Blog of the Society for Menstrual Cycle Research

“Menstrual Hygiene” Explored: Capturing the the Wider Context

December 9th, 2014 by Chris Bobel

This summer, I bought a new camera. I needed it to snap pictures during a research trip to India where I explored diverse approaches to what’s called in the development sector, Menstrual Hygiene Management (MHM). I chose a sleek, high tech device with a powerful, intuitive zoom.

Photo by author

In Bangalore, I captured the sweet intimacy of two schoolgirls as they watched the menstrual health animated video “Mythri” at a government school. In Tamil Nadu, I used my zoom for close shots of skilled women tailors sewing brightly colored cloth menstrual pads for the social business, Eco Femme.

Photo by author

In South Delhi, I used my zoom to preserve the mounds of cloth painstakingly repurposed as low cost menstrual pads at NGO Goonj.

But here’s the problem. These close up shots may please the eye, but they leave out the context that surrounds and shapes each photo’s subject. And what exists outside the frame is at least as important as what is inside. That’s hardly a revelation, I realize, but when it comes to doing Menstrual Hygiene Management work, in an effort to find solutions, the “big picture”—both literally and figuratively—sometimes gets obscured.

Photo by author

For example, when I snapped the picture of the mound of menstrual pads pictured here, I focused on a product, a simple product, that could truly improve the quality of someone’s life. But when I trained my attention on the product, what did I miss?

In short, a wider angle lens reveals the context of menstrual product access—a complicated web of many intersecting issues: infrastructural deficits (safe, secure, and clean latrines and sites for disposal), access to resources (like soap and water), gender norms, and menstrual restrictions rooted in culture or religion.

Imagine that one of brightly colored packages of menstrual pads ends up in the hands of a 15 year old girl. I will call her Madhavi.

Madhavi is delighted to have a dedicated set of her very own clean rags to absorb her flow.

Goonj worker with pads ready for distribution and sale
Photo by author

But does she have access to clean water and soap to wash them?

Does she have family support to dry her rags on the clothesline, in direct sunlight, even though her brothers, uncles, and neighbors will be able to see them?

Does she have a safe, secure place at school to change her rags?

Does she have someone to turn to when she has a question about her menstrual cycle?

These questions are important because they point to what gets in the way of effective and sustainable MHM. My own review of the emerging empirical literature on MHM revealed that the top three impediments to school girls’ positive and healthy menstrual experiences are 1) inadequate facilities 2) inadequate knowledge and 3) fear of disclosure, especially to boys. I want to focus on this last one for a moment by widening the frame a bit more.

Menstrual Hygiene Management is part of a complex and enduring project of loosening the social control of women’s bodies, of working to move embodiment, more generally, from object to subject status—something absolutely foundational to taking on a host of other urgent issues; from human trafficking to eating disorders to sexual assault.

As we know throughout the West, menstrual taboos do not disappear as we upgrade our menstrual care. Without the heavy lifting of menstrual normalization, any menstrual care practice will make a minimal impact.

Thus, menstrual activism must always incorporate an analysis of how gender norms maintain the menstrual status quo. And it must engage the potential of men and boys as allies, not enemies. That’s a tall order that cuts to the very core of gender socialization. But if we don’t take this on, no product in the world will be enough.

Anyone with a camera knows that framing a picture is a choice. Am I suggesting that we should never use the zoom, that we should forgo the rich and textured details possible when we tighten the shot? Of course not, as focus is crucial to our understanding. But when we do aim our figurative cameras and shoot, let’s not forget what lies outside the visual frame. Let’s not forget what else must change for the pad to be a truly sustainable solution.

With this in mind, I turn back to Madhavi and her new pads. Inevitably, even with them, one day soon, someone will know she is menstruating.

Will she be shamed? Will she be supported?

The answer lies in how we frame the picture.

This blog post appears on Girls Globe as part of a series of invited posts organized by Irise Interational.

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

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.

“If Menstrual Health is the Neglected House on the Block … Then Endometriosis is the Basement”

September 12th, 2013 by Saniya Lee Ghanoui

Guest Post by Heather Guidone, CWC, Surgical Program Director, Center for Endometriosis Care

All photos courtesy of Heather Guidone.

