Blog of the Society for Menstrual Cycle Research

#Menstruationmatters and it starts with menarche

September 3rd, 2015 by Laura Wershler

It’s Menarche Month at re: Cycling

Menarche (mə-NAR-kee) refers to the first menstrual bleeding or period, the onset of menstruation. This month at re: Cycling we will explore menarche from many points of view.

I think how we talk with our daughters and other important girls in our lives when they get their first periods truly will influence their experience of menarche. I don’t think you could find a better role model than the fictional character Roseanne, who, in an 1989 episode of the show named for its star Roseanne Barr, aces the first period talk with her daughter Darlene. Fortunately, this three-minute scene is immortalized on YouTube.

Roseanne walks in to her daughter’s bedroom to find tomboy Darlene bagging up her sports equipment. Darlene thinks her life as she knows it is over, but her mother makes a compelling case for why it’s really just beginning.

Re-watching this scene I love how Roseanne avoids the stereotypical first comment on a girl’s first period: “Now you can have a baby.” Yes, menarche implies fertility, but Roseanne, wisely, doesn’t go there at first. Instead, picking up Darlene’s baseball glove and ball, she tells her daughter “these are a girl’s things Darlene as long as a girl uses them.” My favourite bit is Roseanne’s reply to Darlene when she says, “I’m probably going to start throwing like a girl now anyway.” Roseanne, tossing the baseball in Darlene’s mitt, doesn’t miss a beat. “Definitely,” she says, “and since you’ve got your period you’re going to throw a lot farther.”

Roseanne is absolutely right. Menarche means that as a girl’s hormonal cycle kicks in and she starts to ovulate consistently her bones and her muscles will get stronger. When a young athlete or dancer gets her period, she needs to hear from the important people in her life that menstruating will make her stronger, that getting her period will ultimately make her a more capable athlete or a dancer who can jump higher and leap farther.

If a girl is into creative endeavours, then we can frame menstruation and its accompanying cyclic hormonal changes as a pathway to maturity. She’ll have more to write about, sing about, paint about as she gains access to deeper emotional experiences. Maybe your daughter or young niece likes to cook or play the flute. Tell her now that she’s got her period she’ll cook with more “flavor” and play with more feeling. That’s what Roseanne would have done.

This is not to suggest we ignore that menarche brings with it sexual and reproductive pleasures and challenges. We’ll discuss all of these aspects this month on the blog. Roseanne finds a neat way to reference the fertility that comes with menstruation near the end of the scene. I hope you’ll watch to find out what she says. With her “heart-and-soul” humor, Roseanne keeps it real.

This month on re: Cycling, Dr. Lara Briden, ND, writes about why ovulation is important for girls’ good health and why non-hormonal treatments for period problems are the best option for teens. Saniya Lee Ghanoui brings us her research on menstrual education films and endocrinologist Jerilynn Prior of the Centre for Menstrual Cycle and Ovulation Research shares an estimated timeline for what is normal development in the years after menarche for both cycles and ovulation. You’ll also be able to watch and listen to mother and daughter authors Sheryl E. Mendlinger and Yael Magen tell a most original first period story as they read from their recently published book Schlopping.

Keep visiting the blog throughout September for all this and more. Share the posts with friends and colleagues, and, please, share your thoughts and opinions on these posts about menarche in the comment section. Menstruation matters–and it starts with menarche.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re: Cycling.

Menstrual management for women with disabilities, menstrual hygiene taboos, and menstrual cycle awareness

May 28th, 2015 by Laura Wershler

These two concurrent sessions address the menstrual-related challenges of women with disabilities, menstrual hygiene taboos and practices around the world,  and the concept of gynaecological self-help at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.

 

Menstrual Management, Friday, June 5th:

Women with Spinal Cord Injuries Talk about Menopause
Heather Dillaway, Wayne State University

Using data from interviews with 20 women with spinal cord injury, I illustrate how disabled women may think about and experience menopause. Overall, interviewees think positively about menopause as a release from the hassles of menstruation, but face unique experiences when dealing with perimenopausal symptoms. I also discuss their concerns about aging.

