Blog of the Society for Menstrual Cycle Research

Young women’s experiences with cancer-related infertility, and HPV vaccine uptake and avoidance in Eastern Europe

May 21st, 2015 by Laura Wershler

This session will explore Cancer and Menstruation at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.

The Significance of Menstrual Flow for Young Women with Cancer-Related Infertility
Kathryn Nattress, Centre for Health Research, University of Western Sydney

Although the dominant menstrual discourse is one of pain, mess and unpredictability, interviews with 20 young women who were diagnosed with cancer in childhood and adolescence suggest the possibility of alternative discourses. Five themes were identified:

1) A mark of womanhood: “People would talk about puberty or periods like it’s a foregone conclusion that everybody has them. So I would feel a little like I was orbiting and slightly outside of other women.”

2) Connection or disconnection: “People would talk about their periods and what a pain they were. I loved it because it made me feel more like a woman.” For others their differing experience led to disconnection.

3) Menstruation as a signifier of fertility: “I told everyone when I got my period back, I was so excited.”

4) Considering menstruation as abnormal: “My periods are very odd…It was like a tap, it just did not turn off.”

5) Maintaining a natural cycle: “Here I am, trying to do the natural fertility, and not be on the contraceptive pill, and really do everything to have a good cycle, and keep my hormones balanced.”

These young women strongly resisted contemporary, dominant patriarchal discourses and instead accommodated historical, matriarchal discourses where menstruation is seen as a powerful and sacred symbol of life and fertility. Their experiences provide greater understanding of the significance of menstruation for women with cancer-related infertility and allow alternative discourses to be explored.

Young women’s constructions of their post-cancer fertility
Amy Dryden, Centre for Health Research, University of Western Sydney

Young women diagnosed with cancer often face compromised fertility as a result of their treatment. However, little is known about young women’s constructions and experiences of their fertility post-cancer, or their interactions with healthcare professionals in discussing fertility concerns.

Semi-structured one-to-one interviews were conducted with 8 women aged 18-26 across a variety of cancer types including breast and brain tumours, leukaemia, lymphoma and sarcoma. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: Inadequate woman: Accepting the motherhood mandate; Adequate woman: Resisting the motherhood mandate; and Survival of the fittest: Woman as genetically defective. Implications for subjectivity included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners due to compromised fertility; and feelings of guilt and worry about passing on cancer-positive genes. For the majority of participants, motherhood was constructed as an essential component of what they wanted to accomplish in their lives. Alternative pathways to motherhood (i.e adoption, egg donation) were constructed favourably by the majority of participants, although some constructed these options as inferior to biological motherhood.

Overall results suggest that issues surrounding fertility were important to this group of cancer survivors, and that compromised fertility can negatively impact on the subjectivity of young women with cancer. As such, the results reinforce the importance of the provision of information about fertility by healthcare professionals amongst a demographic who remain underserved in the area of reproductive health.

Constructing the HPV vaccine in the context of Eastern Europe
Irina Todorova, Northeastern University & Health Psychology Research Center, Sofia, Bulgaria 

An image about the HPV vaccine circulating in Bulgaria. The text reads “Attention: poisonous vaccine!”

This research paper explores the relevance of local context for understanding meanings, discourses and disparities related to uptake and avoidance of a vaccine for the prevention of Human Papilloma virus (HPV) transmission, associated with cervical and other cancers, in Bulgaria and Romania.

Cervical cancer is one of the leading causes of death for women worldwide, and differences between and within country disparities are striking. Instead of falling, as in many other countries of Eastern and most countries of Western Europe, cervical cancer morbidity and mortality rates in Bulgaria and Romania have been rising. The vaccine embodies an array of personal and cultural meanings and discourses, including those of responsibility, control, morality, health rights, and gender. It also represents multiple interests of many actors, whose attitudes vary depending on local meanings of sexuality, religious beliefs, stigma, their experiences and trust in the health care system.

Data was collected through semi-structured interviews with women, health-care providers and key informants, as well as focus groups with parents, and analyzed thematically. The paper will share dimensions of women’s narratives related to personal experiences, cultural constructions of gender, and the relevant structural and policy contexts in which vaccination behaviors are constituted. The discussion will address the relevance of history, healthcare policy and gendered attitudes in Bulgaria and Romania for the constitution of preventive attitudes and behaviors, and critically reflect on what a consideration of local meanings of medical interventions means for equitable health promotion.

