. medical .

menstrual disorders

menstrual products & medical concerns

sex, menstruation & HIV



"In man, the shedding of blood is always associated with injury, disease, or death. Only the female half of humanity was seen to have the magical ability to bleed profusely and still rise phoenix-like each month from the gore." ~ Estelle R. Ramey, U.S. scientists, educator. "Men's Monthly Cycles (They Have Them Too, You Know)," in The First Ms. Reader (ed. by Francine Klagsbrun, 1972).

The process of menstruation is activated by the pituitary gland, which releases a hormone called the follicle-stimulating hormone (FSH) during the mid-point of a woman's cycle, which on average lasts about 28 days. The pituitary gland also triggers the release of estrogen and progesterone in complimentary amounts during the cycle. Upon the release of the FSH the ovaries prepare to release an egg. Each cycle, either the left or the right ovary produces an ovum which bursts from its sac, the graafian follicle, and travels to the uterus. When the egg is released a process known as ovulation begins. Ovulation is the path that the egg takes from the fallopian tube to the uterus. When the egg travels down the tube without encountering a sperm, estrogen ceases its work and progesterone takes over, stimulating the contraction of the uterus, which will then begin to extract the lining that the uterus has developed during the cycle, the endometrium, or female blood (Dealney, Luptin, & Toth 62).

The menstrual fluid, or female blood, that we extract each month actually consists of more than just blood. Real blood makes one half to three quarters of the fluid, but the remainder consists of mucous, fragments of uterine mucous membrane, and skin cell tissues from the vagina.

. menstrual disorders .

The following are descriptions of the most common menstrual disorders diagnosed in western cultures today. Woman should be aware of the definitions and symptoms associated with each disorder. By doing this they can protect themselves from false diagnoses and/or being diagnosed with a condition which is for them a normal condition or cycle of their own body. For we know that in seventeenth century England, physicians recognized the same pre-menstrual syndromes, as did the ancients, but did not regard them as diseases or disorders.

Amenorrhoea - Amenorrhoea refers to the absence of menstruation. For sexually active women in their reproductive years this condition is usually a clear signal of pregnancy. However, other causes are quite possible such as stress, rapid weight loss, regular strenuous exercise, poor diet, hormone imbalances and illness. In older non-pregnant women this condition may mean that menopause is approaching or has arrived.

Primary amenorrhoea is present when a young female has not yet begun to menstruate by the age of sixteen, due to developmental problems or hormonal imbalances (Gynecological Health Center (A), 1). Primary amenorrhoea is often treatable with hormones and/or surgery. Secondary amenorrhoea strikes a woman who previously had regular periods. It is defined as "an absence of menstruation for a length of time of at least three cycles" (Speroff, Glass, and Kase, 119). Most often a hormone imbalance is responsible for secondary amenorrhoea, which in this case would frequently entail a low level of gonadtropin-releasing hormone (GnRH). GnRH is needed to control the menstrual cycle and ovulation and it's levels can decrease for several reasons, such as excessive regular exercise, weight loss or weight gain, stress and discontinuation of the birth control pill. In addition factors such as breast-feeding, ovarian cysts, premature ovarian failure (early menopause), problems with the adrenal glands, thyroid conditions, tumors, and anorexia may effect the development of a hormone imbalance or amenorrhoea (Gynecological Health Center (A), 1) .

Your doctor can determine whether or not you are experiencing amenorrhoea through a pelvic exam, hormone level tests, testing the cervical mucus or the endometrium, as well as testing fluctuations in body temperature. There are various treatments available for women who are experiencing amenorrhoea. If the problem involves a failure to ovulate many women are treated successfully with birth control pills or progesterone and estrogen. If the amenorrhoea is caused by ovarian cysts many women are treated with medroxyprogesterone scetate or estrogen plus progesterone.

Dysmenorrhea - Dysmenorrhea is the medical term for painful periods or menstrual cramps, thus this is a widespread menstrual disorder. As with amenorrhoea, dysmenorrhea is categorized into both primary and secondary conditions. Both primary and secondary dysmenorrhea include the following symptoms: backache, diarrhea, dizziness, headache, nausea, vomiting, and tenseness (Gynecological Health Center (B), 1).

Primary dysmenorrhea usually affects females in their teens and early 20's, especially those who have never had a baby. The symptoms in this case, primary dysmenorrhea, are caused by a naturally occurring hormone which is produced by cells in the uterine lining called prostaglandin. At the start of menstruation, the cells that have begun to shed in the uterine lining release prostaglandin. Women who suffer from dysmenorrhea have higher level of prostaglandin in their menstrual fluid than those who do not. On the whole the symptoms of primary dysmenorrhea do not last very long, for on the average symptoms are experienced for one or two days (Gynecological Health Center (B), 1).

