Blog of the Society for Menstrual Cycle Research

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

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

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

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

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

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

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

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

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

I’d given up reading the comments on online articles for the good of my mental health when a small slip last week steeled my resolve. In response to an article exploring the arguments made by “birth control truthers” a concerned father decided to have his say, taking the defensive arguments put forward by those in opposition to these “truthers” to their only logical conclusion:

“Perhaps we should market contraceptive pills as hormonal supplements to reduce cancer risk instead of as “contraception”? After all, it is only in modern times that women have hundreds of menstrual cycles throughout their lives. Even up until 1800 it was common for women to be either pregnant or lactating throughout much of their short lives.

The body simply wasn’t built to handle so many menstrual cycles, which raises the risk for cancer.

Who could argue with taking supplements to prevent cancer?

This may sound strange, but I am seriously considering putting my 11 year-old daughter on the pill (with no placebo) just for the health benefits. I just have to convince my wife first who is a little shocked by the idea…”

I cannot count how many times I have heard that the birth control pill “prevents cancer” – specifically “preventing” ovarian and endometrial cancer.  In the last few months I have seen references to this benefit explained less and less so as a “lowered risk” and more and more so as a “preventative” action.  I think this is significant as the word “prevent” suggests that the pill guarantees you will not get these forms of cancer. And yet, to remark that the pill is counted as a carcinogenic substance by WHO – due on the increased the risk of breast and cervical cancers – will get you tagged as a “truther.”

What is interesting, of course, is that despite the “cancer protecting” benefits of pregnancy, and early pregnancy at that, we do not see women encouraged to get pregnant in order to lower their risk of ovarian cancer.  Criticism of child-free women does not generally include comments about their lax attitude towards their own health. The risk goes down further with every pregnancy and further still with breast feeding, especially breast feeding for a long period of time after birth. Women who have children young, and multiple children, have a lower risk of breast cancer than women who have no children or children after 30. Yet we see more talk of women having “too many” children at an age that is “too young” – in fact I was contacted via Twitter by someone who read this piece and who saw, in the comments, that one woman who uses natural family planning admitted to both liking the method and having 14 children. This admission disgusted the person who contacted me, even when I pointed out that it seemed the woman had very much chosen to have those 14 children.

It seems the people who are advocating prescription of the pill for cancer prevention purposes are not advocating women have children earlier, more children, or consider breast feeding for the good of their own health – in fact two of the loudest critics of my “birth control truther” book are vehemently against pregnancy and breast feeding being part of women’s lives (Amanda Marcotte and Lindsay Beyerstein). The risks of the pill are frequently compared to the health risks associated with pregnancy and child birth,  but we don’t often hear women say they are choosing to not have children to avoid putting their health at risk for nine or so months.

Which leads me to this article in the LA Times that suggested nuns should also be on the birth control pill for its cancer-protecting abilities:

“And are the pills really unnatural? Our hunter-gatherer ancestors had their babies four or five years apart, because of long intervals of breastfeeding. As a result of that and their shorter life spans, they had as few as 40 menstrual cycles in a lifetime, while a modern woman can have 400. Though we can’t claim that today’s pills are perfect, their use is certainly less unnatural than enduring the hormone turmoil of hundreds of menstrual cycles.

