Blog of the Society for Menstrual Cycle Research

Obvious Child: The Other Taboo

June 18th, 2014 by Holly Grigg-Spall

cervical mucus

 The recently released rom-com ‘Obvious Child’ has been discussed far and wide for its mature, sensitive and funny approach to the topic of abortion and yet I have not seen one comment on the fact that this movie also makes mainstream (and yes, funny) the topic of cervical mucus.

In the opening scene stand-up comedian Donna (played by real-life comedian Jenny Slate) is performing on stage at her local open mic night. She wraps up with a joke about the state of her underwear and how, she describes, her underpants sometimes look like they have “crawled out of a tub of cream cheese.”

She claims that they often embarrass her by looking as such during sexual encounters, something she feels is not sexy.

Of course, by “cream cheese” I immediately assumed Donna meant cervical mucus. Unless she is supposed to have a vaginal infection – which seeing as it is not discussed amongst the other myriad bodily function-centric conversations in the movie, I doubt to be the case – then it’s clear she is detailing her experience of cervical mucus.

Later on that night, when Donna meets and goes home with a guy, has sex and then wakes up in bed with him the following morning, she sees that her underwear is laying next to the guy’s head on the pillow. Not only that, but this is one of those situations she finds embarrassing as the underwear is actually covered in the aforementioned “cream cheese” or cervical mucus. She cringes, retrieves the underwear and hastily puts it back on under the covers.

At this scene we can assume that the presence of visible cervical mucus indicates that the character is in fact fertile at this time during the movie. Even if we didn’t know this movie was about unplanned pregnancy, perhaps we would know now. Apparently Donna is not on hormonal birth control, and she’s not sure if, in their drunkenness, they used a condom properly. So, I speculate, if Donna had known she was fertile and that the “cream cheese” in her underwear was actually one of the handy signs of fertility her body provides, then she may have taken Plan B and not had to worry about an abortion. But, then, of course, we wouldn’t have had the rest of this movie. We would have had a very different movie – a movie someone should also make.

But it goes to show how some body literacy might go a long way in helping women make more informed choices. The abortion sets her back $500 and causes some emotional turmoil. A dose of Plan B is cheaper and easier to obtain, although not without some side effects. Maybe even, we can speculate, if Donna had known she was fertile she might have avoided PIV sex that night.

It’s great to see a movie approach the choice of abortion as though it really were, well, a choice. But isn’t it interesting that in doing so it shows how women can be hampered in their choices by a lack of body literacy?

We often see women in movies discussing their “fertile time” in regards to wanting to get pregnant – and so meeting their husbands to have sex at the optimum time in usually funny, crazy scenarios. Sometimes we have seen women taking their temperature or using ovulation tests and calendars to figure this out. However, I think this might be the first mention of cervical mucus in cinema.

I had the honor of seeing this movie with longtime abortion rights and women’s health activist Carol Downer and getting to discuss it with her after. Carol pioneered the self-help movement and self-examination, adding much to our collective knowledge of our bodies.  

This is what she had to say:

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

I’d given up reading the comments on online articles for the good of my mental health when a small slip last week steeled my resolve. In response to an article exploring the arguments made by “birth control truthers” a concerned father decided to have his say, taking the defensive arguments put forward by those in opposition to these “truthers” to their only logical conclusion:

“Perhaps we should market contraceptive pills as hormonal supplements to reduce cancer risk instead of as “contraception”? After all, it is only in modern times that women have hundreds of menstrual cycles throughout their lives. Even up until 1800 it was common for women to be either pregnant or lactating throughout much of their short lives.

The body simply wasn’t built to handle so many menstrual cycles, which raises the risk for cancer.

Who could argue with taking supplements to prevent cancer?

