Blog of the Society for Menstrual Cycle Research

What’s In A Name?

March 27th, 2014 by Heather Dillaway

This month an important Sage research journal, Menopause International, “the flagship journal of the British Menopause Society (BMS),” changes its name to Post Reproductive Health. The Co-Editors of this journal are quoted in talking about this name change:

“Women’s healthcare has been changing dramatically over the past decade. No longer do we see menopause management only about the alleviation of menopausal symptomatology, we also deal with an enormous breadth of life-changing medical issues. As Editors of Menopause International, we felt that now is the time for the name and scope of the journal to change; thus moving firmly into a new, exciting and dynamic area. We wish to cover Post Reproductive Health in all its glory – we even hope to include some articles on ageing in men. Our name change is a reflection of this development in scope and focus.”

This name change may seem very insignificant to most people but, for me, a change in name signifies major steps in conceptual thinking, research practice, and (potentially) everyday health care. While I have some problems with the new name (I’ll get to those in a minute), the idea that menopause researchers and practitioners are beginning to see menopause as part of a broader life course transition is phenomenal. It signifies the willingness of many in the business of studying and treating menopause to think more broadly about reproductive aging. It also indicates that many now understand that menopause is not necessarily the “endpoint” of or “final frontier” in one’s reproductive health care needs. Perhaps it also means that we might acknowledge that perimenopausal symptoms are more than single, isolated, “fixable” events and that they may be related to larger, long-term bodily changes. The very idea that “post reproductive health” is important is one that I support and advocate, and I see this as evidence of the realization that there is life after menstruating and having babies. What’s more, the re-branded journal seeks to include research on men’s health too, perhaps signifying that researchers and practitioners acknowledge the sometimes non-gendered aspects of “reproductive” or “post-reproductive” health. Everyone needs health attention, no matter what their life course stage.

What I can still critique about the name change, though, is that the new name of this journal suggests that menopause and other midlife or aging stages are thought of as “post”-reproductive. In my opinion, it is really that we live on a reproductive continuum, that we are never really “post” anything, that prior life stages always continue to affect us and that there are not strict endpoints to the menopausal transition in the way that the word “post-reproductive” might suggest. Reproductive aging as a transition could take as much as 30 years or more, and women report still having signs and symptoms of “menopause” into their 60s and beyond. According to existing research our “late” reproductive years begin in our 30s and don’t end until….what? our 60s? our 70s? The word “post-reproductive” suggests an “end” that maybe doesn’t really exist ever. Here is a link to an article I wrote on this idea of the elusive “end” to menopause, and I think it is important to think about how the word “post” may not be the best way to describe how we live our midlife and older years. We may still have “reproductive” health needs way into our 70s, 80s, and beyond, so how can we think of ourselves as “post” anything?

With this said, however, I still am very happy to see the current name change of the journal, Post Reproductive Health, because I believe it signifies a very important change in the right direction, and I hope to see many more moves like this as we contemplate what midlife and aging health really is.

“If Menstrual Health is the Neglected House on the Block … Then Endometriosis is the Basement”

September 12th, 2013 by Saniya Lee Ghanoui

Guest Post by Heather Guidone, CWC, Surgical Program Director, Center for Endometriosis Care

All photos courtesy of Heather Guidone.

The Center for Endometriosis Care was honored to present at the Society for Menstrual Cycle Research’s 20th Biennial Congress in early June, an event featuring the world’s leading professionals including physicians, nurses, psychologists, sociologists, anthropologists, women’s and gender studies scholars, and many others – not the least of whom was Honoree Gloria Steinem. Tasked with identifying public health challenges and barriers to including menstrual cycle disruption/disorders as key components of women’s health, and explore ways by which to overcome these critical gaps in pelvic health, we tried to drive the point home as to how largely ignored endometriosis is:

“If menstrual health is the neglected house on the block, then endometriosis is the basement.”

We explored and investigated the shortfalls in endometriosis, in that, yes, endometriosis is a disease of menstruation – but it is also true it has far deeper impact on a woman or girl’s life and places a significant public health burden on our society. Endometriosis isn’t merely about painful menses. The disease is a debilitating, costly illness linked to chronic pain, impaired fertility, and significantly reduced quality of life.

Endometriosis affects menstruators and non-menstruators alike (post hysterectomy, post menopause, etc.), and remains fraught by significant diagnostic delays, high treatment failures and consequent recurrence – all of which pose formidable challenges to practitioner and woman alike. Unfortunately, many women and girls are not taught what is ‘normal’ and what may be indicative of a problem; largely, ‘period taboos’ stifle the conversations we should be having about signs and symptoms of the disease.

