Monday, October 22, 2012

What Aristotle Thought about Menstruation


A student of Plato, Aristotle (384 BC – 322 BC) had a view of women that would be viewed as rather peculiar today.  He considered women to be unfinished males, ‘deformed’.  




In his Treatise On the Generation of Animals, he viewed menstrual blood as being a lesser sort of semen, writing on male and female secretions: 

“…This much is evident: the menstrual fluid is a residue, and it is the analogous thing in females to the semen in males.  Its behavior shows that this statement is correct.  At the same time of life that semen begins to appear in males and is emitted, the menstrual discharge begins to flow in females, their voice changes and their breasts begin to become conspicuous; and similarly, in the decline of life the power to generate ceases in males and the menstrual discharge ceases in females…”

A novel invention by the Ancient Greeks was a tampon make from a piece of wood entwined with lint wrapped around it; based on written records, these were believed to be used primarily for contraception.  I don’t know, but it sounds like those would hurt.  No wonder they were used for contraception, as the woman was probably injured afterwards and could not have sexual intercourse, I thought.
The Ancient Egyptians are credited with the invention of disposable tampons made from papyrus that were softened (The Period Blog; Utian, 2008).  Tampons were also used by the Byzantine women, who made them out of wool that was softened.  I can’t help but wonder if they knew when to pull them out.  Did they get toxic shock syndrome back then, from keeping them in too long and acquiring bacteria and then sepsis and then death?
Jump to the 1700’s, where the French considered menstrual blood to be seductive, and also a measure of female fertility (Corbin, 1986).  In 1986, Corbin writes:

 “…in 18th century France, menses was considered to be ‘impregnated with subtle vapors transmitted by the essence of life.  These were particularly seducing, as a woman was ‘dispersing seductive effluvia’ and ‘making an appeal for fertilization.’  Thus societies have celebrated the seductive aroma of menstruation, rather than stifled (it).”

In the early 1800’s, remember that women probably menstruated for less of their lifetime versus now.  Menarche started later, at 17 years of age, and women breastfed much longer, they were pregnant more often, menopause started earlier, and they were more likely to be ill or malnourished.   Today, the age for a girl’s first period is now 13 years old.  The common notion during the 1800's was that menstruation was controlled by lunar phases of the moon (Covington, 2007). 


References:
The Period Blog: View The Period Blog here

Alain Corbin.  The Foul and the Fragrant: Odor and the French Social Imagination. Cambridge, Mass.: Harvard University Press, 1986.

Covington, Sharon N.  Infertility Counseling.  A Comprehensive Handbook for Clinicians, 2nd Edition.  Georgetown University School of Medicine, Washington DV.  Linda Hammer Burns. View Book Here


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Other Articles by Dr. Margaret Aranda



Wednesday, October 17, 2012

Chapter One: From Menarche through Menopause ~ A Journey Through Time


My Work in Progress is a book for Girls, Ladies, and Women, called From Menarche through Menopause: A Journey Through Time.  This is Chapter One for you.
______________________________________________________


