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The Menstrual Cycle: A Feminist Lifespan Perspective
Prepared by the Society for Menstrual Cycle Research I. Introduction A. Why Menstruation Matters
The Menstrual Cycle is one of the most important biological differences between females and males, one that has been
used – in many contexts — to justify discrimination against women and girls. Thus, the more clearly we understand the
biological and social significance of the menstrual cycle for both women and men, the better we understand the
fundamental arrangements of human society. Challenging the shame and secrecy surrounding the menstrual cycle,
encourages embodied consciousness, or a more meaningful and complex appreciation of bodies across the lifespan.
Interdisciplinary menstrual cycle research, especially studies that explore the psychosocial dimensions of menstruation in
diverse cultural settings, is an emerging subfield.
Some menstrual activists and menstrual cycle researchers refer to "menstruators" instead of women when referring to
those who menstruate. This linguistic choice locates menstruation beyond the confines of gender as socially constructed
and expresses solidarity with women who do not menstruate (due to illness, age or some aspect of their physiology) and
transgender men and genderqueer individuals who do in spite of their gender identity. Refusing to assume who does and
does not menstruate is one way of challenging the rigid gender binary that perpetuates privilege and oppression (Bobel,
B. How the Menstrual Cycle Works
Most menstrual cycles are 21-35 days long but variability is common after menarche (the first period) and also before
menopause. Each menstrual cycle is created by a unique egg and its surrounding cells; these produce hormones under
careful feedback control by brain and pituitary hormones. A usual menstrual cycle begins with 2-6 days of vaginal blood
loss (called a "period" or "flow") as the uterine lining is shed. Whole period blood loss averages 8 soaked regular menstrual
products (40 ml) (Hallberg, Hogdahl, Nillson, & Rybo, 1966). Despite cultural concepts of regularity, a third of women, once
a year have a period two weeks early or late (Munster, Schmidt and Helm, 1992). From low levels during flow, estrogen
rises to a midcycle peak over 9-20 days. Next, a pituitary Luteinizing Hormone (LH) peak triggers the release of an egg
(ovulation). Following ovulation, progesterone production rises steeply while estrogen decreases minimally (Nielsen,
Brixen, Bouillon, & Mosekilde, 1990) until both decrease at the next flow. The luteal (post-ovulation) phase normally lasts
10-14 days (Vollman, 1977) but ovulatory disturbances are common (Bedford 2010).
C. Menstrual Attitudes & Representations
Though menstruation is a biological reality, culture-bound values shape its meaning and management. Though there is not
a comprehensive cross-cultural comparison of menstruation, anthropologists have reported extensively on various cultural
practices surrounding menstruation ranging from severe social restriction to special respect and privilege for menstruating
women (Mead, 1949; Shuttle & Redgrove, 2005; Knight, 1991). In most cultures, menarche (the onset of menstruation) is
viewed as differentiating males and females. Though uncommon, artistic and cultural menstrual references exist, such as
bleeding wounds (in crucifixion or Dracula) (Mulvey-Roberts, 1998) or wolf bites in fairy tales (Bettelheim, 1976). In
cinema, as early as 1966, To Sir with Love used a menstrual detail to test the protagonist's manhood, and more recently
Superbad (2007) and No Strings Attached (2011) offered more subtle explorations of male responses to menstrual
encounters. Meanwhile, novelists such as William Faulkner, Joyce Carol Oates, Erica Jong and Philip Roth and Stephen King
(who exploited menstruation in the horror genre), included menstrual content. Artists such as Vanessa Tiegs and Judy
Chicago used menstrual blood and menstrual products, respectively, to challenge menstrual silence and secrecy.
In contemporary advertising venues, menstruation is most often coupled with dominant and recurring themes of secrecy
and concern for restrictions on physical and social activity. In advertisements for drugs marketed for menstrual discomfort,
the menstrual cycle is treated as a "hygienic crisis" (Brumberg, 1997), a medical condition, and a "problem" or malady
requiring treatment (Tavris, 1992; Angier, 1999; Ussher, 2006; Vostral, 2008). One recent study, however, suggests that
teen girls use their menstrual experiences as a "source of power" in their interactions with other girls as well as boys
(Fingerson, 2006).
