Blog of the Society for Menstrual Cycle Research

Illustrating menstruation with something other than femcare products

May 29th, 2013 by Laura Wershler

Frances, a woman in her 50s, had never talked about menstruation with anyone before attending Scarlet Summer.

The woman who created this image brought her baby with her to the event.

Bleedy the Period Puppet was created by artist Bree Horel.

Andrea, 25, said this piece depicts the multiple emotions she feels around menstruation.

It was great to see the media attention garnered last week by Red Moon Howl, the menstrual poetry slam happening in New York City on Friday night, June 7, 2013, at Marymount Manhattan College. The event is part of the upcoming Society for Menstrual Cycle Research conference – Making Menstruation Matter.

But as re:Cycling noted on our Facebook page, it was a shame the only way Jezebel, The Gloss, and The Frisky could think to illustrate their previews of the event was with stock photos of femcare products.

It made me realize the value of the archive I have of menstrual images created by women who attended the menstrual arts and crafts events we hosted when I was executive director of Sexual Health Access Alberta. At Scarlet Summer [pdf], an event held in August 2007, attendees watched Giovanna Chesler’s documentary Period: End of Menstruation, participated in a discussion, then created visual and tactile illustrations of what menstruation means to them.

In anticipation of the upcoming conference and menstrual poetry slam, here are several menstrual images that may inspire your own periodic creativity.

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Posted in Activism, Communication, FemCare, Menstruation | 15 Comments »

How do girls learn about periods?

May 1st, 2013 by Laura Wershler

How do girls learn about menstruation today? Who talks to them? Who do they talk to? Or do most girls rely on the Internet for information about periods?

Take this article by Elizabeth (bylines are first names only) – What I Wish I Knew About My Period – posted last week at Rookie, an online magazine for teenage girls. Not a teenager but definitely a young woman, Elizabeth (Spiridakus) shares the wisdom she’s gained through her menstrual experience. Here’s her sum-up:

These are all the things I wish someone had told me before I got my first period, and in the couple of years that followed. Most of all, I wish I had FOUND SOMEONE TO TALK TO! I had so many questions and fears about the whole business, and I think I would have been so much less self-conscious, and so much HAPPIER, if I had only had access to some friendly advice. So, talk to your friends! Talk to your cool older cousin or aunt or sister or your best friend’s cool mom or your OWN cool mom. Leave your questions—and your good advice—in the comments, because I certainly haven’t been able to cover all the bases here.

Read this again: “Most of all, I wish I had FOUND SOMEONE TO TALK TO!”

Photo courtesy of Laura Wershler

Elizabeth urges readers to talk to their friends, cool older relatives, or their own – or somebody else’s – “cool mom.” Great advice, but I have to ask:  Why aren’t cool moms and older relatives already talking to the girls in their lives about menstruation? Sharing friendly advice? Passing on wisdom from mother to daughter, woman to woman?

Suzan Hutchinson, menstrual activist, educator and founder of periodwise.com, a project dedicated to empowering girls and women to embrace the taboo subject of menstruation, has a few ideas about this. She thinks many moms don’t know when to begin “the period talk” or what to say, so they remain silent until their daughters start their periods, or they wait thinking their daughters will initiate period talk. She warns against this.

“We should all remember that when moms offer too little information or start providing information too late, girls often question their credibility and hesitate to return as new questions arise.”

Although Suzan’s mother talked to her about menstruation, she didn’t start early enough, before Suzan heard things from other girls that she didn’t understand. Her early menstrual experience included lying to her friends about getting her period long before she did at age 15. By then she was “too embarrassed to ask my much more experienced friends” and “too proud to turn to Mom.” She tried to deal with things on her own.

“I needed a period coach – someone to walk through things with me and instruct me…help me figure out what to do, when to do, how to do.”

A period coach. This is exactly what Elizabeth is for the girls at Rookie. Read the comments. Readers loved it.

She’s not the only one using the Internet to connect with girls about menstruation. Despite my reservations about a website operated by the company that sells Always and Tampax, the content of which deserves serious critique, I must acknowledge that thousands of girls are turning to beinggirl.com for period coaching, including tips on how to talk to their moms!

Moms shouldn’t be waiting for their daughters to talk to them. They need to find their own period coaches. Other mothers like Suzan Hutchinson and the mom who started bepreparedperiod.com.

The more information girls have the better. Brava to Elizabeth for What I Wish I Knew About My Period. But moms and cool older relatives have got to get in the game. Now. Don’t wait until the girls in your life come to you.

