Blog of the Society for Menstrual Cycle Research

Midlife Muddle — Own the Power of Naming

May 17th, 2012 by Elizabeth Kissling

Guest Post by Jerilynn Prior, M.D. — Centre for Menstrual Cycle and Ovulation Research

By “midlife muddle” I don’t mean the trouble concentrating or remembering names that sometimes occurs for all of us (but more frequently if we’ve wakened with night sweats and not gotten back to sleep). I mean the condoned and official confusion about naming of women’s reproductive aging. Let me show you why I am upset.

 

STRAW+10 staging system for reproductive aging in women

Stages of Reproductive Aging Workshop (STRAW) held a 10-year anniversary last summer. (As someone frustrated by not being “heard” at the original conference, I still think that the “W” in STRAW should stand for Women!) Despite that, STRAW+10 has made progress because at least some of the classification is now supported by population-based prospective data rather than based on what experts believe. The names that are now politically correct are summarized in the STRAW+10 Executive Summary1 and the diagram1 at right.

 

We in the Society for Menstrual Cycle Research have also had our say about nomenclature: “Naming Women’s Midlife Reproductive Transition”.  I wrote this (with revision and refinement by collective effort of SMCR members) because women keep getting left out of this naming business. For example:

  • a regularly menstruating woman with night sweats, heavy flow, and increased cramps could learn to call herself perimenopausal2 (not STRAW+10 Late Reproductive Phase -3b?!).
  • a woman who just finished her period can say, I’m in late perimenopause and have at least a year without further flow before I’ll be menopausal. Based on STRAW+10 she could be told that specific menstruation was her final menstrual period (nickname “FMP”) and the next day, according to STRAW+10 be told that she is now “postmenopausal”!!
  • a woman with sore breasts, irregular periods, and heavy flow could say, I’m in perimenopause. However, she may instead be told she is in the “Early Menopausal Transition.” Because she has heavy flow she is also likely to be prescribed the birth control pill (as is currently and commonly recommended). Usually she will not be told that The Pill will make her perimenopausal irregular flow worse—she may well start spotting in the middle of her cycle.3

This new and improved STRAW+10 still centers all of women’s reproduction on that mythical FMP. But to call the FMP “menopause”, as many women’s health experts do, is just unscientific. It takes at least a year without another menstruation in those of us over age 45 before nine out of ten of us will not get another period4. But one (out of ten) of us will get a further, normal period even though we’ve been that whole year without any4. We can tell that new flow is normal (in other words, does not need investigation for endometrial cancer) if we had cramps or bloating or sore breasts or moodiness—or all of these—that told us our period was coming.

 

So our new Naming position statement says don’t call it “menopause” until you’ve not had a period for a year. And do call it “perimenopause” if things are variable and changing even if you are still having regular flow2.  Three of nine changes can confirm for you that you are perimenopausal even if your flow is still regular:2

  1. Shorter cycles (25 days or less);
  2. Increased cramps;
  3. Heavier flow;
  4. Increased trouble sleeping—especially waking up in the middle of sleep;
  5. New or increased migraine headaches;
  6. Night sweats—especially if they tend to occur before or during flow;
  7. An increase in or new premenstrual mood swings;
  8. New sore, enlarging or nodular breasts; and
  9. Weight gain without changes in what you eat or the exercise you do.

If women can learn to call themselves perimenopausal, they will be saying they know that perimenopause is not the same as menopause—perimenopause is a midlife transition with higher and erratic estrogen levels. Menopause is a fairly stable life phase with normally low estrogen and progesterone levels that begins one year after their last menstrual flow.

 

Furthermore, by naming themselves accurately they will be able to tell whether a medication that is proposed for them has been tested and proven effective in perimenopausal women. Usually symptomatic women are treated with oral contraceptives (that are proven reasonably safe and useful for premenopausal contraception), or offered hormone therapy that has only been tested and shown effective for hot flushes/flashes in menopausal women.

 

So. . . I like the word, perimenopause and think if women understand and own it they will be on their way out of a midlife muddle.

