Blog of the Society for Menstrual Cycle Research

‘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.

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

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

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

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

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

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

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

Congressional Action on Menstrual Hygiene Day

May 28th, 2014 by Saniya Lee Ghanoui

Maloney press release for the Robin Danielson Act of 2014

As I’m sure you’re well aware, today is Menstrual Hygiene Day and there are activities all across the globe to commemorate this day.

The SMCR is excited to announce that it contributed to the day by endorsing the Robin Danielson Act of 2014, a legislation that would require the National Institutes of Health (NIH) to research whether menstrual hygiene products contain synthetic additives that pose health risks (including risk of Toxic Shock Syndrome). What’s more, Congresswoman Carolyn Maloney (D-NY) introduced an updated version of this Act today, on Menstrual Hygiene Day! According to Maloney’s office, she first introduced legislation regarding tampon safety in 1997 with the Tampon Safety and Research Act; subsequent versions of this bill were introduced in 2003, 2005, 2008, and 2011.

Now it’s time to take more action: turning this introduced legislation into law. Stay tuned for more information regarding petitions of support and other forms of activism and assistance. In the meantime, step one is to write your local congressperson and voice your support for the Robin Danielson Act of 2014. You may find a list of Representatives (and search for your local Rep.) on the House of Representatives website and you may read more about Maloney’s bill (in which SMCR member and President-elect Chris Bobel is eloquently quoted)  on her site.

Happy Menstrual Hygiene Day!

Menstrual Hygiene Day: What’s in a name? Why Menstrual Hygiene Day is called Menstrual Hygiene Day

May 27th, 2014 by Saniya Lee Ghanoui

Guest post by Danielle Keiser

Summary: Menstrual Hygiene Day is not only about the biological process of growing up into a woman, but also about addressing the challenges that exist in many developing countries with regards to managing menstruation safely and hygienically. Such challenges include potential vaginal infections caused by poor access to soap and water and toilets, inadequate or unhygienic sanitary protection materials, or infrequent cleaning or changing of these materials. In many cases, this results in adolescent girls missing school and women missing work. Moreover, the continued silence around menstruation paired with limited access to factual guidance at home and in schools results in millions of women and girls having very little knowledge about what is happening to their bodies when they menstruate and how to deal with it.

Is ‘hygiene’ a negative word?

Menstrual Hygiene Day, oh, be some other name! As Juliet famously said about a rose with regards to Romeo being a Montague, what is in a name? That which we call hygiene by any other name would still be (according to the Oxford Dictionary) “the conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness”, would it not?

Since we launched the initiative to make the 28th of May Menstrual Hygiene Day, we at WASH United have undoubtedly started the conversation about menstruation, with social media buzzing as to why #MenstruationMattersand worldwide events and activities set to take place by many of our 135 partner organizations. One recurring conversation has revolved around disagreement with the term ‘hygiene’, a term that has been criticized for not being ‘period positive’ and doing little to ‘honor the menstrual process’.

I’d like to take the time to explain why we chose the word hygiene, focusing on how optimal Water, Sanitation & Hygiene (WASH) conditions, or more specifically, access to clean water and soap, toilets, sanitary protection materials and factual guidance are prerequisites to enabling women and girls to embrace their periods and feel positive about the whole experience. When menstruation is managed in privacy, with safety and dignity, women and girls are much more likely to develop the comfort and confidence needed to participate in daily activities. And since all human rights stem from the fundamental right to human dignity, when women and girls are forced into seclusion, taunted and teased, or fear leaking due to inadequate menstrual hygiene management (MHM), dignity is difficult to maintain.

 

4 reinforcing thoughts: It’s about hygiene.

1. Imagine that while menstruating, you are either not allowed to bathe or you simply don’t have a shower to rinse your body.

In parts of Kashmir, India, some menstruating women are prohibited from using water sources and advised to stay away from flowing water in general. Also, they are not allowed to look at their reflections in the water.

2. Imagine unexpectedly starting your period in the middle of an important math lesson. Is your first thought, I need to go to the toilet? Do you go to the one dirty latrine that is shared with 65 other boys and girls, without a lock? And what will you do with your stained panties? There’s no hand-washing facility and not even a wastebasket to throw them away in.