Raising Girls


There were six girls and one boy in my family, perhaps my “in” on feminine issues.  I was the second oldest, but always felt like the oldest.  My brother was the 7th child, the baby.  I was a little Mommy when I was 8, patting my little brother’s back to sleep every night, and loving it.  Us girls had our “First Talk” in the 70’s, when refrigerators were avocado green, collars were long and sharp, and Led Zepplin’s Stairway to Heaven blared from my room.
“How did you like the book?” my mother asked.  It was a Red Book with Chapters on male and female anatomy, menstrual periods, and intercourse.  What kind of answer should I give? “Yeah, it was um…it was uhmmmm…Yeah.”   I was more stunned than anything.  So this is what my parents were doing, this Intercourse thing?  This is what every married couple does?  Oh my!
I’m not doing any research here on this Chapter; I’m just going by my experience.  Being a girl wasn’t particularly problem-prone in the 70’s.  I walked to school, thumbed to the beach with my friends, and generally was a “Valley Girl” with blonde-streaked, brunette hair in the summertime.  I was in eighth Grade in Catholic School, about to graduate middle school, and our class was going to go on a Field Trip to Disneyland for graduation.  I loved Disneyland.
 I didn’t pluck my eyebrows or wear makeup when I was 13.  I had Wallabees, wasn’t popular in school, and pretty much minded my own business.  Except for the radio blaring from my room when my parents were gone, that is.  I got straight A’s without really trying, and I liked Composition exams over Multiple Choice ones, because it was easy for me to write.  “I Can’t Live” was the first song I recorded onto a tape player then, as well as “A Horse with No Name”. 
There were six girls in our family, and most of us were one year apart from one another.  Back-to-back babies from a Catholic family with no birth control, I suppose. We weren’t the only ones with a big family at our school. Several families were comprised of more than five kids.  That was just the way it was.  My brother was the youngest.
I looked at the Red Book again.  The rest of the book had to do with menstruation.  I had not started my period quite yet, but was destined to do so in just a few months.  After reading that red book, I remember feeling the unfairness of a woman’s Period.  It just seemed messy.  How do you keep yourself clean?  Doesn’t the blood get on your clothes?  Does it hurt to have your Period?  What if you were swimming when it happened?  Wouldn’t the blood get in the water? I was fearful of the unpredictability, the mess, and the cleanup.  I wasn’t worried about the pain.  I was just worried about the social significance of the bleeding; that was my biggest worry.
No one said a word.  I suppose that my older sister had her Period before me, but I don’t remember it.  I don’t remember her having tampons or pads or anything.
But I remember the night my Period started.  Who could forget?  I was sitting on the sofa watching The Twilight Zone with Rodney McDowell.  It was scary, like Halloween.  It was 10:00 pm on a Saturday night and my Father had gone to the store for something.  I felt alone.  I was waiting for him to get back home.  All my sisters were asleep and my stomach felt a little crampy.  I didn’t know that cramps went together with Periods. 
When my Dad pulled into our U-shaped driveway, I didn’t get up.  I let him open the door and bring me some aspirin.  He was attentive and caring, but he didn’t know what was happening, either.  I took the medication and went to get ready for bed.  When I went to empty my bladder for the last time, that’s when it happened.  I noticed the blood.  There wasn’t too much blood, but it was there and I knew I had started my first Period.  There was no one to talk to, no one to question, no one to help.  I guess I could have asked my Father, but the thought did not occur to me.  I didn’t think that it was in his realm.  I would have been embarrassed and I just frankly would not have known what to say, or how to say it.  Awkward.  Yes, it would have been awkward.
So I balled up some toilet tissue and stuffed it in my underwear, wondering who and when I was going to tell some one.  Or ask some one.  I knew that I needed help, but I really didn’t want to ask for it.  “I can handle this, “ I thought. It was too late to call Adrienne or MaryAnn or Lorie. 
That night, I laid in the bottom bunk bed, staring at the wood planks above me.  The mattress heaved in and out of the planks, like the weavings of a straw basket.  I turned to the wall, pillow and hand under my head.  I remembered the times when we played The Clock Game.  My sister on the top bunk would put her whole arm down between the bed and the wall, and make it go Tick Tock like a clock.  On the bottom bunk, I would then try to catch it as she furiously made it go faster and faster.  We were practically wetting our pants it was so funny.  Inevitably, the sisters in the next room would be yelling at us to be quiet, as we frequently played this game when we couldn’t sleep.  That just made the whole thing funnier, you know.  Of course it did. 
I closed my eyes and went to sleep, thinking that times were changing.  I was leaving my childhood behind.  My period marked a sign of womanhood, maturation, entering a one-way street into the future.  Truly,  I no idea that my life had entered a new phase.