The Center for Endometriosis Care was honored to present at the Society for Menstrual Cycle Research’s 20th Biennial Congress in early June, an event featuring the world’s leading professionals including physicians, nurses, psychologists, sociologists, anthropologists, women’s and gender studies scholars, and many others – not the least of whom was Honoree Gloria Steinem. Tasked with identifying public health challenges and barriers to including menstrual cycle disruption/disorders as key components of women’s health, and explore ways by which to overcome these critical gaps in pelvic health, we tried to drive the point home as to how largely ignored endometriosis is:

“If menstrual health is the neglected house on the block, then endometriosis is the basement.”

We explored and investigated the shortfalls in endometriosis, in that, yes, endometriosis is a disease of menstruation – but it is also true it has far deeper impact on a woman or girl’s life and places a significant public health burden on our society. Endometriosis isn’t merely about painful menses. The disease is a debilitating, costly illness linked to chronic pain, impaired fertility, and significantly reduced quality of life.

Endometriosis affects menstruators and non-menstruators alike (post hysterectomy, post menopause, etc.), and remains fraught by significant diagnostic delays, high treatment failures and consequent recurrence – all of which pose formidable challenges to practitioner and woman alike. Unfortunately, many women and girls are not taught what is ‘normal’ and what may be indicative of a problem; largely, ‘period taboos’ stifle the conversations we should be having about signs and symptoms of the disease.

Moreover, research remains sorely lacking in priority and offers little bench-to-bedside translation; there remains an acute need for coordinated investigation into pathophysiology, precision treatment, association with co-morbid conditions and prevention/cure. Women are too often told the pain is in their head; still others espouse ancient, mythical notions of hysterectomy and pregnancy as cure. None of this is true, and such sentiments are a monumental disservice to those suffering. Sadly, even well-meaning clinicians – not just lay society and the media – remain ignorant of the damaging effects the disease imposes on girl’s and women’s physical well-being, sexual function, fertility and general welfare, creating a vicious cycle of ineffective treatment.

It has been said by some that endometriosis is a disease of the ‘modern age’; that women and girls have brought the disease upon themselves by delaying childbearing in lieu of careers and academic goals. This is completely untrue, as we have seen accounts in the Ebers and Kayun Papyrus’ of what could easily be today translated as endometriosis. There are also rumored cave drawings and Egyptian hieroglyphics depicting uterine pain. As years progressed, we eventually came to a better understanding of endometriosis and the significance of pelvic pain – but this still hasn’t changed society’s view of menstruating women. Menstruation – particularly menstrual pain – remains largely belittled, marginalized, ignored, medicalized and dismissed. It may not be a menstrual hut, but we’re certainly still sending girls away today in the metaphorical sense – away from timely diagnosis and effective intervention for this disease.

Why should we care about painful menstruation? Women bleed, women hurt. Right? Wrong. This disease is not about painful periods. It’s about a debilitating illness that takes tremendous personal and societal toll:

  • Drastically reduced overall quality of life
  • Severely compromised academic/professional opportunities
  • Critically impaired sexual, mental, physical, emotional functionality
  • Negative/far-reaching impact on relationships
  • Significant loss of productivity
  • Erroneous “in your head” diagnoses may lead to emotional/psychosocial issues
  • Dependence/addiction accusations
  • Often unnecessary/ineffective/repeated medical and/or surgical treatments up to and including hysterectomy do little to help, yet contribute to vast and gratuitous healthcare expenditures

The legacy of misinformation is shared widely, from doctors to patients to media, and globally propagated over and over. The incredible bias surrounding menstruation and pelvic pain against women of all races and ages contributes to further delayed diagnoses or mistaken/dismissive diagnoses like STDs, fibroids, “NORMAL PAIN”, etc. Karen Ballard’s landmark paper from 2006 described the stigma given to girls with menstrual pain who were mistakenly believed to simply be unable to ‘handle’ a period.

