Menstrual Experiences Research Articles

Guest Editorial: Perspectives on menstrual cycle experiences

Guest Editorial: Perspectives on menstrual cycle experiences

Our Menses, Ourselves: Research and Commentary from The Society for Menstrual Cycle Research

The menstrual cycle is a unique aspect of being female that includes both biological and psychosocial experience. Individual girls and women experience cycle-related biological events, such as menarche (first menstruation), menstruation, amenorrhea, or menopause, within a cultural context in which prevailing cultural views about menstrual cycle experience play a role. The articles that we present in this special issue of Sex Roles raise awareness about menstrual experience as a biopsychosocial phenomenon that contributes to development of the self-concept in individual women and to more general notions of what being female is all about. More broadly, the authors investigate the contribution of context to contemporary menstrual cycle experience. The authors of these articles are colleagues who are members of the Society for Menstrual Cycle Research (SMCR). The Society was formed in 1977 by a group of multidisciplinary scholars who understood the centrality of the menstrual cycle in women’s health and more broadly in women’s lives. Founding members were committed to promoting feminist, woman-centered research on the menstrual cycle to redress the narrow and mostly negative focus on the role of menstrual cycle in reproduction to that date. Since 1977, the Society has held biennial conferences, which have yielded more than a dozen published volumes on menstrua-

Feminist Disability Studies

Feminist Disability Studies

Menstruation across time: Menarche, menstrual attitudes, experiences, and behaviors

This study explored the relationship between early and current menstrual experiences. The primary hypothesis was that women who reported positive menarcheal experiences (including menstrual education and menarche) would tend to report positive current menstrual attitudes, experiences, and/or behaviors, and vice versa for women who reported negative menarcheal experiences. In this survey-based study, college-aged women (n = 327) were screened by completing a questionnaire concerning their menarcheal experiences. Women who had extremely negative ("negative group," n = 46) or extremely positive ("positive group," n = 38) early menstrual experiences returned to complete questionnaires concerning current menstrual attitudes, experiences, and behaviors. Early and current menstrual experiences were most strongly associated in the domain of menstrual attitudes. Women in the negative group reported more negative menstrual attitudes than did women in the positive group. There were additional associations between early menstrual experiences and measures of body image and health behaviors. Positive group participants reported more positive body image and better general health behaviors. Results suggest that early menstrual experiences may be related to menstrual experiences later in life. This study invites further investigation of the psychology of menstruation and suggests connecting menstruation with other women's health issues.

Epithelial ovarian cancer risk by invasiveness and cell type in the Central Valley of California

To evaluate epithelial ovarian cancer (EOC) risk factors by level of invasiveness and histology. A population-based epidemiologic case-control study of EOC was conducted over a 2-year period (January 2000 to December 2001) in 22 counties of Central California that comprise the reporting area for two regional cancer registries. Telephone interviews were conducted with 256 cases and 1122 control frequencies matched on age and ethnicity. The interview obtained information on demographic factors as well as information pertinent to the respondent's menstrual and reproductive experience, use of exogenous hormones, surgical history, and family history of cancer. Adjusted odds ratios were calculated using stratification as well as Logistic regression methods. Analyses were completed by level of invasiveness and cell type. Strong protective associations were observed for use of oral contraceptives and parity. Risk increased with a family history of ovarian, but not breast cancer and age at first birth was positively associated with increased risk. Hormone replacement therapy was associated with increased risk only in long-term users. Many of the relationships were observed only in specific histologic subtypes of EOC. Risk of EOC is associated with several lifestyle and environmental exposures but the impact of these effects appears to be dependent upon level of invasiveness and histologic subtypes of EOC. However, the sample size available for analysis limits our statistical power and our ability to analyze data by histologic subtype, thus limiting interpretation of our results.

Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California.

Perineal talc use has been suggested as a possible risk factor for ovarian cancer based on its structural similarity to asbestos, a known human carcinogen. A population-based epidemiologic case-control study of epithelial ovarian cancer (EOC) was conducted in 22 counties of Central California that comprise the reporting area for 2 regional cancer registries. Telephone interviews were conducted with 256 cases diagnosed in the years 2000-2001 and 1,122 controls frequency-matched on age and ethnicity. The interview obtained information on demographic factors, menstrual and reproductive experience, exogenous hormone use, surgical history and family history of cancer. Questions on perineal talc use included frequency of use, duration of use and specific years when talc was used. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of talc was 1.37 (CI = 1.02-1.85) compared to never users. However, no dose response association was found. Tubal ligation (TL) modified the effect of talc on EOC such that women with TL had an OR of 0.88 (CI = 0.46-1.68) associated with perineal talc use, whereas women with no TL had an OR of 1.54 (CI = 1.10-2.16). Talc use and EOC risk was highest in women with serous invasive tumors (OR = 1.77; CI = 1.12-2.81). This study provides some support for the hypothesis that perineal talc use is associated with an increased risk of EOC.

