Menstruation or, who says women cant stand the sight of blood?
Menstruation is the approximately monthly shedding of the uterine lining; the blood and tissues leave the body through the vagina. Menstruation is a normal, natural process that occurs in all healthy adult women who haven't reached menopause. Girls can begin to menstruate at any time between eight and eighteen; women might reach menopause anywhere between forty and sixty. Some women have their period every eighteen days, some every thirty-six; some women bleed for two or three days, some for seven or eight; all these and everything in between are normal.
The various cultures of the world have taken a wide variety of attitudes toward menstruation, seeing it as a sacred time, an unclean time, and everything in between. Unfortunately, our society tends towards the "unclean" end of the spectrum. Menstruation is "the curse", something dirty; we can watch pad and tampon ads on TV, but we can't let anyone know we're actually using them.
Many women are embarassed about their bleeding, an attitude which our society encourages.
- "Use this product and no one will be able to tell you're menstruating!" Granted, it's no one's business but your own whether you're menstruating, but we don't take nearly the effort to hide having to blow our nose or use the restroom.
- "Deodorant pads so you won't smell bad!" If you're changing the pads regularly, odor isn't a problem -- and our society goes off the deep end about repressing natural body odors anyway.
- "She's in a bad mood today. She must be on the rag!" As if we can't be in a bad mood for any other reason. And many of us actually feel great after the first day or two of our periods.
If you don't believe women are embarassed about their bleeding, think back to the last time you found someone's used pad or tampon bundled up on the back of the toilet in a stall of a public restroom. Why didn't that woman put it in the trashcan by the sinks? Because she was too embarassed to let other WOMEN know that she was menstruating! (And if you've ever done this yourself, remember that HIV is carried through blood, and the janitor has no way of knowing whether you're HIV-negative. The other women in the bathroom don't care whether you're bleeding or not, and the janitor will thank you for throwing away your pad properly.)
We're not saying you should wear a huge sign with "I'm having my period!" in big letters. We do want to remind you that menstruation isn't a shameful thing, no more than eating or sweating or sneezing or urinating is. It's a normal process that happens to all of us.
Our Pages
Other Links
Tampax web page
A huge amount of information on menstruation, advice for parents, information on Toxic Shock Syndrome, and such. Keep in mind that this _is_ a commercial site and that there will be a bias towards Tampax products (they put a great deal of emphasis on tampons hiding odor better, for example); don't take them as gospel. But overall their information is quite good, and there's a _lot_ of it.
Multiple Sclerosis and menstruation
A July 1995 article from the online magazine Real Living with Multiple Sclerosis on how some women with MS have flareups around their periods.
The Museum of Menstruation
Only some general information on the museum, but something to keep in mind for Washington, D.C. trips!
BigFolks FAQ
The FAQ for the soc.support.fat-acceptance and alt.support.big-folks newsgroups; there's a small segment on fat women and menstruation.
Am I normal?
"I don't bleed at night for the last three days of my period. Is this normal?"
"All my friends have periods every four weeks, but mine is every five. Is something wrong with me?"
"I have to use the bathroom every five minutes on the first day of my period because my intestines go into overdrive. Am I weird, or does this happen to other people?"
"I'm so horny during my period, I want to jump anything that moves. This can't be happening to anyone else, can it?"
Because many of us never talk about the details of our periods, we're left in the dark about what is normal and what isn't. Often we're convinced that we're the only woman in the world that has symptom X or that has a Y-day-long period.
If we define normal as "something that happens to everyone except a few people in odd situations", the only normal thing about menstruation is that it happens to women. However, if we actually mean "healthy" or "something we don't need to worry about", almost anything is normal. We have differently shaped bodies, different textures and colors of hair, different odors, different hunger patterns, different sex drives.... Why should we expect ourselves to all have identical menstrual cycles and symptoms?
I can't list all the things that are normal, because there are too many of them. Here's a very short and HIGHLY incomplete list, though:
- It's normal to have your period every eighteen days. Or every thirty-five. Or anything in between.
- It's normal to have your cycle lengths vary by a few days. It's also normal to have your cycle be exactly x days every time.
- If you've just started menstruating, it's normal to have really irregular cycles for the first few months, or even for the first year or so. It's also normal to have your cycles go like clockwork from the beginning.
- It's normal to bleed for three days. Or five. Or seven. Or anything in between.
- It's normal to be constipated before your period and have intestinal core dumps for the first day or so of your period. It's also normal not to have this pattern.
- It's normal to have mild cramps. Or strong cramps. Or none at all.
- It's normal to not bleed at night toward the end of your period. It's also normal to still bleed at night.
- It's normal to have a really high sex drive during your period. Or a really low one. Or to hit both extremes.
There ARE a few things that may indicate that something at least needs to be checked out. If you have a symptom on this list, DON'T PANIC. But do bring it up with your regular doctor or gynecologist on your next visit, and don't be embarrassed. Again, this list is incomplete:
- You miss more than one period. See also our page on missed periods.
- You bleed heavily for more than a week. (We're not talking about that last tiny dribble that seems to take days to go away; we're talking about heavy bleeding that doesn't stop.)
- You are completely incapacitated by cramps, and over-the-counter medications don't give you any help.
- Your cycles are extremely irregular -- one sixteen days, then one thirty-five days, then one twenty days, and so forth -- even though you've been menstruating for several years. Have this checked out particularly if you've been regular beforehand. (Note: If you're just getting off birth control pills, really irregular periods are normal here.)
Our Experiences
Most of my PMS stuff hits 2-3 days before my period, and continues through the first day or day-and-a-half. I get pissed off at the world, easily frustrated, and overly sensitive. Physically I am a little sluggish, and feel really lightheaded-- sort of off-balance. Sometimes I get cramps too, on the first day of bleeding. Once I'm past about day 2, nothing much happens.
I had my first period at ten and hit a schedule fairly quickly. My periods tend to be about 34 days apart and last four or five days. I have cramps the first day, accompanied by the Intestinal Core Dump, but after that I'm fine.
I started my period the summer between 5th and 6th grade. I *think* that would have made me 10. It was on my brother's birthday and we were able to use it as an excuse to put off a family trip we *really* didn't want to go on that weekend (it was the 4th of July weekend, so we didn't want to mess with the traffic - we went the following weekend, instead :-).
I'm off the pill for the first time in a couple of years, so I'm going on historical data. :-) My cycle is 26 to 28 days. I usually run 5 days, heavily for 2 and very light for the last 3. Sometimes, the last couple of days are light enough that nothing flows out at night.
I *rarely* cramp and it's usually only a few hours before I start, lasts less than an hour or so. In fact, I rarely have any of the traditional premenstral symptoms. The week before my period, I get *incredible* munchies. During my period, I'm usually horny as hell and have no problem having sex during that time.
I was *just* 14. Pretty typical age for me -- low fat, skinny, and tall. I understand that the lankier you are, the later you start.
My periods last about 33 days, adn I bleed for around a week or so. Early days are VERY heavy, and the last are lighter by far. The first three are heavy, the last four nothing much.
*nodnod* Don't bleed at night.
I tend not to have PMS, but I do get cramps. This time, for example, my period snuck up on me. I don't get much advance warning, and since I'm not sexually active right now, I don't worry about it.
The last four days, howver, are almost payback for the first two. I feel like *superwoman*, like I can climb mountains. IT's WONDERFUL -- the last four days of my period are the best days of the month for me!
As far as PMS making women irrational, crazy, or plain old nuts -- I remember quite clearly getting my period the day before I had to take my Ph. D. qualifying examinations when I was in grad school. I finished first in my class in quantum mechanics, and pretty near the top on all the other subjects. Department scuttlebutt had it that I aced my orals, too. So while you can feel crappy from your period sometimes, in all but the most incapacitating circumstances, most women can deal with it. We get our periods, damn it, we're not hysterically insane and irrational, suffering from an incurable disease once a damned month!
My first period came when I was 13 - totally unexpected especially since my mom's started at 19(!!)... I thought I would be a late one too, but it wasn't too bad, there wasn't a whole lot of stuff and there wasn't any cramping at all.
The SECOND time was _deadly_. There was SO MUCH blood and the cramps were horrendous. I remember being really scared, seeing so much blood at a time in one place. I was crying in the bathroom with my panties soaked in this huge red mess (there was so little the first time that I only used some toilet paper folded into a rectangle) and my abdomen hurting like hell - I knew I wasn't going to die but the thought did cross my mind for a bit. I think I went through the entire roll of toilet paper and then some =} My mom was no help (I'm the one who doesn't get along with her mother, remember?) and my dad didn't know how to help me.
It was pretty much the same after that, so I'm used to it. I don't use nearly as much toilet paper; I've learned how to strategically place the maxi-pad on my undies so I don't leak; I learned not to sit still for too long or else there's this big uncomfortable *WWHHOOOOOSSSHHHH* when I got up; trotting down stairs and jumping around helps get it all out faster so I don't menstruate as long; I learned to get _snug_ panties to wear to bed; put a plastic bag under the sheets where my butt is so that if I do leak, the mattress won't get killed; and the power of TYLENOL.
30-35 days... most of the time. They told me it would take "a few months for your period to become regular". They lie through their [collective] teeth. It took mine a few YEARS to finally get into a pattern I could almost predict. It wasn't radically higglety-pigglety, but just unpredictable enough to be extrememly annoying.