“Kahani Her Mahine Ki” – A Menstruation Kit for the visually impaired women
Sadhvi Thukral, National Institute of Design

“I am constantly worried that my dress will stain during my period, I cannot see.”

“I will never be able to tell the colour of my discharge during menstruation or when I need to change my cloth. To be safe, I change every few hours.”

These are unique anxieties of visually impaired young women.

A large gap exists in the area of “Communication for Menstruation” for the visually impaired. This design degree project was an attempt to fill this gap by developing a product for menstruation that would meet the needs of visually impaired girls and women.

The kit “Kahani Her Mahine Ki” (The Same Story Every Month) covers the subject of menstruation and how to manage during periods and has the following features:

1. Tactile diagrams and material in the form of Information Slates, with labels of the different body parts. Each slate has text for the sighted and Braille for the visually impaired. 2. A life size human body model for demonstration.

What they do, what we do, what I do: A critical review of five contemporary international surveys of menstrual management practices and technologies. How can these surveys inform Western practice? What areas remain to be surveyed?
Susannah Clemence, Independent researcher

This critical review compares the catalogues of contemporary menstrual management techniques from around the World, presented in Sommer et al (2013), House et al (2012), Kjellen et al (2012), Bharadwai and Patkar (2004) and Finley’s (1995-2015) Museum of Menstruation.

The purpose is to test how well-documented are contemporary practices across the World, and what areas remain yet unrecorded. The rationale is that diverse technologies and conduct, with their implicit beliefs and attitudes, grant us reference points from which to examine, critique and improve our own practices.

The review shows that there are large gaps in documented knowledge. Furthermore, other than the Museum of Menstruation, existing surveys tend to be rooted in development agendas of Western origin and tend to a deficit perspective of non-Western practices.

 

Menstrual Hygiene, Saturday, June 6th

A Vicious Cycle of Silence: The perpetuation of the menstrual hygiene ‘taboo’ and the implications for the realisation of the human rights of women and girls
Emily Wilson-Smith, Kampala International University & Robyn Boosey, University of Bristol 

Despite the impact of poor menstrual hygiene on the rights of women and girls it has remained largely neglected by International stakeholders. A document analysis of the core international human rights treaties and relevant human rights body reports found an overwhelming silence and an analysis of the existing references revealed an inadequate framework for addressing menstrual hygiene.

Improving Menstrual Health and Hygiene in India: Another critical path way for women emancipation
K Yadagiri, Centre for Economic and Social Studies,UNICEF Division for Child Studies 

Gynecological Self-Help Isn’t Just a Good Feeling – What we learned when we systematically studied our own menstrual cycles – and how you can learn MORE now!
Kathy Hodge, Feminist Women’s Health Center

In 1975, nine members of the Feminist Women’s Health Center collective met daily for over a month, recording changes in our vaginas and cervixes and their secretions, for PAP and ferning smears, charting moods and basal body temperature. We raised questions, some of which remain open and ripe for future woman-controlled research.

 Menstrual Hygiene Management practices in Slums: It’s impacts on the Women and Adolescent Girl’s Health – A Case study of Greater Hyderabad Municipal Corporation Slums, Telangana State, INDIA
Venu Madhav Sharma, Centre for Economic and Social Studies

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

Menstrual education perspectives from Africa, India, Bangladesh, and the United States

May 22nd, 2015 by Laura Wershler

 Menstrual Education perspectives from around the world will be presented in two concurrent sessions at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston. The conference theme is Menstrual Health and Reproductive Justice.


