constipated at midlife? Must be menopause.
  • Have a symptom you can’t explain at midlife? Must be menopause.
  • Turned 50? Must be menopause. (Yes, see, it’s ridiculous.)

And the list goes on. And on. And on.

Okay, so, yes, menopause is a junk category because symptoms (junk) are just thrown in and declared “menopausal” (“perimenopausal”) at every turn. Just like when women go to the doctor and are given pregnancy tests no matter what their symptoms (“must be pregnant”). Ah, the fun of the reproductive life course.

BUT, I would say that there is another kind of “junk” that I see at menopause. I’ve interviewed menopausal women for 12 years now, and one of the hardest things is separating out menopause from all the other things (junk) going on in women’s lives as they make this transition. It is so hard to figure out what menopause really is and what it really means for women because it is surrounded by so much other “junk” at midlife. When you ask women about how they feel about menopause, they tell you but they also contextualize how they feel by telling you about:

  • their kids (the kids that live with them and the ones that have left)
  • their partners (current ones, ex-partners, and ones they wish they had)
  • their jobs (the ones they hate and the ones they care about)
  • their friends (the ones who support them and the ones who don’t)
  • their aging parents (and how hard it is to take care of them)
  • their worries about future aging
  • their doctors (good and bad)
  • their youth
  • their aches and pains
  • their bodies (the parts they like and don’t like)
  • their history of menstruation and other reproductive experiences…

You get the picture.
You have to wade through all of this to understand menopause. Sometimes it feels like junk clogging up their lives and clogging up the path to figuring out what menopause is really like. At the end of the day menopause is such a narrow part of most middle-aged women’s lives, but it is tied in with so much other midlife stuff that it’s hard to separate out. When you ask women about menopause, it’s sort of like asking someone, “How are you?”, on one of their busiest days. The answer you get back is surrounded and dictated by the junk in their lives and, unless you understand that going in, it might seem like menopause itself is a junk-filled process. But maybe it’s not. Despite all the news articles that predict new symptoms and conditions at menopause, and despite all of the midlife contexts that surround menopause, maybe menopause itself is very simple if we can weed out everything that’s not really menopause… What do YOU think?

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