Blog of the Society for Menstrual Cycle Research

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?

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

I’d given up reading the comments on online articles for the good of my mental health when a small slip last week steeled my resolve. In response to an article exploring the arguments made by “birth control truthers” a concerned father decided to have his say, taking the defensive arguments put forward by those in opposition to these “truthers” to their only logical conclusion:

“Perhaps we should market contraceptive pills as hormonal supplements to reduce cancer risk instead of as “contraception”? After all, it is only in modern times that women have hundreds of menstrual cycles throughout their lives. Even up until 1800 it was common for women to be either pregnant or lactating throughout much of their short lives.

The body simply wasn’t built to handle so many menstrual cycles, which raises the risk for cancer.

Who could argue with taking supplements to prevent cancer?

This may sound strange, but I am seriously considering putting my 11 year-old daughter on the pill (with no placebo) just for the health benefits. I just have to convince my wife first who is a little shocked by the idea…”

I cannot count how many times I have heard that the birth control pill “prevents cancer” – specifically “preventing” ovarian and endometrial cancer.  In the last few months I have seen references to this benefit explained less and less so as a “lowered risk” and more and more so as a “preventative” action.  I think this is significant as the word “prevent” suggests that the pill guarantees you will not get these forms of cancer. And yet, to remark that the pill is counted as a carcinogenic substance by WHO – due on the increased the risk of breast and cervical cancers – will get you tagged as a “truther.”

What is interesting, of course, is that despite the “cancer protecting” benefits of pregnancy, and early pregnancy at that, we do not see women encouraged to get pregnant in order to lower their risk of ovarian cancer.  Criticism of child-free women does not generally include comments about their lax attitude towards their own health. The risk goes down further with every pregnancy and further still with breast feeding, especially breast feeding for a long period of time after birth. Women who have children young, and multiple children, have a lower risk of breast cancer than women who have no children or children after 30. Yet we see more talk of women having “too many” children at an age that is “too young” – in fact I was contacted via Twitter by someone who read this piece and who saw, in the comments, that one woman who uses natural family planning admitted to both liking the method and having 14 children. This admission disgusted the person who contacted me, even when I pointed out that it seemed the woman had very much chosen to have those 14 children.

It seems the people who are advocating prescription of the pill for cancer prevention purposes are not advocating women have children earlier, more children, or consider breast feeding for the good of their own health – in fact two of the loudest critics of my “birth control truther” book are vehemently against pregnancy and breast feeding being part of women’s lives (Amanda Marcotte and Lindsay Beyerstein). The risks of the pill are frequently compared to the health risks associated with pregnancy and child birth,  but we don’t often hear women say they are choosing to not have children to avoid putting their health at risk for nine or so months.

Which leads me to this article in the LA Times that suggested nuns should also be on the birth control pill for its cancer-protecting abilities:

“And are the pills really unnatural? Our hunter-gatherer ancestors had their babies four or five years apart, because of long intervals of breastfeeding. As a result of that and their shorter life spans, they had as few as 40 menstrual cycles in a lifetime, while a modern woman can have 400. Though we can’t claim that today’s pills are perfect, their use is certainly less unnatural than enduring the hormone turmoil of hundreds of menstrual cycles.

Etiquette for menstruation

November 19th, 2013 by Holly Grigg-Spall

Photo courtesy of sweeteningthepill.com

Recently I was fortunate enough to be asked to lend an excerpt of my recently released book to the UK Sunday Times Style magazine. The mostly fashion-centric Style magazine is not really known for its edginess or risk-taking (except perhaps in the realm of shoe and make-up choices) and so I was happily surprised when the editor told me that the subject matter discussed in my book that she happened to find most interesting was, in fact, menstruation. I had expected her to want to focus on condoms perhaps, or just my personal story, but no, she was keenly interested in what I wrote about periods.

The argument I make in my book is that how we feel about hormonal birth control is inextricably linked to how we feel about menstruation. In a sense, many of the newer methods of hormonal birth control, as well as the newer uses (running packets of pills together, prescriptions for cramps or heavy bleeding) show an effort to get rid of the period completely, rather than just hide it away. I also discuss in the book, briefly, menstruation activism. However, I do defer to the far better work done by the likes of SMCR’s own Chris Bobel who writes on this topic with far more knowledge (not to mention wit).

