Blog of the Society for Menstrual Cycle Research

SMCR Member Profile: Studying how ovulation and the menstrual cycle impact women’s health

June 23rd, 2016 by Editor

Jerilynn C. Prior BA, MD; Professor of Medicine/Endocrinology at the University of British Columbia; Scientific Director of the Centre for Menstrual Cycle and Ovulation Research

Jerilynn Prior2When and why did you join the Society for Menstrual Cycle Research?
I joined SMCR at the Ann Arbor, Michigan conference in 1987—I presented a paper there saying that the absence of normal premenstrual symptoms (molimina) could tell women they were not ovulating. I was already doing research on menstrual cycles and bone changes in normally active women and in long-distance runners and wanted the support of other researchers with similar interests.

How did you become interested in doing menstrual cycle research?
I’ve wondered what was normal and how menstrual cycle adaptations occurred since my own cycle went away for the first nine months of my university training. I decided to go into endocrinology as a specialty of internal medicine because it required a holistic view and could focus on balance rather than solely on diseases. When I first moved to Canada in 1976 and sought to become an academic I realized I needed a special niche within endocrinology—I chose women’s reproductive endocrinology since at the time the longer distance running exercise that women were just being allowed to do was being blamed for women’s development of amenorrhea. That felt like prejudice. It also was poorly studied.    

Which researcher or paper influenced or inspired you to pursue research in this area? Why?
I think the desire to study menstrual cycles grew out of my own experiences and questions as well as trying to ensure gender equity in exercise opportunities.

What are the primary areas of your menstrual cycle research?
One of the non-scientist leaders on SMCR in the early days asked me: “On what day of the cycle do women ovulate?” Even then I knew it was highly variable both within and between women. 

My research focusses on:

–adaptation of cycle and ovulation to exercise (e.g. marathon running)

–influence of menstrual cycle length and ovulation on bone change

–influence of menstrual cycles and ovulation on women’s later life risks for heart disease

–influence of menstrual cycles and ovulation on women’s risk for breast and endometrial cancer

–cause, consequences and treatment of hot flushes and night sweats

–hormonal and experiential changes during the perimenopause

–influences of use of combined hormonal contraception on changes in bone and reproductive characteristics, especially in adolescence

–treatment of common cycle-related problems such as heavy flow, irregular/absent cycles, cramps   

Where can visitors to our blog read about your work on the menstrual cycle?
This paper on spinal bone loss and ovulatory disturbances showed for the first time that ovulation influences changes in healthy women’s bone. (N Engl J Med 1990)

This controlled trial showed that medroxyprogesterone (a progestin) causes bone gain in healthy, normal-weight premenopausal women with abnormal cycles and ovulatory disturbances. (1994 Am J. Med)

A meta-analysis of prospective studies showed that ovulatory disturbances are related to bone loss. (2014-Epidemiologic Reviews)

A study in a whole population of women 20-49 in Norway showed that, over one cycle, >33% of women with regular, normal-length cycles were not ovulatory. (2015—PLOS ONE)

Estrogen’s Storm Season- Stories of Perimenopause is a unique fiction book whose purpose is to inform and empower midlife women by telling stories of women who are not real but with whom they are likely to resonate. It is also to show how medicine should be practiced—as a collaboration between the woman who knows herself and her goals, and a knowledgeable, understanding physician. (Vancouver, BC: CeMCOR, 2005, 2007)

The Estrogen Errors: Why Progesterone is Better For Women’s Health,co-written with sociologist/journalist Susan Baxter, is a journalistic critique of current appropaches to perimenopause. (Westport: Praeger Publishers, 2009, available as an ebook.)

What is the most interesting, important or applicable thing your research has revealed about women’s experience of menstruation?
That regular cycles do not predict normal ovulation and at least a third of all are anovulatory in population-based data.

What is your current research or work in this area?
Trying to develop a non-invasive, inexpensive test of ovulation.

How has the field of menstrual cycle research changed since you entered this area?
It continues to be a hard area in which to get academic credit but more women are seeking knowledge and the world is becoming more open.

