Blog of the Society for Menstrual Cycle Research
In our May 28 “Saturday Surfing” round-up of recommended reading, we highlighted Lynn Harris’ essay for The Nation about new research on “reproductive coercion”: the alarming frequency with which young men try to get their partners pregnant, often by sabotaging birth control methods. Yesterday, GritTV with Laura Flanders interviewed Harris and Elizabeth Miller, the researcher who conducted the study, about the phenomenon and public health responses.
Art by Flickr user Buhny | CC 2.0
A new study published in the Journal of Obstetrics and Gynecology has found that adolescents are usually able to tolerate the Mirena® IUD rather well. The mean age of girls in this British study was 15.3 years, and they were prescribed the Mirena® for painful and/or heavy periods that did not respond to oral medications. 93.4% of girls in the study (45 young women) reported “significant improvement” within four months. The researchers conclude “that Mirena is a well tolerated and effective alternative for heavy periods±dysmenorrhoea in adolescents who do not respond to oral therapy.”
So will this finding make it easier for young women to obtain an IUD if they’d like it for birth control, now that there is evidence that it is well tolerated?
Photo by Flickr user be_khe | CC 3.0
The Internet, especially the feminist blogosphere, is all abuzz this week with the promise of a new contraceptive pill for men within the next five years. But researchers always say a pill for men is just five years away, according to University of Washington medical professor John K. Amory.
The spark of new hope stems from an interview with Professor Haim Breitbart of Israel’s Bar-Ilan University, published June 28 in London’s Telegraph. Breitbart promises a monthly pill, free of side effects, for men. The Telegraph says human trials are scheduled to begin next year.
How does this proposed pill work? The answer lies in a breakthrough paper Breitbart published four years ago, in which he and his colleagues announced a new discovery about how sperm cells create new proteins after ejaculation, while hanging around in the uterus before fertilization can take place. Breitbart believes that if this protein production process can be derailed, conception can be prevented without hormones. He calls his chemical concoction the Bright Pill (a twist on his name).
So far, the prototype works very well, inducing temporary sterility for one to three months at time, depending on dosage. In mice, that is. Breitbart believes there are no side effects, telling a reporter for an Israeli news service,
The mice behaved nicely. They ate and had sex; they were laughing, and everything, so all I can say is that we couldn’t see any behavioral side-effects–all their sex behavior was retained, which is a very important consideration for human men.
Well, then. If the mice were laughing and still having sex, then it must be all right. (Mice laugh? How can you tell?) I’m certainly willing to give Breitbart the benefit of the doubt on this one and believe that so far, the Bright Pill is very effective for male mice.
But we’re a long way from the jubilation seen in some corners of the Internet over this news. Not only does effectiveness in mice not guarantee effectiveness in humans, Breitbart and his research associate, Dr. Yael Gur, plan to continue rodent testing for at least another year before moving on to test the pill on primates. Then come three phases of clinical trials in humans, after lab and animal testing, to assure the drug’s safety and efficacy before developers can apply for U.S. approval (other countries have similar processes). Funding is needed for this lengthy process, and since there’s presently no drug company behind the project, Breitbart and Gur are seeking investors.
So even if a Pill for men is five years away, would men use it? Depending on the study and the country, anywhere between 14 percent and 71 percent of men say they would. What do you think, re:Cycling readers? If you’re male and heterosexual, would you take Brietbart’s “Bright Pill”? If you’re a woman who has sex with men, would you want your partner to take it?
Cross-posted at Ms. Magazine Blog
Photo courtesy of Jenny Lee Silver under Creative Commons 3.0.
Did you know that last year’s combined sales of Yaz and Yasmin, the most popular oral contraceptives in the U.S., totaled $1.64 billion? Did you know the drugs are also the target of 1,100 lawsuits for potentially fatal blood clots? Did you know that an estimated 50 women have died from taking those contraceptives?
Despite such health risks, however, oral contraceptives remain an extremely popular method of birth control in the U.S., second only to sterilization. The Guttmacher Institute reports that whether a woman prefers the Pill or sterilization is largely a function of age, with women under 30 choosing the Pill and women over 30 choosing permanent methods. These trends have been fairly stable since 1982.
