Blog of the Society for Menstrual Cycle Research

The Menstruation Machine

June 30th, 2010 by Elizabeth Kissling
Hiromi Ozaki's Menstruation Machine

Hiromi Ozaki's Menstruation Machine

Researcher and artist Hiromi Ozaki has created the Menstruation Machine, an art installation featuring an appliance for men or boys (or other people who do not menstruate) to wear to simulate the menstrual experience. It features electrodes attached to the lower abdomen to simulate cramps and a blood-dispensing mechanism that deposits simulated menstrual fluid between the wearer’s legs.

The device is reminiscent of the Empathy Belly® pregnancy simulator, although it is being greeted with much more snark and misogyny. The blogger at Gizmodo is certain he’ll never try it (just skip the comments), and the DC Caller says, “This may appeal to the crowd of women who pull the ‘you don’t understand how I feel’ card once a month to their significant other.”

But the Menstruation Machine is an art project, and the Empathy Belly® is a real product, retailing for $649. It’s intended to be provocative, rather than profitable. Suddenly I’m reminded of the time my college boyfriend told me he wanted to dress as a woman for Halloween. I sneered and told him if he thought its was funny to dress like a woman, he should wear a tampon.

A New Blood Test to “Predict” “Menopause”? Is this What Women Really Want?

June 28th, 2010 by Elizabeth Kissling
Collage by Merlinprincesse | Creative Commons 2.0

Collage by Merlinprincesse | Creative Commons 2.0

Guest Post by Heather Dillaway, Wayne State University

I keep seeing news articles about a “new Iranian study” that hopes to better predict “age at menopause” for women, and the authors of this study supposedly discovered a “blood test” that will be able to “predict menopause” within the next few years. It is touted as a way to judge when women will be “done” or be at the “end” of “menopause” and also to predict by default when they will be at the “end” of their “fertile” years (so that maybe they can know when they have to pop out that first or last baby). After seeing so many references to this study over the last week and having studied how women feel about the “beginning” and “end” of menopause for the last ten years myself, I can’t just sit back and not critique the underlying assumptions that are part of this study and air some of the concerns that I have about this impending blood test.

First, there is an assumption that the cessation of menstruation (as biomedical researchers define it) is the defining moment of “menopause.” Thus, what these scientists are trying to predict is the age when women might reach “menopause” (or 12 months past their last menstrual period). Yet, not all women judge the “end” of menstruation as the most important aspect of their menopause experience, in fact many women are much more concerned about when other signs and symptoms of “menopause” will begin and/or how long they will last, for instance, irregular bleeding or heavy bleeding in “perimenopause” or hot flashes, night sweats, etc. Can a test predict when irregular bleeding might start and how long it might last? And if a test predicts that a woman might reach her “age at menopause” right after her 54th birthday, will that make a 45-year-old woman with irregular bleeding feel assured that she has only 9 years left? In addition, can a test predict how soon a woman might start experiencing hot flashes and how long they might last, if that is instead to be her most worrisome sign or symptom?  If a test predicts that a woman’s age at menopause will be around age 49, will that woman feel assured about her hot flashes at age 48, having no idea how long those hot flashes will last but maybe hoping that they’ll end right alongside her last menstrual period? While the authors of this study (like most other biomedical studies) want to continue to uphold the definition of “menopause” as the official “end” of menstruation and ultimately the “end” of fertility, and hold this up as the most important part of menopause that we should know about, I beg to differ. Women want to know more than just their “age at menopause” or the final end to their fertility.

Second, continuing to define menopause primarily through the cessation of menstruation as this study does means that those women who do not menstruate regularly before menopause (e.g., pregnant women, breastfeeding women, women with amenorrhea before menopause, serious athletes, women with eating disorders and other health conditions, intersexed women, women on Depo-Provera or Seasonale, women with partial hysterectomies, women on hormone therapies, etc.) continue to be defined as abnormal and even infertile, if we follow through with the mindset of the authors of this study. In my mind, this study seems not to be written for those groups who haven’t been menstruating regularly before their “age at menopause” or who might even have been defined as “infertile” before menopause. The assumption is that all women menstruate regularly and are fertile before menopause and, therefore, menopause can mean the end of menstruation and fertility, but so many women’s experiences negate this assumption and reality. Even women who have simply been on the birth control pill for ten years or women who had a tubal ligation negate the idea that “menopause” is the end of fertility. There are so many factors that interrupt “normal” “menopause” or “normal” “fertility,” and this study does not explain any of that. If women have not been faced with a regular menstrual cycle earlier in their lives and have not been “fertile” before menopause, how are they supposed to interpret this study’s definition of “age at menopause” or fertility? Does this calculation still work for them? Presuming it does, what should they assume when they reach that predicted age at menopause? Should they just assume they’re done, and take the authority of the blood test as fact, that they are indeed “menopausal”? And should women who have experienced troubles with fertility before menopause wait to think that they are infertile until after the predicted age of menopause? This blood test leaves me with many questions and few answers, especially when I start to think about all of the supposed causes of age at menopause and infertility, and all of the women who are left with unexplained experiences if we rely on this blood test to give us the answers.

