Blog of the Society for Menstrual Cycle Research

SMCR Member Profile: Exploring attitudes towards menstruation

July 6th, 2016 by Laura Wershler

Jessica Barnack-Tavlaris, PhD, Assistant Professor, Department of Psychology, The College of New Jersey

barnack-tavlaris

My PhD is in Experimental Health/Social Psychology, and I have a Master’s Degree in Public Health Specializing in Epidemiology

When did you join the Society for Menstrual Cycle Research?

I joined SMCR in 2003 when I was a graduate student in my Psychology Master’s program.

How did you become interested in doing menstrual cycle research?

I was diagnosed with endometriosis at the age of 15 and the disease has impacted my life in many ways. Learning about the complexities of women’s health in college and graduate school validated many of the experiences I was having in my own life, and led me to want to pursue this work in my career.

Which researcher or paper influenced or inspired you to pursue research in this area?

Dr. Ingrid Johnston-Robledo and Dr. Joan Chrisler have both been my mentors for many years, and I continue to be inspired by their work. Dr. Johnston-Robledo first involved me in her research when I was an undergraduate at SUNY Fredonia, and I went on to work with Dr. Chrisler in my Psychology Master’s program at Connecticut College.

What are the primary areas of your menstrual cycle research?

I am primarily interested in attitudes toward menstruation, menstrual suppression, and how women are affected by menstrual stigma.

Where can visitors to our blog read about your work on menstruation?

“Kiss Your Period Good-Bye”: Menstrual Suppression in the Popular Press, Ingrid Johnson-Robledo, Jessica L. Barnack-Tavlaris and Stephanie Wares, Sex Roles, 54 (5): 353-360, November 2006. 

The Experience of Chronic Illness in Women: A Comparison Between Women with Endometriosis and Women with Chronic Migraine Headaches; Jessica L. Barnack and Joan C. Chrisler, Women & Health, 46(1):115-33,  2007.

The Medicalization of the Menstrual Cycle: Menstruation as a Disorder, (pp. 61-75), The Wrong Prescription for Women: How Medicine and Media Create a “Need” for Treatments, Drugs, and Surgery, Ed. Maureen C. McHugh and Joan C. Chrisler, Santa Barbara, CA: Praeger, 2015.

What is your current research or work in this area?

I recently conducted a study that examined perceptions of women who openly disclose their menstrual status; this paper is currently under review. I am also working with some students on a study examining ways to encourage menstruation-related helping behaviors (e.g., signing a petition against menstrual product taxation).

For information on becoming a member of the Society for Menstrual Cycle Research contact us by email: info@menstruationresearch.org. Subject line: Membership.

 

SMCR’s re: Cycling becomes Menstruation Matters

May 28th, 2016 by Laura Wershler

SMCRPC.BackMay 28 is Menstrual Hygiene Day. All over the world events are planned in honor of this year’s theme: Menstruation matters to everyone, everywhere. 

May 28, 2016, also marks the date that re: Cycling, the blog of the Society for Menstrual Cycle Research, gets its new name:

Menstruation Matters

The Society created this weblog to increase the visibility of both SMCR and menstruation research in September 2009. We named it re: Cycling to represent our view of menstruation as more than merely bleeding, but as a cycle within the larger cycle of life. The name also pays homage to our late colleague, Randi Koeske, who first used this term.

During the blog’s seven-year history, menstrual advocacy and activism have exploded worldwide. Though it all, this blog has addressed and documented all matters menstrual, at the discretion of its many and varied authors. As noted when the blog launched:

“The views expressed are not necessarily those of SMCR, nor even the unanimous views of all blog contributors. Indeed, although we believe in holding writers accountable for their words, we also reserve the right to change our opinions on the basis of new information. We adhere to a vision of academic freedom that is ethical, fair, and responsible.”

This will not change. Readers of our blog know that our writers share and interpret research, report menstrual happenings, express strong opinions, and offer fresh, informed analyses of menstruation matters related to academia, social justice, media, the arts, advocacy and activism.

Expect this to continue as our blog takes on the name of the heavily used hashtag we founded in the lead-up to our 2013 Biennial Conference in New York City: #MenstruationMatters.

