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It’s My Period and I’ll Have a Party If I Want To
April 6th, 2012 by Elizabeth KisslingUnderstanding Research: Buyer Beware
April 2nd, 2012 by Paula Derry
xkcd.com // CC 2.5
I certainly believe that scientific research is important. Research uncovers new knowledge and prunes away facts that are not accurate. However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications. If a scientific result can be invoked, we can believe that something is true. Is there an unconscious? Freud said so, but he’s out of date. Are we intrinsically social beings? Evolutionary theorists argue. Does meditation really result in an altered state of consciousness? If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.
What’s wrong with this? Isn’t this science doing its job of uncovering truth? There are two things wrong with this. One is that not all knowledge is scientific knowledge. The second is that scientific results are often portrayed inaccurately in our society.
With regard to the first point, I’ll just give a few examples. von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow. Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.
But what I really want to talk about here is the second point. We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means. However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context. When I was a graduate student in psychology, every class included practice in critiquing research.
To understand research, certain mathematical ideas are important. “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why? That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased. Why? Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.
Fog Warning Ahead
March 29th, 2012 by Heather Dillaway
As I embark on my 40th year I look ahead to menopause. I guess there is a good chance I’m approaching some foggy years. Brain fog, that is.
In the past week a flurry of online news articles review new research findings on the “brain fog” that many perimenopausal women experience. The brain fog is more easily understood as a slight memory problem, if you take the time to read through the various news stories. A new study analyzed how 75 individual women, aged 40 to 60, rated their memory performance based on factors like how often they forgot details and how serious their forgetfulness was. Researchers also gathered information about the women’s overall health, mood and hormone levels, as well as other menopausal symptoms, and tried to figure out the extent to which this “brain fog” exists. According to news reports, about 41 percent of the women in the study reported having forgetfulness that was “serious,” and those who felt that their memory problems were serious were more likely to score poorly on tests of working memory and attention. Some women who rated their memory problems as serious also reported some depression and other symptoms like hot flashes and sleeping problems. Other researchers suggest that the memory problems women experience are related to changing levels of estrogen in a woman’s body at menopause, but interestingly this new study did not find links to changing hormone levels.
The whole notion of “brain fog” is interesting, and I am suspicious of it as a strictly menopausal symptom. What about the brain fog we all experience when we’re tired or sick or just way too busy? Defining brain fog as a “menopausal” (really, perimenopausal) symptom further defines middle-aged women as somehow less than functional and set them up to be taken less seriously.
Putting this issue aside, though, what I actually find most interesting about all of the news coverage of this study is just how different each report of the study is. I am reminded that we should all be careful of which report we read about a study. For example, the first article I read on this study was placed in the Los Angeles Times and focused on the possible connections between menopausal brain fog, depression, and dementia. I was left feeling like the author of the article inferred that all menopausal women might have depression or dementia and that they should seek treatment. After reading this article I was angry because I felt as if I had been warned that midlife brain fog was the beginning of an inevitable decline for all women. Then I read a WedMD piece that simply described the study and did not concentrate on depression, dementia, or the need for treatment, and I wasn’t really sure what to make of the research study. Finally I read an article by a HealthDay reporter which quoted one of our own, SMCR member Nancy Wood, who reminds readers that “a number of other stressors in life, from work to taking care of children and parents, that pile up around the same time as menopause can hinder memory and ability to concentrate.” In addition, this article’s author states that “memory problems are not necessarily an early sign of dementia” and cognitive ability is regained after other perimenopausal symptoms subside. This third article concluded that the research study is helpful because findings suggest that brain fog is real – that women aren’t crazy – but that it is normal and not that detrimental to women’s long-term cognitive abilities.
What’s missing from Mother Jones’ birth control calculator?
