Blog of the Society for Menstrual Cycle Research

Culture, menstrual narratives, and the messy politics of reproductive freedom

May 23rd, 2015 by Laura Wershler

Two workshops explore the menstrual health/awareness and reproductive justice connection on Saturday, June 6th at  at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.

POLITICS IS A MESSY BUSINESS: Menstrual Health, Reproductive Health Advocacy, Human Rights and Justice
Sharon L. Powell, Artist and Educator, S L Powell Public Affairs Services

Original image by Sharon L. Powell

Menstruation is part of the spectrum of reproductive health. Menstruation and menstrual cycle discourse takes up space as marker in the health and identity of female bodied individuals as well as in constructions of fertility. As such, it is on a reproductive health advocacy agenda. Menstrual health and menstrual health education are cornerstones of a reproductive health advocacy framework. Human rights and social justice movements concerned with self determination, health, human dignity, privacy, and bodily integrity, should pay political attention to menstrual health’s crucial and complicated place in an interdependent web of reproductive health concerns.

Social and chemical control of fertility is specifically connected to the hormones associated with the menstrual cycle. Menstrual shame. Hysteria. Sexualization. Contraceptive and other reproductive technologies. How does one truly consent to the use of reproductive innovations like hormonal birth control if they do not understand the hormonal patterns they are born with or acquire? Reproductive justice groups and reproductive health advocates must look at issues of self determination with an intersectional lens, acknowledging female bodied individuals’s multiplicity. It is important to explore and create opportunities for female bodied individuals to learn more about their bodies, not just lobby for abstract concepts of reproductive freedom.

Twenty years ago, I presented a paper at the Society’s conference in Montreal, Canada called “Better Dead Than Pregnant: Trends in Contraception – A Case for Menstruation Education.” Connecting my critiques of trends in non-user/”woman” controlled methods of contraception with myths of inconvenience regarding menstruation and convenience regarding methods of contraception, I made connections to the messy politics of reproductive freedom, the differences in the experiences for women of color, women with disabilities, and poor women with this focus on menstruation and the menstrual cycle. My contention that women from these communities were “better dead than pregnant” was picked up by other reproductive rights activists (such as Andrea Smith in her book Conquest). Subsequently, Malcolm Gladwell’s article, “John Rock’s Error, ” detailed how a myth of inconvenience regarding menstruation may have played a role in the development of the oral contraceptive pill.

Our Bodies, Our Stories: Celebrating the Menstrual Narratives of Womanhood
Deborah Dauda, LEPA & Kirthi Jayakumar, Red Elephant Fund

This workshop will look at culture and menstruation by sharing stories and testimonies of women from all over the world and the impact of open conversations in creating comfortable spaces for women to celebrate their womanhood through menstruation. In addition, we will welcome participants to share their own testimonies and stories, along with a session on simple “what-if” scenarios to encourage community conduct and resource sharing.

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

How do women’s menstrual beliefs impact their contraceptive decision-making?

May 16th, 2015 by Laura Wershler

I’m looking forward to chairing this panel presentation exploring the intersections of contraception and menstrual health beliefs on Friday morning, June 5th, at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.  The conference theme is Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

Photo courtesy of Jen Lewis

Dueling Medicines: Contraception and Deeply Rooted Beliefs in Menstruation as a Health-giving Process

This panel will address women’s poor use, misuse, and rejection of medical contraception in Africa, the U.S., and other parts of the world. The first panelist will focus on Sub-Saharan women who either reject or stop using contraceptive pharmaceuticals when they become aware of the irregularities in their periods caused by the drugs. Next is an examination of how women in the U.S. who use natural family planning misuse or stop using medical contraception because of their desire for “normal” and “healthy” periods. The last presentation will work to connect Sub-Saharan women’s faith in a pan-African water spirit called Mami Wata to their reluctance to use contraception; the paper will hypothesize that that this popular divinity is ultimately rooted in a sophisticated prehistoric cosmology that analogized menstruation to universal, life-giving patterns of flow in nature and, thus, saw it as the hermeneutic that established and sustained human culture.

