Blog of the Society for Menstrual Cycle Research

Hormone Therapy and the Brain

November 24th, 2010 by Elizabeth Kissling

Medical-Anatomical-Superior-half-of-diseased-brainSo there’s a surge today in news stories about how hormone treatment for menopause (popularly known as ‘hormone replacement therapy’ or HRT) benefits the brain, apparently based on publicity over this study published in Hormones and Behavior. In media interviews, the researchers suggest that HT enhances the communication between left and right sides of the brain, making the older women’s brains more similar to those of younger women. The researchers had the women perform tasks designed to demonstrate fine motor coordination, such as tapping buttons with different fingers. Of the 62 women in the study, the 36 on hormone treatments showed higher levels of motor coordination, leading the researchers to conclude that hormone treatments, especially estrogen, “exert positive effects on the motor system thereby counteracting an age-related reorganization.”

Admittedly, I have not read the entire study, just the abstract and press summaries, but would you consider me too cynical if I suggested that the publicity this research report is receiving is more about promoting the use the hormones among menopausal women than the significance of the research findings?

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Menstruation Can Lead to Shopping Sprees

October 27th, 2010 by Elizabeth Kissling

Guest Post by Kitty Holman

Yves Saint Laurent Satin Peep-Toe Shoes

Yves Saint Laurent Satin Peep-Toe Shoes

Make no mistake, there are some women who absolutely love to shop. And why not? Shopping has long been described as being a therapeutic activity because it has the uncanny ability to lift the spirit. After all, bringing home a new pair of sassy shoes can do wonders for a foul mood. But shopping can also be a detrimental hobby for women who are carefully monitoring their funds. This is especially true during the week right before menstruation. New research by Karen J. Pine and Ben C. Fletcher at the University of Hertfordshrine’s School of Psychology has shown that women tend to spend more money when they are later into their menstruation cycle than during any other time of the month. Their paper, “Women’s spending behaviour is menstrual-cycle sensitive,” appears in the January, 2011, issue of Personality and Individual Differences.

Menstruation affects women in an almost primal way. At peak ovulation, which is when the female body is the most fertile and therefore the most likely to become pregnant, women may find themselves unconsciously adapting their behavior to attract men, or potential mates. Many women change their dress style during this time in an effort to impress potential partners, which has been dubbed the “ornamentation effect,” according to researchers . The ornamentation effect typically occurs a week before menstruation, coinciding with Pine and Fletcher’s findings that women tend to make more indulgent and reckless expenditures during this time than any other time of the month. The research suggests that the two are connected, as women may make more self-indulgent purchases, typically of clothing or other “preening” items, because they are unconsciously driven to adapt their physical appearance to attract a mate. In fact, the researchers surveyed 443 women, all menstruating and between the ages of 18 and 50, and found that 48 percent of the women who admitted to impulsive and excessive spending did so when they were premenstrual, as opposed to the 34 percent who were menstrual or post-menstrual and the mere 18 percent who were in mid-cycle.

Another factor driving women to overspend a week before menstruation can be attributed to hormones. Immediately before menstruation, the female body is barraged with different signals in addition to the desire to attract a potential partner. Hormonal triggers can bring on mood swings and other irritability symptoms associated with premenstrual syndrome, also known as PMS. These symptoms and the stress that they bring on can dampen a woman’s capacity for self-control, which can further explain why women tend to spend more during the luteal phase, the only time during the menstrual cycle when PMS occurs. If the unawareness of self-control is not one of the driving causes behind overspending during the luteal phase, then it is likely that justification is. Women may feel that they deserve to spend more during this time of the month as they are generally feeling uncomfortable and irritable, even if they understand that the expenditure is extravagant.

Whether excessive spending is caused by an unconscious need to preen, a lack of self-control in the face of PMS-related stress, or a simple license to indulge in shopping caused by luteal phase anxiety, otherwise money-smart women can find themselves more susceptible to making impulse purchases the later they are into their menstrual cycle. Those who wish to watch their spending and protect their funds from reckless behavior can simply avoid the mall during that particular time of the month.