The Society for Menstrual Cycle Research has been making menstruation matter since 1977, when this nonprofit organization was founded by a multidisciplinary group of women who were pioneers in understanding the importance of menstrual cycle research to women’s health. Our 150+ members produce, publish, and convey research findings that impact menstrual health across the lifespan, and are involved in a broad range of advocacy initiatives.

We know Menstruation Matters, and now, finally, so does the media.

As leaders in the field, SMCR applauds all of today’s menstrual advocates and activists—including our members—who have made menstruation mainstream news. Our hard work to break taboos, derail stigma, share accurate information, secure menstrual rights, and meet the menstrual health needs of girls and women around the world led to 2015 being named “The Year of the Period” by Cosmopolitan, BuzzFeed, Feministing and NPR.

And the period party continues.

Newsweek Cover_Apr-2016On April 20, 2016, Newsweek’s online edition published The Fight to End Period Shame is Going Mainstream, which became the cover story for the April 29, 2016 print issue. The bright red cover featured a tampon and the bold headline There Will Be Blood–Get Over It.

The Atlantic, on April 28, 2016, published Seeing Red: The Rise of Mensesplaining. The subhead reads: With women explaining periods to men, pop culture is finally treating menstruation as a societal issue everyone should care about.

Menstruation, a societal issue everyone should care about.” 

The Society for Menstrual Cycle Research has been caring for the last 40 years!

 

Menstruation Matters will carry on the re: Cycling legacy as we continue to report, comment, summarize, analyze and opine on all matters menstrual.

Please keep reading.

Laura Wershler is the editor-in-chief of Menstruation Matters, the blog formerly known as re: Cycling

#MenstruationMatters to Newsweek

April 21st, 2016 by Laura Wershler

The menstrual advocacy movement splashes red all over the cover of Newsweek’s upcoming April 29, 2016 edition. The story by Abigail Jones–The Fight to End Period Shaming is Going Mainstream–published online April 20, 2016, continues the mad rush of period stories that prompted Cosmopolitan to declare 2015 the “year the period went public.” Chris Bobel, President of the Society for Menstrual Research, is quoted briefly in the Newsweek piece. For Chris’s cogent analysis of the recent spate of period positivity check out her Nov. 15, 2015 re: Cycling post:  Will this 2015 menstrual moment make room for all bodies?

Newsweek Cover_Apr-2016

“Endo What?” documentary sets the record straight about endometriosis

March 31st, 2016 by Laura Wershler

Endo what screen shotThe facts are eye-opening, the experts are compelling, but it is the voices of women talking about their lived experience with endometriosis that have the biggest impact in Endo What?, the documentary about the disease that premiered in New York City on March 16, 2016, during #EndometriosisAwarenessMonth.

In one early scene, woman after woman states the number of years it took for their endometriosis to be diagnosed: 18 years, 20 plus years, more than 15, 22 plus, 13, 6, 13, 12, 10 years, years during which many were told their intense pain was normal, or it was in their heads, or they needed to see a psychiatrist, or they were drug-seeking, or worse.

One later describes her pain: “It just feels like someone is taking a roller and rolling up my insides, and it’s tighter and tighter, and then rubbing barbed wire through it.”

The pain caused by endometriosis is NOT normal.

The film’s director and co-producer Shannon Cohn experienced symptoms at 16 and was finally diagnosed at 29. She, too, was told her debilitating pain was normal. In a recent Newsweek article she said, “Millions of other women are basically told the same thing.”

If it takes on average 8 to 10 years from the onset of symptoms to be diagnosed with endometriosis, getting a diagnosis is no guarantee you will receive appropriate or effective medical care.The film makes clear how few real endometriosis experts there are, and how much unhelpful care and how many ineffective, even damaging, treatments are provided by medical professionals who don’t know the facts or still believe the myths about endometriosis.

Contrary to what you may have heard, very young women DO get endo (symptoms can start before the onset of menstruation), it is NOT a career women’s disease, pregnancy is NOT a cure, and hysterectomy—definitely—is NOT a cure.