Method Mistrust: How women’s mistrust of family planning methods which interfere with their menstrual cycles leads to unmet need, incorrect contraceptive use, and method discontinuation
Ann Moore, Guttmacher Institute, @Guttmacher

Many hormonal contraceptives alter women’s menstrual cycles, making periods last longer, flow heavier or lighter, spot throughout the month, or simply stop. Because women widely mistrust such methods, they often resist, misuse, or stop using them. Based on data from developing and developed countries, this paper shows how wanting “normal” periods adds to their risk of unwanted pregnancy.

I shouldn’t mess around on those days: How women’s’ beliefs about their fertility and their menstrual cycles affect their contraceptive use
Lori Frohwirth, Guttmacher Institute

While modern contraception allows women to think about their cycles only in terms of hygiene and convenience, data show that many women view menstruation as a sign of good physical and reproductive health. This paper explores how the beliefs of American women about menstruation affects their use of the Fertility Awareness Method in combination with hormonal and barrier methods.

The Rainbow Goddess and the Rainbow Snake: Mami Wata Worship as a Source of African Women’s Belief in Menstruation as Medicine
Jacqueline Thomas, PhD, Independent Researcher 

Sub-Saharan women often reject hormonal contraceptives, citing belief in the salutary/reproductive benefits of regular periods. This paper argues that this belief likely reflects faith in the snake-entwined Mami Wata, a popular pan-African wealth/fertility deity. It hypothesizes that Mami Wata (aka the Rainbow Goddess) is a modern-day expression of the Rainbow Snake—a prehistoric menstruation-regulating African/Australian water spirit embodying a sophisticated cosmology that held women’s cycle-based solidarity as responsible for earthly order and human happiness.

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

This post was revised and updated on Saturday, May 16, 2015 at 12:35 p.m. MST.


Menstrual suppression, regulation and metaphors

May 8th, 2015 by Laura Wershler

Four takes on Fertility Control at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston

Image by Diana Álvarez

Not A “Real” Period: Redefining Menstruation and Reconfiguring Birth Control
Katie Ann Hasson, University of Southern California

Menstruation, as a “natural” bodily process, seems self-evident, despite a great deal of feminist work that has highlighted menstruation as culturally constructed. Yet even in this work, how menstruation is defined or what “counts” as menstruation is rarely questioned. Examining menstruation alongside technologies that alter it highlights these definitional questions.

I examine the case of menstrual suppression birth control as a technology that regulates menstruation, drawing on an analysis of medical journal articles and FDA advisory committee transcripts paired with websites used to market menstrual suppression to consumers. Across these contexts new definitions of menstruation converged on a distinction between bleeding that occurs when women are taking hormonal birth control and when they are not. This distinction was previously known but became newly salient as it helped to normalize menstrual suppression contraception. Redefining menstruation was an important step in reconfiguring birth control pills into menstrual suppression pills, and thus in reconfiguring co-constructed uses and users of birth control pills. This paper seeks to broaden a sociological understanding of gendered embodiment by attending to the co-construction of users, bodies, and technologies through processes of reconfiguration.

“Bringing Down My Period” – Metaphors Around Ending an Unwanted Pregnancy
Susan Yanow, MSW

Around the world, including in the United States, women are self-inducing miscarriage/abortion using medicines obtained via the Internet, friends, etc. While some women consider this practice “DIY abortion’” others frame it as “bringing down the period” or “menstrual regulation.”

This presentation will share information on prevalence of this practice in the U.S., legal issues, and the disproportionate impact of these restrictions on low income and rural women will be highlighted. Participants will be invited to consider what the role of clinicians and activists could/should be in supporting women who choose to self-induce to end an unwanted pregnancy.

“I would not recommend it to anyone.” – What can we learn from women who share their bad experiences with Depo-Provera?
Laura Wershler, Women’s Health Critic

In three years my blog post Coming off Depo-Provera can be a women’s worst nightmare, (re:Cycling, April 2012)  gathered 900+ comments, many suggesting that the title was an accurate statement of experience for many women. A later post, Stopping Depo-Provera: Why and What to do About Adverse Effects, a Q&A with endocrinologist Dr. Jerilynn C. Prior, received almost 400 comments.