February 22nd, 2012 by Elizabeth Kissling
Source: Public Domain
In response to Rick Santorum’s recent assertion that birth control only costs “a few dollars” and therefore there shouldn’t be such a big fuss about denying insurance coverage, Mother Jones published a birth control calculator this week that estimates your lifetime costs for birth control, based on your current age. The calculator asks you to enter your age and then select your preferred method. Options include the pill, IUDs, Implanon, injections, the patch, the vaginal ring, and surgical sterilization. (It doesn’t specify sterilization for women or for men, but given the context of the current debates, I’m assuming the calculator estimates only the cost of female sterilization.) It also fails to take into account that, in reality, most women use more than one method throughout their reproductive years.
Now, I know that aside from the cost of reference books, charting supplies, and perhaps a course or two to get started, using Fertility Awareness Methods is free, but condoms and spermicide aren’t. And as NPR reported on Tuesday, it can be difficult or inconvenient to get those methods covered by health insurance. Diaphragms and cervical caps aren’t cheap either, and they both require physician visits to be properly fitted. Diaphragms last a long time, but they do need to be replaced every few years. It’s been a while since I needed one, but I’m pretty sure that my health insurance covered the cost of my diaphragm, although I had to pay out-of-pocket for the accompanying spermicide gel. In my student days, I got both at my school’s Student Health Center, covered by the student health insurance fees that we were required to pay whether we used the student health center or remained on parental insurance.
I’ve written before about my bewilderment at the diaphragm’s disappearance, but I’m increasingly frustrated that the current political debates about the pill are contributing to the apparent erasure of all non-hormonal methods of birth control. The pill has become synonymous with birth control in some quarters, without consideration of the profound implications of that swap for women’s health.
I am not opposed to the pill, by the way. I want it to be available, I think it should be covered by health insurance, and I want it to be safe. But I also want women to have complete, accurate, accessible information about all of their birth control options. And let’s get all of them covered by health insurance.
On Menopause Definitions
December 28th, 2011 by Paula DerryGuest Post by Paula S. Derry, Ph.D.
In a recent blog post, Heather Dillaway commented on the uncertainty, confusion, and frustration she felt as a menopause researcher, given the lack of consensus about the most basic aspects of the menopause transition. Researchers don’t agree about their definitions, and can’t even agree on what needs to be defined. She asked for reactions to her entry; I’ve found that my reaction has grown into this separate post.
Fire in the Head by Beate Knappe // CC 2.0
I, unlike Heather, am not a sociologist. I’m a health psychologist. My training and current work include analyzing, critiquing, and making sense of experimental research and theories. I have also developed workshops for community women and for professionals whose aim is to provide health-promoting information and decision-making heuristics. I have given a lot of thought to the issues that Heather raises, and this is as far as I’ve gotten with them.
To me, there are many layers of issues involved. The first is the fact that the science — about the physiology of menopause and the processes leading up to it — is limited and incomplete. Part of the reason that professionals disagree about whether the life course of menstruation has five stages or seven, or why women have hot flashes, or even why women have a menopause, is that we don’t actually know. We simply do not have the scientific facts. We don’t understand what the underlying process is or how it works. Given this uncertainty, professionals must make judgments about how to define terms and what their hypotheses (or best guesses) are about underlying processes. A second fact, along with our limited real knowledge, is the tenacity with which professionals assert their judgments and argue against competing views. People disagree and they hold strongly to their positions—about language and the facts. To me, it makes sense to have definitions of stages of menstrual life that are objective and easily measurable (like the STRAW staging system) for researchers who need to compare results with each other. It doesn’t make sense to assert that this system, based on expert opinion and not on experimental facts, actually defines when a particular stage really “begins.” It makes sense to say that experimental research supports the idea that changes in the thermoregulatory center of the hypothalamus are important processes if you’re trying to understand hot flashes. It does not make sense to conclude that these brain changes in themselves explain hot flashes; other factors must also be involved.