You can read the feature in full here at my website (it’s otherwise behind an online pay wall and frankly I’m pleased to rob Rupert Murdoch of a few pounds by making it freely available).

In the end, the feature was not exactly an excerpt from my book – more so it was quotes from the book mixed with quotes from a long interview with the editor. Therefore I didn’t quite know what would be published in the magazine. The finished piece covered a range of controversial topics seen here at re:Cycling regularly – menstrual outing, reusable femcare products, the potential health benefits of ovulation…

If the high point of my career was getting the word “patriarchy” into the notoriously right-wing British tabloid The Daily Mail, I think I had another peak seeing this sentence in the Style (notorious for its high priced designer fashion spreads) – “This movement believes the act of stopping and hiding our periods with hormonal contraceptives and sanitary products is a mark of corporate ownership of our bodies.” I take great pride in also getting a discussion of menstrual extraction on to Style’s pages, and therefore onto the breakfast table of approximately one million British people – “an entire period’s worth of menstrual blood could be removed in a few hours instead of being experienced over days.” Well, if we can have Page 3, why not menstrual extraction?

The editor who did such a great job on this piece was Fleur Britten and in a funny twist of fate I realized, during our conversations, that in my first full time working position after college, at the publishing company Debrett’s in London, I worked as a production assistant on one of her books – Etiquette for Girls. At that time controversy surrounded Fleur’s section on the proper etiquette for one-night stands (I think it was something about getting out quickly, quietly, but leaving a nice handwritten note). So, it made me smile to see her skewer the etiquette of menstruation in the opening paragraph of this piece: “Many women are bored with having to take a whole handbag into the ladies rather than carry a tampon in their hand. Men say “I’m going to take a dump,” but we don’t say, “I’m just going to change my tampon.””

When I was carrying the proofs of Fleur’s book to the printers back some seven years ago, little did I know we would be conspiring to get the British public to say “I am menstruating” today over tea and toast.

Contemplative Dialogue and the Menstrual Cycle Polarity

August 21st, 2013 by Laura Wershler

Why are media-based discussions about menstrual cycle advocacy vs. menstrual suppression, or hormonal birth control (HBC) vs. non-hormonal birth control (NHBC), so often fraught with conflict, suspicion and untested assumptions?

Because the opposing frames of reference are often considered to be an either/or dilemma, with “right” and “wrong” solutions according to our preferred position, rather than two ends of a polarity between which a dynamic range of positions fluctuate. We live with many common sense polarities, like rain and sunshine, knowing the right combination of both is in our best interests.

Please Don’t Judge Me for Skipping My Period, a recent post by Sarah Fazeli at Xojane illustrates the challenges in managing polarities. The title suggests the writer expects to be or has already been judged for her “wrong” decision, yet many of the 427 comments demonstrate the range of positions held on the issue.

At one end of the menstrual cycle polarity is my preferred position – based on experience, research and evidence-based medicine - that consistent ovulatory menstruation supports women’s bone, breast, heart, reproductive, sexual, psychological and overall health. HBC disrupts endocrine function and stops ovulation, impacting many physiological systems. Many women are choosing NHBC because they are HBC-intolerant and/or want to experience healthy menstrual cycles. I advocate for improved access to information, support and services to help them use NHBC effectively and confidently.

I understand how my position might be construed as an either/or dilemma, but in no way am I demanding HBC be banned, bullying women to stop taking their pills or alluding to anti-abortion views. Yet others make and act on untested assumptions that I and others who hold this position are doing some or all of these things.

So how might we all – advocates, health professionals, educators, journalists, bloggers and the public – talk about the menstrual cycle polarity in ways that create opportunities and commitment to work together to meet all women’s needs?

For answers I revisited my training manual in Contemplative Dialogue. In 2009, I  took a four-day intensive workshop to learn about this process of engaging collective awareness to create “a deep experience of community where division or separation may have been the felt starting point.”

Contemplative means taking a long, compassionate look at the real; dialogue is the practice of creating shared meaning. Compassion is a key element because “it helps us get past the kind of guarded and defended reactions that undercut us doing things together.”

I refreshed my memory on how to avoid acting on untested assumptions. I thought about how I might become skilled enough to back not just myself but other people down Chris Argyris’s “ladder of inference” in a non-threatening way to resolve misunderstandings and create shared meaning.