This may sound strange, but I am seriously considering putting my 11 year-old daughter on the pill (with no placebo) just for the health benefits. I just have to convince my wife first who is a little shocked by the idea…”

I cannot count how many times I have heard that the birth control pill “prevents cancer” – specifically “preventing” ovarian and endometrial cancer.  In the last few months I have seen references to this benefit explained less and less so as a “lowered risk” and more and more so as a “preventative” action.  I think this is significant as the word “prevent” suggests that the pill guarantees you will not get these forms of cancer. And yet, to remark that the pill is counted as a carcinogenic substance by WHO – due on the increased the risk of breast and cervical cancers – will get you tagged as a “truther.”

What is interesting, of course, is that despite the “cancer protecting” benefits of pregnancy, and early pregnancy at that, we do not see women encouraged to get pregnant in order to lower their risk of ovarian cancer.  Criticism of child-free women does not generally include comments about their lax attitude towards their own health. The risk goes down further with every pregnancy and further still with breast feeding, especially breast feeding for a long period of time after birth. Women who have children young, and multiple children, have a lower risk of breast cancer than women who have no children or children after 30. Yet we see more talk of women having “too many” children at an age that is “too young” – in fact I was contacted via Twitter by someone who read this piece and who saw, in the comments, that one woman who uses natural family planning admitted to both liking the method and having 14 children. This admission disgusted the person who contacted me, even when I pointed out that it seemed the woman had very much chosen to have those 14 children.

It seems the people who are advocating prescription of the pill for cancer prevention purposes are not advocating women have children earlier, more children, or consider breast feeding for the good of their own health – in fact two of the loudest critics of my “birth control truther” book are vehemently against pregnancy and breast feeding being part of women’s lives (Amanda Marcotte and Lindsay Beyerstein). The risks of the pill are frequently compared to the health risks associated with pregnancy and child birth,  but we don’t often hear women say they are choosing to not have children to avoid putting their health at risk for nine or so months.

Which leads me to this article in the LA Times that suggested nuns should also be on the birth control pill for its cancer-protecting abilities:

“And are the pills really unnatural? Our hunter-gatherer ancestors had their babies four or five years apart, because of long intervals of breastfeeding. As a result of that and their shorter life spans, they had as few as 40 menstrual cycles in a lifetime, while a modern woman can have 400. Though we can’t claim that today’s pills are perfect, their use is certainly less unnatural than enduring the hormone turmoil of hundreds of menstrual cycles.

The Big, Fat, Menstrual Untruth in Cameron Diaz’s The Body Book

February 5th, 2014 by Laura Wershler

I was curious. If Cameron Diaz’s purpose in writing  The Body Book: The Law of Hunger, the Science of Strength, and Other Ways to Love Your Amazing Body was empowerment, helping women to understand how their bodies work, would she include information about the menstrual cycle?

There was no way of knowing from her Jan. 22, 2014 radio interview with Jian Ghomeshi on CBC’s Q. I listened to Diaz explain that conversations she’d had and overheard in the last few years made it clear to her that women are completely confused about their bodies. She said this had her thinking, “Wow, that’s such a crazy thing that after so many years of living in your body that you actually don’t have an understanding of it.”

Then she revealed her intention in writing the book – to empower women to make “informed decisions about their nutrition and their physical activity.” Judging from this comment, the book’s subtitle, and the fact she did not mention menstruation during the interview, I wondered if the menstrual cycle would even be mentioned.

I sought out The Body Book at my local bookstore and quickly scanned the table of contents and index. I found myself smiling, thinking about Betty Dodson, author of Sex for One: The Joy of Selfloving, and how she revealed in Chapter 1 that whenever she gets a new sex book she “immediately” looks up “‘masturbation’ to see where the author really stands on sex.” Whenever I see a new book about women’s health I look up “menstruation” to see what the author really knows about the menstrual cycle. Turns out Diaz, and/or her co-author Sandra Bark, know both a lot and not so much.

In Chapter 21, Your Lady Body (the book’s introduction starts with the salutation Hello, Lady!), she presents a fairly accurate endocrinological description of the three phases of the menstrual cycle: follicular, ovulatory, luteal. So far so good. But then, in the last paragraph of the luteal phase section, comes the big, fat menstrual untruth, the implication that whether you use hormonal birth control or not, this is how your menstrual cycle unfolds. It’s an absolute falsehood, and one that many women in this age of burgeoning body literacy are sure to see through.

