Blog of the Society for Menstrual Cycle Research

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.

Novel approach to the menstrual cycle: State of Wonder, Part 2

December 17th, 2015 by Laura Wershler

This post was originally published at re:Cycling on March 6, 2015.

State of Wonder–Part 2: Wondering about missing femcare products and birth control references

In State of Wonder–Part 1, I mused as to why, in a novel revolving around the extended menstruation and fertility of the Lakashi tribe, only the menstrual cycles of the Brazilian women being studied are made visible to the reader. Why does author Ann Patchett ignore the menstrual cycles of the novel’s protagonist, Marina Singh, or the other female research scientists? If they are eating the tree bark responsible for the Lakashi’s extended fertility, their menstrual responses should be of interest to the author.

Failure to mention the scientist’s cycles points to another puzzling omission. There is no reference to menstrual-care products the women would have required while living in the rainforest for years at a time. There was opportunity to do so because a few key scenes are set in the store where research leader Dr. Annick Swenson buys all the provisions for the camp.

Marina must visit the store immediately upon landing in Manaus because the airline has lost her luggage. She has no clothing, no toiletries, none of the necessities for daily living. Why does she not purchase, visibly to the reader, tampons or pads? If not on her first trip to the store, then on her second as she prepares to leave for the remote research camp with Dr. Swenson? She obviously will need such supplies as her weeks in Brazil progress, and the timing of her cycle, as deduced by this reader, suggests she needed them while in Manaus or shortly after arriving at the camp.

I think Patchett’s reason for leaving out this menstrual-related information was not literary, but rather socio-cultural in nature. She tastefully shares the intimate details of the Lakashi women’s menstrual cycles, but can’t find a way—with even a few sentences—to convey this aspect of other female character’s lives? (Exception: Dr. Swenson, whose experiences I avoid mentioning to prevent plot spoilers.) Did she try? Did she resist? If so, why? What a missed opportunity. Marina’s interior dialogue makes it clear she is a still-menstruating woman wondering if motherhood will be in her future. How easy it would have been to use Marina’s need for tampons as a segue to consideration of her fertility.

Which brings me to another menstrual-related omission in the book. There is no reference to the birth control methods used by Marina and one of the female scientists who lives in the research camp with her husband.

Drs. Nancy and Alan Saturn are part of the research team in Brazil. Nancy is eating the bark, enhancing her fertility. Pregnancy is not an objective for this couple; they must be using contraception. The pill would be contra-indicated—a double whammy of exogenous estrogen provided by the pill and the Martin tree bark could have negative consequences. Condoms would break down in the heat. A Mirena IUD might not be at odds with the estrogenic bark, which has another critical medicinal effect the researchers are eager to access. Maybe a copper IUD? A diaphragm? Abstinence? Does it matter? Perhaps not, but why not be daring and tell the reader anyway? Surely the author must have asked herself these questions.

And what about Marina’s choice of birth control? At 42 she is in an intimate relationship with a much older colleague, the man who sent her to Brazil. Contraceptive use is implied but the method is, yet again, invisible. One can assume it was non-hormonal and not an IUD because of what happens at the end of the novel. But why not write one or two sentences along the way to convey this information? Isn’t this what good writers do, litter clues as a novel progresses to set up what happens later?

Ann Patchett chose not to mention the femcare products and birth control methods her characters used in her novel State of Wonder. I can’t help wondering: why?

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

Novel approach to the menstrual cycle: State of Wonder, Part 1

December 14th, 2015 by Laura Wershler

As re:Cycling explores media representation of the menstrual cycle, we’ve chosen to republish a three-part series I wrote about how author Ann Patchett uses the menstrual cycle as a major plot devise in her novel State of Wonder. Part 1 was originally published on January 22, 2015.

State of Wonder–Part 1: Wondering about missing menstrual mentions in literature

In her novel State of Wonder Ann Patchett explores, among many broad themes, the question: What if there were a drug women could take to extend menstruation and fertility into their seventies? Not evident on the dust jacket, this storyline grabbed the attention of this menstrual cycle advocate.