Still other medical reviews dating back about 4,000 years found evidence of women being subjected to torturous treatments – leeches, bloodletting, hot douches, being hung upside down, and accused of demonic possession and killed – for their inability to overcome intense pelvic pain in their pelvic area – even famed philosopher Plato mentioned the extreme distress that women experienced. What he and others observed and perceived as ‘suffocation of the womb’ may likely have been endometriosis. [Colliver, V. 2012 October. Endometriosis Sufferers Long Blamed. San Francisco Chronicle.]

We haven’t come very far, sadly.

Due to this significant lack of factual awareness, endometriosis remains an undervalued, underappreciated diagnosis. Women and girls with the disease suffer a diagnostic delay on average of 7-12 years and present to 5 or more physicians before their pain is addressed.

Understanding Research: (Meta)Theoretical Frameworks

August 19th, 2013 by Paula Derry

Research results are often reported by the media as stand-alone statements and as though they are facts. “Slim women have a greater risk of developing endometriosis than obese women.” “Respiratory symptoms vary according to stage of menstrual cycle.” In previous blogs, I have said that a reader needs to understand research methods and basic concepts found in statistics in order to make sense of what results really mean. This blog is about another ingredient that goes into making sense of research. Metatheoretical frameworks, basic ideas of how the world works, are important influences on how researchers choose what problem to study, choose the methods with which to study it, and choose how to interpret the results.

The context of research is always stated in research articles. Articles always include a write-up of previous work, discussing what has been done and what unanswered questions remain. This sets the stage for why the research being reported is interesting and important. However, what I want to discuss are more general, often implicit, basic assumptions. Even what seem to be brute facts are understandable as such only within a given set of basic assumptions or paradigms. Paradigms guide thinking, but change over time.

Thus, as discussed by Sheila Rothman, a  nineteenth century metatheory was that assertiveness and activity are dangerous for women. As stated in a more specific scientific theory: All people have a limited amount of nervous energy; this nervous energy is distributed over a greater number of organs in women than in men (because of their reproductive organs); therefore, all of women’s organs are more “sensitive and liable to derangement (p. 24).” It was concluded from these ideas that exercise and exertion are dangerous for women; further, mental exertion, such as going to college, should be avoided. Rothman describes case studies written up by physicians of women harmed by exertion and cured by rest. In this context, designing research to evaluate whether college harms women appeared to be a sensible, even important undertaking. So did structuring a college curriculum to avoid precipitating debility or insanity.

What are some of our current basic paradigms? One example: Menopause is senescence and reproductive physiology is central to women’s health. It follows from these premises that menopause or the transition to menopause are key factors in the development of chronic illness; research addresses what harm is created or, alternatively, whether these premises are correct. Another example: Cyclic changes in mood, intellect, and energy during different stages of the menstrual cycle are very important, especially to understand distress. Alternatively, a healthy menstrual cycle suggests that a woman is physically healthy.

Research I am conducting with Greg Derry addresses another metatheory about the menstrual cycle. Periods are most often described as cyclic, recurring in a regular repetitive manner (“every 28 days”). However, modern systems theorists know that there is a different kind of system (a “nonlinear dynamical system”) that by its nature generates a little bit of unpredictability and by its nature interacts with other systems (“is an open rather than a closed system”). Our research has provided evidence that the menstrual cycle is a nonlinear dynamical system. This means, among other things, that menstrual periods would be expected to be a little bit irregular with an occasional extreme cycle length.

The psychologist Robert Abelson reminds us that research is an ongoing process of discussion. Understanding research means joining the conversation.

Ethics in Wonderland: The SUPPORT Study

June 24th, 2013 by Paula Derry

Arthur Caplan is a well-known ethicist, the head of the Division of Medical Ethics at New York University’s Langone Medical Center. On June 11, 2013, Caplan posted an article called “Get real: No need to overdo risk disclosure” on the medical website Medscape. According to basic ethical standards, subjects in research projects are supposed to give written informed consent, which means among other things that they are informed of possible risks that a decision to participate in the study might cause. The Office of Human Research Protections (OHRP) of the U.S. Department of Health and Human Services criticized researchers in a large project called SUPPORT for failing to clearly disclose the study’s risks. In his Medscape article, Caplan disagreed with OHRP and argued that strict, inappropriate requirements for consent discourage important research. His sentiments were echoed in a recent editorial in the New England Journal of Medicine, a major respected journal. In contrast, SUPPORT is criticized in a New York Times editorial entitled “An Ethical Breakdown” and by watchdog organizations like the Alliance for Human Research Protection and Public Citizen (many of the critical documents are on the Alliance for Human Research Protection website).

