Blog of the Society for Menstrual Cycle Research

Menstruation, Menopause, and HIV

March 1st, 2010 by Elizabeth Kissling

Menopausal women seeking relief from hot flash in front of electric fan.

POZ magazine and poz.com claim to be the leading publication and website in the U.S. about HIV/AIDS. The March 2010 issue has a great article by Suzanne Bopp about menstruation, menopause, and HIV. As with medical and cultural knowledge about HIV itself, understanding of how HIV affects menstruation continues to evolve. Irregular menstruation is a common complaint of women with HIV, but

“[Today] we have a better grasp of factors associated with abnormal menstrual cycles: substance abuse, AIDS, wasting disease—it relates more to overall nutritional status,” says Kristine Patterson, MD, clinical assistant professor at the University of North Carolina School of Medicine in Chapel Hill. “If the body doesn’t have enough fat, production of estrogen and progesterone shuts down,” Patterson says. This can happen anytime a woman loses too much weight, and it is exacerbated by advanced HIV disease, which causes the body to burn calories more rapidly.

. . . .

Researchers do know, however, that female hormones affect the virus—and that sex hormones generally have an impact on immunity. “We know that where a premenopausal woman is in her menstrual cycle affects her infectiousness,” Patterson says. “Estrogen plays a role—not only in HIV and the interplay of HIV and meds, but also in [the likelihood of] women transmitting and acquiring HIV.” Estrogen’s role may explain why women progress to AIDS at lower viral loads than men.

Highly recommended. Read the whole thing.


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Menstruation and Music Don’t Mix

January 29th, 2010 by Elizabeth Kissling

Cartoon illustration of opera singerThat’s the report from this arts blogger at the New York Times. Yesterday, doctors from the Methodist Center for Performing Arts Medicine of the Methodist Hospital in Houston held a daylong symposium on the management of medical problems among musicians specifically and performing artists more generally. Performing-arts medicine is a relatively new specialty, and frankly, I’m not surprised by the need for it. (I know a drummer who has ongoing neck and back problems caused – or at least aggravated – by his art.)

But I was surprised to see a blanket recommendation that female vocalists use oral contraceptives to suppress menstruation. According to Keith O. Reeves, the deputy chief of Gynecology at the Methodist Hospital and a professor at Weill Cornell, premenstrual syndrome “brings vocal fatigue, decreased range, loss of power and loss of some harmonics.” Continuous use of synthetic hormones is quite an extreme remedy for an illness without a clear definition or etiology.

But apparently menopause is much harder on the vocal folds – our intrepid blogger can’t even tell us:

As for menopause, you don’t want to know. As Dr. Reeves quotes the great mezzo-soprano Christa Ludwig, “It was a hell of some years.”


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Will HPV Screening Replace Pap Tests?

January 26th, 2010 by Elizabeth Kissling

Photo of two women in medical consult.Researchers in Italy have recently completed a study comparing the effectiveness of DNA testing for HPV (human papillomavirus) to the commonly used Pap smear for detecting cervical cancer. Their findings suggest that more cases of cervical cancer can be prevented with HPV testing than with the conventional Pap smear, especially for women over 35.

There are, however, some disadvantages to using DNA tests to detect HPV. For example, the test is less specific, which means that there are more false positives in the results. This means more women have to return for further testing. In practice, HPV screening has a callback rate of about 25-30%, compared to a callback rate of about 5-7% for Pap smears, according to Dr. Mark Einstein, a gynecologic oncologist and director of clinical research at Montefiore Medical Center in New York City.

Health News Review points out that although the HPV test is more effective in the sense that it prevents invasive cervical cancer by detecting persistent high-grade lesions earlier and providing a longer low-risk period for older women, replacing Pap smears with it is not necessarily more cost-effective for patients, given the costs of the additional colposcopies that result from the higher callback rate from HPV testing.



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Don’t Douche!

January 25th, 2010 by Elizabeth Kissling

Unassembled douchebag and accessories.Remember my rant about “vagina wash” back in November? No? I’ll wait while you read it.

Anyway, it’s not just a political rant: there are new data that indicate that douching probably causes bacterial vaginosis. A research team studying the association between douching and bacterial vaginosis published their findings in the February 2010 issue of Sexually Transmitted Diseases. The researchers were interested in determining whether the association between douching and BV is causal, or if the association exists because women douche when they experience symptoms of BV. They compared numerous personal hygiene practices with douching.

A longitudinal study of the vaginal flora of 3620 women – involving a whopping total of 13,517 gynecological visits – found that that only one personal hygiene behavior correlates strongly with bacterial vaginosis: douching. The researchers found no statistically significant correlation between BV and type of underwear (nylon vs. cotton); menstrual product (tampons vs. pads; pads and tampons vs. pads); use of pads or panty liners when not menstruating; weekly or greater use of hygiene spray, powder, or towlettes; or daily versus less than daily bathing and showering.

