Blog of the Society for Menstrual Cycle Research

Male Menopause, Andropause and now “Manopause”?

August 22nd, 2014 by Heather Dillaway

August 18, 2014 cover of TIME magazine

By now, everyone has probably seen this week’s TIME cover story. The magazine’s August 18th cover photo showed a topless, seemingly frumpy, middle-aged man worried about his loss of testosterone and (therefore) manhood under the title, “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry”. The cover story details the booming testosterone (“Low-T”) industry in the U.S., describing the reasons why middle-aged men might go to the growing number of Low-T clinics for treatment. While the article draws some interesting parallels to the hormone therapy industries that have targeted women and highlights some of the important risks and unknowns about Low-T treatments, there are some interesting gaps and missteps in the article that are worth detailing.

First, if we are going to talk about a male menopause, can we please pick one term? This author of this article refers to male menopause, andropause, and then titles his article “manopause.” So, which is it? Having all of these terms floating around is just confusing. As we know from research on women’s menopause, having more than one term or having vague terms for a health condition just leads to confusion. This article adds to the confusion over terminology.

Second, the article is titled “Manopause” but really has little to do with this supposed testosterone “deficiency” condition. The article is mostly about the growing Low-T industry and men’s search to remain youthful. It is more about potential treatments for testosterone deficiency than anything else. Anyone looking for information on what “manopause” is would be misled by the title and would not find any answers in this article. At most, readers learn that men who are worried about aging might have low testosterone. Readers will not gather comprehensive information about manopause, andropause, male menopause, or male aging.

Third, this article only addresses research on testosterone “deficiency” in a cursory manner. Readers looking for actual evidence of decreasing testosterone in midlife or the need for Low-T treatment should make sure to consult scientific studies of such things. Since this is TIME magazine, this is not a source of any real information on these subjects. As another commenter reports, the author’s reference to “foggy science” is also misplaced; while we do not have complete answers, there are real studies to be found on this subject.

Fourth, there are comparisons made to women’s menopause, hormone therapy for women, and how women handle their midlife transitions in this article. While it makes sense to compare endocrinological changes in women’s and men’s bodies and burgeoning hormone replacement industries for midlife women and men, comparisons about how women and men “handle” their midlife transitions are a bit misplaced and subjective here. The author states that “women handle their [bodily] betrayal more matter-of-factly – a nip, a tuck, a tint, maybe, but not a Vegas condo”. The author argues that, “judging by the demographic profile of sports-car buyers,” men don’t deal well with testosterone deficiency and bodily change. As someone who has studied women’s bodies and women’s menopause for almost 20 years, I think this comparison masks the variation in how women or men might experience these transitions and reifies gender dichotomies that help no one in the long run. Women DO have trouble with bodily change at times. And the majority of men still forgo Low-T treatments. The author would have done better if he had steered away from these gendered generalizations about how individuals “handle” midlife.

A commenter at HealthNewsReview.Org asks, Does Manopause Really Warrant one of TIME’s 52 Covers This Year? This is a great question. The power of pharmaceutical industries in this country means that topics like this get more press than is probably warranted (especially in light of all of the topics that could have had this front page, such as Ebola, Ferguson, Parkinson’s or ALS disease, foreign conflicts, etc.). Some scholars argue that we are experiencing the “pharmaceuticalization” of society, which puts industries like the Low-T industry front and center and makes us think in terms of “deficiency”, “disease”, and “replacement”. Pharmaceuticalization reinforces ideas about the importance of youthfulness and unchanging bodies and makes the onset of midlife problematic in general. We are actively urged to fight bodily change (here termed bodily “betrayal”) despite how normal it is.

