Scene 1 10: 45 am:
A quiet Sunday morning, sunny and bright. Brunch on the patio. I sat with my daughter, my partner, and my niece. Over pastries and coffee, I experienced waves of menstrual contractions, coming steadily every 15 minutes. And I winced, swallowing my moans.
While my niece spoke of her back pain, and my partner lamented his brief but powerful bout of the flu, I offered no comment about the vice grip around my uterus, the attention-grabbing cramping that hit me again and again. Through these cramping spells, I coached myself to “tough it out” though I noticed that when I was alone, I audibly groaned. I hurt, but I said nothing.
And interestingly, later, while chatting with my stepson and his boyfriend, I kept the cramps entirely to myself. I chose to suffer in silence.
I hurt and yet, it seemed, my menstrual pain was not worth mentioning. It was mundane, even nearly universal. It was not the type of thing you sit around and whine about. I was aware, at some level, that an occasional mention of my pain would garner some sympathy, but beyond that, let the eye rolling begin. And in some company, it might be too-much-information, too private, too gross, even, to mention.
Scene 2 4:30 pm: Returning home after a 10-day road trip. The house, showing the wear of a place overrun by two cats with little human intervention, needed to be restored to order. Piles of mail. Bags to unpack.
But the very first thing I did when I walked through the door was take a shower and then do laundry. I had leaked badly during the last leg of the trip and I was a mess. My partner and daughter, alternatively, immediately settled on the (cat hair-encrusted) couch and reconnected to their wired worlds. While I, 21st century pioneer wife, scrubbed blood stains out of my clothes and hung another pair of “ruined” panties on the clothesline.
I walked past my family several times during my emergency clean up operation. With each glance, I felt envy rise up, and if i am honest, resentment, too. But I did not complain. My body, my period, my mess. My problem.
But is it? Should it?
During menstrual moments like these, (and now I will generalize) we often experience an acute embodied awareness that arrests our attention. At times, the experiences are painful or messy or both. Sometimes these ‘invasions’ are significant ,and we could benefit from some company. And yet, it is the rare menstruator who is NOT socialized to ‘buck up’ and ‘just deal with it.’ There is a persistent voice in our heads: ‘No body wants to hear about your period…. Cramps are boring. And stain stories? Nobody wants to hear about THAT!”
I’ve argued this point before; it seems the only acceptable menstrual discourse is PMS jokes (in which the punchline is a bitchy, out of control woman [see image above].
When it comes to expressing the reality of our menstrual lives—wherever our experiences fall on the continuum from menstrual joy to menstrual misery—we do so in a veritable sound chamber that CAN hurt us. For many of us, our menstrual experiences are uneventful, at least most of the time. But for the rest, they can be catastrophic. Or they may be normal, ho-hum, TODAY until they are NOT, a day later. Things change. Needs change. But the silence persists.
My concern is this: if we don’t open spaces for menstrual discourse, how can we find the support to discern the normal from the NOT normal? How can we get the info and support we need when we need it?
Scene: 3 3:24 am. I slowly came to consciousness and as I did, I instinctively reached between my legs. Yes. I was wet. Yes. My pad had shifted. And yes, so had the “insurance towel” I placed beneath me to protect the sheets. Damn. I didn’t want to get up and change my pad and underwear, but if I did not, I would have an even bigger stain on my sheet, maybe one that would soak through the mattress pad and onto my mattress. Ugh.
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.”
Everybody knows “an apple a day keeps the doctor away.” Or at least we teach our kids this saying.
It turns out now “an apple a day keeps menopause woes away,” at least according to the Red Hot Mamas’ website, and some other recent news posts. Apples (along with many other fruits and vegetables) apparently help us fight (lessen) menopausal symptoms, and other websites advocate apple cider vinegar to help with menopausal symptoms. Not to mention these things help with weight gain and other chronic health conditions as we age.
Apples help alleviate PMS symptoms too, apparently. A “PMS Comfort” Website even has a Cinnamon Baked Apple recipe for women to make when they need to relieve PMS symptoms. From a perusal of these websites, it seems one of the things apples can do is reduce bloating and swelling.
To some extent I’m skeptical: what makes an apple better than a blueberry or a nice cold glass of water? I guess this simply reminds us that diet definitely matters at all stages of our reproductive life cycles. This also harks back to Paula Derry’s recent post about how the environment affects our bodies and what we put our bodies through matters, and Kati Bicknell’s latest post about the impacts of eating meat on fertility. What we put into our bodies matters too.
I guess it’s true that an apple a day is a good thing. But, how did the apple get some much hype anyway? Seriously, if there is one fruit that has become part of our daily lexicon it is the apple. . . . Adam and Eve’s apple, Johny Appleseed, Mom and Apple Pie, the Big Apple, the poison apples from from Snow White, you’re the apple of my eye, you’re sweet as apple pie, an apple for the teacher, an apple a day keeps the doctor away …. I guess it was a matter of time before apples made it to PMS and menopause.
Saniya Ghanoui and David Linton
How peculiar are the sexual politics of Cosmopolitan magazine?!?! We previously noted the editorial avoidance of menstrual sex, but let’s take a look at their most recent ride on the menstrual cycle.
