Blog of the Society for Menstrual Cycle Research

Coming Off The Pill: Considering “forget-about-it” birth control?

May 30th, 2012 by Laura Wershler

If you quit the pill would you replace it with forget-about-it or mindful birth control?

How you feel about your body, your menstrual cycle and your sexual relationship(s) will influence your choice. Another consideration might be your attitude towards an unintended pregnancy.

Photo: Public Domain // LARC birth control methods are highly effective, in part, because women can "forget about them."

On the Coming off the Pill (COTP) MIND MAP GUIDE I proposed in an earlier post in this Coming Off The Pill series, mindful methods dominate the Birth Control branch: condom, spermicide, diaphragm, fertility awareness and copper IUD. Only the latter could be considered forget-about-it birth control.     Have it put in, then forget about it.

What got me thinking about this dichotomy is the Contraceptive CHOICE Project, a new study by researchers at Washington University School of Medicine in St. Louis. More than 7500 participants were free to choose, with all costs covered, from a range of contraceptives. (Diaphragms and fertility awareness training were not included.) Contraceptive failure rates over the course of the study were compared for the methods offered. The key result?

“Women who used birth-control pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.”

The difference in effectiveness was even more profound for women under 21 who used the pill, patch or ring. Their risk for unintended pregnancy with these methods, versus long-acting reversible contraceptives (LARCs), was almost twice as high as for older women.

The reason for the higher failure rates is human error. Women, and especially women under 21 it seems, don’t always remember to take their pills, change their patches, or check to ensure their rings haven’t fallen out. These methods require a certain degree of mindfulness. The reason that LARCs are more effective, according to senior author Dr. Jeffrey Peipert, is because women can forget about them after clinicians put the devices in place.

There are several things I find troubling about the researchers’ contention that forget-about-it birth control is better just because it’s more effective, and that these methods should be among the first offered to women by clinicians.

Firstly, they fail to acknowledge that many women do not tolerate these “forget-about-them” methods. Among the choices made available to study participants were the contraceptive shot, which I presume was Depo-Provera, and an unspecified hormonal implant. (Implants are slow-release hormonal devices inserted under the skin of a woman’s arm.) Side effects and ongoing problems with such methods abound, and are anything but forgettable. IUDs, both copper and the hormonal Mirena, have fewer drawbacks but they aren’t problem free either. Women experience a range of side effects with the copper IUD. As for the Mirena, some women love it, others hate it.

Secondly, the implication that women under 21 especially should be encouraged (perhaps coerced?) by clinicians to use forget-about-it LARC birth control methods just makes me sad. I get that preventing teen pregnancy is an important public health goal, but the potential for harm to young women’s overall health and psycho-sexual development by the use of such methods, Depo-Provera and contraceptive implants in particular, should be cause for caution and concern.

Maybe it’s time to research mindful birth control methods. Might more women choose barrier and fertility awareness based methods if expert training and support to ensure confident, effective use of these methods were provided free of charge, as were the expensive LARC methods in this study? I guarantee researchers would have no trouble finding women to participate.

Make Friends With Hot Flashes

May 28th, 2012 by Paula Derry

One important idea in a holistic approach to health is that symptoms or uncomfortable physical experiences don’t exist separate and apart from the whole person.  For this reason, it is important to know how a unique individual experiences that symptom or experience.  Another important idea is that the whole person consists of a physical body, but also thoughts, feelings, even spirit, and she lives in a social and physical world that affects her. Holistic practitioners say “I am a body,” not “I have a body.”

Photo by Pennstatelive // CC 2.0

What does this mean to a woman bothered by hot flashes?   First, one good starting place for a woman is to look inside herself at her individual experience.  Hot flashes are often said to be the bane of a woman’s existence, creating intense discomfort, mood swings, embarrassment.  However, in reality women differ.  Some women  are greatly bothered by flashes.  Others are not.  Some say flashes are power surges. For some, the flash is purely a feeling of heat; for others, it feels more like anxiety. Very distressed women may have experiences like insomnia, depression, fatigue, fogginess.  It turns out that the frequency of flashes is distinct from how distressing they are. For some women but not others simple remedies like dressing in layers works. In a scientific sense, we know more than we did not long ago, but there is still no fundamental understanding of what a hot flash is, or why some women but not others experience them.

