Blog of the Society for Menstrual Cycle Research

On Menopause Definitions

December 28th, 2011 by Elizabeth Kissling

Guest Post by Paula S. Derry, Ph.D.

In a recent blog post, Heather Dillaway commented on the uncertainty, confusion, and frustration she felt as a menopause researcher, given the lack of consensus about the most basic aspects of the menopause transition. Researchers don’t agree about their definitions, and can’t even agree on what needs to be defined. She asked for reactions to her entry; I’ve found that my reaction has grown into this separate post.

Fire in the Head by Beate Knappe // CC 2.0

I, unlike Heather, am not a sociologist. I’m a health psychologist. My training and current work include analyzing, critiquing, and making sense of experimental research and theories. I have also developed workshops for community women and for professionals whose aim is to provide health-promoting information and decision-making heuristics. I have given a lot of thought to the issues that Heather raises, and this is as far as I’ve gotten with them.

To me, there are many layers of issues involved. The first is the fact that the science — about the physiology of menopause and the processes leading up to it — is limited and incomplete. Part of the reason that professionals disagree about whether the life course of menstruation has five stages or seven, or why women have hot flashes, or even why women have a menopause, is that we don’t actually know. We simply do not have the scientific facts. We don’t understand what the underlying process is or how it works. Given this uncertainty, professionals must make judgments about how to define terms and what their hypotheses (or best guesses) are about underlying processes. A second fact, along with our limited real knowledge, is the tenacity with which professionals assert their judgments and argue against competing views. People disagree and they hold strongly to their positions—about language and the facts. To me, it makes sense to have definitions of stages of menstrual life that are objective and easily measurable (like the STRAW staging system) for researchers who need to compare results with each other. It doesn’t make sense to assert that this system, based on expert opinion and not on experimental facts, actually defines when a particular stage really “begins.” It makes sense to say that experimental research supports the idea that changes in the thermoregulatory center of the hypothalamus are important processes if you’re trying to understand hot flashes.  It does not make sense to conclude that these brain changes in themselves explain hot flashes; other factors must also be involved.

I think another source of confusion is that menopause is not one thing, but many. It is a circumscribed biological change (lack of periods and what leads up to them physiologically) and also a psychosociocultural matter. We have a term for when girls begin to menstruate (menarche), a separate term for the larger biological changes of which menarche is a part (puberty), and another term for the biopsychosociocultural changes of which puberty is a part (adolescence). I think these kinds of distinctions are confused with regard to understanding menopause in part because there is cultural confusion about midlife (or mature adulthood or whatever term you use) as a life stage.  There is no cultural consensus about this stage of life.  And, indeed, this isn’t surprising.  Some women are planning retirement while others are training for a new job or career.  Some are grandmothers while others are raising a young child.  My opinion, also, is that we as a culture have a paucity of concepts of mature, responsible adulthood and what it means.  Continue reading...

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Posted in Communication, Language, Menopause, Philosophy | 4 Comments »

Waiting

October 28th, 2010 by Heather Dillaway

I’ve been thinking a lot lately about the words we use when we’re talking about menstruation or reproductive experiences more generally. I’ve been noticing lately that we use the word “waiting” quite a bit. I have a friend who is “still waiting” for her menstrual cycle to be “normal” again after her second child, and several other friends who are either “waiting” to figure out whether they will get pregnant, “waiting” to be done with their pregnancies, or “waiting” before they can have their last and final kid. I just had my basement waterproofed and one of the basement repairmen told me that his wife had been “waiting” ten months to get a menstrual period and that they were worried about her (this is information he volunteered after I told him I studied women’s health). I started thinking more about how the menopausal women I interview always talk about “waiting” to figure out whether they are really “at menopause,” or “waiting” to figure out if this is really their last menstrual period. Or how so many girls/young women who are sexually active are “waiting” to get their periods so that they can be relieved to know they are not pregnant. Or how women with painful periods, endometriosis, or migraines are waiting until those days are over each month. What does all of this reproductive waiting (waiting for menstruation, waiting for menstruation to be over, waiting for pregnancy, waiting for birth, waiting for menopause) mean?

 

In all of these instances of reproductive waiting, waiting seems a negative connotation and that seems to stem from the fact that we do not feel in control or in charge of this reproductive time. When I think of the other situations in which I might use the word “waiting”, the same holds true. I tell my kids to “wait their turn” and they don’t like it. And none of us really like waiting in line. Fast food restaurants, frozen dinners, and ATM machines are all in existence because we don’t have time or don’t like to wait. Phrases that we use like “worth the wait” also connote negativity about waiting. So, I finally looked up the actual definition of waiting. Depending on which online dictionary you visit, definitions of “waiting” include: “pause, interval, or delay,” “the act of remaining inactive or stationary,” or “the act of remaining inactive in one place while expecting something.” While some of these definitions do not automatically lend themselves to negativity, waiting is defined mostly as a passive activity that we are forced to participate in, perhaps against our will.