None of these facts surprised me as much as the news that fewer than one percent of women in North America (and northwestern Europe) use the diaphragm–or any other woman-controlled barrier method. I’m puzzled that a safe, reliable, fairly easy-to-use (with some training and practice), inexpensive method of controlling fertility is not more widely recommended. Used correctly and consistently, the diaphragm has an effectiveness rate of 94 percent. Nevertheless, diaphragm use declined after the Pill was introduced, from 25 percent of married women in 1955 to 10 percent in 1965, and kept dropping thereafter, to just 4.5 percent of all women in 1982 and 0.2 percent today, according to the CDC [pdf].
U S. Medical Eligibility Criteria for Contraceptive Use, 2010, released last month by the Centers for Disease Control, shows that the diaphragm has no medical contraindications for most women. The exceptions are latex allergies, immediate postpartum or post-termination use, uterine prolapse, and women with HIV/AIDS, for whom the risk is not the diaphragm itself but the accompanying spermicide nonoxynol-9, which may increase viral shedding and HIV transmission to uninfected sex partners.
Yet the American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice recommends that hormonal methods such as IUDs or injections be offered as “first-line contraceptive methods and encouraged as options for most women.” At this year’s annual ACOG meeting last month in San Francisco, the group issued a press release with eight gushing statements of praise for the Pill on its 50th anniversary. (See re:Cycling‘s response to the ACOG statement here.)
But nearly four of every ten women who use contraceptives are not satisfied with their method, and I hear frequently from young women that they’re pressured at college health centers and physicians’ offices to choose hormonal methods, usually the Pill, over barrier methods such as condoms and diaphragms. Even after negative experiences with the Pill, women are often encouraged to try another brand rather than another method.
I’ve even heard of educators and health care providers actively discouraging use of the diaphragm because “it’s messy”. This complaint baffles me, and I used a diaphragm for 15 years. With or without a diaphragm, sex is messy.
Although diaphragms must be accurately fitted by a health care professional and re-assessed every few years, they remain cheaper than hormonal methods and require less frequent physician visits. A diaphragm can be inserted hours or moments before intercourse, and it is a fully reversible, female-controlled method of birth control. There is some evidence that diaphragm use minimizes women’s exposure to certain STIs , and ongoing research by pharmaceutical companies is aimed at developing a spermicide that is also antimicrobial.
Teen sex: More use rhythm method for birth control.
It was an odd headline for an Associated Press story on the 86 page report on teen sexual activity just released by the Centre for Disease Control and Prevention. Not all that relevant to the broader subject of the study on which the report is based: Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, National Survey of Family Growth 2006-2008. If you’re interested, it is a fascinating read.
But it was the headline and this excerpt from the story that caught my attention:
About 17 percent of sexually experienced teen girls say they had used the rhythm method – timing their sex to avoid fertile days to prevent getting pregnant. That’s up from 11 percent in 2002.
They may have been using another form of birth control at the same time. But the increase is considered worrisome because the rhythm method doesn’t work about 25 percent of the time, said Joyce Abma, the report’s lead author. She’s a social scientist at the CDC’s National Center for Health Statistics.
You can’t study what you don’t understand. The study authors demonstrate their lack of knowledge about natural birth control methods by the question they asked study participants: Have you ever used rhythm or safe period by calendar to prevent pregnancy?
There are many brands of natural birth control. Some , like the Rhythm and Calendar methods, are not effective. No proponent of Natural Family Planning (NFP) or Fertility Awareness Based Methods (FABM), which have effectiveness rates as high as 99.4 percent, would recommend them. Yet this study does nothing to differentiate between these methods of natural birth control, thereby confusing the public, the study results and themselves.
It’s high time researchers studied up on natural birth control methods if they want to include questions about them in a study on the contraceptive practices of teens or adults.
Until they do, I suggest anyone interested in the sexual and reproductive health of teen girls start buying copies of Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body. This book can help our daughters acquire the life skill of body literacy – to understand the mysteries of their menstrual cycles and how this knowledge can serve them well as they make decisions about their sexual and reproductive health and lives.
http://www.flickr.com/photos/santarosa/ / CC BY 2.0
Laura Eldridge’s new book In Our Control: The Complete Guide to Contraceptive Choices for Women (Seven Stories Press, 2010) isn’t kidding with that subtitle. The last time I remember reading so much detail about contraceptive options was poring over Our Bodies, Ourselves when I was in my 20s.