Set mainly in the jungle of Brazil, the novel revolves around the decades-long research of Dr. Annick Swenson who has kept the location and progression of her research secret from the drug company funding her work with the fictional Lakashi tribe. When a male scientist sent by the drug company to find Dr. Swenson and deliver a message is reported dead, Dr. Marina Singh, a research pharmacologist, becomes the second emissary charged with finding Dr. Swenson and assessing her progress towards the promised drug.

Finding Dr. Swenson is a formidable task, but when she does Marina eventually learns the complex botanical explanation for the Lakashi’s extended fertility, as well as the justifiable reasons why the research location has been so scrupulously protected.

This literary novel, a satisfying read, powerfully renders the mystique of the Amazon jungle, conveying both the wonder and trauma Marina experiences there. For an insightful review of State of Wonder I’d recommend Lydia Millet’s. This series of posts is not a review, but rather commentary on the niggling details related to the extended fertility storyline. Spoiler Alert: Some plot points will be revealed.

After a few weeks in the jungle—the timeline is fuzzy—Marina is invited by two other female researchers to the grove of Martin trees where she observes Lakashi women of all ages scraping tree bark with their teeth, a practices she is told that begins at menarche and is the key to their lifelong fertility.

Marina learns the women chew the bark every five days except when they are menstruating and when they’re pregnant; the bark repulses them from the moment of conception. She is told also that although the women don’t all come to the grove on the same five-day cycle, they’re menstrual periods are “pretty much” synchronous so the researchers “get a few days off every month.” That is, days off from observing them in the grove while taking pin-prick blood samples and collecting cervical mucus swabs to monitor estrogen levels that Dr. Swenson has taught the Lakashi to do themselves with Q-tips. Dr. Swenson’s research team charts and studies every cycle of every menstruating girl and woman.

The researchers tell Marina they also chew the bark and invite her to try it. Here is where, in a story that speaks intimately about the tribal women’s menstrual cycles, I wondered why Patchett did not include even one sentence to acknowledge when Marina had her last period. (At 42 she has thought about her fertility and her prospect of having a child someday.) Because she scrapes the bark one assumes she isn’t menstruating, and she’s been in Brazil long enough–weeks spent in Manaus before getting to the jungle–to have had at least one period. Where is she in her cycle? This matters because of what happens later in the story. So, since menstruation is integral to the novel, why not mention it? And why don’t the other female researchers mention whether their cycles, too, have synchronized with the Lakashi’s?

In most novels, probably too many, the menstrual cycles of female characters are invisible unless they figure prominently in the plot. It made no sense to me that Patchett chose to make Marina’s cycle invisible. Even if readers can deduce this missing information, surely this is the wrong novel in which to require us to do so. Again, I ask, “Why?”

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

Flibanserin is NOT “female Viagra” and here’s why

July 30th, 2015 by Laura Wershler

If you’ve been hearing about the “female Viagra” drug Flibanserin in the media over the past couple of months and wonder what it’s all about, Dr. Aaron Carroll at Healthcare Triage sets the record straight and tells you everything you need to know about Flibanserin in this seven-minute video.

To quote Dr. Carroll, “The two drugs aren’t even close to the same thing.” He asks the media and others to stop calling Flibanserin the “female Viagra.” He says, “It makes pharmacology nerds very, very unhappy when you do that.”

#noboozewithflib

For one, Viagra is taken on an as needed basis and does not work if the man is not already sexually aroused. Flibanserin is intended for daily use by premenopausal women and affects the brain, supposedly, to increase feelings of sexual desire. Side effects include, says Dr Carroll, “marked sedation, somnolence and fatigue,” and are made worse in those who consume alcohol.