Cultivating an inner observer can be useful to identify personal experience.   Mindfulness is one approach to this. For many women, thoughts are an integral part of the hot flash experience, and these thoughts might contribute to how distressing flashes are.  Expecting the worst might amplify distress, as it does for other experiences like pain.   One example of an expectation is: “I’m going to have hot flashes for the rest of my life.”  The meaning of flashes—natural, an indication of aging, a worrisome sign that something puzzling is going on in your body–might be important.  Embarrassment and self-doubt in social settings are known to sometimes contribute to experiencing flashes as problems.  Coping self-talk—for example, “this is a hot flash, it will pass” –might be helpful.  Relaxing the body and observing a flash rather than tensing the body to resist it might make flashes less distressing.  Paradoxically, distancing ourselves from bodily experience—for example, tensing the body until a flash passes, may be less effective than accepting bodily experience as our own with an attitude of observing it. Other active problem-solving might also be useful, like finding solutions to social problems.  Women who talk with other women about flashes tend to find them less distressing.

Of course, other women just want to be rid of flashes.  They might have very distressing, debilitating symptoms.  They may simply just not want to put up with them.   For some, focusing their attention on flashes might not make things better or even make things worse. Active problem-solving can work here, also.  For example, flashes are often associated with triggers (stress, foods like chocolate, caffeine, etc.) that vary from woman to woman. Triggers, once identified, can be avoided. A woman can make time to take care of herself, doing something pleasurable or rejuvenating, find ways to reduce stress, or otherwise alter her lifestyle. A variety of remedies have been suggested, ranging from herbal remedies, to alternative practices and practitioners, to hormone therapies. Actively deciding that a hormone therapy is needed given her own situation might be a way a woman actively takes charge of her experience.

Hot flashes are not invaders. They are sometimes welcome, often not, but always one’s own bodily experience.  Through gathering information, self-observation, talking with others, or finding helpful practices and practitioners, they can be dealt with.

Vagina Rules, Frozen Egg Cells, How to Sponsor a Uterus, and More Weekend Links

May 26th, 2012 by Elizabeth Kissling

Should Symptoms Always Be Treated?

May 24th, 2012 by Heather Dillaway

An article on Medscape News on May 7th reported survey results that suggest that “fewer than one third of women with menopause symptoms are receiving treatment for those symptoms.” The article goes on to report that about half of women aged 45 to 60 report “menopausal” symptoms (e.g., hot flashes, sleep problems, mood swings, decreased sexual desire, irregular periods, etc.). In addition, the survey apparently reports that over half of the women reporting symptoms define those symptoms as having some negative effect on their lives. Thus, the assumption is that these symptoms should be treated and, at the very least, lessened.

However, in this same article, it is noted that only 7% of women on this survey reported “very negative” symptoms. Many women reported their symptoms as “moderate.” The article goes on to suggest that only about one-quarter of survey respondents contemplated using hormone therapies to treat symptoms and that too many symptoms go untreated.

So, my question is: did anyone ask women whether they wanted treatment for their symptoms? And did anyone ask women what they meant when they said they had “moderate” symptoms? Did anyone ask women what they meant when they said symptoms had a “negative” effect on their lives? And if all symptoms that are documented are “negative,” what does it mean to have “very negative” symptoms?

This article goes on to tell about a new “Menopause Map” developed by The Endocrine Society and a Hormone Health Network for women who need help figuring out whether and how to get treatment for symptoms. But, the assumption here is that symptoms should be treated and that any symptom that is documented is bad enough to warrant that treatment.
Over the last ten years I’ve interviewed a lot of perimenopausal women. Granted, a portion of women going through this reproductive transition have terrible symptoms that are indeed unmanageable and treatable. But, a lot of women (in fact, the majority) seem to be able to handle their symptoms on a daily basis. Movies like Hot Flash Havoc hype up the fact that “menopausal” symptoms are unmanageable for everyone. The new “Menopausal Map” referred to above also makes it seem like all symptoms are potentially unmanageable. The Medscape News article that I’m referring to here also assumes that “untreated” symptoms are problematic. But maybe they aren’t for everyone.