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

November 26th, 2013 by Chris Bobel

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

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

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

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

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

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

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

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

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

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

Used with Permission

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

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

A Review of Selene: A New Cycle-Tracking App

September 2nd, 2013 by Chris Bobel

Guest Post by Amy Sedgwick, HRHP, Red Tent Sisters

Screenshot of Selene app // Photo courtesy of daringplan.com/selene

While there are no shortage of apps designed to help women track their periods, finding an app that meets the needs of women who are practicing fertility awareness methods (FAM) for birth control or conception can be quite a challenge. As a teacher of the Justisse Method of Fertility Management (there is currently no app available but there is one in development) I am often asked by my clients about web-based solutions to tracking their cycles when they are travelling or find themselves in other situations where their physical charts are impractical. Fertility Awareness users will be pleased to know that there is a new app on the market, Selene, which has been developed with FAM in mind. In addition to being able to chart the standard fertility markers (cervical mucus, cervical position, and basal body temperature), Selene boasts loads of unique features like the ability to make note of the things that affect reliability the most – like sickness, travel, and disturbed sleep. Selene also allows the user to define their own markers to track patterns in health, mood, libido, and more. The chart tab of the app shows you your cycle in a graph format, while the calendar tab displays it from a monthly perspective. Some of the other highlights of the app include a description of the daily moon phase, an automatic luteal phase calculator, the ability to ask questions about your chart in the “Ask an Expert” section, and a detailed instructions and help section. Selene excels at utilizing the principles of the widely-used fertility awareness method taught in Taking Charge of Your Fertility. Using principles from the book, the app will shade out days of predicted fertility based on the information you enter. It will also calculate an ovulation prediction based on the average length of your cycles. The app highly encourages users to seek additional support and education for their fertility awareness practice, particularly if they are using it for birth control. While Selene offers the most nuanced approach to menstrual cycle charting that I have thus seen (although I can’t claim to have evaluated all the apps on the market), one feature I would like to see added in future versions is the ability to manually choose whether a day is considered fertile (i.e., as indicated by bold stripes on the calendar view) so that those schooled in other approaches to fertility awareness, like the Justisse Method, could have the option of applying our own rules and calculations overtop of the calendar view. The only other critique I have of Selene is that the developer has chosen a dark navy background, which I personally find difficult to view. I’d prefer to see them use a colour scheme that is brighter and easier to read. I am grateful to Selene’s creators for being so thoughtful, thorough and conscientious in the creation of their app. I look forward to seeing what enhancements and updates they integrate into future versions.

Contemplative Dialogue and the Menstrual Cycle Polarity

August 21st, 2013 by Laura Wershler

Why are media-based discussions about menstrual cycle advocacy vs. menstrual suppression, or hormonal birth control (HBC) vs. non-hormonal birth control (NHBC), so often fraught with conflict, suspicion and untested assumptions?

Because the opposing frames of reference are often considered to be an either/or dilemma, with “right” and “wrong” solutions according to our preferred position, rather than two ends of a polarity between which a dynamic range of positions fluctuate. We live with many common sense polarities, like rain and sunshine, knowing the right combination of both is in our best interests.

Please Don’t Judge Me for Skipping My Period, a recent post by Sarah Fazeli at Xojane illustrates the challenges in managing polarities. The title suggests the writer expects to be or has already been judged for her “wrong” decision, yet many of the 427 comments demonstrate the range of positions held on the issue.

At one end of the menstrual cycle polarity is my preferred position – based on experience, research and evidence-based medicine - that consistent ovulatory menstruation supports women’s bone, breast, heart, reproductive, sexual, psychological and overall health. HBC disrupts endocrine function and stops ovulation, impacting many physiological systems. Many women are choosing NHBC because they are HBC-intolerant and/or want to experience healthy menstrual cycles. I advocate for improved access to information, support and services to help them use NHBC effectively and confidently.

I understand how my position might be construed as an either/or dilemma, but in no way am I demanding HBC be banned, bullying women to stop taking their pills or alluding to anti-abortion views. Yet others make and act on untested assumptions that I and others who hold this position are doing some or all of these things.

So how might we all – advocates, health professionals, educators, journalists, bloggers and the public – talk about the menstrual cycle polarity in ways that create opportunities and commitment to work together to meet all women’s needs?

For answers I revisited my training manual in Contemplative Dialogue. In 2009, I  took a four-day intensive workshop to learn about this process of engaging collective awareness to create “a deep experience of community where division or separation may have been the felt starting point.”

Contemplative means taking a long, compassionate look at the real; dialogue is the practice of creating shared meaning. Compassion is a key element because “it helps us get past the kind of guarded and defended reactions that undercut us doing things together.”

I refreshed my memory on how to avoid acting on untested assumptions. I thought about how I might become skilled enough to back not just myself but other people down Chris Argyris’s “ladder of inference” in a non-threatening way to resolve misunderstandings and create shared meaning.

Contemplative Dialogue also incorporates into its process Barry Johnson’s work in managing polarities. In emotional debates it helps if we can learn to speak across polar values.

This process calls for me to identify both my preferred value and the opposite value. In dialogue I first acknowledge the upside of the opposite value followed by the potential downside of my preferred value. Keeping my language fair and non-pejorative, I then speak of the downside of the opposite value that I fear. Finally, I get to talk about the upside outcomes to my preferred value that I’m striving for.

I want to keep talking about these issues, but I’m not up for a range war, a spilling of metaphorical menstrual blood to determine who holds the higher ground or owns the greater truth. I’m committed to practicing contemplative dialogue to bridge the divisions between the two ends of the menstrual cycle polarity.

The Truth About Skyla

June 4th, 2013 by Holly Grigg-Spall

Mirena Intra-uterine Device
Public domain image

Do women using the Mirena hormonal IUD have their period?

Does it suppress the hormone cycle for all women or just some?