Moreover, research remains sorely lacking in priority and offers little bench-to-bedside translation; there remains an acute need for coordinated investigation into pathophysiology, precision treatment, association with co-morbid conditions and prevention/cure. Women are too often told the pain is in their head; still others espouse ancient, mythical notions of hysterectomy and pregnancy as cure. None of this is true, and such sentiments are a monumental disservice to those suffering. Sadly, even well-meaning clinicians – not just lay society and the media – remain ignorant of the damaging effects the disease imposes on girl’s and women’s physical well-being, sexual function, fertility and general welfare, creating a vicious cycle of ineffective treatment.

It has been said by some that endometriosis is a disease of the ‘modern age’; that women and girls have brought the disease upon themselves by delaying childbearing in lieu of careers and academic goals. This is completely untrue, as we have seen accounts in the Ebers and Kayun Papyrus’ of what could easily be today translated as endometriosis. There are also rumored cave drawings and Egyptian hieroglyphics depicting uterine pain. As years progressed, we eventually came to a better understanding of endometriosis and the significance of pelvic pain – but this still hasn’t changed society’s view of menstruating women. Menstruation – particularly menstrual pain – remains largely belittled, marginalized, ignored, medicalized and dismissed. It may not be a menstrual hut, but we’re certainly still sending girls away today in the metaphorical sense – away from timely diagnosis and effective intervention for this disease.

Why should we care about painful menstruation? Women bleed, women hurt. Right? Wrong. This disease is not about painful periods. It’s about a debilitating illness that takes tremendous personal and societal toll:

  • Drastically reduced overall quality of life
  • Severely compromised academic/professional opportunities
  • Critically impaired sexual, mental, physical, emotional functionality
  • Negative/far-reaching impact on relationships
  • Significant loss of productivity
  • Erroneous “in your head” diagnoses may lead to emotional/psychosocial issues
  • Dependence/addiction accusations
  • Often unnecessary/ineffective/repeated medical and/or surgical treatments up to and including hysterectomy do little to help, yet contribute to vast and gratuitous healthcare expenditures

Understanding Research: (Meta)Theoretical Frameworks

August 19th, 2013 by Paula Derry

Research results are often reported by the media as stand-alone statements and as though they are facts. “Slim women have a greater risk of developing endometriosis than obese women.” “Respiratory symptoms vary according to stage of menstrual cycle.” In previous blogs, I have said that a reader needs to understand research methods and basic concepts found in statistics in order to make sense of what results really mean. This blog is about another ingredient that goes into making sense of research. Metatheoretical frameworks, basic ideas of how the world works, are important influences on how researchers choose what problem to study, choose the methods with which to study it, and choose how to interpret the results.

The context of research is always stated in research articles. Articles always include a write-up of previous work, discussing what has been done and what unanswered questions remain. This sets the stage for why the research being reported is interesting and important. However, what I want to discuss are more general, often implicit, basic assumptions. Even what seem to be brute facts are understandable as such only within a given set of basic assumptions or paradigms. Paradigms guide thinking, but change over time.

Thus, as discussed by Sheila Rothman, a  nineteenth century metatheory was that assertiveness and activity are dangerous for women. As stated in a more specific scientific theory: All people have a limited amount of nervous energy; this nervous energy is distributed over a greater number of organs in women than in men (because of their reproductive organs); therefore, all of women’s organs are more “sensitive and liable to derangement (p. 24).” It was concluded from these ideas that exercise and exertion are dangerous for women; further, mental exertion, such as going to college, should be avoided. Rothman describes case studies written up by physicians of women harmed by exertion and cured by rest. In this context, designing research to evaluate whether college harms women appeared to be a sensible, even important undertaking. So did structuring a college curriculum to avoid precipitating debility or insanity.

What are some of our current basic paradigms? One example: Menopause is senescence and reproductive physiology is central to women’s health. It follows from these premises that menopause or the transition to menopause are key factors in the development of chronic illness; research addresses what harm is created or, alternatively, whether these premises are correct. Another example: Cyclic changes in mood, intellect, and energy during different stages of the menstrual cycle are very important, especially to understand distress. Alternatively, a healthy menstrual cycle suggests that a woman is physically healthy.

Research I am conducting with Greg Derry addresses another metatheory about the menstrual cycle. Periods are most often described as cyclic, recurring in a regular repetitive manner (“every 28 days”). However, modern systems theorists know that there is a different kind of system (a “nonlinear dynamical system”) that by its nature generates a little bit of unpredictability and by its nature interacts with other systems (“is an open rather than a closed system”). Our research has provided evidence that the menstrual cycle is a nonlinear dynamical system. This means, among other things, that menstrual periods would be expected to be a little bit irregular with an occasional extreme cycle length.