Menstrual Education Concurrent Session Friday, June 5th:

Confident Girls in Charge of their Own Lives
Chantal Heutink, Bilhah Anyango, Jackline Obado & Goretty Obure, Afri-Can Trust

Girls grow up feeling ashamed due to limited knowledge about menstruation and lack of proper sanitary means to take care of themselves during this period creates a huge backlog to these girls hence denying them the opportunity to take their place in the society. Menstrual Hygiene Management matters are important to bridge the gap and provide a pathway towards confident girls in charge of their lives.

Factors impacting on the menstrual hygiene among school going adolescent girls in Mongu District, Zambia
Anne Mutunda Lahme, Akros Global Health, Zambia 

The research showed that in a Zambian context the process of menstruation can turn into a threat to girls’ social, physical and mental well-being and ultimately their school careers, causing gender discrimination and violation of their rights. It also creates an atmosphere of emotional stress, leading to poor school performance.

GrowUp Smart: Demystifying the link between menstruation, fertility and sexuality
Jennifer Gayles, Kim Ashburn & Marie Mukabatsinda, Georgetown University Institute for Reproductive Health, @IRH_GU

GrowUp Smart is an interactive puberty education program for adolescents, parents and communities that links knowledge of the menstrual cycle to improved understanding of fertility and better reproductive health outcomes. This presentation will discuss findings from evaluation of the intervention’s effect on sexual and reproductive health knowledge, attitudes and behaviors.

 

Menstrual Education Concurrent Session Saturday, June 6th:

Health Education and Menstruation: What’s happening in the classroom?
Jax Gonzalez, Brandeis University Graduate School of Arts & Sciences

Preliminary research on educator’s familiarity teaching health education in elementary schools suggests that teachers experience a multitude of limitations when administering the curriculum. By using sociological theory through an intersectional lens this qualitative study provides an important insight into the lived experience of teaching the taboo.

Making Schools Menstrual Friendly: Enhancing experience of girls in public schools
Dhirendra Pratap Singh, Azadi Inc.

A presentation of findings and analysis from the Menstrual Friendly School Program in Balrampur District, Uttar Pradesh, India – an initiative to address the menstruation management needs of girls’ at school so that puberty does not result in school drop out, a risk facing ~30% of India’s 87.5 million adolescent girls.

Menstrual Hygiene Practices of Girls in Rural India
Rita Jalali, American University 

The purpose of this study was to understand menstrual hygiene practices of poor girls living in rural India; their unmet menstrual management needs; and knowledge and awareness about menstruation and commercial napkins. Data were collected through survey, focus group discussions and diary entries and show how poverty and water deprivation impact hygiene.

Borohawa | Grown Up Girl – A short film on managing menstruation in rural Bangladesh
Sara Liza Baumann, Old Fan Films & Richard A. Cash, Harvard T.H. Chan School of Public Health

Whether you live in South America, Africa, Europe or Asia, all women undergo a natural experience that signifies their transition from childhood to adulthood. It may have different cultural significance, and women have a variety of different experiences, but menstruation is a biological event that women around the world share. Setting out with the goal of increasing understanding of these questions, we traveled to a school in Mymensingh, Bangladesh to gather perspectives from adolescent school girls through this short film project.

 

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

Menstrual Hygiene, Human Rights, and Gender Equality – A Focus on the Global South

May 18th, 2015 by Laura Wershler

Scholars and practitioners from the fields of human rights and water and sanitation will discuss menstrual hygiene from the perspective of gender equality on June 4th at the  21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston.

Human Rights in the Private Sphere: Menstrual Hygiene as a Priority for Gender Equality and Human Dignity
Inga Winkler, Scholar-in-residence, Center for Human Rights & Global Justice, NYU School of Law 

In many countries, menstruation is shrouded in taboo and secrecy. Removing the taboos and ensuring better access to menstrual hygiene is essential for achieving gender equality and realizing human rights. The presentation seeks to explore human rights obligations to create an enabling environment for women and girls to practice adequate menstrual hygiene. It discusses various strategies including awareness-raising and breaking taboos, promoting good hygiene, and embedding menstrual hygiene in policies and programs by using examples from different country contexts. With a topic as personal and culturally specific as menstruation, incorporating women’s and girls’ views and preferences into programs and policies cannot be overestimated.