The video provides need-to-know information because the U.S. Food and Drug Administration is leaning towards approving Flibanserin this summer. Though twice rejected by the FDA, an aggressive public relations campaign spearheaded by drug owner Sprout Pharmaceuticals has resulted in a recommendation to the FDA to approve the drug with risk management options. A letter to the FDA signed by Leonore Tiefer, PhD, of the New View Campaign and over 100 other concerned health experts, sex researchers and clinicians urging them to reject approval of flibanserin explains the many problems with the drug. Here’s what the letter says about Flibanserin and alcohol:

We will leave the topic of flibanserin’s safety to others, except for mentioning the truly absurd situation of approving a daily drug to boost the sex lives of women in their 30s and 40s that must not be taken with alcohol. As sexologists we can say with confidence that this advice is both preposterous and doomed.

The New View Campaign also wrote a song advocating that women and the FDA Throw That Pink Pill Away:

 

 

 

 

 

 

 

 

 

 

 

 

 

The Society for Menstrual Cycle Research added its voice to those opposing FDA approval of Flibanserin by passing the following resolution in June at its 2015 Biennial conference in Boston, MA:

The Society for Menstrual Cycle Research regrets the recommendation by the Bone, Reproductive, and Urologic Advisory Committee and the Drug Safety and Risk Management Advisory Committee on June 4, 2015 that Flibanserin be approved with risk management options. The discussion after the vote was recorded made it clear that even those in favor had serious reservations about the efficacy and safety of the drug. We believe that women want safe and effective options, not unsafe and ineffective medications. Therefore, we urge the U.S. Food and Drug Administration to override the Advisory Committees’ decision and reject this drug.

NOTE: This post was updated on July 30, 2015 at 12:55 p.m. EST with the addition of the song.

Exploring menstrual shame, embodiment, and the parameters of premenstrual distress

May 26th, 2015 by Editor

Concurrent sessions on Saturday, June 6th explore unique cultural experiences of menstruation and delve into the parameters of premenstrual distress 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.


Strekkja (stretch, flexible) Original artwork by Magdalena Margrét. Used with permission.

Culture and Embodiment: 

Menstruation and objectification in an Icelandic context
Herdís Sveinsdóttir, University of Iceland

The aim of the study is to describe objectification among Icelandic women and how it relates to menstrual attitudes, women´s body consciousness and health behavior. Participants were 320 women aged 20-40 years drawn from the Register of Iceland in fall 2013. Findings regarding disordered eating and objectification will be discussed.

Shame, secrecy, or celebration: Experiences and constructions of menstruation across cultures
Alexandra Hawkey, Centre for Health Research, University of Western Sydney 

Through qualitative interviews this study aims to reveal culturally specific experiences and constructions of menstruation with migrant women from a range of backgrounds, in Australia and Canada. Analysis of the data highlights a range of themes including, cultural silencing; celebration of the girl to women transition; and menstrual rules.

Black Women, Red Tent: Doing Blood Work and Recovery of Black Girlhood, Spirituality and Ritual Exclamations for Black Girl Periods
Sevonna Brown, Williams College

This project invites black women to explore their relationships to their menstruation and their bodies more holistically through a consideration of blood, spirituality, and monthly ritual. This conversation-making and interactive study anticipates collective issues of shame, survival, birth, infertility, sexuality and disease. The research inquiries desire to find Black women in their own Red Tent in celebration of their own bodies, reproductive mysteries, traumas and triumphs.

Premenstrual Distress:

Psychosocial factors associated with Premenstrual Syndrome
Ina Rosvall & Sandra Ekholm, University of Lund

Inspired by critical feminist research the association between PMS and psychosocial factors was studied using 1320 responses to a web survey. 33,9% of the total variance in PMS could be predicted, emphasizing the importance of social norms, family structure and relational factors over hormones in the understanding of premenstrual distress.

Sarafem Redux: PMDD, Antidepressants, and Big Pharma
Shannon M. Peters, Madeline Brodt & Lisa Cosgrove, University of Massachusetts 

Industry-facilitated approval of antidepressants was used to justify inclusion of PMDD in the DSM-5. We provide data on industry funding of clinical trials of antidepressants for the treatment of PMDD, discuss the consequences of these commercial ties, and discuss the role of implicit bias in psychiatric research.