Menstrual Hygiene, Human Rights, and Gender Equality – A Focus on the Global South

May 18th, 2015 by Laura Wershler

Scholars and practitioners from the fields of human rights and water and sanitation will discuss menstrual hygiene from the perspective of gender equality on June 4th at the  21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.

Human Rights in the Private Sphere: Menstrual Hygiene as a Priority for Gender Equality and Human Dignity
Inga Winkler, Scholar-in-residence, Center for Human Rights & Global Justice, NYU School of Law 

In many countries, menstruation is shrouded in taboo and secrecy. Removing the taboos and ensuring better access to menstrual hygiene is essential for achieving gender equality and realizing human rights. The presentation seeks to explore human rights obligations to create an enabling environment for women and girls to practice adequate menstrual hygiene. It discusses various strategies including awareness-raising and breaking taboos, promoting good hygiene, and embedding menstrual hygiene in policies and programs by using examples from different country contexts. With a topic as personal and culturally specific as menstruation, incorporating women’s and girls’ views and preferences into programs and policies cannot be overestimated.

Poor menstrual hygiene, stigmatization, or cultural, social or religious practices that limit menstruating women’s and girls’ capacity to work, to get an education, or to engage in society must be eradicated. Considering menstruation as a fact of life and integrating this view at all levels will contribute to enabling women and girls to manage their menstruation adequately, without shame and embarrassment—with dignity.

Investigate and Expose: Challenges in Building an Evidence Base around Menstrual Hygiene as a Human Rights Issue
Amanda Klasing, Researcher, Human Rights Watch

Menstrual hygiene has emerged recently as a human rights issue, but this recognition alone does not mean that human rights practitioners will take up the issue. One barrier is the perceived or real limitations in their methodology.

This paper considers how human rights fact-finding methods may not readily lend themselves to building the evidence base for menstrual hygiene as a human rights concern. It will explore examples of how, despite challenges, menstrual hygiene concerns can be exposed within the context of broader investigations and it will address how practitioners can more deliberately incorporate menstrual hygiene in their investigations.

An important first step is for researchers to recognize the impact of menstrual hygiene on a broad array of women’s and girls’ human rights. Next, researchers should consider how best to expose this in the course of their research. Finally, researchers should consider how to include menstrual hygiene in the recommendations it makes to governments and other duty bearers.

Menstrual Hygiene Management in Schools: Meeting Girls’ Rights and Needs in Zambia
Sarah Fry, Hygiene and School WASH Advisor, USAID WASHplus Project

Image by Sarah Fry

Zambia’s schools fall short of acceptable standards and ratios for access to safe drinking water and improved sanitation. The ratio of girls to toilet can be as high as 200:1. These shortfalls are believed to be factor in the high rate of school drop-out among girls, many of whom do not even finish primary school. As in other low-income contexts, dropout rates for girls in Zambia appear to increase after puberty. Menstrual hygiene management (MHM) is burdened with cultural taboo and myths. Girls are still excluded from school for as long as one month at their first menses.

USAID/SPLASH in Zambia address girls’ right to education by removing barriers to menstrual hygiene management in schools. SPLASH and the Ministry of Education research cultural norms, improve girl-friendly facilities and access to menstrual products, break taboos, and integrate MHM in the education system through water, sanitation and hygiene in schools

Menstruation is still a sensitive topic, but experience in Zambia has shown that taboos can break down rapidly and MHM can become a normal part of discourse around girls’ rights at local and policy levels.

 

Media Release and Registration for the SMCR Boston Conference.

 

“Menstrual Hygiene” Explored: Capturing the the Wider Context

December 9th, 2014 by Chris Bobel

This summer, I bought a new camera. I needed it to snap pictures during a research trip to India where I explored diverse approaches to what’s called in the development sector, Menstrual Hygiene Management (MHM). I chose a sleek, high tech device with a powerful, intuitive zoom.

Photo by author

In Bangalore, I captured the sweet intimacy of two schoolgirls as they watched the menstrual health animated video “Mythri” at a government school. In Tamil Nadu, I used my zoom for close shots of skilled women tailors sewing brightly colored cloth menstrual pads for the social business, Eco Femme.

Photo by author

In South Delhi, I used my zoom to preserve the mounds of cloth painstakingly repurposed as low cost menstrual pads at NGO Goonj.