What else would you like our readers to know about the value, importance or influence of menstrual cycle research?
We’ve only begun to piece together the many things that change across the menstrual cycle or the processes that women’s estradiol and progesterone levels influence. Cycle specific measurements need to be built into all studies so that women can participate and the results will be scientific.

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

Writing Menopause, An Anthology: Preview #2

April 28th, 2016 by Editor

WritingMenopauseWriting Menopause, a diverse literary collection about menopause to be published in the spring of 2017 by Inanna Publicationswas first introduced to the Society for Menstrual Cycle Research in a session presented at our June 2015 biennial conference in Boston. The anthology includes about fifty works of fiction, creative nonfiction, poetry, interviews, and cross-genre pieces from contributors across Canada and the United States. With this collection, editors Jane Cawthorne and E.D. Morin hope to shine a light on a wide variety of menopause experiences and to shatter common stereotypes. This week at re: Cycling we are pleased to be able to preview excerpts from the collection. Preview #1 included a short prose piece and a poem by Tanya Coovadia. Today’s preview is by SMCR member Heather Dillaway, a piece that was previously published on this blog.


Fact and Fiction: Two Lists by Heather Dillaway

List One: Things Menopausal Women Would Love to Hear That ARE True

  1. what do i want to hear?It’s okay to be glad to be done with menstruation, the threat of pregnancy and the burdens of contraception. It’s also okay to use the menopausal transition to question whether you really wanted kids, whether you had the number of kids you wanted and whether you’ve been satisfied with your reproductive life in general. It’s normal to have all of these thoughts and feelings.
  2. You’re entering the best, most free part of your life! But, it’s okay if it doesn’t feel like that yet.
  3. Menopause does not mean you are old. In fact, potentially you are only half way through your life.
  4. You are not alone. Lots of people have the experiences you do. You are normal!
  5. I understand what you’re going through. (Or, alternatively, I don’t completely understand what you’re going through but I’m willing to listen.)
  6. It’s okay to be confused and frustrated at this time of life, or in any other time of life!
  7. You’ve had an entire lifetime of reproductive experiences and this is simply one more. How you feel about menopause is probably related to how you’ve felt about other reproductive experiences over time. It might be helpful to reflect back on all of the reproductive experiences you’ve had to sort out how you feel about menopause.
  8. Talk to other women you know. Talking about menopause helps everybody.
  9. Menopause and midlife can be as significant or insignificant as you’d like them to be. For some women, these transitions mean very important things but, for others, they mean little. Whatever it means to you is okay.
  10. Researchers are working hard to understand this reproductive transition more fully.

These represent the kind of supportive comments women might want to hear while going through menopause and, in particular, perimenopause. Items on this list also help us acknowledge that our bodies and bodily transitions cause us to reflect on our life stages, our identities and our choices.

List Two: Things Menopausal Women Would Love to Hear But Might NOT Be True

  1. This is guaranteed to be your last menstrual period. You are done! (Or, a related one: You’ve already had the worst. It gets better from here on out!)
  2. Signs and symptoms of menopause will be predictable and will not interrupt your life.
  3. No one will think negatively of you or differently about you if you tell them you’re menopausal.
  4. There are no major side effects to hormone therapies or any other medical treatments you might be considering.
  5. Doctors will be able to help you and will understand your signs and symptoms, if you need relief.
  6. Leaky bodies are no problem! No one will care if your body does what it wants, whenever it wants.
  7. Partners, children, coworkers and others will completely understand what you’re going through.
  8. Middle-aged women are respected in this society and it is truly a benefit to be at this life stage.
  9. There is a clear beginning and a clear end to this transition.
  10. Clinical researchers are researching the parts of menopause that you care about.

This reflects many of our societal norms and biases about our bodies, aging, gender, fertility and so on. This list also attests to the difficulties that menopausal women have in accessing quality health care or getting safe relief from symptoms when needed and notes the potential disconnects between research findings and women’s true needs during this transition.

Heather Dillaway is an associate professor of sociology at Wayne State University in Detroit, Michigan. Her research focuses on women’s menopause and midlife, and she often writes about the everyday experiences of going through these transitions. She teaches about women’s health, families and gender & race inequalities.