Contemplative Dialogue also incorporates into its process Barry Johnson’s work in managing polarities. In emotional debates it helps if we can learn to speak across polar values.

This process calls for me to identify both my preferred value and the opposite value. In dialogue I first acknowledge the upside of the opposite value followed by the potential downside of my preferred value. Keeping my language fair and non-pejorative, I then speak of the downside of the opposite value that I fear. Finally, I get to talk about the upside outcomes to my preferred value that I’m striving for.

I want to keep talking about these issues, but I’m not up for a range war, a spilling of metaphorical menstrual blood to determine who holds the higher ground or owns the greater truth. I’m committed to practicing contemplative dialogue to bridge the divisions between the two ends of the menstrual cycle polarity.

Two stupid ideas about menopause, and one that makes sense

July 3rd, 2013 by Laura Wershler

Two new suppositions about menopause have been tossed around the media in recent weeks. They make for racy headlines but both, unfortunately, perpetuate the myth that menopause is a disease women need to be protected from.

Most recent was the assertion by researchers from McMaster University in Hamilton, Ontario, Canada, that menopause in women is the unintended consequence of men’s preference for younger mates.

Men to blame for menopause

The writer with her mother Erna Sawyer who turns 95 on July 20, 2013. Is menopause an “age-related disease” that science must figure out how to prevent or an evolutionary adaptation for longevity?

Evolutionary biologist Rama Singh, co-author of the study published in the journal PLOS Computational Biology, gave this explanation in a CBC news story: “What we’re saying is that menopause will occur if there is preferential mating with younger women and older women are not reproducing.”

The study used computer modelling to arrive at this hypothesis. Singh said that this “very simple theory”…”demystifies menopause…It becomes a simple age-related disease, if you can call it that.”

Well, no Mr. Singh, you can can’t call menopause a disease. I challenged this idea in response to the Canadian Heart and Stroke Foundation’s Death Loves Menopause ads in February 2012.

Yet there he is, hoping his work will prompt research on how to prevent menopause in women, helping us to maintain better health as we age. What does he really know about menopause anyway?

Another stupid idea about menopause surfaced in late May with headlines like: Women could evolve out of menopause ‘because it is no benefit to them.’

Women could evolve out of menopause

The story, covered by media everywhere, was based on comments by biologist and science writer Aarthi Prasad at the 2013 Telegraph Hay Festival, Britain’s leading festival of ideas.

The Daily Mail reported that if women evolve out of menopause we could then have children well into our 50s (But how many women want to?), and that “targeted gene therapies will be developed to treat the condition.”

We’ve been fighting the assumption that menopause is a “condition” that needs to be treated for decades, with members of the Society for Menstrual Cycle Research at the forefront of this assumption-busting.

Quoted in The Telegraph, Prasad also said, “What we think is normal is not normal for nature. If it is something not in all mammals, is it something necessary or beneficial for us? I do not see any benefits.”

Wow! Menopause is not “normal for nature.” But what about the argument made by doctors like Elsimar Coutinho who promote menstrual cycle suppression, who assert incessant ovulation (i.e. reproductive capacity) is not natural, normal or healthy in humans, therefore we should take drugs to stop it?

These doctors and scientists need to get on the same page. Which is it? Do we ovulate too much or do we not ovulate enough?

As for “no benefits” to menopause consider this: What if menopause is an evolutionary adaptation that works in women’s favor?

Do women live longer, healthier lives because of menopause?

An October 2010 story in The Calgary Herald - Why don’t monkeys go through menopause? - discussed the research of University of Calgary anthropologists Mary Pavelka and Linda Fedigan who’ve spent years documenting the aging and reproductive histories of Japanese female macaques.

Few study subjects lived past their reproductive capacity, about age 25, and those that did showed signs of serious physical deterioration. For these primates, retaining the ability to reproduce until late in life did not make them healthier. Fedigan noted that they were “crippled up with arthritis, their face is all wrinkled and their fur is falling out.”

The question, they noted, was why would human females lose their ability to reproduce in healthy middle age?

“One hypothesis is that it’s a byproduct of evolution for longevity in humans,” Pavelka said.

Now here’s an idea that makes sense. Think about it. Men produce sperm – albeit of dwindling quantity and quality – until they die; women transition to menopause and can live healthy lives for decades after. Women live significantly longer than men. Therefore, it’s reasonable to hypothesize that menopause supports longevity in women.