Endometriosis is also a disease of associated conditions including irritable bowel syndrome, interstitial cystitis, pelvic floor muscular dysfunction, thyroid problems and chronic fatigue—all of which can complicate diagnosis and treatment.

As for treatment options, hormonal manipulation with birth control pills may manage symptoms for awhile but in no way treats the disease. Stronger drugs like Lupron and other GnRH agonists offer few benefits and many negative side effects, some of which may be permanent.

As Deborah Metzger, MD, PhD, puts it,

“The way we practice medicine is not conducive for what women with endometriosis need…It’s a chronic systemic issue and it needs solutions that are long-term….and using hormones and all those other things, those are Band-Aids.”

The best long-term treatment for endometriosis is surgery, but one of the most startling messages of the film is how few surgeons have the skill to perform laparoscopic excision surgery, considered the gold standard by experts. As one endo surgeon says, “It cannot be done by regular gynecologists as a routine surgery.” To be effective all lesions must be completely excised. Most surgeons use a laser to burn the surface of endometriosis, rather than cut it out, leading to continued pain and repeat surgeries. What endometriosis sufferers need, a voice in the film tells us, is “One surgery, done right.”

Endo What? also explores the connection between infertility and endometriosis—distortion of the reproductive tract by endometrial lesions and inflammation are key factors. Excision surgery can greatly improve the chance of conceiving.

The second half of the film focuses on what women can do post-surgery to restore their health and well-being. Physical therapy to relieve pelvic floor pain, nutritional counselling to restore digestive health and reduce inflammation, exercise, stress reduction strategies, and reducing exposure to environmental toxins and everyday chemicals can help aid recovery to health. A key message is that the disease is individual; what works for some may not work for others.

If the film’s goal is to make people care about endometriosis, it does this effectively by making the viewer care about the women who live with this disease. Be we friends, parents, family members or health-care providers of women with endometriosis, the onus is on all of us to learn the facts about a disease that affects one in 10, and an estimated 176 million worldwide. Medical students should not graduate until they’ve watched this documentary.

The film ends on a hopeful note. ‘There is life after endometriosis.” But to get there, women must be their own best advocates.

“Don’t accept what one or two or 10 doctors tell you is normal when you know that something is wrong,” one interview subject tells us. “Keep pushing until you find the right provider, they are out there.”

Let’s hope, as a result of this film, there will be more of them soon.

Endo What? will be available widely online on April 15th in the US and UK via digital download and DVDs. Watch the trailer here.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re: Cycling.

NOTE: March 31, 2016, is Transgender Day of Visibility. The film Endo What? does not address the unique concerns trans people may have with endometriosis. “Endometriosis and Being a Trans Person: Beyond Gendered Reproductive Health,” published by Hormones Matter, Jan. 22, 2014, provides a trans perspective on this disease.

#Endometriosis art, film and a graphic book: Endo Weekend Links #3

March 19th, 2016 by Laura Wershler

“1 in 10 women suffer from a disease that most people have never heard of.”                  

Weekend Links at re:Cycling acknowledges the many ways in which the creative arts are taking on #endometriosisawareness advocacy.

1. Film: It was a big week for the producers of the documentary Endo What? that premiered on March 16th in New York City.

 

EndoWhatTweet2

 

The film has its European premiere on March 21, 2016 in London, England. The quote above opens the trailer for the film Endo What? You can watch it here:

 

 

2. Graphic Book: Kaye, a graphic artist from the U.K., experienced 15 years of extreme pain before finally being diagnosed with endometriosis. She writes on her Endoawareness website: “As a young woman it was almost an embarrassment to admit how awful the symptoms were and I went to extreme lengths to disguise it from friends and family.” Kaye used her talent to create Living with Endometriosis, a free downloadable e-book. You can read Kaye’s personal endometriosis story here.

endo-ohhhkaye

3. Endometriosis Awareness through Art: This Facebook community presents the work of various artists using various art forms including painting, photography, graphic imagery, video and music to focus attention on endometriosis.