Analysis of these comments (excerpts to be presented) revealed four recurring themes: 1) Uninformed choice 2) Lack of body literacy 3) Feelings of anger, fear, regret, betrayal and solidarity 4) Frustration with health-care providers. I’ll present arguments as to why this contraceptive method, as currently provided, does not serve reproductive choice or justice and offer suggestions for criteria required to ensure Depo-Provera is a contraceptive method that respects informed choice, body literacy, and women’s well-being.

 “I Won’t Have What She’s Having!” – Menstruation Suppression, Illusion of Choice, and the Lure of Posthumanisms
Diana Álvarez, Student, Texas Woman’s University

This paper explores why women choose to take menstruation cessation birth control pills and how this “choice” influences the way women view themselves. I am interested in understanding how the current cultural rhetoric on menstruation serves as a type of coercion for women to take these drugs. The analysis represents women’s eliminated cycles as a type of (dis)placing of the female body. Women are being convinced that the natural physiological occurrences of their bodies are at best inconvenient but at worst completely unnecessary and in need of elimination. Menstrual suppression will be discussed as a step towards posthumanism which as defined by Richard Twine is the “belief that the human race should be ‘enhanced’ using technological means.” I’ll address how the practice of not menstruating embraces a cyborg feminine identity.

Media Release and Registration for the SMCR Boston Conference.

State of Wonder–Part 2: Wondering about missing femcare products and birth control references

March 6th, 2015 by Laura Wershler

In State of Wonder–Part 1, I mused as to why, in a novel revolving around the extended menstruation and fertility of the Lakashi tribe, only the menstrual cycles of the Brazilian women being studied are made visible to the reader. Why does author Ann Patchett ignore the menstrual cycles of the novel’s protagonist, Marina Singh, or the other female research scientists? If they are eating the tree bark responsible for the Lakashi’s extended fertility, their menstrual responses should be of interest to the author.

Failure to mention the scientist’s cycles points to another puzzling omission. There is no reference to menstrual-care products the women would have required while living in the rainforest for years at a time. There was opportunity to do so because a few key scenes are set in the store where research leader Dr. Annick Swenson buys all the provisions for the camp.

Marina must visit the store immediately upon landing in Manaus because the airline has lost her luggage. She has no clothing, no toiletries, none of the necessities for daily living. Why does she not purchase, visibly to the reader, tampons or pads? If not on her first trip to the store, then on her second as she prepares to leave for the remote research camp with Dr. Swenson? She obviously will need such supplies as her weeks in Brazil progress, and the timing of her cycle, as deduced by this reader, suggests she needed them while in Manaus or shortly after arriving at the camp.

I think Patchett’s reason for leaving out this menstrual-related information was not literary, but rather socio-cultural in nature. She tastefully shares the intimate details of the Lakashi women’s menstrual cycles, but can’t find a way—with even a few sentences—to convey this aspect of other female character’s lives? (Exception: Dr. Swenson, whose experiences I avoid mentioning to prevent plot spoilers.) Did she try? Did she resist? If so, why? What a missed opportunity. Marina’s interior dialogue makes it clear she is a still-menstruating woman wondering if motherhood will be in her future. How easy it would have been to use Marina’s need for tampons as a segue to consideration of her fertility.

Which brings me to another menstrual-related omission in the book. There is no reference to the birth control methods used by Marina and one of the female scientists who lives in the research camp with her husband.

Drs. Nancy and Alan Saturn are part of the research team in Brazil. Nancy is eating the bark, enhancing her fertility. Pregnancy is not an objective for this couple; they must be using contraception. The pill would be contra-indicated—a double whammy of exogenous estrogen provided by the pill and the Martin tree bark could have negative consequences. Condoms would break down in the heat. A Mirena IUD might not be at odds with the estrogenic bark, which has another critical medicinal effect the researchers are eager to access. Maybe a copper IUD? A diaphragm? Abstinence? Does it matter? Perhaps not, but why not be daring and tell the reader anyway? Surely the author must have asked herself these questions.