The Society for Menstrual Cycle Research often steers away from using the word “symptom” and often refers to “signs” of menopause or the menstrual cycle – specifically because of the negativity associated with the word “symptom.” If you have a “symptom” of any kind, the assumption is you should run to the doctor! And untreated symptom seems like a problem. But is it really?

One of the perimenopausal women I interviewed way back in 2001 said to me outright “symptoms are supposed to be negative.” The point she was making was that the minute you say you have a symptom, people assume you have a problem.

I’d like us to think more about whether all symptoms really need medical treatment. Maybe we just need to give ourselves time to breathe. Time to sleep 15 more minutes. Time for a break at work. Time to drink more water and less coffee. Time with our partners, kids, friends, parents. Time for ourselves. And then maybe we can really assess whether we need that Tylenol for our headache or hormone therapy for our hot flashes. And the very fact that there are so many non-pharmaceutical options perimenopausal symptoms these days tells us something – women don’t actually always want to run straight to the doctor because they have a “symptom.”

Does a symptom always have to be negative? Does it always need treatment? I think we need to work on what the word “symptom” really even means.

Menstrual Marketing Around the Globe — Israel

May 22nd, 2012 by David Linton

Scary Little Menstruating Girl

[note: Although re:Cycling has an international audience, the following post is written from the perspective of an North American consumer.]

As is well known, cultural practices and attitudes regarding menstruation vary widely from place to place and time to time. re:Cycling has commented on the variety frequently in the past.  Differences also make themselves felt even in advertising and packaging of menstrual products, as the notorious Kotex Beaver ads from Australia demonstrate, despite the fact that the products are manufactured by global, trans-national corporations. Though the fact that the menstrual cycle itself is a world-wide biological phenomenon might suggest that views of its meaning and management would be universal as well, nothing could be further from the truth.

Kita and package of Kotex YoungConsider an ongoing marketing campaign that originated in Israel that features a cartoon character named Kita. To the best of my knowledge this campaign has not been adapted for use in the United States, nor, in my opinion, is it likely to find a place in American advertising nor on American market shelves. The spookiness of the cartoon girl who resembles a Japanese anime character seems strangely unlike the way that American consumers commonly depict young teens in a menstrual context. Even the lettering of “Young” and the way the term is used are unfamiliar to American eyes. Of course, the term “Normal Plus” is meaningless but that’s not unusual in advertising everywhere. And all the shades of red and the display of hearts across the bottom of the package are unfamiliar to American consumers as well. In fact, the menstrual taboos in America have resulted (with few exceptions) in a near absence of red, other than in carefully planted touches such as the ribbon on Mother Nature’s menstrual gift box in Tampax Pearl ads, the hair and lipstick of the magician in the Always pad ads, and the big red dot in many Kotex ads.

The Kita campaign began with careful planning and design. As this promotional video from McCann-Erickson, the Tel Aviv ad agency behind the campaign, explains, it began with the creation of a character and an internet world based on notions of what the target consumers – 10 to 13 year old girls – are thought to love most: shopping, the Internet, shopping, clothing, and, of course, in addition to shopping, more shopping. The character of Kita (“the coolest friend any girl could want”), who narrates her own creation and success story, speaks in a voice that is derived from the American “Valley girl” model, complete with plenty of “like” phrases, a few “awesomes,” an “as if” and a “duh” or two. How Kita immigrated from the San Fernando Valley to Tel Aviv is a mystery, although her native voice does come through a few times via some non-Valley pronunciations. (She pronounces “Kotex” as though it were spelled “Kodex.”) According to the boastful promotional video clip, Kita has achieved remarkably high market saturation. It claims that, “95% of Israeli girls know me and love me” and that “1 of every 2 Israeli girls (12-15) has a profile in Kita City.” Furthermore, since the launch in 2007, the “Kotex market share grew by 56%.” If this is what it takes — a menstrual role model who babbles in clichés, is consumed with consuming, wallows in the trivial, yet does so with seeming self-confidence and menstrual cycle savoir faire — to break down even an iota of menstrual shame and insecurity, who are we to object? And the fact that Kita has become a transnational, widely identified cultural meme, as the agency seems to claim, then maybe her next assignment should be to promote world peace. Ya never know!

