Blog of the Society for Menstrual Cycle Research

The pill, reduced period pain and the ongoing delusion

January 20th, 2012 by Laura Wershler

Is there a woman over the age of 18 anywhere who doesn’t know that taking the birth control pill can make her periods lighter and less painful? Most women know this, but not many know why. The news stories swirling around a new study about the pill and period pain will not enlighten them.

Photo credit: Ceridwen, Creative Commons 2.0

A 30-year longitudinal Swedish study has finally proved the worth of what is accepted practice in North America and Europe: the prescribing of combined oral contraceptives (COCs), or birth control pills with synthetic estrogen and progestin, to treat painful periods known clinically as dysmenorrhea.

Of course, pharmaceutical companies that manufacture COCs are probably eager for this research, as prescribing the pill for dysmenorrhea is still an off-label use in the U.S. (unlicensed use in the U.K.). Pill manufacturers may be able to use this finding to lobby the FDA (or equivalent agencies in other nations) to approve the pill as treatment for menstrual pain, leading to increased sales and insurance coverage. Perhaps that’s why news media have been treating this discovery as breaking news.

Take this headline: Yes, the Pill CAN ease the agony of period pain: Scientists confirm what millions of women already know, or this one: The pill ‘does ease period pain’, or this one: Combination oral contraception pills cut menstruation pain, or, really, any of these.

You can read the abstract of the study by Swedish researchers Ingela Lindh, Agneta Andersson Ellström and Ian Milsom, published this week in the journal Human Reproduction, here: The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. The conclusions are simple: “COC use and increasing age, independent of each other, reduced the severity of dysmenorrhoea. COC use reduced the severity of dysmenorrhea more than increasing age and childbirth.”

Forget the age factor for the purposes of this discussion. The fact that COC use reduces the severity of dysmenorrhea is not astounding. This is old news. So says Dr. Steven Goldstein, an obstetrician/gynecologist at NYU Langone Medical Center in New York City, quoted in a USA Today story:

“The study results are not surprising. It’s gratifying to see researchers documenting scientifically what practitioners have been seeing for a very long time. The amount of discomfort from a woman’s period with a combination birth control pill is a fraction of what it is without the Pill. There is a diminution of pain from the Pill.”

What is astounding is what Dr. Goldstein, and other OBGYNs, didn’t say in responding to the study. That the reason the pill reduces menstrual pain is because the synthetic hormones in the pill shut down a woman’s own menstrual cycle. The “period” women experience when on the pill is technically known as a “withdrawal bleed,” brought on by seven days of placebo pills. While it feels like a period to menstruators, it is not the same physiologically as the period they experience when NOT on the pill. That’s why it doesn’t hurt as much.

The point is, the pill is too often credited with regulating the menstrual cycle. It does no such thing. The pill does not regulate any woman’s menstrual cycle; it supercedes it. This research, and the many news stories that reported it, once again ascribe power to the pill – this time the power to cut menstrual pain. This is an incomplete truth.

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New versions of menstrual suppression drugs on the way?

August 4th, 2011 by Elizabeth Kissling

Successful tests on rhesus monkeys are a long way from clinical trials on women, but this is interesting to those of us following the conversations and debates about cycle-stopping contraceptives: new research testing progestin antagonists indicates that the drug can be successful in suppressing menstruation without necessarily suppressing ovulation. Another variant of the drug can suppress both menstruation and ovulation.

Dr. Robert Brenner, who is the lead researcher conducting these studies in the Division of Reproductive Sciences at Oregon Regional Primate Research Center, notes that this has potential beyond just a new lifestyle drug:

I would emphasize that we are not talking here only about lifestyle choices but also about the potential to bring relief to the many women who suffer years of misery from distressing complaints such as endometriosis, and painful and excessive monthly bleeding. In fact, excessive bleeding is one of the major reasons that women undergo hysterectomy, and this treatment may also reduce the need for this surgical procedure, with all its attendant risks and costs.

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Don’t Ask, Don’t Smell

January 27th, 2011 by Elizabeth Kissling

female-minority-happy-military-wide-horizontalGuest Post by Emily Swan, Marymount Manhattan College

With the military’s history of suppressing minority groups, its new effort to conceal and terminate menstruation comes as no surprise. Hopefully, the menses will be able to come out of the closet soon enough.

