Blog of the Society for Menstrual Cycle Research

Culture, menstrual narratives, and the messy politics of reproductive freedom

May 23rd, 2015 by Laura Wershler

Two workshops explore the menstrual health/awareness and reproductive justice connection on Saturday, June 6th at  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.

POLITICS IS A MESSY BUSINESS: Menstrual Health, Reproductive Health Advocacy, Human Rights and Justice
Sharon L. Powell, Artist and Educator, S L Powell Public Affairs Services

Original image by Sharon L. Powell

Menstruation is part of the spectrum of reproductive health. Menstruation and menstrual cycle discourse takes up space as marker in the health and identity of female bodied individuals as well as in constructions of fertility. As such, it is on a reproductive health advocacy agenda. Menstrual health and menstrual health education are cornerstones of a reproductive health advocacy framework. Human rights and social justice movements concerned with self determination, health, human dignity, privacy, and bodily integrity, should pay political attention to menstrual health’s crucial and complicated place in an interdependent web of reproductive health concerns.

Social and chemical control of fertility is specifically connected to the hormones associated with the menstrual cycle. Menstrual shame. Hysteria. Sexualization. Contraceptive and other reproductive technologies. How does one truly consent to the use of reproductive innovations like hormonal birth control if they do not understand the hormonal patterns they are born with or acquire? Reproductive justice groups and reproductive health advocates must look at issues of self determination with an intersectional lens, acknowledging female bodied individuals’s multiplicity. It is important to explore and create opportunities for female bodied individuals to learn more about their bodies, not just lobby for abstract concepts of reproductive freedom.

Twenty years ago, I presented a paper at the Society’s conference in Montreal, Canada called “Better Dead Than Pregnant: Trends in Contraception – A Case for Menstruation Education.” Connecting my critiques of trends in non-user/”woman” controlled methods of contraception with myths of inconvenience regarding menstruation and convenience regarding methods of contraception, I made connections to the messy politics of reproductive freedom, the differences in the experiences for women of color, women with disabilities, and poor women with this focus on menstruation and the menstrual cycle. My contention that women from these communities were “better dead than pregnant” was picked up by other reproductive rights activists (such as Andrea Smith in her book Conquest). Subsequently, Malcolm Gladwell’s article, “John Rock’s Error, ” detailed how a myth of inconvenience regarding menstruation may have played a role in the development of the oral contraceptive pill.

Our Bodies, Our Stories: Celebrating the Menstrual Narratives of Womanhood
Deborah Dauda, LEPA & Kirthi Jayakumar, Red Elephant Fund

This workshop will look at culture and menstruation by sharing stories and testimonies of women from all over the world and the impact of open conversations in creating comfortable spaces for women to celebrate their womanhood through menstruation. In addition, we will welcome participants to share their own testimonies and stories, along with a session on simple “what-if” scenarios to encourage community conduct and resource sharing.

Media Release and Registration for the SMCR Boston Conference on Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan.

Full-Spectrum Doula Support and Reproductive Justice

May 2nd, 2015 by Laura Wershler

 Emma O’Brien and Sarah Whedon will present the workshop Full-Spectrum Doula Support 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

Learn more about the Boston Doula Project.

The cohort of abortion doulas who participated in the Boston Doula Project’s January 2015 training.

In recent years the full-spectrum doula movement has arisen as an intervention in reproductive health provision in general and abortion provision specifically. Full-spectrum doulas provide free, non-judgmental, and empowering support for people undergoing reproductive experiences. In this one-hour workshop, members of the Boston Doula Project will discuss how full-spectrum doulas engage with the reproductive justice movement; prioritize the voices of marginalized people, including but not limited to people of color and queer, trans*, and gender-nonconforming people; destigmatize abortion by locating it on the reproductive lifecourse; and promote body literacy and empowerment for everybody to be their own best advocate.

Follow the Boston Doula Project on Facebook and Twitter.

Media Release and Registration for the SMCR Boston Conference.

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

March 27th, 2015 by Laura Wershler

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.

NOTE: This post was edited for clarity, and the graphic added, on March 31, 2015. 