Evaluation of the relative efficacy and mechanisms of a couple-based intervention for Premenstrual Syndrome through a randomised control trial
Janette Perz & Jane Ussher, Centre for Health Research, University of Western Sydney

120 women took part in a randomised controlled trial comparing one-to-one and couple psychological therapy for PMS, in comparison to a wait list control group. Whilst women in all three conditions reported reductions in premenstrual distress and improvements in coping, women in the couple condition reported significantly greater reductions in distress post-intervention.

Measuring the Syndrome: An Introduction to the Measurement of Premenstrual Distress Disorders
Marie Hansen, Long Island University Brooklyn

This presentation will cover the history of the scientific measurement of Premenstrual Disorders and will explore the way in which these disorders are measured by researchers today. Included will be an analysis of two widely used scales: Premenstrual Tension Syndrome Observer Scale/ Self-Rating Scale (PMTS-O/SR) and the Daily Record of Severity of Problems (DRSP).

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

Menstrual suppression, regulation and metaphors

May 8th, 2015 by Laura Wershler

Four takes on Fertility Control 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

Image by Diana Álvarez

Not A “Real” Period: Redefining Menstruation and Reconfiguring Birth Control
Katie Ann Hasson, University of Southern California

Menstruation, as a “natural” bodily process, seems self-evident, despite a great deal of feminist work that has highlighted menstruation as culturally constructed. Yet even in this work, how menstruation is defined or what “counts” as menstruation is rarely questioned. Examining menstruation alongside technologies that alter it highlights these definitional questions.

I examine the case of menstrual suppression birth control as a technology that regulates menstruation, drawing on an analysis of medical journal articles and FDA advisory committee transcripts paired with websites used to market menstrual suppression to consumers. Across these contexts new definitions of menstruation converged on a distinction between bleeding that occurs when women are taking hormonal birth control and when they are not. This distinction was previously known but became newly salient as it helped to normalize menstrual suppression contraception. Redefining menstruation was an important step in reconfiguring birth control pills into menstrual suppression pills, and thus in reconfiguring co-constructed uses and users of birth control pills. This paper seeks to broaden a sociological understanding of gendered embodiment by attending to the co-construction of users, bodies, and technologies through processes of reconfiguration.

“Bringing Down My Period” – Metaphors Around Ending an Unwanted Pregnancy
Susan Yanow, MSW

Around the world, including in the United States, women are self-inducing miscarriage/abortion using medicines obtained via the Internet, friends, etc. While some women consider this practice “DIY abortion’” others frame it as “bringing down the period” or “menstrual regulation.”

This presentation will share information on prevalence of this practice in the U.S., legal issues, and the disproportionate impact of these restrictions on low income and rural women will be highlighted. Participants will be invited to consider what the role of clinicians and activists could/should be in supporting women who choose to self-induce to end an unwanted pregnancy.

“I would not recommend it to anyone.” – What can we learn from women who share their bad experiences with Depo-Provera?
Laura Wershler, Women’s Health Critic

In three years my blog post Coming off Depo-Provera can be a women’s worst nightmare, (re:Cycling, April 2012)  gathered 900+ comments, many suggesting that the title was an accurate statement of experience for many women. A later post, Stopping Depo-Provera: Why and What to do About Adverse Effects, a Q&A with endocrinologist Dr. Jerilynn C. Prior, received almost 400 comments.

Analysis of these comments (excerpts to be presented) revealed four recurring themes: 1) Uninformed choice 2) Lack of body literacy 3) Feelings of anger, fear, regret, betrayal and solidarity 4) Frustration with health-care providers. I’ll present arguments as to why this contraceptive method, as currently provided, does not serve reproductive choice or justice and offer suggestions for criteria required to ensure Depo-Provera is a contraceptive method that respects informed choice, body literacy, and women’s well-being.