#Making Menstruation Matter—For All the Wrong Reasons

April 15th, 2013 by Chris Bobel

Oops!

Somebody fell in it.

And by it I mean the tired old WomenCan’tDoStuffBecauseTheyAreWomen pit–a veritable snake hole crawling with misogynists, essentialists, and old school protectionists.

Image adapted from public domain photo // Design by Anne Bobel Zelek
[Actual menstrual status of shooter unknown. That's the point, people. You can't tell]

Terri Proud, a newly hired Administrative Assistant in the Arizona Department of Veterans’ Services, landed in the pit recently when she (allegedly) made comments about women’s menstrual cycles in combat. She was fired, and her boss, Colonel Joey Strickland, was asked by the Arizona governor to resign (apparently, Strickland hired Proud against the Governor’s wishes).

According to the Arizona-Sonora News Service, when asked about women serving on the front lines, Proud said “Women have certain things during the month I’m not sure they should be out there dealing with….”

Proud says she was misquoted. Was she or wasn’t she? Even if the quote is verbatim, I struggle to imagine a government official’s capacity  to register the absurdity of this comment, but maybe I am just cynical. Suffice it to say, there is surely more to this obviously political  here, but I’d like to focus on the menstrual dimension.

The assumptions about what women can and cannot do while menstruating make for a long and logic-defying list. The rationale for menstrual prohibitions is sometimes religious  (e.g., bans on menstruating women from religious rites, sex, and food preparation). There’s another category of no-nos beyond the menstrual taboo, though.  Women can’t do [fill in the blank] because their periods render them incapacitated or otherwise put them at risk. Many people still believe a woman should not camp or hike in bear infested woods because their menstrual odor will render them bear bait.  Not true. Often, women themselves are constructed as the predators during their PRE-menstrual period. You know….PMSing women are dangerous, even potentially homicidal. And women can’t be trusted to make decisions (or serve on the Supreme Court) because they are Out Of Control.

But we know differently. Women—during all phases of the menstrual cycle—can do all manner of things,  all the time, thank you very much, including jobs that are not, shall we say, menstrual management-friendly. They fight forest fires. They collect data in remote field sites. They orbit space. They are perform brain surgery.

Yet, PREJUDICE against women is often JUSTIFIED because they menstruate. The Disability Rights/Inclusion Movement has taught us that often, the most pernicious barriers to inclusion are perceptions, not the actual limits imposed by our disabilities. That’s certainly the case here. Let me go out on limb here: if women were respected, if women were valued, if women were seen as competent peers, then the fact of their menstruation would be less of a “disability” and more of a fact of a life.

But you know what? I want to give Terri Proud the benefit of the doubt for a minute. When pressed about her comment by The Arizona Daily Star, Proud said “I don’t have a problem with women being on the front line if that’s their choice….I’m not going to sit there and say, ‘No, you don’t have that right.” In the same story, Proud is described as harboring  a “curiosity”  about “how menstrual cycles are handled” and noted “that whether or not that hurdle is being addressed is a real issue, even if it isn’t talked about. Women are designed differently from men and need to have their needs met on the front lines.” And I say to that: well done Terri Proud, Menstrual Activist.

Because she is right. Menstruation is a reality, and menstruators need support and resources. Managing our menses can be tough when we don’t have access to facilities, or privacy, or both. Anybody that’s been camping while on their period can tell you that (bears notwithstanding) this IS a REAL issue. So she is right to ask (even if she is merely doing so to recover from blurting out something really dumb) What is the US military doing for women in combat? Now with the ban on women in (officially recognized) combat positions is no more, a change in policy that is expected to open 230,000 front-line positions to women, this question demands answers.

One answer: Suppress menstruation through the use of extended oral contraceptive pills. That is an option, yes, but it might not be the right one for every woman. Even beyond many menstrual cycle researchers discomfort with the one-size-fits-all approach to dosing cycle-stopping contraception (readers of re:Cycling are no stranger to concerns about this trend), there is a deeper concern about the implications of just making the menses go away.

Cycle stopping contraception, Liz Kissling has argued, enables a particularly new manifestation of the docile neoliberal subject. The feminine non-mensturating body, is not, as popularly believed, liberated, but rather, one held even tighter to the hegemonic male standard. Place this compliant amenorrheaic body in the context of the military and a curious paradox is revealed. The submissive soldier? The docile woman packing an assault rifle? Really? Seems both oxymoronic, and hardly like a gain in the fight for women’s equality.

