Blog of the Society for Menstrual Cycle Research

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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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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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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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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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.

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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Some recent news about Hot Flushes and Night Sweats

October 25th, 2011 by Chris Hitchcock

Prevalence of Hot Flushes and Night Sweats in UK women 54-65

In a new, large (over 10 000 women)  survey of UK women aged 54-65, Myra Hunter and colleagues reported on the proportion of women who have hot flushes and night sweats (HF/NS), and on how frequent and bothersome they found them. Surprisingly, they did not find a difference across ages; 54% of women reported that they currently experienced hot flushes and/or night sweats, and this was as true for women in their mid-60′s as in their mid-50′s. Current users of hormone therapy were less likely to have current HF/NS, while those who had discontinued hormone therapy were more likely to have HF/NS compared with never users. It is common to think that HF/NS last for 2-5 years in a woman’s early 50′s. This study suggests that there is a need for therapies that are effective and can be used safely for a much longer duration.

FDA says no to Pristiq for (Post)Menopausal Hot Flushes

In early September, the US FDA (Food and Drug Administration) turned down Pfizer’s request to market it’s antidepressant drug, Pristiq, as a treatment for hot flushes in menopausal women. Pfizer inherited Pristiq when it acquired Wyeth (makers of the hormone therapy medication PremPro).  This is the first anti-depressant to seek official approval for this indication, although there has been research and promotion of antidepressants as alternative, non-hormonal, off-label medications for vasomotor symptoms (hot flushes and night sweats) for some time.

Perhaps not surprisingly, there has been little coverage of this in the media, as contrasted with the coverage of the various steps towards this point.

I have noticed that when a drug therapy is approved or takes a step along the path towards approval, news coverage is general and widespread. When there is a hitch in the approval process, often only the financial markets pick up the story, because it affects share values. However, there is an article in Medscape that provides more background on the history of this application.

 

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I’ll read for the cure, but I won’t drink the pink Kool-Aid

October 19th, 2011 by Laura Wershler

OPINION

Every October it’s the same thing:  Buy pink, think pink, drink the pink Kool-Aid.  All in pursuit of (mostly) the cure for breast cancer.

Forget the cure. I’m much more interested in preventing the disease. As such, I’ve refused for years to walk or run for the cure to breast cancer. Not only am I concerned that too little of the money raised by such events is being spent on prevention research, I also don’t like what can only be called the commodification of breast cancer.  For more on this check out thinkbeforeyoupink, a program of Breast Cancer Action.

In addition to these concerns, I find some of the breast-cancer fundraising and awareness-building activities being promoted this year to be nothing short of cringe-worthy.

I certainly won’t be attending boobyball 10 next month.  This auspicious event is put on by Rethink Breast Cancer, a Canadian non-profit geared to building awareness in the under-40 crowd. Too bad Rethink’s booby fetish seems more appropriate for the under-12 set.

And I won’t be wearing an “I love boobies” bracelet anytime soon.  Nor will students at a middle school in Kelowna, British Columbia, where the bracelets were recently banned because the message was deemed “offensive.” I’d ban the $3.99 over-priced plastic wristbands just for being silly.

The bracelets, along with other silly “I love boobies”  promotional products, are sold by keep-a-breast.org, the mission of which “is to help eradicate breast cancer by exposing young people to methods of prevention, early detection and support.”

Although I’m sure both of these organizations mean well, I want to scream, “Enough already!”  I know I don’t fit either org’s demographic, but still, enough already.

What I will attend, this evening, and with some hesitation, is the inaugural Read for the Cure event in Calgary.  For $90 I’ll enjoy wine and nibbles, hear three Canadian female authors read from their work, and take home three books by these featured writers.

Marina Endicott is one of three featured authors at Read for the Cure in Calgary, Alberta on October 19.

Read for the Cure is a Canadian endeavor launched in Toronto in 2006 by two women from the same book club who had recently completed treatment for cancer.

“Acknowledging the important role of reading in their lives, and the wonderful support they had received from their fellow members during their treatment, they saw an opportunity to harness the energy of enthusiastic book clubs and readers to raise funds for cancer research.”

I love books, I love my own book club, and I’m going to the event with a dear friend whose mother died of breast cancer.

While breaking my self-imposed boycott of cancer-related fundraising events, I plan to ask a few questions of my fellow attendees:

What’s your take on the mammography screening controversy?

Are you aware of the connection between healthy ovulatory menstruation and breast health?

What do you know about vitamin D and cancer prevention?

I’m also hoping to engage representatives from the Alberta Cancer Foundation and the Cancer Research Society — the two recipients of the event’s proceeds — in discussions about the current research projects they’re funding.  Do they know about the Breast Cancer Prevention Study being conducted by Grassroots Health to explore the association between vitamin D levels and breast cancer?

Tonight, my drink of choice will be red wine. Here’s to a fun evening.