Secondary dysmenorrhea is caused by a particular physical condition and is usually experienced by women who are older than those who suffer from primary dysmenorrhea. Some conditions that are cause or spark the development of secondary dysmenorrhea are adenomyosis (when uterine tissue grown into the uterine wall), pelvic inflammatory disease, fibroids (growths in the uterus), endometrial polyps (growths in the uterine lining), endometriosis, the use of an IUD, and a narrowing of the cervix.

The treatments for primary dysmenorrhea include over the counter medications such as aspirin, ibuprofen, or naproxen as well the birth control pill because it stops ovulation and decreases prostaglandin levels (Gynecological Health Center (B), 1). Regular exercise is also thought to help minimize and eliminate symptoms associated with primary dysmenorrhea. Treatments for secondary dysmenorrhea are approached once the underlying cause is found, often they will be similar to treatments for primary dysmenorrhea, but sometimes they vary.

Endometriosis - The exact cause of endometriosis is unknown. However there are five important theories which suggest possible causes for endometriosis: the transtubal migration theory or retrograde menstruation theory, a genetic theory, a lymph/blood theory, the embryo theory, and dioxin exposure. First, the retrograde menstruation theory suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants itself in the abdomen and grows. Some researchers believe that all women experience a degree of menstrual fluid backing up into the fallopian tubes, but endometriosis arises when an immune system or hormonal problem also occurs, which allows this tissue to grow and develop into endometriosis (the Endometriosis Association, 1). Secondly, the genetic theory suggests that endometriosis may be carried in family genes or that some families may have predisposing factors to endometriosis . Thirdly, the lymph/blood theory proposes that endometrial tissue is disturbed from the uterus to other parts of the body through the lymph system or through the blood system (the Endometriosis Association, 1). Fourth, the embryo theory suggests that remnants of tissue from when the woman was an embryo may later develop into endometriosis, or that some of the adult tissues have the ability to transform reproductive tissue, causing endometriosis, as they had to do when they were simply embryonic tissues in order to develop. The fifth theory proposes that exposure to dioxins, which are toxic chemical byproducts of pesticide manufacturing, bleached pulp and paper products, and hazardous waste burning, causes endometriosis. A study done by the Endometriosis Association, which studied a colony of monkeys who had developed endometriosis after exposure to dioxins, revealed that 79% of the monkeys exposed to dioxins developed endometriosis, and those birds who were exposed for longer periods of time developed more severe cases of endometriosis (the Endometriosis Association (A), 1).

Though there is no cure for endometriosis, several treatment options exist, including pain medication, hormonal therapy, surgery, and other various alternative therapies. In terms of pain medication, one may take over the counter drugs such as aspirin, Tylenol, ibuprofen, naproxen sodium, and tolfenamic acid to reduce discomfort. Hormonal treatments, such as oral contraceptives, progesterone drugs, and testosterone derivatives, are also used with the aim of stopping ovulation for as long as possible. Surgical options include both conservative and radical options, depending on what is needed. Conservative surgery would seek to remove or destroy growths and relieve pain, while in some cases still allowing pregnancy to occur. These surgeries can either involve a laparoscopy, which is a minor procedure which involves a tiny abdominal incision, or a laparotomy, which is a more extensive procedure requiring a full incision. Radical surgeries, involves hysterectomies, removal of all growths, and removal of the ovaries. Other treatments for endometriosis may include alternative types of medicine, such as Chinese medicine, nutritional changes in diet, allergy management, and immune therapy (the Endometriosis Association (B), 1).

Menorrhagia - Menorrhagia refers to a condition in which a woman experiences excessive menstrual flow. This condition may entail a particularly heavy blood flow or and extended period of bleeding, or both. Many consider a woman to be suffering from menorrhagia when she soaks through at least one pad per hour for several consecutive hours. The abnormal uterine bleeding, known as menorrhagia, may be caused by medical problems or hormone imbalances (Gynecological Health Center (C), 1).

Menorrhagia is common in women who are in the first few years of their menstruation or those who are approaching menopause because of likely imbalances between estrogen and progesterone, which regulate the buildup of the endometrium. As a result of an imbalance between these two hormones, the endometrium does not stop building itself up, so when it is eventually shed there is extensive and heavy bleeding. Menorrhagia is also common in women who have uterine fibroids (growths), which along with those women who have hormone imbalances, account for 80% of the menorrhagia cases. Other causes include endometrial cancer, infections in the vagina, cervix or pelvic organs, as well as thyroid conditions and liver, kidney and blood diseases (Gynecological Health Center (C), 1).