 

References

  1. Harlow, S. Executive Summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging [pdf]. Fertility Sterility, 2012   doi: 10.1016/j.fertnstert.20012.01.128
  2. Prior JC. Clearing confusion about perimenopause. BC Med J 2005; 47(10):534-538.
  3. Casper RF, Dodin S, Reid RL, Study Investigators. The effect of 20 ug ethinyl estradiol/1 mg norethindrone acetate (MinestrinTM), a low-dose oral contraceptive, on vaginal bleeding patterns, hot flashes, and quality of life in symptomatic perimenopausal women. Menopause 1997; 4:139-147.
  4. Wallace RB, Sherman BM, Bean JA, Treloar AE, Schlabaugh L. Probability of menopause with increasing duration of amenorrhea in middle-aged women. Am J Obstet Gynecol 1979; 135(8):1021-1024.

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Posted in Hormones, Language, Menopause, Menstruation, New Research | 4 Comments »

“Lives will be saved” – the FDA decision not to ban Bayer’s birth control pill

April 18th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall

 

Photo by Monik Markus // CC 2.0

How many of us read the inserts included in a packet of pills? How many decide not to take the pills on the basis of the information enclosed?  The rapidly reeled-off list of side effects stated at the end of a televised advert for a new drug has more comedic value than serious consequence to most. If we do have doubts, many of us will rely on the reassurance of a doctor, and then take the pill anyway.

I recently wrote a piece for Ms. Magazine Blog outlining the FDA reappraisal of top-selling oral contraceptives Yaz and Yasmin. It was discovered that drugs such as these containing drospirenone held a significantly higher risk of causing blood clots. Research by the FDA and other bodies suggested this conclusion was definite, while research funded by the pharmaceutical company behind these billion-dollar products, Bayer, suggested the opposite conclusion to be true: that there was no increased risk evident. A team of experts, some of which had financial ties to the company, voted against having the pills taken off the market when presented with the question of whether the risks of taking these pills outweighed the benefits.

Bayer is facing 11,300 lawsuits from women who have been seriously injured and family members of women who have died after taking one of the company’s bestselling hormonal contraceptives. They have settled the first 500 addressed with a total of $110 million in payouts. When discussing this process with a lawyer representing many of the women I was told that Bayer would do anything to avoid a trial wherein the full spectrum of their marketing strategies would be revealed.

The FDA came to the decision to add into the insert included with these drugs a statement of the discovery of “conflicting” research that suggested the pills had a higher risk of causing blood clots  (up to three times higher) – acknowledging the discrepancy of the research funded by Bayer and giving it equal standing as that performed by other bodies including the FDA itself.

Prior to this decision being announced a number of women’s health groups got together to write a letter to the FDA asking that they look again at the question put to the board of experts. They argued that the correct comparison for the board to consider would be between drospirenone-containing contraceptives and other oral contraceptives, and not between Bayer’s drugs and unwanted pregnancy. In the final sentence, they remarked that they believed that “lives will be saved” if the pills were no longer on the market. They met with the FDA and one representative asked that the FDA strongly reassess its acceptance of Bayer-funded research. Another asked that the drugs no longer be prescribed and that the FDA “get back to the arc of history and progress that protects women while supporting their contraceptive needs.”

The new labeling will state the “conflicting” findings and advise that women speak to their doctor if concerned. The official statement on this decision, relayed through the media coverage, reminded women that when compared to pregnancy the risk of development of a blood clot was insignificant. They also asked that women currently taking the drugs not stop doing so. Despite the FDA studies suggesting the blood clot risk is particularly high for women under 30, the statement compounded the understanding that the issue is only relevant to those over 35,  those overweight, those that smoke, and those with relevant medical history.  Continue reading...

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Posted in Birth Control, Law/Legal, New Research, Pharmaceutical | 3 Comments »

Understanding Research: Buyer Beware

April 2nd, 2012 by Paula Derry

xkcd.com // CC 2.5

I certainly believe that scientific research is important.  Research uncovers new knowledge and prunes away facts that are not accurate.  However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications.  If a scientific result can be invoked, we can believe that something is true. Is there an unconscious?  Freud said so, but he’s out of date.  Are we intrinsically social beings?  Evolutionary theorists argue. Does meditation really result in an altered state of consciousness?  If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.