But here’s the problem. These close up shots may please the eye, but they leave out the context that surrounds and shapes each photo’s subject. And what exists outside the frame is at least as important as what is inside. That’s hardly a revelation, I realize, but when it comes to doing Menstrual Hygiene Management work, in an effort to find solutions, the “big picture”—both literally and figuratively—sometimes gets obscured.

Photo by author

For example, when I snapped the picture of the mound of menstrual pads pictured here, I focused on a product, a simple product, that could truly improve the quality of someone’s life. But when I trained my attention on the product, what did I miss?

In short, a wider angle lens reveals the context of menstrual product access—a complicated web of many intersecting issues: infrastructural deficits (safe, secure, and clean latrines and sites for disposal), access to resources (like soap and water), gender norms, and menstrual restrictions rooted in culture or religion.

Imagine that one of brightly colored packages of menstrual pads ends up in the hands of a 15 year old girl. I will call her Madhavi.

Madhavi is delighted to have a dedicated set of her very own clean rags to absorb her flow.

Goonj worker with pads ready for distribution and sale
Photo by author

But does she have access to clean water and soap to wash them?

Does she have family support to dry her rags on the clothesline, in direct sunlight, even though her brothers, uncles, and neighbors will be able to see them?

Does she have a safe, secure place at school to change her rags?

Does she have someone to turn to when she has a question about her menstrual cycle?

These questions are important because they point to what gets in the way of effective and sustainable MHM. My own review of the emerging empirical literature on MHM revealed that the top three impediments to school girls’ positive and healthy menstrual experiences are 1) inadequate facilities 2) inadequate knowledge and 3) fear of disclosure, especially to boys. I want to focus on this last one for a moment by widening the frame a bit more.

Menstrual Hygiene Management is part of a complex and enduring project of loosening the social control of women’s bodies, of working to move embodiment, more generally, from object to subject status—something absolutely foundational to taking on a host of other urgent issues; from human trafficking to eating disorders to sexual assault.

As we know throughout the West, menstrual taboos do not disappear as we upgrade our menstrual care. Without the heavy lifting of menstrual normalization, any menstrual care practice will make a minimal impact.

Thus, menstrual activism must always incorporate an analysis of how gender norms maintain the menstrual status quo. And it must engage the potential of men and boys as allies, not enemies. That’s a tall order that cuts to the very core of gender socialization. But if we don’t take this on, no product in the world will be enough.

Anyone with a camera knows that framing a picture is a choice. Am I suggesting that we should never use the zoom, that we should forgo the rich and textured details possible when we tighten the shot? Of course not, as focus is crucial to our understanding. But when we do aim our figurative cameras and shoot, let’s not forget what lies outside the visual frame. Let’s not forget what else must change for the pad to be a truly sustainable solution.

With this in mind, I turn back to Madhavi and her new pads. Inevitably, even with them, one day soon, someone will know she is menstruating.

Will she be shamed? Will she be supported?

The answer lies in how we frame the picture.

This blog post appears on Girls Globe as part of a series of invited posts organized by Irise Interational.

Call for Abstracts for SMCR 2015 in Boston

September 25th, 2014 by Chris Bobel

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

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).

I do have to offer my negative reactions to this research as well, however: Whenever I see menopausal women picked out and studied specifically for their difficult symptoms, I worry about how those results will be used by others. Someone skimming the news reports might assume that this research shows that menopausal workers are harder to deal with, or aren’t ideal workers. So, let’s make sure we read this research appropriately: this research does NOT report that the quality of women’s work decreases when they reach perimenopause or menopause. This research only reports that women feel differently about their workplaces and sometimes wish their employers were more supportive of menopausal symptoms. If we don’t read carefully, then we might assume that being menopausal is more deviant than it really is. Working While Menopausal is not typically a negative status, or at least not for most women. Quick news reports also don’t always portray research in full, and I think it’s important to note that women are not always bothered by menopausal signs and symptoms. This was a study that asked primarily about women’s feelings about their workplaces and how health and wellbeing impacted work satisfaction. It is not a study that can give us comprehensive information about women’s menopause experiences. Finally, let’s remember that menopause is just one of many, many health and illness experiences that can affect how people feel and act on the job. Menopause is not necessarily a reason for employers’ alarm, any more than divorce or elderly caregiving or arthritis or back pain is. Rather, employers should be sensitive to the health and wellbeing of all paid workers across the lifespan and recognize that different groups of workers face different health and wellbeing issues.