The psychologist Robert Abelson reminds us that research is an ongoing process of discussion. Understanding research means joining the conversation.

Ethics in Wonderland: The SUPPORT Study

June 24th, 2013 by Paula Derry

Arthur Caplan is a well-known ethicist, the head of the Division of Medical Ethics at New York University’s Langone Medical Center. On June 11, 2013, Caplan posted an article called “Get real: No need to overdo risk disclosure” on the medical website Medscape. According to basic ethical standards, subjects in research projects are supposed to give written informed consent, which means among other things that they are informed of possible risks that a decision to participate in the study might cause. The Office of Human Research Protections (OHRP) of the U.S. Department of Health and Human Services criticized researchers in a large project called SUPPORT for failing to clearly disclose the study’s risks. In his Medscape article, Caplan disagreed with OHRP and argued that strict, inappropriate requirements for consent discourage important research. His sentiments were echoed in a recent editorial in the New England Journal of Medicine, a major respected journal. In contrast, SUPPORT is criticized in a New York Times editorial entitled “An Ethical Breakdown” and by watchdog organizations like the Alliance for Human Research Protection and Public Citizen (many of the critical documents are on the Alliance for Human Research Protection website).

Here’s some background: SUPPORT was a large study of how best to treat very premature babies. These babies often need to be given oxygen to help them breathe. However, if too little oxygen is given, there is a risk of death or brain damage; if there is too much, the babies may develop an eye problem called ROP or blindness. Enter SUPPORT. According to the researchers, their goal was to determine the best oxygen level to get lowest risk of blindness without increased risk of death. This amount had already been narrowed to 85% to 92% oxygen saturation (a measure of the oxygenation of blood) in medical practice; the researchers wanted to find out where within this range is best. Infants in the research were randomly assigned to experimental conditions; in one condition, babies were given enough oxygen to bring the oxygen saturation measure to the lower end of the range (averaging 85%); in the other condition, the higher end (averaging 92%). The researchers found that infants receiving less oxygen did, indeed, have fewer eye problems than did infants given the higher amount, but more of them died.

The critical letter from OHRP stated that the consent forms that the mothers of the babies signed should have clearly stated, but did not, that an increased risk of blindness (for babies in the higher oxygen condition) or death (for babies in the lower oxygen condition) was possible. The ethicist Caplan objected to this. He argued that the researchers were comparing two standard medical practices, since 85% to 92% is the standard range used by doctors. In his view, the current way that doctors decide how much oxygen to use within that range is “a coin flip”; randomly assigning babies to the experimental groups was simply comparing two treatment approaches currently in use to see which one is best and involved no increased risk than the babies would otherwise face. He distinguished this from studies that introduce a new treatment, where informed consent about risks is a different matter. Caplan stated: “I believe that this research is highly ethical” and expressed concern that overly strict rules will hinder needed research. The New England Journal of Medicine editorial also objects to the OHRP letter. The editorial states that the OHRP’s finding that subjects should have been informed of an increased risk of death was based on hindsight. The editorial quotes the researchers, who state that “there was no evidence to suggest an increased risk of death” for infants receiving the lower levels of oxygen before their study was done. The editorial states that OHRP has “cast a pall over the conduct of clinical research” and “strongly disagree[s]” with their letter. SUPPORT, in the editorial’s view is “a model of how to make medical progress.”

What is the controversy? First, with regard to the idea that what was being compared were two versions of standard care, although Caplan does not state this in his article, the OHRP letter specifically addressed this point. In real clinical practice, a range of 85% to 95% exists, but in this study only the extremes were used. As the letter states:

Averages

May 27th, 2013 by Paula Derry

Articles in the media often report research results with a number, for example the number of hot flashes per day or the severity of menstrual cramps.  However, these are not facts in the way that “man bites dog” would be a fact.  In part, this is because the numbers in research reports often are averages.   Averages are useful summaries, but they also leave out a lot of information.  Take shoe size.  If the average woman’s shoes are size 7, this does not mean that all women are size 7.   It does not mean that a woman whose feet are size 8, 9, or 10 is abnormal or has a problem.   At some point, a very large or small foot could mean that someone has a problem, but knowing where to draw the line requires knowing a lot more than the statistics.  It means knowing something about the biology and biomechanics of feet.  It means knowing about the context—for example, is a woman who wears a size 11 shoe five feet tall?  or seven feet tall?   This is different from a situation where numbers have an absolute meaning.  For example, if my temperature is 102 degrees, then I have a fever, because of the realities of the biology of my body and not because of what most people’s average temperature is.