Here’s some background: SUPPORT was a large study of how best to treat very premature babies. These babies often need to be given oxygen to help them breathe. However, if too little oxygen is given, there is a risk of death or brain damage; if there is too much, the babies may develop an eye problem called ROP or blindness. Enter SUPPORT. According to the researchers, their goal was to determine the best oxygen level to get lowest risk of blindness without increased risk of death. This amount had already been narrowed to 85% to 92% oxygen saturation (a measure of the oxygenation of blood) in medical practice; the researchers wanted to find out where within this range is best. Infants in the research were randomly assigned to experimental conditions; in one condition, babies were given enough oxygen to bring the oxygen saturation measure to the lower end of the range (averaging 85%); in the other condition, the higher end (averaging 92%). The researchers found that infants receiving less oxygen did, indeed, have fewer eye problems than did infants given the higher amount, but more of them died.

The critical letter from OHRP stated that the consent forms that the mothers of the babies signed should have clearly stated, but did not, that an increased risk of blindness (for babies in the higher oxygen condition) or death (for babies in the lower oxygen condition) was possible. The ethicist Caplan objected to this. He argued that the researchers were comparing two standard medical practices, since 85% to 92% is the standard range used by doctors. In his view, the current way that doctors decide how much oxygen to use within that range is “a coin flip”; randomly assigning babies to the experimental groups was simply comparing two treatment approaches currently in use to see which one is best and involved no increased risk than the babies would otherwise face. He distinguished this from studies that introduce a new treatment, where informed consent about risks is a different matter. Caplan stated: “I believe that this research is highly ethical” and expressed concern that overly strict rules will hinder needed research. The New England Journal of Medicine editorial also objects to the OHRP letter. The editorial states that the OHRP’s finding that subjects should have been informed of an increased risk of death was based on hindsight. The editorial quotes the researchers, who state that “there was no evidence to suggest an increased risk of death” for infants receiving the lower levels of oxygen before their study was done. The editorial states that OHRP has “cast a pall over the conduct of clinical research” and “strongly disagree[s]” with their letter. SUPPORT, in the editorial’s view is “a model of how to make medical progress.”

What is the controversy? First, with regard to the idea that what was being compared were two versions of standard care, although Caplan does not state this in his article, the OHRP letter specifically addressed this point. In real clinical practice, a range of 85% to 95% exists, but in this study only the extremes were used. As the letter states:

According to the study design, on average, infants assigned to the upper range received more oxygen than average infants receiving standard care, and infants assigned to the lower range received less. Thus the anticipated risks and potential benefits of being in the study were not the same as the risks and potential benefits of receiving standard of care.

Further, in real clinical practice, physicians would be making decisions about where within this range to aim, and how much oxygen a particular infant needed. Caplan assumes that random assignment in the experiment was no different than a physician making a decision. In my view, this is a pretty big assumption. Since the researchers compared infants receiving higher vs. lower levels of oxygen, but did not compare either group with a control group of infants getting real standard care, we do not have evidence whether the babies did better, the same, or worse, than babies given genuine standard care. We know that babies receiving less oxygen in the experiment had fewer eye problems than did babies receiving higher amounts, but we do not have definitive evidence of whether they did better or worse than babies receiving usual care.


May 27th, 2013 by Paula Derry

Articles in the media often report research results with a number, for example the number of hot flashes per day or the severity of menstrual cramps.  However, these are not facts in the way that “man bites dog” would be a fact.  In part, this is because the numbers in research reports often are averages.   Averages are useful summaries, but they also leave out a lot of information.  Take shoe size.  If the average woman’s shoes are size 7, this does not mean that all women are size 7.   It does not mean that a woman whose feet are size 8, 9, or 10 is abnormal or has a problem.   At some point, a very large or small foot could mean that someone has a problem, but knowing where to draw the line requires knowing a lot more than the statistics.  It means knowing something about the biology and biomechanics of feet.  It means knowing about the context—for example, is a woman who wears a size 11 shoe five feet tall?  or seven feet tall?   This is different from a situation where numbers have an absolute meaning.  For example, if my temperature is 102 degrees, then I have a fever, because of the realities of the biology of my body and not because of what most people’s average temperature is.