Oral contraception and cyclic changes in premenstrual and menstrual experiences

Despite the widespread use of oral contraceptives (OC) there is no consensus regarding their effect on menstrual cycle experiences. This study examines the cyclic changes of prospectively collected, daily menstrual cycle experiences of two groups of ‘healthy women’ using monophasic and triphasic OC compared with a group using non-hormonal contraception.A total of 119 ‘healthy women’ using monophasic, triphasic or non-hormonal contraception for three months, made daily ratings over at least two complete menstrual cycles. Cyclic changes of ratings within and between the groups were analyzed.The three groups showed significant cyclic changes in abdominal fullness, abdominal discomfort, breast fullness, general ‘premenstrual syndrome-like symptoms’ and in at least two mood ratings. Maximal changes in ratings occurred during the late premenstrual and menstrual phases.There were no significant differences between the three groups in cyclic changes for any physical rating, but there were for tiredness or fatigue (non-OC users reported experiencing tiredness or fatigue more frequently than the OC users) and sadness or depression (non-OC users experienced sadness or depression less frequently than OC users during the early part of the cycle, followed by a sharp rise from early premenstrual to the menstrual phase). There were no significant cyclic differences in ratings between the monophasic and triphasic groups.In conclusion, ‘healthy women’ using OC experience premenstrual and menstrual changes. Any differences between OC formulations are subtle and not of clinical significance in ‘healthy women’ already established on monophasic or triphasic hormonal contraception.

Das Erleben des Menstruationszyklus - eine empirische Untersuchung bei 234 Frauen in der Schweiz

In einer repräsentativen Untersuchung wurden 234 Frauen aus der Schweiz zu ihrem Erleben des Menstruationszyklus mit Hilfe eines strukturierten Interviews zu Hause befragt.

Menstrual-related changes expected by premenarcheal girls living in rural and urban areas of Mexico

Most women experience changes surrounding the start of menstruation. These changes are influenced by sociocultural context. Consequently, certain changes are more pronounced in some cultures than in others. Girls enter menarche with a clear set of paramenstrual expectations that may alter their menstrual cycle-related experiences when they become postmenarcheal. This study explored expectations concerning the paramenstrual changes of 1173 premenarcheal girls living in rural and urban areas of Mexico. In accordance with the findings of studies conducted in other countries, Mexican premenarcheal girls associate menstruation with a set of mostly negative expectations. A comparison of the results from urban and rural girls revealed that urban girls expected negative paramenstrual changes more, while rural ones expected positive changes more. These differences suggest that the cultures in which girls are brought up have an impact on their expectations. Urban girls are more exposed to media which present a picture of menses as a debilitating event, while rural girls link menses with health because it is associated with the ability to have children.

The assault on ignorance: teaching menstrual etiquette in England, c. 1920s to 1960s.

At the end of the nineteenth century, medical paradigms of menstruation were located in a language of pathology and disability. Women were, therefore, perceived as incapable of competing with men in the world of education, work, and economics on account of their erratic and debilitating biology. This essay examines the challenge posed to this vision of menstrual disability by female medical practitioners in the early decades of the twentieth century. The new narratives of menstruation authored by these women not only re-cast normative menstrual experience as non-disabling, but were also formulated on the basis of canvassing the opinions of healthy schoolgirls rather than developing theories based on clinical contact with a minority of women defined as 'ill'. Yet female practitioners remained tied to a culture of 'menstrual discretion', thus perpetuating the secrecy and taboo associated with menstruation in the nineteenth century. This essay explores the tensions inherent in striving to overturn an oppressive medical model of menstruation whilst promoting menstrual discretion, and aims to place such apparent contradictions within the context of cultural notions of gendered identity and feminine sexuality.

YOUNG WESTERN WOMEN'S EXPERIENCES OF MENARCHE AND MENSTRUATION

A qualitative approach was used to examine young women's experiences of menarche and menstruation that were included in personal stories of growing up sexually. The personal experiences were examined by cross-case analysis to learn more about the narrators' attitudes toward menarche and their menstrual-related education. This was a secondary analysis using data collected for a study of common themes in the stories gathered in a 1998 study by Beausang. The data came from 332 stories written by students taking a sexuality course in a Midwestern community college. Of 227 stories written by women, 85 stories included menstrual experiences. Eleven narrators described menarche as a positive experience. In 10 of these stories, the mother was the primary teacher. The two most frequently identified sources of information by narrators were mothers and schoolteachers, with most narrators having a primarily negative view of their menstrual education regardless of the source. Problems with menstrual-related education were described as perceptions of unwillingness by teachers to discuss menstruation, time limits for education, unclear instruction leading to misconceptions, and the presence of peers in group learning situations that lead to embarrassment.