Lately I’ve also seen a lot of press on men and masculinity. NPR has been running an “All Things Considered” series on boys and men this summer, detailing the hardships and unique experiences that boys and men have. I also read that a group of middle aged men recently got together to create a play called “Four Play” to combat the hype around Menopause: The Musical – to make sure that men have their stage too. In Detroit this summer we’ve also been tangoing with groups of Men’s Rights Activists who feel that feminists are taking over the world. To me, the “Manopause” cover of TIME magazine falls right in line with other recent attention to “men’s issues”. To me, this is all a backlash against attention given to women’s issues. In some cases I don’t even think it’s a conscious or calculated backlash but it still presents as one.

Overall, I’m indifferent about this TIME story. I don’t think it warrants the cover photo or the cover story but it is interesting to find out about a growing testosterone industry. Nonetheless the hype around the story concerns me because I keep thinking about what’s lurking behind the hype. For instance, we have to think about the gendered dynamics behind these stories and media portrayals, for gender forms an important backdrop here and can hinder the pursuit of real knowledge about these midlife transitions. Gender ideologies are what make testosterone (and estrogen) important in the first place. In addition, I do think we need to settle on one term for male menopause/andropause/manopause and why it might be important for us to think about. Finally, we really need to think about what pharmaceuticalization means for all of us.

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

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.

In Honor of (a Sampling of) our Brave Menstrual Champions!

November 26th, 2013 by Chris Bobel

The recent death of writer Doris Lessing led me to revisit her work a bit. *

Author of more than 50 books as well as an opera, Lessing was brave. She spanned genres, refused to tow a singular ideological line and used her Nobel Prize moment to remind us that privilege shapes greatness as much, even more perhaps, than talent.  And Lessing wrote about menstruation when few others dared.

In her 1962 novel The Golden Notebook, protagonist Anna Wulf journals on the first day of her period—chronicling every thought and feeling her menses produced for her. In the passage below, Wulf’s disgust with her body is hardly a menstrual-positive standpoint (and isn’t something off with her cycle if she detects such an offensive smell?). But there is an honesty, here. A broken silence. Lessing brought to the fore the reality of the fraught and conflicted menstruating body in the early 1960s, and that was a bold move.

I stuff my vagina with the tampon of cotton wool … I roll tampons into my handbag, concealing them under a handkerchief … The fact that I am having my period is no more than an entrance into an emotional state, recurring regularly, that is of no particular importance … A man said he would be revolted by the description of a woman defecating. I resented this … but he right … For instance, when Molly said to me … I‘ve got the curse; I have instantly to suppress distaste, even though we are both women; and I begin to be conscious of the possibility of bad smells … and I begin to worry: Am I smelling? It is the only smell that I know of that I dislike. … But the faintly dubious, essentially stale smell of menstrual blood, I hate. And resent. It is a smell that I feel as strange even to me, an imposition from outside. Not from me. Yet for two days I have to deal with this thing from outside—a bad smell, emanating from me. … So I shut the thoughts of my period out of my mind; making, however, a mental note that as soon as I get to the office I must go to the washroom to make sure there is no smell (pp. 339-340).

Lessing is not alone among the brave who dare to Speak a Menstrual Language. In honor of Thanksgiving in the US, I offer this shout out to a short list of  the courageous who inspire. Thank you menstrual champions.

Rachel Horn, of Sustainable Cycles, who cycled coast to coast this summer, promoting menstrual literacy and menstrual cup awareness.

Holly Grigg-Spall, who has put herself on the line with her new book Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control. Grigg-Spall has been challenged, sometimes pretty nastily, for suggesting that one can use a feminist reproductive justice lens to be critical of the pill.

And how about radical feminist pioneer of queer cinema, Barbara Hammer. Her 1974 expeimental film Menses playfully interprets, though a group of women enacting their own individual fantasies, what menstruation means to them. 1974!

Menarchists Jaqueline J. Gonzalez and Stephanie Robinson, who founded the Menstrual Activist Research Collective (M.A.R.C) in 2011, and just released their line of menstrual gear (http://www.etsy.com/shop/menarchists) at cost so you can help them spread the good word, or as they put, leave your MARC! We bleed. It is okay. We bleed. 