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Posted in Communication, Girls, magazines, Menarche, Menstruation | 6 Comments »

Stopping Depo-Provera: Why and what to do about adverse experiences

April 11th, 2013 by Laura Wershler

Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist

A screen shot of comments to Laura Wershler’s blog post of April 4, 2012: “Coming off Depo-Provera can be a woman’s worst nightmare.”

With 250 comments – and counting – to my year-old post Coming off Depo-Provera is a women’s worst nightmare (April 4, 2012) I thought it was time to revisit this topic.

That blog post has become a forum for women to share their negative experiences with stopping Depo-Provera (also called “the shot,” or Depo), the four-times-a-year contraceptive injection. (Commenters reporting positive experiences have been extremely rare.) Many women have experienced distressing effects either while taking Depo and/or after stopping it. They report that health-care professionals seem unable to explain their problems or to offer effective solutions. What is puzzling for many is why they are experiencing symptoms like sore breasts, heavy and ongoing bleeding (or not getting flow back at all), digestive problems, weight gain and mood issues when they stop Depo.

This post aims to briefly explain how Depo works to prevent pregnancy, its common side effects and, most importantly, why and what to do about adverse experiences when stopping it.

What follows is my interview with Dr. Jerilynn C. Prior, Society for Menstrual Cycle Research board member, professor of endocrinology at the University of British Columbia, and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) Section 1 explains how Depo-Provera works and what causes its side effects. Section 2  explains the symptoms women are experiencing after stopping the drug.

1) Taking Depo-Provera: How it works and established side effects

Laura Wershler (LW): Dr. Prior, what is Depo-Provera® and how does it prevent pregnancy?

Ask Jerilynn: The term, “depo” means a deposit or injection and Provera is a common brand name of the most frequently used synthetic progestin in North America, medroxyprogesterone acetate (MPA). Depo is a shot of MPA given every three months in the large dose of 150 mg. Depo prevents pregnancy by “drying up” the cervical mucus so sperm have trouble swimming, by thinning the endometrium (uterine lining) so a fertilized egg can’t implant and primarily by suppressing the hypothalamic and pituitary signals that coordinate the menstrual cycle. That means a woman’s own hormone levels become almost as low as in menopause, with very low progesterone and lowered estrogen levels.

LW: Could you explain the hormonal changes behind the several established side effects of Depo? Let’s start with bleeding issues including spotting, unpredictable or non-stop bleeding that can last for several months before, in most women, leading to amenorrhea (no menstrual period).

Ask Jerilynn: It is not entirely clear, but probably the initial unpredictable bleeding relates to how long it takes for this big hormone injection to suppress women’s own estrogen levels. The other reason is that where the endometrium has gotten thin it is more likely to break down and bleed. These unpredictable flow side-effects of Depo are something that women should expect and plan for since they occur in the early days of use for every woman. After the first year of Depo (depending on the age and weight of the woman) about a third of women will have no more bleeding.

LW: What about headaches and depression?

Ask Jerilynn: It is not clear why headaches increase on Depo—they tend not to be serious migraine headaches but are more stress type. Perhaps they are related to the higher stress hormones the body makes whenever estrogen levels drop. Unfortunately, headaches tend to increase over time, rather than getting better as the not-so-funny bleeding does.  Continue reading...

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Posted in Amenorrhea, Birth Control, coming off the pill, Dysmenorrhea, Health Care, Hormones, Menorrhagia, Menstruation, Ovulation, Perimenopause | 30 Comments »

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.

It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).

Hormonal contraceptives clearly act as EDCs according to the definition used in this report:

An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.

Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.

The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and  progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”

The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.

How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?

Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.

Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”

Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors.  Continue reading...

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Posted in Birth Control, Fertility, Hormones, Menstruation, Pharmaceutical, Reproduction | 25 Comments »

Does Depo-Provera work like a charm or a curse?

February 6th, 2013 by Laura Wershler
Author’s Update, February 14, 2013: As clarified by Bedsider.org in the comments section below, the Works Like A Charm Contest mentioned in this post is not current but ended in 2011. The contest website pages are now inactive.

If Bedsider.org sponsored a contest called Why I Hate My LARC, there would be no shortage of contest entrants. But I expect it will be a long time before the nay-sayers get as much attention as the yeah-sayers.

Composite illustration by Laura Wershler

Bedsider has jumped on the LARC bandwagon. The online birth control support network for women 18-29 has launched the Works Like a Charm contest encouraging “the awesome women and couples” who use long-acting reversible contraception to share why they love their LARCs for the chance to win up to $2000. This is a variation of the Why I Love my LARC video campaign sponsored by the California Family Health Council last November, only with prizes!