Image created by Paula Derry

What is an average?  There are a few common ways of computing this. The median is the score for which half of the people being studied have higher scores and half lower. If the scores of all of the people being studied are added together and then divided by the number of people, this gives us the mean.  The standard deviation is a number that indicates variation around the mean.  If whatever is being measured has what is called a “normal distribution” (which is most often assumed) then over 68% of measurements will be within one standard deviation, and over 95% within two standard deviations of the mean.

Take osteoporosis and osteopenia.  Osteoporosis is a bone disease that typically develops in old age in which bone is fragile and more likely to fracture [pdf].  This has been defined as a bone density measurement that is more than 2.5 standard deviations below that of an average 30-year-old woman.   Osteopenia is having bone density that is not thin enough to be osteoporosis, but thinner than “normal,” and is defined as bone density 1-2.5 standard deviations below that of a 30-year-old woman. These definitions are statistical, i.e., different from an average (young) woman. Sometimes women are told that they have bone disease based on these definitions.  With regard to osteopenia, the assumption is that this is an early stage of disease that will get worse over time and become osteoporosis.  Sometimes women with osteopenia are advised to use a medication to prevent the disease progressing.  However, these statistical definitions have been controversial.  For example, other doctors assert that it is normal for bone to thin as women age and that only a small percentage of women with osteopenia go on to get osteoporosis.  Some doctors believe that a diagnosis of osteoporosis itself requires more than low bone density—for example, that a woman has had a bone fracture or that other indications exist.

Or take the number of days in the normal menstrual cycle.  The stereotype is that the average menstrual cycle is 28 days long and that regularly recurring cycles are what is healthy.  A study published in 1967 by Treloar and colleagues presents some of the complexities that this stereotype ignores.   Assuming that there is one average menstrual cycle length for all women leaves out important information about changes that occur over time, across a woman’s adult life.  The average cycle length when a large group of women were studied was indeed 28 to 26 days (median length). However, this was for women aged 20-40. During the first few years after menarche and the last few years before menopause, median cycle length was over 30 days. Even more striking is the amount of variability from one woman to the next, and how this variability changes over time.  Among 20-year-old women, for example, the cycle could be anywhere from 24 to 38 days, or occasionally less or more.  However, the first year that periods began, these differences between women were larger—cycle length was between 18 and 83 days. Variability between women decreased for about eight years, but, as I have said, even when women were most similar (at ages 20-40) there were still big differences among them.  Variability increased again about eight years before menopause; the last year before menopause, women had cycle lengths from 18 to 80 days.  An individual woman’s cycle lengths changed over her life span; further, cycle lengths varied from month to month as well as over a span of years in ways that were very different for different women.

Averages have useful information.  However, it’s always important to know what the numbers mean in order to interpret them.  This is important for knowing what an average means, and it’s always important to remember that an individual’s reality may be very different from the picture derived from finding an average for a large group of people.

Working Mothers

April 29th, 2013 by Paula Derry

“Working Mother and Son” Photo by Russell Chopping // Creative Commons 2.0
http://www.flickr.com/photos/russellchopping/3501039851/

Research is often reported as though it is news, as though the most recent article is the best and research that was not published this year is somehow not as interesting or is out-of-date. I recently dug out some articles I wrote about the psychology of working mothers that were based on a study I did in the mid-1980s. I interviewed psychotherapists about how being a mother had affected their professional lives. This study was qualitative research. I offer the results as interesting ideas, not as definitive conclusions.  Some points I think are still interesting:

  1. Overall, about 64% of the 25 mothers I interviewed opted for part-time work; when children were preschoolers, this was about 78%. Psychotherapists, unlike many other women, have the option of working part-time:  part-time jobs, especially for therapists who see clients in private practice, are the same jobs that a full-time worker would have.
  2. I compared the mothers with another group of 19 therapists who did not have children. The non-mothers tended to work full time (about 90%).  However, both groups of women were deeply and apparently equally committed to their jobs.
  3. Many of the mothers (about 60%) felt that work was not as important to them as it would be if they were childless. However, this did not mean that work was unimportant. For most women, it only meant that they now had two strong priorities instead of one.
  4. Almost all of the mothers (88%) felt that having children affected their work as psychotherapists by deepening their empathy, understanding, or emotional knowledge about parents and parenting. This was not simply intellectual, that they knew more facts, although this was also true. It was experiential understanding, a different experience of what facts mean. This was so even though their profession involves helping clients understand their parents or their parenting, and was reported whether they had a child while in graduate school or after they had worked for many years.
  5. One aspect of this increased knowledge was an experience of how passionate an experience mothering is. Another aspect was a less idealized view of both parents and children, and greater tendency to see the experiences of parents and children from their own perspectives. For example, in addition to seeing parents in terms of how their children felt (e.g., that the parent was mean or rejecting), the therapists might perceive more clearly where parents were coming from or that children might misunderstand or be unreasonable.
  6. This greater ability to see the position of both parents and children more clearly is what a psychologist might call psychological individuation. That is, the stereotype is that mothers are or should be all-giving, selfless, thinking only about their children. However, these mothers seemed to grow more realistic, clear about and accepting of who children as well as parents are. As I said in one paper:  “Interconnectedness, or intimacy, requires a sense of oneself and the other as separate but related. (If children really do lack a sense of this separation, that is no reason why their parents, who are adults, should identify with their perspective.)”