All of this makes me think further about whether women really dislike the waiting or the time that comes with menstruation or other reproductive experiences, and whether women really feel out of control as they engage in their experiences. Is this just a word we use or are we really impatient about menstruation and reproduction? When I think about alternative words that are sometimes used, like “tracking,” other words seem much more agentic in that they put women back in control of their cycles and other reproductive experiences. So, is it just the word “waiting” that has the negative connotation or is that word signifying some larger impatience that we have about reproduction these days? I have a colleague who writes about the “inconveniences” of reproduction and how, in so many ways, we try to avoid the reproductive waiting or reproductive uncertainties we face. For instance, instead of waiting to see when a baby is born, we might plan a c-section so that we can know when we’ll get that baby. Or, now we’re told that if we’re “waiting” more than 6 months to get pregnant that we should probably start taking fertility drugs to shorten our wait or get rid of some of that uncertainty. Or now we can find out that we’re pregnant a couple weeks after conception instead of waiting to see whether we menstruate a few weeks later. We attempt to cut out some of those reproductive waits these days. Menstrual suppression is at least partially popular because then women won’t have to be surprised by their periods or wait to know what bad day their period might fall on.  Continue reading...

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Posted in Language, Menopause, Menstruation, Philosophy | 9 Comments »

S.H.E. = Sustainable Health Enterprises

October 13th, 2010 by Elizabeth Kissling

Check out the new video about the latest developments from Sustainable Health Enterprises (SHE).

(Previously at re:Cycling — SHE featured in Marie Claire; Girls, Periods, and Missing School II: Breaking the Silence.)

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Posted in Activism, DIY, FemCare, Girls, Menstruation, Philosophy | Comments Off

SMCR Bloggers Respond to ACOG’s Homage to the Pill

May 20th, 2010 by Laura Wershler

MenstruationResearch.org – Today, during an email exchange among the Society for Menstrual Cycle Research blogging team, research-advocacy experts on the menstrual cycle spoke out in response to the unbridled passion for the pill expressed by members of the American College of Obstetricians and Gynecologists at their 58th Annual Clinical Meeting. Amidst the hoopla surrounding the 50th anniversary of the pill, it must be noted that not all experts believe the pill to be an unequivocally positive contribution to women’s health and well-being that those quoted in the ACOG media release purport it to be.



“The pill has literally changed the world, and it was a primary stimulus to the women’s movement of the 60s. It has done far more for women’s rights than any legislation that has been passed and should be recognized as the great emancipator of women.”


Mark S. DeFrancesco, MD, MBA, Cheshire, CT
Secretary Elect, The American College of Obstetricians and Gynecologists

“When the pill first came out, young unmarried women had to fight for the right to take it. Now, they have to fight for the right NOT to take it. Overhyped as medicine’s gift to women’s health, by mostly male gynecologists who have never taken the drug, the pill has become an almost forced right of passage – the “standard of care” treatment for being a girl. Emancipation or subjugation? Ask the young women who face coercion and control by their doctors when they ask for support to use non-hormonal methods of birth control.”

Laura Wershler, Sexual Health and Reproductive Rights Advocate,
Executive Director, Sexual Health Access Alberta

“Birth control pills provide women with many non-contraceptive benefits, including cycle control, cancer prevention, and pain relief. They have been an integral part of women’s health.”

Scott D. Hayword, MD
Mt. Kisco, NY
Chair, District II, The American College of Obstetricians and Gynecologists

“Birth control pills provide women with many risks in exchange for contraception, including blood clots, stroke, breast, cervical, and liver cancers, diminished libido, and mood disorders. They have been instrumental in activating the women’s health movement, as feminists
demanded responses to these risks.”

Elizabeth Kissling, Ph.D.
President, Society for Menstrual Cycle Research


“I have often thought that the birth control pill should be called a hormone regulation pill because its use and impact have been so much broader than contraception alone. The pill has certainly improved reproductive control, but the impact on menstrual regulation has been very important for women, from adolescence to menopause.”