Menstrual taboos shape many religious and secular practices across the globe (Delaney, et al, 1988; Knight, 1991; Laws, 1990; Van de Walle & Renne, 2001). For example, certain religious traditions regard menstrual fluid as ritually impure and thus, the menstruating woman is banned from religious rites, sex, and/or food preparation (Delaney, et al, 1988; Douglas, 1966; Houppert, 1999; Knight, 1991, Mendlinger & Cwikel, 2006; Stein & Kim, 2009). Theorists, including psychoanalysts Freud (1962) and Horney (1967) tried to account for the existence of menstrual taboos; the former claimed that menstrual taboos were an attempt to control women while the latter contended that male fear of menstruation had roots in castration anxiety. Some feminists critique the uses of taboo to disenfranchise women (Bobel, 2010; Delaney, et al, 1988) but not all menstrual prohibitions are equally disadvantageous and women assert their agency in the particular cultural and religious contexts in which various menstrual practices are embedded (Buckley & Gottlieb, 1988; Shuttle and Redgrove, 2005). For example, In Genesis Rachel manipulated a menstrual taboo to defeat her hated father Laban when she claimed to have her period ("the way of women is upon me") so that he would not search her belongings. Menstrual myths endure, such as the fear that menstruating women attract bears, in spite of research to the contrary (Rogers, et al, 1991). II. Early Experiences of Menstruation Menarche, or first menstruation, is one of the last pubertal changes, occurring after breast bud and pubic hair development. Menarche can occur as early as age 8 and as late as 17 (Hilliard, 2002). The development of full reproductive maturity, however, takes several years. With respect to girls in western culture, early menstruation can be challenging for girls; some experience negative outcomes regarding sexuality and body image (e.g., Mendle, Turkheimer, & Emery, 2007; Posner, 2006). Whether girls are experiencing early puberty related to early menarche is a controversial issue (Dorn & Rotenstein, 2004). The average age of menarche in both the United States and Europe is 12.5 years, and has not changed in 50 years; African American girls menstruate about six months earlier than European American girls (Steingraber, 2007). A trend of earlier menarche is evident in newly industrialized countries (Steingraber, 2007). In Western culture, girls have mixed, but mostly negative feelings about menstruation: they see it as a sign of growing up but are also embarrassed about it (Stubbs, 2008). Preparation leads to more positive attitudes and experiences (e.g., McPherson & Korfine, 2004). For example, supportive, engaged mothers who react in a matter-of-fact way can buffer widespread negative cultural messages about menstruation (Lee, 2008). However, most educational materials and menstrual product advertising focus exclusively on keeping clean and hiding menstruation (Erchull, Chrisler, Gorman, & Johnston-Robledo, 2002; Simes & Berg, 2001). Girls who see menstruation as a barrier to a sexualized self-presentation, highly valued in Western culture, are likely to see these products as especially attractive (Stubbs & Johnston-Robledo, in press). III. Menstrual Management A. Menstrual Care
Mainstream menstrual products – commercial pads and tampons typically made of a blend of pesticide-treated cotton and
rayon (wood pulp)— raise both environmental and health concerns (Bobel, 2010). The average menstruator uses
approximately 11,000 menstrual products (pads, tampons) over the lifespan and thus produces 250-300 lbs of garbage
(Stein and Kim, 2009). Tampon use is linked to Toxic Shock Syndrome (Berkley, Hightower, Broome and Reingold, 1987,
Kehrberg, et al, 1981, Tierno and Hanna, 1989 and Vostral, forthcoming). TSS develops when the bacteria Staph. Aureus
produces a toxin that rapidly overwhelms the immune system sending the woman into acute circulatory collapse (CDC,
2005). Half of all known cases of Toxic Shock are in women using tampons (FDA, 2009). The FDA recommends using the
lowest absorbency for one's flow, changing tampons at least every 4 to 8 hours and alternating pads with tampons to
reduce TSS risk. Though rumors do circulate about the biohazardous contents of tampons, there is no evidence of asbestos
in tampons and it has been estimated that dioxin (a byproduct of tampon and pad bleaching processes) exposure is
negligible. (FDA, 2009). Concerns about conventional products lead some menstruators to opt instead for reusable cloth
pads, menstrual cups, sponges and/or tampons made only of organic cotton.