Saturday Surfing: Summertime Blues edition

June 26th, 2010 by Elizabeth Kissling


Should the pill be available over-the-counter?

June 25th, 2010 by Elizabeth Kissling

The New York Times published an op-ed piece a few days ago about making the birth control pill available without a prescription. Kelly Blanchard, president of Ibis Reproductive Health, offers the following rationale:

Women don’t need a doctor to tell them whether they need the pill — they know when they are sexually active and want to avoid pregnancy. Pill instructions are easy to follow: Take one each day. There’s no chance of becoming addicted. Taking too many will make you nauseated, but won’t endanger your life, in contrast to some over-the-counter drugs, like analgesics.

I have mixed feelings, myself. I’m in favor of just about anything that makes contraceptives more accessible to the people who need them, but I fear that the likely increase in cost of OTC pills means the availability won’t benefit those who most the need them – the young and the poor. Also, there are some contraindications for pill use, such as high blood pressure, history of migraine, and use of certain anti-seizure drugs for epilepsy. And despite the happy, shiny images of Yaz and Seasonique commercials, some women just can’t tolerate the side effects, for any number of reasons.

What do you think, re:Cycling readers?

The Disappearing Diaphragm

June 24th, 2010 by Elizabeth Kissling
Photo courtesy of Jenny Lee Silver under Creative Commons 3.0.

Photo courtesy of Jenny Lee Silver under Creative Commons 3.0.

Did you know that last year’s combined sales of Yaz and Yasmin, the most popular oral contraceptives in the U.S., totaled $1.64 billion? Did you know the drugs are also the target of 1,100 lawsuits for potentially fatal blood clots? Did you know that an estimated 50 women have died from taking those contraceptives?

Despite such health risks,  however, oral contraceptives remain an extremely popular method of birth control in the U.S., second only to sterilization. The Guttmacher Institute reports that whether a woman prefers the Pill or sterilization is largely a function of age, with women under 30 choosing the Pill and women over 30 choosing permanent methods. These trends have been fairly stable since 1982.

None of these facts surprised me as much as the news that fewer than one percent of women in North America (and northwestern Europe) use the diaphragm–or any other woman-controlled barrier method. I’m puzzled that a safe, reliable, fairly easy-to-use (with some training and practice), inexpensive method of controlling fertility is not more widely recommended. Used correctly and consistently, the diaphragm has an effectiveness rate of 94 percent. Nevertheless, diaphragm use declined after the Pill was introduced, from 25 percent of married women in 1955 to 10 percent in 1965, and kept dropping thereafter, to just 4.5 percent of all women in 1982 and 0.2 percent today, according to the CDC [pdf].

U S. Medical Eligibility Criteria for Contraceptive Use, 2010, released last month by the Centers for Disease Control, shows that the diaphragm has no medical contraindications for most women. The exceptions are latex allergies, immediate postpartum or post-termination use, uterine prolapse, and women with HIV/AIDS, for whom the risk is not the diaphragm itself but the accompanying spermicide nonoxynol-9, which may increase viral shedding and HIV transmission to uninfected sex partners.

Yet the American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice recommends that hormonal methods such as IUDs or injections be offered as “first-line contraceptive methods and encouraged as options for most women.” At this year’s annual ACOG meeting last month in San Francisco, the group issued a press release with eight gushing statements of praise for the Pill on its 50th anniversary. (See re:Cycling‘s response to the ACOG statement here.)

But nearly four of every ten women who use contraceptives are not satisfied with their method, and I hear frequently from young women that they’re pressured at college health centers and physicians’ offices to choose hormonal methods, usually the Pill, over barrier methods such as condoms and diaphragms. Even after negative experiences with the Pill, women are often encouraged to try another brand rather than another method.

I’ve even heard of educators and health care providers actively discouraging use of the diaphragm because “it’s messy”. This complaint baffles me, and I used a diaphragm for 15 years. With or without a diaphragm, sex is messy.

Although diaphragms must be accurately fitted by a health care professional and re-assessed every few years, they remain cheaper than hormonal methods and require less frequent physician visits. A diaphragm can be inserted hours or moments before intercourse, and it is a fully reversible, female-controlled method of birth control. There is some evidence that diaphragm use minimizes women’s exposure to certain STIs , and ongoing research by pharmaceutical companies is aimed at developing a spermicide that is also antimicrobial.