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.

Understanding Research: (Meta)Theoretical Frameworks

August 19th, 2013 by Paula Derry

Research results are often reported by the media as stand-alone statements and as though they are facts. “Slim women have a greater risk of developing endometriosis than obese women.” “Respiratory symptoms vary according to stage of menstrual cycle.” In previous blogs, I have said that a reader needs to understand research methods and basic concepts found in statistics in order to make sense of what results really mean. This blog is about another ingredient that goes into making sense of research. Metatheoretical frameworks, basic ideas of how the world works, are important influences on how researchers choose what problem to study, choose the methods with which to study it, and choose how to interpret the results.

The context of research is always stated in research articles. Articles always include a write-up of previous work, discussing what has been done and what unanswered questions remain. This sets the stage for why the research being reported is interesting and important. However, what I want to discuss are more general, often implicit, basic assumptions. Even what seem to be brute facts are understandable as such only within a given set of basic assumptions or paradigms. Paradigms guide thinking, but change over time.

Thus, as discussed by Sheila Rothman, a  nineteenth century metatheory was that assertiveness and activity are dangerous for women. As stated in a more specific scientific theory: All people have a limited amount of nervous energy; this nervous energy is distributed over a greater number of organs in women than in men (because of their reproductive organs); therefore, all of women’s organs are more “sensitive and liable to derangement (p. 24).” It was concluded from these ideas that exercise and exertion are dangerous for women; further, mental exertion, such as going to college, should be avoided. Rothman describes case studies written up by physicians of women harmed by exertion and cured by rest. In this context, designing research to evaluate whether college harms women appeared to be a sensible, even important undertaking. So did structuring a college curriculum to avoid precipitating debility or insanity.

What are some of our current basic paradigms? One example: Menopause is senescence and reproductive physiology is central to women’s health. It follows from these premises that menopause or the transition to menopause are key factors in the development of chronic illness; research addresses what harm is created or, alternatively, whether these premises are correct. Another example: Cyclic changes in mood, intellect, and energy during different stages of the menstrual cycle are very important, especially to understand distress. Alternatively, a healthy menstrual cycle suggests that a woman is physically healthy.

Research I am conducting with Greg Derry addresses another metatheory about the menstrual cycle. Periods are most often described as cyclic, recurring in a regular repetitive manner (“every 28 days”). However, modern systems theorists know that there is a different kind of system (a “nonlinear dynamical system”) that by its nature generates a little bit of unpredictability and by its nature interacts with other systems (“is an open rather than a closed system”). Our research has provided evidence that the menstrual cycle is a nonlinear dynamical system. This means, among other things, that menstrual periods would be expected to be a little bit irregular with an occasional extreme cycle length.

The psychologist Robert Abelson reminds us that research is an ongoing process of discussion. Understanding research means joining the conversation.

Two stupid ideas about menopause, and one that makes sense

July 3rd, 2013 by Laura Wershler

Two new suppositions about menopause have been tossed around the media in recent weeks. They make for racy headlines but both, unfortunately, perpetuate the myth that menopause is a disease women need to be protected from.

Most recent was the assertion by researchers from McMaster University in Hamilton, Ontario, Canada, that menopause in women is the unintended consequence of men’s preference for younger mates.

Men to blame for menopause

The writer with her mother Erna Sawyer who turns 95 on July 20, 2013. Is menopause an “age-related disease” that science must figure out how to prevent or an evolutionary adaptation for longevity?

Evolutionary biologist Rama Singh, co-author of the study published in the journal PLOS Computational Biology, gave this explanation in a CBC news story: “What we’re saying is that menopause will occur if there is preferential mating with younger women and older women are not reproducing.”

The study used computer modelling to arrive at this hypothesis. Singh said that this “very simple theory”…”demystifies menopause…It becomes a simple age-related disease, if you can call it that.”

Well, no Mr. Singh, you can can’t call menopause a disease. I challenged this idea in response to the Canadian Heart and Stroke Foundation’s Death Loves Menopause ads in February 2012.

Yet there he is, hoping his work will prompt research on how to prevent menopause in women, helping us to maintain better health as we age. What does he really know about menopause anyway?