Writing Menopause, An Anthology: Preview #1

April 26th, 2016 by Editor

WritingMenopauseWriting Menopause, a diverse literary collection about menopause to be published in the spring of 2017 by Inanna Publicationswas first introduced to the Society for Menstrual Cycle Research in a session presented at our June 2015 biennial conference in Boston. The anthology includes about fifty works of fiction, creative nonfiction, poetry, interviews, and cross-genre pieces from contributors across Canada and the United States. With this collection, editors Jane Cawthorne and E.D. Morin hope to shine a light on a wide variety of menopause experiences and to shatter common stereotypes. This week at re: Cycling we are pleased to be able to preview excerpts from the collection.


Two pieces by Tanya Coovadia:

The Things We Carry

Last January, I attended a reading series during which two distinguished male authors, in separate opening remarks, said derogatory things about middle-aged women. I don’t think I would have noticed twenty years ago, but lately, for some reason, I am particularly attuned to discussions regarding women of my uncertain age, especially when they are uttered in tones suggestive of a shameful affliction.

Benign anal tumours, say.

One of these men, after his reading, went on to add further insult. He described the typical bumbling misapprehension of his work by that admiring but clueless fan who, he assured us, in his laconic drawl, was “always a middle-aged woman.” As a late-blooming member of the midlife sisterhood, this incident sparked a poem in me.

And (in a laconic drawl) it’s dedicated to Tim O’Brien.

Always a Middle-Aged Woman

(because middle-aged men are just men)

Striding up
with her staunchly held head
her opinions bared like wrinkled breasts

And those years she wears
a bitter glory of furrows and lines
etched by thousands of erstwhile smiles.

Who do they think they are,
these ladies (and we mean you, ma’am)
thriving so steadily
from their cloak of invisibility

We don’t see your once young face
we never stroked your once shining hair

We can’t hear your
sweet, barely caught breath
because you’re
Blatantly!
middle-aged

As though ageing is some kind of victory
as though youth and beauty
are not mandatory

As though you can bring
something new to the world
when your womb is too old to care.

My mirror,
I,
we,
you
reflect this, true

We lift our jowls toward our ears
and smile
a spasm, a rictus. Of youth.

Tanya Coovadia is a technical writer, blogger and angry-letter-writer-cum-fictionalist who occasionally dabbles in poetry. She’s a Canadian transplant to Florida who, during the writing of this poem, realized her interminable hot flashes were not weather-related after all. Ms. Coovadia has an MFA in Creative Writing from Pine Manor College in Boston. Her first collection of short fiction, Pelee Island Stories, recently won an IPPY award.

Premenopause / Early Menopause / Primary Ovarian Insufficiency (or Failure) / Perimenopause / Menopause / Postmenopause: Why these names matter

April 5th, 2016 by Editor

Making sense of the many names for women’s reproductive aging by Dr. Jerilynn C. Prior

Jerilynn C. Prior BA, MD, FRCPC, ABIM, ABEM is a Professor of Endocrinology and Metabolism at the University of British Columbia in Vancouver, B.C. She is the founder (2002) and Scientific Director of the Centre for Menstrual Cycle and Ovulation Research(CeMCOR).

The process of aging of women’s reproductive system, like puberty and most biological transitions, occurs in a generally standardized but variable way and over many years. Also, there are broad age ranges at which we consider something normal or not. Then add on top of that cultural presuppositions, chief among them that “menopause means estrogen deficiency” (rather than that menopausal estrogen and progesterone levels are normally low), and we have real confusion and a situation that is not helpful1 for women or for their communication with health care providers.

I will do my best to describe some of these standardized ways that women’s physiology changes during reproductive aging. I will mention the current terms and the words that have some physiological relevance and should be used. Because I am a physician, I believe that understanding of “the story” of life phases and the “why” of experiences is helpful. It is also necessary to appreciate the whole woman in her social, cultural, physical and experiential environments markedly influence her experiences.