 

 

 

 

 

 

 

 

 

 

 

 

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Cardiovascular deaths increase with steady aging, not menopause

September 27th, 2011 by Chris Hitchcock

Earlier this month, researchers published a statistical analysis of mortality data in England, Wales and the United States, disproving the common statement that, after menopause, women face increased rates of mortality from heart disease. There are other studies that have come to similar conclusions, but there are a few things that make this study different. One is that it drew on epidemiological data from three different parts of the world, which reduces the likelihood of a local coincidence. A second is that they took care to create longitudinal data sets, comparing women born in different birth decades with the appropriate mortality over time. In doing so, they avoided the problems of cross-sectional data.

The authors found that there was a steady exponential increase in risk with age, and that there was no sign of accelerated risk at the typical age of menopause (50). They compared different versions of mortality curves, and were able to show that a two-stage model of mortality with a hinge at menopause was not a good fit to the data.

These findings have received national and international coverage, and are a major blow to the argument that menopausal women require premenopausal hormones to retain premenopausal protection from cardiovascular risk. Menopausal women are older than premenopausal women, and that is why they are more likely to die from cardiovascular disease, not because of the hormonal changes of menopause.

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Vitamin D and Early Onset of Menstruation

September 21st, 2011 by Laura Wershler

Could vitamin D deficiency in young girls contribute to early onset of menstruation?  

A study conducted by the University of Michigan School of Public Health suggests this may be the case.  Blood vitamin D levels were measured in 242 girls between the ages of 5 and 12 in Bogota, Colombia. The girls were then followed for 30 months.

“Compared to girls in the vitamin D-sufficient group who first menstruated at the age 12.6 years, those in the vitamin D-deficient group started menstruating at11.8 years. (Epidemiologist Eduardo)Villamor says that although 10 months may seem like a small gap, the difference is momentous because at that age, a young girl’s body may undergo many changes rapidly.”

The findings are significant because of other research suggesting links between early onset of menarche, or first menstruation, before the age of 12 and serious health concerns later in life such as cardiovascular disease and breast cancer. Vitamin D deficiency is also associated with poor bone health and osteoporosis.

This study showing an association between vitamin D deficiency and early menarche raises many questions. Should mothers be asking their doctors to test their daughters vitamin D levels? How might vitamin D supplementation prevent future health concerns now associated with early menarche? What blood level for vitamin D is optimal?

Grassroots Health, a non-profit advocacy organization promoting optimal vitamin D levels for the prevention of disease and maintenance of good health, has recently launched a study on breast cancer prevention with vitamin D. The group also has an initiative called D*Action involving a consortium of scientists, institutions and individuals committed to solving what they consider to be a worldwide vitamin D deficiency epidemic.

Might the girls in Colombia lead the way for vitamin D supplementation to begin at a young age to protect the bones, breast and hearts of the next generation?

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Tampon Wars

August 12th, 2011 by Elizabeth Kissling

Remember back in February when I made fun of Tampax for explicitly comparing their Tampax Pearl to U by Kotex in their newest print ads? Such direct comparison to the competitor’s product is not a trendy marketing strategy; it hearkens back to the days when Darrin Stephens was a copywriter. (You young-uns can look up that reference.)

I wasn’t the only one who noticed: a recent article in Ad Age says the “30% better protection” strategy has not been used in femcare marketing since Rely tampons were withdrawn from the market in 1980. Not coincidentally, that was the last time Tampax picked up significant market share — a lot of those former Rely users switched to Tampax (Tampax was not owned by P&G at the time, but Rely was).

With the U by Kotex brand apparently winning new customers as well as winning others away from Tampax, how successful will “30% better protection” be as a persuasive strategy? Jack Neff (author of the Ad Age piece) points out that it’s pretty challenging “in a category where absorbency has been tightly regulated by the Food and Drug Administration in the wake of the Rely withdrawal.”

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New versions of menstrual suppression drugs on the way?

August 4th, 2011 by Elizabeth Kissling

Successful tests on rhesus monkeys are a long way from clinical trials on women, but this is interesting to those of us following the conversations and debates about cycle-stopping contraceptives: new research testing progestin antagonists indicates that the drug can be successful in suppressing menstruation without necessarily suppressing ovulation. Another variant of the drug can suppress both menstruation and ovulation.

Dr. Robert Brenner, who is the lead researcher conducting these studies in the Division of Reproductive Sciences at Oregon Regional Primate Research Center, notes that this has potential beyond just a new lifestyle drug:

I would emphasize that we are not talking here only about lifestyle choices but also about the potential to bring relief to the many women who suffer years of misery from distressing complaints such as endometriosis, and painful and excessive monthly bleeding. In fact, excessive bleeding is one of the major reasons that women undergo hysterectomy, and this treatment may also reduce the need for this surgical procedure, with all its attendant risks and costs.

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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.