Photo Illustration by Laura Wershler
Note: This is the only reference to contraception in The Body Book

The last paragraph of this luteal phase description (page 182) is ridiculously misleading. If a woman’s birth control method is the pill, patch, ring, implant or (Depo-) Provera shot, the synthetic hormones each contains will shut down her normal menstrual cycle function. She most definitely will not experience a cycle with follicular, ovulatory and luteal phases. Hormonal contraception does not “protect” her eggs. She will not ovulate, therefore the egg will not die. She may have a “withdrawal bleed” but it is not a true period. This is the truth.

I can understand, possibly, why Diaz made this egregious implication. What were her choices? Open a can of worms? State categorically, as every description of menstrual cycle function should, that you don’t ovulate or experience a normal menstrural cycle while taking hormonal contraception? 
Maybe something like this?

Hey Lady! If you use hormonal birth control none of this fascinating menstrual information applies to you. Wish I could tell you what this means for your health and fitness but, sorry, that’s beyond my area of expertise.

If Diaz’s intention for this book is to empower women to better understand their bodies, then she failed when it comes to the menstrual cycle. I hope she’ll correct this big mistake in any future editions.

Food. Fashion. Blood?

January 10th, 2014 by Laura Wershler

A month ago I was musing about what it might be like to blog about fun stuff like food, fashion or travel – you know, topics not quite so “fraught” as the menstrual cycle. Sometimes it feels like just so much work sharing facts and opinions about why body literacy matters, why knowing how our cycles work and how ovulation impacts our health can lead us into meaningful, self-determined relationship with our bodies and ourselves.

But in the days leading up to Christmas, I was reminded by two young women, both of whom I’ve known since they were babies, daughters of friends, one in her late 20s, the other in her early 30s, why I do what I do.

Photo by Laura Wershler

The younger had contacted me last September, at the suggestion of her mother, with questions about switching birth control methods. She was fed up with the Pill, wanted to quit, was considering the Mirena IUD, told me about her history with ovarian cysts, irregular cycles. In a stable relationship, she hadn’t thought much about children. We talked about options. I assured her there were effective non-hormonal methods she could use, that by doing so she could assess her fertility, get her cycle functioning normally before making a decision about the Mirena. I sent her information about treatment – not involving hormonal contraceptives – for ovarian cysts; I asked a medical colleague questions on her behalf. She was thankful, emailing me that she had “some heavy thinking to do, including my actual timeline for children.”

I hoped to see her at her family’s annual Christmas party. We greeted each other briefly when I arrived, but not until the house was teeming with guests did we have the chance to talk privately amidst the holiday din. She told me she’d stopped the Pill three months before, could hardly believe how much better she felt, even though she’d yet to have a period. She thanked me, again, for validating her desire to quit the Pill. It so happened she had an appointment the next day with her family doctor; she knew what treatment she would request to help get her cycle started.

It did not go well. Her doctor, like so many I’ve heard about, was not interested in the menstrual cycle research she had done or the choices she wanted to make about her reproductive health. Quite the contrary: her doctor was hostile. It was disheartening for her, maddening to me, but not surprising.

A day later, at another holiday gathering, the other young woman stopped me in the hall to ask what I thought of the Mirena. She’d made the switch from the combined Pill (estrogen/progestin) to a progestin-only version to help with migraines. She offered that she and her partner had not yet decided about children, but she was concerned about leaving it too late. I told her the Mirena was intended as a five-year method, and if she was thinking she might want a child, it was a good time to stop hormonal contraception and assess her fertility before making a decision, either way.

I forwarded both women links to a naturopath skilled in menstrual cycle and fertility issues, and to a fertility awareness instructor who’d just announced her 2014 Eco-Contraception Program. The decision about what to do next, of course, will be theirs.

I sense both young women are searching for new, mindful connections to their bodies. Even if all I ever do is help a few such women find the support they need to make this connection, then to hell with food and fashion, I’ll keep writing about the menstrual cycle.