After extensive research to understand mine and my patient’s puzzling midlife experiences, I learned that the ovaries start to make less Inhibin (really Inhibin B) while cycles are still regular2;3. Inhibin is small hormone made in the follicular cells surrounding stored eggs; its job is to control levels of follicle stimulating hormone (FSH). Because FSH stimulates follicles to grow, Inhibin is necessary to limit the number of stimulated follicles and to prevent us having litters. As shown (Figure below), by very early perimenopause there are fewer remaining ovarian follicles (B), Inhibin is decreased and this allows higher FSH levels and more stimulated follicles. Since each recruited follicle makes some estrogen, levels rise and the higher estrogen levels are also not reliably able to control FSH3.

menopauseDiagram

Legend: The ovaries are shown as a stylized oval with follicles in various degrees of maturation. A. shows what is occurring in the follicular phase of a premenopausal ovary; B. illustrates the normal changes that occur in perimenopause. Reprinted from Prior Endocrine Reviews 1990

The same normal reproductive aging pattern of lower Inhibin, higher FSH and estrogen occurs when the ovary is injured; this can be by chemotherapy or radiotherapy for cancer, partial removal, more rapidly than normal after hysterectomy or tubal ligation/removal and in those with immune or genetic problems. The chaos of women’s reproductive aging occurs for these Inhibin-related reasons but also because the hypothalamic-pituitary ovarian feedbacks are disrupted (so a normal midcycle estrogen peak may not trigger the luteinizing hormone (LH) peak or the LH peak may not stimulate ovulation4). An FSH level, even one that is taken on cycle day 3, is not diagnostic of perimenopause. That estrogen levels average 20% higher in perimenopausal than in premenopausal women 3, I learned from a systematic review of studies within each of several centres; but symptomatic women may have double or triple normal cycle phase-specific levels that create the “perimenopausal ovarian hyperstimulation syndrome” because this situation resembles an adverse effect that may occur in IVF 3.

With this understanding we can define the three terms for normal reproductive life phases, the term used for perimenopause or menopause that comes too early and also identify some inappropriate labels.

Premenopause is the entire time (usually 30-40 years) from the first menstruation (menarche) until the changes of perimenopause start.

Perimenopause begins when cycles are still regular (called very early perimenopause and this phase lasts 2-5 years) but an observant woman notices typical experience changes5. Because the current official classification of reproductive aging begins with irregular cycles6, no one knows at what age on average this may start; likely it is normal from as young as age 35. At least three of nine typical experience changes, especially the start of night sweats, sleep problems or heavy flow, can be used to determine that you have begun this phase5. Additional potential perimenopause changes are: increased cramps, increased premenstrual physical and emotional unwanted experiences, shorter cycles (usually ≤25 days), increased or new breast tenderness, increased or new migraines and weight gain without important changes in exercise or food intake7. Perimenopause’s early menopausal transition starts when cycles become irregular and lasts a year or so; the late menopause transition begins with the first skipped cycle (60 days without flow) and late perimenopause is the year after the last flow.

Menopause is the life phase that lasts from a year after the final flow for the rest of women’s lives. It is normal for both estrogen and progesterone levels to be low. Hot flushes/flashes and night sweats may continue for many years but heavy flow, cramps, breast tenderness, premenstrual-type symptoms and severe migraine are usually gone.  (The term “postmenopause” is sometimes used interchangeably with menopause but is double-speak and refers to an erroneous use of the word “menopause” to mean the literal final menstrual flow).

Experiencing Menopause: Sexuality, desire and literary exploration

April 27th, 2015 by Editor

Three paper presentations on Menopause at the 21st Biennial Conference of the Society for Menstrual Cycle Research at The Center for Women’s Health and Human Rights, June 4-6, 2015, Suffolk University, Boston will explore sexuality and the menopausal woman, as well as personal menopausal experiences as collected in a literary anthology.

1. Sex and the Menopausal Woman: Resisting Representations of the Abject Asexual Woman
     Presented by Jane Ussher and Janette Perz, Centre for Health Research, School of Medicine, University of Western Sydney 

Drawing on qualitative research conducted with women at midlife, and those who have experienced premature menopause after cancer, we argue that sexuality can continue to be a positive experience for women throughout adult life and into old age.

Medical discourse has traditionally positioned the menopausal transition as a time of sexual atrophy and loss of femininity, with hormonal replacement as the solution. In contrast, feminist critics have argued that women’s experience of sexual embodiment during menopause is culturally and relationally mediated, tied to discursive constructions of aging and sexuality, which are negotiated by women.

