Blog of the Society for Menstrual Cycle Research

Understanding Research: Buyer Beware

April 2nd, 2012 by Paula Derry

xkcd.com // CC 2.5

I certainly believe that scientific research is important.  Research uncovers new knowledge and prunes away facts that are not accurate.  However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications.  If a scientific result can be invoked, we can believe that something is true. Is there an unconscious?  Freud said so, but he’s out of date.  Are we intrinsically social beings?  Evolutionary theorists argue. Does meditation really result in an altered state of consciousness?  If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.

What’s wrong with this? Isn’t this science doing its job of uncovering truth?  There are two things wrong with this. One is that not all knowledge is scientific knowledge.  The second is that scientific results are often portrayed inaccurately in our society.

With regard to the first point, I’ll just give a few examples.  von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow.   Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.

But what I really want to talk about here is the second point.  We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means.   However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context.  When I was a graduate student in psychology, every class included practice in critiquing research.

To understand research, certain mathematical ideas are important.  “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why?  That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased.  Why?  Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.

The woman, the serpent and the cycle

March 13th, 2012 by Chris Hitchcock

According to a recent study, women are best at picking out a picture with a snake during the days immediately before their period. You might think this would be a surprise, given the general idea of premenstrual compromise in women. Mind you, there isn’t much data to support poorer thinking or performance for women during the premenstrual period.

However, the authors were able to salvage the idea of premenstrual compromise here. They argue that about 30% of women have premenstrual syndrome, and most of the rest of us show some kind of cyclicity. And so they attribute the 200 millisecond (1/5 of a second) faster response to anxiety and fear. Either that, or it is maternal instinct, protecting the small cluster of cells that might possibly be an impending pregnancy.

Media has picked this up, with headlines about PMS being good for something after all.

Sometimes it seems that women can’t win for losing.

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Coming Off The Pill: A Mind Map Guide

March 7th, 2012 by Laura Wershler

Everybody can use a good map to help them get to where they’re going. Why not women heading to the land of non-hormonal contraception?

In my post on January 11, 2012 I asked if coming off the pill was a growing trend. I proposed to write a series of posts about the issues associated with the decision to stop using hormonal birth control.  For the purposes of this discussion assume that “coming off the pill” refers to quitting any method of hormonal contraception including the pill, patch, ring, shot, implant or Mirena intrauterine system.

As I was preparing a list of possible topics, I realized that one way to represent the complexity of issues involved in this decision is with a mind map: “a diagram used to represent words, ideas, tasks, or other items linked to and arranged around a central key word or idea.” It also occurred to me that readers could then add to this schematic, filling in important points based on personal or professional experience. So I got out my colored markers, did a little brainstorming and came up with Coming Off the Pill: Mind Map 1.0. I invite readers to comment, offering additions under the key headings I’ve noted and suggesting other categories that should be included.  Could this become a talking, planning or process guide for women considering the transition to non-hormonal birth control methods?

If you’ve thought about or been through the experience of quitting hormonal contraception, or if you’ve helped others through the experience, please contribute to the development of Coming Off The Pill: Mind Map 2.0 by posting your comments and suggestions. (I’ve already thought about other headings I could have included.) Besides providing me with a guide for writing future posts, what other ways can you imagine this mind map might be used?

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Badass Baristas and PMS Superpowers

August 25th, 2011 by Elizabeth Kissling

Crimson Tide, a.k.a. Cassie Taylor (Super Power: Epic Rage)

Are you following the PMS Adventures of Crimson Tide, Maxi Pad, and Tam Pon? After a paid medical trial went bad, these ladies developed extraordinary superpowers that manifest only when they’re menstruating — and since they’re roommates, their cycles are often synchronized.

Start here to read an abridged version of their origin story and follow the links to catch up on all of their adventures.

[via LunaGal]

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We’re back!

July 27th, 2011 by Elizabeth Kissling

Tap, tap.

Is this thing working? Is this thing on?

