Blog of the Society for Menstrual Cycle Research

A doc about birth control, #LiveTweetYourPeriod, and other 4th of July weekend links

July 4th, 2015 by Laura Wershler
  • It’s old news that men find women’s faces more attractive when they are fertile, but the facial cues to explain this have eluded researchers. A new study from the University of Cambridge, as reported in the Science Daily, shows that women’s face skin gets redder at the point of peak fertility. However, as this change in face redness is too subtle for the human eye to detect, skin colouration has been ruled out as the reason for this “attractiveness effect.” Dr. Hannah Rowland, who co-led the study, said, “Women don’t advertise ovulation, but they do seem to leak information about it, as studies have shown they are seen as more attractive by men when ovulating.” The mystery continues.

When Elynn Walter walks into a room of officials from global health organizations and governments, this is how she likes to get their attention:

“I’ll say, ‘OK, everyone stand up and yell the word blood!’ or say, ‘Half of the people in the world have their period!’ ”

It’s her way of getting people talking about a topic that a lot of people, well, aren’t comfortable talking about: menstrual hygiene.

Menstrual management for women with disabilities, menstrual hygiene taboos, and menstrual cycle awareness

May 28th, 2015 by Laura Wershler

These two concurrent sessions address the menstrual-related challenges of women with disabilities, menstrual hygiene taboos and practices around the world,  and the concept of gynaecological self-help 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.


Menstrual Management, Friday, June 5th:

Women with Spinal Cord Injuries Talk about Menopause
Heather Dillaway, Wayne State University

Using data from interviews with 20 women with spinal cord injury, I illustrate how disabled women may think about and experience menopause. Overall, interviewees think positively about menopause as a release from the hassles of menstruation, but face unique experiences when dealing with perimenopausal symptoms. I also discuss their concerns about aging.

“Kahani Her Mahine Ki” – A Menstruation Kit for the visually impaired women
Sadhvi Thukral, National Institute of Design

“I am constantly worried that my dress will stain during my period, I cannot see.”

“I will never be able to tell the colour of my discharge during menstruation or when I need to change my cloth. To be safe, I change every few hours.”

These are unique anxieties of visually impaired young women.

A large gap exists in the area of “Communication for Menstruation” for the visually impaired. This design degree project was an attempt to fill this gap by developing a product for menstruation that would meet the needs of visually impaired girls and women.

The kit “Kahani Her Mahine Ki” (The Same Story Every Month) covers the subject of menstruation and how to manage during periods and has the following features:

1. Tactile diagrams and material in the form of Information Slates, with labels of the different body parts. Each slate has text for the sighted and Braille for the visually impaired. 2. A life size human body model for demonstration.

What they do, what we do, what I do: A critical review of five contemporary international surveys of menstrual management practices and technologies. How can these surveys inform Western practice? What areas remain to be surveyed?
Susannah Clemence, Independent researcher

This critical review compares the catalogues of contemporary menstrual management techniques from around the World, presented in Sommer et al (2013), House et al (2012), Kjellen et al (2012), Bharadwai and Patkar (2004) and Finley’s (1995-2015) Museum of Menstruation.

The purpose is to test how well-documented are contemporary practices across the World, and what areas remain yet unrecorded. The rationale is that diverse technologies and conduct, with their implicit beliefs and attitudes, grant us reference points from which to examine, critique and improve our own practices.

The review shows that there are large gaps in documented knowledge. Furthermore, other than the Museum of Menstruation, existing surveys tend to be rooted in development agendas of Western origin and tend to a deficit perspective of non-Western practices.


Menstrual Hygiene, Saturday, June 6th

A Vicious Cycle of Silence: The perpetuation of the menstrual hygiene ‘taboo’ and the implications for the realisation of the human rights of women and girls
Emily Wilson-Smith, Kampala International University & Robyn Boosey, University of Bristol 

Despite the impact of poor menstrual hygiene on the rights of women and girls it has remained largely neglected by International stakeholders. A document analysis of the core international human rights treaties and relevant human rights body reports found an overwhelming silence and an analysis of the existing references revealed an inadequate framework for addressing menstrual hygiene.