What’s wrong with this? Isn’t this science doing its job of uncovering truth?  There are two things wrong with this. One is that not all knowledge is scientific knowledge.  The second is that scientific results are often portrayed inaccurately in our society.

With regard to the first point, I’ll just give a few examples.  von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow.   Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.

But what I really want to talk about here is the second point.  We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means.   However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context.  When I was a graduate student in psychology, every class included practice in critiquing research.

To understand research, certain mathematical ideas are important.  “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why?  That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased.  Why?  Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.  Continue reading...

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Posted in Language, Menstruation, New Research, PMS | 6 Comments »

Fog Warning Ahead

March 29th, 2012 by Heather Dillaway

As I embark on my 40th year I look ahead to menopause. I guess there is a good chance I’m approaching some foggy years. Brain fog, that is.

In the past week a flurry of online news articles review new research findings on the “brain fog” that many perimenopausal women experience. The brain fog is more easily understood as a slight memory problem, if you take the time to read through the various news stories. A new study analyzed how 75 individual women, aged 40 to 60, rated their memory performance based on factors like how often they forgot details and how serious their forgetfulness was. Researchers also gathered information about the women’s overall health, mood and hormone levels, as well as other menopausal symptoms, and tried to figure out the extent to which this “brain fog” exists. According to news reports, about 41 percent of the women in the study reported having forgetfulness that was “serious,” and those who felt that their memory problems were serious were more likely to score poorly on tests of working memory and attention. Some women who rated their memory problems as serious also reported some depression and other symptoms like hot flashes and sleeping problems. Other researchers suggest that the memory problems women experience are related to changing levels of estrogen in a woman’s body at menopause, but interestingly this new study did not find links to changing hormone levels.

The whole notion of “brain fog” is interesting, and I am suspicious of it as a strictly menopausal symptom. What about the brain fog we all experience when we’re tired or sick or just way too busy? Defining brain fog as a “menopausal” (really, perimenopausal) symptom further defines middle-aged women as somehow less than functional and set them up to be taken less seriously.

Putting this issue aside, though, what I actually find most interesting about all of the news coverage of this study is just how different each report of the study is. I am reminded that we should all be careful of which report we read about a study. For example, the first article I read on this study was placed in the Los Angeles Times and focused on the possible connections between menopausal brain fog, depression, and dementia. I was left feeling like the author of the article inferred that all menopausal women might have depression or dementia and that they should seek treatment. After reading this article I was angry because I felt as if I had been warned that midlife brain fog was the beginning of an inevitable decline for all women. Then I read a WedMD piece that simply described the study and did not concentrate on depression, dementia, or the need for treatment, and I wasn’t really sure what to make of the research study. Finally I read an article by a HealthDay reporter which quoted one of our own, SMCR member Nancy Wood, who reminds readers that “a number of other stressors in life, from work to taking care of children and parents, that pile up around the same time as menopause can hinder memory and ability to concentrate.” In addition, this article’s author states that “memory problems are not necessarily an early sign of dementia” and cognitive ability is regained after other perimenopausal symptoms subside. This third article concluded that the research study is helpful because findings suggest that brain fog is real – that women aren’t crazy – but that it is normal and not that detrimental to women’s long-term cognitive abilities.  Continue reading...

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Posted in Communication, Health Care, Hormones, Internet, Language, Literature, Media, Menopause, Menstruation, New Research | 3 Comments »

The woman, the serpent and the cycle

March 13th, 2012 by Chris Hitchcock

According to a recent study, women are best at picking out a picture with a snake during the days immediately before their period. You might think this would be a surprise, given the general idea of premenstrual compromise in women. Mind you, there isn’t much data to support poorer thinking or performance for women during the premenstrual period.

However, the authors were able to salvage the idea of premenstrual compromise here. They argue that about 30% of women have premenstrual syndrome, and most of the rest of us show some kind of cyclicity. And so they attribute the 200 millisecond (1/5 of a second) faster response to anxiety and fear. Either that, or it is maternal instinct, protecting the small cluster of cells that might possibly be an impending pregnancy.

Media has picked this up, with headlines about PMS being good for something after all.

Sometimes it seems that women can’t win for losing.