The researchers concluded that “[d]ouching, but not other feminine hygiene behaviors, is significantly associated with BV, providing additional evidence that douching may be causally associated with BV and is not simply a response to BV symptoms.”

So let’s reserve douche and douchebag to describe anti-feminist people and actions: douches are unnecessary, harmful to women, and sold to women in insulting ways.

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“Abortion is a matter of survival for women”

January 22nd, 2010 by Elizabeth Kissling

It was 37 years ago today that the U.S. Supreme Court decided Roe v. Wade, in which the Court held that a woman’s right to an abortion fell within the right to privacy protected by the Fourteenth Amendment.

In commemoration of that decision and women’s right to autonomy over personal reproductive decisions, I’m posting some of the newly released video of the late Dr. George Tiller talking about why he performed abortions.


Thank you, Dr. Tiller, for trusting women.


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New Treatment for Uterine Fibroids

January 18th, 2010 by Elizabeth Kissling

Illustration of radiofrequency ablation technique to remove fibroids.Tuesday’s Wall Street Journal reports a new surgical technique for relief of uterine fibroids is currently being tested at six medical centers in the U.S., along with two in Mexico and one in Guatemala. Presently, the only sure cure is hysterectomy, because fibroids sometimes grow back when suppressed with drugs or removed individually.

Fibroids are benign growths in the uterus that are estimated to occur in as many as 70% of women. Fibroids are often asymptomatic; many women don’t even know they have them. But fibroids can become large and painful, and can cause heavy menstrual bleeding. Sometimes they can grow large enough to interfere with other organs.

The new technique under investigation is called radiofrequency ablation. The procedure involves three small incisions: one for the laproscopic camera so the surgeon can see inside the abdomen, a second for an intra-abdominal utrasound probe to determine the size and location of fibroids, and a third for the Halt device, a needle electrode that penetrates the fibroid and burns the cells, which are eventually reabsorbed by the body. The device also cauterizes the incision to minimize bleeding.

In early tests outside the U.S. with 70 women, 90% were satisfied with the results. It is unknown whether fibroids destroyed with this technique will grow back.


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Open Call: Medical Screening Procedures Unique to Women

December 27th, 2009 by Elizabeth Kissling

One of the reviewers for the forthcoming edition of Our Bodies, Ourselves, who blogs anonymously at Mom’s Tinfoil Hat, is seeking contributions for the chapter she is reviewing.

I am busy reviewing and contributing to the second chapter of Our Bodies, Ourselves that was assigned to me. It is called “Unique to Women” and is about screening tests and medical procedures. I am trying to get through the technical side of writing this: checking on new screening guidelines, new screening tools, and such scientific type things. But, I really want to take into account the needs and points of view of many women, including disabled women, women of color, women from different cultural and religious backgrounds, women who are trans, men who are trans, women who are survivors of sexual abuse and/or assault, women who work in the sex industry, women who are polyamorous, women who are gay, women with piercings and tattoos, women of size, etc.

Her deadline is New Year’s Eve, so please contact her ASAP if you can contribute.

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The “standard of care” for being a girl?

December 22nd, 2009 by Laura Wershler

In a December 21, 2009 news release the American College of Obstetricians and Gynecologists (ACOG) proclaimed that “hormonal contraceptives offer benefits beyond pregnancy prevention“.

You’d have to be an ostrich with her head in the sand not to have heard this message before.  Just open any woman’s magazine to any ad for the pill, or any of the myriad varieties of drug-based birth control, and you’ll find the litany (a prolonged and tedious account) of non-contraceptive benefits used as marketing messages to “sell” birth control to girls and women.  So the news release begs the question: why now?

Maybe the pharmaceutical companies are putting pressure on the gynies to protect their funding and the drug companies profits.  Maybe this news release is damage control.  A recent article in Maclean’s magazine proclaimed a trend towards ”ditching the pill for good“.

[O]ral contraceptive prescriptions in Canada levelled off in 2008, reports pharmaceutical industry analyst IMS Health Canada. Health care workers are seeing a growing demand for non-hormonal methods. Spurred by concerns about their health, the environment, or even frustration with family doctors, who sometimes seem to push the pill as a modern-day cure-all, Canadian women are looking for other options.

Are declining prescriptions for hormonal contraceptives a growing trend in North America?  Is there a backlash brewing against the pill, the patch and the ring?  One can only hope that the days when your gynecologist could convince you that taking the pill is a panacea for everything that, supposedly, is “wrong” with women’s bodies are coming to an end.