Jeanne A. Conry, MD, PhD
Roseville, CA
Chair, District IX, The American College of Obstetricians and Gynecologists

“I’m so happy to have The Pill called “a hormone regulation pill” because that is the way it is currently used by many physicians, and some women. It is used to cover up the far-apart cycles of anovulatory androgen excess (also known as PCOS) but doesn’t promote ovulation. The Pill is used to treat heavy bleeding in teenagers, but doesn’t restore her own balance of estrogen and progesterone. It is used for menstrual cramps when ibuprofen or other non-steroidal is more effective and has no suppressive effect. It is used to treat premenopausal osteoporosis when the evidence suggests it causes rather than prevents subsequent fragility fractures.

In short–the Pill has become the major non-surgical tool of gynecology.”

Jerilynn C. Prior, MD, FRCPC
Professor of Endocrinology / Department of Medicine
Centre for Menstrual Cycle and Ovulation Research
University of British Columbia

“The introduction and rapidly accepted, widespread adoption of oral contraceptives among women of reproductive age drastically reduced women’s fear of unplanned pregnancy in ways their mothers and grandmothers never knew. The pill has allowed women to take different roles in all aspects of their lives—career, education, travel, and a host of other beneficial ways.”

J. Craig Strafford, MD, MPH,
Gallipolis, OH
Vice President, The American College of Obstetricians and Gynecologists

“Women realize their full potential when they are supported in making informed decisions in all aspects of their lives. Indeed, oral contraception has enabled women to avoid unplanned pregnancies, but it has never been a risk-free option. While providers are eager to prescribe the pill, they are less eager to fully explain how hormonal contraception works and the side effects it carries. Until women have access to a full range of safe, affordable and accessible options, their freedom is compromised.”

Chris Bobel, Ph.D.
Chair and Associate Professor of Women’s Studies, University of Massachusetts-Boston

“The pill has revolutionized women’s health care. Obviously, the contraceptive benefits are paramount, but I have become a huge advocate for all of the non-contraceptive reproductive health benefits that the pill offers. Another advantage is that the pill has enjoyed incredible safety over its 50-year history.”

Douglas H. Kirkpatrick, MD, Denver, CO
Immediate Past President, The American College of Obstetricians and Gynecologists

“The Pill has its roots in a time much farther back than fifty years.
Historically the female body has been feared and the release of the
Pill fitted very easily into this history. Victorian doctors removed
women’s ovaries in response to many perceived female problems, and today doctors prescribe the Pill, shutting down ovulation. The Pill is not only prescribed for birth control – it is handed out to women with acne, PMS, irregular periods, heavy periods. Even light, regular periods are now considered enough of an inconvenience to warrant a long-term drug dependency. The Pill has developed into a medication for the disease of being female. In place of changing society, society decided to fix women. At a time when we are more concerned about what we eat, what we wear, what we use to clean the toilet than ever before, we are still celebrating millions of otherwise healthy women taking a powerful medication every day, for years.”

Holly Grigg-Spall, Journalist

“The advent of effective contraception was revolutionary, transforming, empowering, and a tremendous boost to women’s health. It continues to play a major role in the effort to achieve responsible reproductive health and choice for all women—a goal of every child being a wanted child delivered into a supportive and secure environment.”

James N. Martin, MD, Jackson, MS Secretary, The American College of Obstetricians and Gynecologists

“If the pill was as revolutionary, transforming and empowering as is suggested, then all women should be taking it from menarche to menopause, except when we are ready to have the “wanted child.” But we aren’t. Today, young women are ditching the pill in favor of non-hormonal methods, and still managing to achieve responsible reproductive health choices. As for the pill being ”a tremendous boost to women’s health” – I think not. Troublesome side effects, serious health concerns, and a growing interest in holistic approaches to health care are putting the pill in its proper place. One contraceptive choice that works for some women, some of the time.”

Laura Wershler, Sexual Health and Reproductive Rights Advocate,
Executive Director, Sexual Health Access Alberta


“The pill is probably the single biggest contribution to women’s health in our lifetime. Not only has it given women more control over their fertility, it has been successfully used to treat many gynecologic conditions such as dysmenorrhea, menometrohaggia, PMS, acne, PCOS, and endometriosis, enabling women to have a better quality of life.”


James A. Macer, MD, Pasadena, CA

Assistant Secretary Elect, The American College of Obstetricians and Gynecologists


“Long term safety data on the current patterns of use of the pill do not exist, and are not being collected. When first approved, the pill was available to married women, most of whom had children, and allowed them to space their families. Currently, the pill is most commonly used by childless young women, often during the teen years, and can extend for decades. The consequences of pharmaceutical suppression of the developing endocrine system (during the 12 years following the first period) have, to my knowledge, not been explored. For example, taking the pill interferes with bone acquisition, compromises the accumulation of bone density, and may compromise peak bone mass. Peak bone mass sets the bar for lifelong bone health. In a cohort expected to live into their 80’s, casual and enthusiastic use of the pill may be something society regrets half a century from now. There is a tendency to blame side effects on the bad old days, and to say that things are better now. But a recent large study confirmed blood clot risks with today’s “modern” formulations, and, more worryingly, these risks are amplified by obesity and smoking, both of which are more prevalent in modern populations.”