References

Derry, P.S. (1994) Motherhood and the importance of professional identity to psychotherapists. Women & Therapy, 15, 149-163.
Derry, P.S. (1992) Motherhood and the clinician/mother’s view of parent and child. In  J. Chrisler & D. Howard (Eds.), New directions in feminist psychology:  Scholarship/Practice/Research. New York: Springer.

Bored by Research Updates and News Headlines

January 3rd, 2013 by Heather Dillaway

"— Allons, à ton tour, ma petite... vas-y ! — Non, Papa ; si on devient si vilaine que ça en un an, j'aime mieux pas entrer".

By Achille Lemot (1846-1909) [Public domain], via Wikimedia Commons

Sometimes I think biomedical researchers and media spokespersons are just searching to find the pathology in our lives. Not that we don’t know this already, especially when it comes to women’s health. Because of how medicalization works, of course anything that veers from the defined “norm” for women (here, a young woman who menstruates every 28 days like clockwork) is pathological. Thus, menopausal women are pathological by definition. But, sometimes this gets pretty depressing, and really, it’s not very accurate considering that the vast majority of women go through menopause at some point during the midlife (so doesn’t that make menopause pretty normal and non-pathological?). In my Google alerts last week, here were the “menopause” headlines:

Diet, Exercise Post Menopause Help Reduce Risk of Breast Cancer
Medical Daily

Menopause linked to higher brain aneurysm risk
abc7.com

Healthy lifestyle during menopause may decrease breast cancer risk later on
Medical Xpress

Weight-y menopause
The Star Online

Diet To Overcome Menopause Problems
BoldSky

I do understand that there are many more health risks in middle age and beyond, and that changing/waning hormone levels at menopause induces different concerns/risks than women might have faced before menopause. Researchers, doctors, and media spokespersons have made it crystal clear over the past few decades that this is the case. But, as feminist and social science researchers have urged us to get beyond the “menopause as death” or “menopause as problem” perspectives, it seems that we’re not making much progress in thinking differently or more broadly about this transition. As I read the articles on menopause leading to more breast cancer risk, risk of brain aneurysm, and risk of weight gain, it is reaffirmed in my mind that we’ve made very little progress in broadening the dialogue (at least the published and mainstream dialogue) on this important life stage.

Sure, this life stage is filled with problems, risks, and interesting situations, but what life stage isn’t? Isn’t there published research coming out on ANYTHING ELSE about menopause? I want to read about something different! Readers, feel free to comment about any other interesting stuff you’ve read about menopause recently because I for one am searching for new takes on menopause. Seriously, people, was there nothing else new last week on menopause? As we head into 2013 I’m hoping for something new.

Understanding Research: Buyer Beware

April 2nd, 2012 by Paula Derry

xkcd.com // CC 2.5

I certainly believe that scientific research is important.  Research uncovers new knowledge and prunes away facts that are not accurate.  However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications.  If a scientific result can be invoked, we can believe that something is true. Is there an unconscious?  Freud said so, but he’s out of date.  Are we intrinsically social beings?  Evolutionary theorists argue. Does meditation really result in an altered state of consciousness?  If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.

What’s wrong with this? Isn’t this science doing its job of uncovering truth?  There are two things wrong with this. One is that not all knowledge is scientific knowledge.  The second is that scientific results are often portrayed inaccurately in our society.

With regard to the first point, I’ll just give a few examples.  von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow.   Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.

But what I really want to talk about here is the second point.  We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means.   However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context.  When I was a graduate student in psychology, every class included practice in critiquing research.

To understand research, certain mathematical ideas are important.  “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why?  That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased.  Why?  Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.