Eldridge reviews every method of birth control known to modern woman–and, importantly, some that aren’t widely known. She even briefly reviews the history of contraception in 19th and 20th centuries, reminding us that birth control is not a new invention. People, especially female-bodied people, have struggled to control their fertility from pretty much the first moment humans figured out how it worked.
In Our Control differs from Our Bodies, Ourselves in offering more than just the mechanics of both hormonal and barrier methods: Eldridge provides a history of each method and analysis of the political and cultural contexts of their use in the 21st century U.S.
For example, the chapter about the morning-after pill (also known by either the brand name Plan B or as emergency contraception, EC) discusses the political battle to achieve Federal Drug Administration approval, including Susan Wood’s resignation from the FDA’s Office of Women’s Health over what she believed to be “willful disregard of scientific evidence showing Plan B to be safe.”
Eldridge extensively addresses the relationship between birth control and menstruation, focusing one chapter specifically on the use of hormonal contraception to reduce or eliminate menstrual cycles. She draws upon a wide range of resources to illustrate the cultural attitudes and contexts of menstruation, from stories of the role of birth-control pill co-developer John Rock’s Catholicism in the three-weeks-on/one-week-off dosing of the first pill to a Saturday Night Live parody of advertising schemes for menstrual suppression drugs (with Annuale, you’ll menstruate only once a year, but hold on to your fucking hat!).
The book also covers environmental impacts of contraception, the politics of HPV vaccinations, ongoing research into a birth control pill for men and natural methods of birth control such as fertility awareness–which Eldridge carefully distinguishes from the much-maligned “rhythm method.” She notes that the method approved by the Catholic church is properly called a calendar-based method and involves estimating when ovulation occurs and avoiding sex during that time. Fertility awareness, however, involves a more complex, systematic attention to physiological markers of female fertility. It requires careful monitoring of waking temperature, vaginal sensation, position of cervix and cervical fluid, as well as dates of menstrual flow and sexual activity. Eldridge cautions that fertility awareness is too complicated to be taught in a short chapter, and that observing and charting one’s cycle must be done “for a significant amount of time before you begin to rely on it for contraception.”
Laura Eldridge learned women’s health writing at the side of the late women’s health advocate and activist Barbara Seaman, and it shows. She contextualizes her work with her own experience and preferences, but provides thorough documentation so that women can more easily make their own decisions. This is women’s health activism at its best. Feminism isn’t just about choices, but about having access to information and resources to make informed, authentic choices–and that is only possible when reliable and comprehensive information is widely available.
Cross-posted at Ms. magazine blog.
You know how most superheros become superheros because of exposure to some weird, intensified chemical or element? Take Peter Parker’s spider bite for example.
According to a story reported in various media, including International Planned Parenthood Federation’s website, if science can perfect the contraceptive effect of ultasound on men’s testicles, then we may be in for a new breed of superhero. Ultrasound Man: able to bear the burden of pregnancy prevention for women everywhere.
I joke, but for decades women have yearned for gender equality when it comes to bearing the burden of birth control. Could the promise of six months of ultrasound induced, reversible infertility in men be the answer? Well, to date, we only know it works in rats. There is a long way to go before we send the men for a bi-annual ultrasound “zap test”.
This isn’t the first male method touted over the last decade. In 2003, news out of the UK about a birth control pill for men had women nodding their heads with approval. I was immediately dubious and dashed off a commentary for the Calgary Herald that began thus:
Memo to Big Pharma: Save your money. If you think the male birth control pill is going to be a big seller, think again. Memo to women everywhere: Curb your enthusiasm. If you think it’s time men took more responsibility, you’re right — but the Pill for Bill is not going to be it.
Because of the complex hormonal action of the pill for men, I knew it wouldn’t fly. As I noted in my piece:
According to a story from the London Telegraph, because the treatment is invasive, it is likely to be used only by men in long-term relationships. Read it and weep, gals, because this is the wicked truth. It’s OK for women of any age or relationship status to ingest birth control pills or receive the Depo-Provera injection that completely shuts down their reproductive systems, but men would never do the same. It is already postulated that only men in committed relationships are likely to submit to invasive hormonal contraception. That would be supportive husbands and partners of the best kind.