The next morning was a Saturday, and I could hear the chirping of the birds.  As was my habit, I peered out the window to check on the sun.  On many days it was cloudy in June, the classic June Gloom of Los Angeles.  Other days, the sun was bright and strong, shining such that my arms headed for the second drawer of my crème-colored dresser.  Tossing aside socks and underwear, I fished for my bikini top and bottom.  Let’s see…yes, they are both there and no one stole them.  Being in a big family was frought with borrowed clothes, missing items, and the need to hide things that were of value to me.  So I was relieved to find both parts of the bikini.
The bright sun signified that it was time to whip out the baby oil and tin foil.  In my mind’s eye, I imagined the next steps to take.  Normally, I would position the foil around my face as I laid on a beach chair.  This of course intensified the suntan and the risk of skin cancer, but no one really knew about the risk of skin cancer then.   The baby oil and tin foil were the habits of the season.
Normally, I would couple the bikini, baby oil, and tin foil with a selection of Diet Shasta.  My Dad would purchase a case of soda, ten different flavors.  The case was on the floor in the kitchen, next to the avocado green telephone that hung on the wall.  I would pour one out into a glass of ice and take all this gear outside with me outside to lay out in the sun.  
My favorite place to lay out was in the front yard, because we had a Golden Retriever and a mutt in the backyard.  If I laid out in the backyard, they just refused to leave me alone.  Licking.  I would get licked and licked and it was simply gross.  Besides, there were more flies and I didn’t want them sticking to my baby oil.  So off to the front yard I prepared to go, seeing in my mind’s eye all the supplies in hand. La-la-la…
Oops.  Yes and no.  As my hand came out of my dresser drawer now, my image of laying out in front suddenly dashed out of my focus.  I looked down at my legs, squatted down with the black bikini strewn across. 
I started my Period last night.  I started my Period last night, I said! 
I didn’t have any one to go to.  I wish that one of my friends had a mother that I could talk to, as I figured the conversation was over with my own mother.  My shoulders hunched downward in defeat and despair as the dawning came over me.  I was alone. 
Back then, girls were not really taught to go to college, to get a job, or to think about a career goal.  None of my friends wanted to be anything. For sure Adrienne with her blonde, floating hair and immaculate smile was already attracting boys that could drive.  Destined to be a model or an actress, everyone considered her to be the most popular girl in school.  Her mother was a nurse.  She worked nights, but it seemed like she really didn’t work too much, as she was always home.  I don’t remember that she was particularly tired or crabby or anything.  She seemed like a normal mother but I didn’t know her well enough to ask about my Period. 
In fact, I didn’t even tell my girlfriends about it.  Somehow, I imagined that it was up to me to figure it out for myself.  I was going to have my Period for a long time now, and it wasn’t gong to go away. 
I thought about telling MaryAnn or Lorie.  MaryAnn had an older sister too, and maybe Carla knew about Periods.  Ahhh, but Carla played basketball and volleyball and was super athletic.  She would probably think I was being baby-ish if I asked, and then MaryAnn would have to know about it to, by default. 
Peer pressure seemed to dictate that girls didn’t talk to other girls about starting their Period.  I was 13 years old, in 8th grade, and I was getting ready to enter Catholic High School next year.  I though well, if I’m big enough to go to High School, then I’m big enough to figure it out on my own.
I don’t know why I didn’t want my friends to know I started my Period.  I just thought that it was supposed to be a secret thing.  No one ever talked to me about it.  Older sisters were everywhere, and surely they were already on their Periods.  Why didn’t they sit us down and tell us about it?  You’d think that it would be a chance for them to be the ‘big’ sister and give us advice and tell us what to expect, what to use, etc.  There must be so much to know, isn’t that true?  Since no one had really talked to me about having a Period before, my conclusion was that I wasn’t supposed to talk about it.  Well, I thought, let me think about this one more time before I keep it quiet.
Lorie was the cool-headed friend that was level.  Nothing startled her.  She could handle ten frightful situations without having a meltdown, but…I couldn’t go to her.  I was too embarrassed.  How do I say the word, “vagina”?  How could I tell her that I had blood coming from my Private Part?  Would she think less of me?  Would she be jealous?  Maybe she already started her Period?  No, why would she start her Period and then not tell me?  She couldn’t have started it yet. Ahhh, but if she did start her Period and she didn’t tell me, then I’m stuck again!  Maybe we’re not supposed to talk about it!  Oh no!  
I threw down my bikini on the mustard-and black shag wall-to-wall carpeting.  It was well worn by now, dog hair scattered here and there.  I didn’t care.  I was bleeding!  What do I do about the blood? Oh my goodness!  If I squat, does that make the blood come out worse?  What if my Dad sees it on my clothes?  What if my sisters see it?  Surely they will point at me and laugh if they see blood. 