Then there’s Arunachalam Muruganantham, the self described “school dropout” (and now the subject of a new documentary) who developed a table top machine that rural Indian women can use to produce and sell low cost single use menstrual pads. He wants to make life easier for Indian women (and he is not interested in getting rich). Yes, there are sustainability issues, here, but there’s also a widening of options for women.

Used with Permission

Every teenager who, on the way to the school toilet, ever dared to walk down the hall with femcare-product-of-choice in open view. 

Every menstruator who hangs cloth pads on the clothesline with the rest of the laundry.

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.

Essentialism and experience

August 26th, 2013 by Holly Grigg-Spall

My forthcoming book ‘Sweetening the Pill or How We Got Hooked on Hormonal Birth Control’ began to take shape on the pages of this blog and much of the process of its development was spurred on by the work of members of SMCR. As such, it seems only fitting, with the release date of September 7th soon here, to share for my post this month an excerpt and to say thank you for the support of this community. I hope to have added something of interest and value to this on-going conversation.

……

Women often discuss menstruation and birth as happening to them, rather than as part of them and their experience. Emily Martin remarks in ‘The Woman in the Body’ that women often see their self as separate to their body. Women’s central image is that “your body is something your self has to adjust to or cope with” and therefore, Martin concludes,“your body needs to be controlled by your self.”

Martin explores the idea that women did not fit into the structure of the jobs that were open to them in industrialized society. These jobs most often required monotony, routine and repetition. Although in reality no more suited to men than they were women, it was women that were judged as innately unable to succeed in such positions due on the constantly changing and supposedly unpredictable nature of their physical state.

As Martin states, “Women were perceived as malfunctioning and their hormones out of balance,” especially when experiencing PMS and menstruation, “rather than the organization of society and work perceived as in need of transformation to demand less constant discipline and productivity.”

The rigidity of society was forcefully imposed on women as it was on men. For all, both men and women, it is inhumane but it was women that were required to adapt in a more dramatic and overt way. Men are viewed as naturally given to the industrious and disciplined way of life demanded of them and the structure of society is built on these assumed capabilities.

If we admit that women do change through the month, that we do menstruate, experience PMS, have differing moods week to week, we fear that this admission will be used as justification for negative judgment.

Martin counters the feminist refrain of “biology is not destiny”; “I think the way out of this bind is to focus on women’s experiential statements – that they function differently during certain days. We could then perhaps hear these statements not as warnings of the flaws inside women that need to be fixed, but as insights into flaws in society that need to be addressed.”

The idea that men are otherwise unchanging is falsified. Men also experience hormonal changes with studies suggesting they experience a cycle daily that is equivalent to the monthly cycle of women as well as changes in hormone levels across their lifetimes.

Women’s “experiential statements” as Martin describes them are often silenced in the discourse surrounding hormonal contraceptives. It is a betrayal of the feminist cause to speak out with openness about the side effects of the pill.

When Yaz and Yasmin were released the marketing strategy co-opted the idea of word of mouth. In a commercial women were seen passing along the “secret” of these new drugs with their host of beneficial yet superficial side effects. Receiving messages of increased physical attractiveness as the result of a drug that many women were using anyway, only a different brand, increased the transference of this experience from one woman to the next.

In the face of such powerful manipulation, what place does a skillfully worded informational insert have in women’s decision making process? The time of the Nelson Pill Hearings was a very different to today.

Naomi Wolf mentions the pill briefly in ‘The Beauty Myth.’ She remarks that it was originally marketed as a drug to keep women “young, beautiful and sexy,” concepts parallel to those promoted by Bayer through its contemporary advertising. Wolf quotes, in the context of the beauty industry, John Galbraith, “Behavior that is essential for economic reasons is transformed into social virtue.”

Yaz and Yasmin Back in the Spotlight

May 9th, 2013 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

Last year the FDA made the decision to keep the birth control pills Yaz, Yasmin, and Beyaz on the market despite controversy over corporate corruption of the review process.These drugs are back in the spotlight.