How does it work to prevent pregnancy exactly?

It seems these questions can’t be answered even by the assumed experts. We are told the Mirena “partially” suppresses ovulation and that some women will bleed and some won’t bleed at all. Mostly we hear that the impact must be limited to the reproductive organs because the level of synthetic hormone used is so low.

In an article entitled ‘Mirena: The Other Side of the Story’, AAA Ewies, a consultant gynaecologist at a UK NHS hospital wrote, “The argument used that serum concentration of LNG is extremely low and that its influence on ovarian function is limited has been disputed recently by many investigators. Xiao et al. found that Mirena was associated with substantial systemic absorption of the synthetic progesterone and recorded levels equivalent to two synthetic progesterone-containing ‘minipills’ taken daily on a continuous basis. A study documented that 21% of Mirena users experienced progestogenic adverse effects. Wahab and Al-Azzawi reported that Mirena suppresses oestrogen production, inducing a clinical situation similar to a premature menopause in at least 50% of treated women”.

In an effort to cut through the confusion, Bayer Pharmaceuticals went ahead and released the Skyla hormonal IUD in February of this year. Skyla is smaller than the Mirena, lasts three instead of five years, but contains the same synthetic progesterone and is also 99% effective at preventing pregnancy.

It was interesting timing, considering the American Congress of Obstetricians and Gynecologists (ACOG) almost simultaneously released a recommendation that doctors provide the IUD (it didn’t specify if they meant the hormonal or copper device in the statement) as “first-line contraceptive options for sexually active adolescents”. Teens often struggle with heavier or painful periods and are far more likely to be offered the Skyla, which is said to lighten bleeding, than the Paragard copper IUD, which is thought to increase bleeding. Not to mention the Skyla costs significantly more, has a shorter span of use, and is backed by a Bayer’s marketing department. The Mirena has been advertised heavily since its release in 2001 and the aggressiveness of the campaign – with television commercials proclaiming Mirena would make a woman “look and feel great” – was reprimanded by the FDA.

As a consequence of this combination of the ACOG recommendation and the release of Skyla we have seen articles in recent weeks with headlines such as ‘Could New Skyla Contraception Help Women Reach For The Stars’ and yet more that worry over the lack of knowledge that is preventing doctors from providing the IUD to young women or preventing young women from asking for an IUD. There was a time when IUDs were only given to women who had already had children – in part because of concerns regarding the devices causing damage that led to infertility. The tone is always the same – why are they keeping this near-perfect sounding birth control choice from us? If it is an undercover marketing technique to get women riled up about their access to hormonal IUDs then that department of Bayer deserves a raise.

Some of the doctors may have not received the memo but others may be concerned about the mounting lawsuits regarding the serious physical side effects of the Mirena, or at least they should be. The production of Skyla appears to be a deliberate effort by Bayer to reach the teens and twenty-somethings market. Even Bitch magazine got in on the advertorial action last week linking through their website to a suspicious looking post that seemed much like a marketing placement. Most of the media coverage does not flag the difference between the hormonal IUD and the copper, blithely using the term “IUD” in the same way the phrase “birth control” is now synonymous with “hormonal birth control.”

Professor at the University of California at Riverside Chikako Takeshita outlines in her book, The Global Biopolitics of the IUD, the history of the IUD, from its coercive use in developing countries to its presentation as a convenient method for the modern woman in the US and Europe. “The ACOG recommendation and release of Skyla is clearly going to expand the market for these devices”, she states, “This normalizes the use of long-acting contraceptives. Such normalization makes the use of the devices a technological imperative. The idea is that if a solution, a technological fix, to the problem of unintended pregnancy exists then you must take it. It silences other ways to approach the problem. The IUD doesn’t fix the fundamental issue which is the lack of sex education for teenagers”.

Rather than seizing the ACOG recommendation as simply a victory in the war against the teen pregnancy “epidemic” we must look critically at the potential result. This may seem like the easy answer, but is it the right one?

Yaz and Yasmin Back in the Spotlight

May 9th, 2013 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

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

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

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

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

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

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

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

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

Little Girls! Just Say Yes to Your Dreams!

March 18th, 2013 by Chris Bobel

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

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

Let’s discuss.

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

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

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

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

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

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

AND

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

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

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

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

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

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

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

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

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

But I have to say one more thing.

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

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

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

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

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

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

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

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

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

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

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

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

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

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

Does Depo-Provera work like a charm or a curse?

February 6th, 2013 by Laura Wershler
Author’s Update, February 14, 2013: As clarified by Bedsider.org in the comments section below, the Works Like A Charm Contest mentioned in this post is not current but ended in 2011. The contest website pages are now inactive.