And what about Marina’s choice of birth control? At 42 she is in an intimate relationship with a much older colleague, the man who sent her to Brazil. Contraceptive use is implied but the method is, yet again, invisible. One can assume it was non-hormonal and not an IUD because of what happens at the end of the novel. But why not write one or two sentences along the way to convey this information? Isn’t this what good writers do, litter clues as a novel progresses to set up what happens later?

Ann Patchett chose not to mention the femcare products and birth control methods her characters used in her novel State of Wonder. I can’t help wondering: why?

Continued in State of Wonder—Part 3: Wondering about menstrual cycle misconceptions in postulating a theory of extended fertility

Depo-Provera and Fifty Shades of Grey—The Movie

February 13th, 2015 by Laura Wershler

Dear Readers: The following post first appeared on July 25, 2012, during the media think-piece flurry over the soaring popularity of E.L James’s Fifty Shades of Grey trilogy. With the movie opening on Valentine’s Day, 2015, I can’t wait to find out if or how Depo-Provera is referenced as the contraceptive choice made for heroine Anastasia Steele by ob-gyn Dr. Greene, a character I have confirmed via IMDb is in the movie. I argued in the post that Depo-Provera as Ana’s birth control method was an unrealistic plot device. Commentary on Fifty Shades has again started to snowball, but I doubt anyone besides myself will have the slightest interest in this facet of the story. I invite readers who get to the theater before I do to report back in the comments section.

Menstrual Considerations in Fifty Shades of Grey

Fine literary fiction it is not, but the Fifty Shades of Grey trilogy by E.L. James can certainly claim to be libido-boosting storytelling. Deirdre Donahue at USA Today summarized the books’ appeal in 10 reasons ‘Fifty Shades of Grey’ has shackled readers. She pretty much nailed it. And she’s read the books, which is more than can be said for other writers, including this one who implied that heroine Anastasia (Ana) Steele signs a contract to become hero Christian Grey’s submissive in a BDSM relationship. She doesn’t.

Until he meets Ana, Christian’s sexual history has included only BDSM relationships, those involving bondage, discipline, dominance, submission and sadomasochism. BDSM plays a role in their love story, but the most sadistic thing that Ana submits to is a shot of Depo-Provera. re:Cycling readers know what I think of this contraceptive: I. Am. Not. A. Fan.

As a menstrual cycle advocate, I pay attention to menstrual mentions wherever they appear. It was impossible for me NOT to hone in on how James handles menstruation and birth control.

Christian quickly ascertains that Ana, a virgin when he meets her, is not using birth control. (His unflinching communication about sexuality is one of the books’ most appealing aspects.) As their sexual affair begins, he uses condoms. Within a week or so he asks when her period is due and says, “You need to sort out some contraception”. But our hero is a rich control freak, so he arranges for “the best ob-gyn in Seattle” to come to his home on a Sunday afternoon. Ana, the narrator:

“After a thorough examination and lengthy discussion, Dr. Greene and I decide on the mini pill. She writes me a prepaid prescription and instructs me to pick the pills up tomorrow. I love her no-nonsense attitude — she has lectured me until she’s as blue as her dress about taking it at the same time every day.”

Alas, Anastasia, just 21, is the perfect example for why researchers with the Contraceptive CHOICE Project are recommending that women under 21 use long-acting reversible contraceptive methods. She forgets to keep taking her pills when she and Christian briefly break up. It’s back to condoms for this couple, until Dr. Greene reappears, confirms Ana is not pregnant, and, after Depo-Provera’s side effects are dismissed as irrelevant because “the side effects of a child are far-reaching and go on for years,” gives her the shot. I almost had to stop reading.

I get it that James uses Depo-Provera as a plot device, as becomes apparent. But the author’s decision to give Ana Depo-Provera is not in keeping with either Dr. Greene’s or Christian’s characters. I don’t believe for one minute that the best ob-gyn in Seattle would give Depo-Provera to any patient; she’d recommend a Mirena IUD. As for control-freak Christian, he is adamantly committed to Anastasia’s safety, evidenced in many ways. He would never consent to her taking a drug with these potential side effects: weight gain, digestive problems, depression, loss of bone density, vaginal dryness, and — especially — loss of sexual sensitivity and desire. Never! And he’s too smart not to know this.