This paper will present a critical examination of women’s experiences of sexuality during and after the menopausal transition, drawing on in-depth one-to-one interviews we have conducted with 21 women at midlife, and 39 women who have experienced premature menopause as a consequence of cancer treatment.

Theoretical thematic analysis was used to identify three themes across the women’s accounts: ‘Intrapsychic negotiation of sexual and embodied change’; ‘Feeling sexy or frumpy: Body image and the male gaze’; ‘Indifference or desire? The relational context of sexuality during menopause’. Through this analysis, we challenge myths and misconceptions about the inevitability of sexual decline at menopause, as well as normalise the embodied changes that some women experience–whether menopause is premature, or occurs at midlife. We argue that sexual difficulties or disinterest reported by women during and after menopause are more strongly associated with psycho-social factors than hormonal status, in particular psychological well-being, relationship context and a woman’s negotiation of cultural constructions of sex, aging, and femininity. However, sexuality can continue to be a positive experience for women throughout adult life and into old age, with many menopausal women reporting increased sexual desire and response, as well as re-negotiation of sexual activities in the context of embodied change. This undermines the bio-medical construction of menopause as a time of inevitable sexual atrophy and decay.

2. Writing Menopause: Creating an Anthology
     Presented by Jane Cawthorne and E. D. Morin

The editors will discuss their process of envisioning and creating a new literary anthology that considers the diverse experience of menopause from various points of view. The anthology is composed of new works of poetry, short fiction, interviews, creative non-fiction, and cross-genre pieces, along with several previously published creative works that were chosen to round out the collection.

Although the editors make no claims that this work is in any way definitive, their focus instead was to create a venue for more stories and to encourage a richer vocabulary about this important transition within a literary context. The editors have observed that few literary representations of menopause exist. They will explain how they arrived at wanting to create this collection, as well as the submission process, the criteria used in accepting submissions, and how the shape of the collection shifted organically with the nature of submissions received. They will reflect on what types of submissions they would not accept, what they think the volume says about menopause, and how their own ideas about menopause were changed during the process. A few excerpts will be read.

3. Sexuality and Post-Menopausal  Women:  Desirability and Desire
     Presented by Maureen C. McHugh, and Camille J. Interligi,  Department of Psychology, Indiana University of Pennsylvania

Ageist cultural messages portray old bodies as ugly, asexual and undesirable (Calasanti & Slevin, 2001; Furman, 1997), and yet not engaging in sufficient partner sex is viewed as a sexual dysfunction.  How do contradictory cultural messages about the sexuality of older women impact their sense of themselves as sexual beings?

Aging threatens women’s sense of themselves as women, as sexual beings, and as sexually desirable (Clarke, 2011). Ageist cultural messages convey the cultural value placed on youthfulness and portray old bodies as ugly, asexual and undesirable (Calasanti & Slevin, 2001; Furman, 1997). Stereotyped as experiencing physical and sexual decline, and viewed as asexual, older women’s sexual interest may be deemed inappropriate. Yet not engaging in sufficient partner sex is seen as a dysfunction (McHugh, 2006).  Who says how much sex is enough? How do contradictory cultural messages about the sexuality of older women impact their sense of themselves as sexual beings?

Limited research on older women’s sexual desire and desirability reflects an androcentric bias. Research has rarely addressed appearance concerns, or the embodied nature of older women’s experiences (Clarke, 2011). Research on older women’s sexuality has emphasized sexual declines, diseases, and dysfunctions.  As the research on older women becomes less ageist, heteronormative and androcentric, we increasingly recognize the complexity and the contextual nature of women’s sexual desirability (Clark, 2011) and desire.

We Bring Our Bodies to Work

May 23rd, 2014 by Heather Dillaway

“Woman Working,” courtesy of Open Clip Art

A recent study by researchers at La Trobe University and Monash University in Melbourne, Australia, suggests that working women “need more managerial support [while] going through menopause.” This “Women at Work” study explored the health and wellbeing of working women and women’s satisfaction at work, yet focused on working experiences in or around menopause. The lead researcher, Professor Gavin Jack, reports that “menstrual status did not affect work outcomes” but that “if a woman had one of the major symptoms associated with the menopause — for example weakness or fatigue, disturbed sleep or anxiety, then this did influence how they regarded work.” Jack is further quoted as saying: “What is really important is not the fact of going through the menopause in itself, but the frequency and severity of symptoms which women experience, and how these factors affect their work.”