Winning the Menstrual Battle in the Abortion War

October 15th, 2014 by Chris Bobel

Last week, Loretta Ross, the pioneering women’s health activist, came to Boston for a public lecture.  Ross will keynote at our upcoming “Menstrual Health and Reproductive Justice: Human Rights Across the Lifespan” (What? You didn’t hear?). Hearing her speak tripled my excitement for her keynote in June. I, a serious fangirl, listened intently as she narrated a personal history of the women’s health movement and offered a clear-eyed, no nonsense way forward. This lady knows some stuff! If you don’t know Ross, you should. For one, she was one of 12 women who developed the globetrotting concept of “Reproductive Justice”—which intersects social justice and reproductive rights, or as Ross, puts it, “brings Human Rights home by looking at the totality of women’s lives.”

Though I generally resist militarized language, I also know that the persistent assault on abortion rights is nothing short of a war against women. Many of us, caught up in our own fisticuffs on neighboring battlegrounds (for affordable better birth control, against pinkwashing, for comprehensive sexuality education, for transgender health care), may not realize how our struggles are, indeed, united. We are all fighting for bodily autonomy, after all. Ross’ remarks made clear to me how our battles are united and that we will NOT win any of them if we don’t manage to see these connections.

Let’s look at how the abortion issue and menstrual health are linked.

To begin, thinking about abortion in a REPRODUCTIVE JUSTICE framework allows us to address what Ross calls the “Oh My God!” Reactions many women face when they think they might be pregnant:

1) OMG! I am in an abusive relationship. What do I tell my partner? Will I be safe?

2) OMG! I am 16. What will my family say?

3) OMG! I am a college student. Can I finish school?

4) OMG! I have no health insurance? How do I pay for this?

When we pay attention to the OMG reactions, we acknowledge the reality of women’s lives—and the complicated context that shapes reproductive decision making. And as we consider that context, we have to tune into the following:

• Safe abortion is not enough. It must ALSO be safe to TALK about abortion.

• We need ‘kitchen table conversations’ about women taking reproductive knowledge back into our own hands. (And my favorite line of the night: “Why are we ceding the responsibility of our bodies to a bunch of assholes. We built a women’s health movement. Let’s act like it.”)

• We absolutely must listen to Women of Color and the issues that matter to them (e.g voting rights, immigrant rights).

The menstrual connections are evident here. Do you see them, too? Improving menstrual health through menstrual literacy for health care workers and menstruators alike is fundamental to winning this war.

I submit the following:

FIRST: Breaking Silence. Yup. Challenging menstrual shame, silence and secrecy is JOB ONE for many of us. We know that our cultural allergy to making mensruation audible and visible (to quote filmmaker Giovanna Chesler) is at the root of menstrual ILLiteracy which leads to poor reproductive health. Imagine if menstruators felt supported to speak up when they had questions about their cycles—from pre menarche (what does a period feel like?) through menopause (is this heavy bleeding normal?).

SECOND: Taking our health care into our own hands. Do It Yourself. DIY has been foundational to the women’s health movement since its genesis. DIY vaginal exams. DIY menstrual extraction. Menstrual activists, at least since the 70s, have been promoting DIY menstrual care as a way to take control BACK from the body shaming FemCare industry while doing our part to protect the planet.

THIRD: Paying attention to Women of Color in everything we do. When it comes to ANY reproductive health issue, race matters. White supremacy, capitalism, and patriarchy have had disastrous effects on women of color’s lives (sterilization abuse, higher mortality and morbidity for heart disease lung and breast cancers, and HIV/AIDS are just a few examples).

Using a critical race lens on menstrual and ovulatory health sharpens our focus and begs important questions, such as:

Why do African American girls reach puberty 6 months earlier than European-American girls?

How do norms of sexual respectability serve to discourage women of color from challenging the menstrual status quo?

Making menstruation matter fortifies the fight. When we situate menstrual health in a reproductive justice framework, we take our place fighting alongside others straining toward embodied autonomy. We fight for choices of all kinds when we fight together. As Ross asked at the end of her talk, “Can we be brave together and do this?”

Can we?