 “I Won’t Have What She’s Having!” – Menstruation Suppression, Illusion of Choice, and the Lure of Posthumanisms
Diana Álvarez, Student, Texas Woman’s University

This paper explores why women choose to take menstruation cessation birth control pills and how this “choice” influences the way women view themselves. I am interested in understanding how the current cultural rhetoric on menstruation serves as a type of coercion for women to take these drugs. The analysis represents women’s eliminated cycles as a type of (dis)placing of the female body. Women are being convinced that the natural physiological occurrences of their bodies are at best inconvenient but at worst completely unnecessary and in need of elimination. Menstrual suppression will be discussed as a step towards posthumanism which as defined by Richard Twine is the “belief that the human race should be ‘enhanced’ using technological means.” I’ll address how the practice of not menstruating embraces a cyborg feminine identity.

Media Release and Registration for the SMCR Boston Conference.

State of Wonder–Part 1: Wondering about missing menstrual mentions in literature

January 22nd, 2015 by Laura Wershler

In her novel State of Wonder Ann Patchett explores, among many broad themes, the question: What if there were a drug women could take to extend menstruation and fertility into their seventies? Not evident on the dust jacket, this storyline grabbed the attention of this menstrual cycle advocate.

Set mainly in the jungle of Brazil, the novel revolves around the decades-long research of Dr. Annick Swenson who has kept the location and progression of her research secret from the drug company funding her work with the fictional Lakashi tribe. When a male scientist sent by the drug company to find Dr. Swenson and deliver a message is reported dead, Dr. Marina Singh, a research pharmacologist, becomes the second emissary charged with finding Dr. Swenson and assessing her progress towards the promised drug.

Finding Dr. Swenson is a formidable task, but when she does Marina eventually learns the complex botanical explanation for the Lakashi’s extended fertility, as well as the justifiable reasons why the research location has been so scrupulously protected.

This literary novel, a satisfying read, powerfully renders the mystique of the Amazon jungle, conveying both the wonder and trauma Marina experiences there. For an insightful review of State of Wonder I’d recommend Lydia Millet’s. This series of posts is not a review, but rather commentary on the niggling details related to the extended fertility storyline. Spoiler Alert: Some plot points will be revealed.

After a few weeks in the jungle—the timeline is fuzzy—Marina is invited by two other female researchers to the grove of Martin trees where she observes Lakashi women of all ages scraping tree bark with their teeth, a practices she is told that begins at menarche and is the key to their lifelong fertility.

Marina learns the women chew the bark every five days except when they are menstruating and when they’re pregnant; the bark repulses them from the moment of conception. She is told also that although the women don’t all come to the grove on the same five-day cycle, they’re menstrual periods are “pretty much” synchronous so the researchers “get a few days off every month.” That is, days off from observing them in the grove while taking pin-prick blood samples and collecting cervical mucus swabs to monitor estrogen levels that Dr. Swenson has taught the Lakashi to do themselves with Q-tips. Dr. Swenson’s research team charts and studies every cycle of every menstruating girl and woman.

The researchers tell Marina they also chew the bark and invite her to try it. Here is where, in a story that speaks intimately about the tribal women’s menstrual cycles, I wondered why Patchett did not include even one sentence to acknowledge when Marina had her last period. (At 42 she has thought about her fertility and her prospect of having a child someday.) Because she scrapes the bark one assumes she isn’t menstruating, and she’s been in Brazil long enough–weeks spent in Manaus before getting to the jungle–to have had at least one period. Where is she in her cycle? This matters because of what happens later in the story. So, since menstruation is integral to the novel, why not mention it? And why don’t the other female researchers mention whether their cycles, too, have synchronized with the Lakashi’s?

In most novels, probably too many, the menstrual cycles of female characters are invisible unless they figure prominently in the plot. It made no sense to me that Patchett chose to make Marina’s cycle invisible. Even if readers can deduce this missing information, surely this is the wrong novel in which to require us to do so. Again, I ask, “Why?”

Continued in State of Wonder—Part 2: Wondering about missing menstrual femcare products and birth control references

 

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

Is the birth control pill a cancer vaccine?