There’s even research on a one-size-fits-all diaphragm in progress: Program for Appropriate Technology in Health (PATH) has developed and patented a single-size diaphragm designed to fit most women comfortably. The modified device has proven effective in initial studies, and the organization plans to apply to the FDA for approval as a contraceptive by the end of next year.

Early last century, Margaret Sanger risked prison to introduce the diaphragm to an American public desperate for effective birth control. We need a contemporary crusader to re-introduce the diaphragm in the 21st century for those seeking safe, effective, hormone-free birth control.

Cross-posted at Ms. magazine blog.

Latest News on Hormone Therapy

June 23rd, 2010 by Elizabeth Kissling
Wellcome Library, London // CC 2.0

Wellcome Library, London // CC 2.0

The Endocrine Society has released a new, peer-reviewed statement on the risks and benefits of hormone therapy for menopausal women. The upshot is that risks and benefits vary depending on the age of the patient and the length of time since menopause:

One interesting finding . . . was that women who start hormone therapy within 10 years of menopause have a 30% to 40% reduction in total mortality.

In addition, in the 50 to 55 age group the task force concluded that hormone therapy reduced hot flashes and overactive bladder and that vaginal estrogen reduced recurrent urinary tract infections. The evidence also showed that hormone therapy reduced pain on intercourse and improved quality of life.

Given that there are thousands of lawsuits pending over the role of HT in breast cancer, I was especially interested in this nugget of new information:

“Our conclusion is that [the estrogen/progestin hormone combination] didn’t cause breast cancer — it caused preexisting tumors to grow to a size where they became detectable.”

Saturday Surfing: Summertime Reading

June 19th, 2010 by Elizabeth Kissling

This week’s picks:

Advanced Technology Isn’t Always Advanced Medicine

June 17th, 2010 by Elizabeth Kissling

Panel from Sally Forth cartoon, "About my idea for robot monkeys...."A new report indicates that surgery for endometriosis performed by a robot is less effective than the same procedure performed by a surgeon. The mechanically assisted procedure also took longer to complete. Performing this surgery the traditional way can also help keep hospital costs down.

It’s OK to Talk to My Daughter about Sex, but Don’t Tell Her about her Vulva!

June 15th, 2010 by Elizabeth Kissling

In Therese Shechter’s guest-post about the German teen magazine feature article, “Every Vulva Is Different”, she noted that we’re unlikely to see such an explicit, body-positive article in a U.S. teen magazine. Therese, as usual, knows what she’s talking about. In this just-released video clip from her forthcoming documentary How to Lose Your Virginity, Susan Schulz, the Editor-in-Chief of CosmoGirl! magazine, tells viewers about the time CosmoGirl! ran an article titled “Vulva Love”, which included a cartoon drawing of vulvar anatomy and some basic, age-appropriate physiological and health information about vulvas. It was the most complained about article ever published by the magazine. The complaints were not from the magazine readers, however: the grievances were filed by the mothers of subscribers. Parents thought it was inappropriate material for their teen daughters.

After you watch the clip, consider throwing a few bucks Trixie’s way so she can complete the film – the project needs another $3585 pledged by July 1 to receive the $10,000 they’re trying to raise.

Tonight’s the Night: Listen to Seeing RED

June 14th, 2010 by Laura Wershler

Tonight’s the night, Monday, June 14th, to tune in as CBC Radio airs Part One of: Seeing RED: A Cultural History of Menstruation This two part documentary concludes next Monday, June 21st. If you miss the original broadcast, which you can listen to online at 9:00 PM in all time zones (choose the program IDEAS) you will be able to link to the podcast at any time convenient to you as of Tuesday, June 15th.  SHAA SEP 07 029

Introduction to the documentary:

They are misfits. Witches. Children. Just a few of the labels used to portray menstruating women over time. The Bible has described the bleeding woman as undergoing “customary impurity”. In the Middle Ages, it was thought that women menstruated to release “sexual overflow”. Their counterparts in the Victorian era were told that a period would deplete their body’s precious resources. Twentieth century feminists worked hard to reclaim menstruation as a vital and positive part of womanhood. IDEAS producer Mary O’Connell explores menstruation from a cultural and historical perspective.

Several members of the Society for Menstrual Cycle Research were interviewed for this documentary. We invite our readers to listen to the program and share their thoughts and comments.    (Photo by Laura Wershler of Bleedy, the Period Puppet, created by Bree Horel at a Menstrual Arts and Crafts event held by Sexual Health Access Alberta.)

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.