This guest post is contributed by Kitty Holman, who writes on the topics of nursing schools.  She welcomes your comments at her email address kitty.holman20@gmail.com  Continue reading...

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Posted in Menstruation, New Research | 3 Comments »

And the Bad News about Hormone Therapies Continues to Accumulate…

October 21st, 2010 by Heather Dillaway

Yes, the hormone therapies prescribed for women in perimenopause and beyond have already been suspect. Especially after the initial Women’s Health Initiative (WHI) trial results in 2002 (but even before that), researchers documented the health risks associated with the use of hormones during menopause, especially combination hormone therapies (therapies including estrogen plus progesterone, such as Prempro). SMCR’s Jerilynn Prior has done plenty of work on this as has SMCR’s Paula Derry, and WHI researchers and spokespeople have had to come out about many of the health risks as well. Now, this week, we find out that not only is there an increased risk of breast cancer for women who use these hormone therapies but that, according to a New York Times article published on Tuesday, “Women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.” According to this New York Times article, this report is the first to reveal WHI death rates.

After the dust settled from the original WHI reports about the risks of hormone therapies, researchers and doctors often made claims that it was still okay for women to be on hormone therapies for an extended period of time. Instances of death (instead of just disease/illness) are now causing some researchers and doctors to come forward and say that it is no longer safe for women to be on hormone therapies for this amount of time. Dr. Chleblowski, an author of the latest study about women’s mortality, is quoted in the New York Times article as saying that women should not stay on Prempro for more than a year or two.

Bottom line, these drugs are dangerous for women. The older we get, the more we realize that illness, disease, and death are a normal part of life. I find myself realizing this more and more each day as I watch people around me get sick, die, or have to deal with the loss of loved ones. But illness, disease, and death caused by prescriptions and indirectly by doctor’s care (what is often termed iatrogenic illness or death) is just not okay – especially when more caution could be used. Sure, it’s happened all throughout history. Plenty of people died so we could have Aspirin, Viagra, epidurals, Coumadin, birth control pills, safe abortions, hysterectomies, and pacemakers, just to name a few.  But, as a doctor quoted in the New York Times article says, “The fallback is that doctors and patients should be deciding this on a one-to-one basis, weighing risks and benefits,” [but] “How do you do that when you don’t know what the risks are?”

We know that doctors are left in a precarious position, as are female patients, as they contemplate the use of hormone therapies….but what these articles and reports aren’t saying outright is that it is probably better NOT to use these drugs unless we absolutely have to. I was listening to Detroit’s NPR station driving home from work yesterday and heard even Dr. Susan Hendrix, a Detroit-based WHI researcher and doctor say, “maybe we can now just laugh at hot flashes,” instead of rely on combination hormone therapies to help us. At least that’s what she was inferring. We don’t completely understand all of the risks of combination hormone therapies but we know they include possible cancer and death, and delayed diagnosis of cancer as well (which means further death).  Since yesterday was “Love Your Body Day,” I think perhaps we need to love our bodies more by remembering that some of the signs and symptoms we experience (such as hot flashes and irregular bleeding in menopause, no matter how hard to deal with) are not life-threatening, are completely normal, and can be dealt with without drugs — because the alternative is not so benign. Why should women continue to worry about whether they’ll die by Prempro? It seems WHI results are beginning to get even clearer, and I’ll be interested to see whether rates of prescription decrease after this last report. I also wonder what the makers of Hot Flash Havoc might think of this.  Continue reading...

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My Cycle Made Me Do It

October 19th, 2010 by Elizabeth Kissling

g2241hormonesThis morning, ladymag The Stir posted an article titled, “5 Weird Things Our Menstrual Cycles Make Us Do”. Over the weekend, science site Live Science featured an article about the recent surge in ovulation-related research (with the unfortunate title, “Booty Call: How to Spot a Fertile Woman”). As a quick perusal of re:Cycling archives will reveal, these are only the most recent mass media reports of research on how ovulation and female hormones purportedly determine women’s behavior. Recent research has linked hormones and/or ovulation to women’s preferences for masculine faces, why there are so few women sushi chefs, fluctuating cholesterol levels, chocolate cravings, and competitive bidding in online auctions.