Endo Art Facebook Page

 

 

#EndometriosisAwarenessMonth: Weekend Links #2

March 12th, 2016 by Laura Wershler

As Endometriosis Awareness Month continues, here are a few worthy and/or interesting media stories that mention endometriosis so far this March:

awareness_month_bannerMarch 8, 2016, Medical Xpress, Survey launched to learn more about Endometriosis

You’d think the medical community would know a lot about a serious disease that impacts the lives of about 176 million women worldwide. Not so:

Researchers from the University of Liverpool’s Institute of Translational Medicine, in collaboration with the Universities of Edinburgh and Oxford, are launching a national survey to further understanding of a common gynaecological condition called endometriosis.

 

March 9, 2016, Christine Hauser, The New York Times, Padma Lakshmi Opens Up About Rushdie in Memoir

Endometriosis advocate, cookbook author and reality television star Padma Lakshmi released her memoir Love, Loss and What We Ate on March 8th. The news story makes clear the broad impact endometriosis can have on a woman’s life:

Ms. Lakshmi suffered from endometriosis, a painful uterine disorder in which tissue grows outside the organ. The struggles of dealing with it — she had extensive surgery — upended their sex life and contributed to the demise of their marriage, she writes. Ms. Lakshmi said Mr. Rushdie at one point called her “a bad investment” and was insensitive to her medical condition even as she tried to recuperate.

 

March 10, 2016, Sola Ogundipe, Vanguard,  Nordica, Diamond Bank walk in Lagos for endometriosis awareness

Events to mark Endometriosis Awareness Month are happening all over the world. In attendance at the Endo Walk in Lagos, Nigeria, was international model and endometriosis advocate Millen Magese.

IT was a star-studded list of  Nigerians that braved the early-morning downpour on Saturday March 5, 2016, to  participate in the annual Endo Walk, aimed at breaking the silence around Endometrioisis – a silent but growing health condition that predisposes women of reproductive age to ill health, infertility and severe periodic pains.

 

March 11, WTOP, Endometriosis and period pain: Redefining normal for teenage women

An article sponsored by  The Center for Innovative GYN Care based in Washington, DC, makes the point that far too often teenagers and young women are told that the menstrual pain they feel is normal:

The perception is that this is a burden a woman must bear as part of her biological make-up, and the less said about it the better, unless you are selling a pain reliever/diuretic combo. Those who manage to make it through years without experiencing pain are deemed “lucky.” But, the mere acceptance of pain as a side effect of the onset of female fertility has served, some would say for thousands of years, to ignore a sign of an actual disease: Endometriosis. A disease that increases in intensity over time.

 

Coming up next Saturday, March 19, is the 2016 Worldwide EndoMarch taking place in various cities throughout the world. Click here for information.

#EndometriosisAwarenessMonth: Weekend Links #1

March 5th, 2016 by Laura Wershler
Photo courtesy of Heather Guidone

Photo courtesy of Heather Guidone

Worldwide, and here at re:Cycling, March is #EndometriosisAwarenessMonth. To increase your knowledge of this insidious disease, read through this series of articles and personal stories, briefly quoted here, that were published by The Guardian last September.

 

Sep. 27, 2015, The GuardianWhat is endometriosis guide

Endometriosis is a condition in which tissue similar to the lining of the uterus (the endometrium) is found outside the uterus, most commonly in the pelvic cavity.

It can grow on organs including the ovaries, uterus, bowel and pelvic sidewall, causing inflammation and pain.

 

Sep. 27, 2015, Gabrielle Jackson, The Guardian, Endometriosis: 20 things every woman (and every doctor) should know

11. 
Endometriosis affects the immune system but it isn’t an autoimmune disease.

12. 
The severity of endometriosis doesn’t necessarily correlate with the amount of pain or other symptoms a women has.

 

Sep. 27, 2015, Gabrielle Jackson, The GuardianI’m not a hypochondriac. I have a disease. All these things that are wrong with me are real, they are endometriosis

I feel sad that this is the hardest story I’ve ever written and that I’m embarrassed that people will read it and know the intimate details of my life. But I’m also hopeful that a conversation has begun.