Length of my period -- I can't really tell. Do you count the days when it's stopped looking red and more brown and _really_ light flow? I get about 3 days of red and about 2 more days of brownie goop. All I _can_ say for sure is that by the same day the following week, it will be gone.
The first day is heavy and I get cramps within half an hour of the first gush. The second and third days are usually much lighter especially if I've been jumping around the first day. Some periods I've noticed, I don't bleed at night even on the first day (I think it's a certain position I've been sleeping in).
I might gross someone out, but in the mornings, I roll over on my bed as close as I can to my bedroom door before I spring up, high-tail it to the bathroom, then yank everthing off, sit down in a hurry and having the whole gush land in the toilet. Now THAT'S talent. =) =)
Cramps -- They used to be strong enough to disable me for the rest of the day. I couldn't do anything, I couldn't keep my mind on anything else. Mine usually last 6 hours. I'd writhe around in bed for a bit and then fall asleep. When I woke up, it's be gone. Now I just take two Extra Strength Tylenol when I see the first gush and the Tylenol kicks in just as the cramps are supposed to start (in about half an hour), so I don't feel anything at all.
Menopause -- I'm looking forward to it. I'm glad I'm a woman, able to have babies, yes it's miraculous and all, but menstruation is damn annoying. Hate it. Hate it. Hate it.
I'm right around 30 days, I'd say 30 plus or minus 5.
I bleed for 5 days. I almost always start when getting up in the morning - literally! Sometimes I can tell "if I sit up, I'm going to gush", and I roll as close to the door as I can before actually getting vertical to dash to the bathroom.
The first two days are heavy, the third day is medium, and the last two days are light "pantyliner" days. Towards the end, I won't bleed at night. That fourth day sometimes is more like day 3 than day 5, but usually it's a light day.
Hm, I started when I was 11 years old. Couldn't use a tampon for the first year or two (and went through *absolute hell* during this time because I loathed the whole idea of menstruation and wearing what amounted to *diapers* for the damn thing). Of course any time we went camping, I always got my period and couldn't swim with a *^%$# *pad* in my swimsuite. Once I was able to use tampons, I was much more comfortable with the whole thing. I still hate pads. I DESPISE THEM!!
*ahem*
I've always been very regular -- up until my early 20s, every 30-33 days, six days of flow, heavy for four or five, tapering off on the fifth or sixth day, almost gone for a day, and then a trickle later. Got on the pill and went like clockwork 28 day cycle, moderate for five days, almost nothing on the sixth, and a dribble on the very end of the sixth day. Just got off the pill about a year or two ago over concerns of long term pill usage and I've gone back to a 35 day cycle (which is pretty nice, actually), and a pretty heavy five day flow, with dramatic tapering off the fifth or sixth day.
Cramps are almost always the first day or two and I just pop an aspirin or two when I notice, works very well. Sometimes I feel bloated. Definitely cranky and bitchy a few days beforehand, though I won't notice myself unless I stop and figure out when my period is due.
To be honest, I'm looking forward to menopause. In my family, I'll probably be 60 before it hits, though *sigh*.
I've just gone off the Pill, which I was on for 2 years. So I can't tell you much about my "natural" cycle right now (although I'm sure it will be horribly irregular like it always was). On the Pill, my periods were 5 days, always the same: Heavy the first 2, including bleeding at night, then light for a day, then a splash the morning of the third day, light again, and one more tiny splash on the morning of the 5th day and that was it. In my personal language, I called the stages the first, second, and third waves. No blood the last 3 nights.
Cramps
Many women get menstrual cramps during their periods. Here's some information on how to deal with them. In the future, we hope to have some information on the biological causes of cramps as well.
Treating Cramps
There's many different ways to alleviate the discomfort or pain from cramps. Experiment with some of these and see what works, or if you have another technique, email us.
- Exercise, particularly stretches and calisthenics involving the abdominal region.
- Sexual activity. Intercourse, masturbation, whatever. Arousal and orgasm seem to involve some of the same muscles involved in cramps, or at least to override the sensations from those muscles. See also our Sex During Menstruation page.
- Heat on the abdomen -- hot water bottles, heating pads, a hot bath, and so forth.
- Distraction. If you have fairly mild cramps, something that holds a lot of your attention, like a good movie, can keep you from really noticing the cramps.
- Raspberry leaf tea. In herbal medicine, this is traditionally considered to be a good uterine tonic; some women find that drinking it regularly before their periods helps with cramps.
- Eating high-calcium foods or taking calcium supplements before your period. Some people feel that just as a lack of calcium may increase the chance of nighttime leg cramps, so it may also increase menstrual cramps.
- Cutting back on caffeine and/or alcohol before and during your period.
- Eating a lighter diet around menstruation -- less grease, less starch, more fruits and vegetables.
- Over-the-counter medication. I list this last not because I consider it a bad option -- I use them myself on the first day of my period to keep from waking up in the middle of the night in pain -- but because American society tends to believe that the optimum solution for anything medical is to pop a pill. Sometimes that really is the best option, but it's still good to keep in mind that there may be other ways to deal with the problem.
Our Experiences
I didn't use to get them. Once I went on the pill (age 22 or around there) I got them; when I went off the pill and was really irregular for a year, my cramps were irregular, too. Now I usually get them (only on the left side) the day before my period starts. They're my early warning system, this knot in my abdomen, so I know to be alert (i.e., don't wear pale colored slacks).
I rarely cramp at all, but when I do it usually lasts between a couple of hours and a day. One Midol usually deals with it.
I get them the first two days, immediately when I start. Usually if I can pop six Advils or so (yes, six) the SECOND I start bleeding I'm okay. Otherwise I feel like SHIT for two days. I don't think I get snarky beforehand or anything, but then with me, it's hard to tell. :-) I do know that I get no crampy symptoms prior to my period -- the only thing that happens is that my breasts swell just a tad and are a bit sore. But I literally get no cramps at all until I start, then it's two days of ick. Again, though -- usually popping a bunch of Advil helps that, and I figure that six Advils at one time isn't that bad. It's only once a month. I really resent the whole concept of getting cramps in a big way, so I don't like to put up with them, and if six Advil will do the trick, then so be it. :-) I figure that it's pointless pain -- usually pain means that something is drastically wrong with your body. This is a flavor of pain that means that everything is working, more or less, unless it's very severe, and as a result I feel VERY put out at having to put up with it.
I usually get paid back, though -- the last four days or so of my period are FANTASTIC! I feel great, I'm creative as hell, horny as anything (I'm talking find the nearest beautiful young thing and haul them into bed with no introduction at all), and just generally feel energetic and fantastic. It's always irked me that the only things I could ever talk about on surveys and stuff like that is the negative stuff -- the only questions you ever see on these surveys are "How depressed do you get," "How bitchy do you get," "How uncomfortable do you get?" Never how horny do you get, how energetic do you get, how much of a good mood does it put you into. It's like good side effects of getting your period don't exist.
Now all in all, it IS a pain in the butt most times, but those four days are worth the first two. I have cramps on the first day, but masturbation makes them manageable and a Tylenol or such takes care of the rest. On the second day I might have a light ache, but I only notice if I'm paying attention.
Bloodcatchers and Other Practical Matters
There's a lot more to bloodcatchers than pads or tampons! We have plenty of options out there, each with its own advantages and disadvantages.
Note: The companies and sites that I've linked to are ones that I found on the Web; I don't have personal experience with them.
Pads
Pads are flat pieces of absorbent material, usually with a plastic lining underneath to prevent leakage. They're also known as "sanitary napkins" or "sanitary pads", rather silly terms in my opinion; a store-bought pad is no more or less sanitary than a homemade one (see below). There are many brands of pads (at least on the U.S. market), so you can try different varieties and see what suits you, or use different brands on different days of your period.
Most storebought pads have adhesive strips on the back so you can attach them to your underpants. There used to be pads that you fastened into a belt that you wore around your waist, but I'm not sure whether those are still made. [I've since been told that they are; see the comments section at the bottom of the page.] The storebought pads are usually disposable; when you take them out, wrap them in toilet paper if you want and put them in the trash. DO NOT FLUSH PADS -- you'll clog the toilet. And PLEASE, if you're in a public restroom, don't leave them on the back of the seat. It's impolite anyway and particularly rude in this day of HIV fears.
Reusable Pads
You don't have to use disposable pads -- you can buy or make reusable ones.
Pads can be sewn from muslin or flannel; you can fill them with absorbent material or just use several layers of fabric. You can make a belt to wear them, or you can sew Velcro fasteners to the pad and to a special pair of underwear, or you can use safety pins; some people find that they don't even need fasteners, depending on the pad fabric and underwear fabric.
When you change them, if you're concerned about stains you can soak them in cold water immediately; if you aren't worried about it, you can just wash it later. You'll also want to carry a plastic bag that you can put the used pads in until you get home and can toss them in the wash.
Advantages to pads:
- Since they don't go in the body, the shape and size of your vagina doesn't matter. Pads can be used by women of any age; they're a common choice for girls who have just begun menstruation.
- You have no risk of toxic shock syndrome.
Disadvantages to pads.
- Since they're outside your body, the blood can get in contact with air, and a pad left on for a long time may develop an odor. This isn't necessarily a problem -- our society is far too finicky about natural body odors -- but if you're concerned about odor, make sure you change your pad at least every three to four hours.