Those women who are young or experiencing the onset of menstruation and are experiencing menorrhagia because of hormonal imbalances can easily be treated with hormone therapies. If a woman is suffering from menorrhagia because of an underlying medical condition, that treatment should be treated, and will usually also take care of the menorrhagia (Gynecological Health Center (C), 2).


Premenstrual Syndrome - Premenstrual syndrome, PMS, which is also called late-luteal-phase dysphoric disorder or premenstrual dysphoric disorder, affects a very large percentage of women around the world. Researchers suspect premenstrual syndrome to be a neuro-endocrinopathy, which means it is a hormone disorder that appears in the brain (Berke, Blumer, and Zack, 1). Because it is widely defined in American culture the range of symptoms vary greatly and many women find themselves being diagnosed with PMS, which has both negative and positive implications. The symptoms include but are not limited to breast tenderness, irritability, lethargy, acne, compulsive eating, joint pain, poor conception, paranoia, bowel disorders, headaches, sinus problems, weight gain, depression, anxiety, mood swings, and bloating. Because these symptoms may seem unrelated, PMS is difficult to diagnose, the one tell tale sign is if there is a cyclical monthly pattern to a woman's cycle.

Researchers claim that forty percent of women of child bearing age suffer from some degree of premenstrual syndrome. While problems can appear during puberty, or as later as menopause, the onset of PMS seems to follow some type of shock to the endocrine system, such as menarche, childbirth, tubal ligation, hysterectomy, major life stress and going on and off birth control pills (Berke, Blumer, and Zack, 2).

Some scientists, because extreme cases of PMS (those which inhibit daily life) in many ways resembles states of depression and anxiety, have begun to advocate drug therapy. A study conducted by D.R. Schmidt and P.J. Engel in Canada reported that drugs that inhibit serotonin reuptake, such as fluoxetine (Prozac), also help to fight PMS. Their study, a randomized, double-blind, placebo-controlled trial of two different doses of fluoxetine on 405 women found that doses of 20 mg. a day or lower is effective in reducing psychological symptoms of tension, depression and irritability in women with PMS (Rubinow, Schmidt, 1575). To read the complete documentation of this study, please visit: Medical Sciences Bulletin.

An additional study by Kimberly Yonkers, MD., from the the University of Texas Southwestern Medical Center at Dallas, reveled similar findings with the drug Zoloft, which is also a serotonin reuptake inhibitor. In this study of 200 women, Yonkers found reduced depression, anger and irritability, mood, relationship problems, interference in hobbies and social activities, and impaired productivity in all cases by a substantial percentage. To read this study, please visit: Doctor's Guide.

Despite the above findings regarding drug therapy for PMS, there are other more natural alternatives that are widely available, more easily accessible, and more affordable that women should consider. These alternatives include a properly balanced diet, regular exercise, decreased salt intake, vitamin supplements, decreased caffeine, an increase in bran, stress reduction, masturbation and safe sex (Berke, Blumer, and Zack, 3 & 5). The Premenstrual Institute believes that it is always important for a woman to keep her blood sugar on an even level. However, they advocate that it is particularly important to do so immediately following ovulation because at this time the change in hormone levels alters your biochemistry, making you more susceptible to blood sugar reactions such as those associated with PMS: irritability, migraines, panic, tears, and depression. In terms of exercise, it is recommended that women exercise three times a week all month for at least half hour periods in order to increase mood and physical fitness. Reducing salt intake is thought to possibly reduce bloating during your menstrual cycle, in that salt causes the body to retain water. Adding vitamin supplements to your diet, especially B vitamins, is also thought to be helpful in that they fight bloating and have an anti-depressant effect. Adding bran to your diet during your cycle will help to alleviate constipation and avoiding alcohol during this time as well is a good idea because it takes more than half your usual amount to affect you and cause inebriation. Lastly, many women use sexual stimulation as a means to alleviate some of the symptoms of PMS such as pent up tension and pelvic congestion.


Toxic Shock - Toxic Shock Syndrome, more commonly referred to as TSS, is caused by a staphylococcal infection, which activates a bacteria that is usually already present in the body, to release a toxin into the bloodstream (UCSD, 1). The bacteria that causes toxic shock, usually present in a woman's body, does not cause any harm unless it is provided with an opportunity to breed or get through the walls of the vagina. The bacteria is especially likely to find this opportunity when super absorbent tampons, or the like, are used because they seem to allow the TSS bacteria to breed more rapidly and/or get through the walls of the vagina quicker. Tampons also cause small scratches on the walls of the vagina that may provide an avenue for the bacteria to enter the blood stream (UCSD, 1).