 

Sep. 27, 2015, Sarah Boseley, Jessica Glenza and Helen Davidson, The Guardian, Endometriosis: the hidden suffering of millions of women revealed

The lack of research and funding for a disease that affects so many women is “a major scandal”, said Lone Hummelshoj, who heads the World Endometriosis Research Foundation and the World Endometriosis Society. 

“Endometriosis affects women in the prime of their life. It is not a lifestyle disease. It is not a disease you get later in life. It attacks teens, young women when they should be out being active, working, having children, having sex – 50% of them are struggling with sex because it is too painful,” she said.

 

Sep.28, 2015,  The Guardian view on endometriosis: a silent source of unnecessary misery–Editorial

A disease that affects one in 10 women of childbearing age, that forces young girls to take days off school, older women to abandon careers and condemns others to childlessness should not be near-invisible. And yet endometriosis is rarely discussed, and when it is, it is often obscured by myths suggesting that women themselves are in some way to blame. Many are ashamed to admit to suffering, and often doctors seem ill-prepared to diagnose and treat the disease. It is a secret plague; yet it could afflict as many as 176 million women around the world.

 

Sep. 28, 2015, Hilary Mantel, The GuardianEndometriosis took my fertility, and part of my self

My own battle with the disorder seems to have occupied most of my life. Period pains were normal, I was told, and if I seemed to suffer more than most, it must be because I had a “low pain threshold”. At 19, I began actively seeking a diagnosis. I was 27 when I received it, and by that stage, major surgery was the only answer. Abruptly I lost my fertility and, in some ways, lost myself. Though I was told I was cured, the condition recurred, and drug treatment led to huge weight gain. Thyroid failure followed and the devastating chain of consequences pursues me to this day. Anything I have achieved has been in the teeth of the disease.

 

Sep. 28, 2015, The Guardian, ‘The pain is paralysing’: 30 women describe living with endometriosis

I’m a gynaecologist and I didn’t want to accept that I had it

It’s treated like some shameful secret

Endometriosis is ruining my marriage

Doctors who know how to treat it are few and far between

 

Sep. 28, 2015, Jessica Glenza, The GuardianEndometriosis often ignored as millions of American women suffer

Many patients and specialists contend that the lack of research funding and public knowledge of endometriosis is because of who and what it impacts: almost exclusively women, largely during menstruation. 

“I went 10 years, through 22 surgeries, before I got help,” said Heather C Guidone, the surgical program director at the Center for Endometriosis Care in Atlanta. Through those 10 years, and since hearing the stories of other patients, she said doctors often tell women, “‘Periods are supposed to hurt. It’s a woman’s lot in life to suffer.’”

 

March is Endometriosis Awareness Month—Worldwide

March 1st, 2016 by Laura Wershler

awareness_month_banner“Endometriosis affects an estimated 176 million women worldwide during their most reproductive and productive years.” 

      World Endometriosis Research Foundation 

 

 

 

 

 

 

 

Around the world throughout the month of March women living with endometriosis, health-care providers who treat the condition, and endometriosis advocates, will be hosting events and using social media to raise awareness of a condition that affects 1 in 10 women. How many women do you know who live with endometriosis? How much do you actually know about the disease?

Having endometriosis is much, much more than having bad periods. It is a complex disease that defies easy definition and easy treatment, one about which much misinformation persists. As the Center for Endometriosis Care explains in an article on their website:

Despite being among the most common of diseases, persistent myths, misinformation and deficient health literacy about the disease continue to enshroud endometriosis – even by the most well-intentioned sources – often resulting in poor information systems and continued lack of effective care.

On re:Cycling this month, we aim to amplify the voices of women from around the world for whom endometriosis is either a personal or professional experience, and many times both.

We want readers to know the difference between myths and facts about endometriosis, to learn about treatment options, and to understand what it is really like to live with a condition that can take up to 10 years or more to be diagnosed, all the while growing more severe and debilitating.

Subscribe to re:Cycling so you don’t miss a post. Follow #endometriosisawarenessmonth on Twitter. And share the details of any Endometriosis Awareness Month Events happening in your community.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re:Cycling.