I find myself increasingly weary of such stories, especially when they’re uncritically accepted and advanced.  I’m not so naïve as to argue that there aren’t any biological differences between women and men,* but in isolation, hormones explain very little about human behavior. Ovulation is part of a complex endocrine system, which is part of an even more complex body, which exists in a social world with complicated, byzantine, ever-evolving norms, rules, and consequences for our choices. Why are overly simple explanations so popular? Is the current embrace of biological determinism a marker of a new backlash?


*I will argue, however, that most of those differences aren’t as important as they’ve been made out to be.


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Ghostwritten articles funded by Wyeth overstated benefits and downplayed harms

September 8th, 2010 by Chris Hitchcock

An open-access article published in PLOS Medicine yesterday, Dr. Adriane Fugh-Berman, associate professor in the Department of Physiology at Georgetown University Medical Center in Washington DC, presents an article describing the ways in which the pharmaceutical industry used a medical education & communication company to produce ghostwritten articles that inserted marketing messages into articles published in medical journals.

This article is the first academic analysis of the 1500 documents unsealed in recent litigation against the pharmaceutical giant Wyeth (now part of Pfizer). It reveals the ways in which pharmaceutical companies use ghostwriters to insert marketing messages into articles published in medical journals. Dr. Adriane Fugh-Berman, associate professor in the Department of Physiology at Georgetown University Medical Center in Washington DC, analyzed dozens of ghostwritten reviews and commentaries published in medical journals and journal supplements that were used to promote unproven benefits and downplay harms of Prempro—a brand of menopausal hormone therapy (HT)—and to cast competing therapies in a negative light. These articles were widely circulated to drug reps and doctors to disseminate the company’s marketing messages. The analysis appears in this week’s PLoS Medicine.

Wyeth used a medical education & communication company, DesignWrite, to produce ghostwritten articles in order to mitigate the perceived risks of breast cancer associated with HT, to defend the unsupported cardiovascular ‘‘benefits’’ of HT, and to promote off-label, unproven uses of HT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles, writes Fugh-Berman.

The analysis revealed that DesignWrite was paid US$25,000 to ghostwrite articles reporting clinical trials, including four manuscripts on the HOPE trials of low-dose Prempro. DesignWrite was also assigned to write 20 review articles about the drug, for which they were paid US$20,000 each.

The analysis concludes that “Given the growing evidence that ghostwriting has been used to promote HT and other highly promoted drugs, the medical profession must take steps to ensure that prescribers renounce participation in ghostwriting, and to ensure that unscrupulous relationships between industry and academia are avoided rather than courted.”

In July 2009, PLoS Medicine, represented by the public interest law firm Public Justice, and The New York Times acted as intervenors in litigation against menopausal hormone manufacturers by 14,000 plaintiffs whose claims related to the development of breast cancer while taking the hormone therapy Prempro (conjugated equine estrogens). This resulted in a US federal court decision to release approximately 1500 documents to the public. The Wyeth Ghostwriting Archive is available at http://www.plosmedicine.org/static/ghostwriting.action or through the UCSF Drug Information Document Archive at http://dida.library.ucsf.edu/documents.jsp

Funding: The author received no specific funding for this article.

Competing Interests: Dr. Fugh-Berman was a paid expert witness on behalf of plaintiffs in the litigation referred to in this paper. She was not paid for any part of researching or writing this paper. Dr. Fugh-Berman directs PharmedOut, a Georgetown University-based project founded with public money from the Attorney General Consumer and Prescriber Grant program and currently supported by individual donations.

Citation: Fugh-Berman AJ (2010) The Haunting of Medical Journals: How Ghostwriting Sold ‘‘HRT’’. PLoS Med 7(9): e1000335. doi:10.1371/journal.pmed.1000335

(This blog largely lifted from the article press-release).