There are still 2.5 billion people who do not have access to adequate sanitation. If roughly half of the world’s population is female, that’s 1.25 billion girls and women who cannot simply ‘go to the ladies’ room’ to check on themselves and change their pad, tampon or cup in privacy.

3. Imagine having no idea, or a very faint one, about what a period is, why it happens, or how to take care of it when it happens.

Worldwide, many girls feel a ‘culture of silence’ around menstruation, including in their families. Often, male family members are clueless about menstruation, treating it as something negative or a curse. Girls do not feel comfortable even talking to their mothers about the subject, and many teachers only skim the surface on lessons about puberty and reproduction because it makes them uncomfortable.

“Home Made Menstrual Period for Game-Playing With Doctors”

May 14th, 2014 by Holly Grigg-Spall

(photo by Holly Grigg-Spall)

In the past few weeks I have been meeting with women’s health activist Carol Downer to collaborate on a new book. She shared with me a work published in 1969 that was a catalyst for her development of the self-help movement and feminist women’s health clinics – ‘The Abortion Handbook’ by Patricia Maginnis and Lana Clark Phelan – which is extremely hard to get hold of these days (Carol found her current copy on Ebay for a significant sum). This book has a strikingly contemporary tone- snarky, conversational, with a lot of black humor. It is also conspiratorial with very much an “us” (women) against “them” (medical establishment) tone. It’s something like ‘Sex and the Single Girl’ by Helen Gurley Brown, but with a recipe for a “home made hemorrhage” instead of a “fabulous dinner.”  That is, the writers outline ways in which women could circumvent the restrictions on abortion access of the time in creative, guerrilla-style ways in order to have a legal abortion. One of these is getting an IUD inserted in the early stages of pregnancy.

In an chapter entitled ‘The Loop Can Be Your Little Friend’ the writers provide women who have missed a period with a plan for persuading a doctor to insert an IUD, when, at the time, it was required that this be done during a woman’s menstruation, in part, it is claimed here, to ensure that an abortion would not be the outcome. Firstly the woman makes the appointment as soon as possible, not waiting for a pregnancy test to confirm, as, they say, she can always pull the IUD out herself later if she doesn’t want it as a contraceptive. Then:

“Buy some raw, fresh beef liver…dip your well-scrubbed forefinger into the blood on the raw liver and rub this bloody finger into your vaginal tract. Go way up, beyond your cervix, not just the opening. Menstrual blood collects in the back of the vagina, so be sure and put some there to make it look more authentic…if you wear a tampon, use a bit more blood before you insert it so there will be discoloration on the tampon. Do not remove the tampon before you see the doctor or loop-installer…if you use an external sanitary napkin, smear a bit of beef blood down the center of the napkin just as your natural menstrual flow would be distributed…not side-to-side and end-to-end like butter on bread.

(Sorry if this makes you feel sick, but this whole business nauseates us. We’d like to get out of this whole trickery business, and we will, just as soon as doctors get out of the abortion business so all this planned deception can stop)

Be sure to smear your vaginal interior lightly also, as this napkin-evidence may be removed by a nurse, and it would be hard to explain you nice, bloodless vagina after that bloody napkin. For heaven’s sake, don’t douche before adding your bloody, dramatic “proof of period.” Keep yourself naturally revolting and smelly to get even for this humiliation.”

Once the IUD is installed the writers suggest the woman go about exercising vigorously, swimming, horse back riding, dancing, moving pianos and having sex in order to help the IUD act as a fertilized embryo remover. They conclude:

“This has worked many times for desperate women lacking money for proper medical care, and who hadn’t the stomach for self-surgery. It is certainly worth a trial. Except for your spiritual humiliation for being forced to deception, it is certainly harmless to you physically.”

Reading this I was reminded of how today we see menstrual activists stain white jeans with fake menstrual blood to confront the menstrual taboo in public or create accessories like the Stains by Chella Quint, that are an attachable fake period of sorts, in order to question the need to be secretive about this natural bodily function. On the television show ‘Nashville’ a main character used animal blood to fake a miscarriage for the observation of her husband in order that he remain married to her (it’s complicated, but a great show, you should check it out!). I was also reminded of the study from 2012 that claimed 38% of women have used having their period as a way to avoid an activity they did not want to do at the time. 20% said they have used their period as an excuse not to go into work. The study did not show how many women are actually having their period when they do this or how many are pretending to be having their period.