2016 Endometriosis Awareness Events:

Endo What Film Premiere, March 16, 2016, New York City

Worldwide EndoMarch, March 19, 2016

San Francisco

Australia

Endometriosis New Zealand

The Endometriosis Network of Canada

List of events happening around the world (Canada, Finland, Germany, Ireland, Italy, Netherlands, Spain, Sweden, United Kingdom, USA)

Media all over “end-the-tampon-tax” advocacy

January 30th, 2016 by Laura Wershler

As U.S. advocacy to end the “tampon tax” on all feminine hygiene products continues, Democratic politicians, including President Obama, dialled up the media conversation about the issue as 2016 got underway. Here’s a January timeline:

This tampon art piece might be considered a luxury item, but the real thing is not. Special Edition Playtex by Danielle Hogan, 2006. Used with permission. daniellehogan.com

This tampon art piece might be considered a luxury item, but the real thing is not. Special Edition Playtex by Danielle Hogan, 2006. Used with permission. daniellehogan.com

Jan. 5, 2016, Michele Gorman, NewsweekCalifornia legislators seek to end “tampon tax” on feminine hygiene products

Jan. 7, 2016, Josh Barro, The New York Times, The Latest Sales Tax Controversy: Tampons

So why shouldn’t tampons get the same tax break as other necessities? It’s a question that’s been debated in legislatures around the world, with tampon tax cuts adopted in Canada and rejected in France last year.

Jan. 8, 2016, Mary Elizabeth Williams, Salon,  Time to end the tampon tax: Sales tax on feminine hygiene products unfairly penalize women

But while arguments over what makes something a necessity are open to debate, arguments over a fee that only affects one segment of the population are not. That’s what makes the sales tax unfair. And that’s a price women don’t deserve to pay.

Jan. 8, 2016, Sarah Larimer, The Washington Post, The ‘tampon tax,’ explained

It’s an issue that’s gaining more and more attention around the world. Canada’s tax on feminine hygiene products was lifted over summer, after thousands signed an online petition on the matter. In Britain, a few women staged a “tampon tax” protest while on their periods last fall.

Jan. 20, 2016, Sade Strehlke, Teen VogueWatch YouTube Star Ingrid Nilsen School President Obama on the “Tampon Tax”

As Ingrid and our president point out, however, periods are not optional for most women, and we shouldn’t be burdened with an extra charge when it’s that time of month.

President Obama sheepishly admitted that he doesn’t know why states tax tampons, but he suspects “it’s because men were making these laws when those taxes were passed.”

“I don’t know anyone who has a period who thinks it’s a luxury,” Ingrid responded. President Obama agreed, and said his wife, would probably agree with her too. “It’s something that’s part of our everyday lives, and is crucial to our health as women,” she continued.

Jan. 26, 2016, Jennifer Weiss-Wolf, The NationWhy Are We Paying Sales Tax on Tampons?

Jan. 28, 2016: Haley Snyder, Huff Post PoliticsThere Will Be Blood–So Long As There Is Inequality

For a woman making decent money, a simple tax on tampons may be unnoticeable, but for someone who is poor who spends a larger percentage of her money on tampons, a “small” difference may strip away her ability to afford a product entirely.

Jan 28, 2016, Kerry Close, Money (Time Inc.), The Tampon Tax Could Finally Be Eliminated in These States

At home, there’s hope for women who live in the majority of states that still somehow consider tampons a luxury. The issue has been getting a lot of press lately, with even President Obama admitting he doesn’t understand why the tax exists.

When asked this month by YouTube personality Ingrid Nilsen why tampons are considered luxury items in so many states, the president replied, “I suspect it’s because men were making the laws when those taxes were passed.

Meanwhile, the Change.org petition (No Tax On Tampons: Stop Taxing Our Periods! Period.) launched by Jennifer Weiss-Wolf and Cosmopolitan magazine needs just over 6,000 more signatures to reach the 50,000 mark.

Canadian Laura Wershler, SMCR member and editor-in-chief of re:Cycling, was proud when the Canadian parliament agreed unanimously to lift the federal tax on femcare products in mid-2015. 