Positively Reframing Perceptions of the Menstrual Cycle among Women with Premenstrual Syndrome

To positively reframe perceptions of menstrual cycle experiences to diminish reports of negative perimenstrual symptoms among women with premenstrual syndrome (PMS). A longitudinal quasi-experimental research design; data were collected on 28 women. Treatment sessions were conducted in a university classroom in the northeastern United States. The intervention consisted of a health promotion program that provided social support and a psychoeducational intervention with a positive reframing psychotherapeutic maneuver. To describe (a) perceptions of biologic, psychologic, and social outcomes related to perimenstrual changes and (b) compare biologic, psychologic, and social outcomes of women participating in a health promotion intervention with women not participating. Negative perimenstrual symptom reports decreased for women in the experimental group. In addition, the participants' personal resources increased significantly. Participation in a peer support group that provides women with information on positive concomitants of the menstrual cycle can benefit women with PMS.

Idealised versus tainted femininity: discourses of the menstrual experience in Australian magazines that target young women

Information and messages concerning health-related issues are not confined to material provided by official figures or sources. Much information exists in the community and comes from a variety of sources. One such source is the media. This paper reports the findings of a study conducted over a 12-month period of advertisements for menstrual products in a selection of four monthly Australian magazines (n = 48) directed towards young women. The study examined the way in which menstruation and the menstrual experience were depicted in terms of page space, textual content and visual images. Findings revealed that advertisements for menstrual products provided confusing, conflicting and paradoxical messages. These included stressing the normality of menstruation while also emphasising the importance of keeping it hidden and secret. Menstruation was depicted as being a state of tainted (idealised) femininity because of the potential for the menstrual silence to be shattered by people finding out. Protection failure was depicted as being the ultimate in tainted femininity and a result of a woman's incorrect choice of product. Choosing menstrual-care products was depicted as simple but, paradoxically, complex and confusing. Women were depicted as liberated and sophisticated but images and language related to infancy were used. Freedom and liberation were conferred by the use of the advertised product. Overall, in common with previous studies, menstruation was depicted as a crisis of hygiene that is a risk to femininity. Advertisements for pantyliners suggest that femininity itself poses a threat to (idealised) femininity. This study demonstrates the crucial role of the media as a source of health information for young women.

Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery.

Irregular bleeding remains a common reason for the discontinuation of progestin-only contraception. The levonorgestrel releasing intrauterine system (LNG-IUS) has profound morphological effects upon the endometrium. Specific features are gland atrophy and extensive decidual transformation of the stroma. Morphological changes in the endometrium may be associated with perturbation of mechanisms regulating normal endometrial function. This study describes endometrial stromal and glandular features prior to and up to 12 months following insertion of the LNG-IUS. Comparison is made with first trimester decidua. In order to elucidate further mechanisms governing endometrial function with local intrauterine delivery of LNG, we here report histological features consistent with decidualization; a significant increase in granulocyte-macrophage colony stimulating factor (GM-CSF) immunoreactivity in decidualized stromal cells; glandular and stromal prolactin receptor expression and an infiltrate of CD56 + large granular lymphocytes and CD68 + macrophages. We are unaware of previous reports which have documented longitudinally both morphological and functional observations in endometrium exposed to local intrauterine levonorgestrel delivery. These studies demonstrate that long-term administration of intrauterine levonorgestrel results in features of altered morphology and function. No correlation was apparent between the end points in the study and the bleeding patterns described by the subjects. Further evaluation of these features in the context of menstrual bleeding experience may contribute to a better understanding of this troublesome side-effect which often leads to dissatisfaction and discontinuation of the intrauterine system.

PROSPECTIVE ASSESSMENT OF MENSTRUAL AND PREMENSTRUAL EXPERIENCES OF ICELANDIC WOMEN

In the only Icelandic study on premenstrual symptoms, a retrospective one conducted in 1991, investigators found 30% of the sample to have severe premenstrual changes. In light of critique that retrospective data primarily reflect socioculturally held beliefs about menstruation, the present study was undertaken in order to assess prospectively Icelandic women's premenstrual and menstrual symptoms and experiences. A total of 211 menstrual cycles were recorded by 83 women using a daily health diary. A symptom pattern was defined for each woman. A small majority of the women (51.8%) displayed a low symptom pattern. Two women (2.4%) demonstrated a premenstrual syndrome pattern, and 5 women (6.0%) exhibited a premenstrual magnification pattern. The remaining women displayed mixed symptom patterns indicating wide variability in women's experiences. These findings differ from the Icelandic retrospective study and from a USA study using prospective data. Therefore, it is concluded that menstrual socialization influences symptoms expectation and reporting.