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Posted in Menstruation, New Research, PMS | 2 Comments »

Talking Makes Menopause Better — Anyone Surprised?

March 1st, 2012 by Heather Dillaway

Adapted from a photo by Ed Yourdon // CC 2.0

The results are in: if you talk to your friends more during menopause, then your menopausal symptoms will bother you less. A study reported in The Telegraph last week suggests that talking either lessens women’s symptoms or helps them cope better (or both). In one study, women undergoing breast cancer treatments who also participated in “talking cure group therapy” as part of a study at Kings’ College in London “coped much better” with menopausal symptoms. Half of the women in this study were asked to participate in workshops with other women for six weeks. Women in the study were encouraged to talk about signs and symptoms of menopause, such as hot flashes (or hot “flushes” in the UK) and night sweats; they were taught techniques for eliminating “negative thoughts” and stress as well. Researchers touted this “talking cure group therapy” as giving “people the mental tools to tackle problems more positively” and led to “improvement” in symptoms. The author of the article suggests that non-medical approaches to symptom relief not only work but also could be growing in popularity among women who can’t or don’t want to use prescribed hormone therapies.

This is not unlike what I’ve found in my own studies of menopause and what plenty of other feminist scholars have found about women’s experiences of reproductive health more generally. Women who have support networks and/or who talk to other women about their experiences do indeed feel better about their own experiences and do gain some symptom relief (or, at the very least, coping strategies) just from talking to people. Indeed, even women with severe symptoms can get relief from sharing and talking. SMCR’s very own Jerilynn Prior and Christine Hitchcock have also done studies of how women will rate the severity of their hot flashes differently once they hear other women talk about theirs. Hearing and then knowing that people around you are (a) experiencing the same thing and then (b) might have suggestions for how you could navigate the experience always helps. This isn’t specific to women’s health – anyone experiencing any bodily event, symptom, or process will probably feel better if they talk to others. And of course we could go on from there – anyone experiencing anything confusing or hard or long in duration will probably benefit from talking to others. Anyone who has failed a math test or survived a hard relationship knows that.

The question I have is, isn’t it sad that this is a finding? Shouldn’t we all know that talking to others is better for our health and our sanity? I’m as much of a culprit as anyone else: I don’t talk to anyone anymore. I’m too busy. I barely see my kids or partner, let alone tell people how I feel about menstruation, whether I really feel “done” having kids, whether I think menopause is near, whether I feel reproductively healthy (or healthy in any aspect of my life for that regard), etc.  Maybe some of you are much better than me about talking to others, but it’s pretty bad when major research journals have to remind us in their published findings that talking is good for us.

Feminist scholars have already documented the medicalization of women’s reproductive health and the fact that women now typically consult doctors as the “experts” on reproductive health and, by default, no longer trust themselves or other women for advice. Thus, to some extent, talking is stifled by the medicalization of women’s health experiences. But, ironically, now medical journals are reporting that we should talk more? Seems like we’ve made it full circle and women should consult other women as the real “experts” again.  Continue reading...

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Posted in Communication, Menopause, Menstruation, New Research | 6 Comments »

The pill, reduced period pain and the ongoing delusion

January 20th, 2012 by Laura Wershler

Is there a woman over the age of 18 anywhere who doesn’t know that taking the birth control pill can make her periods lighter and less painful? Most women know this, but not many know why. The news stories swirling around a new study about the pill and period pain will not enlighten them.

Photo credit: Ceridwen, Creative Commons 2.0

A 30-year longitudinal Swedish study has finally proved the worth of what is accepted practice in North America and Europe: the prescribing of combined oral contraceptives (COCs), or birth control pills with synthetic estrogen and progestin, to treat painful periods known clinically as dysmenorrhea.

Of course, pharmaceutical companies that manufacture COCs are probably eager for this research, as prescribing the pill for dysmenorrhea is still an off-label use in the U.S. (unlicensed use in the U.K.). Pill manufacturers may be able to use this finding to lobby the FDA (or equivalent agencies in other nations) to approve the pill as treatment for menstrual pain, leading to increased sales and insurance coverage. Perhaps that’s why news media have been treating this discovery as breaking news.