Symptoms of toxic shock syndrome include: sudden high fever, vomiting, diarrhea, dizziness, weakness, fainting, a rash (particularly on the palms and soles), disorientation, sore throat, bloodshot eyes, rapidly falling blood pressure, and muscular pain. The use of tampons puts women at the greatest risk for getting toxic shock syndrome, because they provide a breeding ground for the bacteria. Those women who use super-absorbent tampons when their flow does not necessitate them are at the highest risk. Other causes of TSS include infected wounds, surgery, or other staphylococcal infections, but the rates of infection from these are rare compared to the rates of infection from tampon use, especially tampons which are too absorbent for your flow (UCSD, 1). It is important to be aware of the falsities which the commercial tampon industries present and not accept everything that they do or do not say. Some recommendations for avoiding toxic shock include wearing the correct tampon absorbency for your particular flow, not using tampons overnight or between menstrual periods, alternating between tampons and pads, using a menstrual collection cup, and thoroughly washing your hands before inserting a tampon or menstrual cup. Once our society allows women to abandon the taboos so prevalent in our society they will begin to feel more comfortable using tampons less frequently and thus avoid many of their dangers, including their most prevalent danger, toxic shock.

links:

Clini Web - A completely thorough site on amenorrhoea, dysmenorrhea, menorrhagia, oligomenorrhea, and premenstrual syndrome from the Oregon Health Sciences University and the National Library of Medicine.

Endometriosis Association - The best site on the web, in our opinion, dealing with endometriosis. Visit and find out tons concerning symptoms, causes, treatments & the organization itself.

Gynecological Health Center - A site that has extensive information on learning about several menstrual disorders & assessing whether or not you have one. This site, operated by the Women's Health Interactive, also provides great information on how to interact with other women and an opportunity to develop a personal action plan.

Premenstrual Institute - A great stop for anyone interested in or concerned with any aspect of PMS. Information from a group of board certified gynecologists on symptoms, treatments, research and dietary recommendations.

. menstrual products & medical concerns .

In the United States alone there are at least eighty million menstruating women, and approximately 60% of them use tampons during all or part of their menstrual cycle (Diederichs, 1). How many of them are aware of the health risks associated with these products?

The use of tampons alone puts you at risk for toxic shock syndrome, vaginal dryness, and vaginal lacerations. The bacteria which causes TSS resides in most women's bodies in small quantities and is usually harmless because our bodies have mechanisms, particularly the magnesium found in our blood, to control the low level of toxins produced by the bacteria. However, the use of high absorbency tampons made of rayon (as most commercial tampons are) deplete the magnesium in the bloodstream and hamper the body's ability to fight off the bacteria, causing the bacteria to multiply and release large amounts of toxins which bodies are not able to fight off. Using high absorbency tampons when your flow necessitates it is fine, if that is the method you choose, because your magnesium levels are high enough during this time to control the bacteria. But, when you use super absorbent tampons when your flow is not heavy, or even light, your magnesium levels will not be high enough to fight off the bacteria (Diederichs, 1). Tampons also cause vaginal dryness by absorbing natural and necessary vaginal secretions in addition to blood. Only 65% of what tampons absorb is blood, the remaining 35 % are secretions that are necessary to have a healthy vagina, without these necessary secretions mucous membranes are peeled from our vaginal walls. Also, tampons that have applicators puts you at risk for vaginal lacerations because upon inserting the tampon, the plastic or cardboard applicator is capable of cutting the vaginal walls.

The bleaches and chlorines that are used in processing tampons as well as other sanitary products are also extremely harmful in that dioxins are a by-product of the bleaching process and chlorine has been found to cause cancer. These dioxins, originally claimed to be very low and thus harmless by the producers of the products, have been found to cause endometriosis in women, low sperm counts in men, as well as depressing the immune systems of both women and men (Houppert, 3). Women must not only make conscious efforts to find and use alternative products for the sake of their own body's health, but should also ask themselves why these huge commercial companies continue to market these harmful products.

"In the 1990's, the sanitary products industry is a more- than- $2 billion- a- year business, built on scientific and popular beliefs about personal cleanliness as well as changes in contemporary women's lives: earlier menarche, fewer pregnancies, and later menopause-- all of which foster more periods and more sales." ~ Joan Jacob Brumberg. The Body Project (1997).