After some rest, reconnaissance, and re-organization, re:Cycling is back — bigger, bolder, and with more menstruation and women’s health news than ever. Most of our old team is back, along with a few new recruits and some exciting guest bloggers. There’ll be some new features here as well. More about all of that is coming soon. Our posting will be spotty and irregular throughout August, but expect to see a more consistent, regular flow after September 1. (Yeah, see what I did there? )

We’ve missed a lot of action in four months away. We can’t possibly summarize all of it, but here are some of my personal highlights:

 

July 19 – The Institute of Medicine (U.S.)  just released a report on preventive health services for women, and the consensus is that health plans under the Patient Protection and Affordable Care Act (ACA) of 2010 should cover contraception without demanding co-payments. You can read and/or download the full report here.

 

July 18 – Remember Summer’s Eve marketing disaster last summer? They still don’t get it. This year’s “Hail to the V” campaign may be saluting vaginas, but it’s still telling everyone vaginas are dirty.

As Maya put it over at Feministing.com,

That chatty hand claims to be my vagina but is clearly an impostor, because my vagina would never refer to herself as a “vertical smile,” knows better than to even mention vajazzaling to me, and is too busy complaining about how long it’s been since she’s gotten laid to give a damn about if my cleansing wash is PH-balanced. My vagina is not a whiny little pussy.

If you’re not offended enough, check out the stereotypes in the Black and Latina vaginas. For a satisfying satirical response, check out Stephen Colbert’s July 25 program.

 

July 13 – Bloggers at Ms. magazine have done yeoman work drawing attention to the sexism in the latest PSA from the milk industry, criticizing the sexism toward both women and men in the Milk Board’s stereotype-rich “Everything I Do Is Wrong” campaign about PMS. Ms. has also promoted Change.org’s petition protesting the campaign. Update: By July 24, the campaign had been pulled in response to protests.

2011 Ad for Always brand maxi padJuly 5 – As copyranter astutely notes, the use of a RED spot in the center of a maxi-pad to represent menstrual blood is an historic moment in advertising history. Are we finally done with the mysterious blue fluid? (By the way, copyranter is THE source for smart, snarky analysis of advertising;  he oughta know — his day job is writing the stuff.)

 

June 20 – Corporate and subsidized donations of disposable menstrual pads may be good for girls, but not so good for the environment.

 

June 2 – British artist Tracey Emin  art student at University of Wisconsin, follows in Judy Chicago’s inspirational footsteps and turns her tampons into art.

 

What else have we missed? Add your links in the comments, and don’t be shy about sending us suggestions!

 

 

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Herbal treatments for PMS — what works?

February 7th, 2011 by Elizabeth Kissling

Given the variety of symptoms of PMS (more than 150), it’s not surprising that no single treatment is effective for all cases, or that women would seek remedies in alternative medicine. A new review of 30 years of literature on herbal remedies sought to discover if randomized clinical trials (RCTs) on these alternatives found any of them effective. However, of the 102 articles identified, only 17 were RCTs and only 10 were included in the study: the researchers report that “the heterogeneity of population included, study design and outcome presentation refrained from a meta-analysis.” Based on this limited study, here are the findings:

Vitex agnus castus was the more investigated remedy (four trials, about 500 women), and it was reported to consistently ameliorate PMS better than placebo. Single trials also support the use of either Gingko biloba or Crocus sativus. On the contrary, neither Evening primrose oil nor St. John Worth show an effect different than placebo. None of the herbs was associated with major health risks, although the reduced number of tested patients does not allow definitive conclusions on safety.

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PMS Is Not Universal

December 14th, 2010 by Elizabeth Kissling

images(3)Not only does PMS not turn women into Vikings, heavyweight boxers, or Mexican wrestlers (see yesterday’s post about ads for Kitadol), it does not affect every woman who menstruates. Research using daily surveys to examine patterns of depression and anxiety symptoms in young women found that some women experience symptoms mid-cycle, others pre-menstrually, and still others do not experience mood changes in association with their menstrual cycle.