This study has been described in several news sources over the past few weeks, such as the International Menopause Society, Science Daily, and IrishHealth.com. I have many reactions to this research, both positive and negative.

I’ll present my positive feelings first: I appreciate the fact that researchers are talking about the fact that menopausal women are a large part of the workforce and that menopausal experiences matter for individual women. I also applaud the attention given to the fact that workers are human beings with bodies, and that bodies matter. The idea that employers should recognize that paid workers have bodies and that paid workers may be affected by their bodies is an excellent one. I agree that employers should be educated to be more sensitive to menopause and other bodily experiences that their paid workers might have, and simple adjustments in work policies and work environments can go a long way in making employees happier and more productive (plenty of research has already shown this). Finally, and maybe most importantly, as one article in Science Daily notes, “Not enough attention is paid to the experiences which people go through at different stages of life — the workplace treats this very unevenly.” I couldn’t agree more. Especially when it comes to midlife and aging, we forget that paid workers are still dealing with bodily transitions. We forget the range of chronic illnesses that paid workers might have at midlife and beyond, as well as the many normal health transitions that any midlife or aging individual deals with. Anything from the acquisition of bifocals (and learning to see differently through bifocal lenses) to the hassles of dealing with back pain, neck pain, arthritis, hearing impairments, insomnia, etc., can affect one’s work. Not to mention menopause, prostate conditions, and other aging health concerns that can involve a range of different signs, symptoms, and stages. Starting at midlife, it is also much more common to deal with caregiving for elderly parents, divorces and remarriages, putting kids through college (or putting up with adult kids living at home), deaths of parents and spouses/partners,  and other social transitions, and all of these things will impact how a paid worker feels and acts on the job. There is much to pay attention to about paid workers in their 40s, 50s, 60s, and beyond, and I believe that this research is a good start on that. Middle-aged paid workers may be reaching the peaks of their careers and may be excellent at their jobs, but they’re still dealing with a multitude of other life circumstances at the same time. And if they’re not performing well on the job, it may well be because of these very same issues. Paid workers are people, with full lives and physical bodies that they can’t leave at home (no matter how much they try).

I do have to offer my negative reactions to this research as well, however: Whenever I see menopausal women picked out and studied specifically for their difficult symptoms, I worry about how those results will be used by others. Someone skimming the news reports might assume that this research shows that menopausal workers are harder to deal with, or aren’t ideal workers. So, let’s make sure we read this research appropriately: this research does NOT report that the quality of women’s work decreases when they reach perimenopause or menopause. This research only reports that women feel differently about their workplaces and sometimes wish their employers were more supportive of menopausal symptoms. If we don’t read carefully, then we might assume that being menopausal is more deviant than it really is. Working While Menopausal is not typically a negative status, or at least not for most women. Quick news reports also don’t always portray research in full, and I think it’s important to note that women are not always bothered by menopausal signs and symptoms. This was a study that asked primarily about women’s feelings about their workplaces and how health and wellbeing impacted work satisfaction. It is not a study that can give us comprehensive information about women’s menopause experiences. Finally, let’s remember that menopause is just one of many, many health and illness experiences that can affect how people feel and act on the job. Menopause is not necessarily a reason for employers’ alarm, any more than divorce or elderly caregiving or arthritis or back pain is. Rather, employers should be sensitive to the health and wellbeing of all paid workers across the lifespan and recognize that different groups of workers face different health and wellbeing issues.

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.

A Letter to My Mom: I am Sorry I Was A Brat

February 17th, 2014 by Chris Bobel

Photo courtesy someecards.com

Dear Mom,

I owe you an apology.

Remember when you were perimenopausal (or as we called it, “going through menopause”)? Remember when you experienced hot flashes? And remember when you did, how we, your loving family, either 1) ignored 2) trivialized or 3) mocked you? Your hot flashes were a constant source of humor around our house and I recall you joining the fun.