I recently wrote a paper about menstruation in the military and was excited to see this recent post at re:Cycling. Researchers have suddenly become sensitive to the “devastating” effects of menstruation on women in combat and training, citing a potential link to iron-deficiency, among other things. (Might I add that, while the article identifies menses as the culprit, the actual data suggest no correlation between the loss of menstrual blood and the low iron levels of the participants.) Researchers have also conducted studies and interviews to determine the level of difficulty menstruation adds to a variety of physical activities and expose reported difficulty in obtaining, storing, transporting, changing, and disposing of “sanitary products” (Note the hygiene-promoting terminology). These reports have indicated a significant struggle with menstrual management, giving grounds to the military’s new encouragement for women to use continuous oral contraceptive pills (OCPs) to “temporarily” induce amenorrhea.

What’s happening here is not simply a conquering of the menses but an overpowering of women as a whole. The article about iron deficiency says it best, with its opening paragraph explaining the biological disadvantages of women: women’s lower levels of physical strength, inferior aerobic performance, and a number of other physical and mental “shortcomings” that include the ability to menstruate. It states, “the physical differences between genders in the military setting should be minimized as much as possible” (866). They’re not trying to make women more comfortable by stopping their periods; they’re using men to set the physical and mental performance standard for which women must strive. The failure of women to meet this standard lies in their very biology; the study directly blamed their femaleness as the source of this imbalance. It’s not, “Stop menstruating because it will help you.” It’s, “Stop menstruating because it will get you that much closer to being a man.” Oh joy.

The misogyny embedded within this move toward menstrual suppression does not discount the results of the studies; menstrual management poses a serious issue for most military women! In addition to the difficulty reported in transporting, obtaining, and storing products, another article relayed the troubling results of interviews from women of the Air Force, Army, and Navy regarding personal hygiene and field menstrual management.4 These interviews told of highly unsanitary bathroom facilities in combat environments, lack of privacy for the use and changing of menstrual products, and bathrooms that rarely contained receptacles for disposing of the products. The women reported collecting used products in Ziploc bags to either bury them in the secrecy of night or to keep them in their luggage until they returned to the U.S. Because of the hot, moist climates inhabited during deployment; the heavy, reused, and unwashed clothing; and the frequent lack of water or time to wash up, the interviewees reported constant awareness and humiliation surrounding menstrual odor. Most of the women also admitted hesitancy toward utilizing the clinic for menstrual health issues because they were made to feel that their menstrual symptoms were not worthy of care. They also reported that gynecological exams were excluded from their general deployment health examinations.

Menstrual Suppression for Military Women

January 13th, 2011 by Elizabeth Kissling

One of the arguments for using hormonal contraception to suppress the menstrual cycle is that it mitigates the logistical challenges menstruation can present in high-stress occupations in harsh settings — such as military service in a combat theatre. Given how  compelling the argument is, it’s surprising that birth control pills/patches aren’t used in these settings more frequently.

A new study in Women’s Health Issues indicates that although service women are eager to learn more about the option of menstrual suppression, education about it is lacking. A survey of U.S. women serving in Iraq, Afghanistan, and other combat operations indicates that the number of lost duty days due to menstrual pain would likely decrease with better education about suppression options and compliance regimens.

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How the Birth Control Pill Works: An Illustrated Guide

November 17th, 2010 by Elizabeth Kissling

tumblr_pill_500


[Source: Jackie, Let's Be Honest]

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Blood on Screen: Red Moon

August 2nd, 2010 by Giovanna Chesler



Red Moon: Menstruation, Culture and the Politics of Gender may have crossed your path as The Moon Inside You (its original title prior to 2010 its current distribution through Media Education Foundation). It is a film that has enjoyed wide release, with exhibition on French television and inclusion in an EU showcase of films that circulated last year. The broad exhibition strategy of Red Moon is fitting; it has a casual, heartfelt and humorous style that should appeal to many.

The purpose of Red Moon, as articulated by the filmmaker Diana Fabianova in voice over, is to answer this question: “At any given time, 25% of the female population is menstruating. Invisible. Discreet. Why is this normal, biological function taboo? There must be some deeper meaning.” There are problems with this statistical framing device – 25% is an over inflated number that eliminates girls and post-menopausal women as “females”. It also glosses over females that do not menstruate because of gender transformations and amenorrhea. Outside of this statistical malfunction, there are a few other facts provided through voice over which are not supported by specific research or attributed directly to any menstrual researchers. However, beyond these slights, Red Moon has great potential to make a taboo subject approachable.