Contraceptive Ignorance, Surviving the Zombie Apocalypse, Period Photoshoot, and other Weekend Links

May 19th, 2012 by Elizabeth Kissling

  • TLC is developing a new reality show about “extreme savers” and wants to talk with women who use cloth menstrual pads to save money. If you’re interested, GladRags has the casting call. This could be a great opportunity for menstrual education, or it could be a nightmare. Given that this is the network of Toddlers and Tiaras and Tattoo School, I know where I’m putting my money down.
  • A new study from the Guttmacher Institute finds that a nationally representative group of 1,800 unmarried women and men between the ages of 18 and 29 apparently do not truly understand how proper use of contraception can prevent pregnancy:
  • The quiz asked respondents to choose “true” or “false” answers for basic statements such as “all IUDs are banned from use in the United States” or “condoms have an expiration date.” More than half of the men and a quarter of the women received either a D or F on the quiz.

  • In a guest post at Sexy Period, Suzan Hutchinson, TSS survivor and Director of Connectivity for You ARE Loved, reminds us that while Toxic Shock Syndrome isn’t common, it still happens and the risks and symptoms aren’t well known. (I somehow missed this back in January when it first appeared.)
  • Dr. Jen Gunter’s Gynecology Survival Guide for the Zombie Apocalypse is also useful in an an earthquake, snow storm, flood, or any other natural disaster.
  • Friend of re:Cycling Amy Sedgwick (of Red Tent Sisters) is offering a free teleseminar on May 24 for women who are finding it difficult to conceive.
  • There Will Be Blood. Vice magazine has published a series of fashion photos featuring menstruation. View as a slide show, or click here to see thumbnails of all seven photos, which you can click to enlarge.

Midlife Muddle — Own the Power of Naming

May 17th, 2012 by Elizabeth Kissling

Guest Post by Jerilynn Prior, M.D. — Centre for Menstrual Cycle and Ovulation Research

By “midlife muddle” I don’t mean the trouble concentrating or remembering names that sometimes occurs for all of us (but more frequently if we’ve wakened with night sweats and not gotten back to sleep). I mean the condoned and official confusion about naming of women’s reproductive aging. Let me show you why I am upset.


STRAW+10 staging system for reproductive aging in women

Stages of Reproductive Aging Workshop (STRAW) held a 10-year anniversary last summer. (As someone frustrated by not being “heard” at the original conference, I still think that the “W” in STRAW should stand for Women!) Despite that, STRAW+10 has made progress because at least some of the classification is now supported by population-based prospective data rather than based on what experts believe. The names that are now politically correct are summarized in the STRAW+10 Executive Summary1 and the diagram1 at right.


We in the Society for Menstrual Cycle Research have also had our say about nomenclature: “Naming Women’s Midlife Reproductive Transition”.  I wrote this (with revision and refinement by collective effort of SMCR members) because women keep getting left out of this naming business. For example:

  • a regularly menstruating woman with night sweats, heavy flow, and increased cramps could learn to call herself perimenopausal2 (not STRAW+10 Late Reproductive Phase -3b?!).
  • a woman who just finished her period can say, I’m in late perimenopause and have at least a year without further flow before I’ll be menopausal. Based on STRAW+10 she could be told that specific menstruation was her final menstrual period (nickname “FMP”) and the next day, according to STRAW+10 be told that she is now “postmenopausal”!!
  • a woman with sore breasts, irregular periods, and heavy flow could say, I’m in perimenopause. However, she may instead be told she is in the “Early Menopausal Transition.” Because she has heavy flow she is also likely to be prescribed the birth control pill (as is currently and commonly recommended). Usually she will not be told that The Pill will make her perimenopausal irregular flow worse—she may well start spotting in the middle of her cycle.3

This new and improved STRAW+10 still centers all of women’s reproduction on that mythical FMP. But to call the FMP “menopause”, as many women’s health experts do, is just unscientific. It takes at least a year without another menstruation in those of us over age 45 before nine out of ten of us will not get another period4. But one (out of ten) of us will get a further, normal period even though we’ve been that whole year without any4. We can tell that new flow is normal (in other words, does not need investigation for endometrial cancer) if we had cramps or bloating or sore breasts or moodiness—or all of these—that told us our period was coming.