March 11th, 2014 by Holly Grigg-Spall

I’d given up reading the comments on online articles for the good of my mental health when a small slip last week steeled my resolve. In response to an article exploring the arguments made by “birth control truthers” a concerned father decided to have his say, taking the defensive arguments put forward by those in opposition to these “truthers” to their only logical conclusion:

“Perhaps we should market contraceptive pills as hormonal supplements to reduce cancer risk instead of as “contraception”? After all, it is only in modern times that women have hundreds of menstrual cycles throughout their lives. Even up until 1800 it was common for women to be either pregnant or lactating throughout much of their short lives.

The body simply wasn’t built to handle so many menstrual cycles, which raises the risk for cancer.

Who could argue with taking supplements to prevent cancer?

This may sound strange, but I am seriously considering putting my 11 year-old daughter on the pill (with no placebo) just for the health benefits. I just have to convince my wife first who is a little shocked by the idea…”

I cannot count how many times I have heard that the birth control pill “prevents cancer” – specifically “preventing” ovarian and endometrial cancer.  In the last few months I have seen references to this benefit explained less and less so as a “lowered risk” and more and more so as a “preventative” action.  I think this is significant as the word “prevent” suggests that the pill guarantees you will not get these forms of cancer. And yet, to remark that the pill is counted as a carcinogenic substance by WHO – due on the increased the risk of breast and cervical cancers – will get you tagged as a “truther.”

What is interesting, of course, is that despite the “cancer protecting” benefits of pregnancy, and early pregnancy at that, we do not see women encouraged to get pregnant in order to lower their risk of ovarian cancer.  Criticism of child-free women does not generally include comments about their lax attitude towards their own health. The risk goes down further with every pregnancy and further still with breast feeding, especially breast feeding for a long period of time after birth. Women who have children young, and multiple children, have a lower risk of breast cancer than women who have no children or children after 30. Yet we see more talk of women having “too many” children at an age that is “too young” – in fact I was contacted via Twitter by someone who read this piece and who saw, in the comments, that one woman who uses natural family planning admitted to both liking the method and having 14 children. This admission disgusted the person who contacted me, even when I pointed out that it seemed the woman had very much chosen to have those 14 children.

It seems the people who are advocating prescription of the pill for cancer prevention purposes are not advocating women have children earlier, more children, or consider breast feeding for the good of their own health – in fact two of the loudest critics of my “birth control truther” book are vehemently against pregnancy and breast feeding being part of women’s lives (Amanda Marcotte and Lindsay Beyerstein). The risks of the pill are frequently compared to the health risks associated with pregnancy and child birth,  but we don’t often hear women say they are choosing to not have children to avoid putting their health at risk for nine or so months.

Which leads me to this article in the LA Times that suggested nuns should also be on the birth control pill for its cancer-protecting abilities:

“And are the pills really unnatural? Our hunter-gatherer ancestors had their babies four or five years apart, because of long intervals of breastfeeding. As a result of that and their shorter life spans, they had as few as 40 menstrual cycles in a lifetime, while a modern woman can have 400. Though we can’t claim that today’s pills are perfect, their use is certainly less unnatural than enduring the hormone turmoil of hundreds of menstrual cycles.

This brings us back to the Colorado nuns, the Little Sisters of the Poor. Nuns have a substantially higher risk of reproductive cancers than women who have children, in part because of their celibacy, which means a lifetime of uninterrupted menstrual cycles. In 2011, my wife and I attended an obstetric conference in the Pontifical University of the Holy Cross in Rome. The keynote lecture there recommended that nuns use oral contraceptives for two or three years after taking their vows, in order to benefit from a long-term reduction in reproductive cancers to which nuns are otherwise exposed by their celibate life.”

Of course, no one would suggest nuns should give up on God and get pregnant, despite the fact that their increased risk comes from not having children or breast feeding, anymore than the father of that 11 year-old would likely encourage his daughter to have multiple children before she hits 30.

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