As it begins with man-on-the-street interviews, the film seems to have interest in addressing men as equally as women. Through interviews with researchers who have written about menstruation in the 80’s and 90’s, the film attends to menstrual taboo historically and highlights menstrual suppression as an issue to address within patriarchy. There is a fantastically creepy interview with Elsimar Couthino, famous for inventing Depo Provera, Norplant and for writing Is Menstruation Obsolete (the book that launched millions of suppressed periods.) In his interview Couthino believes that women should have no more than one period in her lifetime and he likens menstruation to pending death: “First of all, menstruation is incompatible with life and nature, because an animal cannot survive bleeding longer than a few minutes in the forest. Blood, the smell of blood (he sniffs) attracts the predators. This one is bleeding. She is going to die.” Fabianova comically cuts to a hooting owl, waiting for your blood.

Fabianova is critical of pill-popping mentality and finds it better to challenge the negative view of menstruation, and silence around it, rather than do away with the period altogether. While she provides some examples of solutions to painful PMS (a belly dancing class delights, for example) the film does not directly address dysmenorrhea and severe menstrual challenges which have become justification for suppression in the first place. It does however, remind menstruators on hormonal birth control that the blood you see is a fake-period.

In fellow Re:Cycling blogger Chris Bobel’s recently released book New Blood: Third Wave Feminism and the Politics of Menstruation, she focuses on the type of menstrual activist stylings akin to Red Moon. In short, feminist spiritualism, according to Bobel, is a narrowly focused mode of menstrual positivism that essentializes the idea of womanhood through menstruation. The movement typically appeals to middle class white women and identifies menstrual change through the self. In feminist spiritualism, political action is limited to the individual menstruator or to the girls the menstruator is encouraged to educate. Red Moon treads in this territory throughout as interviewees speak to menstrual energy, the preciousness of menstruation, and the spiritualism in bleeding. The film ends with this logic as a nude woman walks through city streets, dropping red blobs that spring new trees to life through CGI effects. In voice over we hear about the filmmaker’s changed subject position: “I no longer fight with my hormonal clock, because it is she that reminds me once a month that I have a personal, intimate connection to nature and the universe.” It’s too bad the film narrows its final message to the individual, rather than reflecting on some of the broader work done throughout, like connecting negative menstrual associations to patriarchy, and demonstrating how certain menstrual practices harm the environment and our wallets. Overall, Red Moon is a conversation starter that requires additional reading to supplement its message.

How to overcome resistance to Cycle-Stopping Contraception (a physician’s guide)

May 12th, 2010 by Chris Hitchcock

If you’re wondering why your doctor might not take you seriously when you question taking the pill to abolish your periods, you might want to look at this piece of advice.

I had a look at the Clinical Advisor magazine information – it looks like they pay for articles, help to massage them into shape, but as far as I can tell the articles are not peer-reviewed, and the editorial staff do not have any credentials after their names, so they look like non-medical people. But it is freely available on the web, and apparently gets sent to many practicing physicians and nurses. And it’s a lot more readable than other sources of medical education.

The article is framed as a doctor-to-doctor question:

What can I do to overcome patient resistance to continuous use of oral contraceptives (OCs)? So many women say it’s not natural.—SHERRY HILL, ARNP, Bothell, Wash.

And, the answer? Explain the physiology, explain that there is no build up of old blood, that menstrual flow doesn’t have any effect on infections or toxins. And, for talking points, use the educational materials about cycle-stopping contraceptives on the Association of Reproductive Health Professionals web page (coincidentally funded with unrestricted educational funds from companies who happen to make cycle-stopping contraceptive products). And use Malcolm Gladwell’s 2000 article, John Rock’s Error, to reframe monthly menstrual flow as a historic anomaly (“you don’t need that old-fashioned thing”) and help women to see their regular menstrual flow as unnatural, so that the synthetic drugs you are suggesting will seem less unnatural by comparison.

But, ultimately, “if a patient feels that a monthly withdrawal bleed suits her best, many OCs containing 21 active pills and seven inert pills are available.”

I guess the option of using non-hormonal contraception just won’t come up.

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What’s Up with Yaz?

April 3rd, 2010 by Elizabeth Kissling

Yaz box and pill pack.We’ve mentioned Yaz and its sister drug Yasmin before, and our friend Holly Grigg-Spall tracks the progress of complaints against them and other oral contraceptives. Yaz and Yasmin were Bayer’s top-selling drugs in 2008, bringing in about $1.8 billion, a 17 percent increase from 2007. The key element that makes them different from other OCs is drospirenone, a new form of synthetic progestin which has a pharmacological profile that is reported to be closer to the human body’s own progesterone but a safety profile that has come under scrutiny since the FDA approval of Yaz/Yasmin. Last fall, Bayer revealed that they were fighting 129 lawsuits over side effects and marketing of Yaz and Yasmin. More suits have since been filed.