To see more of the Loretta Ross interview from the video above, please go here.

Obvious Child: The Other Taboo

June 18th, 2014 by Holly Grigg-Spall

cervical mucus

 The recently released rom-com ‘Obvious Child’ has been discussed far and wide for its mature, sensitive and funny approach to the topic of abortion and yet I have not seen one comment on the fact that this movie also makes mainstream (and yes, funny) the topic of cervical mucus.

In the opening scene stand-up comedian Donna (played by real-life comedian Jenny Slate) is performing on stage at her local open mic night. She wraps up with a joke about the state of her underwear and how, she describes, her underpants sometimes look like they have “crawled out of a tub of cream cheese.”

She claims that they often embarrass her by looking as such during sexual encounters, something she feels is not sexy.

Of course, by “cream cheese” I immediately assumed Donna meant cervical mucus. Unless she is supposed to have a vaginal infection – which seeing as it is not discussed amongst the other myriad bodily function-centric conversations in the movie, I doubt to be the case – then it’s clear she is detailing her experience of cervical mucus.

Later on that night, when Donna meets and goes home with a guy, has sex and then wakes up in bed with him the following morning, she sees that her underwear is laying next to the guy’s head on the pillow. Not only that, but this is one of those situations she finds embarrassing as the underwear is actually covered in the aforementioned “cream cheese” or cervical mucus. She cringes, retrieves the underwear and hastily puts it back on under the covers.

At this scene we can assume that the presence of visible cervical mucus indicates that the character is in fact fertile at this time during the movie. Even if we didn’t know this movie was about unplanned pregnancy, perhaps we would know now. Apparently Donna is not on hormonal birth control, and she’s not sure if, in their drunkenness, they used a condom properly. So, I speculate, if Donna had known she was fertile and that the “cream cheese” in her underwear was actually one of the handy signs of fertility her body provides, then she may have taken Plan B and not had to worry about an abortion. But, then, of course, we wouldn’t have had the rest of this movie. We would have had a very different movie – a movie someone should also make.

But it goes to show how some body literacy might go a long way in helping women make more informed choices. The abortion sets her back $500 and causes some emotional turmoil. A dose of Plan B is cheaper and easier to obtain, although not without some side effects. Maybe even, we can speculate, if Donna had known she was fertile she might have avoided PIV sex that night.

It’s great to see a movie approach the choice of abortion as though it really were, well, a choice. But isn’t it interesting that in doing so it shows how women can be hampered in their choices by a lack of body literacy?

We often see women in movies discussing their “fertile time” in regards to wanting to get pregnant – and so meeting their husbands to have sex at the optimum time in usually funny, crazy scenarios. Sometimes we have seen women taking their temperature or using ovulation tests and calendars to figure this out. However, I think this might be the first mention of cervical mucus in cinema.

I had the honor of seeing this movie with longtime abortion rights and women’s health activist Carol Downer and getting to discuss it with her after. Carol pioneered the self-help movement and self-examination, adding much to our collective knowledge of our bodies.  

This is what she had to say:

“I enjoy the genre of romantic comedies with all their faults; I’m not as critical of them as I am of other genres, and ‘Obvious Child’ more than met my expectations. I particularly liked ‘Obvious Child.’ I liked the uninhibited tipsy lovemaking scenes that showed casual sex at its best. Then, the complications that arose when she found out she was pregnant and needed to have an abortion and when he continued to be very interested in having a real relationship rang absolutely true to me. It’s just our luck, isn’t it, to get pregnant when there’s no realistic way to continue the pregnancy? The women, married or unmarried, who get abortions have some variation of this experience. When we have such bad timing, it’s the pits! I loved that their relationship grew in facing the regrettable necessity of the abortion and the recovery together, and you get the feeling that the relationship has a good future ahead of it. A darned good story.”

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel


January 3rd, 2014 by Heather Dillaway

A few years ago, in response to an article of mine on menopause, an editor encouraged me to think of women’s reproductive lives as “recursive”. Little did he know how much his comment would affect my thinking about women’s lives and life in general. Recursiveness is a common sense concept, but something we don’t often think about. But, especially in light of the “new” year and the sense that we all hold that we are beginning 2014 as if we have a clean slate, I decided to blog here about recursiveness. This is very relevant for anyone thinking about menstruation and menopause, which is why I write about it here.

