MENSTRUATION MATTERS

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.

Third, the idea that this blood test essentially predicts time to failure/time to the “end” of fertility is problematic for those interested in promoting women’s health, in my opinion. The study is praised already for its potential ability to predict “early menopause” and allow women to know when (not if, but when) they should switch gears and begin to have those children they always wanted to have (assuming they wanted them, of course – there is no room for “childfree” women from the perspective of researchers touting this blood test).  As this study is praised for its ability to predict when women should start worrying about their fertility (and might want to have that baby before it’s “too late”), what does the predicted “age at menopause” do for a woman? Does it help her figure out when she might start having trouble getting pregnant, or when she should start trying to have that first or last baby? Does it help the woman trying to decide whether she really wants children or not?

If we are truly to promote positive gender identities, a healthy view of both menstruation and menopause, a healthy view of women who either decide to have children or decide to be child-free, and the women who delay childbearing until their forties, the idea that this study predicts the “end” of fertility (read: the end of women’s delay of childbearing now that she can plan “well”) could be problematic, if it is couched in terms of “time left” and (essentially) time to system failure. Ultimately, does that mean that, if you don’t plan well and end up childless that it’s your fault? Does that mean that if you are still concentrating on your career with only 5 years left until age at menopause that you are not scheduling your time well? Does that mean when you get to the “end,” you should maybe think of yourself in a different way? And should you worry if your blood test says you only have a year left of regular menstruation?

Or what happens if you get to your appointed cessation time and you don’t stop menstruating? And do we really want to let women think that if they reach their appointed age at menopause, then they don’t need to use birth control anymore? Furthermore, this study’s researchers admit that their new blood test can predict within a 4 month window but, from my calculations, that might leave women guessing whether they have hit their “age at menopause” within an 8-month period (4 months on either side of the predicted time, best case). And the authors of the study admit that the margin of error could be as much as 3-4 years off at the current time (but of course they’re hoping their estimations will be improved by the time that this blood test is approved and marketed).

How are women supposed to feel about all of this? I don’t know, but I worry about the extra anxiety that individual women might feel if they received this “simple blood test.”  I realize we all want to plan well and plan more, and that our entire society is geared towards planning when exactly that tornado will hit, that market will fall or recover, that housing market will get better, that weight will come off, that baby will be born, or that illness will be gone, but are we really truly better off and less anxious with all of this planning and prediction? And, at the bottom of it all, is this what women actually want? I’m left more anxious just thinking about the repercussions of this “simple blood test,” and I wonder what women really would rather know. And even if they did want to know their predicted age at menopause, is that the most important thing to them, and will this actually lessen their fertility concerns?

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