So with this context in mind, it was with great interest that I noticed this study in my periodic searching of menstruation research literature: Bleeding patterns and menstrual-related symptoms with the continuous use of a contraceptive combination of ethinylestradiol and drospirenone: a randomized study, published in last month in Contraception. It’s a small study, only 78 women over six months time, but the researchers conclude: “Continuous use was associated with amenorrhea and fewer menstrual-related symptoms compared to cyclic use.”

It looks like Yaz and/or its analogues are being tested for marketing as menstrual suppression drugs. Time to put in an interlibrary loan request to get my hands on the full study. Anyone want to place bets on how the study was funded?

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What’s Sick?

March 31st, 2010 by Chris Bobel

crestorToday, there’s a front page story in the New York Times about Astra-Zeneca’s move to market their cholesterol pills (known as statins, and as the NYT reports, already the most prescribed drugs in the US)  at healthy people in spite of unresolved concerns about risks, namely an elevated risk of developing Type 2 diabetes.

Gee. This sure sounds familiar: a  product aimed at healthy people, approved by the FDA, even before there’s ample evidence of safety.

I am imagining the new ad campaign…”Why let cholesterol worries slow you down? Choosing healthy foods and getting adequate exercise is sooooooo 20th century.Take a pill. Done.”

Of course, the comparison I am hinting at here is flawed. High levels of cholesterol ARE a genuine hazard. Heart disease is deadly.  Conversely, menstruation is NOT a disease and under most conditions, need not be treated.

But my point here is to call attention to Big Pharma’s too-quick impulse to sell drugs of questionable safety to healthy people and FDA collusion in this.  Marketing cycle-stopping contraception (a.k.a. menstrual suppressive contraception a la brands Lybrel and Seasonique, for example) to healthy women is not an isolated incidence of the premature and high-risk mainstreaming of prescription medications. See recent critiques here and here (and the official Society for Menstrual Cycle Research position statement on cycle-stopping contraception here).

In the eyes of Big Pharma, if we aren’t sick, we will be soon. If we aren’t dosing  The. Next. New. Drug, we aren’t taking charge of our health.

Sick? I think THAT’S sick.

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So the pill won’t kill me; what’s the point?

March 18th, 2010 by Laura Wershler

Women on the pill live longer. So touts a March 12, 2010 Reuters news story out of London, England reporting on a study published March 11 in the British Medical Journal (BMJ). A misleading headline if ever there was one.

The study followed 46, 000 women for up to 40 years, to see if the mortality risk among women sho have used oral contraceptives differs from that of never users. What the study actually found, according to the public release issued by BMJ on March 12 is this: “Women in the UK who have ever used oral contraceptives are less likely to die from any cause, including all cancers and heart disease, compared with never users.”

The study also found a slightly higher risk (of death, I presume) in women under 45 years old who are current or recent users of the pill.  As such, the authors assert:

Many women, especially those who used the first generation of oral contaceptives many years ago, are likely to be reassured by our results.  However, our findings might not reflect the experience of women using oral contraceptives today, if currently available preparations have a different risk than earlier products.

I’m 56 years old. I didn’t take the pill in the UK. But I did take it in Canada in the early to late seventies, back when it was much stronger than it is today. And back when it was NOT common for women to start the pill at 15 and take it for a decade or longer.  Am I reassured by these findings? Sort of. Although years of hard-fought-for healthy, ovulatory menstruation, subsequent to my year long post-pill amenorrhea, are more likely responsible for my good health than having  been an “ever user” of oral contraceptives. And more likely to protect me from heart disease and cancer than whatever benefits I may have derived from my on again, off again pill-taking history.

As for women under 45, it’s not just the “currently available preparations” I’d be concerned about. And there are tons of them: multiple variations of standard pills, continuous use pills like Seasonale and Lybrel, and cycle-stopping contraceptives like Depo-Provera and the Mirena IUD. The other concern is that the contraceptive use of young women today is much different than it was in my youth. They start using oral and other hormonal contraception at younger ages, before their reproductive systems have fully matured and their fertility (regular, ovulatory menstrual cycles) is well established. And they tend to take it for longer. The verdict on the long-term effects of this kind of contraceptive use is yet to be determined.

I’m not going to debate the merits or faults of this study or the unanswered questions it raises. The question I really want to ask is “What’s the point?”

The cynic in me believes that this study, and misleading headlines like Women on the pill live longer, will be used to compel women of all ages to ‘shut up already’ about their growing concerns with hormonal contraception. It will be dragged out as “scientific evidence” that taking the pill saves lives, as is implied in this article published by the Daily Mail:

The contraceptive Pill can extend your life and may even save 1,500 lives a year, a study has suggested.