I think another source of confusion is that menopause is not one thing, but many. It is a circumscribed biological change (lack of periods and what leads up to them physiologically) and also a psychosociocultural matter. We have a term for when girls begin to menstruate (menarche), a separate term for the larger biological changes of which menarche is a part (puberty), and another term for the biopsychosociocultural changes of which puberty is a part (adolescence). I think these kinds of distinctions are confused with regard to understanding menopause in part because there is cultural confusion about midlife (or mature adulthood or whatever term you use) as a life stage. There is no cultural consensus about this stage of life. And, indeed, this isn’t surprising. Some women are planning retirement while others are training for a new job or career. Some are grandmothers while others are raising a young child. My opinion, also, is that we as a culture have a paucity of concepts of mature, responsible adulthood and what it means.
How do YOU define reproductive health?
December 8th, 2011 by Heather Dillaway
By Justine Siegemundin, 1723. Public Domain, via Wikimedia Commons.
Menstruation and menopause are reproductive health experiences, aren’t they? At least that’s what I think. But I’m starting to wonder how many people agree. I’ve been thinking a lot lately about how people define the things they experience and how researchers define the things they research. The last blog entry I wrote was on the confusing and frustrating definitions of the menopause transition. Today I thought I’d zoom out a bit more and think about what “reproduction” and/or “reproductive health” means. I personally think of reproductive health as encompassing a woman’s entire life course and including a whole range of experiences (and the pursuit and achievement of individual wellbeing throughout all of these experiences) but I don’t know if others do. For instance, about two weeks ago I was on the phone with a potential coauthor, and she and I had a misunderstanding because I was talking about “reproductive health” as including prevention of HIV and other STDs and she was thinking of “reproductive health” as just about conception, pregnancy, and birth. I’ve been studying what I think of as women’s normal reproductive processes and experiences (e.g., menopause, menstruation, pregnancy, childbirth, and breastfeeding) for a long time, so I thought I would use this blog entry to tell readers what I think about “reproductive health” and see if anyone agrees with me.
Adrienne Rich, in her 1986 edition of Of Woman Born, proposes that biological reproduction has been defined narrowly by most people (feminist or otherwise). Thus, for many, “reproduction” is equated with just two female processes: pregnancy and childbirth. While it may not have been the goal of any one person to define reproduction so narrowly, this seems to be a reality. At various points throughout history, conception and contraception – at times, even abortion – have been added to the definition of what “reproduction” meant, or what “reproductive rights” women were owed, but “reproduction” and “reproductive health” still refers to a very short list of experiences.
I believe we should acknowledge, however, that women’s “reproductive” experiences include more than just conception, contraception, pregnancy, and birth. Reproduction includes an entire range of reproductive experiences, including: menstruation and menopause, use of and problems with contraceptives, choosing whether to become a mother/father, breastfeeding, HIV and other sexually-transmitted diseases/infections, prostate and breast cancer, awareness of and access to reproductive health care, protection against sterilization abuse, vasectomy and hysterectomy experiences, the rights of single and/or lesbian mothers, the rights of single and/or gay fathers, donor insemination, cloning and other new advancements in reproductive technology, adoption, infertility treatments and experiences, gynecological practices, alternative reproductive health movements, decisions over whether to engage in heterosexual intercourse, and making informed “choices” in any of these instances. This is just a partial list, and I could go on and on. I propose that we think of “reproduction” (and, by default, “reproductive health” experiences) as the collection of (a) biological, physiological and/or embodied processes and (b) emotional, social, economic, and political decisions and/or actions that individuals — along with their families and other social groups — participate in (either voluntarily or sometimes through some sort of coercion), as they transition in and out of certain stages of their life course, decide whether or not to be sexually-active, and/or decide whether or not to become genetic, gestational and/or social “parents” or caregivers of children. Any one reproductive experience – for example, menstruation or menopause – can also really be a set of processes and decisions and actions that women make/take/experience/pass through over an indefinite period of time – usually not happening in just one moment. Thus, menstruation or menopause are full-fledged and complicated reproductive experiences in and of themselves, as much as pregnancy or childbirth or any other “reproductive” experiences are, that the majority of women pass through, albeit in different ways, throughout their lifetimes. So are all of the other processes and experiences I’ve named above, and more I haven’t named. “Reproductive health” would then refer to a state of physical and mental wellbeing, indeed biopsychosocial wellbeing, while experiencing any of these sets of processes or decisions or actions.