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Hold the Eggs When Ovulating

August 11th, 2010 by Elizabeth Kissling

Fascinating new research from the National Institutes of Health finds that women’s cholesterol levels correspond with cyclic changes in estrogen levels. Total cholesterol levels can vary by as much as 19% over the course of the cycle.

The researchers found that as the level of estrogen rises, high-density lipoprotein (HDL) cholesterol also rises, peaking at the time of ovulation.

In a typical cycle, estrogen levels steadily increase as the egg cell matures, peaking just before ovulation. Previous studies have shown that taking formulations which contain estrogen — oral contraceptives or menopausal hormone therapy — can affect cholesterol levels. However, the results of studies examining the effects of naturally occurring hormone levels on cholesterol have not been conclusive. According to the NIH’s National Heart, Lung and Blood Institute, high blood cholesterol levels raise the risk for heart disease.

. . . .


In contrast, total cholesterol and low-density lipoprotein (LDL) cholesterol levels — as well as another form of blood fat known as triglycerides — declined as estrogen levels rose. The decline was not immediate, beginning a couple of days after the estrogen peak at ovulation.

These findings provide another reason for girls and women to learn to track their cycles, so their blood tests can be interpreted more precisely.

It also gives more weight to the frequent assertion of members of the Society for Menstrual Cycle Research that menstruation matters — and is worthy of our study — in part because it is not an event isolated in the uterus and vagina, but a complex part of the endocrine system that has effects on health and well-being throughout a woman’s body.

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Hot Flash—Progesterone is an Effective Alternative to Estrogen

July 19th, 2010 by Elizabeth Kissling

Guest post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

hot flash hellIt’s been two weeks since Chris Hitchcock and I returned from San Diego’s recent Endocrine Society meetings. We are feeling incredibly happy with the success of our protracted, intense commitments to a controlled trial of oral micronized progesterone (marketed in the USA and Canada as Prometrium®) for night sweats and hot flushes/flashes. At the Endocrine Society we presented the first-ever trial showing that the molecularly identical progesterone by mouth is effective treatment for vasomotor symptoms (VMS = hot flushes/flashes and night sweats)(1). We were also invited to present our data at an Endocrine Society-sponsored press conference.

Why did a scientific study require so much from us? First, this trial started in 2003 as the initial scientific venture of the newly founded Centre for Menstrual Cycle and Ovulation Research–thus CeMCOR’s reputation became tied to this trial. Second, despite concerted efforts, we were never able to obtain peer reviewed funding for this study—we successfully supported it with individual private donations. Finally, because of the “estrogen myth” and its corollary negatives about progesterone, I wanted to gain additional accurate information about how Prometrium® works in women’s cardiovascular system from this same study. For that reason we decided to enroll only very healthy women who were within 1-10 years since their final flow—they had to be non-smokers, without obesity, diabetes, or high blood pressure, and further to have normal measured waist circumference, blood pressure, cholesterol, and fasting blood sugar levels. Therefore many women were interested but few were eligible.

Late last fall when we broke to code on this study, we were ecstatic to discover that our trial was highly successful. After only three months’ therapy with Prometrium® (300 mg at bedtime daily) the 127 (of 133 randomized) women’s vasomotor symptoms score (VMS Score, combination of number of flushes times their intensity during the day and during sleep) was decreased by about 60% on progesterone compared to less than 30% decrease on placebo.

In early June we learned the answer to another important question: Does progesterone effectively treat intense VMS? The answer is yes! Although less than half all the treatment-seeking women in our study met the FDA’s criteria for more than 50 moderate-intense VMS/week, the 30 women who did who were randomized to Prometrium® showed significantly more improvement in hot flushes than did women on placebo.

What were the reactions to this news? Some local doctors said they already knew that progesterone was good for VMS! Others people were curious, or skeptical but many realized the importance of providing women with an effective alternative to estrogen for VMS. Other reactions were predictable—many questions about whether this couldn’t really be explained, somehow, by estrogen (Prometrium® is converted into estrogen—not!). And there were several questions about side effects and alleged serious health risks from progesterone (wrongly attributed because of confusion of progesterone with synthetic progestins). Happily I was able to respond that participants had no serious negative effects—more placebo-treated than Prometrium®-treated women dropped out before completion. And it is likely that in estrogen-treated women progesterone decreases breast cancer risk rather than increasing it as medroxyprogesterone does (2). Because of Prometrium®’s significant sleep benefit (3), some women who entered the trial sleep-deprived experienced short-lived morning drowsiness. But the estrogen myth-related mood, bloating, weight gain, migraine headaches, and breast tenderness did not occur.