Improving Menstrual Health and Hygiene in India: Another critical path way for women emancipation
K Yadagiri, Centre for Economic and Social Studies,UNICEF Division for Child Studies 

Gynecological Self-Help Isn’t Just a Good Feeling – What we learned when we systematically studied our own menstrual cycles – and how you can learn MORE now!
Kathy Hodge, Feminist Women’s Health Center

In 1975, nine members of the Feminist Women’s Health Center collective met daily for over a month, recording changes in our vaginas and cervixes and their secretions, for PAP and ferning smears, charting moods and basal body temperature. We raised questions, some of which remain open and ripe for future woman-controlled research.

 Menstrual Hygiene Management practices in Slums: It’s impacts on the Women and Adolescent Girl’s Health – A Case study of Greater Hyderabad Municipal Corporation Slums, Telangana State, INDIA
Venu Madhav Sharma, Centre for Economic and Social Studies

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

Menstrual Hygiene, Human Rights, and Gender Equality – A Focus on the Global South

May 18th, 2015 by Laura Wershler

Scholars and practitioners from the fields of human rights and water and sanitation will discuss menstrual hygiene from the perspective of gender equality on June 4th 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.

Human Rights in the Private Sphere: Menstrual Hygiene as a Priority for Gender Equality and Human Dignity
Inga Winkler, Scholar-in-residence, Center for Human Rights & Global Justice, NYU School of Law 

In many countries, menstruation is shrouded in taboo and secrecy. Removing the taboos and ensuring better access to menstrual hygiene is essential for achieving gender equality and realizing human rights. The presentation seeks to explore human rights obligations to create an enabling environment for women and girls to practice adequate menstrual hygiene. It discusses various strategies including awareness-raising and breaking taboos, promoting good hygiene, and embedding menstrual hygiene in policies and programs by using examples from different country contexts. With a topic as personal and culturally specific as menstruation, incorporating women’s and girls’ views and preferences into programs and policies cannot be overestimated.

Poor menstrual hygiene, stigmatization, or cultural, social or religious practices that limit menstruating women’s and girls’ capacity to work, to get an education, or to engage in society must be eradicated. Considering menstruation as a fact of life and integrating this view at all levels will contribute to enabling women and girls to manage their menstruation adequately, without shame and embarrassment—with dignity.

Investigate and Expose: Challenges in Building an Evidence Base around Menstrual Hygiene as a Human Rights Issue
Amanda Klasing, Researcher, Human Rights Watch

Menstrual hygiene has emerged recently as a human rights issue, but this recognition alone does not mean that human rights practitioners will take up the issue. One barrier is the perceived or real limitations in their methodology.

This paper considers how human rights fact-finding methods may not readily lend themselves to building the evidence base for menstrual hygiene as a human rights concern. It will explore examples of how, despite challenges, menstrual hygiene concerns can be exposed within the context of broader investigations and it will address how practitioners can more deliberately incorporate menstrual hygiene in their investigations.

An important first step is for researchers to recognize the impact of menstrual hygiene on a broad array of women’s and girls’ human rights. Next, researchers should consider how best to expose this in the course of their research. Finally, researchers should consider how to include menstrual hygiene in the recommendations it makes to governments and other duty bearers.

Menstrual Hygiene Management in Schools: Meeting Girls’ Rights and Needs in Zambia
Sarah Fry, Hygiene and School WASH Advisor, USAID WASHplus Project

Image by Sarah Fry

Zambia’s schools fall short of acceptable standards and ratios for access to safe drinking water and improved sanitation. The ratio of girls to toilet can be as high as 200:1. These shortfalls are believed to be factor in the high rate of school drop-out among girls, many of whom do not even finish primary school. As in other low-income contexts, dropout rates for girls in Zambia appear to increase after puberty. Menstrual hygiene management (MHM) is burdened with cultural taboo and myths. Girls are still excluded from school for as long as one month at their first menses.

USAID/SPLASH in Zambia address girls’ right to education by removing barriers to menstrual hygiene management in schools. SPLASH and the Ministry of Education research cultural norms, improve girl-friendly facilities and access to menstrual products, break taboos, and integrate MHM in the education system through water, sanitation and hygiene in schools

Menstruation is still a sensitive topic, but experience in Zambia has shown that taboos can break down rapidly and MHM can become a normal part of discourse around girls’ rights at local and policy levels.