Image created by Paula Derry

What is an average?  There are a few common ways of computing this. The median is the score for which half of the people being studied have higher scores and half lower. If the scores of all of the people being studied are added together and then divided by the number of people, this gives us the mean.  The standard deviation is a number that indicates variation around the mean.  If whatever is being measured has what is called a “normal distribution” (which is most often assumed) then over 68% of measurements will be within one standard deviation, and over 95% within two standard deviations of the mean.

Take osteoporosis and osteopenia.  Osteoporosis is a bone disease that typically develops in old age in which bone is fragile and more likely to fracture [pdf].  This has been defined as a bone density measurement that is more than 2.5 standard deviations below that of an average 30-year-old woman.   Osteopenia is having bone density that is not thin enough to be osteoporosis, but thinner than “normal,” and is defined as bone density 1-2.5 standard deviations below that of a 30-year-old woman. These definitions are statistical, i.e., different from an average (young) woman. Sometimes women are told that they have bone disease based on these definitions.  With regard to osteopenia, the assumption is that this is an early stage of disease that will get worse over time and become osteoporosis.  Sometimes women with osteopenia are advised to use a medication to prevent the disease progressing.  However, these statistical definitions have been controversial.  For example, other doctors assert that it is normal for bone to thin as women age and that only a small percentage of women with osteopenia go on to get osteoporosis.  Some doctors believe that a diagnosis of osteoporosis itself requires more than low bone density—for example, that a woman has had a bone fracture or that other indications exist.

Or take the number of days in the normal menstrual cycle.  The stereotype is that the average menstrual cycle is 28 days long and that regularly recurring cycles are what is healthy.  A study published in 1967 by Treloar and colleagues presents some of the complexities that this stereotype ignores.   Assuming that there is one average menstrual cycle length for all women leaves out important information about changes that occur over time, across a woman’s adult life.  The average cycle length when a large group of women were studied was indeed 28 to 26 days (median length). However, this was for women aged 20-40. During the first few years after menarche and the last few years before menopause, median cycle length was over 30 days. Even more striking is the amount of variability from one woman to the next, and how this variability changes over time.  Among 20-year-old women, for example, the cycle could be anywhere from 24 to 38 days, or occasionally less or more.  However, the first year that periods began, these differences between women were larger—cycle length was between 18 and 83 days. Variability between women decreased for about eight years, but, as I have said, even when women were most similar (at ages 20-40) there were still big differences among them.  Variability increased again about eight years before menopause; the last year before menopause, women had cycle lengths from 18 to 80 days.  An individual woman’s cycle lengths changed over her life span; further, cycle lengths varied from month to month as well as over a span of years in ways that were very different for different women.

Averages have useful information.  However, it’s always important to know what the numbers mean in order to interpret them.  This is important for knowing what an average means, and it’s always important to remember that an individual’s reality may be very different from the picture derived from finding an average for a large group of people.

Working Mothers

April 29th, 2013 by Paula Derry

“Working Mother and Son” Photo by Russell Chopping // Creative Commons 2.0

Research is often reported as though it is news, as though the most recent article is the best and research that was not published this year is somehow not as interesting or is out-of-date. I recently dug out some articles I wrote about the psychology of working mothers that were based on a study I did in the mid-1980s. I interviewed psychotherapists about how being a mother had affected their professional lives. This study was qualitative research. I offer the results as interesting ideas, not as definitive conclusions.  Some points I think are still interesting:

  1. Overall, about 64% of the 25 mothers I interviewed opted for part-time work; when children were preschoolers, this was about 78%. Psychotherapists, unlike many other women, have the option of working part-time:  part-time jobs, especially for therapists who see clients in private practice, are the same jobs that a full-time worker would have.
  2. I compared the mothers with another group of 19 therapists who did not have children. The non-mothers tended to work full time (about 90%).  However, both groups of women were deeply and apparently equally committed to their jobs.
  3. Many of the mothers (about 60%) felt that work was not as important to them as it would be if they were childless. However, this did not mean that work was unimportant. For most women, it only meant that they now had two strong priorities instead of one.
  4. Almost all of the mothers (88%) felt that having children affected their work as psychotherapists by deepening their empathy, understanding, or emotional knowledge about parents and parenting. This was not simply intellectual, that they knew more facts, although this was also true. It was experiential understanding, a different experience of what facts mean. This was so even though their profession involves helping clients understand their parents or their parenting, and was reported whether they had a child while in graduate school or after they had worked for many years.
  5. One aspect of this increased knowledge was an experience of how passionate an experience mothering is. Another aspect was a less idealized view of both parents and children, and greater tendency to see the experiences of parents and children from their own perspectives. For example, in addition to seeing parents in terms of how their children felt (e.g., that the parent was mean or rejecting), the therapists might perceive more clearly where parents were coming from or that children might misunderstand or be unreasonable.
  6. This greater ability to see the position of both parents and children more clearly is what a psychologist might call psychological individuation. That is, the stereotype is that mothers are or should be all-giving, selfless, thinking only about their children. However, these mothers seemed to grow more realistic, clear about and accepting of who children as well as parents are. As I said in one paper:  “Interconnectedness, or intimacy, requires a sense of oneself and the other as separate but related. (If children really do lack a sense of this separation, that is no reason why their parents, who are adults, should identify with their perspective.)”


Derry, P.S. (1994) Motherhood and the importance of professional identity to psychotherapists. Women & Therapy, 15, 149-163.
Derry, P.S. (1992) Motherhood and the clinician/mother’s view of parent and child. In  J. Chrisler & D. Howard (Eds.), New directions in feminist psychology:  Scholarship/Practice/Research. New York: Springer.

Bored by Research Updates and News Headlines

January 3rd, 2013 by Heather Dillaway

"— Allons, à ton tour, ma petite... vas-y ! — Non, Papa ; si on devient si vilaine que ça en un an, j'aime mieux pas entrer".

By Achille Lemot (1846-1909) [Public domain], via Wikimedia Commons

Sometimes I think biomedical researchers and media spokespersons are just searching to find the pathology in our lives. Not that we don’t know this already, especially when it comes to women’s health. Because of how medicalization works, of course anything that veers from the defined “norm” for women (here, a young woman who menstruates every 28 days like clockwork) is pathological. Thus, menopausal women are pathological by definition. But, sometimes this gets pretty depressing, and really, it’s not very accurate considering that the vast majority of women go through menopause at some point during the midlife (so doesn’t that make menopause pretty normal and non-pathological?). In my Google alerts last week, here were the “menopause” headlines:

Diet, Exercise Post Menopause Help Reduce Risk of Breast Cancer
Medical Daily

Menopause linked to higher brain aneurysm risk

Healthy lifestyle during menopause may decrease breast cancer risk later on
Medical Xpress

Weight-y menopause
The Star Online

Diet To Overcome Menopause Problems

I do understand that there are many more health risks in middle age and beyond, and that changing/waning hormone levels at menopause induces different concerns/risks than women might have faced before menopause. Researchers, doctors, and media spokespersons have made it crystal clear over the past few decades that this is the case. But, as feminist and social science researchers have urged us to get beyond the “menopause as death” or “menopause as problem” perspectives, it seems that we’re not making much progress in thinking differently or more broadly about this transition. As I read the articles on menopause leading to more breast cancer risk, risk of brain aneurysm, and risk of weight gain, it is reaffirmed in my mind that we’ve made very little progress in broadening the dialogue (at least the published and mainstream dialogue) on this important life stage.

Sure, this life stage is filled with problems, risks, and interesting situations, but what life stage isn’t? Isn’t there published research coming out on ANYTHING ELSE about menopause? I want to read about something different! Readers, feel free to comment about any other interesting stuff you’ve read about menopause recently because I for one am searching for new takes on menopause. Seriously, people, was there nothing else new last week on menopause? As we head into 2013 I’m hoping for something new.