- Leakage. Many of us report that pads leak at night or off the sides, though one of us has a solution to this (see our experiences for more information).
- Pads are outside your body -- which means that you can't wear them when swimming, and they can be visible under very tight clothing. How much of a disadvantage this is, if at all, depends on your activities and your attitudes. If you never go near a swimming pool, you never wear tight pants or leotards, or you don't care if someone can tell you're menstruating, this won't be a problem. And keep in mind that 99% of your activities can still be done while wearing a pad.
- Disposable pads may present something of an ecological problem; you can go through several thousand pads in your lifetime, and all those pads have to be manufactured and then added to our landfills. Of course, you can avoid this by using cloth pads that you wash and reuse, but then you have to factor in the cost and energy of the washing. A lot of the discussion in the cloth-vs-disposable diaper debate applies here as well (wonderful comparison, eh?).
- Some women are concerned about hazards from the chemical used to bleach many disposable pads. A few companies do make unbleached menstrual pads, disposable or reusable.
- Some women find that pads chafe their inner thighs. This can sometimes be helped by switching brands or changing to another type of pad.
Pad Links
Tampons
Tampons are pieces of absorbent material inserted into the vagina to soak up the blood flow. They have strings for removal, and most brands have cardboard or plastic applicators for insertion. As with pads, there are several different brands of them, with varying absorbencies for different phases of your period.
Advantages to tampons:
- When you properly insert a tampon, you don't feel it.
- As they're worn internally, you can swim while wearing a tampon.
- If you're concerned about odor, tampons do tend to be less smelly than pads, since they're internal.
- Tampons can't be seen through tight clothing.
Disadvantages to tampons:
- Tampon use increases your risk of Toxic Shock Syndrome, an illness whose exact causes are still unknown. To reduce your risk, use only the absorbency of tampon you need, and change tampons regularly.
- When the string on a tampon gets wet, it can act as a wick to carry bacteria into your vagina, leading to possible infections. Try not to urinate on the tampon string, and be especially careful when you have a bowel movement.
- Because tampons should be changed every 3 or 4 hours, most sources recommend that you not wear them at night.
- As with pads, some people are concerned that the dioxins produced by chlorine-bleaching the cotton will cause health problems, and in fact may cause greater problems than with chlorine-bleached pads because the tampons are worn internally; some also think that synthetic materials in tampons or any pesticides used in growing the cotton can cause problems as well. If you're concerned about this, you can use tampons made from unbleached organic cotton, or you can switch to another kind of bloodcatcher. (We know of no health concerns with the cotton itself, but we don't know of any studies on this topic either.)
- Not all women can use tampons. If you can't insert a tampon without pain, then don't force yourself to use it! Pads do a perfectly good job.
Tampon Links
- NatracareChlorine-free cotton tampons and pads; some advocacy information.
- EcoYarn Co An Australian company manufacturing 100% organic cotton tampons. (Note: As of September 1998, some of the links on their page work oddly. If the link in one part of the page doesn't work, try the one in the bottom bar.)
- terra femme Chlorine-free cotton tampons; advocacy for safer menstrual products.
- S.P.O.T. An advocacy page for safer menstrual products; their article archive is quite interesting.
Sponges
You can use natural sea sponges for reusable, effective tampons. Find a natural sea sponge that is about the size of your fist (don't worry, you are not going to use the whole thing!). Boil it in water first before you use it.
Now cut it up into several pieces. Cut them to about the length of your favorite tampon and about twice the diameter. You might need to experiment a bit, so don't cut your main piece all up at once. You will want two or three pieces to work with. You should change them as often as you would regular tampons. If they should leak before that, then you need to cut your pieces a little larger. Take the used sponge and rinse it out in the sink and put it in a little container of hydrogen peroxide. The hydrogen peroxide disinfects and cleans out all the blood quite easily. When you are out in public places, just carry a few empty film canisters to pop the used sponge in to deal with later (if possible, rinse out before putting in the cannister, but if you can't it will hold for a few hours). After your period, boil the sponges, let them dry thoroughly, and store them until next time. Advantages to sponges:
- All the advantages to tampons apply here as well. You can wear sponges while swimming, they don't show, odor isn't a major problem.
- Since they do not have a wick, you do not risk infection like you can with most commercial tampons.
Disadvantages to sponges:
- In using this method, you must be very comfortable with touching your genitals and with getting blood all over your fingers. While it can be a very effective way of collecting your menstrual flow, it's a little messy changing them.
- Because the sponges don't have a wick, you may have to probe a bit to find it or to get a good grip on it for removal.
- Some women may find it embarrassing or impractical to rinse a bloody sponge in a public or office restroom.
- If you have trouble physically inserting a tampon, you might have some trouble with the sponge as well.
The Keeper
The Keeper is a rubber cup that you insert in your vagina to catch the blood. It comes in two sizes, one for women who've given birth vaginally and one for women who haven't. It's reusable; you simply empty it out and reinsert it. At the end of your period, you wash it with mild soap and water, then put it away until your next period.
Advantages of the Keeper:
- It's completely reusable, and it doesn't take a great deal of water to clean it.
- Since the Keeper is worn internally, it has the same advantages that go with other interally-worn menstrual products.
- The Keeper catches the blood rather than absorbing it, and it doesn't soak up the natural lubricants produced by the vaginal walls, which means that you can leave it in for long periods of time without worrying about Toxic Shock Syndrome. In fact, you can wear the Keeper overnight.
- If you've inserted it properly, it won't leak. (And unless you have really heavy flow, it's unlikely that the cup will overflow.)
Disadvantages of the Keeper:
- Removing it may take a little getting used to; you'll sometimes get blood on your fingers, so it might be wise to get some toilet paper first. (The removal is definitely messier than wearing it!)
- The product web page says that it's gum rubber rather than latex, so it shouldn't bother people with latex sensitivity, but I'd still suggest caution if you have some kind of rubber allergy. (On the other hand, it's got a three-month guarantee, so if you do have problems, you can return it.)
- The first couple times you use it, the rubber tab at the end may be a bit irritating. Trimming it to the appropriate length helps, and from my experience you get used to it pretty quickly.
- If you're uncomfortable with inserting your fingers into your vagina, or if you have trouble inserting tampons, then this definitely isn't the bloodcatcher for you. Also, you may not want to use it if you're in some situation where you can't wash your hands afterward.
Keeper Links
Instead
A disposable cup worn inside the vagina; when you take it out, you just toss it.
Advantages of Instead:
- Again, it's worn internally, so it has the standard pros of other internal bloodcatchers.
- Unlike most menstrual products, you can wear it while you're having sex.
Disadvantages:
- Since it's disposable, you have the same environmental issues as with other disposable menstrual products.
- It apparently comes in only one size; some women might have trouble getting it to fit properly.
- As far as I know, it's made with synthetic materials; if you're concerned about using menstrual products made from synthetic materials, you might want to pass on this one.
Instead Links
http://www.instead.com/ used to be the main link for their page, but when I last checked it out, it was defunct. If you know another link, please yell.
Dealing with Bloodstains
No matter what form of bloodcatcher you use, you'll have to deal with bloodstains -- something will leak, or you'll get your period unexpectedly, or whatever. If you get a stain on something, wash the item as soon as possible in cold water (hot water will cause the stain to set). My own experience is that an enzyme detergent like Era does a pretty good job, but YMMV.
Or you can take the avoidance route. Some women have specific pairs of old underwear that they wear around or during their periods -- if they leak into that, big deal! My own favorite way to avoid bloodstains is to wear black underwear when I'm menstruating; the stains are invisible.
What We Use
I swear by the Keeper. I've been using it for over a year, and I love it. It doesn't leak, it's comfortable, and I'm not throwing anything away but my blood.
I use Always pads -- I hate tampons since I'm tighter'n a drum, and I have heard people who have gotten stuck in class or something with that feeling that you'd better change the thing NOW or else. With a pad, you've got more leeway time wise, and if you get stuck, it'll just get a bit soggy on you, you won't stain much. I use Always ONLY -- the ones with wings -- other pads are gross, slimy cotton blobs that move around and are basically disgusting after about ten minutes of wear. The Always ones keep their shape better and that special covering that they use on them really does work to keep it from being slimy. All other pads only pretend to be pads -- Always is the ONLY one anyone should ever buy.
I also nearly never stain (sometimes, but very rarely, usually when I'm sleeping). The secret to this is VERY simple -- do not use your standard panties when you wear one. The old cotton baggies or the nylon ones will slide all over and you are GUARANTEED to stain. What you want to use is a pair of control top panties about a half size too small -- the ones with the little tummy ocntrol panel in the front. I know it sounds weird -- I'm 125# and I actually do buy tummy control panties -- but they smash the pad against you and it doesn't MOVE. I'm not talking girdles, just a pair of VERY taut and sturdy polyester panties with a little tummy panel in the front. You can usually get them from Hanes catalogues or department stores in the regular underwear section. Get them a half size or so too small. That pad ain't gonna MOVE, and sometimes the extra support can feel nice when you feel sloshy down there.
Pads. I dislike tampons as a rule, though I've used them a couple of times when I wanted to swim during my period.
I used pads when I first started menstruating and had no problems except for the fact that they always leaked at night -- the blood would flow down between my buttocks and leak out from there. The old-fashioned version that you fastened to a belt on front and back actually worked better at night than the ones that adhere to your panties -- are those even MADE anymore?