Christian’s occasionally expressed distaste for condoms also seems to be a plot device considering he uses them so skillfully, and without obvious diminishment to either his or Ana’s pleasure, through 986 pages of the 1594-page trilogy. The tearing of foil condom packets is a leitmotif that in no way hinders this man’s exceptional “sexing skills.”

But James gets full marks for this: Christian Grey is not afraid of blood. While making love in a spacious hotel bathroom, he gently removes Ana’s tampon and tosses it in the toilet. Later, sitting on the bathroom floor, Ana remembers she has her period:

“I’m bleeding,” I murmur.

“Doesn’t bother me,” he breathes.

‘Yuck’-busting conversations about menstruation

July 22nd, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

In my line of work, I talk and write a lot about the female reproductive system. It’s no secret…I’m pretty vag-savvy. I don’t randomly walk up to strangers and start talking lady parts, but I certainly don’t hesitate to share repro info when the topic arises or when people ask me what I do for a living.

While some people constantly look like they are secretly planning an escape from the conversation, more often than not, the folks I’ve encountered are genuinely very curious and inquisitive about female reproduction. After all, it’s something that most of us have never really been taught. One big thing I’ve noticed is that talking about the topic like it’s no big deal makes people a lot more likely to truly engage. Having frank conversations rather than ones riddled with “ewws” and “yucks” goes a long way toward helping people break down internal menstrual stigmas, and it’s an awesome thing to be part of.

I recently spent some time in Chicago visiting a friend, and while I was there, we went out to dinner with her friends. Then comes the obligatory question about what I do for a living. To this day, when someone asks me this question, I still have moments of mild internal panic, wondering how they will react. I would imagine that when most of us ask this question, we’re not expecting to be faced with a deeply personal, and often polarizing, subject. So, in some ways, I can totally understand the initial shock-factor that some people experience. But I somehow always manage to answer very matter-of-factly, and on this particular day, it couldn’t have gone better.

 

One of the women in the group, after hearing that I specialize in lady parts and natural fertility management, mentioned that she was really struggling with the birth control pill and had been thinking for a while about stopping. And she asked for my advice. I’m always very careful not to say “this is what you should do,” because autonomy is incredibly important and I’ll never claim to know the best birth control option for someone…especially someone I just met. So, instead, I opened up about my personal experience with the pill, my hesitation in deciding to stop, my work with Groove and fertility awareness, and what it has all meant for my life. I wasn’t surprised that she was interested in my story (it’s always nice to know you aren’t alone), but I start to get pretty giddy when others jump into the conversation, too. Which is precisely what happened.

I was in mixed company and everyone in the group was actively engaging in a conversation about periods, birth control, and cervical fluid. Not a single person murmured an “ew,” and I (of course) was thrilled. There were a lot of wonderful questions asked, a lot of great dialogue about how the female reproductive system works, and even some thoughtful critiques of modern birth control methods. In the end, the woman who initially asked for my advice said that she found my experience both validating and reassuring, and she mentioned that she planned to stop the pill. But even if this hadn’t been her decision, the conversation was still a wild success.

Any initial hesitation felt by the individuals in our group quickly dissipated after the conversation began. In the end, there was no shame, no embarrassment, no stigma. This is precisely why I do what I do. If I can help even one person overcome female reproductive stigmas, then I consider my work a success. On this day, I felt enormously successful.

Obvious Child: The Other Taboo

June 18th, 2014 by Holly Grigg-Spall

cervical mucus

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

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

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

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

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

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

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

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

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

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

This is what she had to say:

“I enjoy the genre of romantic comedies with all their faults; I’m not as critical of them as I am of other genres, and ‘Obvious Child’ more than met my expectations. I particularly liked ‘Obvious Child.’ I liked the uninhibited tipsy lovemaking scenes that showed casual sex at its best. Then, the complications that arose when she found out she was pregnant and needed to have an abortion and when he continued to be very interested in having a real relationship rang absolutely true to me. It’s just our luck, isn’t it, to get pregnant when there’s no realistic way to continue the pregnancy? The women, married or unmarried, who get abortions have some variation of this experience. When we have such bad timing, it’s the pits! I loved that their relationship grew in facing the regrettable necessity of the abortion and the recovery together, and you get the feeling that the relationship has a good future ahead of it. A darned good story.”