What if the coin came up heads 60 times? Is the coin honest or not?   The question is this: When is an outcome still “what you would expect by chance even though the numbers are not exactly alike (since we expect approximately 50 heads, not exactly 50)”?  On the other hand, when is the difference big enough that you would conclude that the coin is probably biased?   Sometimes it’s hard to tell.  In research, very often results are in the “hard to tell” category.   For example, if 55 percent of the women in my research prefer chocolate ice cream, while 65 percent of the men prefer chocolate, is there a real sex difference (it’s so improbable there’s a real difference) or is there not (the numbers seem different, but I’m not sure whether this is just because there is a range due to chance and not a real difference). Sometimes numbers that seem very different are actually what you could commonly get by chance, and sometimes numbers that don’t seem very different are very improbable.  In addition, what I’m studying may produce a weak rather than a larger, obvious effect because among us humans, for all kinds of psychological, social, and biological research, what is being studied is only one factor contributing to a situation and not the only thing going on.  In the example, even if men and women do have different likelihoods of preferring chocolate, there are many possible reasons for a person’s choices—diabetes, city you grew up in, getting rejected by a date while you were eating chocolate ice cream, etc.

Fog Warning Ahead

March 29th, 2012 by Heather Dillaway

As I embark on my 40th year I look ahead to menopause. I guess there is a good chance I’m approaching some foggy years. Brain fog, that is.

In the past week a flurry of online news articles review new research findings on the “brain fog” that many perimenopausal women experience. The brain fog is more easily understood as a slight memory problem, if you take the time to read through the various news stories. A new study analyzed how 75 individual women, aged 40 to 60, rated their memory performance based on factors like how often they forgot details and how serious their forgetfulness was. Researchers also gathered information about the women’s overall health, mood and hormone levels, as well as other menopausal symptoms, and tried to figure out the extent to which this “brain fog” exists. According to news reports, about 41 percent of the women in the study reported having forgetfulness that was “serious,” and those who felt that their memory problems were serious were more likely to score poorly on tests of working memory and attention. Some women who rated their memory problems as serious also reported some depression and other symptoms like hot flashes and sleeping problems. Other researchers suggest that the memory problems women experience are related to changing levels of estrogen in a woman’s body at menopause, but interestingly this new study did not find links to changing hormone levels.

The whole notion of “brain fog” is interesting, and I am suspicious of it as a strictly menopausal symptom. What about the brain fog we all experience when we’re tired or sick or just way too busy? Defining brain fog as a “menopausal” (really, perimenopausal) symptom further defines middle-aged women as somehow less than functional and set them up to be taken less seriously.

Putting this issue aside, though, what I actually find most interesting about all of the news coverage of this study is just how different each report of the study is. I am reminded that we should all be careful of which report we read about a study. For example, the first article I read on this study was placed in the Los Angeles Times and focused on the possible connections between menopausal brain fog, depression, and dementia. I was left feeling like the author of the article inferred that all menopausal women might have depression or dementia and that they should seek treatment. After reading this article I was angry because I felt as if I had been warned that midlife brain fog was the beginning of an inevitable decline for all women. Then I read a WedMD piece that simply described the study and did not concentrate on depression, dementia, or the need for treatment, and I wasn’t really sure what to make of the research study. Finally I read an article by a HealthDay reporter which quoted one of our own, SMCR member Nancy Wood, who reminds readers that “a number of other stressors in life, from work to taking care of children and parents, that pile up around the same time as menopause can hinder memory and ability to concentrate.” In addition, this article’s author states that “memory problems are not necessarily an early sign of dementia” and cognitive ability is regained after other perimenopausal symptoms subside. This third article concluded that the research study is helpful because findings suggest that brain fog is real – that women aren’t crazy – but that it is normal and not that detrimental to women’s long-term cognitive abilities.

Of course, nothing is a substitute for reading the original article published by Miriam Weber and her co-authors this March in the journal, Menopause. But if you need a quick synopsis of what a research study finds just make sure you know its source and think about whether the coverage of the details makes sense! I for one like the tone of the HealthDay news article – that, if brain fog exists, it is temporary and normal and could be caused by lots of things. It is not necessarily an indicator of depression or dementia or even a permanent memory problem.

Talking Makes Menopause Better — Anyone Surprised?