Friday, October 12, 2012

Research Questions on Menopause



by Dr. Margaret Aranda

Women who are older usually go through something called Menopause.  Menopause occurs when the ovaries don't make hormones any more, so the monthly periods stop.  It may take 1 year for the periods to stop, or a woman might have her period twice a year for a few years.  Whenever a woman has had no period for 1 year, she is officially in Menopause.

The interesting thing is that she does not usually know that she is IN menopause until after 1 Year after it is over.

First I need age and ethnicity information, to distinguish you from everyone else:

Age and Ethnicity:
A.   How old are you now?
B.   What is your ethnicity?


Questions:

1.  Did you have your uterus taken out by surgery? __ Yes or __ No
    3a.  If you had your uterus taken out, did you also have your ovaries taken out at the same time?       __Yes  __ No)
    3b.  If you had your uterus taken out, how old were you when you had the surgery? ____ Years old

2.  Did you have any complaints after you stopped having your period?  __ Yes  __ No
3.  What were they?  (Did you have __ hot flashes? __ Vaginal dryness? __ Bone or joint pain? __ Thinning hair, or __ hair falling out? __ Insomnia? __ Mood swings? __ Irritability? __ Trouble concentrating? __ Memory problems? __ Dry skin? __ More wrinkles?
4.  Did any one offer you hormone therapy after your ovaries stopped working? __Yes __ No
5.  If you take medications, what are they?  __  Estrogen    __ Progestin  __ Testosterone
6.  Are you still having symptoms? __Yes __ No)
7.  How do you feel now that you are in menopause?


Then we need this information on the First Period:

#1.  How old were you when you had your first period? ___ Years old
#2.  Where were you? (e.g., at school, in the garden, etc.)
#3.  Who was with you? (e.g., your sister, no one, etc.)
#4.  What did you do? 
#5.  Did you tell your mother?  __ Yes  __ No Your father? __ Yes  __ No
#6.  How did you feel?
#7.  (And since I'm a doctor, I have to ask...)  Did you tell your doctor?  __ Yes __ No

To Participate, Simply copy and paste the Research Questions into an email.  Answer the questions, check the box below with an "X", and your data will be included.

Informed Consent for Research on Menstruation and Menopause



I,  ____________________________________________, understand that Margaret A. Ferrante, MD, is interviewing me about my menstrual period and/or menopause.  She is collecting information from about 1,000 women for inclusion in her book, From Menarche through Menopause: A Journey Through Time; and her data may be presented at national and/or international professional meetings about women, culture, ethnicity, age, menstruation, menopause, or any related topic.

I agree that I am not getting paid, that I am giving up all my rights to the information, and that I cannot change my mind.  If I do change my mind about allowing Dr. Margaret A. Ferrante to use my information, I need to tell her; afterwards, it is up to her whether she will omit my information or include it.

Dr. Ferrante will keep all information confidential.  My name will not be used in connection with the information.  If any of my stories are used, she will change my name and/or identifiers so that no one knows my identity.  I am providing my contact information in case Dr. Ferrante does a follow-up or other Research study that I may be interested in.  She may contact me at her discretion, even if it is 10 years from now, to follow up on additional research questions.

I promise that the information I give Dr. Ferrante is true and that I’m not making anything up.  Information is anticipated to benefit society, medicine, and culture for women’s issues.  Thank you for your kind and benevolent participation.