B. Cycle-stopping Contraception ("menstrual suppression")
Hormonal contraceptives ("the Pill"), traditionally taken 21 of 28 days, stop ovarian cycling and alter endometrial and
cervical changes needed for fertility. Marketing the "choice" of no periods, pharmaceutical companies have touted
continuous hormonal contraception (Johnston-Robledo, Barnack, Wares, 2006, Hitchcock, 2008, Gunson, 2010, Mamo and
Fosket, 2009). Hormonal contraceptives are promoted as more "natural" by pharmaceutical companies, citing that hunter-
gatherer women had fewer menstruations (Jones, 2011). However, in the populations referred to, hormone exposure was
low due to nursing and/or under nutrition, both of which can cause menstruation to temporarily halt, rather than high, as
is the case with modern drugs (Hitchcock & Prior, 2004). These products have high rates of unpredictable spotting and flow, especially with initial use. Furthermore, cycle stopping contraception exploits menstrual-related stigma and promotes menstrual concealment norms, and may be particularly attractive to young women who have not yet developed comfort with menstrual management and are socialized to see their flow as merely a nuisance. Cycle-stopping contraceptive products medicalize menstruation, are likely to lead to earlier initiation and prolonged use of hormonal contraception, and normalize replacing a biological function with a pharmaceutical product to meet social expectations of menstrual concealment. Long-term safety data, especially for the breast and in adolescents, are lacking (Hitchcock, 2004). IV. Problems attributed to the Menstrual Cycle A. Premenstrual Syndrome (PMS) is the repeated occurrence of behavioral, physical, and mood symptoms severe
enough to impact a woman's social and work-related functioning during the premenstrual/post-ovulatory phase of the
menstrual cycle (Taylor, 2005). Evidence-based treatment for moderately severe PMS includes a combination of personal
and environmental stress management, dietary awareness, nutritional supplements, and exercise (Taylor & Colino, 2002;
Taylor, 2005).
B. Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS affecting less than 8% of menstruating women, and
may be a cyclic form of depression (Huo et al, 2007; Klatzkin et al, 2010); Taylor, 2006). PMDD is an accepted diagnosis by
the U.S. Food & Drug Administration that has approved newer antidepressants for its treatment--it is not accepted by the
International Classification of Diseases (Mintzes 2006; European Agency 2004). Critics argue that labeling women with PMS
and PMDD individualizes problems as merely psychological. Ultimately, they assert, these labels hide the external sources
of symptom expression that arise from a host of situations, such as stressful work environments, social relationships,
poverty, or living in unsafe neighborhoods (Caplan, 1995, 2004; Offman & Kleinplatz, 2004).
C. Other Menstrual Cycle Concerns include heavy flow, cramps, anovulatory androgen excess (polycystic ovary syndrome
or PCOS) and irregular, absent or long cycles. Heavy menstruation is flow more than 6 days and/or more than 16 soaked
"regular" size menstrual products (80 ml blood loss] per period). Heavy flow is more common in adolescence,
perimenopause and in those of any age with higher estrogen levels and ovulatory disturbances (Seltzer, Benjamin, &
Deutsch, 1990; Moen, Kahn, Bjerve, & Halvorsen, 2004). Cramps occur normally in teenagers and can improve following
childbirth. They are most often effectively treated with short-term, high dose over-the-counter ibuprofen. Anovulatory
androgen excess (
AAE/PCOS) occurs in about 4-10% of women (Talbott, Wild, Remsberg, Gibson, & Casoglos, 1999). It is
defined by clinical evidence of high male hormones (testosterone) that presents as acne, facial hair, oily skin and hair and
head hair loss), lack of regular egg release, and long or absent cycles (Pedersen, Brar, Faris, & Corenblum, 2007). It runs in
families, causes a marked increased risk for insulin resistance, type 2 diabetes and fertility problems, and is associated with
obesity and depression. Far apart cycles (cycles 36-180 days apart), irregular or absent menstruation (no flow for 6
months) are relatively rare—less than 6% of women ages 16-35 experience these in a year (Munster, Helm, & Schmidt,
1992); younger women, those under emotional or nutritional stress, and/or who over-exercise are more at risk (Bedford
V. Rethinking Menstruation
A. Menstrual Activism
Activists from across the feminist spectrum have challenged the menstrual status quo of shame, secrecy and silence,
through visual and performance art, ritual, humor, direct action, informational workshops, the production and
dissemination of zines (independent, small scale publishing), the use of websites, blogs and other social media, as well as
research which normalizes the menstrual cycle as a healthy bodily process (Bobel, 2010; Kissling, 2006). Some menstrual
activists celebrate the menstrual cycle as a source of feminine power and connection while others resist an essentialist
framing of menstruation in which a biological process is conflated with a socially constructed category. Instead, such
activists target the global menstrual care industry while promoting the use of environmentally-sustainable, safer and less
costly alternatives (Bobel, 2010). This activism has not gone unnoticed; the Vital Sign campaign from the American
Academy of Pediatrics (2006) reframes menstruation as a key indicator of girls' and women's overall health.
B. Fertility Awareness and the Menstrual Cycle
A woman who monitors and charts her menstrual cycle events to determine her phases of fertility and infertility is
practicing fertility awareness (FA). Women can use FA to prevent or achieve pregnancy and/or to monitor gynecological
and general health. Technical and contextual differences exist between the many variants of FA based methods of birth
control ( Methods vary in their focus on signs of fertility. FA methods, which do not prevent STI's, are
gaining credibility and attention in comprehensive discussions of contraceptive choices for women (Eldridge, 2010).