Women who have taken the Pill at any stage in their life are less likely to die from any cause – including heart disease and all types of cancer – than those who have never taken the oral contraceptive.

But wait, here’s the next paragraph:

However, the positive effects may only be enjoyed by women who have taken older-style pills rather than those on newer drugs.

Bravery and Intellect Over Easy: Scrambled

March 12th, 2010 by Giovanna Chesler

(This post also published at the blog g6pix.)

I’ll try not to sound too fan-girlish here as I write about the documentary Scrambled: A Journey through PCOS by Randi Cecchine, but admittedly, it is a difficult task. For in this film, which chronicles Cecchine’s struggle with Polycystic Ovarian Syndrome, we meet a filmmaker brave enough to show us, wart-hairs and all, the challenges inherent in this disease embodied. She does so with humor, with information, and with space for personal reflection.

As Cecchine and the health practitioners she speaks with share, PCOS is a condition that affects 8% of women but that goes under-diagnosed. Though largely undetected in the women who have PCOS, the first sign of something wrong is the absence or change in the menstrual period. According to Cecchine’s participant Dr. Geoffrey Redmond, an endocrinologist who has studied female hormone problems for over twenty years, PCOS generally shows up during puberty or shortly during the menarche period. In his interview, he argues that a delay of fifteen years in diagnosis typically occurs because “people who care for teenagers are typically not clued into this condition.”

In popular rhetoric on menstruation and menstrual suppression, there are many voices who have argued that having a menstrual period is unnecessary and should be done away with through hormonal birth control regimens (for example, Lybrel, Depo-Provera and Seasonale.) These drugs are often presented as choices to girls and young women close to menarche. Scrambled serves to intercept this discourse by demonstrating how the cycle becomes a sign of imbalance and illness. This film reminds us of the value of attending to the menstrual cycle. In Cecchine’s case, as in the case of the many women she interviews in her film, the lack of a period is a personal introduction to the disease.

Cecchine works with a light yet serious tone. A visit to Harry Finley’s Museum of Menstruation underscores the connections between menstruation, body awareness and PCOS. Yet we are able to marvel and smirk at Finley’s collection of menstrual advertising and decades old menstrual protection products which now live in his basement. As her lived investigation continues, Cecchine meets up with the Polycystic Ovarian Association (PCOSA) at their conference. There her film does remarkable work, as it invites the viewer to join in the conversation. In the scenes around the conference, we see how this film works to invite fellow PCOS women into the information Cecchine has gleaned. Though knowledge will not cure one from the illness, certain techniques shared in the film (like limiting carbohydrate intake) will result in reduced symptoms.

In the recent release of the film, which is self distributed, Scrambled is a two disc set. The first disc includes the documentary, but the second disc is chock-full of informative interviews on a variety of topics. Cecchine profiles Redmond along with many other health workers practicing western, eastern and alternative medicine who speak of the options for treatment. These include diet alterations, drug regimens, psychotherapy, acupuncture and others. In this disc, Cecchine provides the tools for a viewer with PCOS to address her syndrome through many methods. By providing information in this manner, Scrambled becomes a guide and a tool for holistic health on a personal level.

But these treatments comes at an expense. Here Cecchine’s humor bubbles up again when she shares the different techniques, like hair removal, pills, acupuncture treatments and their resulting costs. Yet, the feeling that comes afterward: “Priceless!” Bitingly Cecchine reminds us that being a patient also involves being a consumer. Therein she complicates these treatments as choices and necessities simultaneously.

Menstruation and Music Don’t Mix

January 29th, 2010 by Elizabeth Kissling

Cartoon illustration of opera singerThat’s the report from this arts blogger at the New York Times. Yesterday, doctors from the Methodist Center for Performing Arts Medicine of the Methodist Hospital in Houston held a daylong symposium on the management of medical problems among musicians specifically and performing artists more generally. Performing-arts medicine is a relatively new specialty, and frankly, I’m not surprised by the need for it. (I know a drummer who has ongoing neck and back problems caused – or at least aggravated – by his art.)

But I was surprised to see a blanket recommendation that female vocalists use oral contraceptives to suppress menstruation. According to Keith O. Reeves, the deputy chief of Gynecology at the Methodist Hospital and a professor at Weill Cornell, premenstrual syndrome “brings vocal fatigue, decreased range, loss of power and loss of some harmonics.” Continuous use of synthetic hormones is quite an extreme remedy for an illness without a clear definition or etiology.

But apparently menopause is much harder on the vocal folds – our intrepid blogger can’t even tell us:

As for menopause, you don’t want to know. As Dr. Reeves quotes the great mezzo-soprano Christa Ludwig, “It was a hell of some years.”


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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.