Poor menstrual hygiene, stigmatization, or cultural, social or religious practices that limit menstruating women’s and girls’ capacity to work, to get an education, or to engage in society must be eradicated. Considering menstruation as a fact of life and integrating this view at all levels will contribute to enabling women and girls to manage their menstruation adequately, without shame and embarrassment—with dignity.

Investigate and Expose: Challenges in Building an Evidence Base around Menstrual Hygiene as a Human Rights Issue
Amanda Klasing, Researcher, Human Rights Watch

Menstrual hygiene has emerged recently as a human rights issue, but this recognition alone does not mean that human rights practitioners will take up the issue. One barrier is the perceived or real limitations in their methodology.

This paper considers how human rights fact-finding methods may not readily lend themselves to building the evidence base for menstrual hygiene as a human rights concern. It will explore examples of how, despite challenges, menstrual hygiene concerns can be exposed within the context of broader investigations and it will address how practitioners can more deliberately incorporate menstrual hygiene in their investigations.

An important first step is for researchers to recognize the impact of menstrual hygiene on a broad array of women’s and girls’ human rights. Next, researchers should consider how best to expose this in the course of their research. Finally, researchers should consider how to include menstrual hygiene in the recommendations it makes to governments and other duty bearers.

Menstrual Hygiene Management in Schools: Meeting Girls’ Rights and Needs in Zambia
Sarah Fry, Hygiene and School WASH Advisor, USAID WASHplus Project

Image by Sarah Fry

Zambia’s schools fall short of acceptable standards and ratios for access to safe drinking water and improved sanitation. The ratio of girls to toilet can be as high as 200:1. These shortfalls are believed to be factor in the high rate of school drop-out among girls, many of whom do not even finish primary school. As in other low-income contexts, dropout rates for girls in Zambia appear to increase after puberty. Menstrual hygiene management (MHM) is burdened with cultural taboo and myths. Girls are still excluded from school for as long as one month at their first menses.

USAID/SPLASH in Zambia address girls’ right to education by removing barriers to menstrual hygiene management in schools. SPLASH and the Ministry of Education research cultural norms, improve girl-friendly facilities and access to menstrual products, break taboos, and integrate MHM in the education system through water, sanitation and hygiene in schools

Menstruation is still a sensitive topic, but experience in Zambia has shown that taboos can break down rapidly and MHM can become a normal part of discourse around girls’ rights at local and policy levels.

 

Media Release and Registration for the SMCR Boston Conference.

 

Menstrual education and hygiene management initiatives seek collaborators

May 15th, 2015 by Laura Wershler

 Two experiential workshops on Friday, June 5th, invite participants to collaborate in menstrual health initiatives at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston. With one in the morning and one in the afternoon, you can take in both!

Menstruation Matters: Period! – A Public Education Campaign Whose Time Has Not Yet Come
Presenters:
Heather Guidone – Director, Center for Endometriosis Care; Medical Writer; Women’s Health Educator
Diana Karczmarczyk, PhD – Adjunct Professor, George Mason University and Senior Analyst, Association of State and Territorial Health Officials
Evelina Sterling, PhD—Visiting Professor, Kennesaw State University and Public Health Consultant, Southern Research and Evaluation Institute
Peggy Stubbs, PhD— Professor, Chatham University

How might menstrual arts and crafts be included in menstrual cycle education campaigns?
Photo by Laura Wershler

 

 

 

As menstrual cycle educators and advocates, we know all too well the frustrations and inadequacies related to menstrual cycle education targeting the general public. This hands-on workshop provides participants the opportunity to contribute to designing effective public health education messaging grounded in health education theory and strategies which address the importance of menstruation to girls’s and women’s health and well-being.