But I am betting that while you were yukking it up, you felt lonely and misunderstood. I think you were just ‘being a good sport’ because what choice did you have?

You deserved better.

I admit that until recently, until I began hotflashing myself, I forgot about your transition and how we responded to it. But now that I am living with my own body thermostat on the fritz, I get it.

Now that I am consumed by cycles of heat and chill with no warning, I am having a major A HA ! moment. Now that I find myself waking in the night, my pillow wet, my face wetter, my sleep disrupted, I am time traveling to our sunny kitchen on 2nd Street—you: flapping your blouse, face flushed. Me: rolling my eyes.

I feel badly that I did not appreciate that this process is HARD. I feel badly that I made fun of you, thinking you just a silly old woman whining about something meaningless.

In short, I was a total brat.

Sure. I did not have models for compassionate support. It seems that the discourse of peri/menopausel has two nodes 1) joking  2) patholgizing—another distorted binary that fails to capture the complexity of human experience.

I know that today, struggling through my own perimenopause, I need some simple understanding. I am normal. This is normal. AND this normal reproductive transition can suck to high heaven.

While, we don’t need to stop the clocks or call the midwife, I would like some acknowledgement (minus the sexist aging jokes, please) that doesn’t make me  (or my body) the butt of a joke.

You deserved better when it was your time, Mom, and I am so sorry you didn’t get it.

Love, Chrisi

Give the Gift of Body Literacy

December 16th, 2013 by Laura Wershler

Photo by Laura Wershler

This holiday season consider giving the women in your life the gift of body literacy. The books, resources and services compiled below support understanding and appreciation of our bodies.

Gifts for teenagers:

* To hold a Wondrous Vulva Puppet is to experience a loving representation of the female body. Dorrie Lane’s vulva puppets are used around the world to spark conversations about our bodies and our sexuality. To quote a testimonial on the website: “The sensual curves, velvety feel and beauty of these puppets seems to disarm people in a way that opens the door to real discussion about women’s sexuality.”

* Toni Weschler, widely known for her best-selling book on fertility awareness Taking Charge of Your Fertility, has also written a book for teenagers. Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body makes the perfect gift for your daughter or younger sister, neice or cousin. This book can transform a young teenager’s experience and understanding of her body as it teaches her the practical benefits of charting her menstrual cycles. Available in paperback and Kindle editions.

Gifts for those who want to learn fertility awareness:



* Justisse Method: Fertility Awareness and Body Literacy A User’s Guide by Justisse founder Geraldine Matus is a helpful gift for anyone wanting to learn about fertility awareness based methods (FABM) of birth control. It is “a primer for body literacy, and a guide for instructing women how to observe, chart and interpret their menstrual cycle events.”

For someone who wants to learn fertility awareness to prevent or achieve pregnancy, or to fix menstrual problems, finding a certified practitioner is getting easier. Technology can connect women with skilled instructors who may live thousands of miles away. Check out the practitioners below online and on Facebook.

*   *    *   *   *   *

* Flowers Fertility (Colleen Flowers, Colorado): Facebook.

* Grace of the Moon (Sarah Bly, Oregon): Facebook.

* Holistic Hormonal Health (Hannah Ransom, California): Facebook.

* Justisse Healthworks for Women provides a directory of Justisse-trained Holistic Reproductive Health Practitioners (Worldwide): Facebook.

* Red Coral Fertility (Justina Thompson): Facebook

* Red Tent Sisters (Amy Sedgwick, Ontario, Canada): Facebook

I invite other certified instructors who work locally to leave their contact information in comments.

Gifts for women in midlife

* For women who are in the perimenopausal transition – which can last from six to 10 years for most women, ending one year after the final menstrual period – give the gift of information. Connect friends and family with the website of the Centre for Menstrual Cycle and Ovulation Research where they’ll find many free resources that offer explanations and treatment suggestions for the symptoms they may experience throughout this transition including night sweats, hot flushes, heavy and/or longer flow, migraines, and sore, swollen breasts.