An epic journey for me, Chris, and CeMCOR ends in triumph. Now that the dust has settled, I am so grateful that CeMCOR’s many researchers over the last six years dedicated themselves to a world class trial, that local donors made the trial possible, and that the Prometrium® and placebo were provided by Schering Canada (for the first two years) and subsequently by the world-wide manufacturer, Besins Healthcare of Belgium.  Continue reading...

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Latest News on Hormone Therapy

June 23rd, 2010 by Elizabeth Kissling
Wellcome Library, London // CC 2.0

Wellcome Library, London // CC 2.0

The Endocrine Society has released a new, peer-reviewed statement on the risks and benefits of hormone therapy for menopausal women. The upshot is that risks and benefits vary depending on the age of the patient and the length of time since menopause:

One interesting finding . . . was that women who start hormone therapy within 10 years of menopause have a 30% to 40% reduction in total mortality.

In addition, in the 50 to 55 age group the task force concluded that hormone therapy reduced hot flashes and overactive bladder and that vaginal estrogen reduced recurrent urinary tract infections. The evidence also showed that hormone therapy reduced pain on intercourse and improved quality of life.

Given that there are thousands of lawsuits pending over the role of HT in breast cancer, I was especially interested in this nugget of new information:

“Our conclusion is that [the estrogen/progestin hormone combination] didn’t cause breast cancer — it caused preexisting tumors to grow to a size where they became detectable.”


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Early Menarche: A New Theory

June 13th, 2010 by Elizabeth Kissling
Photo by Splorp // CC 2.0

Photo by Splorp // CC 2.0

It’s well-documented that girls today reach menarche earlier than previous generations. A century ago, it was common to experience one’s first period at 16 or 17; today, that’s regarded as so late that medical examinations are often conducted to reassure parents and girls that their development is normal. The typical North American girl sees her first period at age 12, give or take a few months.

Many explanations have been posited for this phenomenon; personally, I’ve long suspected that a primary cause is endocrine disruptors that are the hormones used in raising beef and dairy cattle as well as chicken in this country. Also, girls today typically achieve the minimal body fat necessary to menstruate at younger ages, due to improved health and nutrition. Now a new study suggests that it is not merely consumption of meat that lowers the age of menarche, but the high content of zinc and iron in a meat-rich diet.

Oddly, the lead researcher is quoted in the news story as saying, “These results add to the evidence that it is healthiest to avoid diets containing very high amounts of meat,” but also that there is no need for young girls to cut their meat intake. (I haven’t yet been able to locate a copy of the actual study.)


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Are you ready?

May 29th, 2010 by Elizabeth Kissling

EvoPsych BINGOReady to play Evo-Psych bingo, that is. I don’t know quite what else to do with a study like this: Women’s preferences for masculinity in male faces are highest during reproductive age range and lower around puberty and post-menopause.

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Pill Protests – It’s About the Environment

May 25th, 2010 by Elizabeth Kissling
Empty birth control pill packet in the street

Photo by Gnarls Monkey // CC by 2.0

A whole bunch of anti-choice political organizations are co-sponsoring a national protest against birth control pills, but they say it’s not about killing babies or controlling women; it’s all about the environment!