March 1st, 2012 by Heather Dillaway

Adapted from a photo by Ed Yourdon // CC 2.0

The results are in: if you talk to your friends more during menopause, then your menopausal symptoms will bother you less. A study reported in The Telegraph last week suggests that talking either lessens women’s symptoms or helps them cope better (or both). In one study, women undergoing breast cancer treatments who also participated in “talking cure group therapy” as part of a study at Kings’ College in London “coped much better” with menopausal symptoms. Half of the women in this study were asked to participate in workshops with other women for six weeks. Women in the study were encouraged to talk about signs and symptoms of menopause, such as hot flashes (or hot “flushes” in the UK) and night sweats; they were taught techniques for eliminating “negative thoughts” and stress as well. Researchers touted this “talking cure group therapy” as giving “people the mental tools to tackle problems more positively” and led to “improvement” in symptoms. The author of the article suggests that non-medical approaches to symptom relief not only work but also could be growing in popularity among women who can’t or don’t want to use prescribed hormone therapies.

This is not unlike what I’ve found in my own studies of menopause and what plenty of other feminist scholars have found about women’s experiences of reproductive health more generally. Women who have support networks and/or who talk to other women about their experiences do indeed feel better about their own experiences and do gain some symptom relief (or, at the very least, coping strategies) just from talking to people. Indeed, even women with severe symptoms can get relief from sharing and talking. SMCR’s very own Jerilynn Prior and Christine Hitchcock have also done studies of how women will rate the severity of their hot flashes differently once they hear other women talk about theirs. Hearing and then knowing that people around you are (a) experiencing the same thing and then (b) might have suggestions for how you could navigate the experience always helps. This isn’t specific to women’s health – anyone experiencing any bodily event, symptom, or process will probably feel better if they talk to others. And of course we could go on from there – anyone experiencing anything confusing or hard or long in duration will probably benefit from talking to others. Anyone who has failed a math test or survived a hard relationship knows that.

The question I have is, isn’t it sad that this is a finding? Shouldn’t we all know that talking to others is better for our health and our sanity? I’m as much of a culprit as anyone else: I don’t talk to anyone anymore. I’m too busy. I barely see my kids or partner, let alone tell people how I feel about menstruation, whether I really feel “done” having kids, whether I think menopause is near, whether I feel reproductively healthy (or healthy in any aspect of my life for that regard), etc.  Maybe some of you are much better than me about talking to others, but it’s pretty bad when major research journals have to remind us in their published findings that talking is good for us.

Feminist scholars have already documented the medicalization of women’s reproductive health and the fact that women now typically consult doctors as the “experts” on reproductive health and, by default, no longer trust themselves or other women for advice. Thus, to some extent, talking is stifled by the medicalization of women’s health experiences. But, ironically, now medical journals are reporting that we should talk more? Seems like we’ve made it full circle and women should consult other women as the real “experts” again.

It seems I need to stop being so busy and start cultivating my friendships again . . .

 

Alongside Scientists Exploring Why Women Menstruate

January 19th, 2012 by Alexandra Jacoby

I read a blog post about a paper (that I have not read). The post is “Why do women menstruate?“ by PZ Myers, a biologist and associate professor at the University of Minnesota, Morris, blogging at Pharyngula. The paper is “The evolution of menstruation: A new model for genetic assimilation: Explaining molecular origins of maternal responses to fetal invasiveness.” by Emera D, Romero R, Wagner G.

I’m not a scientist and don’t routinely have access to papers like these. Usually, by the time ideas raised  in them reach me, they would be solid-feeling facts, authoritative and done — not inspiring questions and wonderings that I can pursue in my way.

They might be about the products that were developed in response to, or as a side-effect of the research, or maybe I’d hear about newly discovered dangers to my health.

Rarely, do I get to be in on the “why.” To think about the story of it–my body–alongside the scientists when they are exploring what might be the origin of, or deciding factors in, why we are the way we are. As human bodies.

(So, thank you, internet. Thank you, bloggers).

"The anatomy of the human gravid uterus exhibited in figures" by William Hunter, Public domain.

This paper (as I understand it via the Pharyngula post) focuses on the conflicting interests of the relationship between a fetus and the woman carrying it: the fetus acting for its survival and development, and the woman as agent for her life, health, and the ability, should she want to, to carry more pregnancies to term.

The research notes a difference among mammals who spontaneously initiate the process of building up the uterine lining, regardless of whether there’s an implanted embryo (like us, with our monthly-ish menstrual cycles) and those who build up the lining only when triggered by an embryo, and asks why do we do this? Why not wait until you need it?

The answer seems to be because you won’t be ready if you wait. Maybe it’s like having guests over last-minute. You might have food and drink enough for all, but you might not. And, you might have stuff laying around that is more personal than you want guests to see. Or, maybe it’s all fine enough. Last-minute is frequently doable, but it’s better to be prepared. Prepared gives you options. Prepared gives you a chance to make it really comfortable and welcoming. Prepared sets you up to have the experience you wanted to have.

Women menstruate to be body-ready to handle the situation of pregnancy in the context of their whole lives, and their family’s whole life.