Getting Congress on the Right Menstrual Track

April 25th, 2014 by David Linton

Rep. Carolyn Maloney

For nearly 20 years Congresswoman Carolyn Maloney has been working to have enacted into law a bill aimed at providing better quality control of tampon manufacture. Researchers have repeatedly raised alarms regarding the potential health risks women are exposed to due to the effects of some of the chemicals used in their composition, especially those involved in tampons. However, despite having attracted strong support from some other members of Congress, the bill in various forms has never made it through the committee process onto the floor of the US House of Representatives for a vote.

Undaunted, Congresswoman Maloney is about to try again and this time the members of the Society for Menstrual Cycle Research are on board to muster support. Partly due to SMCR input, the bill has been refined and clarified so as to spell out the reasons it is needed and the expected outcomes. And, the bill has a new name, The Robin Danielson Act, in recognition of a woman who died of Toxic Shock Syndrome.

The timing for this legislative push coincides with SMCR commitment to support the international Menstrual Hygiene Day being spearheaded by the Berlin-based organization, WASH-United. Around the world various groups will be hosting special events, film screenings, menstrual poetry and art activities, and educational efforts throughout the month of May, all geared to a May 28, Menstrual Hygiene Day, celebration of the cycle and rejection of the taboos, stigmas, and shame factors.

More information will be forthcoming shortly on how everyone can get involved by signing petitions, contacting members of Congress, and becoming activated to pass the Robin Danielson Act.

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?

The Subject of Sneers or Jests: Menstrual Education in the Service of Racism

March 20th, 2014 by David Linton

Title page of What a Young Woman Ought to Know

Sometimes, when it seems that progress toward the elimination of harmful menstrual stereotypes, myths, and misinformation is slow or even stalled, it is bracing to take a look back at the kinds of educational materials, marriage manuals, and sources of advice that women were offered in the past in order to be reminded that progress does actually exist. Consider, for instance, an effort to enlighten women about sex, marriage, and the menstrual cycle from the early 20th Century.

One hundred years ago, in 1913, a book appeared in the “Self and Sex Series” titled, What a Young Woman Ought to Know by an author identified as Mrs. Mary Wood-Allen, MD. Her credentials, displayed on the title page, include the following: “National Superintendent of the Purity Department Woman’s Christian Temperance Union,” and she is credited with having written six other books, including Almost a Man and Almost a Woman.

To get a hint of the direction the book takes in its effort to instruct young women in what they ought to know a glance at some of the chapter titles may suffice:

Ch. V – “Breathing”
Ch. VI – “Hindrances to Breathing”
Ch. VII – “Added Injuries from Tight Clothing”
Ch. XVI – “Some Causes of Painful Menstruation”
Ch. XVII – “Care During Menstruation”
Ch. XIX – “Solitary Vice”
Ch. XXVII – “”The Law of Heredity”
Ch. XXXIV – “Effects of Immorality on the Race”
Ch. XXX – “The Gospel of Heredity”

As these titles suggest, the book manages to link menstrual education with some of the most virulent eugenic nonsense that had gained widespread acceptance in American science and politics of the time, the same sham-science that led to sterilization of disabled people and African-Americans in the U.S. and found a welcome home in Nazi Germany in the following decades.

Perhaps the best way to communicate the stupidity of the book’s content is to allow it to speak for itself. Consider the explanations of menstrual discomfort and the effects of bad reading habits:

“Whenever there is actual pain at any stage of the monthly period, it is because something is wrong, either in the dress, or the diet, or the personal and social habits of the individual.” (119)

“Romance-reading by young girls will, by this excitement of the bodily organs, tend to create their premature development, and the child becomes physically a woman months, or even years, before she should.” (124)

“…if girls from earliest childhood were dressed loosely, with no clothing suspended on the hips, if their muscles were well developed through judicious exercise, they would seldom find it necessary to be semi-invalids at any time.” (146)

The underlying disdain or fear of sexual pleasure is expressed in the chapter about masturbation, titled “Solitary Vice,” in which it states, “the reading of sensational love stories is most detrimental…This stimulation sometimes leads to the formation of an evil habit, known as self-abuse….The results of self-abuse are most disastrous. It destroys mental power and memory, it blotches the complexion, dulls the eye, takes away the strength, and may even cause insanity.”