Building Better Solutions for Monitoring and Evaluation in Menstrual Hygiene Management
Presenters from Pasand (USA), @PasandTeam, Pasand on Facebook:
Rebecca Scharfstein, Co-Founder and Executive Director
Ashley Eberhart, Co-Founder and Director of Marketing
Allison Behringer, Director of Partnerships
Lacy Clark, Monitoring & Evaluation Project Lead, MBA Intern

According to often-cited data, 88% of women do not have access to sanitary protection (instead using “cloth, husks, mud, and ash”), and 23% percent of girls drop out of school upon menarche. In the field, however, questions come to mind, such as: “Who are these women using rags because we can’t find them!” While shocking statistics about menstrual hygiene management have been used successfully in recent years to generate an unprecedented level of interest in the topic, how can we avoid inflammatory statements, recognize geographical and socioeconomic nuances, and develop quantitative rigor in a relatively new field?

In this workshop, participants will discuss challenges in monitoring and evaluation in the menstrual hygiene management sector through an interactive human-centered design workshop approach. We will use Pasand, a social venture that partners with schools and NGOs in India to teach women’s health and provide access to affordable sanitary protection, as a case study and present four challenges the organization faces with respect to data collection.

Participants will be divided into facilitated “challenge teams,” each assigned with the task of collaboratively identifying solution(s) to one of the challenges presented. At the end of the session, groups will share their solutions, and individuals will come away with a deeper understanding of effective monitoring and evaluation in the sector, as well as new ideas that can be implemented in their own work.

In the days following the conference, Pasand will compile a summary of the ideas and major themes coming out of the workshop and send to participants so that they can take the results back to their own organizations, expanding the reach beyond the walls of the workshop.

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan. 

Religious and cultural menstrual traditions, Jewish ritual around menstruation, and abortion rights in Israel

May 11th, 2015 by Laura Wershler

Three papers will explore the theme Religion and Reproductive Rights and Traditions on June 4th at 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston

Tour a Jewish ritual bath on a Mikveh Visit with Mayyim Hayyim, a pre-conference event on Wednesday, June 3, 3:30-5:30 p.m. The Jewish ritual bath is intended to mark transitional moments, including niddah (the practice of monthly immersion following menstruation). This event it open to the public.

Menstruation and Reproductive Practices: Religion and Traditions and the Influence of Immigration on Mother-Daughter Dyads across Cultures
Sheryl Mendinger, PhD, Institute on Urban Health Research and Practice, Northeastern University &
Julie Cwikel, PhD, The Center for Women’s Health Studies and Promotion, 
Ben-Gurion University of the Negev, Beer Sheva, Israel

A menstrual hut in Ethiopia. Image provided by Sheryl Mendlinger.

“In Ethiopia there is no rest until you go to the hut, only during menstruation the women rests.”

This paper presents a theoretical analysis of in-depth interviews with multicultural mother-daughter dyads and quantitative data that examines how women from different cultural and religious backgrounds view menstruation and family planning practices. Both of those practices changed rapidly among both mothers and daughters following immigration to Israel.

Some of the themes identified in this analysis include traditions, ceremonies and religious observance in relation to menarche, such as European women and ‘the slap’ and Ethiopian women going to the menstrual hut during their menstrual cycles. In terms of family planning, the data show how women from Ethiopia practiced extensive breastfeeding and women from the CIS used therapeutic abortions as birth control. Both of those practices—menstruation and family planning—changed rapidly among both mothers and daughters, following immigration to Israel. The move away from a tradition that is passed down from mother to daughter may also reflect a movement from a ‘mother to daughter’ model of knowledge transmission to a ‘peer to peer’ channel of transmission.

The Jewish Ritual around Menstruation: How “Family Purity” Laws Affect Modern Women
Naomi Marmon Grumet, PhD, The Eden Center, Jerusalem, Israel

The Jewish rituals surrounding menstruation are complex. For those who observe the religious framework, these rituals affect and circumscribe actions throughout the monthly cycle. This lecture will explore the scope of these rituals, and how modern women make meaning of the practice of these ancient laws.