Then I switched to tampons and never used pads again. I used Tampax tampons for about seven years, because I liked the flushable cardboard applicator.
And THEN someone on a mailing list I'm on told me about the Keeper. The idea of not throwing away anything other than my blood appealed to me, and I gave it a try. I love it. I've had mine for about two years, and it seems to be holding up well so far. I can leave it in as long as I want (within reason, of course!), rinse it out, and put it away until next month. The only place where I _wouldn't_ use it would be on a campout where the sanitation is dubious, like the big event I went to where the portapotties had excrement above the chemical line by the last day.
I use regular-absorption tampons at the beginning, and I even wear them overnight. (I admit that I did this before they started advertising Tampax Overnight on TV-- it was a chance I was willing to take because I was tired of leaking onto the sheets). Then later when the flow is lighter, I like Carefree Pantyliners-- they're really comfortable and decently effective too. Two of them side-by-side (overlapping down the middle) are as effective as a thicker pad, but much more comfortable).
Re: natural sponges: I personally found them very comfortable. They are softer and less rigid then commercial tampons, so they are easier to insert and once in, you cannot feel them. They also worked very well; I never leaked while using them.
In your report on "Bloodcatchers" the question is raised about the, once, traditional sanitary napkins and sanitary belts are still available. The answr is a definite yes although they are typically quite hard to find as most stores no longer carry them However, they are well worth looking for and, at least, trying. Relative to this, I definitely recommend the MODESS "Super" Feminine Napkins as they are far superior to the, suppossedly, more higly regarded KOTEX.
I tried Instead and thought I would write to you about my experience since you don't have one listed on your page. I actually found out about it through your site and then ordered the free sample (4 cups). I normally use the Keeper. I found Instead to be a little messier than the Keeper because it's harder to take out and put in. There's no "cup" to grab; rather you grab the upper ring. It didn't really leak on me except for once when it moved out of place somehow. I prefer the Keeper but would use Instead if I needed something disposable but long-lasting. So hopefully this opinion helps someone.
I got Instead just this last month. (price is good, btw) I had trouble understanding how to insert it at first, but they have an 800 number with RN's to help you with this if need be. I did call to ask some questions and I got it in correctly after that. I think the product is great. It allows much more freedom during this time of the month. It is not as big and scary as that Keeper thing, either. It worked great during sex and there was no mess at all. My fiance could not even feel the product and neither could I. The only problem I noticed is that when I remove it, it can be messy. Overall, it was a very good product.
Menstrual Extraction
Menstrual extraction:
- can be used to remove menstrual blood all at once in cases of inconveniently timed periods, and
- can be used to effect low-risk early abortions.
Menstrual extraction is a process by which menstrual blood is evacuated from the uterus by use of an airtight, hand-operated suction device. It can also be used in cases of very early low risk pregnancy, to perform abortions without anaesthesia and with lower risk of infection and complications than the standard dilation-curettage method. It is often an outpatient procedure, sometimes performed in the home by a trained medical professional. In cases of extraction abortion, most patients have stated that it is far more comfortable and less painful than a standard dilation-curettage procedure.
The most common device used to effect a menstrual extraction is called a Del-Em, and is constructed according to the following diagram:
The cannula is inserted into the uterus through the undilated cervix. The syringe, via a one-way valve, is used to create the suction necessary to evacuate the interior of the uterus, and the evacuated material collects in the collection container, often an airtight glass jar. Prior extraction devices did not employ a one-way valve or a collection jar between the cannula and syringe; this meant that the material extracted from the uterus at any one time could not exceed the volume of the syringe, and it also carried with it the risk of air entering the uterus, which can be fatal. With the introduction of the valve and collection jar, these limitations and risks were lessened dramatically.
In a small number of cases, a second extraction process will need to be performed if the abortion was not entirely effected the first time.
Via this procedure, menstrual blood can be removed from the uterus, thus eliminating an inconveniently timed period, useful in cases of honeymoons and athletic events. It can also be used to effect low-risk early abortions without anaesthetics and with a greatly decreased risk of infection. In both cases, the procedure must be performed by a trained medical professional, although the materials used to construct a Del-Em device are easily obtainable through a laboratory or chemistry scientific catalogue.
Toxic Shock Syndrome
Sounds scary. What is it?
Well. It's pretty closely related to tampons, so let me back up a bit.
A long time ago, in a galaxy right, right here - in 1936, actually - a Denver physician named Earle Haas invented a cardboard tube of compressed cotton with a little string inside. The very first tampon. For the next 40 years, tampons were sold in the United States with little or no federal or state health protective oversight.
In the 1970's Tampax ran up against some serious competition - they'd dominated the field until that time - but now Procter & Gamble, Playtex, Kimberly-Clark and Johnson & Johnson jumped into the market, each trying to carve their niche.
Perfumed tampons.
High absorbancy tampons.
I won't go so far as to say "tampons of every shape and color", but...
The upshot here is that manufacturers were doing their best to snag a significant market share, and to do it, they needed to top the competition.
And the marketing surveys all said "security". Women didn't want leakage. Didn't want accidents. Didn't want to wear the same black slacks every day of their period just in case.
The market of American women was ready for a super absorbent tampon. No muss, no fuss, no bother!
The first absorbancy breakthrough came in 1974, from Procter & Gamble, with a tampon based on polyester as opposed to cotton. The use of synthetics allowed (dare I say it?) "tampon engineers" to vary the shape and relative absorbancy of a tampon.
Keep in mind that at this time there were no federal guidelines for tampons, as to what was or was not safe for a woman to be inserting in her vagina.
In 1979, Procter & Gamble released a tampon line called Rely, a superabsorbant tampon composed of compressed beads of polyester and carboxymethyl cellulose, this composite cabable of absorbing nearly 20 times its own weight in fluids (yikes!).
This is more than most women actually had in their vaginas at a given time - so an internal surface normally mucus-coated could become dried out. If one of these tampons was left in the vagina long enough, removal would leave behind a residue of synthetic pieces, or tear cells off the vaginal wall. Especially if the tampon had widened to such a size that it became extremely difficult to remove. And for some women, "extremely difficult" meant their doctor had to help.
Ewwwww.
"From the moment superabsorbent tampons hit the market there were published accounts of vaginal ulcerations, lesions, and lacerations." (Laurie Garrett, The Coming Plague, Penguin, 1994).
An unrelated-to-tampon-research study noted that CMC (one of the components in the Rely tampon) was particularly good at filtering toxins made by the Staphylococcus bacteria.
In early 1980, the Centers for Disease Control were notified of a sudden surge in cases of Toxic Shock Syndrome in the state of Wisconsin. All but one of the cases were menstruating females.
Toxic Shock Syndrome: An S. aureus infection, - caused by a particularly virulant and penicillin resistant strain of the bacteria - secreting a poison into the bloodstream, causing fevers over 102 F, diffuse red rashes, death and shedding of skin cells, drop in blood pressure, vomiting, diarrhea, muscle aches, kidney dysfunction, liver failure, elevated blood clotting & platelet formation, mental confusion and loss of consciousness. Not necessarily all of those symptoms in every case.
Double ewwwww.
Between 1975 and 1980, 95 percent of women contracting TSS were menstruating at the time, and 100% of those were tampon users. A study of a segment of the cases of TSS victims versus a non-TSS tampon-using control group, 71% of the TSS victims used the Rely tampon. The CDC suggested that tampons provided a good environment for growth of the culprit organism, or facilitated infection by traumatizing the vaginal walls.
Subsequent studies showed slightly lower percentages (around 60% instead of 70%), but all showed high use of a superabsorbent tampon in TSS cases. Use where the tampon is left in place for not 1-3, but 6+ hours at a time.
And in 1983, when the Today contraceptive sponge was released to the market - a sponge designed to be worn for 24 hours - TSS cases rocketed.
Tampons now are a Class Three Medical Device, and absorbancy ratings are standardized.
The problem does not seem to be the type of tampon used, but the length of time you keep it or something else in your body. Saying to yourself "oh, they don't make that kind of tampon anymore, I'm perfectly safe" is dead-nuts wrong. It wasn't the type of tampon, it was the amount of time women were wearing these superabsorbent tampons during their menstrual period that caused TSS.
Different women are going to have different absorbancy needs. You may be one of those women who desperately needs to change the highest-absorbancy tampon on the market every 2 hours because your flow is so heavy.
Or you may not. Do NOT use a tampon of high absorbancy simply because it's available for sale -- "oh, it must be safe" -- and you think it's convenient to insert one in the morning and change it again before you go to bed. You could have a bacterial colony doubling inside you every 20 minutes for that entire time.
Sounds yummy, doesn't it?
So yes, change tampons regularly - don't wear one all night long - and use a low-absorbancy tampon or a pad on your light flow days.
If you're like me, you may want two different types of tampons, plus pads. One super-absorbancy tampon for the one or two heavy days, one regular-absorbancy for the other one or two days, pads at night and on the really light day, and pantiliners on the one day I think it's over and always get a surprise.
If you're going to be cheap - don't skimp on the low-absorbancy stuff, skip buying the higher-absorbancy product and change your tampons every 3 hours instead of 4 on your heavy days. Hey, I'm cheap, I buy just the lowest-absorbancy tampon and the pads.
TSS can kill you. It's not a joke.