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PMS, Chocolate, and Other Stereotypes

November 12th, 2010 by Elizabeth Kissling

Screen_Shot_of_PSM-SOSThere’s already more than 60 apps on the market for tracking PMS and other aspects of the menstrual cycle, but there always room for one more: Betty Crocker introduced the PMS SOS app this week. In addition to sad stereotypes about gender and how women are ruled by their hormones, this app gives you coupons for discounts on General Mills baking products.

PMS SOS is so over-the-top it’s this week’s deserving prize winner of Bitch magazine’s Douchebag Decree. I really can’t add anything to their remarks but applause.

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Because women aren’t medicated enough?

September 19th, 2010 by Elizabeth Kissling

ProzacSome of you may recall that in my book, Capitalizing on the Curse, I argued that the addition of PMDD to the DSM-IV and the re-branding of fluoxetine HCI as Sarafem are linked. It was no coincidence that pharmaceutical manufacturer Eli Lilly sought a unique FDA approval for Sarafem as treatment for PMDD just as the patent on Prozac, also composed of fluoxetine HCI, was about to expire. Eli Lilly initially secured the patent for Sarafem until 2007, and it is no longer the only FDA-approved treatment for PMDD.

Lilly must be in need of a new way to keep milking the cash cow. How fortunate that new research suggests that Prozac can relieve garden-variety PMS as well. A neuroscientist at the University of Birmingham presented research last week at the British Science Festival that asserts a 2mg daily dose of fluoxetine in the week before menstruation could alleviate PMS. She tested it for three years on rats. Of course, rats don’t actually experience PMS, so they were “induced to have PMS-like symptoms”.

Every time I read another article about new treatments for PMS, I remember Joan Chrisler’s comments about over-diagnosis of PMS and PMDD (which are both associated with high levels of relationship and family stress): “We’re conditioned to want a pill. Instead of something you might need more, like a nap or a divorce, or the ERA.”

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Napping is Good for You!

April 28th, 2010 by Elizabeth Kissling
The Importance of Nap Time by Age, graph by cmoney345

The Importance of Nap Time by Age, graph by cmoney345

This is a very small study, but I don’t need much encouragement for an afternoon nap. Researchers wanted to test whether a mid-afternoon nap during the late-luteal phase of the menstrual cycle (commonly known as the premenstrual period) would improve symptoms of sleepiness, mood, and cognitive performance without negatively impacting subsequent nocturnal sleep. They tested this hypothesis on ten women with significant premenstrual symptoms and a control group of nine women with minimal or no symptoms, and found that napping made both groups feel better. More precisely,

Napping improved sleepiness, alertness, mood, and some aspects of cognitive performance. Improvements were maintained for at least 30 minutes and up to 6 hours after napping. An afternoon nap benefited both groups of women, but those with significant symptoms had a slightly greater improvement in intensity of mood 30 minutes after the nap.

Napping – it’s not just for kindergarteners. Wouldn’t the world be a better place if everyone could have a Fig Newton and a blankie at about 2:30 pm?

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Is PMDD Genetic?

March 9th, 2010 by Elizabeth Kissling

White lab mouse sitting in a gloved palm.

Guest Post by Amber Steele, University of Cambridge

There have been a couple of stories in the press recently touting a study by Joanna Spencer and colleagues suggesting that PMDD may be genetic. I had a cursory look through the paper and read the article. Changes in dendritic branching of neurons in the limbic system across the menstrual cycle, owing to changes in estrogen, has been well documented in the female mice and rat. Additionally, changes in neuronal activity and accompanying receptor activity is also well document during periods of hormone change, again in the female mice and rat models. Individual differences in how this change occurs and the fact that it can be linked to differences in genes make sense. It seems that Spencer et al., have identified one of probably many genes that mediates these differences. This is not the first time that a gene of this kind has been identified or implicated. For example, Susan Girdler at Chapel Hill has done some interesting work on PMDD and suggests a genetic i.e., differing protein response to a hormone, difference in response to progesterone that might, in part, explain symptoms associated with PMDD.