Although a recent survey by the Family Planning Association found that one third of men would definitely use a birth control pill for men if it became available, I doubt very much, once the mechanism of action were explained (full disclosure), that there would be many takers. I suspect the side effects, and concerns about synthetic testosterone, would result in a pathetic compliance rate.
Certainly the ultrasound method sounds much less invasive. Research leader James Tsuruta of the University of North Carolina said: “We think this could provide men with reliable, low-cost, non-hormonal contraception from a single round of treatment.
Happily, “the team plans to investigate the mechanism that causes temporary infertility.” I think the guys would want to know how and why it works before signing up. But they can rest assured because Dr. Tsuruta also said: “Establishing safety, efficacy and reversability: these are our top concerns.”
As media stories proliferate documenting the growing trend among young women to eschew the Pill (et. al) in favour of non-hormonal methods, news that there may be a safe, simple method for men on the horizon is both welcome and long overdue.
What I find hard to take, however, is this suggestion expressed by Allan Pacey from the University of Sheffield:
There is certainly a place for an effective non-hormonal contraceptive in men, but whether men would find it acceptable to have their testicles scanned regularly remains to be seen.
I read The Birth-Control Riddle by Melinda Beck, published today in The Wall Street Journal with interest and frustration. As a veteran pro-choice sexual and reproductive health advocate, I’ve spent decades contemplating this ”riddle”. I have two specific comments in response to the piece, and a few suggestions for potential follow-up stories.
1) I find it discouraging, but understandable, that the article failed even to mention fertility awareness based methods (FABM) of birth control, which when taught so that women/couples can use the method effectively and confidently have a 99.4% effectiveness rate. Don’t take my word for it. The German study called: The effectiveness of a fertility awareness based methods to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study was published in the prestigious journal Human Reproduction in late 2007.
In addition to the typical North American dismissiveness (by healthcare providers) of FABM as ineffective, is the dismissive response given to North American women who express an interest in learning FABM. A quick google search or a week’s hits on a google news alert for “Fertility Awareness” (the secular, pro-choice variation of the religiously contextualized Natural Family Planning) quickly establishes the burgeoning interest and use of these methods by young American women. Why is this so readily ignored by the mainstream sexual and reproductive health community (of which I am a part)? I have been mulling over this question for years. I have arrived at several answers. How I would love to see a journalist, any journalist, start asking this question.
2) My second comment is that this article is a missed opportunity. It is useless merely to list (yet again) the birth control “choices” available to women, as if just knowing about these methods of contraception should make the problem of unintended pregnancy go away. Of one thing we can all be certain: it can’t and it won’t. What this piece lacks is any attempt to explore in depth the writer’s accurate but unexamined statement – Why are the numbers so high? The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors. Why not make an effort to get to the bottom of the so-called birth control riddle?
Should Beck be interested in continuing to write about this issue, one angle she might consider exploring is barriers to access to information, support and services for women seeking to use non-hormonal methods of birth control effectively and confidently, including diaphragms, cervical caps and fertility awareness based methods. This is a huge issue of concern to me and the many women who can’t, won’t or don’t want to use hormonal birth control.
I have a theory that a good number of unintended pregnancies happen because women are finding little or no support to access and effectively use non-hormonal methods. Yet this lack of support is not enough to keep them on the pill, patch or ring, or to agree to submit to invasive shots or implants. Therefore, care providers’ dismissal of young women’s requests for non-hormonal methods may actually be the cause of some of the unintended pregnancies we seem to be so puzzled by. Another issue not being talked about is that some women are getting pregnant while using the pill, patch or ring. These unintended pregnancies, which oddly don’t seem to pull down the “typical use” effectiveness rate of these methods, is partly behind the growing interest in IUDs. The other reason IUDs are growing in popularity is backlash against traditional hormonal methods.
Here’s a hint: the title of the new study by the National Campaign to Prevent Teen and Unplanned Pregnancy is How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy.
The study [PDF] surveyed American singles ages 18–29 about their perceptions about and use of contraception. Twenty-eight percent of young men think that wearing two condoms at a time is more effective than just one. Twenty-five percent think that women can prevent pregnancy by douching after sex. Eighteen percent believe that they can reduce the chance of pregnancy by doing it standing up.