To quote my blog post about the earlier campaign: “Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.”

One long-acting, not-so-reversible contraceptive in particular – Depo-Provera – is causing grief for many women. Yet “the shot” is front and center in the graphic on the contest website.

Considering the rah-rah tone of the Works-Like-a-Charm campaign messages, it seems that bedsider.org, a project of the National Campaign to Prevent Teen and Unplanned Pregnancy, is oblivious to the misery caused by this contraceptive. Often, Depo works like a curse.

I acknowledge that Bedsider is doing good work: The website provides youth-friendly, accessible information about the full range of birth control methods. But, in my opinion, any organization that promotes Depo-Provera as a contraceptive method should be totally transparent about the ill effects many women experience both while taking and after stopping the drug.

Depo-Provera, to put it bluntly, fucks with a woman’s endocrine system.

The long list of ill effects while on or after stopping this drug includes: continual bleeding (from spotting to heavy), mood disorders, severe anxiety, depression, digestive issues, loss of sex drive, extreme weight gain (often without change to exercise or eating habits), lingering post-shot amenorrhea, intensely sore breasts, nausea, and ongoing fear of pregnancy leading to repeated pregnancy tests. (Not to mention its documented negative effect on bone density.)

These effects are why the continuation rate of Depo-Provera is only 40-60% after one year of use, and why women are filling online comment pages with stories of their struggles coming off this drug.

At Our Bodies, Ourselves, the blog post Questions About Side Effects of Stopping Contraceptive Injections has been attracting comments since November 3, 2009, with no end in sight.

On my April 4, 2012 re:Cycling post – Coming off Depo-Provera can be a woman’s worst nightmare - there are over 130 comments. All but six were posted since mid-November when the post caught fire. Not more than a day or two goes by before another women shares her story of distress, confusion or frustration. I read each one and respond occasionally. Rarely, a positive experience appears; one criticized other commenters for complaining.

It’s one thing to read or hear about potential ill effects while trying to decide whether or not to use Depo-Provera. It’s quite another to experience some or many of them for months on end without acknowledgement or health-care support from those who promote or provide this drug.

The Works Like a Charm contest website says about LARCS:

Reversible = not permanent. If and when you’re ready to get pregnant, simply part ways with your LARC and off you go.

“Off you go?” Tell that to the thousands of women who are waiting, months post-Depo, to get their bodies and their menstrual cycles back to normal. Most of them still aren’t ready to get pregnant.

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Posted in Activism, Amenorrhea, Birth Control, coming off the pill, Health Care, Hormones, Menstruation, Pharmaceutical | 10 Comments »

Coming off Depo-Provera can be a woman’s worst nightmare

April 4th, 2012 by Laura Wershler

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies Ourselves: Questions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.  Continue reading...

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Posted in Birth Control, coming off the pill, Health Care, Hormones, Menstruation | 289 Comments »

Coming Off The Pill: A Mind Map Guide

March 7th, 2012 by Laura Wershler

Everybody can use a good map to help them get to where they’re going. Why not women heading to the land of non-hormonal contraception?

In my post on January 11, 2012 I asked if coming off the pill was a growing trend. I proposed to write a series of posts about the issues associated with the decision to stop using hormonal birth control.  For the purposes of this discussion assume that “coming off the pill” refers to quitting any method of hormonal contraception including the pill, patch, ring, shot, implant or Mirena intrauterine system.

As I was preparing a list of possible topics, I realized that one way to represent the complexity of issues involved in this decision is with a mind map: “a diagram used to represent words, ideas, tasks, or other items linked to and arranged around a central key word or idea.” It also occurred to me that readers could then add to this schematic, filling in important points based on personal or professional experience. So I got out my colored markers, did a little brainstorming and came up with Coming Off the Pill: Mind Map 1.0. I invite readers to comment, offering additions under the key headings I’ve noted and suggesting other categories that should be included.  Could this become a talking, planning or process guide for women considering the transition to non-hormonal birth control methods?

If you’ve thought about or been through the experience of quitting hormonal contraception, or if you’ve helped others through the experience, please contribute to the development of Coming Off The Pill: Mind Map 2.0 by posting your comments and suggestions. (I’ve already thought about other headings I could have included.) Besides providing me with a guide for writing future posts, what other ways can you imagine this mind map might be used?

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Posted in Activism, Amenorrhea, Birth Control, coming off the pill, Communication, Dysmenorrhea, Health Care, Hormones, Menorrhagia, Menstruation, Ovulation, Pharmaceutical, PMS, Reproduction | 10 Comments »

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.