The French health minister has called for doctors to stop writing prescriptions, 2,000 lawsuits against Bayer launched in Canada last month, and Marie Claire Australia dedicated five pages to an in-depth feature about the side effects, instigating an investigation by the country’s top current affairs show Today Tonight.

Bayer has gone about settling the 13,000 lawsuits in the US out of court, likely with the hope of keeping the details of confidential files regarding marketing techniques and research out of the public eye. Unperturbed by mounting reports from women of the myriad health issues caused by their products, the company launched Yaz Flex in Australia at the end of 2012. The first oral contraceptive on the Australian market presented as being for the purpose of preventing periods, Yaz Flex comes in a digital dispenser that records how many pills have been taken and alerts the user when she’s missed a dose. There are enough tablets to allow for just three breaks a year. In the US in April the FDA, equally unperturbed, ruled that pharmaceutical company Activis can start selling generic versions of Yaz, providing a low-cost version of what has been the most expensive oral contraceptive of recent years.

The feature in Marie Claire Australia generated 300+ comments on the magazine and television show’s Facebook pages. Many of the commenters were women who had developed blood clots when taking these brands. Some had made the connection at the time and others made the link only as a result of the coverage after months or years of not knowing why they had endured the injuries. Some of the women were presently experiencing the symptoms of a blood clot mentioned in the show and made the decision to stop taking the pill as they typed.

The piece was written by a long-time member of the Yaz and Yasmin Survivors forum and balances interviews with women who suffered the serious physical side effects with those who have been victim to the serious psychological side effects. I’m among those who experienced a long list of negative physical and psychological effects when taking Yasmin for more than two years and it was this forum that prompted me to stop taking it.

Monash University in Australia is one of the few facilities to have undertaken research into the correlation between birth control pills and depression. Professor Jayashri Kulkarni found that women on the pill were twice as likely to experience depression, anxiety, and mental numbness (known as anhedonia). The Yale Daily News reports that in the wake of her research receiving a little media attention Dr Kulkarni received more than 300 emails from women “clearly describing when they went off the pill that they felt subjectively more happy. The anhedonia, for example, disappeared, the irritability disappeared, the sense of poor self esteem disappeared”.

She is now focusing her attention on researching what she believes to be the particular psychological impact of the Yaz brands, those pills containing the synthetic progesterone drospirenone and low-dose synthetic estrogen.

Although there is no direct-to-consumer advertising in Australia these brands of pill gained popularity there just as they did in Europe and Canada. It is interesting to note that Marie Claire US ran an article in 2011 titled ‘The New Super Pill’ that named Yaz and Yasmin as the latest, greatest “no-acne, no-bloat and pms-be-gone” pills that also allow you to “shorten your period”. The pages of magazines such as Marie Claire in the US are usually scattered with adverts for Yaz and Yasmin, the NuvaRing, Nexplanon impant, and Mirena IUD. The print and television commercials often play on the same insecurities reflected and bolstered by the majority of the women’s magazine articles.

Little Girls! Just Say Yes to Your Dreams!

March 18th, 2013 by Chris Bobel

Seen this one yet? (or the (eerily) related “Birth Control on the Bottom“?)

We posted “Sassy Girlz Candy Birth Control Pills” (written by Carissa Leone in 2011) in our regular installment Weekend Links on Feb 2. I had a mixed reaction. And when a couple re:Cycling readers described the video as “nasty,” I knew we needed to dig in a bit.

Let’s discuss.

There’s something very absurdly funny about eating birth control, even if the women are still tweens and the birth control is merely mulit- colored jelly beans intended to get young girls in the pill-popping groove before they are saddled with a baby and an half-finished high school education.

First of all, women CAN eat their birth control, donchaknow… Warner Chilcott brought to market their chewable, spearmint flavor oral contraceptive, Femcon Fe, for women who have difficulty swallowing pills and apparently, find stopping for 30 seconds to swallow water.