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

There seems to be a growing disconnect in recent years between physicians and their patients, and women are especially susceptible to this given our reliance on doctors for information about contraception. When compared to the questions many of us ask our doctors, the information we receive isn’t always up to snuff.

Patient autonomy, as defined by medical dictionaries, is “the right of patients to make decisions about their medical care without their healthcare provider trying to influence the decision.” Based on many conversations with other women, in addition to my own personal experiences, patient autonomy often does not exist for women seeking information about contraception. And this is a huge problem. Deadly (and rare) birth control side effects have become a hot-topic in the news as of late – which is likely contributing to this physician–patient disconnect – but the growing patient interest in control and autonomy means that this cannot simply be dismissed as a side effect of the media.

A recent study, published in the Journal of Contraception, asked both women and healthcare providers to rank the importance of 34 questions relating to contraceptive options. They found that the things that are most important to women are often not as important to their healthcare providers. For example, knowing exactly how a method works to prevent pregnancy was ranked by women as the most important piece of information, whereas how to use a method correctly topped the list for providers. Effectiveness, while still important, was ranked fifth by women, which is a stark inconsistency if you consider just how central a method’s effectiveness is in ads and in the media. The study also found that questions regarding potential side effects ranked in the top three for 26% of women, but only 16% of providers.

These stats may seem inconsequential – after all, physicians should be educating patients about proper use of contraceptive methods. But here’s the problem: the methods suggested by physicians don’t always align with a woman’s stated preferences. I’m certain I’m not the only woman who has been pressured to use a hormonal method (despite my voiced concerns) simply because these methods are considered to be easy and effective. While it seems like a logical solution for physicians to advocate for hormonal methods over methods with higher typical-use failure rates, this approach is ultimately a detriment to women.

A growing number of women seem to be turning to withdrawal, and while this isn’t inherently bad, it becomes bad when a patient isn’t educated on how to properly use it simply because her physician is hesitant to discuss “unreliable” methods. This means that women are turning to potentially unreliable internet sources (or, worse, misinformed friends) for this information. The same can be said for diaphragms, cervical caps, and fertility awareness-based methods. If we want to continue to drive down unintended pregnancy rates, dismissing patient concerns and eliminating patient autonomy isn’t the route we should take. Contraceptive methods aren’t one-size-fits-all, which should be obvious by the huge differences in side effects experienced from person to person. So why do so many contraceptive consultations continue to be carried out in this one-size-fits-all fashion?

Empowering women through family planning is more complex than simply prescribing the most effective methods. It must be coupled with engagement in an open dialogue, including acknowledgement of patient concerns and a respect for patient autonomy. Patients are increasingly demanding autonomy, and if healthcare providers wish to remain a respected part of a woman’s health, it’s time to set aside contraceptive biases and listen.

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.

This brings us back to the Colorado nuns, the Little Sisters of the Poor. Nuns have a substantially higher risk of reproductive cancers than women who have children, in part because of their celibacy, which means a lifetime of uninterrupted menstrual cycles. In 2011, my wife and I attended an obstetric conference in the Pontifical University of the Holy Cross in Rome. The keynote lecture there recommended that nuns use oral contraceptives for two or three years after taking their vows, in order to benefit from a long-term reduction in reproductive cancers to which nuns are otherwise exposed by their celibate life.”

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.

YOU, for reading this blog and demonstrating that menstrual issues are important, and deeply connected to how we ALL experience our embodiment, whether we shed or not. Can you imagine living in a world in which menstrual talk was NOT taboo? Pause for a moment and ponder that. Wow. Where’s the shame?  I see people talking freely about their experiences. Questions answered. Needs met. Isolation broken. As Liz Lemon of 30 Rock fame was known to say “I want to go to there.” I really do.

These menstrual champions are just a fraction of those who are actively creating that world so we can.

 

 

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.