Novel approach to the menstrual cycle: State of Wonder, Part 3

December 19th, 2015 by Laura Wershler

This post was originally published at re:Cycling on March 27, 2015. 

State of Wonder–Part 3: Wondering about menstrual cycle misconceptions in a fictionalized theory for extended fertility

In Parts 1 and 2, I wondered why author Ann Patchett chose not to include information about menstruation, femcare products and birth control that, logically, would have enhanced her novel’s inciting premise—lifelong menstruation and fertility—while retaining the literary integrity of State of Wonder. I believe just a few sentences could have accomplished this.

Now, I wonder about the menstrual cycle misconceptions that underpin Patchett’s proposed explanation for the extended fertility experienced by the Lakashi tribe.

The reader learns with Dr. Marina Singh, the novel’s protagonist, that the Lakashi women continue to menstruate, ovulate, conceive and give birth into their 70s because they regularly chew the bark of Martin trees found in the Brazilian rainforest. The bark is so effective there are no post-menopausal Lakashi.

The women chew the bark once every five days except when they are menstruating and when they’re pregnant, because the bark repulses them from the moment of conception. The researchers, led by Dr. Annick Swenson who has been studying the Lakashi for decades, observe the women chewing the bark and collect cervical mucus swabs to monitor their estrogen levels. They dab the swabs on slides for “ferning.”

“No one does ferning anymore,” Marina said. It was the slightly arcane process of watching estrogen grow into intricate fern patterns on slides. No ferns, no fertility.

Dr. Saturn shrugged. “It’s very effective for the Lakashi. Their estrogen levels are quite sensitive to the intake of the bark.”

Hormonal changes during the menstrual cycle: Used with permission from Geraldine Matus, Justisse Healthworks for Women

Patchett perpetuates the myth that fertility is all about estrogen. Actually, fertility is dependent upon the cyclic ebb and flow of estrogen and progesterone. As the graphic illustrates, estrogen rises in the pre-ovulatory phase, peaks, then drops dramatically just before ovulation occurs. Post ovulation, estrogen continues to be produced but its effect on cervical mucus is suppressed (no ferns) by the substantially higher level of progesterone which acts upon the endometrium in preparation for pregnancy.

It would make more sense for the Lakashi to chew the bark more often during the pre-ovulatory phase but be repulsed by it post-ovulation as progesterone rises. How neat would that have been? The researchers could have pinpointed ovulation in their study subjects. Oddly, ovulation is not even mentioned.

Furthermore, if intake of the bark raises estrogen levels, chewing the bark every five days would interfere with the post-ovulatory rise of progesterone, throwing the hormonal interplay of estrogen and progesterone required to achieve and support a pregnancy out of whack.

Another issue: Marina is told that by chewing the bark “her window for monthly fertility would be extended from three days to thirteen.” What does this really mean? According to the scientific principles underlying the fertility awareness method of achieving or avoiding pregnancy, the fertile phase starts when fertile-quality cervical mucus is first observed and ends when three dry days have passed. The bark would increase the fertile quality of the mucus and the number of days fertile mucus occurs pre-ovulation, thereby increasing the chances for conception. But sperm can only survive five days, kept viable by the mucus that locks it in the cervical crypts until an egg is released. And that egg will remain viable for only 24 hours. Timing of intercourse still matters. The extended fertility explanation in the novel does not suggest the Martin tree bark has any effect on these accepted reproductive factors.

Am I being too picky? Perhaps. State of Wonder is, after all, a work of fiction. But I expect a seasoned novelist to have researched basic menstrual cycle facts so as not to pose an explanation for extended fertility that doesn’t pass scrutiny. Had Patchett consulted with a menstrual cycle expert, perhaps an SMCR member, she might have imagined a much more plausible scenario. In the actual book I read, there were no acknowledgements to those she may have consulted on the subject.

I loved State of Wonder for all it’s literary complexity that goes far beyond the details related to the menstrual cycle that I have wondered about in this 3-part series. But it’s been fun to explore how one novelist wrote about a subject I am intimately familiar with and to suggest how she might have done it differently.

Thank you Ann Patchett. Here’s to more menstrual mentions in literature.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re:Cycling.

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.