As if these dire consequences were not bad enough, it turns out that once one has inflicted these conditions on one’s self, they can enter the girl’s genetic code and be passed along to future generations. Even a girl’s clothing choices can have long term, disastrous effects: “The dress of women is not merely an unimportant matter, to be made the subject of sneers or jests. Fashions often create deformities, and are therefore worthy of most philosophical consideration, especially when we know that the effects of these deformities may be transmitted.” (223)

The author minces no words as to the effects on the children of such a careless mother: “The tightly-compressed waist of the girl displaces her internal organs, weakens her digestion, and deprives her children of their rightful inheritance. They are born with lessened vitality, with diminished nerve power, and are less likely to live, or, living, are more liable not only to grow up physically weak, but also lacking in mental and moral stamina.”

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.

The Big, Fat, Menstrual Untruth in Cameron Diaz’s The Body Book

February 5th, 2014 by Laura Wershler

I was curious. If Cameron Diaz’s purpose in writing  The Body Book: The Law of Hunger, the Science of Strength, and Other Ways to Love Your Amazing Body was empowerment, helping women to understand how their bodies work, would she include information about the menstrual cycle?

There was no way of knowing from her Jan. 22, 2014 radio interview with Jian Ghomeshi on CBC’s Q. I listened to Diaz explain that conversations she’d had and overheard in the last few years made it clear to her that women are completely confused about their bodies. She said this had her thinking, “Wow, that’s such a crazy thing that after so many years of living in your body that you actually don’t have an understanding of it.”

Then she revealed her intention in writing the book – to empower women to make “informed decisions about their nutrition and their physical activity.” Judging from this comment, the book’s subtitle, and the fact she did not mention menstruation during the interview, I wondered if the menstrual cycle would even be mentioned.

I sought out The Body Book at my local bookstore and quickly scanned the table of contents and index. I found myself smiling, thinking about Betty Dodson, author of Sex for One: The Joy of Selfloving, and how she revealed in Chapter 1 that whenever she gets a new sex book she “immediately” looks up “‘masturbation’ to see where the author really stands on sex.” Whenever I see a new book about women’s health I look up “menstruation” to see what the author really knows about the menstrual cycle. Turns out Diaz, and/or her co-author Sandra Bark, know both a lot and not so much.

In Chapter 21, Your Lady Body (the book’s introduction starts with the salutation Hello, Lady!), she presents a fairly accurate endocrinological description of the three phases of the menstrual cycle: follicular, ovulatory, luteal. So far so good. But then, in the last paragraph of the luteal phase section, comes the big, fat menstrual untruth, the implication that whether you use hormonal birth control or not, this is how your menstrual cycle unfolds. It’s an absolute falsehood, and one that many women in this age of burgeoning body literacy are sure to see through.

Photo Illustration by Laura Wershler
Note: This is the only reference to contraception in The Body Book

The last paragraph of this luteal phase description (page 182) is ridiculously misleading. If a woman’s birth control method is the pill, patch, ring, implant or (Depo-) Provera shot, the synthetic hormones each contains will shut down her normal menstrual cycle function. She most definitely will not experience a cycle with follicular, ovulatory and luteal phases. Hormonal contraception does not “protect” her eggs. She will not ovulate, therefore the egg will not die. She may have a “withdrawal bleed” but it is not a true period. This is the truth.

I can understand, possibly, why Diaz made this egregious implication. What were her choices? Open a can of worms? State categorically, as every description of menstrual cycle function should, that you don’t ovulate or experience a normal menstrural cycle while taking hormonal contraception? 
Maybe something like this?

Hey Lady! If you use hormonal birth control none of this fascinating menstrual information applies to you. Wish I could tell you what this means for your health and fitness but, sorry, that’s beyond my area of expertise.

If Diaz’s intention for this book is to empower women to better understand their bodies, then she failed when it comes to the menstrual cycle. I hope she’ll correct this big mistake in any future editions.