Hormonal contraceptives are drugs that disrupt a woman’s normally functioning endocrine system with synthetic versions of estrogen (ethinyl estradiol) and progesterone (progestin) to induce infertility.  [Do not be fooled by the language used in the press release.]  These drugs have a time and place.  But precribing the pill must never become the “standard of care” for being a girl.  Mothers everywhere, take note.




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Who Lacks Health Literacy?

December 18th, 2009 by Elizabeth Kissling

You may have heard the news that 23 hormone replacement therapy lawsuits filed by women diagnosed with breast cancer were dismissed by a New York judge this week. Judge Martin Shulman granted Pfizer’s motion to dismiss for two reasons: the plaintiff’s delayed filing exceeded the the three-year statute of limitations in New York, and that “the potential risk of contracting breast cancer from taking HRT medication was well known at all times out there in the stream of public information.” Oddly, Judge Shulman simultaneously asserted “that the debate over HRT health problems has not yet been settled.”

I can’t argue about exceeding the statute of limitations, but it’s difficult for a judge to assert that breast cancer risk of hormone therapy is well known public information. The Lancet reported today that up to half of US adults have trouble interpreting medical information, displaying low levels of health literacy. Health literacy, according to The Lancet, is the ability to comprehend and use medical information that can affect access to and use of the health-care system. Health literacy is more than reading and comprehending news reports of medical issues (which are often of poor quality – see Health News Review for sharp analysis of health news); one must also know how to navigate the complexities of the health care system, including knowing how and when to question one’s physicians and pharmacists.

It’s also hard to argue that HT risks are well known when gynecologists, the primary prescribers of HT, refuse to believe the scientific evidence. In 2000 – well after 1990s publication of data from the Heart and Estrogen/Progestin Replacement Study (HERS), a prospective, randomized, double-blind study of 2,763 women with coronary disease which found no benefit of hormones in preventing heart disease – 94.6% of American gynecologists surveyed recommended HT during menopause. Denial continued even after the Women’s Health Initiative (WHI) study – a large, prospective, randomized placebo-controlled trial of estrogen (with and without progestin) in healthy menopausal women – was stopped early in July 2002, because the treated group experienced higher rates of breast cancer, cardiovascular disease, as well as other risks of harm.

WHI was a large, primary prevention trial that contained enough subjects (more than 27,000) to answer the research question; used a design widely acknowledged to be the standard in testing therapeutic efficacy; tested Prempro, the most popular hormone combination; and was monitored by a data safety monitoring board using pre-established criteria. Practitioners should have been satisfied that the question of estrogen as a health-protecting drug had been resolved. Instead, a storm of protest erupted from physicians who could not, or would not, believe the results. Objections to the WHI results (almost exclusively from gynecologists) were so widespread that the media characterized the WHI results as confusing and controversial.

In truth, there was no confusion about the data, which were monotonously consistent with HERS and other randomized controlled studies. [Fugh-Berman & Scialli, 2006]

Why do gynecologists, judges, and others still regard this question as unsettled? Scholars offer several explanations. Paula Derry (board member of the Society for Menstrual Cycle Research) proposed in a 2008 article that faulty decision-making criteria are in play, such as

not valuing rigorous scientific thinking (e.g., ignoring normal rules for judging what counts as scientific evidence, sometimes while claiming to be scientific); not placing a primary value on avoiding harm (e.g., considering heart disease outcomes while not simultaneously considering other risks such as stroke); and basing judgments on a preconception about menopause (i.e., that menopause is an estrogen deficiency disease that causes health problems). [Derry, 2008]

Women’s Health News: Cancer Genes, HPV Vaccine

December 11th, 2009 by Elizabeth Kissling

gardasilToday I want to point to two important articles about women’s health from our friends at Women’s eNews:

  1. Yesterday, they published a story about Myriad Genetics and their firm grasp on the patents for diagnostics tests for BRCA1 and BRCA2 genes, which are known to place women at high risk for breast and ovarian cancers. Until the patents expire in 2014 and 2015, its laboratory is the only place in the country where diagnostic testing for the BRCA genes can be performed. A lawsuit representing patients, women’s health groups, medical professionals and four organizations has been filed bythe American Civil Liberties Union, or ACLU, and the Public Patent Foundation.
  2. Today, Women’s eNews published a story about the need for more research on Gardasil, the HPV vaccine recommended for young women and recently approved for boys and young men too.

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Adenomyosis: Under-diagnosed cause of pelvic pain

December 3rd, 2009 by Elizabeth Kissling

adenomyosis1.jpg (JPEG Image, 250x297 pixels)A couple of months ago, we wrote about Kate Seear’s research findings that menstrual etiquette is a frequent cause of delayed diagnosis of endometriosis. In related news, medical researchers writing in a recent issue of the Journal of Obstetrics and Gynaecology have found that adenomyosis, the presence of endometrial tissue embedded within the muscular wall of the uterus, is under-diagnosed.