Another stupid idea about menopause surfaced in late May with headlines like: Women could evolve out of menopause ‘because it is no benefit to them.’

Women could evolve out of menopause

The story, covered by media everywhere, was based on comments by biologist and science writer Aarthi Prasad at the 2013 Telegraph Hay Festival, Britain’s leading festival of ideas.

The Daily Mail reported that if women evolve out of menopause we could then have children well into our 50s (But how many women want to?), and that “targeted gene therapies will be developed to treat the condition.”

We’ve been fighting the assumption that menopause is a “condition” that needs to be treated for decades, with members of the Society for Menstrual Cycle Research at the forefront of this assumption-busting.

Quoted in The Telegraph, Prasad also said, “What we think is normal is not normal for nature. If it is something not in all mammals, is it something necessary or beneficial for us? I do not see any benefits.”

Wow! Menopause is not “normal for nature.” But what about the argument made by doctors like Elsimar Coutinho who promote menstrual cycle suppression, who assert incessant ovulation (i.e. reproductive capacity) is not natural, normal or healthy in humans, therefore we should take drugs to stop it?

These doctors and scientists need to get on the same page. Which is it? Do we ovulate too much or do we not ovulate enough?

As for “no benefits” to menopause consider this: What if menopause is an evolutionary adaptation that works in women’s favor?

Do women live longer, healthier lives because of menopause?

An October 2010 story in The Calgary Herald - Why don’t monkeys go through menopause? - discussed the research of University of Calgary anthropologists Mary Pavelka and Linda Fedigan who’ve spent years documenting the aging and reproductive histories of Japanese female macaques.

Few study subjects lived past their reproductive capacity, about age 25, and those that did showed signs of serious physical deterioration. For these primates, retaining the ability to reproduce until late in life did not make them healthier. Fedigan noted that they were “crippled up with arthritis, their face is all wrinkled and their fur is falling out.”

The question, they noted, was why would human females lose their ability to reproduce in healthy middle age?

“One hypothesis is that it’s a byproduct of evolution for longevity in humans,” Pavelka said.

Now here’s an idea that makes sense. Think about it. Men produce sperm – albeit of dwindling quantity and quality – until they die; women transition to menopause and can live healthy lives for decades after. Women live significantly longer than men. Therefore, it’s reasonable to hypothesize that menopause supports longevity in women.

What Prasad proposes – doing away with menopause through natural or scientific means – could then be considered a devolution not an evolution.

As for Rama Singh and his research team, let’s give NPR writer Anna Haensch the last word on this silly, mathematically-determined, computer-generated hypothesis:

“What does this mean for us? Assuming this model is correct, if older women begin to eschew paunchy, balding partners in favor of younger mates, male menopause could become a reality in a few thousand years.”

Ethics in Wonderland: The SUPPORT Study

June 24th, 2013 by Paula Derry

Arthur Caplan is a well-known ethicist, the head of the Division of Medical Ethics at New York University’s Langone Medical Center. On June 11, 2013, Caplan posted an article called “Get real: No need to overdo risk disclosure” on the medical website Medscape. According to basic ethical standards, subjects in research projects are supposed to give written informed consent, which means among other things that they are informed of possible risks that a decision to participate in the study might cause. The Office of Human Research Protections (OHRP) of the U.S. Department of Health and Human Services criticized researchers in a large project called SUPPORT for failing to clearly disclose the study’s risks. In his Medscape article, Caplan disagreed with OHRP and argued that strict, inappropriate requirements for consent discourage important research. His sentiments were echoed in a recent editorial in the New England Journal of Medicine, a major respected journal. In contrast, SUPPORT is criticized in a New York Times editorial entitled “An Ethical Breakdown” and by watchdog organizations like the Alliance for Human Research Protection and Public Citizen (many of the critical documents are on the Alliance for Human Research Protection website).

Here’s some background: SUPPORT was a large study of how best to treat very premature babies. These babies often need to be given oxygen to help them breathe. However, if too little oxygen is given, there is a risk of death or brain damage; if there is too much, the babies may develop an eye problem called ROP or blindness. Enter SUPPORT. According to the researchers, their goal was to determine the best oxygen level to get lowest risk of blindness without increased risk of death. This amount had already been narrowed to 85% to 92% oxygen saturation (a measure of the oxygenation of blood) in medical practice; the researchers wanted to find out where within this range is best. Infants in the research were randomly assigned to experimental conditions; in one condition, babies were given enough oxygen to bring the oxygen saturation measure to the lower end of the range (averaging 85%); in the other condition, the higher end (averaging 92%). The researchers found that infants receiving less oxygen did, indeed, have fewer eye problems than did infants given the higher amount, but more of them died.