Earlier menopause with ovary-saving hysterectomy
November 22nd, 2011 by Chris HitchcockRecently Heather Dillaway blogged about the challenges and frustrations of naming, and this blog continues with that theme, looking at a recent article about increased rates of ”ovarian failure” following ovary-preserving hysterectomy.
“Ovary-saving hysterectomy linked to early menopause,” reads the USA Today on-line headline, and the article opens with the statement that:
Younger women who have a hysterectomy that spares the ovaries are almost twice as likely to go through early menopause as women who do not have their uteruses removed, according to a new study.
It’s an alarming statement, and one likely to alarm an already anxious woman. The study in question was a longitudinal study following 406 women aged 30-47 at the time of their surgery and a control group of 465 similar-aged women who did not have a hysterectomy. The study will be published in the December 2011 issue of the peer-reviewed journal Obstetrics & Gynecology, and the news coverage was drawn from the Duke University press release, entitled “Hysterectomy Increases Risk for Earlier Menopause In Younger Women”.
The first challenge of naming is in the subtle difference between the press release’s earlier menopause, and the USA today article’s early menopause. Early menopause is defined as menopause that occurs before the age of 40; the earlier menopause in the article is a difference of about 2 years — an important difference.
In women who no longer have menstrual flow, how did the authors establish menopausal status, or ”ovarian failure”, as they called it? In women with a uterus, menstrual flow is a convenient landmark, which is roughly aligned with the hormonal changes to decide when menopause (or is it post-menopause?) has begun. We assume that 12 months without menstrual flow likely means that there will be no further flow (although that is not always true), and that it is a good estimate of when ovarian hormonal cycles have stopped. In this article, the authors used an annual blood sample to measure a hormone called FSH (follicular stimulating hormone). FSH is high in menopausal women, and an FSH>40 IU/L was used as a criterion for reaching menopause. However, we have known since 1994 that a high FSH level is not diagnostic of menopause, and, indeed, 6 of the 504 women were excluded because they had a baseline FSH > 40 IU/L, despite having menstruated within the previous three months. Regularly cycling women in their 40′s can have high FSH levels, and later have low FSH levels and ovulatory cycles. In menstruating women, blood samples would also be timed, which is not possible for women who don’t menstruate. It would be interesting to know how the high FSH criterion corresponded to menstrual cycle history in the control group.
Studies like this are hard to do. The authors were careful — they enrolled women prior to surgery and followed control women in the same way. To get 403 women with complete data, they started with over 900 women. The controls were fairly well matched — similar in age, age at first period, c-section and oral contraceptive history. However, women undergoing surgery were more likely to have had at least one full-term pregnancy (84.5% vs 68.3% in controls), and more likely to have had a previous tubal ligation. In addition, fibroids, endometriosis, ovarian cysts and previous surgery for fibroids were more common in those having a hysterectomy. Both the hysterectomy itself and the history of previous surgery, particularly tubal ligation, may also contribute to a difference between the two groups. Finally, women with hysterectomy were heavier than the control group.
Feeling Uncertainty, Confusion, and Frustration about Menopause
November 10th, 2011 by Heather DillawayLast Friday I attended a conference on autoethnography and was privileged enough to listen to Carolyn Ellis give the keynote speech on this new and upcoming qualitative methodology. Sitting there and listening to Ellis talk about the need for all of us to be reflexive and put ourselves into our research projects, I realized that I probably do need to acknowledge my own feelings of uncertainty and frustration as I study menopause and midlife. Therefore, this blog entry is for you, Carolyn Ellis, as I am inspired by you to be better from now on about acknowledging the connections between me and my work and trying to understand myself as a research instrument as I seek to understand menopause and midlife better.