Signed,



Printed name




Address:        

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            Street                                                  City, State, ZIP

_____________________________________                       ___(_____)_____________________
Email address                                    Phone




__  By placing a Checkmark "X" here, I agree to the above.


Thursday, October 11, 2012

The History of Menopause

by Dr. Margaret Aranda

On his Treatise on the History of Animals, Aristotle wrote that menopause occurred in
the fortieth year, but some childbearing up to the fifties was not uncommon.  There is a paucity of writings on menopause in the Greek literature, perhaps because fewer women lived to be of a postmenopausal age. 

The ancient Greeks attributed an “imbalance of humors” to various conditions. Today, we would call it an “imbalance of hormones”.  One of those conditions was the state of infertility due to an inability of an aging woman to have a baby.

The international, social, and biological deficiency state of “imbalance of humors” placed a certain taboo on women worldwide.  Women sought to restore the imbalance, and some of their means were bold.  They placed leeches on their legs, so that the blood-sucking bugs would get rid of the excess blood and create balance. In India, testicular juice was a remedy.  In North America and China, wild yam was used.  There are other extreme measures that women undertook to try to either bring back their periods or alleviate symptoms (see Table).  But these experiments of concoctions proved useful when in the 1950's, the root of the wild yam was harvested for its diosgenin, which is a phytoestrogen. A phytoestrogen is a plant with a hormone that is structurally similar to estrogen.  In the 1960's, based on this chemical conversion of a phytoestrogen to an estrogen, this is how the first birth control was originally formulated.


Early Treatments of Menopause
Time Period
Reference
Can be treated with black cohosh, (Cimifuga racemosa), a natural precursor to estrogen
1700’s
eHow 2012
Can be treated with wild yam, Dioscoria villosa
1800’s
Buchanan 2012
Can be treated with testicular juice
1930’s
Singh et al, 2002
Can be treated with crushed ovaries of animals
1930’s
Singh et al, 2002
Devil had a covenant with the woman
Old pagan and religious belief
Body Logic, 2012
‘Usual mixture’ before meals: carbonated soda, opium, vaginal injections of lead acetate, morphine hydrochlorate, distilled water, chloric ether
1855
Foxcroft 2009
Ovarian extracts used to relieve vasomotor symptoms
1897
Speroff, 1999
Herbals, belladonna, cannabis, or opium
1899
Merck
“Ovarlin” flavored powder, dessicated and pulverized cow ovaries
1899
Merck
Women were insane, giving ‘insane interpretations’ of their symptoms.
1903
Savage 1903
 Table.  Descriptions of the early beliefs of menopause through time.  Menopause carries with it a vivid history of remedies to alleviate the 'insanity' of it all.  Today, some hold that hormone imbalance is best treated with bioidentical hormone replacement therapy.



The Ancient Egyptians are credited with the concoction of elixirs that were used for anti-aging purposes (Utian, WH.,  2008).

Trotula of Salerno, who may have been a female physician, wrote in the 13th Century writing of women in medieval Europe, The Diseases of Women:

 “Since in women not so much heat abounds that is suffices to use up the moistures which daily collect in them, their weakness cannot endure so much exertion as to be able to put forth that moisture to the outside air as in the case of men.

Nature herself, on account of this deficiency, has assigned for them a special purgation namely the menses, commonly called flowers.  Now a purgation of this sort usually befalls women about the 13th or 14th year or a little later according to whether heat or cold abounds in them more.  It lasts up to about the 50th year if she is lean; sometimes up to the 60th or 65th year if she is moist; in the moderately fat up to about the 45th.” 

In 1821, the term ‘menopause’ was coined by Dr. Charles Négrier (1792 – 1862).  It is derived from the Greek; month is ‘men’, and pause is ‘pausis’. 