If you look up the word “recursive” in a dictionary, you find this as one of several definitions:
“of, relating to, or constituting a procedure that can repeat itself indefinitely…”
— re•cur•sive•ly adverb
— re•cur•sive•ness noun

If you think about reproductive events like menstruation, menopause, pregnancy, childbirth or anything else, we often think of them one at a time, almost in isolation. But, they’re not isolated at all and many of them have a tendency to repeat because of the cyclical nature of all life processes. In addition, reproductive events are tied to each other in meaning and we think of them only in relation to what comes before and they only mean things in relation to what other events meant to us in the past or what situations we are dealing with in the present. Thus, potentially when two menstrual periods or other reproductive events occur, we might tend to think of them similarly, approach them similarly, and/or compare them even when they could be very different, because the first experience colors the second and beyond. To think that we might approach each reproductive event as it comes as something new and unrelated to past events or experiences is almost silly, for the past always colors our perceptions of things even if it shouldn’t. Likewise, if we think of 2014 as a brand “new” chunk of time that represents a blank slate, we are also fooling ourselves (perhaps we do so knowingly though). We can make different decisions or act somewhat differently if we’d like, but we approach 2014 with our past in mind and potentially may repeat our attitudes and behaviors in the future automatically. Even if we live different experiences in the new year and very purposely separate ourselves from past attitudes and behaviors, we might think of our new attitudes and experiences in relation to other past experiences, making attitudes and behaviors recursive in meaning at least (even if our newer experiences are not the same as in the past).

I have written here about similar themes in the past, and I do really like thinking about the recursiveness of our experiences. My brother is a forester and farmer and always talks about nature’s cycles and tendency towards repetition, but I think we can think about recursiveness in much broader terms than that too. Recursiveness is a powerful idea and it makes a lot make sense in the world. It doesn’t mean we can’t experience things differently over time. Thinking about transitions like menopause makes us realize that things (like menstruation or fertility) are definitely not the same over time and maybe stop repeating and cycling. But, in our minds, we might expect things to repeat indefinitely (and therefore emotionally wrestle with the physiological changes we experience because we don’t expect change). Previous experiences might repeat in the identities we continue to hold dear or in the ways in which we think about reproductive transitions or any other changes in our lives, even when the experiences themselves change.
As we approach this new year, I propose we acknowledge recursiveness as a real thing.

Happy new year, everyone.

A Review of Selene: A New Cycle-Tracking App

September 2nd, 2013 by Chris Bobel

Guest Post by Amy Sedgwick, HRHP, Red Tent Sisters

Screenshot of Selene app // Photo courtesy of

While there are no shortage of apps designed to help women track their periods, finding an app that meets the needs of women who are practicing fertility awareness methods (FAM) for birth control or conception can be quite a challenge. As a teacher of the Justisse Method of Fertility Management (there is currently no app available but there is one in development) I am often asked by my clients about web-based solutions to tracking their cycles when they are travelling or find themselves in other situations where their physical charts are impractical. Fertility Awareness users will be pleased to know that there is a new app on the market, Selene, which has been developed with FAM in mind. In addition to being able to chart the standard fertility markers (cervical mucus, cervical position, and basal body temperature), Selene boasts loads of unique features like the ability to make note of the things that affect reliability the most – like sickness, travel, and disturbed sleep. Selene also allows the user to define their own markers to track patterns in health, mood, libido, and more. The chart tab of the app shows you your cycle in a graph format, while the calendar tab displays it from a monthly perspective. Some of the other highlights of the app include a description of the daily moon phase, an automatic luteal phase calculator, the ability to ask questions about your chart in the “Ask an Expert” section, and a detailed instructions and help section. Selene excels at utilizing the principles of the widely-used fertility awareness method taught in Taking Charge of Your Fertility. Using principles from the book, the app will shade out days of predicted fertility based on the information you enter. It will also calculate an ovulation prediction based on the average length of your cycles. The app highly encourages users to seek additional support and education for their fertility awareness practice, particularly if they are using it for birth control. While Selene offers the most nuanced approach to menstrual cycle charting that I have thus seen (although I can’t claim to have evaluated all the apps on the market), one feature I would like to see added in future versions is the ability to manually choose whether a day is considered fertile (i.e., as indicated by bold stripes on the calendar view) so that those schooled in other approaches to fertility awareness, like the Justisse Method, could have the option of applying our own rules and calculations overtop of the calendar view. The only other critique I have of Selene is that the developer has chosen a dark navy background, which I personally find difficult to view. I’d prefer to see them use a colour scheme that is brighter and easier to read. I am grateful to Selene’s creators for being so thoughtful, thorough and conscientious in the creation of their app. I look forward to seeing what enhancements and updates they integrate into future versions.