Etiquette for menstruation

November 19th, 2013 by Holly Grigg-Spall

Photo courtesy of sweeteningthepill.com

Recently I was fortunate enough to be asked to lend an excerpt of my recently released book to the UK Sunday Times Style magazine. The mostly fashion-centric Style magazine is not really known for its edginess or risk-taking (except perhaps in the realm of shoe and make-up choices) and so I was happily surprised when the editor told me that the subject matter discussed in my book that she happened to find most interesting was, in fact, menstruation. I had expected her to want to focus on condoms perhaps, or just my personal story, but no, she was keenly interested in what I wrote about periods.

The argument I make in my book is that how we feel about hormonal birth control is inextricably linked to how we feel about menstruation. In a sense, many of the newer methods of hormonal birth control, as well as the newer uses (running packets of pills together, prescriptions for cramps or heavy bleeding) show an effort to get rid of the period completely, rather than just hide it away. I also discuss in the book, briefly, menstruation activism. However, I do defer to the far better work done by the likes of SMCR’s own Chris Bobel who writes on this topic with far more knowledge (not to mention wit).

You can read the feature in full here at my website (it’s otherwise behind an online pay wall and frankly I’m pleased to rob Rupert Murdoch of a few pounds by making it freely available).

In the end, the feature was not exactly an excerpt from my book – more so it was quotes from the book mixed with quotes from a long interview with the editor. Therefore I didn’t quite know what would be published in the magazine. The finished piece covered a range of controversial topics seen here at re:Cycling regularly – menstrual outing, reusable femcare products, the potential health benefits of ovulation…

If the high point of my career was getting the word “patriarchy” into the notoriously right-wing British tabloid The Daily Mail, I think I had another peak seeing this sentence in the Style (notorious for its high priced designer fashion spreads) – “This movement believes the act of stopping and hiding our periods with hormonal contraceptives and sanitary products is a mark of corporate ownership of our bodies.” I take great pride in also getting a discussion of menstrual extraction on to Style’s pages, and therefore onto the breakfast table of approximately one million British people – “an entire period’s worth of menstrual blood could be removed in a few hours instead of being experienced over days.” Well, if we can have Page 3, why not menstrual extraction?

The editor who did such a great job on this piece was Fleur Britten and in a funny twist of fate I realized, during our conversations, that in my first full time working position after college, at the publishing company Debrett’s in London, I worked as a production assistant on one of her books – Etiquette for Girls. At that time controversy surrounded Fleur’s section on the proper etiquette for one-night stands (I think it was something about getting out quickly, quietly, but leaving a nice handwritten note). So, it made me smile to see her skewer the etiquette of menstruation in the opening paragraph of this piece: “Many women are bored with having to take a whole handbag into the ladies rather than carry a tampon in their hand. Men say “I’m going to take a dump,” but we don’t say, “I’m just going to change my tampon.””

When I was carrying the proofs of Fleur’s book to the printers back some seven years ago, little did I know we would be conspiring to get the British public to say “I am menstruating” today over tea and toast.

“Prescribing the pill has become ‘standard-of-care’ for being a girl”

October 16th, 2013 by Laura Wershler

I had the privilege of writing the foreword for Holly Grigg-Spall’s recently published book Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control. It’s astounding to me that more than 30 years ago, before Holly was born, I was asking some of the same questions she explores in her book. I thought we’d have more answers by now, but one thing is certain: Holly’s book has prompted long-overdue discussion and debate about issues related to hormonal birth control. Below is my foreword to Sweetening the Pill.

………………..

In a letter dated March 22, 1980, I proposed to the editor of an American woman’s magazine that they consider my enclosed article: The Contraceptive Dilemma – A Subjective Appraisal of the Status of Birth Control.

I wrote:

“Recent articles (about birth control) deal almost exclusively with the basic pros, cons, and how-tos of the various contraceptives available – matter-of-fact discussions that reduce birth control to a mere pragmatic decision. If only that were the case. 