On one hand, Cosmo aspires to liberate women from sexual repression into a world of ever better orgasms and perpetual youth and beauty. On the other hand, it ceaselessly stokes anxiety and insecurity with its constant twin emphasis on pleasing “him” and urging the purchase of the latest Big Thing. Occasionally, in an effort to demonstrate concern for women’s health there appears a reference to some aspect of the menstrual cycle.
The most recent example occurs in the June 2012 issue whose cover, under a hot photo of the rock star Pink, announces that inside you can learn, “Why your Period Makes You Cra-a-zy”. Off the bat, the cover recirculates the tired notion that the period is responsible for some kind of transformation, turning a woman into a crazy person. The use of an extra “a” emphasizes the word in a way that enhances its meaning, thus the period causes almost an abnormal form of craziness. There’s also a lovely irony to this cover. Pink is dressed in a vibrant solid-red dress that counters her pale skin and hair. She pulls up one side of outfit as she claws her dress and her expression is meant to show a “tough girl” side to her personality. It’s as if the cover alludes to notions of craziness, as caused by the period, via the image of Pink.
The article does seem to contain practical advice for those who experience some level of discomfort prior to getting their period. The five suggestions include topics such as diet, exercise, orgasms, coffee, and laughter. Unfortunately, embedded in the nuggets of advice one finds relentless reinforcements of age-old prejudices, stereotypes, and negative perspectives. Even the opening page, which sets up the piece, is titled “Beat the PMS Brain Haze” and shows a woman whose head is slightly out of focus and fading into a cloud. In case you miss the point, a sentence beside her head states, “It’s hard to function when your head is in the clouds”. In larger type under the title the message is reinforced, “It’s when you feel so foggy, you can barely choose between a lemon and a lime for your diet soda”.
The next two pages of suggestions comprise a litany of ways to cope with the “annoying symptom”, “hormonal cloud”, “haze”, and “PMS coma” that leave women “easily overwhelmed, stressed out, forgetful and indecisive”, Women are told to “cancel everything that’s optional”, “snack on yummy oatmeal” to “make up for the PMS brain drain”, “ask your guy to rub your back”, and have “a dose of caffeine”.
What is obvious about the article and the tips that are meant to keep women “sane”, insinuating that one may be insane while PMSing, is the way in which each bit of advice is meant to fix some frustrating characteristic that is either caused or heightened by PMS. Thus, the message is that women have an extra hindrance they must overcome in order to have a peaceful week leading up to their period. In order to solve the problem Cosmo advises some simple changes, such as having a cup of coffee, to more radical ones like changing or canceling items on your schedule. What the latter puts forward is the idea that PMS is such a hindrance that one must change one’s weekly agenda in order to function normally. While it is true that some may have discomfort during PMS and desire extra time to relax, to completely cancel or modify a weekly schedule suggests a level of wealth or leisure that is in the realm of fantasy.
Despite the appearance that the article is simply a pleasant set of suggestions, it turns out that the three pages are actually a lead into a fourth page on the right side so the connection can’t be missed, consisting of the latest ad for Tampax Radiant tampons. In design and placement the ad blends perfectly with the article so as to flow, as it were, directly from the pre-menstrual days into the period itself with Tampax waiting there to fill the need.
There has been a lot written in recent years about the blurring of lines between editorial content and advertising but the only blurring in this case is the unintentional design of the first page of the piece which is purposely shot out of focus to visually illustrate how women must feel as their hormones debilitate them.
Furthermore, the ad purposely counters all the frustrations exhibited in the previous three pages. The ad promotes the “invisible” period, thanks to this specific tampon, that has “leakguard technology” and a “discreet resealable wrapper.” All of these characteristics are meant to ease irritations associated with the period. And why wouldn’t a woman want to have her aggravations eliminated, especially after reading three pages of problems associated with PMS? It seems the message is that since there isn’t a menstrual product (outside of drugs) that can ease PMS, at least the period can be eased by this tampon.
Guest Post by Joan Chrisler, Connecticut College
I have to admit that I have not been closely following the news about the forthcoming edition (5th) of the Diagnostic and Statistical Manual of Mental Disorders, which is expected to be published by the American Psychiatric Association in May 2013. So, when our blog editor Elizabeth Kissling asked me to take a look at a recent update on PMDD in Psychiatric News, I was intrigued. As I read the article I found myself becoming irritable, very irritable, even angry – but, don’t worry about me; I couldn’t possibly have PMDD, as I no longer menstruate. No, my emotional lability has more to do with the psychiatrists’ tendency to play fast and loose with facts than it does with my physiology.
The “news” begins with a statement that PMDD has been “proposed” to be included in the section on depressive disorders rather than in the appendix, which is reserved for disorders that need more study and shouldn’t yet be used clinically. This is a canard. PMDD appears in both the appendix and the depressive disorders section of the current edition – the DSM-IV-TR, which was published in 2000. As a result, it is already being used clinically. Perhaps what they really mean to say is that it is being removed from the appendix because we already know enough about it. Hmmm.