Media Release and Registration for the SMCR Boston Conference.


Menstrual education and hygiene management initiatives seek collaborators

May 15th, 2015 by Laura Wershler

 Two experiential workshops on Friday, June 5th, invite participants to collaborate in menstrual health initiatives 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. With one in the morning and one in the afternoon, you can take in both!

Menstruation Matters: Period! – A Public Education Campaign Whose Time Has Not Yet Come
Heather Guidone – Director, Center for Endometriosis Care; Medical Writer; Women’s Health Educator
Diana Karczmarczyk, PhD – Adjunct Professor, George Mason University and Senior Analyst, Association of State and Territorial Health Officials
Evelina Sterling, PhD—Visiting Professor, Kennesaw State University and Public Health Consultant, Southern Research and Evaluation Institute
Peggy Stubbs, PhD— Professor, Chatham University

How might menstrual arts and crafts be included in menstrual cycle education campaigns?
Photo by Laura Wershler




As menstrual cycle educators and advocates, we know all too well the frustrations and inadequacies related to menstrual cycle education targeting the general public. This hands-on workshop provides participants the opportunity to contribute to designing effective public health education messaging grounded in health education theory and strategies which address the importance of menstruation to girls’s and women’s health and well-being.

Building Better Solutions for Monitoring and Evaluation in Menstrual Hygiene Management
Presenters from Pasand (USA), @PasandTeam, Pasand on Facebook:
Rebecca Scharfstein, Co-Founder and Executive Director
Ashley Eberhart, Co-Founder and Director of Marketing
Allison Behringer, Director of Partnerships
Lacy Clark, Monitoring & Evaluation Project Lead, MBA Intern

According to often-cited data, 88% of women do not have access to sanitary protection (instead using “cloth, husks, mud, and ash”), and 23% percent of girls drop out of school upon menarche. In the field, however, questions come to mind, such as: “Who are these women using rags because we can’t find them!” While shocking statistics about menstrual hygiene management have been used successfully in recent years to generate an unprecedented level of interest in the topic, how can we avoid inflammatory statements, recognize geographical and socioeconomic nuances, and develop quantitative rigor in a relatively new field?

In this workshop, participants will discuss challenges in monitoring and evaluation in the menstrual hygiene management sector through an interactive human-centered design workshop approach. We will use Pasand, a social venture that partners with schools and NGOs in India to teach women’s health and provide access to affordable sanitary protection, as a case study and present four challenges the organization faces with respect to data collection.

Participants will be divided into facilitated “challenge teams,” each assigned with the task of collaboratively identifying solution(s) to one of the challenges presented. At the end of the session, groups will share their solutions, and individuals will come away with a deeper understanding of effective monitoring and evaluation in the sector, as well as new ideas that can be implemented in their own work.

In the days following the conference, Pasand will compile a summary of the ideas and major themes coming out of the workshop and send to participants so that they can take the results back to their own organizations, expanding the reach beyond the walls of the workshop.

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

Period Positives, Menstrual Hygiene Management, and The Feminist Issue of Our Times

May 1st, 2015 by Laura Wershler

An international panel will lead a discussion 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 on Menstrual Hygiene Management Campaigns & Menstrual Activists: What can we learn from each other?

1. Stiff Lower Lips: Challenging and changing British attitudes to menstruation
Presenter: Chella Quint,The #PeriodPositive Project, Sheffield, UK

Chella Quint offers at least 28 ways to disrupt narratives of menstrual shame globally and locally by recounting her #PeriodPositive methods: using comedy, activism, research, education, and, more recently, as part of a wider discourse around improved sex and relationships education, at grassroots, local school board and national policy levels. She developed #PeriodPositive to counteract the mainly negative public discourse. She accepts that people both love and hate periods, but tries to unpick how big an influence the media plays in these attitudes. She aims for ‘period neutral’, using a positive approach.