Instead, can we imagine an expanded universe of menstrual management options?

  • Reusable cups and sponges provided for free (with eww-effect reduction training included) ?
  • Cycle stopping contraception offered as an option (not a mandate)—including an honest discussion of risks and benefits?
  • Quality reproductive health care in which menstrual health is a part of a comprehensive whole?
  • Work cultures, even remote ones, that acknowledge cyclical and variable human needs of all sorts?

Otherwise, if women must alter their very bodies to “fit in” and be taken seriously in their jobs, show me the ground we have gained. Cuz when I look down, all I see is the bottom of the same ole stinky pit.

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.

The reasons for depression are mysterious to me but this is an important adverse effect. I believe that anyone who has previously had an episode of depression (whether diagnosed or not, but sufficient to interfere with life and work) should avoid Depo.

LW: Although there has been little discussion about bone health concerns on the previous blog post, I think we should address the fact that Depo causes bone loss. How does it do this?

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.

Hormone Imbalance: Breaking the Silence

September 5th, 2012 by Elizabeth Kissling

Guest Post by Leslie Carol Botha Women’s Health Freedom Coalition Coordinator, Natural Solutions Foundation

I still remember the first Society for Menstrual Cycle Research Conference I attended in Tucson, AZ in June, 1999. The statement that made the most impact was the collective concern that in ten years there might no longer be a menstrual cycle. It turns out the truer words were never spoken.

In the past 40 years, the pharmaceutical industry has spewed out and packaged and repackaged so many synthetic hormone contraceptives – pills, injections, and implants that virtually eliminate the menstrual cycle.  It also amazes me that in the 30 years I have been involved with the women’s health movement condoms and spermicide are still the safest and most effective contraceptive on the market.

However, a new trend is emerging as condoms and birth control pills are being pushed on the back burner because of ‘human error’. Women and men are not always diligent or careful about condom use, and many girls and women forget to take their pills.  What is now being prescribed to adolescent girls – whether or not they are sexually active — are implants and injections. Health considerations are not taken into consideration, nor are hormone levels. Somehow the pharmaceutical industry still views this as a one-size-fits-all prescription for all women, no matter their age of their state of health.

Menstrual cycle advocates are most aware that birth ‘control’ is about control…controlling the woman’s body with potentially harmful synthetic hormones. What has been overlooked are education and natural methods of fertility awareness.

While our focus recently has been on the politics of birth control, another ugly monster has reared its head and that is the silent epidemic of hormone imbalance. Not only is this the result of taking synthetic hormones for birth control but our environment, our foods, and water supplies are filled with estrogen mimickers upsetting the delicate orchestration of hormones in our bodies.

Another concern is the excess estrogen stored in women’s bodies and passed on genetically to their offspring.  It is possible that their children are hormonally imbalanced at birth.

Either way, the damage has been done. I believe we are at the tip of the iceberg in this silent epidemic and that hundreds of thousands of women are being misdiagnosed and over-prescribed. In most cases, thyroid imbalance is not considered as a cause of depression, and the prescribed fix is generally Prozac or a higher dose of synthetic hormones.

In 2009, I posted an article to my blog, from eHow editor, Shelly Macrea titled: What is Hormone Imbalance?, a very informative article and probably one of the first pieces for a general audience on the myriad of conditions that hormone imbalance can cause.

At the time I had three responses (with an average of 30,000 unique visitors a month.) In June of this year, another post on the article (which by this time was buried in my archives) appeared from a woman suffering anxiety due to hormone imbalance. And then another post appeared and I decided to bring the article out of the archives and re-post it. What ensued was a steady stream of women commenting on almost a daily basis on their extreme anxiety and depression and the myriad of misdiagnosis and drugs they were prescribed. I am posting the link here so that others can read what I believe should be of concern to all of us: Hormone Imbalance Anxiety, A Precursor to Other Health Issues.

In March of this year, I posted Laura Wershler’s article Coming off Depo Provera Can Be a Woman’s Worst Nightmare. Once again, truer words were never spoken. More and more women are now posting about their experiences on this drug – and the ensuing hormone imbalance and health issues.

Women are suffering.