The presentation will give voice to a range of Jewish women’s experiences with the framework of these laws, often known as taharat hamishpacha. This aspect is based upon formal interviews with more than 70 religious women (as well as separate interviews with their husbands) who are observant of taharat hamishpacha, and informal discussions with dozens of others.

Abortion Legal Rights in Israel: Reproductive and Sexual Health
Yael Magen, Esq., Multigenerational Family Law and Taxes

In Judaism a fetus is not considered a “nefesh”, a soul, or a human being, until it is born.

This presentation will present an overview of the abortion issue in Israel including Israel’s legal system, Jewish legal position of the fetus vs. the mother, Israeli legislative history, and its applicability and practicality in Israel today.

Media Release and Registration for the SMCR Boston Conference.

Waiting

August 20th, 2014 by Heather Dillaway

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Heather Dillaway originally appeared October 28, 2010.

I’ve been thinking a lot lately about the words we use when we’re talking about menstruation or reproductive experiences more generally. I’ve been noticing lately that we use the word “waiting” quite a bit. I have a friend who is “still waiting” for her menstrual cycle to be “normal” again after her second child, and several other friends who are either “waiting” to figure out whether they will get pregnant, “waiting” to be done with their pregnancies, or “waiting” before they can have their last and final kid. I just had my basement waterproofed and one of the basement repairmen told me that his wife had been “waiting” ten months to get a menstrual period and that they were worried about her (this is information he volunteered after I told him I studied women’s health). I started thinking more about how the menopausal women I interview always talk about “waiting” to figure out whether they are really “at menopause,” or “waiting” to figure out if this is really their last menstrual period. Or how so many girls/young women who are sexually active are “waiting” to get their periods so that they can be relieved to know they are not pregnant. Or how women with painful periods, endometriosis, or migraines are waiting until those days are over each month. What does all of this reproductive waiting (waiting for menstruation, waiting for menstruation to be over, waiting for pregnancy, waiting for birth, waiting for menopause) mean?

In all of these instances of reproductive waiting, waiting seems a negative connotation and that seems to stem from the fact that we do not feel in control or in charge of this reproductive time. When I think of the other situations in which I might use the word “waiting”, the same holds true. I tell my kids to “wait their turn” and they don’t like it. And none of us really like waiting in line. Fast food restaurants, frozen dinners, and ATM machines are all in existence because we don’t have time or don’t like to wait. Phrases that we use like “worth the wait” also connote negativity about waiting. So, I finally looked up the actual definition of waiting. Depending on which online dictionary you visit, definitions of “waiting” include: “pause, interval, or delay,” “the act of remaining inactive or stationary,” or “the act of remaining inactive in one place while expecting something.” While some of these definitions do not automatically lend themselves to negativity, waiting is defined mostly as a passive activity that we are forced to participate in, perhaps against our will.


All of this makes me think further about whether women really dislike the waiting or the time that comes with menstruation or other reproductive experiences, and whether women really feel out of control as they engage in their experiences. Is this just a word we use or are we really impatient about menstruation and reproduction? When I think about alternative words that are sometimes used, like “tracking,” other words seem much more agentic in that they put women back in control of their cycles and other reproductive experiences. So, is it just the word “waiting” that has the negative connotation or is that word signifying some larger impatience that we have about reproduction these days? I have a colleague who writes about the “inconveniences” of reproduction and how, in so many ways, we try to avoid the reproductive waiting or reproductive uncertainties we face. For instance, instead of waiting to see when a baby is born, we might plan a c-section so that we can know when we’ll get that baby. Or, now we’re told that if we’re “waiting” more than 6 months to get pregnant that we should probably start taking fertility drugs to shorten our wait or get rid of some of that uncertainty. Or now we can find out that we’re pregnant a couple weeks after conception instead of waiting to see whether we menstruate a few weeks later. We attempt to cut out some of those reproductive waits these days. Menstrual suppression is at least partially popular because then women won’t have to be surprised by their periods or wait to know what bad day their period might fall on.