S. Basak and A. Saha, the study’s authors, examined the data of more than 1000 hysterectomies performed for pelvic pain or abnormal uterine bleeding (in other words, hysterectomies for cancer and uterine prolapse were excluded from the data set) in the UK in a three-year period. In 26 of those cases, adenomyosis was identified post-surgery via tissue analysis.

The medical histories in these 26 cases were then examined more closely. The majority of the women had sought medical attention for menorraghia (excessive menstrual bleeding) and dysmenorrhea (painful periods). Eleven of the women’s uteruses were enlarged, and 16 underwent pelvic ultrasound exams. But adenomyosis was suspected clinically in only one case; the others were identified as uterine fibroids (five cases) or “dysfunctional uterine bleeding” (20 cases).

Examination of patients’ case histories found that the medical consultations focused on menstrual flow. The researchers found that other symptoms of adenomyosis, such as pelvic pain, pain during intercourse, painful periods, and feelings of pelvic pressure, were not adequately addressed – even when examination or ultrasound findings indicated an enlarged uterus.

Basak and Saha ask,

Does failure of preoperative suspicion of adenomyosis matter? In the absence of an accurate diagnosis, appropriate treatment is unlikely to be offered, or may be delayed. This results in failure of treatment and continued suffering.

To identify adenomyosis earlier, they recommend more careful discussion with patients of pelvic symptoms, MRI, and follow-up care with women who elect for conservative management of their symptoms. Once again, open communication about all aspects of menstruation isn’t about challenging taboos just for the sake of challenge; it’s critical for women’s health and well-being.

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Because Health Care Reform Is A Women’s Issue

October 22nd, 2009 by Elizabeth Kissling

A Woman Is Not A Pre-Existing ConditionOur readers outside the U.S. may want to just skip over this post.

I’ve been watching what passes for debate over health care reform in the U.S. for months now, and it’s making me increasingly cranky. I suppose I’ve known for years that political decision making is heavily influenced by lobbyists and other financial interests, but it has never been so crystal clear to me as it has been this summer as I’ve watched so-called progressive and democratic congress members fight against doing what’s right. Americans need health care reform, and especially American women need it. Not only do women have distinct health care needs, women are more likely than men to require health care their whole lives, including care related to reproductive and menstrual concerns. That is not “extra”.  As Sen. Debbie Stabenow (D-Michigan) forcefully reminded Sen. John Kyl (R-Arizona), the sad fact that 60% of insurance plans don’t cover basic maternity is relevant to everyone.

Furthermore, women are frequently decision-makers regarding health care for their whole family, especially in woman-headed single-parent families (which are approximately 23% of all families in the U.S.). According to the Department of Labor, women make approximately 80% of all family health care decisions. Women are also more prone to certain chronic conditions, and on average, use more prescription drugs than men.

Yet in most of this country, insurers are allowed to set premium rates that take sex into account: these “gender ratings” mean that women (and businesses with predominantly female workforces), are often charged more than men for the exact same coverage. Sometimes the gender penalty is as much as 140% more. In a few states, a woman can be legally denied health insurance if she has been a victim of intimate partner violence; it’s a pre-existing condition. Now reports are emerging that women who have been sexually assaulted are denied insurance coverage for rape exams and medication and therapy for trauma.

And you don’t want to get me started on affordability issues; I’ve witnessed the struggle to keep health insurance first-hand in my own family, helping my parents pay for their coverage as their rates were jacked up each year. Rather than just rant about the insurance industry and the state of health care in the U.S., I’m going to leave you with these links to recommended reading:

Sharon Lerner, The Nation, Why Women Need Healthcare Reform

Nancy Folbre, economics professor at M.I.T.: Health Care Reform is a woman’s issue

Michelle Chen, Air America, Being A Woman Is A Pre-Existing Condition: Domestic Violence and Health Care

Ezra Klein, Washington Post, You Have No Idea What Health Costs

Matt Tiabbi, Rolling Stone, Sick and Wrong (Tiabbi’s trenchant analysis is one of the best pieces I’ve read about the need for health care reform in the U.S.):

Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.

The National Women’s Legal Center has several excellent articles about health care, health care reform, and women’s needs (NWLC reports are the sources for much of the data I cite above), including this brief intro (.pdf) and this longer statement (.pdf). Visit their Reform Matters site for more.

You can also visit their educational campaign site, complete with easy links for emailing your representatives in Congress. Because being a woman is not a pre-existing condition.

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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.