Understanding Research: Buyer Beware

April 2nd, 2012 by Paula Derry // CC 2.5

I certainly believe that scientific research is important.  Research uncovers new knowledge and prunes away facts that are not accurate.  However, in our society, research is also a coinage to justify views of reality. A Biblical scholar might invoke a sentence from the Bible before holding forth on his own interpretation or opinions. In a similar manner, a scientific study might be cited or a scientist quoted to justify that something is real before jumping off into one’s own thoughts, opinions, theories, or justifications.  If a scientific result can be invoked, we can believe that something is true. Is there an unconscious?  Freud said so, but he’s out of date.  Are we intrinsically social beings?  Evolutionary theorists argue. Does meditation really result in an altered state of consciousness?  If I present results from research, preferably using a high tech measurement like a brain scan, or if I can come up with a theory that uses words like “neural nets” or “neurotransmitters,” then I can believe all of these things.

What’s wrong with this? Isn’t this science doing its job of uncovering truth?  There are two things wrong with this. One is that not all knowledge is scientific knowledge.  The second is that scientific results are often portrayed inaccurately in our society.

With regard to the first point, I’ll just give a few examples.  von Bertalanffy, a systems theory scientist, wrote that even a physicist will chase his (sic) hat when the wind blows it without knowing the mathematics determining which way the hat will blow.   Einstein famously said that not everything that was important could be measured, and not everything that could be measured was important.

But what I really want to talk about here is the second point.  We are inundated with scientific results in newspapers, websites, and other places. Most often, a brief summary of research is followed by broad generalizations about what the research means.   However, the outcome of research is not simple facts. Experiments are complicated things that must be evaluated by readers and understood in context.  When I was a graduate student in psychology, every class included practice in critiquing research.

To understand research, certain mathematical ideas are important.  “Statistical significance” is important to both accurate interpretation of research and to inaccurate or misleading reports. If you’ll bear with me, I’ll run through what I mean. Suppose you have a coin. If you toss the coin 100 times, it will come up heads about 50 times, not exactly 50 but close. Why?  That’s just the way the world we live in works, there are laws of probability. Since there are two possible outcomes—heads or tails—each will come up about half the time. If I toss my coin 100 times and it always comes up heads, I’ll probably conclude the coin is biased.  Why?  Because it just doesn’t happen; it’s extremely improbable, in the world we live in, that an honest coin would do this.

What if the coin came up heads 60 times? Is the coin honest or not?   The question is this: When is an outcome still “what you would expect by chance even though the numbers are not exactly alike (since we expect approximately 50 heads, not exactly 50)”?  On the other hand, when is the difference big enough that you would conclude that the coin is probably biased?   Sometimes it’s hard to tell.  In research, very often results are in the “hard to tell” category.   For example, if 55 percent of the women in my research prefer chocolate ice cream, while 65 percent of the men prefer chocolate, is there a real sex difference (it’s so improbable there’s a real difference) or is there not (the numbers seem different, but I’m not sure whether this is just because there is a range due to chance and not a real difference). Sometimes numbers that seem very different are actually what you could commonly get by chance, and sometimes numbers that don’t seem very different are very improbable.  In addition, what I’m studying may produce a weak rather than a larger, obvious effect because among us humans, for all kinds of psychological, social, and biological research, what is being studied is only one factor contributing to a situation and not the only thing going on.  In the example, even if men and women do have different likelihoods of preferring chocolate, there are many possible reasons for a person’s choices—diabetes, city you grew up in, getting rejected by a date while you were eating chocolate ice cream, etc.

Enter tests of statistical significance. These are mathematical procedures which assess how likely an outcome is to have occurred by chance if there was no real underlying difference. If my statistical test revealed that the difference in the percentages of men and women who prefer chocolate ice cream could have occurred purely by chance only one time out of a thousand, I would conclude that my results were in the “there probably is a sex difference” category. Researchers have an arbitrary  convention:  If results could have happened by chance 5% of the time or less, then the results are considered evidence of a real difference and are said to be “statistically significant.”

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.