The Other Dangers of Yasmin and Yaz

July 2nd, 2013 by Holly Grigg-Spall

Recently, in a piece for the Ms. Magazine blog, re:Cycling’s Elizabeth Kissling remarked on the lack of media coverage of serious safety issues with the popular birth control pill brands Yaz and Yasmin. Of the coverage there has been, little has looked beyond the significant number of injuries and deaths caused by blood clots to the potential dangers held in the negative psychological impact of these drugs, an impact that it appears a large number of women may have experienced.

As I read the stories of women who had suffered strokes or gone blind, I wondered how many women using Yaz or Yasmin had also been driven close to death, or perhaps even died, due to the depression the pills can provoke.

I decided to interview Dr Jayashri Kulkarni at Australia’s Monash University, one of the few people researching into this area, to find out more. As a practicing psychiatrist Dr Kulkarni treats women with mental health issues as well as leading research studies into this possible root cause of psychological problems.

Of the potential for these pills to create suicidal tendencies in users Dr Kulkarni says, “We have seen amongst women using these oral contraceptives a profound lowered self-esteem which causes them to lose perspective, misinterpret comments, and feel like no one would notice, or the world would be better off, if they weren’t around anymore. We’ve seen suicide attempts.

Dr Kulkarni is undertaking both a large-scale national and international survey of women’s subjective experiences with Yaz, Yasmin, as well as the Mirena IUD, Depo Provera shot, and Implanon implant and a smaller scale in-clinic study of the impact of oral contraceptives like Yaz and Yasmin on women over a three month period. The psychological impact is not what she calls “major depression” but instead a “sub-clinical depression” wherein women experience a mood change that impacts their relationships, work, and overall happiness.

“This depressive syndrome has a spectrum of symptoms. We tend to think depression just means sadness, but it can present as fuzzy headedness, inability to multitask, guilt, irritability, anxiety, and in behavioral changes like the development of obsessive compulsive disorders. Women experience a change in perspective that makes them magnify issues that occur in their lives, be that a slight weight gain or an argument with a partner, into feelings of worthlessness. It can also cause impulsivity, making the woman suicidal.”

At her clinic Dr Kulkarni describes treating a mother who found it difficult to let her children go to school for fear something would happen to them and another who became transfixed with the idea that her partner was cheating, and so called his phone repetitively to check on him. She believes that the provoked anxiety can display itself clearly as panic attacks, but it can also appear as paranoia and agoraphobia. When taken off Yasmin and Yaz these women returned to their previous state with a healthy perspective.

The Depo Provera shot and Implanon implant have shown in the research to also cause particularly profound depression. For women who have a history of mental health issues or have environmental factors that make them more vulnerable to mental health issues, these methods have been seen to provoke serious negative changes in mood.

Dr Kulkarni’s hypothesis is this: “Low estrogen pills and progesterone-only methods seem to cause depression at the highest rate. In our research we’ve seen women respond better to higher dose estrogen and natural progesterones. Clinical studies on animals have shown progesterone in a low dose causes increased anxiety, but conversely in a high dose it alleviates anxiety.” Her findings will be published later this year in full.

At present Dr Kulkarni treats her patients by changing their hormonal birth control method with her research in mind, a practice she believes to be generally successful. She prescribes new pill Zoely to patients who have responded badly to other brands. Zoely (which contains 2.5 mg of nomegestrol acetate and 1.5 mg of 17-beta-estradiol) was refused approval by the FDA for the US in 2011.

Yaz and Yasmin: An Unacceptable Level of Risk?

June 25th, 2013 by Elizabeth Kissling

Photo by Flickr user Beautiful Lily // Creative Commons 2.0

Don’t feel bad if you missed last week’s headline news about the deaths of 23 young women from their birth control. It was a top story for CBC news and a few other Canadian sources, but it was barely a blip on the radar of most U.S. news outlets. Yaz and Yasmin, two similar new-generation birth control pills from Bayer, are suspected in the recent deaths of these young Canadian women.

These are among the best selling oral contraceptives in the world, but this is not the first time Yaz and Yasmin have been suspected of causing death or adverse effects. Earlier this year, Bayer agreed to pay up to $24 million to settle claims from plaintiffs with gall bladder injuries caused by the drugs, and the company set aside $1 billion to settle claims from approximately 4,800 women who have suffered blood clots due to Yaz or Yasmin. As of February, 2013, approximately 10,000 lawsuits against Bayer are still pending in the U.S., and an additional 1,200 unfiled claims are pending. The company anticipates additional lawsuits—and additional settlements—regarding blood clot injuries, such as pulmonary embolisms or deep-vein thrombosis.