A staggering 42% of men and 40% of women believe that the chance of getting pregnant within a year while using the birth control pill is 50% or greater (despite research suggesting that the pill is typically 92% effective).
And many unmarried young adults believe they are infertile. Although available data suggest that about 8.4% of women 15–29 have impaired fecundity (measured as an inability to conceive or carry a baby to term): 59% of women and 47% of men say it is at least slightly likely they are infertile (19% of women and 14% of men describe it as quite or extremely likely.
In a very good short essay about the study at The Sexist, Amanda Hess links men’s lack of knowledge about contraception to their lack of knowledge about menstruation and physiology more generally, and illustrates with some telling anecdotes. There are a few more examples in the video at right, in which Amanda corners several men and asks them to explain how hormonal birth control works.
It all seems quite shocking, until one remembers that abstinence-only sex education that includes lessons about the ineffectiveness of condoms and other contraceptives has been standard in the U.S. since 1996. (See here for U.S. Government definitional criteria for abstinence-only sex education. At present, 22 states have opted out of receiving federal funding, so that they may provide accurate and comprehensive sex education.)
There are Tupperware parties, Passion Parties, Pampered Chef parties, and…Mirena IUD parties? Yes, apparently these events popped up early last year and were a joint effort from Bayer Pharmaceuticals and the mom marketing site Mom Central.
Here’s one mom blogger’s description of the Mirena party that she hosted:
Then tonight I hosted a party at my house with Mom Central. Mom Central had found me through this blog and asked me if I would be interested in hosting an event sponsored by Mirena. As I welcome any opportunity to sit down with some girlfriends with some free food and drink, I was happy to accept. Before the party started, I walked around nervously, terrified that only a couple of people would show up. We’re all so busy, and I worried that people would end up skipping a strange commercial-sounding event. But one by one, they rolled in and I began to relax.
We had an amazing evening, talking about sex, fashion, and living a simpler life. I realized that we don’t actually spend a lot of time talking about sex and relationships. We laughed a lot but also went home with some great tips.
If you’re thinking that “strange commercial-sounding event” sounds like an accurate description for a party like this, you won’t be surprised by what comes next. What this mom didn’t mention, possibly because she wasn’t aware, was the fact that the script used at these parties didn’t comply with FDA implementing regulations or the Federal Food, Drug, and Cosmetic Act, prompting the FDA to send a warning letter to Bayer at the end of last year. (Bayer is no stranger to FDA warnings – they recently had to “correct” ads for their Yaz/Yasmin birth control pills, which are also the subject of several lawsuits, after the FDA said they were unclear and misleading.)
Before I get into the specifics of the FDA violations in this case, let’s take a look at some more details about these events. First, let’s look at Mom Central. The main Mom Central site has forums, blogs, parenting tips, a product testing panel, giveaways, and so on, but it’s the Mom Central Consulting site that we’re really interested in. Here are some quotes from the site about what they do:
Our two-pronged targeted approach connects clients with our vast proprietary network of leading Mom Experts and Opinion Leaders and then activates Moms to become trusting, loyal advocates and consumers of your brand, product or service, making us experts at marketing to women.
So maybe the goal of the hosts and attendees at these parties was to have a fun night eating free food and talking about sex and relationships, but it’s important to keep in mind that that’s not the main goal of Mom Central or the product that they’ve been hired to represent. What they want to do is “activate” some Mirena evangelists.
Illustration from Feminist Women's Health Center
The Federal Drug Administration (FDA) announced today that Mirena® has been approved for use as treatment for heavy menstrual bleeding. Mirena® is an intra-uterine device (IUD) for preventing pregnancy. It combines the technology of old-school IUDs with the hormone levonorgestrel, a synthetic progesterone.
I’m a little puzzled, though, by the apparent limited usage recommended: the press release states,
The U.S. Food and Drug Administration today approved Mirena (levonorgestrel intrauterine system) to treat heavy menstrual bleeding in women who use intrauterine contraception as their method of pregnancy prevention.
This sounds like Mirena® is approved for women who already using IUDs. So if you’re already using Mirena® for birth control, congratulations. Now you can use it to reduce menstrual flow.
For those keeping score at home, Mirena® is manufactured by Bayer, also makers of beleaguered birth control pill, Yaz.