Two stupid ideas about menopause, and one that makes sense

July 3rd, 2013 by Laura Wershler

Two new suppositions about menopause have been tossed around the media in recent weeks. They make for racy headlines but both, unfortunately, perpetuate the myth that menopause is a disease women need to be protected from.

Most recent was the assertion by researchers from McMaster University in Hamilton, Ontario, Canada, that menopause in women is the unintended consequence of men’s preference for younger mates.

Men to blame for menopause

The writer with her mother Erna Sawyer who turns 95 on July 20, 2013. Is menopause an “age-related disease” that science must figure out how to prevent or an evolutionary adaptation for longevity?

Evolutionary biologist Rama Singh, co-author of the study published in the journal PLOS Computational Biology, gave this explanation in a CBC news story: “What we’re saying is that menopause will occur if there is preferential mating with younger women and older women are not reproducing.”

The study used computer modelling to arrive at this hypothesis. Singh said that this “very simple theory”…”demystifies menopause…It becomes a simple age-related disease, if you can call it that.”

Well, no Mr. Singh, you can can’t call menopause a disease. I challenged this idea in response to the Canadian Heart and Stroke Foundation’s Death Loves Menopause ads in February 2012.

Yet there he is, hoping his work will prompt research on how to prevent menopause in women, helping us to maintain better health as we age. What does he really know about menopause anyway?

Another stupid idea about menopause surfaced in late May with headlines like: Women could evolve out of menopause ‘because it is no benefit to them.’

Women could evolve out of menopause

The story, covered by media everywhere, was based on comments by biologist and science writer Aarthi Prasad at the 2013 Telegraph Hay Festival, Britain’s leading festival of ideas.

The Daily Mail reported that if women evolve out of menopause we could then have children well into our 50s (But how many women want to?), and that “targeted gene therapies will be developed to treat the condition.”

We’ve been fighting the assumption that menopause is a “condition” that needs to be treated for decades, with members of the Society for Menstrual Cycle Research at the forefront of this assumption-busting.

Quoted in The Telegraph, Prasad also said, “What we think is normal is not normal for nature. If it is something not in all mammals, is it something necessary or beneficial for us? I do not see any benefits.”

Wow! Menopause is not “normal for nature.” But what about the argument made by doctors like Elsimar Coutinho who promote menstrual cycle suppression, who assert incessant ovulation (i.e. reproductive capacity) is not natural, normal or healthy in humans, therefore we should take drugs to stop it?

These doctors and scientists need to get on the same page. Which is it? Do we ovulate too much or do we not ovulate enough?

As for “no benefits” to menopause consider this: What if menopause is an evolutionary adaptation that works in women’s favor?

Do women live longer, healthier lives because of menopause?

An October 2010 story in The Calgary Herald – Why don’t monkeys go through menopause? – discussed the research of University of Calgary anthropologists Mary Pavelka and Linda Fedigan who’ve spent years documenting the aging and reproductive histories of Japanese female macaques.

Few study subjects lived past their reproductive capacity, about age 25, and those that did showed signs of serious physical deterioration. For these primates, retaining the ability to reproduce until late in life did not make them healthier. Fedigan noted that they were “crippled up with arthritis, their face is all wrinkled and their fur is falling out.”