* To those who love fiction, consider giving Estrogen’s Storm Season, a fictionalized account of eight women’s journey through perimenopause written by CeMCOR’s Scientific Director, endocrinologist Dr. Jerilynn Prior:

They are as different as women can be—yet they share the mysterious experiences of perimenopause, night sweats, flooding periods or mood swings. We follow these women as they consult Dr. Madrona, learn the surprising hormonal changes explaining their symptoms, get better or worse, and try or refuse therapies. As each woman lives through her particular challenge, we begin to see how we, too, can survive perimenopause!

Proceeds from book sales support ongoing research.

From menarche to menopause, it is never too early or too late to acquire body literacy. I invite readers to share other gift ideas that promote menstrual cycle comfort and support body literacy.

What Menopausal Women Want to Hear

November 7th, 2013 by Heather Dillaway

 

Photo Courtesy of Heather Dillaway

I’ve been thinking a lot about the messages that women do or don’t get at menopause.

Because of this, I decided to come up with a list of things that women would love to hear at menopause (or perimenopause, if we are talking about when women experience the majority of their signs and symptoms).

I’ve divided my list into things that they might want to hear that are true, and things that they might want to hear but might not be true yet (but should be). I’d love to hear reader comments on this division and any ideas about what I’ve forgotten that should be on my lists!

 

Things Menopausal Women Would Love to Hear That ARE True:

1. It’s okay to be glad to be done with menstruation, the threat of pregnancy, the burdens of contraception, etc. It’s also okay to use the menopausal transition to question whether you really wanted kids, whether you had the number of kids you wanted, and whether you’ve been satisfied with your reproductive life in general. It’s normal to have all of these thoughts and feelings.

2. You’re entering the best, most free part of your life! But, it’s okay if it doesn’t feel like that yet.

3. Menopause does not mean you are old. In fact, potentially you are only half way through your life.

4. You are not alone. Lots of people have the experiences you do. You are normal!

5. I understand what you’re going through. (Or, alternatively, I don’t completely understand what you’re going through but I’m willing to listen.)

6. It’s okay to be confused and frustrated at this time of life, or in any other time of life!

7. You’ve had an entire lifetime of reproductive experiences, and this is simply one more. How you feel about menopause is probably related to how you’ve felt about other reproductive experiences over time, however. It might be helpful to reflect back on all of the reproductive experiences you’ve had to sort out how you feel about menopause.

8.  Talk to other women you know. Talking about menopause helps everybody.

9. Menopause and midlife can be as significant or insignificant as you’d like them to be. For some women, these transitions mean very important things but, for others, they mean little. Whatever it means to you is okay.

10. Researchers are working hard to understand this reproductive transition more fully.

 

Things Menopausal Women Would Love to Hear But Might NOT Be True:

1. This is guaranteed to be your last menstrual period. You are done! (Or, a related one: You’ve already had the worst signs and symptoms. It gets better from here on out!

2. Signs and symptoms of menopause will be predictable and will not interrupt your life.

3. No one will think negatively of you or differently about you if you tell them you’re menopausal.

4. There are no major side effects to hormone therapies or any other medical treatments you might be considering.

5. Doctors will be able to help you, and will understand your signs and symptoms, if you need relief.

6. Leaky bodies are no problem! No one will care if your body does what it wants whenever it wants.

7. Partners, children, coworkers, and others will completely understand what you’re going through.

8. Middle-aged women are respected in this society, and it is truly a benefit to be at this life stage.

9. There is a clear beginning and a clear end to this transition.

10. Clinical researchers are researching the parts of menopause that you care about.

 

In my opinion, things that menopausal women would love to hear but might not be true speak to many of our societal norms and biases. Menopausal women are in a tough spot when it comes to norms about bodies, aging, gender, etc. Items on this second list also speak to menopausal women’s difficulties in accessing quality health care or getting safe relief from symptoms when needed. The latter list also notes the potential disconnects between research findings and women’s true needs during this transition. The first list represents what we should probably tell women and represents the kinds of supportive comments they might want to hear while going through perimenopause in particular.

I think we should contemplate both of these lists though and think about exactly how rarely women hear things off of either list. Readers, feel free to comment on, add to, or critique these lists. Most importantly, can you help me make either of these lists longer?

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.