Next, we are told that there has been an “explosion” of research on PMDD in the “past 20 years.” Why 20 years? PMDD was originally named Late Luteal Phase Dysphoric Disorder and proposed for listing in the DSM-II-R (1987); early research that was intended to support the new diagnosis was not convincing, which probably factored into the decision to change its name. The current edition of the DSM was published 12 years ago, and the original DSM-IV in 1995 (17 years ago). According to PsycINFO, the largest psychology database, there have only been 259 articles published since the most recent edition of the DSM appeared, which hardly seems like an explosion, especially if we consider that many of them are about PMS, not PMDD. Others are not empirical reports of studies about PMDD; they are literature reviews, critiques of the diagnosis, and articles about psychotherapy for women with the diagnosis. The 259 even include random studies of migraines, schizophrenia, bipolar disorder, and menopause. The psychiatrists believe that these studies provide “greater legitimacy” for the diagnosis. Sorry, but I am not convinced.
The news report indicates that the criteria have been sharpened to require the presence of at least five of eleven symptoms during “most” menstrual cycles of the previous year. Prospective daily ratings are recommended, but it seems unlikely to me that most patients would be willing to wait or that most doctors would really insist that women rate themselves daily for a year before prescribing medication for PMDD. Another change is that the symptoms must produce “clinically significant distress” and “interference” with work, school, relationships, or social activities. These require judgment calls: “clinical significance” is the doctor’s call, and “interference” is the patient’s call.
I predict that these “sharper” descriptions are still vague enough to be overused. Example: A student in one of my classes told me in all seriousness that her menstrual cramps interfered with her daily life because she had to take an aspirin occasionally. Did she have to skip class and lay down with a heating pad? No, she took her pill and went about her business. “Then, how is that interference?”, I asked. “I don’t usually have to take an aspirin!”, she insisted. Now, I hope that that young woman is unusual, but I ask you to consider that the youth culture seems to value anything “extreme” and consider much of their experience to be unusual. My students think that (almost) everything is “awesome”, “incredible”, and “amazing”. If they were asked if their irritability is “extreme”, I suspect they would be much more likely than I would be to say “yes”.
Perhaps the most interesting (well, in a bad way) part of the news is that symptoms have been reordered to give priority to emotional lability, irritability, and anger and to deemphasize depressed mood. Why? “The work group agreed that clinically depressed mood is not the first thing you think of when you think of PMDD”. Perhaps the work group is thinking about cultural stereotypes of premenstrual women! If depressed mood is no longer a key criterion for PMDD, why is it still called PMDD? Shouldn’t the work group have proposed a name change that would drop “dysphoric disorder”? Why will it be continue to be classified with depressive disorders if it isn’t one?
Finally, the news report notes that how much distress and/or interference premenstrual symptoms produce depends on women’s personality, coping style, and life circumstances. Well, of course. There are many studies in the literature that show this. Stress, trauma, and even frequency of perceived discrimination (Pilver et al., 2011) predict severity of premenstrual complaints. There is much that psychotherapists can do to help women to manage their symptoms, but all the DSM suggests is drug treatment: SSRIs (selective serotonin reuptake inhibitors — the most commonly prescribed anti-depressants in the U.S.).
In conclusion, I refer readers to the SMCR’s resolution dated June 2001. Women should continue to be cautious about whether their premenstrual symptoms constitute a mental illness and whether they want to take a strong anti-depressant medication for the rest of their menstrual lives. Other types of help, without potentially serious side effects and the stigma of a psychiatric diagnosis, might be effective.
For more information about PMDD and the DSM, see:
Caplan, P. J. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. Reading, MA: Addison Wesley.
Chrisler, J. C., & Caplan, P. (2003). The strange case of Dr. Jekyll and Ms. Hyde: How PMS became a cultural phenomenon and a psychiatric disorder. Annual Review of Sex Research, 13, 274-306.
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.
What if the coin came up heads 60 times? Is the coin honest or not? The question is this: When is an outcome still “what you would expect by chance even though the numbers are not exactly alike (since we expect approximately 50 heads, not exactly 50)”? On the other hand, when is the difference big enough that you would conclude that the coin is probably biased? Sometimes it’s hard to tell. In research, very often results are in the “hard to tell” category. For example, if 55 percent of the women in my research prefer chocolate ice cream, while 65 percent of the men prefer chocolate, is there a real sex difference (it’s so improbable there’s a real difference) or is there not (the numbers seem different, but I’m not sure whether this is just because there is a range due to chance and not a real difference). Sometimes numbers that seem very different are actually what you could commonly get by chance, and sometimes numbers that don’t seem very different are very improbable. In addition, what I’m studying may produce a weak rather than a larger, obvious effect because among us humans, for all kinds of psychological, social, and biological research, what is being studied is only one factor contributing to a situation and not the only thing going on. In the example, even if men and women do have different likelihoods of preferring chocolate, there are many possible reasons for a person’s choices—diabetes, city you grew up in, getting rejected by a date while you were eating chocolate ice cream, etc.
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.
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?
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.