I think perhaps we do need to be more conscious of the words we use to describe our own and others’ reproductive events. Is “waiting” the correct word to use? Is “tracking” a better word to use because of the agency/active control it implies? Is “experiencing” a broader, less value-laden word to use? What do we really mean when we use these words?

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

Give the Gift of Body Literacy

December 16th, 2013 by Laura Wershler

Photo by Laura Wershler

This holiday season consider giving the women in your life the gift of body literacy. The books, resources and services compiled below support understanding and appreciation of our bodies.

Gifts for teenagers:

* To hold a Wondrous Vulva Puppet is to experience a loving representation of the female body. Dorrie Lane’s vulva puppets are used around the world to spark conversations about our bodies and our sexuality. To quote a testimonial on the website: “The sensual curves, velvety feel and beauty of these puppets seems to disarm people in a way that opens the door to real discussion about women’s sexuality.”

* Toni Weschler, widely known for her best-selling book on fertility awareness Taking Charge of Your Fertility, has also written a book for teenagers. Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body makes the perfect gift for your daughter or younger sister, neice or cousin. This book can transform a young teenager’s experience and understanding of her body as it teaches her the practical benefits of charting her menstrual cycles. Available in paperback and Kindle editions.

Gifts for those who want to learn fertility awareness:



* Justisse Method: Fertility Awareness and Body Literacy A User’s Guide by Justisse founder Geraldine Matus is a helpful gift for anyone wanting to learn about fertility awareness based methods (FABM) of birth control. It is “a primer for body literacy, and a guide for instructing women how to observe, chart and interpret their menstrual cycle events.”

For someone who wants to learn fertility awareness to prevent or achieve pregnancy, or to fix menstrual problems, finding a certified practitioner is getting easier. Technology can connect women with skilled instructors who may live thousands of miles away. Check out the practitioners below online and on Facebook.

*   *    *   *   *   *

* Flowers Fertility (Colleen Flowers, Colorado): Facebook.

* Grace of the Moon (Sarah Bly, Oregon): Facebook.

* Holistic Hormonal Health (Hannah Ransom, California): Facebook.

* Justisse Healthworks for Women provides a directory of Justisse-trained Holistic Reproductive Health Practitioners (Worldwide): Facebook.

* Red Coral Fertility (Justina Thompson): Facebook

* Red Tent Sisters (Amy Sedgwick, Ontario, Canada): Facebook

I invite other certified instructors who work locally to leave their contact information in comments.

Gifts for women in midlife

* For women who are in the perimenopausal transition – which can last from six to 10 years for most women, ending one year after the final menstrual period – give the gift of information. Connect friends and family with the website of the Centre for Menstrual Cycle and Ovulation Research where they’ll find many free resources that offer explanations and treatment suggestions for the symptoms they may experience throughout this transition including night sweats, hot flushes, heavy and/or longer flow, migraines, and sore, swollen breasts.

* To those who love fiction, consider giving Estrogen’s Storm Season, a fictionalized account of eight women’s journey through perimenopause written by CeMCOR’s Scientific Director, endocrinologist Dr. Jerilynn Prior:

They are as different as women can be—yet they share the mysterious experiences of perimenopause, night sweats, flooding periods or mood swings. We follow these women as they consult Dr. Madrona, learn the surprising hormonal changes explaining their symptoms, get better or worse, and try or refuse therapies. As each woman lives through her particular challenge, we begin to see how we, too, can survive perimenopause!

Proceeds from book sales support ongoing research.

From menarche to menopause, it is never too early or too late to acquire body literacy. I invite readers to share other gift ideas that promote menstrual cycle comfort and support body literacy.

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.