The fact that Spencer et al., found a relationship to anxious behavior does not say anything conclusively about PMS or PMDD. It only states that if you have this variant then your levels of anxiety may change as estrogen fluctuates.

The news article is exploiting the findings from the Spencer study to construct a simplistic view of varying responses to hormone change within and across women. I suppose the author of the news article thought it might be interesting to examine the debate on whether or not there is a “clinically disordered” state during the luteal phase of the menstrual cycle in some women and whether it should be recognized officially. While it may do this, it also perpetuates misunderstandings and stereotypes about women’s hormones and their emotional states.

Amber Steele is a graduate student at the University of Cambridge with a biomedical background. She is writing a thesis is on wellbeing over the menstrual cycle and how it relates to hormonal “biomarkers” cortisol and progesterone.

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Will the new PMDD please stand up?

February 21st, 2010 by Chris Hitchcock

The American Psychiatric Association has pushed back their timeline for the 5th version of the Diagnostic and Statistics Manual. The new psychiatric bible was originally scheduled to come out in 2011, but has now been delayed to 2013 .

Initial drafts have been posted to the web page, but the controversial and provisional (that is, not yet officially accepted) diagnosis of premenstrual dysphoric disorder (PMDD) does not yet appear ready for comment. Which is a shame, because traditionally SMCR and its members have had a lot to say about PMDD, and we’re looking forward to the opportunity to consider and critique its new incarnation. Here’s a recent post as an example.

PMDD was first introduced in the DSM-III-R as Late Luteal Phase Dysphoric Disorder. The “late luteal” was meant to include cycling women who did not bleed, for example, those with a hysterectomy but preserved ovaries, but was criticized because “luteal phase” implies ovulation, and assessing ovulation was not part of the diagnosis.

Paula Caplan (e.g. this article) and other members of the SMCR were vocal in their challenge to the psychiatric label. Paula Caplan wrote a book about her experiences with the DSM process (They Say You’re Crazy), and the SMCR produced the following position statement:

June 2001 / Resolution #1: PMDD and Sarafem
Whereas the Society for Menstrual Cycle Research has since 1977 been the pre-eminent organization that focuses on scientific research on the menstrual cycle;

Whereas there is no empirical evidence that there is premenstrual illness that is separate or different from other forms of depression or anxiety or responses to stressful life circumstances;

Whereas there is good empirical evidence the Premenstrual Dysphoric Disorder does not exist;

Whereas the widespread use of Sarafem and related drugs results in both the masking of real causes of women’s suffering and the production of negative drug effects;

Therefore, be it resolved the the Society for Menstrual Cycle Research calls upon the Food and Drug Administration

a) to reconsider its approval of Sarafem for the treatment of “Premenstrual Dysphoric Disorder” and

b) to enjoin Eli Lilly from airing or publishing advertisements for Sarafem to lay and professional audiences until such reconsideration is completed.

In the end, The FDA approved Sarafem (Prozac, re-colored lavender and repackaged, with a brand new patent and a new lease on life) for the treatment of this newly minted psychiatric disorder; a panel from the European Agency for the Evaluation of Medicinal Products declined to follow suit, recognizing that PMDD was not a widely accepted diagnostic label in Europe, and concluding that

There was considerable concern that women with less severe premenstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short- and long-term use of fluoxetine [Prozac].

Psychiatrists in the USA require an official DSM label to be paid by insurance companies for the services they provide to women with cyclic mood issues; insured treatment-seeking women in the USA require those who hold the medical purse strings to recognize their distress. And having an entry in the DSM meets both of those needs.

Here are some points that I think are helpful to start a discussion:

  1. We acknowledge that some women, at some times in their lives, experience significant increases in negative mood and physical symptoms around the time of menstrual bleeding, that for some these changes are extreme and seriously interfere with their lives, and that this experience needs to be recognized and treated.
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.