Contraception, like the sexual interaction that necessitates it, involves our emotions as much as it does the facts. Yet the subjective, personal aspect of contraception is so often ignored. In this age of scientific research we are expected to (subjugate) our emotional reactions to significant probabilities, our anger to logic. Very real fears and earnest questions are dismissed as irrelevant….”

Although today I wouldn’t use the phrase “emotional reactions,” it’s hard to believe that three decades later, the status of birth control and women’s relationship to it has not much changed. Websites, not magazines, now host information about the basic pros, cons and how-tos of available birth control methods. And it is writers like Holly, half my age, who honour women’s real fears and ask earnest questions that are still being dismissed as mostly irrelevant.

Just as my personal story with the pill – including over a year of distressing post-pill amenorrhea – set me on a course of research and advocacy, so too has Holly’s personal experience. Sweetening the Pill explores and challenges the ways in which the pill and other drug-based contraceptives damage women’s health, threaten our autonomy and thwart body literacy. What we don’t know about our bodies helps pharmaceutical companies “sell” their contraceptive drugs, and keeps us “addicted” to them.

At some point between my first attempt at non-hormonal contraceptive advocacy and Holly’s exploration of how we’ve become hooked on hormonal birth control, something disturbing transpired. Prescribing the pill, or other forms of hormonal contraception, has become, in the minds of most health-care providers, the “standard of care” for being a girl. It is all too common to subjugate a girl’s menstrual cycle to synthetic hormones that superficially “regulate,” but actually suspend the maturation of her reproductive system. And for many girls, the use of hormonal contraception continues well into their 20s, without awareness of what might be or has been sacrificed.

There are many women like Holly who are fed up with hormonal birth control. I’ve met scores of them during my 30 years involvement within the mainstream pro-choice sexual and reproductive health community, the one that prides itself on inclusion and diversity. Yet I’ve been unsuccessful in my constant advocacy for this community to accommodate a more inclusive, diverse approach to contraception, to provide acknowledgement, support and services to women who cannot or do not want to use drug- or devised-based methods. We pay lip service to the idea, but the message we convey is: “You’re on your own.”

I’ve found enthusiasm in other realms for my menstrual cycle advocacy and my belief that many women want to, and can, learn to use non-hormonal methods effectively and confidently. I’ve found scientific evidence of the value of ovulation to women’s health and well-being.

I’ve read, met or worked with several of the sources included in this book. Many have devoted their careers to understanding women’s bodies and our relationships with our bodies in ways the medical mainstream typically ignores and barely comprehends. They have made contributions that help us imagine a different way of thinking about fertility, contraception and our menstrual cycles in relation to our sexual, reproductive and overall health.

A Review of Selene: A New Cycle-Tracking App

September 2nd, 2013 by Chris Bobel

Guest Post by Amy Sedgwick, HRHP, Red Tent Sisters

Screenshot of Selene app // Photo courtesy of daringplan.com/selene

While there are no shortage of apps designed to help women track their periods, finding an app that meets the needs of women who are practicing fertility awareness methods (FAM) for birth control or conception can be quite a challenge. As a teacher of the Justisse Method of Fertility Management (there is currently no app available but there is one in development) I am often asked by my clients about web-based solutions to tracking their cycles when they are travelling or find themselves in other situations where their physical charts are impractical. Fertility Awareness users will be pleased to know that there is a new app on the market, Selene, which has been developed with FAM in mind. In addition to being able to chart the standard fertility markers (cervical mucus, cervical position, and basal body temperature), Selene boasts loads of unique features like the ability to make note of the things that affect reliability the most – like sickness, travel, and disturbed sleep. Selene also allows the user to define their own markers to track patterns in health, mood, libido, and more. The chart tab of the app shows you your cycle in a graph format, while the calendar tab displays it from a monthly perspective. Some of the other highlights of the app include a description of the daily moon phase, an automatic luteal phase calculator, the ability to ask questions about your chart in the “Ask an Expert” section, and a detailed instructions and help section. Selene excels at utilizing the principles of the widely-used fertility awareness method taught in Taking Charge of Your Fertility. Using principles from the book, the app will shade out days of predicted fertility based on the information you enter. It will also calculate an ovulation prediction based on the average length of your cycles. The app highly encourages users to seek additional support and education for their fertility awareness practice, particularly if they are using it for birth control. While Selene offers the most nuanced approach to menstrual cycle charting that I have thus seen (although I can’t claim to have evaluated all the apps on the market), one feature I would like to see added in future versions is the ability to manually choose whether a day is considered fertile (i.e., as indicated by bold stripes on the calendar view) so that those schooled in other approaches to fertility awareness, like the Justisse Method, could have the option of applying our own rules and calculations overtop of the calendar view. The only other critique I have of Selene is that the developer has chosen a dark navy background, which I personally find difficult to view. I’d prefer to see them use a colour scheme that is brighter and easier to read. I am grateful to Selene’s creators for being so thoughtful, thorough and conscientious in the creation of their app. I look forward to seeing what enhancements and updates they integrate into future versions.