One reason why companies who produce sanitary products were not traditionally held responsible for the products they produced was because tampons and pad were considered cosmetics until 1976, at which time the FDA adopted a rule classifying menstrual tampons, not pads, under the Medical Device Amendment of 1976 as class II medical devices. A result of this new classification was an effort to develop national performance standards for the safety and efficiency of tampons. (Pads were not included because they are still considered class I medical devices, which places them in the same category with tongue depressors, thus not making them subject to performance standards.) The FDA approached several companies, including Tampax Corp., Procter and Gamble, Personal Products Corp., Playtex Corp., and Johnson and Johnson, who they were interested in having participate on the task force which would create performance standards. While this conglomerate of corporations did set some standards regarding absorbency, they did not approach issues concerning bleaches and dioxins. We must ask ourselves why this task force was made up of the very corporations that have such a large self-interest in protecting their harmful products and making money off the millions of women who blindly use their products. Their power over us, which facilitated them being picked by the FDA to be on the task force in the first place, can not last once more women become aware of the harms of these products and boycott the sanitary products industry, utilizing alternative menstrual products, such as those available through the following links provided.

links:

S.P.O.T. - Visit S.P.O.T. to learn about the dangers of synthetic tampons and to take action against those companies who continue to mass produce and promote these harmful products.

Visit any or all of the following sites for alternatives to popular, commercial, and harmful sanitary products:

Glad Rags - Stop by Glad Rags' home page for cotton menstrual pads, nursing pads, and organically grown cotton diapers from a company in Portland, Oregon.

Many Moons - This company, operated by Janet Trenaman in Victoria, Canada offers washable pads and accessories as well as menstrual cups.

Natracare - This site feature information on the history and development of feminine hygiene products and it also offers its own line of non-chlorine bleached sanitary products.

Organic Essentials, Inc. - Certified Organic Farmers who offer 100% organic cotton tampons, along with a plethora of other all natural products.

terra femme - This company offers chlorine-free, cotton tampons. The site also features interesting postings on issues concerning the politics of tampons and menstrual products in general.


. sex, menstruation & HIV .

Virtually all the medical literature agrees that it is fine for a woman to have sex during her menstrual period, just as it is fine for her to engage in all the other activities that were once considered a taboo during the menstrual cycle, such as exercising or swimming.

However, one should be aware, for other reasons than social taboo, that avoiding sex during menstruation might reduce the risk of HIV transmission. In a health letter on September 25, 1995, the U.S. Centers for Disease Control and Prevention reported that avoiding sex that causes bleeding, or takes place while a woman is menstruating, cuts the risk of HIV infection. This CDC report was presented at the 11th meeting of the International Society for Sexually Transmitted Disease Research, which was held in New Orleans, Louisiana from August 27-30 in 1995. The CDC's letter focused on a case controlled analysis conducted by W.J. Kassler, in which 95 HIV cases of HIV transmission were closely studied. Kassler and his colleagues found that bleeding during sex accounted for 11% of the cases, and concluded that this type of transmission was a risk for both men, with a ratio of 8:1, and women, with a ratio of 4:1. Kassler also found that for women, having sex during menses, which accounted for 20% of the cases studied, was associated with a six-fold risk of transmission (6:1). The letter concluded with suggestions from Kassler, relaying suggestions for personal protective measures that may be effective in reducing the risk of acquiring HIV, including: avoiding sexual practices that result in bleeding, asking partners if they have had an HIV test, and avoiding unprotected sex during menstruation.


links:

Sex On Tuesday - Visit this column, written by Laura Lambert for the Daily Californian, and find out about the taboos associated with sex during menstruation and the realities of these risks.

For more information on menstrual taboos see another part of this web endeavor: Rituals, Taboos & Superstitions

Bibliography:

Berke, Michael L., Blumer, Abraham, and Zack, Ronald G. The Premenstrual Institute Home Page.
http://www.pmsinst.com/

Delaney, Janice & Lupton, Mary Jane & Toth, Emily. The Curse: A Cultural History of Menstruation. E.P. Dutton & Co., Inc., New York. 1976.

Golub, Sharon. Lifting the Curse of Menstruation. Harrington Park Press, New York. 1985.

Henderson, Charles W. "Health Letter on the CDC." Information Access Company (IAC), Newsletter Database. September 22, 1995.

Rubinow D.R., Schmidt P.J. "The Treatment of Premenstrual Syndrome - Forward into the Past." The New England Journal of Medicine. 1995; 332: 1574-1575.

Sexuality Database. "Menstruation." http://www.sexualitydata.com/sex_data/topics/menstruation.html