The question, they noted, was why would human females lose their ability to reproduce in healthy middle age?

“One hypothesis is that it’s a byproduct of evolution for longevity in humans,” Pavelka said.

Now here’s an idea that makes sense. Think about it. Men produce sperm – albeit of dwindling quantity and quality – until they die; women transition to menopause and can live healthy lives for decades after. Women live significantly longer than men. Therefore, it’s reasonable to hypothesize that menopause supports longevity in women.

What Prasad proposes – doing away with menopause through natural or scientific means – could then be considered a devolution not an evolution.

As for Rama Singh and his research team, let’s give NPR writer Anna Haensch the last word on this silly, mathematically-determined, computer-generated hypothesis:

“What does this mean for us? Assuming this model is correct, if older women begin to eschew paunchy, balding partners in favor of younger mates, male menopause could become a reality in a few thousand years.”

Bring it on! Men should be so lucky to keep us company in our healthy old age.


Medical Training for Menopause? Wishful Thinking.

May 23rd, 2013 by Heather Dillaway
Medical Training for Menopause?

Photo by Ctorrear via Wikimedia Commons

OB-GYNS receive little to no medical training about menopause. Or at least that’s what recent research results show. Results of a web-based survey of 258 OB-GYN residency training directors across the country suggest that about one in five doctors receive any training on menopause, but that as many as seven in ten would like to receive that training. Residency training directors were asked to forward the survey to their residents, leading to a sample of 510 residents responding to the survey. Of the residents who responded, only 20% (100) reported any formal curriculum on menopause and only 78 residents reported participating in a hands-on “menopause clinic” as part of their residency. News articles reporting on this study suggest that this is a major problem considering how many women (as many as 50 million by the year 2020) are entering menopause in recent years.

My reaction to this is simple: of course there is little to no medical training on menopause. Of course. Anyone who has ever been to the doctor (for a simple cold, for a reproductive reason, or anything else) knows that doctors are easily stumped and that their training is often surface-level. If you present anything besides a “normal” case, the likelihood is that doctors will not have in-depth knowledge of your condition (regardless of whether that condition means you’re “healthy” or “sick”). In addition, if your body or your reproductive system represents something besides the norm then you should just brace yourself for doctors’ lack of knowledge about your body. Individual doctors are not necessarily at fault for this since they do not get training on aging bodies, disabled bodies, reproductive bodies that do not behave according to textbook info —  let alone the fact that the male body is really the norm and so women are already at a disadvantage since their reproductive bodies already represent an abnormal case. I’ve interviewed menopausal women who’ve talked about going to the doctor and having those doctors not really know much about their symptoms. I’ve also interviewed women who have had hysterectomies but then are not told anything about what effect that hysterectomy might have on long-term health or menopause. I have a student who just completed a dissertation on the reproductive experiences of women with sickle cell disease, and it is clear from her study that doctors have no idea how to deal with the reproductive needs of women with a congenital disease. I’m also working on a project about women with spinal cord injuries who can’t even find a doctor who will give them a proper pelvic exam because doctors have no idea how to handle a body that does not neatly fit on an exam table.

Women who really want answers learn to strategize about how to cobble together knowledge about their health or illness by seeing multiple doctors, going to alternative doctors as well as mainstream doctors, consulting others who have the same health or illness, doing their own research outside of medical institutions, and to some extent just putting up with their bodies and life stages without medical help. Women learn these strategies over time as doctors remain unable to help them. This is not a new situation by any means, rather it is just what women have learned (or have to learn) to expect over time. As much as biomedicine would like to declare doctors as the experts on women’s health and health or illness in general, in practice we know that doctors are not these experts. They are probably trying the best they can most of the time, but just have little training and knowledge in anything specific. Unless an individual doctor becomes extremely proactive and wants to seek out extra knowledge by themselves, the likelihood is that they will only have cursory knowledge of specific women’s health conditions or life stages. This means that women have to be ready to be their own experts and know their own “normal” in any life stage, because we cannot rely on doctors to have any training that might help us. Yes, on one level, this is a serious problem but, on another level, this is just reality.

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.