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.

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

April 11th, 2013 by Laura Wershler

Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist

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

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

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

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

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

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

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

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

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

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

LW: What about headaches and depression?

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

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

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

I am a pro-choice menstrual cycle advocate

January 9th, 2013 by Laura Wershler

As 2013 begins, I give thanks to each and every one of my colleagues at the Society for Menstrual Cycle Research and all my blogging buddies at re:Cycling. Without them I’d feel left out in the cold.  

Are menstrual cycle advocates left out in the cold? Photo by Laura Wershler

I’ve been a menstrual cycle advocate since 1979 when, during a year of post-pill amenorrhea that totally freaked me out, I began to research the ill effects of hormonal contraception. It is not an understatement to say that reading  Barbara Seaman’s national bestseller Women and The Crisis in Sex Hormones changed my life. It started me on a path of self-discovery, and commitment to the idea that healthy, ovulatory menstruation is integral to women’s health and well-being. If you don’t know about Barbara Seaman and her work in women’s health activism, please read about her.

My menstrual cycle advocacy took what could be considered a counter-intuitive path. I aligned myself with the pro-choice sexual health community, committed to comprehensive access to sexual and reproductive health information, education and services. I’ve been as much a contraception and abortion rights advocate over the last three decades as I’ve been a menstrual cycle advocate. But I was a successful user and ardent advocate of the fertility awareness method long before I became a board director at the pro-choice Calgary Birth Control Association in 1986. I went on to serve 10 years on the board of Planned Parenthood Federation of Canada and worked for six years as executive director of Planned Parenthood Alberta, which became Sexual Health Access Alberta in 2006. I’m currently on the board of Canadian Federation for Sexual Health, the former PPFC.

I stress my pro-choice credentials because I think I’m often suspected of being anti-choice. Surely any woman who advocates for healthy, ovulatory menstruation and speaks out against the health concerns inherent in hormonal birth control methods must be anti-contraception and anti-choice. I am neither. More broadly, I’ve written and talked a lot about the value of body literacy for women’s health and well-being.

I wonder sometimes why I’ve stuck it out with the pro-choice sexual health community. While many have been open to my ideas, I have seen little effort to learn about the health benefits of ovulatory menstruation or acknowledge the need – let alone act – to better serve women who want to use non-hormonal contraception. It’s frustrating to be a lone voice, but I keep talking.

It took me over 20 years to find the community that serves and appreciates my menstrual cycle advocacy. I attended my first Society for Menstrual Cycle Research conference in 2005, and that’s how I came to belong to this diverse group of academics, medical professionals, researchers, activists and artists committed to advancing knowledge and awareness of the menstrual cycle. We come from different perspectives, we ask different questions and we focus on different aspects of women’s menstrual lives. But we all hold true to the same idea: #menstruationmatters.

Menstrual cycle advocacy can be lonely and oh so frustrating. Chris Bobel’s recent post about how difficult it can be to help others make the menstrual connection included this quote from me:

Caring about menstruation and the menstrual cycle makes me almost a freak in the pro-choice world. I get ignored or criticized a lot because people don’t want to ask or answer some of the questions I keep trying to pose about choice around non-hormonal contraceptive methods. 