C. Body Literacy and Informed Choice Making
Body literacy is the self-knowledge acquired by women who learn to observe, chart and interpret scientifically proven signs
of fertility and infertility - their individual menstrual cycle events - together with other health and wellness observations.
Body literacy helps a woman to understand how her health is connected to her menstrual cycle, and thus make informed
decisions about her health care (Wershler, 2005) and resist institutional control of her body, for example, vis a vis
pharmaceutical companies (Bobel, 2010).

VI. Perimenopause and Menopause
A. Definitions and "Symptoms"
Female reproductive hormones have a unique lifecycle—they are low in childhood, rapidly increase during puberty and
maintain mean high levels throughout young-mid adulthood. In perimenopause, estrogen levels become erratic, their
mean is higher than in young adulthood, and progesterone levels become lower (Prior 1998). Perimenopause refers to the
whole, highly variable transition to menopause that begins one year following final flow (Prior and Hitchcock 2011). During
both perimenopause and menopause, some women experience night sweats and/or hot flashes (vasomotor symptoms),
sleep problems, decreased interest in sex and/or migraines.
B. Social Constructions and Dimensions of Peri/Menopause
Because biomedical discourse regards menopause as a "deficiency disease," women in the United States can find it difficult
to resist the power of pervasive negative definitions of this normal transition (Lyons and Griffin 2003). Feminist scholars
counter that menopause is a broad, biosocial transition that individual women may see as positive or neutral (Dillaway
2005a, 2005b). While some women view menopause as the dawn of a better and more carefree life-stage, free from the
burdens of pregnancy, menstruation, and contraception, others may find the transition fairly inconsequential (Ballard,
Elston, & Gabe, 2005; Trethewey 2001). Others may still define menopause negatively when negotiating symptoms (e.g.,
hot flashes/flushes). The negative view of menopause is linked to gender norms (about women's physical attractiveness
and youthfulness) and certain reproductive experiences and choices, such as delayed childbearing or infertility (Dillaway
2005b; Lyons and Griffin 2003). Nonetheless, when social class, racial, and other cultural differences are studied, great
variation exists across groups of women as they think about menopause (Avis & Crawford, 2008). For instance, while
African American and lower-income women report higher rates of menopausal symptoms and/or more intense symptoms
when surveyed, research also suggests that they report more positive (or at least more neutral) attitudes towards
menopause than their European American counterparts (Green & Santoro, 2009; Nixon, Mansfield, Kittell, & Faulkner,
2001). The reasons for these variations are only partially understood.
C. A Woman-Centered, Critical Approach to Perimenopause and Menopause Therapy
Perimenopause and menopause are hormonally very different, thus menopause therapies may not be suitable/safe for
perimenopause, and no study in perimenopause has shown that menopausal type hormone therapy (HT) or the Pill
improve symptoms (Casper, Dodin, Reid, & Study Investigators, 1997). Knowing the course and variability of
perimenopause, having social support, maintaining exercise and a good diet are helpful. Use of hormone therapy (HT) for
menopause (aka "postmenopause") by women without vasomotor symptoms does not prevent but actually increases risks
for heart attacks, stroke, blood clots, breast cancer and memory problems. HT does reduce osteoporosis/fractures (WHI
2002; Anderson et al., 2004) and vasomotor symptoms (MacLennan, Broadbent, Lester, & Moore, 2004). Vitamin D,
regular exercise, community involvement and maintaining a healthy weight likely prevents osteoporosis, memory
problems and heart disease. Vaginal dryness, due to menopause, can be treated with regular, gentle sex and vaginal non-
hormonal or, if still necessary, very low dose, vaginal estrogen therapy (Speroff, 2003).

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Journal of Adult Development, Vol. 12, Nos. 2/3, August 2005 ( C Neurofeedback Treatment of Depression and Anxiety D. Corydon Hammond1,2 A robust body of research documents that there are biological predispositions that oftenexist for depression, anxiety, and obsessive–compulsive disorder. However, new researchhas shown that medication is only mildly more effective than placebo in the treatment ofthese problems. In treating these conditions, neurofeedback (EEG biofeedback) may offer analternative to invasive treatments such as medication, ECT, and intense levels of transcrancialmagnetic stimulation. This paper reviews the neurofeedback literature with these problems,finding particularly positive research support for the treatment of anxiety disorders. Newfindings on the neurofeedback treatment of depression are presented.

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EAST ASIA SECURITI ES C OMPA NY LIMI TED 9/F, 10 Des Voeux Road Central, Hong Kong. Dealing: 3608 8000 Research: 3608 8096 Facsimile: 3608 6113 HONG KONG RESEARCH Analyst: Sabina Cheng 9th February 2010 – Research Ruinian International Limited [Stock Code: 02010] Sole Sponsor, Sole Global Coordinator and