The critical letter from OHRP stated that the consent forms that the mothers of the babies signed should have clearly stated, but did not, that an increased risk of blindness (for babies in the higher oxygen condition) or death (for babies in the lower oxygen condition) was possible. The ethicist Caplan objected to this. He argued that the researchers were comparing two standard medical practices, since 85% to 92% is the standard range used by doctors. In his view, the current way that doctors decide how much oxygen to use within that range is “a coin flip”; randomly assigning babies to the experimental groups was simply comparing two treatment approaches currently in use to see which one is best and involved no increased risk than the babies would otherwise face. He distinguished this from studies that introduce a new treatment, where informed consent about risks is a different matter. Caplan stated: “I believe that this research is highly ethical” and expressed concern that overly strict rules will hinder needed research. The New England Journal of Medicine editorial also objects to the OHRP letter. The editorial states that the OHRP’s finding that subjects should have been informed of an increased risk of death was based on hindsight. The editorial quotes the researchers, who state that “there was no evidence to suggest an increased risk of death” for infants receiving the lower levels of oxygen before their study was done. The editorial states that OHRP has “cast a pall over the conduct of clinical research” and “strongly disagree[s]” with their letter. SUPPORT, in the editorial’s view is “a model of how to make medical progress.”

What is the controversy? First, with regard to the idea that what was being compared were two versions of standard care, although Caplan does not state this in his article, the OHRP letter specifically addressed this point. In real clinical practice, a range of 85% to 95% exists, but in this study only the extremes were used. As the letter states:

According to the study design, on average, infants assigned to the upper range received more oxygen than average infants receiving standard care, and infants assigned to the lower range received less. Thus the anticipated risks and potential benefits of being in the study were not the same as the risks and potential benefits of receiving standard of care.

Let’s Celebrate!

June 6th, 2013 by Alice Dan

Public domain photo by Jim Henderson // Creative Commons 1.0
http://commons.wikimedia.org/wiki/File:Marymount_dorm_door_231_E55_jeh.jpg

Today marks the start of Making Menstruation Matter, the 20th conference focusing on menstrual cycle research and women’s health. For 36 years, these conferences have been open to those interested in the latest information on menstrual aspects of women’s lives, from menarche to menopause. Not only scientists, but clinicians, educators, artists, writers, and interested members of the general public have contributed to our discussions and debates.

Since the first conference in 1977, the Society for Menstrual Cycle Research has been working to bring menstruation out of the shadows and to legitimize our concern with how our culture, medical and pharmaceutical industries, advertising, and educational efforts, have served women’s needs (or not).

Over the years, the disciplines involved in our work have broadened to include participants from around the world in fields including nursing and medicine, psychology and sociology, anthropology and communication studies, as well as the arts. The menstrual cycle is entangled in so many aspects of our lives—the personal is truly political!

It is especially appropriate to celebrate today, because we will be awarding the very first “Menstruation Matters Award” to our beloved feminist hero, Gloria Steinem! Her early article, “If Men Could Menstruate“, pointed out the entitlement that men would feel to honor their bodies. Somehow, this normal female experience has been shamed, devalued, and medicalized—girls learn at an early age not to value our amazing bodies. Recent research shows how empowering it can be for girls to get to know their bodies, to chart their cycles, and to trust their own experience.

Pediatricians have begun to recognize that menstruation can been seen as a “vital sign” or indicator of healthy functioning. Absence of menstruation can be related to dietary or exercise practices that will harm bone development in young women, or to other problems of our reproductive systems. Recognizing these problems early is important to preventing future disease or disability.

Menstrual myths are rampant in our social discourse, and it is often difficult for girls and women to know what’s really true about our menstrual cycles:

Questions like these have inspired our research over the years, and discussions of them can be found at conferences like the one beginning this evening. We are always pleased to nurture the research of our students, and we award prizes for student research in memory of some of our founding mothers.