So our new Naming position statement says don’t call it “menopause” until you’ve not had a period for a year. And do call it “perimenopause” if things are variable and changing even if you are still having regular flow2.  Three of nine changes can confirm for you that you are perimenopausal even if your flow is still regular:2

  1. Shorter cycles (25 days or less);
  2. Increased cramps;
  3. Heavier flow;
  4. Increased trouble sleeping—especially waking up in the middle of sleep;
  5. New or increased migraine headaches;
  6. Night sweats—especially if they tend to occur before or during flow;
  7. An increase in or new premenstrual mood swings;
  8. New sore, enlarging or nodular breasts; and
  9. Weight gain without changes in what you eat or the exercise you do.

If women can learn to call themselves perimenopausal, they will be saying they know that perimenopause is not the same as menopause—perimenopause is a midlife transition with higher and erratic estrogen levels. Menopause is a fairly stable life phase with normally low estrogen and progesterone levels that begins one year after their last menstrual flow.


Furthermore, by naming themselves accurately they will be able to tell whether a medication that is proposed for them has been tested and proven effective in perimenopausal women. Usually symptomatic women are treated with oral contraceptives (that are proven reasonably safe and useful for premenopausal contraception), or offered hormone therapy that has only been tested and shown effective for hot flushes/flashes in menopausal women.


So. . . I like the word, perimenopause and think if women understand and own it they will be on their way out of a midlife muddle.



  1. Harlow, S. Executive Summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging [pdf]. Fertility Sterility, 2012   doi: 10.1016/j.fertnstert.20012.01.128
  2. Prior JC. Clearing confusion about perimenopause. BC Med J 2005; 47(10):534-538.
  3. Casper RF, Dodin S, Reid RL, Study Investigators. The effect of 20 ug ethinyl estradiol/1 mg norethindrone acetate (MinestrinTM), a low-dose oral contraceptive, on vaginal bleeding patterns, hot flashes, and quality of life in symptomatic perimenopausal women. Menopause 1997; 4:139-147.
  4. Wallace RB, Sherman BM, Bean JA, Treloar AE, Schlabaugh L. Probability of menopause with increasing duration of amenorrhea in middle-aged women. Am J Obstet Gynecol 1979; 135(8):1021-1024.

It’s National Women’s Health Week — Celebrate and Reminisce with the FDA

May 15th, 2012 by Elizabeth Kissling

I admit, I didn’t know that this is National Women’s Health Week until I received a reminder in my inbox from a U.S. FDA mailing list, letting me know about the Food & Drug Administration’s role in promoting Women’s Health. They’ve published a brochure (available in both HTML and PDF versions) commemorating 100 Years of Protecting and Promoting Women’s Health.

Image Source: Public Domain

Society for Menstrual Cycle Research members and other women’s health advocates and activists will want to look through the list of the accomplishments the FDA claims responsibility for and lists as unequivocal improvements in women’s health.

For instance, we’ve had many discussions at re:Cycling about the FDA approval of the pill in 1960 as one holding mixed benefits for women, and not always the best choice for women’s health. The brochure also asserts that in 1970, “FDA initiated the first package insert written for consumers to explain to women the benefits and potential risks of oral contraceptives.” That happened in 1970, but Barbara Seaman, Alice Wolfson, and the other founding mothers of the National Women’s Health Network had more to do with its initiation than the FDA.

And here’s another inspiring quote from the FDA brochure:

1980: Making Tampon Use Safer

Problem: In 1980, there were 814 confirmed cases of menstrual related Toxic Shock Syndrome (TSS) and 38 deaths from the disease.
Response: FDA began requiring all tampon packages to include package inserts educating women about the risk of TSS and how to prevent it. In 1997, there were only five confirmed menstrually-related TSS cases and no deaths. The tampon package inserts with TSS information continue to be used today.