The history of the birth control pill and its social impact is well documented. First approved by the U.S. Food and Drug Administration in 1960, it quickly became the world’s first “lifestyle drug,” and it has become the one of the most studied drugs in history. It is considered to be so safe that the American Congress of Obstetricians and Gynecologists (ACOG) recently recommended that oral contraceptives be sold without a prescription.

But all hormonal contraceptives–the pill, the patch, the shot and the vaginal ring–carry a risk of blood clots. For most users, this is a minor concern, affecting approximately six of every 10,000 pill users. For users of new-generation pills—that is, pills containing drospirenone, the fourth-generation synthetic progesterone found in Yaz, Yasmin, Ocella and several other brands—the risk jumps to ten of every 10,000 users, although Bayer maintains that their own clinical studies find the risk comparable to older pills. Note, however, that the risk in most of these studies is compared either to other hormonal contraceptives or to pregnancy, not to using effective non-hormonal contraception. As if women’s only choices were to be pregnant or be on the pill.

And it is this matter of women’s choices that brings me to my main point: Why we have we seen so little media attention to the safety profile of Yaz/Yasmin (and hormonal contraceptives more generally)? This isn’t about just a few unlucky Canadian women: Four women in Finland have died, more than 50 U.S. users of Yaz and Yasmin died in just a few years and France reports 20 deaths per year due to birth control pills between 2001 and 2011, with 14 attributed to the new-generation contraceptives. This is a major consumer safety concern, and a women’s health issue.

In an earlier time, this might have led to Congressional investigations, such as the Nelson Pill Hearings, which resulted in FDA-mandated Patient Package Inserts (PPIs)—the printed information about risks, ingredients and side effects included in pill packets, first required for oral contraceptives and then for all prescription drugs. It is hard to imagine today’s Congress calling for such an investigation. Among many other social changes since 1970, drug manufacturers in the U.S. hold more influence over both legislators and consumers, now spending nearly twice as much on promotion as they do on research and development.

A parallel can be found in the health crisis triggered by an outbreak of Toxic Shock Syndrome (TSS) linked to tampon use in 1980. TSS is a potentially fatal infection caused by bacterial toxin Staphylococcus Aureus. A new brand of superabsorbent tampon was linked with 813 cases of TSS, including 38 deaths, that year. By 1983, the number of menstrual-related cases reported to the CDC climbed past 2,200, and manufacturer Proctor & Gamble had “voluntarily” pulled the product from the market before the FDA forced them to do so. The intense media coverage, public concern and outcry from feminist activists pushed the FDA to reclassify tampons as a Class II medical device, an upgrade which meant tampons would require more specific regulation and possibly after-market surveillance. They were much slower to mandate absorbency standards, but eventually did so under court order. These actions resulted in a documented decrease in menstrual-related TSS, although it is important to note that it has not disappeared.

Today, more than 30 years later, young women are again dying from something purported to help them, something that affects mostly women. Thousands more are experiencing life-threatening, health-destroying side-effects, such as blindness, depression and pulmonary embolism. Canada’s professional association of OB-GYNs defended the drug, suggesting that perhaps the recent deaths could be attributed to non-contraceptive reasons for which it was prescribed, such as PCOS or diabetes, both of which are associated with higher risks of blood clots. But there is little evidence of public concern, outside of Yaz/Yasmin user message boards. Even feminist outlets aren’t always covering these issues as vigorously as we might hope.

Yet the birth control pill in general has never been more politicized in the U.S.: In the last year or so, we’ve seen headlines and public debates about insurance coverage of the pill, access to emergency contraception and so-called personhood bills which have been introduced in legislatures in at least eight states. Feminist activists and health care advocates have been working tirelessly to protect access to the pill along with other forms of birth control, as well as the right to end an unintended pregnancy—and feminist journalists have been writing about these activities.

In the urgency of responding defensively to these political attacks—and we must respond—feminists cannot ignore corporate threats. Just as preserving contraceptive and abortion access is critical to women’s health and well-being, so is protecting contraceptive safety.

Cross-posted from Ms. magazine blog.

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