This is an insidious ‘War on Women’. On the one hand we have had to fight for our reproductive rights and the availability of birth control – on the other hand it is the same birth control that is slowly killing us.

Flipping the Image: Try New Semen-Off!

June 11th, 2012 by Chris Bobel

Cartoon created by Lisa Leger, with photo by Λ |_ ν- Γ Ø // CC BY-NC-SA 2.0

At the 2007 conference of the Society for Menstrual Cycle Research, a presenter cited the famous satirical essay by Gloria Steinem, If Men Could Menstruate, as inspiration for ”flipping the image”  to raise awareness about an issue.

 

Remembering this and frustrated by the marketing of cycle-stopping contraception, Lisa Leger created this spoof ad for a drug that suppresses an integral part of the male reproductive cycle.

She says,

I work in a pharmacy setting and monitor the medical journals to observe how the pharmaceutical industry markets drugs to both doctors and patients. An ad framing male ejaculation as a bothersome and icky inconvenience mirrors the way cycle-stopping contraceptives are marketed to women as a modern way to escape the hassles and mess of menstruation. By flipping the image and taking the same marketing tactics that are used toward women and using them toward men, the absurdity of suppressing a vital body function for the sake of convenience is revealed.

 

Lisa Leger is an SMCR member and fertility awareness educator who works in a community pharmacy setting on Vancouver Island. Her cartoons featuring the adventures of Wanda the Wandering Uterus have appeared in Femme Fertile, the newsletter of Justisse Healthworks for Women.

 

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 OurselvesQuestions 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.

Misogyny, Medicine, or Menstrual Madness?

February 29th, 2012 by Elizabeth Kissling

Guest Post by Lydia Aponte — Marymount Manhattan College

In Professor David Linton’s Social Construction and Images of Menstruation course, our class watched two documentaries involving menstruation and menstrual suppression. Both Period: The End of Menstruation? and Red Moon addressed what is becoming an increasingly concerning topic: now that menstrual suppression in the form of birth control is becoming more and more readily available – and is even being promoted to specifically stop or slow the menstrual cycle – is menstruation necessary?

Many women, including myself, have asked themselves this very question – some because of the monthly cramps that have reduced us to a fetal position, some because of the awkward situations that menstrual stigma has put us in. Yet, many women still do not question it because menstruation is believed to be a natural occurrence that must happen because, well, that’s just life. What happens, on the other hand, when a man questions the necessity of menstruation? Or even further, does something about it? Meet Dr. Elsimar Coutinho.

From São Paulo, Brazil, Dr. Coutinho appeared briefly in Red Moon avidly disputing the necessity of menstruation. He believes that it is not necessary, because “what is the use of an ovulation if it does not result in a pregnancy?” I was initially stunned by his intensity when it came to the subject, not only because of his stance against menstruation, but because of the role he seemed to be playing. It seemed as if Dr. Coutinho were playing the “mad scientist,” distributing birth control to women and spreading the word that menstruation was “unnecessary” and “unnatural.” So I decided to look up this “character,” and came upon Dr. Coutinho’s biography page. Of course, the first paragraph of his bio was nothing but praise: “Dr. Elsimar Coutinho is, unquestionably, a man born to make history. For more than 50 years, his research and discoveries in the fields of human health and reproduction have broken paradigms and brought down millenary concepts.” (For a man who made history, I had never heard his name before Red Moon.)

Yet, I was more taken aback by how he had been quoted regarding menstruation. “My greatest contribution to humanity was to realize that menstruation was unnecessary, a disposable phenomena.” (Coutinho, E.M.) Not only is a doctor refuting the biological necessity of menstruation, which alone is jarring, but a man is refuting the necessity of a cycle highly regarded by many women, including myself, as a symbol of womanhood and deeming it “disposable.” Not only is Dr. Coutinho refuting it, he is actively taking measures to suppress menstruation through his research and practices.

If menstruation equals womanhood to so many, and Dr. Coutinho believes that menstruation is unnecessary, what is he saying about the beliefs and values that many people hold in regards to femininity? According to his philosophy, those,too, would be disposable. Dr. Coutinho’s suggestions — although questionable — have caused me to ask these questions: has something I regarded a natural part of my female biology been unnecessary this entire time? Is the human body wrong, and is Coutinho seeking to correct it with medicine? Or is misogyny still a key player in the menstrual realm?

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.