But I digress (I guess I just want to be clear that we are ALREADY munching our pills).

It is hard not to love how this sketch takes down the pandering to the girl tween market. Oh lordy. There’s so much potential there! (one estimate figures that kids aged 8-12 years are spending $30 billion OF THEIR OWN MONEY and nagging their parents to spend another $150 billion annually!) Little girls quickly move from Disney to diets, from fingerpaint to fake eyelashes, from tutus to belly shirts…..I have seen it with my own girls and it feels, frankly, like an inexorable force.

Viral sketch writer Carissa Leone graciously replied to my questions regarding the piece. When I asked her what inspired her, she channeled her Women’s Studies training (go team!) and supplied her two main reasons:

(1) “I saw a little girl on the subway,holding a baby doll in one of those pretend baby slings…and I thought, “If only she really knew what motherhood was like. I wonder if anyone has explained the authentic experience. I wish she were carrying a briefcase and reading a teeny issue of Ms. magazine instead… “

AND

(2) “The idea that women can/should have it all, in terms of relationships and families and career still seems to be put forth as a tangible (and”correct”) goal in Western culture. It’s a pressure I and many other peers feel, and one that I don’t think is truly possible, or necessarily awesome.”

And Big Pharma takes a hit, too, per the spot’s director, Brian Goetz, who offered this when I asked him about what led to the sketch:

“I wanted to do the video because the script spoke so well to the branding of pharmaceutical commercials, where no matter what the product, as long as you say there’s a problem and that you have the solution, throw some happy people and fun b-roll in it, you’ve got a successful campaign. On top of that, it’s always fun to legitimize terrible ideas in sketch comedy. And if that means having multi-colored jelly bean birth control pills, all the better.”

But I think there’s more to it that that.

Why do I find myself laughing and crying at the same time? Well, I just finished my advance copy of Holly Grigg-Spall’s forthcoming Sweetening the Pill  or How We Became Hooked on Hormonal Birth Control (out this Spring with Zero Books). In it (and here as well, on this blog), Grigg-Spall makes the case the hormonal contraceptives have become so normative that we, as consumers, permit an imperfect (at best) product to flourish even while other options may be more appropriate. The one-pill-fits-all mindset is so pervasive and bores in so deep, so young, Grigg-Spall argues, that when someone says, ‘hey! I don’t want to be on the pill,’ these—what she calls “pill refugees” — are hastily branded as irresponsible, antifeminist, or just plain dumb. That is, the pill gets constructed as our savior, our liberator, our saving grace, even when its not.

And that’s where this spoof enters….since the pill IS all these things, let’s get those girlies on board NOW! Why wait? Good habits start young, after all. And product loyalty is not just for toothpaste and laundry detergent….

And so, “Sassy Girlz Candy Birth Control Pills” is super smart feminist critique. It calls out the enduring wrongheadnessness of romanticizing motherhood and co-opting what I would call a tragically hollowed-out pseudo feminism harnessed to push product:

  • Little girls playing Mommy is cute, and kinda bullshit!
  • Its never too early to teach little girls about options!
  • She’ll know that birth control means winning a college scholarship

Yup. There’s lots of problems with that. Thanks to the feminist satirists to help us see.

But I have to say one more thing.

Leone and I discussed (what I consider) the unfortunate below-the-belt invocation of gender dysphoria to as she put it, “most absurd, heightening beat” in the sketch (here’s another, more recent example of same, on SNL). I don’t think trans or gender queer or otherwise gender variant people should ever serve as punchlines, as I told Leone so in our email exchange. When I inquired about this moment in an otherwise spot-on sketch, she said that is was never intended it as a negative perception of transgendered kids. But still  it is, and I think it points with a big fat finger at how much work we still need to do to move trans issues from margin to center.

Let’s push forward without leaving anyone behind. Let’s laugh at feminist satire that avoids (even unintended) transphobia. Let’s keep our targets clear and our allies clearer. Let’s say YES to that dream, for real.