Take this headline: Yes, the Pill CAN ease the agony of period pain: Scientists confirm what millions of women already know, or this one: The pill ‘does ease period pain’, or this one: Combination oral contraception pills cut menstruation pain, or, really, any of these.

You can read the abstract of the study by Swedish researchers Ingela Lindh, Agneta Andersson Ellström and Ian Milsom, published this week in the journal Human Reproduction, here: The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. The conclusions are simple: “COC use and increasing age, independent of each other, reduced the severity of dysmenorrhoea. COC use reduced the severity of dysmenorrhea more than increasing age and childbirth.”

Forget the age factor for the purposes of this discussion. The fact that COC use reduces the severity of dysmenorrhea is not astounding. This is old news. So says Dr. Steven Goldstein, an obstetrician/gynecologist at NYU Langone Medical Center in New York City, quoted in a USA Today story:

“The study results are not surprising. It’s gratifying to see researchers documenting scientifically what practitioners have been seeing for a very long time. The amount of discomfort from a woman’s period with a combination birth control pill is a fraction of what it is without the Pill. There is a diminution of pain from the Pill.”

What is astounding is what Dr. Goldstein, and other OBGYNs, didn’t say in responding to the study. That the reason the pill reduces menstrual pain is because the synthetic hormones in the pill shut down a woman’s own menstrual cycle. The “period” women experience when on the pill is technically known as a “withdrawal bleed,” brought on by seven days of placebo pills. While it feels like a period to menstruators, it is not the same physiologically as the period they experience when NOT on the pill. That’s why it doesn’t hurt as much.

The point is, the pill is too often credited with regulating the menstrual cycle. It does no such thing. The pill does not regulate any woman’s menstrual cycle; it supercedes it. This research, and the many news stories that reported it, once again ascribe power to the pill – this time the power to cut menstrual pain. This is an incomplete truth.

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Posted in Birth Control, Communication, Dysmenorrhea, Health Care, Menstruation, New Research, Pharmaceutical | 6 Comments »

Alongside Scientists Exploring Why Women Menstruate

January 19th, 2012 by Alexandra Jacoby

I read a blog post about a paper (that I have not read). The post is “Why do women menstruate?“ by PZ Myers, a biologist and associate professor at the University of Minnesota, Morris, blogging at Pharyngula. The paper is “The evolution of menstruation: A new model for genetic assimilation: Explaining molecular origins of maternal responses to fetal invasiveness.” by Emera D, Romero R, Wagner G.

I’m not a scientist and don’t routinely have access to papers like these. Usually, by the time ideas raised  in them reach me, they would be solid-feeling facts, authoritative and done — not inspiring questions and wonderings that I can pursue in my way.

They might be about the products that were developed in response to, or as a side-effect of the research, or maybe I’d hear about newly discovered dangers to my health.

Rarely, do I get to be in on the “why.” To think about the story of it–my body–alongside the scientists when they are exploring what might be the origin of, or deciding factors in, why we are the way we are. As human bodies.

(So, thank you, internet. Thank you, bloggers).

"The anatomy of the human gravid uterus exhibited in figures" by William Hunter, Public domain.

This paper (as I understand it via the Pharyngula post) focuses on the conflicting interests of the relationship between a fetus and the woman carrying it: the fetus acting for its survival and development, and the woman as agent for her life, health, and the ability, should she want to, to carry more pregnancies to term.

The research notes a difference among mammals who spontaneously initiate the process of building up the uterine lining, regardless of whether there’s an implanted embryo (like us, with our monthly-ish menstrual cycles) and those who build up the lining only when triggered by an embryo, and asks why do we do this? Why not wait until you need it?

The answer seems to be because you won’t be ready if you wait. Maybe it’s like having guests over last-minute. You might have food and drink enough for all, but you might not. And, you might have stuff laying around that is more personal than you want guests to see. Or, maybe it’s all fine enough. Last-minute is frequently doable, but it’s better to be prepared. Prepared gives you options. Prepared gives you a chance to make it really comfortable and welcoming. Prepared sets you up to have the experience you wanted to have.

Women menstruate to be body-ready to handle the situation of pregnancy in the context of their whole lives, and their family’s whole life.