@chellaquint  #periodpositive

2. The Feminist Issue of Our Time: The role of menstruation in achieving better reproductive health for women worldwide
Presenter: Dr. Emily Wilson-Smith, Irise International, University of Sheffield—School of Health and Related Research, Kampala International University 

Women’s reproductive health begins with their experience of menstruation, influencing their health-seeking behaviors for life. With the lifetime risk of maternal death over 200 times greater in poor countries compared with Western Europe and North America, an over-romanticized view of a women’s natural state is damaging in this context. Wilson-Smith believes that the fate of the 800 women who die every day during childbirth from preventable causes is the feminist issue of our age. All who aspire to advance women’s rights need to engage in a meaningful way with the realities these women live, their struggles to access healthcare and information, control their fertility and survive childbirth. We may have to leave some appealing myths about the female body behind if we wish to extend the freedoms that many women in the west currently enjoy to women around the world.

 3. Menstrual Hygiene Day – Uniting Partners
Presenter: Danielle Keiser, WASH United, Berlin, Germany 

In addition to deeply enshrined socio-cultural taboos about menstruation, the ability to hygienically manage menstruation is a major struggle in many parts of developing countries. This is largely due to the lack of access or limited affordability of hygienic products and/or the lack of private and clean facilities with water, soap and a safe place to dispose of menstrual waste. Such an environment prevents girls and women from being able to practice ‘healthy’ habits around menstruation, have ‘positive’ attitudes about menstruation or lead ‘normal’ lives on menstruating days.

Menstrual Hygiene Day (May 28) is an initiative with a vision to ensure that all girls and women, wherever they are, can hygienically manage their menstruation – in privacy, safety and with dignity. Initiated by WASH United, Menstrual Hygiene Day is a global and open platform that unites the many different actors and sectors by coordinating and strengthening efforts to make this vision a reality. Since 2013, over 200 organisations worldwide have joined the partner network.


4. Experiences from India—Reclaiming a positive & celebratory outlook towards menstruation
Presenter: Sinu Joseph, Mythri Speaks

In India, practices around menstruation, such as women taking time off during their period, eating and drinking from separate vessels, and not visiting religious places or ceremonies during menstruation, are rooted in the cultural context. It is nearly impossible to talk about menstruation in India without understanding the traditional cultural practices. Throughout Joseph’s journey of discovery, the positive celebratory attitude of early religious texts towards the experience of menstruation has been enlightening. Ancient societies have much untapped wisdom that could benefit menstruators and inform our views today.

Media Release and Registration for the SMCR Boston Conference.

Sustainable Cycles: Cross Country Activism and Menstrual Health Education on Bicycles

April 24th, 2015 by Laura Wershler

Presenters Sarah Wilson, Ruby Gertz, Rosie Sheb’a, Rachel Horn, Olive Mugalian and Rachel Saudek will present the workshop Sustainable Cycles: Cross Country Activism and Education on Bicycles, 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, USA.

Read more about their journey in Biking 2000 Miles to Talk Period published by Jamaica Plain News.

In March of 2015 seven women from three different countries are biking across America for one reason: because they are passionately period positive. The purpose of Sustainable Cycles is to catalyze a grassroots, person-to-person revolution away from single-use, disposable menstrual products to reusable sustainable options. We want as many women to make the switch as possible and for users to become advocates—“spokeswomen” – in their communities. We see our work as a feminist, social and environmental justice project.

Sustainable Cycles was started in 2011 by Sarah Konner and Toni Craige, who biked down the West Coast meeting with groups of women to discuss the cultural taboos of menstruation and pass around a show-and-tell kit of alternatives to single-use pads and tampons. The project has since gained momentum, making the 2015 tour the third and largest trip. This year the trip will be taking three simultaneous routes: through middle America via San Francisco, Southern America via San Diego and from Florida up the Eastern Coast. The project has been supported by multiple re-usable companies including Diva Cup, Ruby Cup, Party in My Pants, Glad Rags, Lunette and My Own Cup.

As the culmination of our 2015 tour, it is a privilege to present our travels with other menstrual enthusiasts at the 2015 SMCR conference. We will be presenting our project in three parts. Firstly, reminding and educating about the presence and importance of alternative menstrual products. We will then be sharing the details, triumphs, and difficulties of holding these workshops with women across America. This will include pictures from our journey, a report of current attitudes about menstruation and alternative products and our personal growth during our journey. Lastly, we will be discussing ways that women can access their own inner activist and combine their passions to make a difference in the world. We are thrilled to be sharing our passion and products with women across America and to share our story at the upcoming conference.