The following is released by the American Life League and the following groups:

WHO: American Life League , Human Life International, Pro-Life Wisconsin, Pharmacists for Life International, Archdiocese of Mobile Respect Life, Operation Rescue, Jill Stanek, Generation Life/Brandi Swindell, Life Education Ministry, Pro-Life Unity, Movement for a Better America, AMEN (Abortion Must End Now), Pro-Life Action of Oregon, Children of God for Life, Expectant Mother Care/Chris Slattery, Mother and Unborn Baby Care, Defenders of the Unborn, California Right to Life Education Fund, Delaware Pro-Life Coalition, Life Guard, Homeschoolers for Life, Focus Pregnancy Center, Central Texas Voices for Life and Dubuque County Right to Life

WHAT: Protest the Pill Day 2010: The Pill Kills the Environment

This year, birth control advocates are celebrating 50 years of decriminalized hormonal contraceptives. American Life League and our co-sponsors don’t think half a century of contaminating our waterways is something to celebrate. Study after study has shown that hormonal estrogen in the water has severely damaged the ecosystem and our health.

Join American Life League and co-sponsors as they launch the largest nationwide protest against the birth control pill.

You know what, American Life League? ALL prescription drugs, not just birth control pills, contaminate our waterways, both through human excretion and production waste. And some of that “hormonal estrogen” is from the hormone supplements taken by middle-aged women. Are you protesting hormone “replacement” therapy, too?

[via Miriam at Feministing]

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Posted in Activism, Birth Control, Pharmaceutical, politics | 3 Comments »

Ultrasound Man:Birth Control Superhero

May 17th, 2010 by Laura Wershler

superheroYou know how most superheros become superheros because of exposure to some weird, intensified chemical or element? Take Peter Parker’s spider bite for example.

According to a story reported in various media, including International Planned Parenthood Federation’s website, if science can perfect the contraceptive effect of ultasound on men’s testicles, then we may be in for a new breed of superhero.  Ultrasound Man: able to bear the burden of pregnancy prevention for women everywhere. 

I joke, but for decades women have yearned for gender equality when it comes to bearing the burden of birth control. Could the promise of six months of ultrasound induced, reversible infertility in men be the answer? Well, to date, we only know it works in rats. There is a long way to go before we send the men for a bi-annual ultrasound “zap test”.

This isn’t the first male method touted over the last decade. In 2003, news out of the UK about a birth control pill for men had women nodding their heads with approval. I was immediately dubious and dashed off a commentary for the Calgary Herald that began thus:

Memo to Big Pharma: Save your money. If you think the male birth control pill is going to be a big seller, think again. Memo to women everywhere: Curb your enthusiasm. If you think it’s time men took more responsibility, you’re right — but the Pill for Bill is not going to be it.

Because of the complex hormonal action of the pill for men, I knew it wouldn’t fly. As I noted in my piece:

According to a story from the London Telegraph, because the treatment is invasive, it is likely to be used only by men in long-term relationships. Read it and weep, gals, because this is the wicked truth. It’s OK for women of any age or relationship status to ingest birth control pills or receive the Depo-Provera injection that completely shuts down their reproductive systems, but men would never do the same. It is already postulated that only men in committed relationships are likely to submit to invasive hormonal contraception. That would be supportive husbands and partners of the best kind.

Although a recent  survey by the Family Planning Association found that one third of men would definitely use a birth control pill for men if it became available, I doubt very much, once the mechanism of action were explained (full disclosure), that there would be many takers. I suspect the side effects, and concerns about synthetic testosterone, would result in a pathetic compliance rate.

Certainly the ultrasound method sounds much less invasive. Research leader James Tsuruta of the University of North Carolina said: “We think this could provide men with reliable, low-cost, non-hormonal contraception from a single round of treatment.

Happily, “the team plans to investigate the mechanism that causes temporary infertility.” I think the guys would want to know how and why it works before signing up.  But they can rest assured because Dr. Tsuruta also said: “Establishing safety, efficacy and reversability: these are our top concerns.”

As media stories proliferate documenting the growing trend among young women to eschew the Pill (et. al) in favour of non-hormonal methods, news that there may be a safe, simple method for men on the horizon is both welcome and long overdue.

What I find hard to take, however, is this suggestion expressed by Allan Pacey from the University of Sheffield:

There is certainly a place for an effective non-hormonal contraceptive in men, but whether men would find it acceptable to have their testicles scanned regularly remains to be seen.  Continue reading...

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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.