The monthly preparation of the uterine lining establishes optimal conditions for the relationship, the active give-and-take, between woman and fetus. And, while there are conflicting interests in this shared space of blood and nutrients, I see it as like any relationship between any things living — on a continuum of interaction between self-expressing creatures, cells or trees. There are intricate, elegant processes taking place to make it all happen. There is preparation and desire on both parts — blood, nutrients, and soil, air and water being exchanged and used up among us. There are points of contact, expected and understood, or surprising, or painful, or deadly. We’re in it together for better or worse. All of our relationships are active. Everything is interrelated and contingent and based on routines and cycles. On those we build, change, evolve…

I think only we are impatient about it — want it done  faster, with less work and no mess. The stuff of life is messy, though.

For me, when I understand the purpose of the mess, the effort required, the time and attention, become meaningful — I am able to recognize participants (rather than adversaries), to value the work we do and remember the vision and desire that infuse it all.

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Posted in Menstruation, New Research | 2 Comments »

Everything you need to know about the menstrual cycle in less than 3000 words

December 26th, 2011 by Chris Bobel

The Research Pile by Krista Kennedy // CC 2.0

What happens when get a bunch of interdisciplinary menstrual cycle researchers together and give them each a topic or two and a word count?

 

You get a pithy document called “The Menstrual Cycle: A Feminist Lifespan Perspective” available to anyone who needs to put their finger on the state of menstrual cycle research today. Readers of re:Cycling know there is deep complexity swirling around the menstrual cycle (indeed, that’s why this blog exists!)  so it sure is helpful to have a resource that collects the key info in one tidy place.

The Fact Sheet –four pages of content and two pages of must-have references—was collaboratively written by a team of members of the Society for Menstrual Research. It is available for download here [pdf]. Sections include menstrual attitudes and representations, menarche, peri/menopause, menstrual care, problems associated with menstruation and more. Something for everybody.

 

The Fact Sheet is commissioned and published by Sociologists for Women and Society (SWS), who, since 2002, has been publishing several fact sheets each year on topics ranging from Women & Size to Title IX to Women, Poverty and Welfare Reform. These resources are immensely helpful to scores of folks—teachers, activists, clinicians, the interminably curious—anyone , really, who needs concise accurate info.

 

Impress your friends. Go grab the Fact Sheet!

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Posted in Menarche, Menopause, Menstruation, New Research | 1 Comment »

Food insecurity is associated with later puberty

December 20th, 2011 by Chris Hitchcock

Many girls in Africa have insecure access to food, that is, they worry about getting enough food, and they sometimes eat less than they want, or go without food. There are two theories about how this might affect the onset of menstruation (menarche). One is that the limitations in energy and nutrition might slow development, resulting in a later menarcheal age. The other evolutionary theory is that early life stressors trigger a shift in so-called life history strategy, leading to accelerated development and an earlier menarche. In a recent article in the journal Reproductive Biology and Endocrinology, researchers from Ethiopia, Belgium and the USA presented data from the first two years of the Jimma Longitudinal Family Survey of Youth to contrast these two theories. The survey was conducted in southwest Ethiopia, sampling across rural, urban and small town areas and including boys and girls. Data about the household and the girls’ experience of food insecurity were assessed by questionnaire in the first year, and in the second year girls were asked whether and how old they were when they first menstruated. 900 girls, with an average age of 14.8 at baseline, participated in both of the first two years of the five year study.

Overall, girls who reported some degree of food insecurity (n=225/900) were similar in age, region (urban, semi-urban, rural), and nutritional status (whether they were short for age). However, they were more likely to be in a male-headed household, tended to be in middle income rather than high income households, and reported more domestic work than those reporting food security. Overall, girls with moderate to severe food insecurity were significantly less likely to have undergone menarche. The estimate of the age at menarche was one year older for Ethiopian girls who have insecure access to food.

Girls in the developing world experience menarche at an older age than those in the developed world, and, with development, other countries are experiencing the secular change of earlier age at menarche. In this study, the estimated age at menarche was younger in urban centres (14) than in semi-urban or urban areas (15), and girls in high income households had an earlier menarche, suggesting that improved food security may be part of the puzzle explaining these changes.