Christine L Hitchcock, PhD, Research Associate, Centre for Menstrual Cycle and Ovulation Research, and Clinical Assistant Professor, School of Population and Public Health, University of British Columbia

This ACOG statement furthers a broader message to young women that they should trust pharmaceutical menstrual rhythms over that of their own bodies and that they should trust clinical authority over their own authority. In and of itself, ceding their bodily authority, ownership and stewardship to medicine causes harm to women.

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The Society for Menstrual Cycle Research is a nonprofit, interdisciplinary research organization. Our membership includes researchers in the social and health sciences, humanities scholars, health care providers, policy makers, health activists, and students with interests in the role of the menstrual cycle in women’s health and well-being.

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Posted in Birth Control, Communication, Health Care, Pharmaceutical, Philosophy | 1 Comment »

Riddle me this: What’s wrong with birth control?

April 20th, 2010 by Laura Wershler

I read The Birth-Control Riddle by Melinda Beck, published today in The Wall Street Journal with interest and frustration.  As a veteran pro-choice sexual and reproductive health advocate, I’ve spent decades contemplating this ”riddle”. I have two specific comments in response to the piece, and a few suggestions for potential follow-up stories.
       birthcontrolmethods                                                                                                                                      
 1) I find it discouraging, but understandable, that the article failed even to mention fertility awareness based methods (FABM) of birth control, which when taught so that women/couples can use the method effectively and confidently have a 99.4% effectiveness rate. Don’t take my word for it. The German study called: The effectiveness of a fertility awareness based methods to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study was published in the prestigious journal Human Reproduction in late 2007. 

In addition to the typical North American dismissiveness (by healthcare providers) of FABM as ineffective, is the dismissive response given to North American women who express an interest in learning FABM.  A quick google search or a week’s hits on a google news alert for “Fertility Awareness” (the secular, pro-choice variation of the religiously contextualized Natural Family Planning) quickly establishes the burgeoning interest and use of these methods by young American women. Why is this so readily ignored by the mainstream sexual and reproductive health community (of which I am a part)? I have been mulling over this question for years. I have arrived at several answers. How I would love to see a journalist, any journalist, start asking this question.

 2) My second comment is that this article is a missed opportunity. It is useless merely to list (yet again) the birth control “choices” available to women, as if just knowing about these methods of contraception should make the problem of unintended pregnancy go away. Of one thing we can all be certain: it can’t and it won’t. What this piece lacks is any attempt to explore in depth the writer’s accurate but unexamined statement – Why are the numbers so high? The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors.  Why not make an effort to get to the bottom of the so-called birth control riddle?  

Should Beck be interested in continuing to write about this issue, one angle she might consider exploring is barriers to access to information, support and services for women seeking to use non-hormonal methods of birth control effectively and confidently, including diaphragms, cervical caps and fertility awareness based methods. This is a huge issue of concern to me and the many women who can’t, won’t or don’t want to use hormonal birth control.

I have a theory that a good number of unintended pregnancies happen because women are finding little or no support to access and effectively use non-hormonal methods. Yet this lack of support is not enough to keep them on the pill, patch or ring, or to agree to submit to invasive shots or implants.  Therefore, care providers’ dismissal of young women’s requests for non-hormonal methods may actually be the cause of some of the unintended pregnancies we seem to be so puzzled by. Another issue not being talked about is that some women are getting pregnant while using the pill, patch or ring. These unintended pregnancies, which oddly don’t seem to pull down the “typical use” effectiveness rate of these methods, is partly behind the growing interest in IUDs.  The other reason IUDs are growing in popularity is backlash against traditional hormonal methods.  Continue reading...

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Posted in Birth Control, Newspapers, Pharmaceutical, Philosophy | 6 Comments »

For Now, Your Genes Belong to You

April 6th, 2010 by Elizabeth Kissling

Guest Post by Barbara A. Brenner Executive Director, Breast Cancer Action

One of the saddest aspects of capitalism is that companies think they can and should own anything they get their hands on. Some time ago, they started obtaining patents on human genes, including two genes implicated in breast cancer: BRCA1 and BRCA2.

The company that obtained the patents on these genes is called Myriad Genetics. With the patents, Myriad controls both the tests given to women to see if they carry mutations on these genes that may predisposed them to breast and ovarian cancer, as well as all the research related to the genes.