If Bedsider.org sponsored a contest called Why I Hate My LARC, there would be no shortage of contest entrants. But I expect it will be a long time before the nay-sayers get as much attention as the yeah-sayers.

Composite illustration by Laura Wershler

Bedsider has jumped on the LARC bandwagon. The online birth control support network for women 18-29 has launched the Works Like a Charm contest encouraging “the awesome women and couples” who use long-acting reversible contraception to share why they love their LARCs for the chance to win up to $2000. This is a variation of the Why I Love my LARC video campaign sponsored by the California Family Health Council last November, only with prizes!

To quote my blog post about the earlier campaign: “Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.”

One long-acting, not-so-reversible contraceptive in particular – Depo-Provera – is causing grief for many women. Yet “the shot” is front and center in the graphic on the contest website.

Considering the rah-rah tone of the Works-Like-a-Charm campaign messages, it seems that bedsider.org, a project of the National Campaign to Prevent Teen and Unplanned Pregnancy, is oblivious to the misery caused by this contraceptive. Often, Depo works like a curse.

I acknowledge that Bedsider is doing good work: The website provides youth-friendly, accessible information about the full range of birth control methods. But, in my opinion, any organization that promotes Depo-Provera as a contraceptive method should be totally transparent about the ill effects many women experience both while taking and after stopping the drug.

Depo-Provera, to put it bluntly, fucks with a woman’s endocrine system.

The long list of ill effects while on or after stopping this drug includes: continual bleeding (from spotting to heavy), mood disorders, severe anxiety, depression, digestive issues, loss of sex drive, extreme weight gain (often without change to exercise or eating habits), lingering post-shot amenorrhea, intensely sore breasts, nausea, and ongoing fear of pregnancy leading to repeated pregnancy tests. (Not to mention its documented negative effect on bone density.)

These effects are why the continuation rate of Depo-Provera is only 40-60% after one year of use, and why women are filling online comment pages with stories of their struggles coming off this drug.

At Our Bodies, Ourselves, the blog post Questions About Side Effects of Stopping Contraceptive Injections has been attracting comments since November 3, 2009, with no end in sight.

On my April 4, 2012 re:Cycling post – Coming off Depo-Provera can be a woman’s worst nightmare - there are over 130 comments. All but six were posted since mid-November when the post caught fire. Not more than a day or two goes by before another women shares her story of distress, confusion or frustration. I read each one and respond occasionally. Rarely, a positive experience appears; one criticized other commenters for complaining.

It’s one thing to read or hear about potential ill effects while trying to decide whether or not to use Depo-Provera. It’s quite another to experience some or many of them for months on end without acknowledgement or health-care support from those who promote or provide this drug.

The Works Like a Charm contest website says about LARCS:

Reversible = not permanent. If and when you’re ready to get pregnant, simply part ways with your LARC and off you go.

“Off you go?” Tell that to the thousands of women who are waiting, months post-Depo, to get their bodies and their menstrual cycles back to normal. Most of them still aren’t ready to get pregnant.

Getting Over The Pill

January 15th, 2013 by Kati Bicknell

Here’s a notion: Birth control pills are not the only way manage your reproductive health.

The pill came out more than 50 years ago, and at the time, it was a symbol of liberation and freedom for women. Suddenly, they no longer had to worry about unplanned pregnancy. It was great. But now that 50-year-old technology is starting to lose much of the appeal it once had.

Adapted from a photo by Jess Hamilton // Creative Commons A-NC-SA 2.0

Today many women get on the pill as teenagers to “regulate” irregular cycles, and they get off the pill in their late 20s or early 30s when they want to get pregnant. The unfortunate reality is many women find it’s not as easy as they thought it would be to get pregnant. Ten or fifteen years of being on oral contraceptives doesn’t “fix” an irregular cycle; it just kind of pushes the pause button on your reproductive system.

When you come off the pill in your late 20s or early 30s because you finally want kids, your body has to pick up where it left off when you were a teenager. Often women at this stage of their lives find it takes longer than expected to conceive and wind up on the assisted reproductive technology track — reproductive endocrinologists, expensive and annoying tests, procedures, hormone injections ,and all that jazz. And, heartbreakingly, after several years and thousands of dollars, that doesn’t always work.

The side effects of the pill are a real pain in the ass for many women, too. Weight gain, depression, loss of libido, and “not feeling like myself” (AKA “I seem to have gone insane”) are some of the more common complaints cited. In fact, a CDC report on contraceptive use states that 10.3 million women have stopped taking the pill due to side effects, or fear of side effects.