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.

It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).

Hormonal contraceptives clearly act as EDCs according to the definition used in this report:

An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.

Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.

The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and  progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”

The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.

How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?

Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.

Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”

Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors.

Medicating the Postmenopausal Vagina

March 4th, 2013 by Paula Derry

On February 26, 2013, the Food and Drug Administration issued a news release saying that it had approved a medication called Osphena to treat a problem called postmenopausal dyspareunia (pain during sexual intercourse associated with changes in the vagina after menopause). The medical website Medscape reported that the news release had been issued. How to read these announcements? It seems as though FDA approval should be enough to know that a medication is safe and effective.   However, what are some guidelines in reading and evaluating this announcement?

First, some background: After menopause, when estrogen levels decline, tissues (cells) of the vaginal lining can become thinner, drier (thus providing less lubrication during intercourse), and less elastic or flexible.

This can result in pain during intercourse, feelings of burning or soreness, inflammation, and irritation.

Andreyeva by Ilya Repin // Public Domain via Wikimedia Commons

There are a variety of solutions for dealing with this.  Regular sexual stimulation (intercourse, masturbation) is recommended to keep vaginal tissues healthy.  Water-based lubricants can help reduce discomfort during intercourse.  Expanded views of sexual pleasure that don’t include intercourse might work around the problem. Leaving enough time to become aroused during intercourse (extended foreplay), communication between partners about when sex is painful and when not, can also help. Herbs like dong quai and black cohosh are recommended, especially by complementary/alternative practitioners, although the herbs  lack a research base. A low-dose estrogen applied to the vaginal area (as a cream, tablet, etc.), is effective. Local application minimizes estrogen being absorbed into the bloodstream, traveling through the body, and having effects, some of them potentially negative, distant to the vagina. There is, however, controversy about some estrogen being absorbed.

Now, to the FDA announcement:  The FDA requires proof of a medication’s safety and effectiveness before it is approved.  According to the news release: “Osphena’s safety and effectiveness were established in three clinical studies of 1,889 postmenopausal women with symptoms of vulvar and vaginal atrophy. Women were randomly assigned to receive Osphena or a placebo. After 12 weeks of treatment, results from the first two trials showed a statistically significant improvement of dyspareunia in Osphena-treated women compared with women receiving placebo. Results from the third study support Osphena’s long-term safety in treating dyspareunia.”

Notice, first, that the drug’s effectiveness was tested for 12 weeks. This is not an unusual amount of time for such a study, but it is not very much time. Notice also that women treated with Osphena had a “statistically significant” improvement. As I discussed in a previous post, “statistically significant” means “unlikely to have occurred by chance.” In other words, there was evidence that Osphena  really did have an effect, but we don’t know how big an effect—it might be very large or very small.

Safety was established by studying the experiences of women for one year: however, one year is not a long time for side effects to develop. Osphena is a systemic medication. That means it is not applied locally in the vaginal area, it is ingested as a pill so that it travels to all parts of the body in the bloodstream. It is a selective estrogen-receptor modulator, or SERM. SERMs act like estrogen in some places in the body while not in others. The idea is that a SERM like Osphena would act like estrogen in keeping vaginal cells healthy while not acting like estrogen to increase health risks like certain cancers. However, more time than a year might be needed for health problems to show up. Indeed, the FDA news release stated that “Osphena is being approved with a boxed warning alerting women and health care professionals that the drug, which acts like estrogen on vaginal tissues, has shown it can stimulate the lining of the uterus (endometrium) and cause it to thicken…. Women should see their health care professional if they experience any unusual bleeding as it may be a sign of endometrial cancer or a condition that can lead to it.” The FDA announcement also stated that “Common side effects reported during clinical trials included hot flush/flashes, vaginal discharge, muscle spasms, genital discharge and excessive sweating” and that Osphena should be prescribed for the “shortest duration consistent with treatment goals and risks for the individual woman.”

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.