The reasons I really started studying menopause are the very reasons why I’m still studying it but also frustrated by it. In the mid to late 1990s, my experiences as a birth control counselor at Planned Parenthood in Delaware and Michigan led me to realize that plenty of middle-aged women don’t understand what’s happening to them when they start to have irregular periods in perimenopause. I also watched my mother begin perimenopause in the mid 1990s and be confused and embarrassed to talk about the experience when she had always been the first one who always wanted to talk about pregnancy, childbirth, breastfeeding, and birth control (“What was so confusing about menopause?,” I thought). I’ve now formally studied and written about women’s thoughts and experiences of menopause since 1999. All along, the terminology and definitions of menopause have been as problematic for me as for the women I’ve studied. I’ve listened to menopausal women who tell me that they are completely confused about biomedical terminology for their life stage and completely baffled about what they’re going through. I’ve heard them talk about how doctors and other women they talk to are just as confused as they are. What is this thing they’re going through? I’ve talked to other feminist social scientists and humanities scholars who think we should call menopause “reproductive aging” or “the menopause transition” to signify that variation over time is really the only guaranteed experience at this time of life. Endocrinologists and biologists turn around and tell me that the term “reproductive aging” is faulty because all that term signifies is that we are all maturing from birth on – that it is an empty term signifying nothing. I listen to endocrinologists, epidemiologists, public health educators, women’s health advocates, menstrual activist researchers, biologists, and clinical/biomedical researchers who are all ready with their own take on what terminology and definition is “best” for describing this time of life. Some argue that there is a strict three-phase model of perimenopause, menopause, and postmenopause that we should follow. Some argue for a five or even seven stage model for “menopause,” parsing out pre, post, early and late stages of the menstrual life course (such as early and late premenopause, early and late perimenopause, menopause, early and late postmenopause, etc.). Some argue that perimenopause is really the only “stage” of “menopause” or late reproductive life that women really want to know about because that is when all the (negative) symptoms come. I hear others argue that “menopause” and “postmenopause” are the same thing, or are that these are conflated terms that mean nothing, and that both of these terms should be scrapped. (Yet then I hear individual women I interview tell me that postmenopause is as frustrating as perimenopause.) I hear other researchers say that EVERY term associated with menopause or reproductive aging is faulty. If I listen to individual menopausal women, they tell me the same. Two months ago, I did a presentation on midlife in general, and a feminist humanities scholar (whom I respect quite a bit) told me I shouldn’t be using the term “midlife” at all, because it is a non-term itself, defined by nothing. If I think about all of the terms I associate with menopause – menopause, the climacteric, the change, the change of life, perimenopause, postmenopause, the late reproductive years, the menopause transition, women’s midlife transition, reproductive aging, etc. – I don’t even know what terms I should be using. Over time I have thought that the best case scenario is just to use the term that women themselves use (therefore I used the word “menopause” a lot to describe a whole transition, or adopted the term “reproductive aging” when urged by feminist scholars to do so in order to define a broader transition). But, now, I’ve been critiqued recently for not correcting individual women when they use the “wrong” term to describe what they’re going through.
You’re Taking WHAT Class???
October 7th, 2011 by Elizabeth KisslingGuest Post by Alexandra Epstein – Marymount Manhattan College.
how school helped me come out of the menstrual closet
Finally, the time had come where I was choosing my classes for my senior year of college. I had finished my required courses to complete my social work minor, and with only a few required courses left until I complete my psychology major, I had lots of room to choose electives! What to take though? Maybe an art class? Or what about a science class? As I scrolled though my options online, something caught my eye. “The Social Construction and Images of Menstruation”. Honestly, anything to do with the social construction of anything is good in my book, so without even thinking much about it, I registered.
Day one in class, it hit me; I was in a class completely focused on the idea of how menstruation is viewed by society. I was a bit taken aback. As a woman, I had grown up “dealing” with my period, but I had never actually thought about it, or what it meant to me as a woman. Now, I can’t stop. I can’t stop thinking about it, I can’t stop talking about it, I can’t stop reading about it. The idea of the social construction behind menstruation has not left my head since I entered that classroom on the first day of the semester.