Thanks to SMCR and re:Cycling, I’m not going to stop asking hard questions, or challenging the ignorance and avoidance that many in the mainstream sexual health-care community demonstrate when it comes to ovulation, the menstrual cycle and fertility awareness. I’ll keep chirping and chipping away.

How to Make Sure Your Period is Never “Late”

November 20th, 2012 by Kati Bicknell

Have you ever been concerned because your period was late? I know I have. But I’m not anymore! And you don’t have to be either! And since I’m sure you’d rather not spend several days every month nervously pacing and counting dates backwards on your hands while glaring at the general vicinity where you guess your uterus is, I’ll tell you how.

It’s simple:

LEARN ABOUT YOUR BODY!

Your period is not a Rolex watch; it was not specifically crafted in Switzerland to accurately tell time. A woman’s reproductive system is designed to … wait for it … reproduce! It takes into account all kinds of things when determining whether or not “now” is a good time to try and have a baby, and not ONE of those things is what day it is.

“Oh rats! I’m late for … uh … me ….”  This is something your period will never say. Think about it for a second. Your period is late? For what? For itself? Do you see how insane that is?

Whether or not, and when, a woman gets her period each cycle depends on a slew of hormonal events, which can be influenced by many things, such as diet, environmental and emotional stress, and on and on.

So let’s take things from the top and see why you think your period is “late,” shall we?

To begin, there is a theory that all women used to cycle with the moon. They would ovulate at the full moon, and they got their period with the new moon. But there is some evidence that suggests that the amount of ambient light in your bedroom while you’re sleeping at night can influence your cycle, in the same way that the moon supposedly did.

So if we are basing the notion of a “standard 28 day cycle” off when we used to cycle with the moon, we’re all pretty much screwed! Think of your bedroom — your alarm clock, a charging cell phone, a streetlamp, a light from under the door because your roommate is on another ‘Friday Night Lights’ bender: most of us do not sleep in a room where the only light is moonlight.

To further confuse matters, women who are on the pill “get their period” at around the same time every month, but anyone who knows anything about the pill knows that is not an actual period. It’s a bleed caused by the body’s withdrawal from progesterone on the week of placebo pills.

So we’ve got these two things that mislead women into thinking that their cycle should be 28 days.  One of my colleagues who has been teaching the Fertility Awareness Methodfor years says that she’s never had a client whose cycle was the same exact length every single time.

Sample chart for Example 1
© Kindara, used with permission


Period not arrive when you thought it would? Let’s take a look at your chart, it could be several things:

If you actually learn about what is going on in your body each cycle, and chart your fertility using the symptothermal method, you will be able to see and understand what is actually happening with all your heretofore “mystery bits.”

1. You haven’t ovulated yet, which means that a period is a ways off.  You might experience breakthrough or withdrawal bleeding later, but this would not technically be a true menstruation.

 

Sample chart for Example 2
© Kindara, used with permission

2. You ovulated and are currently in your luteal phase, which appears up until now, to be of a normal length.  Depending on how long your luteal phases typically are, you could have a better idea of when to expect your period, and if that day passes with no period, let’s see what’s behind door number 3.

 

 

 

 

3. You ovulated and are currently in your luteal phase, which appears to be longer than normal, which could indicate pregnancy.  (Or in very rare cases, a luteal cyst.)

Sample Chart for Example 3
© Kindara, used with permission

You see, there is always a reason that your period has not come yet, if you’re waiting on it. Certainly, you could say I’m just arguing semantics, but the truth of the matter is that your period is never “late,” it is doing exactly what your body is telling it too. The trick is to understand your body, rather than blame it and stare wistfully up at the moon, hoping it will work its sweet, sweet magic on your uterus.

 

Chart your cycle, and you’ll always know what the deal is.

Doooooooo it.

Editor’s note: Click on images to view at full size.

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.