Missed Periods
You'd expected to get your period early last week; now here it is Friday of the next week, and still no sign. Now what?
First, don't panic. (Or don't cheer, depending.) Pregnancy isn't the only cause of missed periods; almost every woman misses a period at some point in her menstruating life.
Of course, if you have engaged in genital-to-genital contact with a male partner, pregnancy is a possibility. If you're really worried about it, or you can't wait to find out so you can celebrate, or you think you'd have an abortion, I'd suggest that you go ahead and get a pregnancy test as soon as possible. Otherwise, it's probably fine to wait and see if you miss another period, but it's in the meantime you might want to treat yourself as if you're definitely pregnant (take folic acid supplements; eat more veggies and fruits; cut out recreational drugs, legal and otherwise; and so forth). See the links on the Pregnancy page.
Here are some other possibilities to consider:
- Have you only started menstruating in the last year or so? It's quite likely that your cycle will be irregular for the first year or two; missing a period during this time isn't unusual at all.
- On the other end, are you old enough to be starting menopause?
- Are you exercising heavily? Or are you on a severe diet? Women who lose a lot of body fat will often stop menstruating.
- Have you been under a lot of stress lately? Stress can definitely delay your period.
- Are you using Depo-Provera or Norplant? Both these birth control methods may have the side effect of stopping your periods -- see our contraception page for more information.
- Did you just get off the Pill? It can take six to eight weeks for you to start menstruating again.
- And of course, if you've just given birth, it can be several weeks to several months before you begin menstruation again, especially if you're breastfeeding.
If none of these possibilities seem to fit your situation, but you don't have any particular symptoms (abdominal pain, unusual vaginal discharge, low fever, or such), it's probably safe to wait and see. If you do have odd symptoms, or if you've missed two periods, we strongly suggest that you make an appointment with your medical practictioner.
And remember, the Virgin Mary and various incidents in Greek mythology aside, if you have had no contact whatsoever with a male or a sperm sample, then you're not pregnant. (And you're not the only one who's had that paranoid thought at some point!)
Our Experiences
I started my period when I was 10. Since then, I was 6 days late once due to stress and then again when I was pregnant.
I miss my period when I travel, and sometimes when I'm under other stress, but mostly it's just travel. Ever since I entered menarche it's been that way. On the one hand it's kind of neat, on the other hand occassionally I'm relaxed enough (or whatever) so that my period will arrive when I'm out of town, so I still have to plan for it. On the last hand, as I'm getting older (exit puberty, enter real life) and am sexually active, I a) am more relaxed and likely to stay regular even under stress, and b) am more worried that the lack of period could indicate pregnancy.
There's only been once that the condom broke and we bit nails for three weeks -- of course, I figured that I was so stressed my period wouldn't come! Came through like a trooper, though.
I missed a period when I'd just gotten off the Pill, and I've had a couple times when it was several days late due to stress. Once my period came the day after I went to a clinic and got a pregnancy test (which did come back negative).
Never have. My schedule has altered a few times, but I've been mostly like clockwork since the beginning. And since I'm not sexually active at the moment, missed period don't mean jack.
Menopause
- Haven't been through it? I haven't. Want to know more about it? Me too.
Standard Disclaimer
Our goal is to spread information, you may find links here with conflicting opinions. We are not medical professionals. If you are in menopause or think you may be entering menopause, see your doctor regularly and don't be afraid to ask questions.
Menopause and Hot Flashes
What's a Hot Flash?
Fevers and hot flashes both are thought to originate in the hypothalamus (a part of the brain). A fever is generally brought on by the release of bacterial toxins in the body. White blood cells sense the presence of these toxins and release a substance called interleukin-1, which is a pyrogen...meaning it causes fever. IL-1 raises the set point temperature in the hypothalamus (just like turning up the thermostat in your house) and your body responds by shivering (getting "the chills") to produce more heat. This is a defensive reponse -- bacteria can't grow optimally when it's hotter than they're used to.
Hot flashes (aka vasomotor instability) are also thought to be controlled by a hypothalamic mechanism, but the specifics are not as clear. The rate of "estrogen withdrawal" (as if women were all estrogen addicts...) is thought to play a role, as are the higher levels of luteinizing hormone and gonadotropin releasing hormone, which both regulate estrogen release and are markedly increased as menopause ensues. Since exercising, emotional upset and alcohol can precipitate a hot flash, catecholamines are also thought to be involved. The exact causes of hot flashes have yet to be elucidated...maybe because research grants mostly go to people who do not suffer from them. Women born without ovaries and girls who lose their ovaries before puberty never get hot flashes...but if these women are given exogenous estrogen for over 1 yr. and the estrogen is quickly stopped, they will experience hot flashes (aka "power surges") So, hot flashes do involve a change in the hypothalamic set point, and can increase skin temperature by 2.5 degrees C. 10-35% of menopausal women are bothered by severe hot flashes, which usually persist for 2-3 years but can last for 6 or more years.
How to tell the difference? Hot flashes tend to come in bursts and last seconds to minutes before subsiding, and may be brought on by stimuli such as eating, exercise, or lying under a blanket. Fever caused by infection, on the other hand, would tend to give you a more constant elevation in temperature (for the duration of the illness anyway), and you'd probably also have other symptoms of that infection (sore throat, muscle aches, etc.) If you had both a fever and a hot flash at the same time, it'd be hard to sort them out!
You're not in Menopause but feel Overheated during your Period
Estrogen levels do drop off during your period. A possible explanation for this is that your estrogen levels maybe fluctuating more widely [than normally]or decreasing more rapidly [than normally].
Menopause Brought on by Chemotherapy
As I understand it, menopause can be brought on by chemotherapy because ovarian cells (like cancer cells, and the cells lining the GI tract) are especially vulnerable to those drugs, and when ovarian cells die, the entire ovary is less effective at producing enough estrogen/progesterone to keep your cycle going. I would assume that the symptoms are the same as in natural menopause - hot flashes, vaginal mucosal atrophy (which, incidentally, is less prominent in sexually active women, including masturbation as a sexual activity -- so the saying "use it or lose it" applies here!), sleep disturbance, and increased risk of heart disease and osteoporosis. Unfortunately, the damage to the ovary from chemotherapy (and radiation therapy, as well) is usually irreversible.
Finally, in my female pathophysiology class last year, menopause was referred to as "the climacteric", a word which implies to me that a woman's life simply goes downhill after what was referred to as "ovarian failure". I'd much rather think of menopause in the manner in which it was addressed in one of my undergraduate women's studies classes: "Menopause: the pause that refreshes".
Estrogen May Reduce Risk of Osteoarthritis
According to a study released by the American Medical Association, older women who take estrogen may have a lower risk of the cartilage disease osteoarthritis, the leading cause for hip replacement surgery in the U.S. Doctors at the University of California - San Francisco said, "Women who were current users of oral estrogens had a 38 percent lower risk of osteoarthritis of the hip." Dr. Michael C. Nevitt said that estrogen would likely have the same effect on osteoarthritis of the knee.
The report concluded that estrogen replacement therapy may "protect against the development or progression of the disease" and that the hormone itself might slow changes in the bone beneath the cartilage. The production of estrogen wanes as a woman approaches menopause, and women in the study who had been taking the hormone for over 10 years showed a somewhat greater benefit than others. Researchers believe estrogen may block the production of enzymes that break down cartilage. Affecting more than 16 million Americans including virtually everyone over the age of 75, osteoarthritis is the most common form of arthritis in the U.S..
The findings, published in the Archives of Internal Medicine, were based on a study of 4,388 white women over 65 from four areas around the U.S. Because black women typically have a low incidence of hip fractures, researchers excluded them from the study.
The Menopause Time Of Life
(posted by Hopkins Technology)
WHAT IS MENOPAUSE?
Menopause or "change of life" is the time in a woman's life when menstruation stops and the body no longer produces the monthly ovum or egg from which a baby could be formed. It usually occurs at about age 50, although it can occur as early as 45 or as late as 55. Menopause is usually considered finished when a woman has not menstruated for a year. Completion of menopause marks the end of the childbearing years.
Menopause is natural and takes place smoothly for most women. It is part of a gradual process sometimes called the climacteric, which begins about 5 years before menopause and may last about 10 years. During the climacteric a woman's body produces decreasing amounts of the hormones estrogen and progesterone. This reduction in hormone production causes menstrual periods to stop.
Many women welcome menopause - no more periods, and after at least a year without a period to be sure it's safe, no more worry about pregnancy.
Surgical Menopause
Surgical procedures involving the ovaries (see diagram) and the uterus can affect how menopause takes place. When the uterus is removed (called a hysterectomy) and the ovaries remain, menstrual periods stop; meanwhile, other aspects of menopause occur in the same way and at the same age that they would occur naturally. When only one ovary is removed, menopause occurs normally. With the removal of both ovaries, complete menopause takes place abruptly, sometimes with intense effects.
THE REPRODUCTIVE CYCLE AND MENOPAUSE
During puberty increasing amounts of the female hormones estrogen and progesterone stimulate the reproductive system to mature and menstruation to begin. For more than 30 years of a woman's life (except during pregnancy) a monthly cycle takes place. The pituitary gland, located at the base of the brain, produces hormones that stimulate the ovary to release a new ovum or egg cell each month. The ovum produces the hormones estrogen and progesterone which cause the lining of the uterus to become thicker in order to receive and nourish a fertilized egg which could develop into a baby. If fertilization does not occur, estrogen and progesterone levels drop; the lining of the uterus breaks down, and menstruation occurs. Then the whole process begins again.