Sure, the FDA is proud of those safety rules now, but in 1982 the agency asked the industry to come up with their own voluntary standards because they did NOT want to regulate tampon safety. After years of pressure and organizing from Boston Women’s Health Collective members Esther Rome and Judy Norsigian, activist Jill Wolhander, researcher Nancy Reame, and others to standardize tampon absorbency ratings, the FDA finally enacted regulations in 1989, by court order. Nine years after 38 women died from a tampon-related illness.

Just last year, the FDA could have made another decision that would almost certainly save women’s lives, by removing birth control pills containing the synthetic progesterone drospirenone from the market, but instead the advisory panel voted by a four-person margin that the drugs’ benefit outweighed the risks.

You know what else isn’t on the list? Emergency contraception, a.k.a. the Morning After Pill and Plan B. The agency hemmed and hawed and delayed unconscionably for years, until finally approving it for limited over-the-counter availability in 2006 — a year after Susan Wood walked out of the FDA Office of Women’s Health for good over what she believed to be “willful disregard of scientific evidence showing Plan B to be safe.”

Celebrating organizational achievements that advance and protect women’s health is a fine thing. I’m glad Frances Kelsey withheld approval of Thalidomide in 1960, and for the most part, I’m glad the FDA is on the job. But while we’re celebrating women’s health and reminding everyone to be active, eat healthy, and get preventive health care (if they are so fortunate to have access to health care), let’s also celebrate the activists and advocates that keep agencies like the FDA in line.

Are We Stalled?

May 14th, 2012 by Chris Bobel

What is worse? A problem unnamed or a problem named and denied as our own?

In a recent class discussion, a (white) student shared that she while she was in high school (a racially diverse high school, she explained), “everybody got along and racism was not a problem.” But now, since taking my class, she sees there IS racism around her.

The denial of racism in our own lives. This denial, like so many others, is certainly not uncommon, especially among those protected by some measure of privilege. Sometimes our denial is less passive (I didn’t know better); sometimes it is more active (I sure do know, but the knowing is painful and expects me to DO SOMETHING and I rather not, thank you very much).

This reminds me of the responses I typically hear from my students when we discuss menstrual shame. When I show commercials like the one below, they tell me they are NOT ashamed of their periods. They talk openly about their cycles. This menstrual taboo I speak of—old school. When I probe and ask if they carry their menstrual products around in the open, then, they tell me, “No…that’s just not something you do.”


A student denies racism in her high school, but sees it OUT THERE. Young women deny menstrual shame while concealing their tampons. These contradictions vex me. What gives?

I think we are in the midst of what sociologist Arlie Hochshild calls a ‘stalled revolution.’

Hochschild uses this concept to explain how the feminist movement helped women pursue careers but stalled before it (and by it, I mean WE) succeeded in dramatically altering the gendered division of household labor. I think the concept applies here, too.

We see racism but NOT HERE, not involving ME.  We follow the rules of concealment even while we deny that we are embarrassed. I am not ashamed; other people are. We can name the problem, but we cannot, will not, claim it for ourselves. That’s where the engine cuts out. That’s where we are stalled.

We live in a culture where racism is DISCUSSED, at least. Look at the tremendous response to the murder of Travyon Martin for a recent example. And we ARE  talking more about periods and about our bodies; the very fact that Kotex launched its ’break the cycle’ campaign in 2010 is fair evidence that the menstrual discourse IS enlarging. But forgive me if I am not jumping up and down with glee. After all, there’s more talk about EVERYTHING now. We have more ways, more means, more access to express and connect, instantaneously.  Some might argue we talk too much; we tweet and post and text before we think. Sometimes talk is just…talk.

Are talking toward change? Or we just talking, talking, talking about other people’s racism, other people’s shame.

What will it take to re-start our engines and both name and CLAIM the problems for ourselves?


Man boobs, Teen Sexuality, a Drug to Prevent HIV, and More Weekend Links

May 12th, 2012 by Elizabeth Kissling
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.