Members of the Society have contributed greatly to healthy practices for women:

  • through advocacy with tampon manufacturers and the FDA to standardize tampon absorbancy labeling;
  • through supporting and participating in the Women’s Health Initiative, research that showed the harmful effects of longterm hormonal therapies for postmenopausal women;
  • through questioning all the negative views of hormonal changes, as if a biological rhythm is somehow unusual in our lives.

More information about positions that the Society has taken on issues such as terminology used for the menopausal transition or use of cycle-stopping hormonal drugs by young women, see the Society’s website, where you can also find information about past conferences, publications, and members of the Society.

And join us, either online, or tonight at Marymount Manhattan College, for the celebration!

Averages

May 27th, 2013 by Paula Derry

Articles in the media often report research results with a number, for example the number of hot flashes per day or the severity of menstrual cramps.  However, these are not facts in the way that “man bites dog” would be a fact.  In part, this is because the numbers in research reports often are averages.   Averages are useful summaries, but they also leave out a lot of information.  Take shoe size.  If the average woman’s shoes are size 7, this does not mean that all women are size 7.   It does not mean that a woman whose feet are size 8, 9, or 10 is abnormal or has a problem.   At some point, a very large or small foot could mean that someone has a problem, but knowing where to draw the line requires knowing a lot more than the statistics.  It means knowing something about the biology and biomechanics of feet.  It means knowing about the context—for example, is a woman who wears a size 11 shoe five feet tall?  or seven feet tall?   This is different from a situation where numbers have an absolute meaning.  For example, if my temperature is 102 degrees, then I have a fever, because of the realities of the biology of my body and not because of what most people’s average temperature is.

Image created by Paula Derry

What is an average?  There are a few common ways of computing this. The median is the score for which half of the people being studied have higher scores and half lower. If the scores of all of the people being studied are added together and then divided by the number of people, this gives us the mean.  The standard deviation is a number that indicates variation around the mean.  If whatever is being measured has what is called a “normal distribution” (which is most often assumed) then over 68% of measurements will be within one standard deviation, and over 95% within two standard deviations of the mean.

Take osteoporosis and osteopenia.  Osteoporosis is a bone disease that typically develops in old age in which bone is fragile and more likely to fracture [pdf].  This has been defined as a bone density measurement that is more than 2.5 standard deviations below that of an average 30-year-old woman.   Osteopenia is having bone density that is not thin enough to be osteoporosis, but thinner than “normal,” and is defined as bone density 1-2.5 standard deviations below that of a 30-year-old woman. These definitions are statistical, i.e., different from an average (young) woman. Sometimes women are told that they have bone disease based on these definitions.  With regard to osteopenia, the assumption is that this is an early stage of disease that will get worse over time and become osteoporosis.  Sometimes women with osteopenia are advised to use a medication to prevent the disease progressing.  However, these statistical definitions have been controversial.  For example, other doctors assert that it is normal for bone to thin as women age and that only a small percentage of women with osteopenia go on to get osteoporosis.  Some doctors believe that a diagnosis of osteoporosis itself requires more than low bone density—for example, that a woman has had a bone fracture or that other indications exist.

Or take the number of days in the normal menstrual cycle.  The stereotype is that the average menstrual cycle is 28 days long and that regularly recurring cycles are what is healthy.  A study published in 1967 by Treloar and colleagues presents some of the complexities that this stereotype ignores.   Assuming that there is one average menstrual cycle length for all women leaves out important information about changes that occur over time, across a woman’s adult life.  The average cycle length when a large group of women were studied was indeed 28 to 26 days (median length). However, this was for women aged 20-40. During the first few years after menarche and the last few years before menopause, median cycle length was over 30 days. Even more striking is the amount of variability from one woman to the next, and how this variability changes over time.  Among 20-year-old women, for example, the cycle could be anywhere from 24 to 38 days, or occasionally less or more.  However, the first year that periods began, these differences between women were larger—cycle length was between 18 and 83 days. Variability between women decreased for about eight years, but, as I have said, even when women were most similar (at ages 20-40) there were still big differences among them.  Variability increased again about eight years before menopause; the last year before menopause, women had cycle lengths from 18 to 80 days.  An individual woman’s cycle lengths changed over her life span; further, cycle lengths varied from month to month as well as over a span of years in ways that were very different for different women.

Averages have useful information.  However, it’s always important to know what the numbers mean in order to interpret them.  This is important for knowing what an average means, and it’s always important to remember that an individual’s reality may be very different from the picture derived from finding an average for a large group of people.

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.