The monthly preparation of the uterine lining establishes optimal conditions for the relationship, the active give-and-take, between woman and fetus. And, while there are conflicting interests in this shared space of blood and nutrients, I see it as like any relationship between any things living — on a continuum of interaction between self-expressing creatures, cells or trees. There are intricate, elegant processes taking place to make it all happen. There is preparation and desire on both parts — blood, nutrients, and soil, air and water being exchanged and used up among us. There are points of contact, expected and understood, or surprising, or painful, or deadly. We’re in it together for better or worse. All of our relationships are active. Everything is interrelated and contingent and based on routines and cycles. On those we build, change, evolve…

I think only we are impatient about it — want it done  faster, with less work and no mess. The stuff of life is messy, though.

For me, when I understand the purpose of the mess, the effort required, the time and attention, become meaningful — I am able to recognize participants (rather than adversaries), to value the work we do and remember the vision and desire that infuse it all.

On Menopause Definitions

December 28th, 2011 by Paula Derry

Guest Post by Paula S. Derry, Ph.D.

In a recent blog post, Heather Dillaway commented on the uncertainty, confusion, and frustration she felt as a menopause researcher, given the lack of consensus about the most basic aspects of the menopause transition. Researchers don’t agree about their definitions, and can’t even agree on what needs to be defined. She asked for reactions to her entry; I’ve found that my reaction has grown into this separate post.

Fire in the Head by Beate Knappe // CC 2.0

I, unlike Heather, am not a sociologist. I’m a health psychologist. My training and current work include analyzing, critiquing, and making sense of experimental research and theories. I have also developed workshops for community women and for professionals whose aim is to provide health-promoting information and decision-making heuristics. I have given a lot of thought to the issues that Heather raises, and this is as far as I’ve gotten with them.

To me, there are many layers of issues involved. The first is the fact that the science — about the physiology of menopause and the processes leading up to it — is limited and incomplete. Part of the reason that professionals disagree about whether the life course of menstruation has five stages or seven, or why women have hot flashes, or even why women have a menopause, is that we don’t actually know. We simply do not have the scientific facts. We don’t understand what the underlying process is or how it works. Given this uncertainty, professionals must make judgments about how to define terms and what their hypotheses (or best guesses) are about underlying processes. A second fact, along with our limited real knowledge, is the tenacity with which professionals assert their judgments and argue against competing views. People disagree and they hold strongly to their positions—about language and the facts. To me, it makes sense to have definitions of stages of menstrual life that are objective and easily measurable (like the STRAW staging system) for researchers who need to compare results with each other. It doesn’t make sense to assert that this system, based on expert opinion and not on experimental facts, actually defines when a particular stage really “begins.” It makes sense to say that experimental research supports the idea that changes in the thermoregulatory center of the hypothalamus are important processes if you’re trying to understand hot flashes.  It does not make sense to conclude that these brain changes in themselves explain hot flashes; other factors must also be involved.

I think another source of confusion is that menopause is not one thing, but many. It is a circumscribed biological change (lack of periods and what leads up to them physiologically) and also a psychosociocultural matter. We have a term for when girls begin to menstruate (menarche), a separate term for the larger biological changes of which menarche is a part (puberty), and another term for the biopsychosociocultural changes of which puberty is a part (adolescence). I think these kinds of distinctions are confused with regard to understanding menopause in part because there is cultural confusion about midlife (or mature adulthood or whatever term you use) as a life stage.  There is no cultural consensus about this stage of life.  And, indeed, this isn’t surprising.  Some women are planning retirement while others are training for a new job or career.  Some are grandmothers while others are raising a young child.  My opinion, also, is that we as a culture have a paucity of concepts of mature, responsible adulthood and what it means.

Finally, I think another source of confusion has been relying on biomedical information to understand menopause. Biomedical information is important. A woman who is experiencing odd changes in her periods, clots or frequent bleeding or whatever, should be able to get information about whether this is a health problem. And so on. However, research has shown that the kinds of questions that interest women are often not the questions that interest physicians. What does this stage of life mean to me? What are good ways of coping with uncomfortable or distressing experiences? All too often, biomedical information has encouraged a negative view that menopause is the gateway to old age or a body that is vulnerable to illness, a view that goes far beyond the facts. The biomedical perspective has thus often encouraged a view that menopause is extremely important, a watershed experience that must be vigilantly attended to and worried about, while not providing information about how to effectively deal with the changes ascribed to menopause.  Biomedical perspectives have even encouraged a passivity in the face of physiological changes, a pessimism that anything other than medical care can be effective in alleviating problems.

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.