Menstrual and premenstrual experiences of women in a developing country

The menstrual and premenstrual experiences of black Zimbabwean women were examined. Twenty‐five professional women and twenty‐five domestic workers were interviewed using semistruc‐tured, open‐ended interviews designed to explore their experiences. An analysis of consensual data indicated a number of predominant themes, including secrecy associated with menstruation, the negativity surrounding menarche, the breakdown of the traditional family network that passes on information about menstruation, and the acceptance of menstrual cycle experiences by the women. The main differences between the two groups concerned explanations of the functions and purpose of menstruation and the reporting of physical and affective symptoms. These differences are suggestive of the impact of educational level on experiences of menstruation.

Effect of positive reframing and social support on perception of perimenstrual changes among women with premenstrual syndrome

Traditional menstrual cycle research reflects a stereotypical negative bias that does not encompass the complexity of the phenomena. For example, even though the majority of menstrual cycle literature has focused on negative changes during the perimenstruum, some women report positive changes. This article describes a unique intervention aimed at refraining perceptions of menstrual cycle experiences for the purpose of diminishing perimenstrual impairment. The intervention was a health promotion program that provided social support and a positive reframing component for women with premenstrual syndrome (PMS) across four menstrual cycles. Through use of a preexperimental design, data were collected on 18 women. Daily measures included prospective assessment of perceptions of perimenstrual changes (impairment and activation). Retrospective assessments of moods (anxiety and depression), social resources (personal resources and marital satisfaction), and perimenstrual change perceptions were gathered at three time periods—before, during, and after the experimental condition. Data analyses included descriptive and multivariate strategies. Results indicated that, although perimenstrual activation did not increase significantly, impairment did decrease. In addition, there were significant changes from baseline to follow‐up on state depression and personal resource variables. Findings from this study underscore the need for further investigation of the wide continuum of women's diverse menstrual cycle experiences.

What are young undergraduate women's qualitative experiences of the menstrual cycle?

The dominant ideology of the premenstrual woman is that of a person who has no control over her moods, cognition and behavior because of her fluctuating hormone levels. The social influence of this stereotype has been put forward as an explanation for discrepancies between retrospective and prospective accounts of premenstrual experiences. However, recent research has found that women can and do distinguish between their own experience and that of the stereotype. What their own experience is (positive as well as negative) was the question that we set out to answer in this study. Nine undergraduate women were interviewed about their menstrual cycle experiences. Using qualitative analysis of their subjective accounts, a clear distinction between self and other premenstrual experiences emerged. White the women did experience premenstrual symptoms, they considered them to be relatively minor in comparison to what they defined as premenstrual syndrome. Furthermore, none of them had previously considered any positive menstrual cycle related experiences but the management of menstruation was emphatically viewed as a ‘hassle’. We conclude that women can and do distinguish their own experience from the premenstrual stereotype and this needs to be recognized in the treatment setting; there is a lack of positive discourse for the menstrual cycle which needs to be developed and more attention needs to be paid to menstrual management because it is of great concern to women but is currently not discussed openly.

Journeys into The Interior: Psychiatric Approaches to Women's Menstrual Experience, Then and Now

Journeys into The Interior: Psychiatric Approaches to Women's Menstrual Experience, Then and Now

Premenarcheal expectations and postmenarcheal experiences of positive and negative menstrual related changes

Longitudinal examination of early adolescent girls' premenarcheal expectations and postmenarcheal experiences of positive and negative menstrual related changes. Ratings of 14 positive and negative changes were made by 80 girls on three occasions: (1) in grade 6 when girls were premenarcheal, (2) at the test occasion within six months after each girls' own menarche, and (3) in grade 9 when girls were postmenarcheal. Premenarcheal girls rated expectations of changes, and postmenarcheal girls rated experiences of changes, for both premenstrual and menstrual phases. Girls also rated preparation for, and emotional response to, menarche and mothers' helpfulness on the first two occasions. Ratings for positive and negative changes were at similar levels premenarcheally and decreased at menarche; once menstruation became established, ratings of negative changes increased while those of positive changes decreased. Ratings for negative changes were higher in the menstrual phase, while ratings for positive changes were higher in the premenstrual phase. Premenarcheal expectations of changes contributed to the prediction of menarcheal experiences of changes. Premenarcheal expectations and menarcheal experiences, along with anticipated emotional response to menarche, contributed to the prediction of longer-term experience of negative changes; menarcheal experiences, along with preparation for and emotional response to menarche, contributed to the prediction of longer-term experience of positive changes. Both expectations about, and initial experiences of, menstrual cycle-related changes were associated with longer-term menstrual experiences. The different outcomes for positive and negative changes have implications for menstrual socialization, and provide the basis for some optimism about facilitating a more complex and multidimensional understanding of menstruation.