After age 35 estrogen and progesterone levels begin a very gradual decline. In the late forties this process accelerates and hormone levels eventually decrease so that the menstrual cycle becomes irregular or stops.
Following menopause the ovaries still produce some estrogen; other tissues and organs also produce hormones which are converted to estrogen.
What Are Signs of Menopause?
The only sign of menopause for many women is the end of menstrual periods. They may stop suddenly or become irregular, with a lighter or heavier flow and with longer intervals between periods, until they eventually stop. About 80 percent of women experience mild or no signs of menopause; the other 20 percent report symptoms severe enough to seek medical attention.
Two other signs associated with menopause are hot flashes (which are often accompanied by sweating) and vaginal dryness. The fatigue, heart palpitations, or depression reported by some women during this time may be symptoms of menopause in some cases, but there is wide disagreement about this.
Hot Flashes
Hot flashes, or hot flushes, are one of the more common and earliest sign of menopause, sometimes beginning several years before other signs. They give a sudden feeling of warmth throughout the upper body or over all of the body. The face may become flushed, with red areas appearing on the chest, back, shoulders, and upper arms. This is often followed by perspiration and a cold clammy sensation as the body temperature readjusts. The process may last anywhere from a few seconds to a half-hour or more.
Hot flashes may occur several times a day or only once a week. The sensations vary from woman to woman and from one episode to another. In most cases hot flashes are not severe and usually disappear after a few months, although in some women they can continue for several years. Sometimes hot flashes disturb sleep at night and may cause heavy perspiration.
Vaginal and Urinary Tract Changes
With age the walls of the vagina become thinner, less elastic, and drier. The vagina is then more vulnerable to infection. Also, these changes sometimes result in uncomfortable or painful sexual intercourse, although continuing regular sexual activity will reduce the possibility of problems developing. (Also see section on sexuality and menopause.)
As body tissues change with age some women experience urinary stress incontinence, which is the loss of a small quantity of urine when exercising, coughing, laughing, or performing other movements that put pressure on the bladder. As well as age changes, lack of physical exercise may also contribute to the condition. While incontinence can be embarrassing, it is common and treatable - for example, certain exercises can strengthen the affected muscles or sometimes surgery is performed to cure it.
Some women are prone to urinary tract infections. These tend to recur but are easily treated with antibiotics or other measures. Preventive techniques include urinating after intercourse, not keeping the bladder over-full for long periods, drinking adequate amounts of fluids, and keeping the genital area very clean. It is important to see a doctor as soon as any symptoms appear, such as painful or frequent urination.
Osteoporosis
"Postmenopausal" osteoporosis is closely associated with menopause since it is caused in part by the decrease in estrogen that occurs with menopause. It is a major cause of bone fractures in older women. In women with this condition bone mass slowly decreases over the years to produce thinner, more porous bone. Osteoporotic bone is weaker than normal bone and fractures more easily. Common sites for fractures are the spine, wrists and forearms, and hips.
Osteoporosis is sometimes called the "silent disease" because there are no symptoms during the early stages. Too often the condition is not recognized until it reaches an advanced stage when fractures are most likely to occur.
Once bone is lost it cannot be replaced, so an early prediction of which individuals are at high risk or have already developed mild osteoporosis is important. Unfortunately, accurate and inexpensive medical tests are not yet widely accessible. The most accurate tests - single and dual photon absorptiometry and the computerized axial tomogram or CT scan - are expensive and usually available only at major medical and research centers.
Who is most likely to develop osteoporosis? In everyone the risk increases with age, but it is highest in white women after menopause - particularly in individuals who have an early or surgical menopause. Other people at high risk include those with fair skin (especially blonds and redheads), those whose diets are low in calcium, and those who are physically inactive, under-weight, or smoke cigarettes. Women with a close relative (mother or sister) with the disease are also at high risk.
Lifelong habits may be the best way to prevent osteoporosis. By practicing simple health measures young women can prevent bone loss and older women who have already developed osteoporosis can slow down further bone loss. These measures include eating foods high in calcium, going outdoors for a short time every day (exposure to sunlight helps the body manufacture the vitamin D necessary for calcium absorption), and exercising regularly in activities that place stress on the weight-bearing bones (such as walking, jogging, or aerobics). Also, for women most likely to develop osteoporosis, some doctors recommend the use of estrogen replacement therapy (see next section).
WHEN DOES MENOPAUSE NEED TREATMENT? WHAT TREATMENTS ARE AVAILABLE?
Menopause is a natural part of aging and does not necessarily require treatment. But if you experience great discomfort at this time, consult your physician.
For severe symptoms of menopause (hot flashes, vaginal changes) and to prevent osteoporosis, many doctors prescribe estrogen replacement therapy (ERT), a synthetic estrogen which supplements the decreasing amounts of estrogen produced by the body. Estrogen in pill form is most often used for the prevention of osteoporosis, topically applied estrogen creams are used for severe vaginal symptoms.
Estrogen can be highly effective but it must be used with care. One reason for this caution is that roughly 10 percent of women who use estrogen experience side effects such as headaches, nausea, vaginal discharge, fluid retention, swollen breasts, and weight gain.
Second, some early studies suggested that breast cancer and heart disease are associated with estrogen use. Current evidence* indicates that no relation exists between breast cancer and ERT. Studies on heart disease however show contradictory results; for example, researchers at the Harvard Medical School recently found that estrogen may possibly reduce heart disease, while reports from the Framingham Heart Study stated that heart attack and stroke tend to occur more frequently among persons using estrogen.
Third, cancer of the endometrium (lining of the uterus) has been found to occur more frequently in women who use ERT containing estrogen as the only ingredient, compared with untreated women. However, today's ERT usually combines estrogen and progestin (another female hormone), and this combination appears to reduce the risk of endometrial cancer. But even with this improved form of estrogen therapy, experts do not yet know if its long-term use is completely safe. This is why ERT is recommended primarily for women who are at greatest risk of developing osteoporosis (see section on osteoporosis).
Who should NOT use ERT? Some women are not good candidates since estrogen can worsen certain conditions or increase the risk of complications. Persons who should avoid ERT are those who have had (or now have) heart disease, endometrial or breast cancer, stroke, migraine headaches, high blood pressure, blood clots, or other disorders related to the circulatory system.
Other conditions warrant that ERT be used with extra caution. These include exposure at birth to diethylstilbestrol (DES), obesity, a history of cancer in the family, vaginal bleeding, liver or gallbladder disease, and diabetes.
If you are at high risk of developing osteoporosis or have severe symptoms accompanying menopause, discuss the use of ERT with your doctor. To help ensure that ERT is safe for you, he or she should perform a thorough medical history and examination before prescribing treatment. Then, as treatment proceeds, continue to see your physician for frequent follow-up examinations.
Stay informed. Research is being conducted at many universities and medical centers, and this research periodically results in new information that may bear on your treatment.
Other Treatments for Menopause
Several drugs are available to reduce hot flashes or to relieve other menopausal symptoms for women who cannot use ERT.
Some women report that certain vitamins are successful in reducing hot flashes or stress, although no scientific evidence supports these claims. (The safe use of vitamin and mineral supplements requires the advice of a health professional; see section on nutrition.)
Doctors sometimes prescribe tranquilizers for women who are particularly tense, irritable, or nervous, but they are not recommended for symptoms specifically related to menopause. Tranquilizers are like other drugs: they can have side effects and should be used with care. Before turning to medication to reduce stress, many people first try exercise, an improved diet, or relaxation techniques.
MENTAL HEALTH AND MENOPAUSE
Most women have a healthy outlook throughout the menopause process and afterward feel "in their prime," glad to no longer be menstruating.
Mood changes may occur during menopause. Other symptoms commonly reported are fatigue, nervousness, excess sweating, breathlessness, headaches, sleeplessness, joint pain, depression, irritability, and impatience. These symptoms may be due in part to shifting hormonal balances or other factors such as heredity, general health, nutrition, medications, exercise, life events, and attitude. More research is needed on the role hormones play an how they interact with these other factors.
There is no specific mental disorder associated with menopause, and research shows that women experience no more depression during these years than at other times during life. Tension or depression can occur at any stage, but when these states occur during menopause, there is a tendency to blame the menopause process. Thus women with emotional problems are on occasion tagged "menopausal," sometimes long after menopause has taken place.
Important life changes often coincide with the menopause years: perhaps grown children are leaving home, aged parents need more attention and assistance, or a woman's life is taking on new directions. This is a time when many women think about growing older and the changes it will bring.
Developing positive attitudes toward menopause and aging is an important part of adjusting to life changes. As long as menopause is regarded as simply a normal life change and a woman goes on to participate in satisfying activities, coping with the transitions and body changes becomes easier. But viewing menopause as the end of a useful life only makes the transition difficult - so that if a crisis develops, such as a divorce or the need to care for parents who are ill, menopause is likely to seem an added burden.
Supportive friends and satisfying activities help ease any transition or crisis. Emotional support can come from a variety of sources: a friend, your husband, or relatives. Various types of support groups exist which can provide opportunities for you to talk with other people who are going through similar experiences. When coping is difficult, it may be useful to consult a gynecologist or seek the services of a social worker, psychologist, psychiatrist, or other mental health professional.