In the 1800’s, there was much medical interest in menopause, but not the way that you would think.  The average of menopause in England was 45. Consider that you went into menopause in the 1800’s, complaining of depression, hot flashes, and irregular periods.  Doctors were quick to diagnoses these women with “hysteria”, a major term that literally referred to the uterus in Latin.  The Greek 'hysterus' means ‘womb’, and thus the uterus literally caused ‘hysteria’. The uterus was thought to be the organ responsible for physical problems that led to neuroses.

During this time period, it was not uncommon for wives and daughters to be committed to an insane asylum for reasons of “lunacy”.  Women were even “put away” for gong through menopause.  Husbands would put them away, divorce them, then marry a much younger woman.  No one was allowed to visit the woman in the insane asylum, and they were locked up until they died.  Many times, the husbands would simply say that the woman had died.  Women in this situation were subjected to conditions of poor heating, substandard food, unsanitary and unclean conditions, and communicable diseases spread widely in this environment, which sometimes was adjacent to or part of a prison system (Sansone 2012).

In the 1850’s, Edward Tilt, MD determined that “the keystone of mental pathology” was the uterus.  The Greek hysterus means ‘womb’, and thus the uterus caused ‘hysteria’. 

By 1870, the surgical procedure of hysterectomy was perfected as a quick method to deal with menopausal complaints.  Surgeons took out not only the uterus, but also the ovaries and the cervix.  

It seems that the hysterectomy is still an ultimate alternative to menopause.  Is this a good thing?  In a 2004 study, it was found that Counseling and a Second Opinion physician determined that 98% of hysterectomies were not needed.  Couple that with a 2010 study that estimated that about 500,000 hysterectomies are performed per year in the USA, such that 40% of all women over age 45 do not have a uterus.  How many of these women are offered or are placed on hormone replacement therapy?  

Should postmenopausal women, including those with Surgical Menopause, take hormones?  For many practicing physicians, this is no longer a professional 'debate', it is a public debate that began with the Women's Health Initiative in 1992.   Today, the issues are clear, as the treatment is individualized.  Stay tuned for more.

As 2013 nears, it is important to understand that menopause is still a taboo subject for many women, in many cultures, and throughout the world.  Women are embarrassed to talk about it, and some clam up when the doctor starts asking questions.  Only after effective rapport is established will some women discuss the subject so that symptoms, time increments, and a proper Medical History can be reported.  Women need to speak freely about the matter, so that the medical field can determine the problem, and work towards a solution for each individual woman.  What is it all about?  Quality of life.  It's a Quality of Life issue.


References:

Body Logic MD. The History of Menopause, 2012. http://www.bodylogicmd.com/hormone-articles/the-history-of-menopause


Buchanan, Paul A.  Wild yam restores sex drive during menopause.  Ezine Articles, 2012. http://ezinearticles.com/?Wild-Yam-Restores-Sex-Drive-During-Menopause&id=7099288


eHow.  How to naturally treat hot flashes and menopausal symptoms, 2012. http://ezinearticles.com/?Wild-Yam-Restores-Sex-Drive-During-Menopause&id=7099288

Foxcroft, L. The mad, mad menopause: Louise Foxcroft charts its fascinating, and sometimes gruesome, history.  April 9, 2009.  http://www.dailymail.co.uk/femail/article-1168710/The-mad-mad-menopause-LOUISE-FOXCROFT-charts-fascinating-gruesome-history-.html#comments

Merck Manual: Diagnosis & Therapy.  New York:  Merck and Co., 1899.


Savage George.  A Lecture on the mental disorders of the climacteric.  The Lancet, 1903.


Singh A., et al.  A historical perspective on menopause and menopausal age.  Bull Indian Inst Hist Med Hyderabad 2002 Jul-Dec; 32(2):121-35.

Speroff L.  Clinical Gynecologic endocrinology and infertility.  6th Edition. Baltimore, MD: Williams and Wilkins; 1999.


Utian WH, et al.  Effect of raloxifine on quality of life: a prospective study using the Utian Quality of Life (UQOL) scale.  Menopause 2004 Jay-Jun:11(3):275-80.