Follow Sustainable Cycles on Twitter @bikeperiod and on Facebook 

Media Release for 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, USA

Register here for the 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

“Menstrual Hygiene” Explored: Capturing the the Wider Context

December 9th, 2014 by Chris Bobel

This summer, I bought a new camera. I needed it to snap pictures during a research trip to India where I explored diverse approaches to what’s called in the development sector, Menstrual Hygiene Management (MHM). I chose a sleek, high tech device with a powerful, intuitive zoom.

Photo by author

In Bangalore, I captured the sweet intimacy of two schoolgirls as they watched the menstrual health animated video “Mythri” at a government school. In Tamil Nadu, I used my zoom for close shots of skilled women tailors sewing brightly colored cloth menstrual pads for the social business, Eco Femme.

Photo by author

In South Delhi, I used my zoom to preserve the mounds of cloth painstakingly repurposed as low cost menstrual pads at NGO Goonj.

But here’s the problem. These close up shots may please the eye, but they leave out the context that surrounds and shapes each photo’s subject. And what exists outside the frame is at least as important as what is inside. That’s hardly a revelation, I realize, but when it comes to doing Menstrual Hygiene Management work, in an effort to find solutions, the “big picture”—both literally and figuratively—sometimes gets obscured.

Photo by author

For example, when I snapped the picture of the mound of menstrual pads pictured here, I focused on a product, a simple product, that could truly improve the quality of someone’s life. But when I trained my attention on the product, what did I miss?

In short, a wider angle lens reveals the context of menstrual product access—a complicated web of many intersecting issues: infrastructural deficits (safe, secure, and clean latrines and sites for disposal), access to resources (like soap and water), gender norms, and menstrual restrictions rooted in culture or religion.

Imagine that one of brightly colored packages of menstrual pads ends up in the hands of a 15 year old girl. I will call her Madhavi.

Madhavi is delighted to have a dedicated set of her very own clean rags to absorb her flow.

Goonj worker with pads ready for distribution and sale
Photo by author

But does she have access to clean water and soap to wash them?

Does she have family support to dry her rags on the clothesline, in direct sunlight, even though her brothers, uncles, and neighbors will be able to see them?

Does she have a safe, secure place at school to change her rags?

Does she have someone to turn to when she has a question about her menstrual cycle?

These questions are important because they point to what gets in the way of effective and sustainable MHM. My own review of the emerging empirical literature on MHM revealed that the top three impediments to school girls’ positive and healthy menstrual experiences are 1) inadequate facilities 2) inadequate knowledge and 3) fear of disclosure, especially to boys. I want to focus on this last one for a moment by widening the frame a bit more.

Menstrual Hygiene Management is part of a complex and enduring project of loosening the social control of women’s bodies, of working to move embodiment, more generally, from object to subject status—something absolutely foundational to taking on a host of other urgent issues; from human trafficking to eating disorders to sexual assault.

As we know throughout the West, menstrual taboos do not disappear as we upgrade our menstrual care. Without the heavy lifting of menstrual normalization, any menstrual care practice will make a minimal impact.

Thus, menstrual activism must always incorporate an analysis of how gender norms maintain the menstrual status quo. And it must engage the potential of men and boys as allies, not enemies. That’s a tall order that cuts to the very core of gender socialization. But if we don’t take this on, no product in the world will be enough.

Anyone with a camera knows that framing a picture is a choice. Am I suggesting that we should never use the zoom, that we should forgo the rich and textured details possible when we tighten the shot? Of course not, as focus is crucial to our understanding. But when we do aim our figurative cameras and shoot, let’s not forget what lies outside the visual frame. Let’s not forget what else must change for the pad to be a truly sustainable solution.

With this in mind, I turn back to Madhavi and her new pads. Inevitably, even with them, one day soon, someone will know she is menstruating.

Will she be shamed? Will she be supported?

The answer lies in how we frame the picture.

This blog post appears on Girls Globe as part of a series of invited posts organized by Irise Interational.

‘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.

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?

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.