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Posted in Menarche, Menstruation, New Research | 2 Comments »

Earlier menopause with ovary-saving hysterectomy

November 22nd, 2011 by Chris Hitchcock

Recently Heather Dillaway blogged about the challenges and frustrations of naming, and this blog continues with that theme, looking at a recent article about increased rates of ”ovarian failure” following ovary-preserving hysterectomy.

“Ovary-saving hysterectomy linked to early menopause,” reads the USA Today on-line headline, and the article opens with the statement that:

Younger women who have a hysterectomy that spares the ovaries are almost twice as likely to go through early menopause as women who do not have their uteruses removed, according to a new study. 

It’s an alarming statement, and one likely to alarm an already anxious woman. The study in question was a longitudinal study following 406 women aged 30-47 at the time of their surgery and a control group of 465 similar-aged women who did not have a hysterectomy. The study will be published in the December 2011 issue of the peer-reviewed journal Obstetrics & Gynecology, and the news coverage was drawn from the Duke University press release, entitled “Hysterectomy Increases Risk for Earlier Menopause In Younger Women”.

The first challenge of naming is in the subtle difference between the press release’s earlier menopause, and the USA today article’s early menopause. Early menopause is defined as menopause that occurs before the age of 40; the earlier menopause in the article is a difference of about 2 years — an important difference.

In women who no longer have menstrual flow, how did the authors establish menopausal status, or ”ovarian failure”, as they called it? In women with a uterus, menstrual flow is a convenient landmark, which is roughly aligned with the hormonal changes to decide when menopause (or is it post-menopause?) has begun. We assume that 12 months without menstrual flow likely means that there will be no further flow (although that is not always true), and that it is a good estimate of when ovarian hormonal cycles have stopped. In this article, the authors used an annual blood sample to measure a hormone called FSH (follicular stimulating hormone). FSH is high in menopausal women, and an FSH>40 IU/L was used as a criterion for reaching menopause. However, we have known since 1994 that a high FSH level is not diagnostic of menopause, and, indeed, 6 of the 504 women were excluded because they had a baseline FSH > 40 IU/L, despite having menstruated within the previous three months. Regularly cycling women in their 40′s can have high FSH levels, and later have low FSH levels and ovulatory cycles. In menstruating women, blood samples would also be timed, which is not possible for women who don’t menstruate. It would be interesting to know how the high FSH criterion corresponded to menstrual cycle history in the control group.

Studies like this are hard to do. The authors were careful — they enrolled women prior to surgery and followed control women in the same way. To get 403 women with complete data, they started with over 900 women.  The controls were fairly well matched — similar in age, age at first period, c-section and oral contraceptive history. However, women undergoing surgery were more likely to have had at least one full-term pregnancy (84.5% vs 68.3% in controls), and more likely to have had a previous tubal ligation. In addition, fibroids, endometriosis, ovarian cysts and previous surgery for fibroids were more common in those having a hysterectomy. Both the hysterectomy itself and the history of previous surgery, particularly tubal ligation, may also contribute to a difference between the two groups. Finally, women with hysterectomy were heavier than the control group.  Continue reading...

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Does the Pill cause prostate cancer?

November 16th, 2011 by Laura Wershler

Of the growing list of reasons why women might want to reconsider using birth control pills, this could well be the strangest.

Researchers at Princess Margaret Hospital in Toronto published a study on Nov. 15  in the BMJ Open Journal in which they found a “strong correlation” between the use of birth control pills and the incidence of prostate cancer worldwide.

One of the possible explanations of how the two are related is the potential impact of the estrogen compound – ethinyloestradiol – that women using the pill secrete in their urine. It has been speculated elsewhere that these endocrine-disrupting substances could end up in our drinking water or get into the food chain.

The Pill, introduced in the 60’s, has been widely used for decades. The study suggests that exposure to these substances over 20 to 30 years could have a clinically significant effect. Researchers said further study of this link is needed.

In 2010 the media was full of stories marking the 50th anniversary of the birth control pill. The Pill at 50: Sex, Freedom and Paradox, rang the headline of a Time Magazine article by Nancy Gibbs. Could rising rates of prostate cancer be part of this paradox?

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Posted in Birth Control, Health Care, Men, New Research | 3 Comments »

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