SEXUALITY AND MENOPAUSE
An active and fulfilling sex life can continue throughout menopause. While some physical responses slow with age, the capacity and need for sexual expression continues into old age. Some women report that sex is even more enjoyable after menopause, possibly because pregnancy is no longer a concern and there is more time and privacy when children are gone from home.
Although many women report no change in their sexual feelings or performance during and after menopause, certain physical changes occasionally cause sexual problems for some women. As the body produces less estrogen, for example, the walls of the vagina become smooth, drier, and less elastic. This may cause tiny sores on the vaginal wall, a burning or itching sensation, and intercourse may be uncomfortable. These physical changes can be treated successfully through a number of methods including vaginal lubricants and estrogen creams. Whether or not estrogen is used however depends on the nature of the problem and on whether the individual can tolerate estrogen.
Staying Healthy
Good health depends on many factors - heredity, diet, exercise, rest, and if one smokes or drinks alcohol. No one has the correct formula for a long and healthy life, but there are measures you can take to enhance your chances of staying healthy.
Nutrition
Just about everyone agrees that a well-balanced, nutritious diet is important for good health, but we still have a lot to learn about what constitutes a good diet. Nutritional requirements vary from person to person and often change with age as many people become less active and are able to handle fewer calories. We do know that eating a wide variety of foods every day is essential since no single food supplies all the necessary nutrients.
Evidence shows that diet can increase the likelihood of developing certain types of cancer and heart disease, as well as other disorders. The following guidelines (issued by the National Research Council) offer suggestions to help reduce the risk of cancer and other diseases:
.Eat fewer foods containing saturated and unsaturated fat. Fat intake should be no more than 30 percent of daily calories.
.Eat fruits, vegetables, and whole-grain cereal products, especially those high in vitamin C and carotene (oranges, grapefruit, dark-green leafy vegetables, carrots, winter squash, tomatoes, cabbage, broccoli, cauliflower, and brussel sprouts).
.Eat very little salt-cured, salt-pickled, or smoked foods such as sausages, smoked fish and ham, bacon, bologna and hot dogs.
A balanced diet with adequate calcium (experts recommend 1,500 mg of calcium each day for women after menopause and 1,000 mg for younger women) can help avoid bone loss that occurs with age. Foods high in calcium include milk and other dairy products, sardines and salmon canned with bones, oysters, and dark-green leafy vegetables. Milk processed to be more digestible is available for those who have problems digesting milk; soy or acidophilus milk can also be used. In addition, calcium supplements (especially calcium carbonate) are frequently prescribed.
Getting enough vitamin D is also important since it is needed by the body to absorb calcium. The recommended daily allowance (RDA) for vitamin D is 400 units (International Units), and it is provided in foods such as fortified milk, egg yolk, liver, tuna, salmon, and cod liver oil. Vitamin D is also produced in the body after exposure to sunlight (only a short period of exposure each day is sufficient).
To further minimize bone loss, some doctors suggest that women eat less red meat and avoid certain carbonated soft drinks. These contain high levels of phosphorus (a mineral normally present in almost equal amounts in bone and teeth) and might contribute to a phosphorus-calcium imbalance which has been associated with osteoporosis.
Other health-promoting guidelines include avoiding excess coffee and tea, as well as foods high in sugar. Sugar contains empty calories that take the place of nutritious foods and adds excess weight. Too much sugar can also cause a vaginal discharge.
LOOKING AHEAD
No one has all the answers about menopause. Medical research is beginning to give us more information, but myths and negative attitudes remain deep-seated. Fortunately, more women are challenging stereotypes, gaining support from other women, learning about what takes place in their bodies, and taking more responsibility for their health.
More and more women are moving in positive new directions at mid-life and assuming new roles in society. It is common to find mid-life women in college classes, professional schools, and other types of educational programs. Women are training for and holding jobs in many areas once reserved for men.
There is wide disagreement concerning the use of vitamin supplements. Taking them without your doctor's instructions can be risky since large doses of some vitamins can have serious side effects. Vitamins A and D in large doses are particularly dangerous, and even large doses of vitamin C can cause problems. Vitamins depend on one another to be utilized in the body, so taking one without its counterparts may be useless.
The Hazards of Smoking
There are many good reasons for not smoking. Probably most important is that smoking greatly increases the possibility you will develop lung cancer - now the leading cause of death from cancer in women. Heavy smokers also tend to have an earlier menopause, which in turn has been linked to higher rates of cardiovascular disease and bone loss.
Physical Exercise
Many experts recommend physical exercise to maintain a healthy body. Exercise is especially important for bones and can help prevent osteoporosis. In addition, many women report that they are more relaxed and in a better mental state when they exercise regularly.
Consult your doctor before starting a rigorous exercise program. He or she can help you decide which types of exercises are best for you. Also an exercise program should be graduated: it should start slowly and build up to more strenuous activities.
Aging is a normal part of the life process, but it is common to sometimes fear growing older and to worry about the changes it will bring. The incidence of disease increases with age; still, most women remain relatively healthy and independent until late in life. Advertising and fashion stress youth and beauty, but in time most people discover that the finest aspects of human relationships are based on more enduring qualities which enable us to maintain loving relationships and satisfying work and leisure activities throughout all stages of life.
Postmenopausal Hormone Therapy and Mortality
From the New England Journal of Medicine...
Postmenopausal Hormone Therapy and Mortality
Abstract
Background. Postmenopausal hormone therapy has both benefits and hazards, including decreased risks of osteoporosis and cardiovascular disease and an increased risk of breast cancer.
Methods
We examined the relation between the use of postmenopausal hormones and mortality among participants in the Nurses' Health Study, who were 30 to 55 years of age at base line in 1976. Data were collected by biennial questionnaires beginning in 1976 and continuing through 1992. We documented 3637 deaths from 1976 to 1994. Each participant who died was matched with 10 controls alive at the time of her death. For each death, we defined the subject's hormone status according to the last biennial questionnaire before her death or before the diagnosis of the fatal disease; this reduced bias caused by the discontinuation of hormone use between the time of diagnosis of a potentially fatal disease and death.
Results.
After adjustment for confounding variables, current hormone users had a lower risk of death (relative risk, 0.63; 95 percent confidence interval, 0.56 to 0.70) than subjects who had never taken hormones; however, the apparent benefit decreased with long-term use (relative risk, 0.80; 0.67 to 0.96, after 10 or more years) because of an increase in mortality from breast cancer among long-term hormone users. Current hormone users with coronary risk factors (69 percent of the women) had the largest reduction in mortality (relative risk, 0.51; 95 percent confidence interval, 0.45 to 0.57), with substantially less benefit for those at low risk (13 percent of the women; relative risk, 0.89; 95 percent confidence interval, 0.62 to 1.28).
Conclusions
On average, mortality among women who use postmenopausal hormones is lower than among nonusers; however, the survival benefit diminishes with longer duration of use and is lower for women at low risk for coronary disease.
Postmenopausal Hormone-Replacement Therapy: Time for a Reappraisal?
From the New England Journal of Medicine...
Postmenopausal Hormone-Replacement Therapy: Time for a Reappraisal?
In this issue of the Journal, Grodstein and colleagues (1) present important data from a large study of the risks and benefits associated with postmenopausal hormone-replacement therapy. Like previous investigators, they found a significantly reduced risk of death from all causes among recent hormone users. This reduction in mortality is the consequence of a profound decrease in the risk of death from coronary heart disease and a somewhat smaller reduction in mortality from cancer, although this reduction was not evident for all types of cancer. The study showed that the reduction in mortality from cardiovascular disease and cancer was probably not due to patterns of selective prescribing of estrogens for women without these diseases or to the discontinuation of hormone therapy at the onset of the fatal disease. It is less clear that these issues of bias were addressed with respect to other causes of death. In addition, questions remain about the extent to which reduced mortality from cancer may reflect earlier disease detection among hormone users. Furthermore, since the study considered only exposures before the development of fatal diseases, it did not address the issue of hormone use after the diagnosis of disease, a particularly important issue with regard to cardiovascular disease.
One strength of this study is the assessment of mortality in relation to both how recently and for how long hormones were used. The protective effect of hormones was lost five years after the discontinuation of use, and extended exposure provided no additional benefit among current users. In fact, there was some attenuation of the protective effect with long duration of use, which was attributable primarily to a 43 percent increase in deaths from breast cancer among women who had used hormones for 10 or more years. However, the proportion of deaths due to breast cancer was higher in the study cohort than in the general population, possibly limiting the generalizability of the results.
Mortality from breast cancer was reduced overall in this latest study, a finding consistent with those of other studies, but the increased mortality among current users who had been taking hormones for 10 or more years is a matter of concern, particularly given that some studies have shown an increased incidence of breast cancer among long-term or current users. (2,3,4) A curious finding was that short-term users had a reduced risk of death from breast cancer, which more than offset the increased risk in long-term users. It is possible that the inconsistency in the results for short- and long-term users reflects the small number of deaths in each category. However, if the adverse effect of long-term hormone use on breast-cancer mortality is confirmed by additional research, this will argue against the notion that hormones predispose women to low-risk breast tumors, as suggested by studies showing better survival (5) and diagnosis of less advanced disease (3) in hormone users than in nonusers.