How can anyone own our genes? Up until now, no court has been asked that question. But last week, in a ground breaking decision, a federal judge in New York declared that Myriad’s patents on the breast cancer genes are invalid because they patent a part of nature.

That may seem like an obvious thing to most of us, but the research community is up in arms about how their inability to patent genes will inhibit their ability to innovate new treatments. Sounds plausible, but don’t be fooled. These patents are more about making money than they are about taking care of people who are sick.

Breast Cancer Action, an education and advocacy organization that carries the voices of people affected by breast cancer, was a plaintiff in the lawsuit brought by the American Civil Liberties Union against Myriad over the patents. Because — unlike almost all other breast cancer organizations — we don’t accept funding from Myriad or other companies that profit from breast cancer, we could stand up for  the interests of patients who either couldn’t afford the very expensive test, or who couldn’t learn what their “ambiguous” test results meant because the research wasn’t being done to find out.

Ambiguous gene test results are not uncommon, and they are most often found in women who are not white. So, once again, the worst impact of health policy – in this case, the policy to allow genes to be patented – fell on the people who were most likely to have the worst breast cancer outcomes.

Thanks to the ACLU, the Public Patent Foundation and a federal judge, the patents on the breast cancer genes are now invalid. That means that, once the decision becomes final, new tests will be on the market, and researchers will be able to pursue a greater understanding of what mutations on the genes mean.

Myriad will appeal. The case will probably eventually end up in the US Supreme Court. Myriad might get a stay of the trial court ruling pending that appeal. If they do, we’ll have to wait for our genes to be returned once again to their rightful owners – us.

Reprinted with permission.

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Posted in Law/Legal, Philosophy | 1 Comment »

Is Menstruation a Disability?

November 19th, 2009 by Elizabeth Kissling

I think few people would consider menstruation per se a disability, with exceptions for menorrhagia and unusually painful periods. But I’ve been reading a bit in the field of disability studies lately, for both professional and personal interest, and starting to think about disability differently. I’m currently reading Susan Wendell’s The Rejected Body and finding it especially powerful and provocative.*

She writes of disability as social construction; that is, disability cannot be defined solely in biomedical terms but must be considered in terms of a person’s social, physical, and cultural environment. A person is disabled when they live in a society that is “physically constructed and socially organized with the unacknowledged assumption that everyone is healthy, non-disabled, young but adult, shaped according to cultural ideals, and, often, male” (p. 39).

A feminist philosopher by training, Wendell points out that feminists have long sustained criticisms that the world has been designed for the convenience of men and male bodies.

In many industrialized countries, including Canada and the United States, life and work have been structured as though no one of any importance in the public world, and certainly no one who works outside the home for wages, has to breast-feed a baby or look after a sick child. Common colds can be acknowledged publicly, and allowances are made for them, but menstruation cannot be be acknowledged and allowances are not made for it. Much of the public world is also structured as though everyone were physically strong, as though all bodies were shaped the same, as though everyone could walk, hear, and see well, as though everyone could work and play at a pace that is not compatible with any kind of illness or pain, as though no one were ever dizzy or incontinent or simply needed to sit or lie down. [p. 39, emphasis added]

It is this physical structure and social organization that causes much of the disability in our society. Similarly, it is the physical structures and social organization of my culture that make menstruation a problem and a secret. I’ve written about some of this before (and SMCR members probably also see Emily Martin’s work echoing here), but was reminded of this issue in a recent conversation with a reporter about attitudes toward menstruation.

The journalist wanted to know if perhaps menstruation was kept hidden just because it’s private, rather than shameful. I asked her to think about the ways our society structures work that compel us to keep it private and secret. For instance, how easily can you find menstrual products in your school or workplace when you need them? (There’s a tampon dispenser in the women’s room in my campus building, but the sign has read EMTY for the all the years I’ve worked there.) I also spoke with her about a terrific study by Tomi-Ann Roberts and her colleagues about attitudes toward menstruation, in which a research confederate dropped a hair clip in one scenario and a tampon in another. Dropping the tampon led the research participants to offer lower evaluations of the confederate’s competence and decreased liking for her; they even displayed a mild tendency to avoid sitting close to her. This suggests that women conceal menstruation for good reason – to avoid appearing disabled.

Prejudice against menstruators is similar to prejudice against people with disabilities, particularly in judgments about competence, intelligence, and strength. Many disabled people do their damnedest to pass as non-disabled to avoid these same judgments. And in most of North America, people who menstruate do their damnedest to conceal their menstruation, because our physical and social structures are configured in ways that make it disadvantageous to menstruate.  Continue reading...

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Posted in books, Menstruation, Philosophy | 4 Comments »

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.