All women need a way to have children when they want them, and to not have children when they don’t. And they need to feel good about the whole thing — not freaked out, bloated and crazy. Imagine how the world would be different if this was a reality.

This reality is possible thanks to the wonderful simplicity of the Fertility Awareness Method — the technology behind Kindara. Instead of women’s reproductive reality being like this:  “Oh my god,  I don’t want to get pregnant” during her twenties, followed by “Oh my god,  I want to get pregnant NOW!” in her thirties, the Symptothermal Method makes it one question: “When do I want to get pregnant?”

Charting your cycle using the Fertility Awareness Method can help you achieve your reproductive goals without pills, side effects, or stress, whether you want to have kids in the next few years, in 10 years, or never. By charting your cycle, you will see if and when you are ovulating, and you will know when you are fertile, which is the trick to knowing when you can or cannot pregnant. Charting your cycle could help clarify issues that need to be remedied before you can get pregnant too. You can even confirm pregnancy with your chart. Exciting!

If women were taught the basics of Fertility Awareness as soon as they entered their reproductive years and knew that they could avoid or plan for pregnancy by charting their primary fertility signs (temperature and cervical fluid), they would save a lot of time, money, and stress.

What a different world we would all be living in if each woman shifted her thinking from “I need this pill so I don’t have unplanned pregnancies, and I need my doctor to prescribe this pill” to “I know just what is going on with my cycle at all times. I am calm, confident, and empowered. I manage my own fertility thank you very much, and I don’t need pills to do it.”

Now I’m not saying that oral contraceptives have no place in the world. They are a wonderful invention. Thanks to the pill, women today can take it as fact that pregnancy can be prevented easily and effectively. But because this is now a forgone conclusion, we are free to look for even better options — options like the Fertility Awareness Method that can prevent pregnancy easily, effectively, autonomously and without side effects.

Originally published at Kindara.com on December 15th, 2012

Do you love your LARC?

December 12th, 2012 by Laura Wershler

Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.

Nov. 25 to Dec. 1, 2012, was LARC Awareness Week, billed by the California Family Health Council as “a chance to increase awareness about LARCs as a safe, effective, and long-acting birth control method.” Women were invited to contribute video messages on the theme Why I Love My LARC.

This catchy acronym stands for long-acting reversible contraceptive, and the push is on for many more women to choose this form of birth control. Make no mistake, it’s all about control: What the doctor puts in, only the doctor can take out. Ergo, it’s 99% effective. You can quit taking your pills, rip off your patch, or NOT show up for your next Depo-Provera shot. But if you hate the side effects caused by your IUD or implant, you’ve gotta go see a health-care provider to have it removed.

I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week.

According to the awareness campaign, LARCs include the ParaGard (copper) IUD, Mirena (progestin) IUD and Implanon, a non-biodegradable flexible rod, also containing progestin, that is inserted under the skin and left for up to three years. (Here’s a story about the rods going missing in women’s bodies.) Read the patient information about Implanon. Would you agree to have it inserted into your body?

Women who hate Implanon are speaking out. So are women who don’t love their ParaGard or Mirena IUDs. On YouTube, a video by a women with Mirena issues has over 6000 views;  Why I Love My LARC, posted 8 days earlier, has about 100.

The old-school LARC – Depo-Provera – is not on the campaign’s list of LARCs, though it is heavily used in the United States. Holly Grigg-Spall recently reported that “one in five African American teens are on the Depo shot, far more than white teens.” Hmm. Will they all be switched to other LARCs when, or if, they come back for their next shot? Perhaps Depo is not on the list because women can discontinue this contraceptive without clinician intervention. But it’s probably because Depo causes bone density loss – and because this LARC is not a lark. Women are sharing their Depo stories on another re:Cycling post:  Coming off Depo-Provera can be a women’s worst nightmare. You can find more bad news about this LARC than any other.

What about getting your LARC removed if you hate it instead of love it? One re:Cycling blogger shared what happened when she wanted her ParaGard IUD removed:

I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like ‘”Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.”

This is not the only reason why women who end up hating their LARCs will be discouraged from rejecting them. The Affordable Care Act requires all health plans issued on or after August 1, 2012 to provide no-charge access to FDA-approved LARCs. What’s it going to take to convince health-care providers to remove an expensive contraceptive – provided for free – that was supposed to last for three to 10 years?

Maybe a YouTube video about Why I Hate My LARC will help make it as easy to get rid of one as it now is to get one.

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.