The study provides important data on the increasingly popular regimen of estrogens in conjunction with progestins, showing substantial reductions in overall mortality among users of the combined regimen as well as users of estrogens alone. These results indirectly address the concern aroused by experimental data that progestins may diminish the apparently cardioprotective effect of estrogen therapy. This issue was addressed more directly in a recent report from the Nurses' Health Study, (6) which showed a reduction in coronary heart disease among users of estrogens with progestins equal to or greater than that among users of estrogens alone. It would also be of interest for studies to assess mortality from breast cancer in relation to the use of estrogen combined with progestin, particularly because there is some concern, although based on limited (2,4) and inconsistent (7) epidemiologic data, that combined therapy may increase the incidence of breast cancer more than estrogen alone. As the number of deaths from endometrial cancer accrues in this cohort, it will also be important to assess the mortality from this disease, given evidence that the addition of progestins may not completely counteract the adverse effect of estrogens on the endometrium. (8)
Given that a white woman's cumulative absolute risk of death from the ages of 50 to 94 years has been estimated to be 31 percent from coronary heart disease, 2.8 percent from breast cancer, and 2.8 percent from hip fracture, (9) the benefits of estrogen use appear to far outweigh the risks. Notably, in this study long-term hormone users had a 20 percent reduction in mortality. However, for many women the benefits of hormone use may not compensate for the fear of acquiring breast cancer and living with its repercussions. Furthermore, in some women at low risk for cardiovascular disease but at high risk for breast cancer, the benefits of hormone therapy may not outweigh the risks. (10) Unfortunately, the issues of risks versus benefits do not easily lend themselves to simple formulas for calculating who should take estrogen and for how long. Decisions need to be personal ones and should involve detailed discussions between a woman and her physician. These discussions should consider individual risk profiles, (10) such as the one discussed in the article by Grodstein et al. However, a number of unresolved questions about individualized risks remain. Although the latest findings show the greatest reductions in hormone-associated mortality among women at high risk for coronary disease, previously published findings from this cohort showed hormone use to result in similar reductions in major coronary disease regardless of a woman's risk-factor profile. (6) The study addresses an important question by showing that hormone users with a family history of breast cancer are not at any greater risk of death than hormone users without such a history. However, in terms of making decisions about the risk of breast cancer, it might be more useful to evaluate breast-cancer mortality, specifically assessing hormone-related risks for women at high risk for breast cancer as compared with those at low risk and considering not only the factors mentioned but also others known to have a major impact on the risk of breast cancer (e.g., reproductive behavior and benign breast disease).
Given the findings that hormone use is associated with reduced mortality for multiple causes of death (11) and that there are marked lifestyle differences between hormone users and nonusers, (12) there continue to be lingering questions regarding the extent to which reductions in mortality are due to hormone use itself as opposed to the characteristics of the user. Some of the unresolved issues must await the results of ongoing intervention trials of menopausal hormones. However, since these trials may not continue long enough to accrue large numbers of patients in whom cancer develops, it will also be important to evaluate data from large observational studies. If the protective effect of long-term use continues to dissipate with time and adverse effects on breast-cancer mortality are confirmed, the optimal duration of hormone-replacement therapy will need to be reconsidered. That the beneficial effects of hormones are dependent on recent use raises questions about when to initiate use. It is encouraging that hormone use begun later in life offers bone-conserving benefits nearly equal to those conferred by use initiated earlier. (13) Furthermore, it is important, as Grodstein et al. and others have pointed out, that other means of reducing the incidence of cardiovascular diseases and osteoporosis have been identified. Physical activity is one such approach, (14) of interest in that it may also reduce the incidence of breast cancer. (15) Although further research is needed to clarify the relative benefits of various interventions as compared with hormone-replacement therapy, it may now be the time to question seriously whether hormone-replacement therapy should be prescribed for life or whether for some women, it should be more restricted in duration and combined with other effective disease-prevention techniques.
Note for Parents
A while back, I read an article in my local paper about a father who pulled his young children from the Catholic school they were attending because he objected to the school's teaching a sex education course. The father believed that children should be kept innocent about sex until they were old enough to need to know.
I don't particularly agree with his view, but I would have no problems with his action if the children were five or six. But the oldest child, a girl, was nine.
The AVERAGE age for girls to begin menstruation in the U.S. is now about 12, and it's no longer out of the ordinary for girls to begin at nine. And a girl who's old enough to menstruate is also old enough to become pregnant.
How you as parents handle teaching your children about sex and their reproductive systems is up to you, but I urge you to make sure your daughters (and for that matter, your sons) know the facts BEFORE they need to know. Menarche can be startling even to a girl who knows to expect it, let alone a girl who doesn't have any idea why she should be bleeding in "that place". And a girl who's old enough to menstruate is old enough to get pregnant. Do you want your daughter to learn about sexual intercourse from you -- or from her boyfriend?
How Our Parents Told Us
My mom was great -- she sent away to Kotex for a little kit with a sample of everything in it and a few pamphlets describing EXACTLY what would happen in great detail. I wish I still had those pamphlets, I'm a little sentimental towards them. They were relatively upbeat -- telling you that there were some myths out there and that having your period didn't mean a thing, and that you could swim and dance and do anything you wanted. It glossed over the cramps thing, which it could have stood to discuss in more detail, but I guess they wanted to not scare kids. When it came in the mail, she was great -- took it upstairs and told me what everthing was called, what she used, what she used when she first started, and everything. Those little kits are the best things ever -- I hope that Kotex or whoever does it now still makes them. They are just great for little girls.
I feel silly saying this, but I never actually asked my mom or dad about sex. When I was a kid, and even well into high school, I simply wasn't *interested* in it. The latest issue of "Astronomy" magazine was lots more interesting than parties and guys -- I really simply had NO interest in sex when I was a kid. And then, by the time I was old enough to start noticing guys I had already run into most of the information. So I never got the sex ed talk at all from my parents out of sheer disinterest. And GOD knows that until recently, I didn't even know that I was interested in women, so THAT was entirely blank for me. By the time I became interested, I had already learned most of it on my own. I do remember wondering how pregnancy happened, though -- I mean, I knew what went where, but I had no clue how long you had to leave it there -- did you just sort of put Tab A into Slot B and then wait around for something to come out or what? Ejaculation answered a lot of questions I had about just how the sperm got to where it was supposed to go.
I don't remember ever having had 'The Talk'. On the other hand, I am the youngest of four so I think I just picked it up from general talk around the house. I was very uninterested in the whole thing for a long time. Or perhaps I should say that I was never interested in the boys I knew. As for periods, my sisters and mother kept track of their periods on a calendar that was for public use so there was no mystery there. Add to that only having one bathroom and a kid learns the ins and outs of menstruation just from living. :-) We didn't have any books or pamphlets or anything around (though it would have been nice, I think). As a result, I probably didn't get into any of the specific details until jr. high health classes started filling them in. :-) I didn't feel at all cheated by it, either, though some of my friends were terribly embarrassed about not knowing.
As for telling my daughter, my two year old finds me changing my pads during my period fascinating. The first time she noticed (if you don't have children, here's a little commented on part of it - you *never* go to the bathroom alone if the little darling's awake :-) she was a touch concerned until I told her it was ok and that Momma wasn't hurt. I told her that this was something that happens every month after a girl grows up. Not totally accurate, but sufficient for a two-year old. I think that's where a lot of people go wrong. They don't consider what's age appropriate. It's perfectly fine for a young child (boy or girl) to see the pad/tampon and have Mom explain in a very calm, matter of fact voice that this is just a normal part of being a woman/girl. That doesn't mean that a two-year old is ready to hear what the entire process is and go through an anatomy lesson. Time enough for that when she's older and *wanting* that information. If you're willing to offer it and are open in other areas, she'll know and she'll *ask*. Trying to force the information down her throat before she's ready is almost as bad as keeping her ignorant.
At this age, the tone and attitude are probably more important than the actual words, at any rate. Children *know* when you're trying to pull the wool over their eyes. You can *not* fool them. If you feel embarrassed or dirty or guilty or any of a thousand other negative ways women sometimes feel about their periods, your children *will* pick that up.
I knew most of the details of pregnancy by time I was five or six, thanks to a book on pregnancy my parents had. But I never could figure out how the sperm got inside the mother in the first place.
When I was nine, my parents gave me this set of books called The Life Cycle Library, which as far as I know is still around in an updated edition. That's where I learned about menstruation ("oh, so that's what all this stuff about 'monthly periods' is in the Bible!) and intercourse ("aha, THAT'S how it works!), as well as birth control, more information on pregnancy, and assorted other topics.
They never really talked to me about sex themselves, though. I'm grateful that they gave me the information (they knew that if they gave me a book, I'd read it), since that's a lot more than many kids get, but I sometimes wish they'd talked to me about it.
Sex Education in Schools?
Regards sex ed -- teaching them how pregnancy occurs and how to avoid it is the most important thing, along with how to keep from getting sick. The rest of it, I can't say -- it seems like so much of it is connected to life experience, self-esteem, and so on, and I'm not sure how to teach that in school. The most important thing to teach a kid is how to keep from getting sick or pregnant, or getting someone else pregnant, and that having a kid is NOT having a toy doll that you get to buy cute stuff for. Once you're a parent, you're a parent until you're DEAD. Having a kid isn't trivial -- you are now majorly responsible for the formation of a human mind. This isn't a game, and you don't risk that for stupid reasons.