Not only has this class opened my mind to a whole new concept, but it has made me more comfortable to openly talk about menstruation and everything that goes along with it. It wasn’t even two months ago that I was so uncomfortable with the concept of the period. I wouldn’t talk about it often with my friends, I would hide my tampons in bags within bags so no one would know that I was on my period, and I thought of my period as a burden and huge inconvenience. Within the past month I have grown to love my period. It is something I am proud to be able to experience. I have become very open with conversation regarding menstruation. I have asked all of my female friends about their first experience with their periods, and all of my male friends if they know how to use a tampon. I love the responses I get. Some people embrace the chance to talk about something we as humans don’t normally talk about. However, most people I talk to become so uncomfortable with the fact that I’m talking about such a taboo topic. They ask me why I choose this class, or why my school even offers such a rare subject to study. What they are most shocked by is the fact that my professor is a male. “A guy teaches that class? Isn’t that awkward?” “No!” I reply, “Its brilliant and insightful and I am in love with it.” Too many people are uncomfortable with this topic. I am making it my mission to take the awkwardness out of menstrual conversations.
The Pussy is Stronger
October 3rd, 2011 by Chris Bobel
A friend shared this clip from stand-up comedian and actor Hal Sparks.
He leads with this “I disagree—vehemently—with the use of the word “pussy” to describe a weak person. Because the vagina is the tougher of the two genitals…. by a long shot!”
And later…”It bleeds every month and it won’t die.”
That puzzled reaction to menstruation is as old as time, say the cultural historians of menstruation. We know now, of course, that the monthly shedding of the uterine lining is no mystery. Nor does this regular occurrence suggest that women are necessarily witches or demons or otherwise intrinsically cursed or even blessed.
But his point is a good one.
It IS important to reframe the female body as POWERFUL. As RESILIENT.
And demonstrate how our language—especially the words we use to slur and to exalt—obscures this reality.
Thanks, Hal, for a good laugh and a better think. You are a REAL pussy.
But I Thought Lightning Never Strikes Twice
August 16th, 2010 by Elizabeth Kissling
Procter & Gamble femcare ads are such an easy target. It’s shooting fish in a barrel.
Periods = lightning? Really? And the classic deictic euphemism, “it”, well, that just makes me tired.
At least there’s no blue liquid.
Visit From A Friend
August 10th, 2010 by Elizabeth KisslingGuest post by Anastacia Kurylo, Marymount Manhattan College
"Ovulation", oil on canvas by Von Taylor
It’s been four years since I had my period. I did get a visit from my ‘friend’ for six months a couple of years ago but considering that I menstruated regularly for nearly twenty years before that six months was not a long time to get reacquainted. Now I am menstruating again regularly.
Having my period again reminds me of the person I was for the twenty years before I had my children-independent, in control, free to eat and sleep when I wanted – and how that part of my life is over.
Having my period again also reminds me of the person I have become the last four years – pregnant or lactating with one of my two children either in my belly or on my breast for most of this time – and how that part of my life is over too.
I never liked or understood the euphemism of my ‘friend’ representing menstruation. I saw it as a silly way to refer to a mundane biological occurrence females should own, be proud of, and state bluntly.
Now I understand the metaphor. For twenty years, my ‘friend’ was close to me physically and emotionally. My period was a reminder of my maturity and femininity and just as often an inconvenience and annoyance. I knew her well – her tendencies, how she would behave, and how to handle her. After twenty years of being inseparable, my ‘friend’ left and was replaced by my daughter and, then, my son. At times, my children are also reminders of my maturity and femininity and are also, at times, an inconvenience and annoyance. As I have begun to get to know my children, I forgot about my ‘friend.’
Having my period again and no longer being or anticipating being pregnant or lactating marks the start of yet another part of my life. Now that my ‘friend’ is back, we have to get reacquainted –she is not the same and neither am I.
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.
