Belly Tales

A friend of a friend recently asked me a question that I couldn’t answer. She is in her late 30s, has a two year old daughter, and has been breastfeeding on demand for the past two years. She and her husband have been trying to have another child, but she just recently learned that she miscarried after their first attempt. She has only recently started getting her period again, and was wondering if the breastfeeding could negatively impact her body’s ability to get pregnant again. I speculated that the high levels of prolactin which occur during breastfeeding might inhibit ovulation, just as high levels of estrogen inhibit breastmilk supply by competing with prolactin for binding sites in breast tissue, but I told her I wasn’t really sure and that I would investigate. I thought that somehow estrogen and prolactin were counter opposites: one could not exist in high levels while the other was around. Turns out I was waaaaay off base. Here’s what I found:

During pregnancy, the corpus luteum, acting on instructions from the placenta, secretes the estrogen and progesterone necessary to maintain the pregnancy. These high levels of steroid hormones simultaneously supress Follicle Stimulating Hormone (FSH) and Leutenizing Hormone (LH), the two hormones most responsible for ripening an egg and then triggering ovulation—after all, if you’re already pregnant, there’s no need to ovulate. After delivery, once the placenta is removed, the high levels of estrogen and progesterone no longer exist, and the levels of FSH and LH gradually begin to rise again, preparing the body for ovulation. Eventually, as the levels creep up, the pituitary takes notice again, and begins to release more FSH and LH through a negative feedback loop, which eventually will trigger ovulation.

“Most nonlactating women resume menses within 4 to 6 weeks of delivery, but about one-third of the first cycles are anovulatory, and a high proportion of first ovulatory cycles have a deficient corpus luteum that secretes sub-normal amounts of steroids. In the second and third menstural cycles, 15% are anovulatory and 25% of ovulatory cycles have luteal-phase defects…Lactation, or breastfeeding, further extends the period of infertility and despresses ovarian function. Plasma levels of FSH return to normal follicular phase values by 4 to 8 weeks postpartum in breastfeeding women. In contrast, pulsatile LH stimulation is depressed…in the majority of lactating women throughout most of the period of lactational amenorrhea.” [1]

In other words, after not menstruating for so many months, it takes the body a few tries to get the delicate hormone balance back up to speed again. The first few cycles either don’t release an egg, or if an egg is released, the corpus luteum, which is responsible for secreting enough progesterone to maintain the pregnancy until the placenta can take over, isn’t quite up to the task. This is called a luteal phase defect, and it’s a very common cause of early miscarriages. In women who are breastfeeding, the process of returning to normal ovarian cycles takes even longer.

In breastfeeding women, FSH, the hormone responsible for ripening an egg, returns to normal pre-pregnancy values fairly early, but LH, the hormone responsible for triggering egg release, continues to be surpressed due to the breastfeeding. (However, contrary to popular belief, prolactin is not at all responsible for this supression. It’s the constant suckling and stimulation of the nipple itself which actually suppresses ovarian function, which is why on demand breastfeeding is so essential to maintaining lactational amenorrhea.)

So, there you have it. To answer the question: it will probably just take a few more cycles for your body to get back into full swing in terms of ovulating, but continued breastfeeding did not contribute or cause the miscarriage in any way, and will not prevent conception. Most likely, the miscarriage was caused by a short luteal phase or corpus luteum that just wasn’t quite ready to maintain a pregnancy, and this will no longer be a problem once your body goes through a few more cycles and gets used to ovulating again.

[1] Hatcher, R.A. et. al. (2004) Contraceptive Technology, 18th Revised Edition. Ardent Media, Inc.: New York.

We’ve been talking so much about menstruation lately that it seems only natural that the subject of alternative menstrual gear would come up at some point. In fact, just last week we were talking about it after class one day, and I ended up bringing my Keeper to school with me to show to a few curious classmates. Frankly, it’s high time that this website had a position statement on alternative menstrual gear. This is something I believe very strongly in, and something I have personally been using for several years now, and it seems just plain Wrong that I haven’t been talking it up something fierce on my own website already. So, enough is enough. Time to spread the good word.

The word goes something like this: About five years ago, I was broke (notice how much has changed in the intervening five years!). I had recently befriended a woman who lived in my neighborhood, and one evening, while hanging out at her house, I noticed that she had a bunch of terry cloth pads laid out next to her sewing machine, made from a cut-up bath towel. When I asked her what they were for, she introduced me to the concept of alternative, reuseable menstrual gear. I was, to put it mildly, a bit flabbergasted. Keep in mind, I was a good girl from the midwest, who’d only been living in New York City for two years at that point, and still hadn’t fully lost my shy, midwestern ways. The message that our society sadly pounds into the skulls of young women (myself included) is that your period is dirty, something that needs to be kept secret and “sanitary”, and most definitely hidden from others. As girls, we’re taught that menstruation is an unfortunate part of growing up, a curse, or at the very least, a major, monthly pain in the ass—something that needs to be tolerated and dealt with, but rarely something that should be celebrated and enjoyed. As part of our induction into womanhood, we’re inundated with ads from the feminine “hygiene” industry, promoting the benefits of this product over that, and encouring the idea that the selection of a feminine hygiene brand is an important rite of passage. All of this just compounds the sense of shame and embarrassment that so many of us feel about our bodies—magazines are full of ways for us to “fix” our bodies, lose weight and attract the man of our dreams by wearing the right clothes and smelling the right way. Commercials for pads and tampons rave about how fresh, clean and discrete their products are. Douches urge us to “cleanse” our (naturally dirty?) vaginas so that they’re strawberry-scented or flower-fresh (and cause untold infections in the process through drastic vaginal flora disruption).

The feminine hygiene industry is a billion dollar industry that feeds off of women’s insecurities and doubts, and has us all suckered into the idea that spending $200 on menstrual products a year is just an unavoidable part of being a woman. Let me put it this way: do you think men would spend $200 a year on hygiene products if they too had an unavoidable monthly biological process that was part of their healthy life-cycle? I’m guessing not. If men had menstrual cycles, I bet health insurance companies would have started covering the expense of their supplies long ago, since, after all, these products would be essential to the health of the insured, same way insurance companies will pay for prenatal vitamins, or the needles and glucometers of diabetics. Why should women be expected to pay out-of-pocket for something that’s part of their yearly health and wellness? (This is somewhat similar to the “logic” used when health insurance companies will pay for viagra, but refuse to cover birth control…but that’s a rant I’ll save for another day). Women have been using cloth for centuries. It’s only very recently that we’ve been expected to pay every month for the pleasure of bleeding onto pearly white, cotton pads.

One woman, in her lifetime, will go through close to 11,000 pads or tampons. That’s a huge amount of uneeded waste going straight to the landfill. The women on this earth account for 51% of the population. If all of us use 11,000 pads in our lifetimes…that’s gotta be a landfill the size of Australia! It’s worth switching to re-useable products for that reason alone, but wait, there’s more: disposable pads suck! Not only do they take up way too much space, and get tossed out after only a few hours of use, but the packaging that comes with the products (the boxes and applicators) are also nothing but landfill fodder, and often end up washing up on beaches. While the FDA assures us that tampon companies no longer use chlorine-bleaching processes to get those pure, snow-white results they’re looking for, this was a practice that was used for decades before the FDA recently outlawed it, and untold amounts of toxic dioxins have been released into our environment because of it, disrupting ecosystems and bioaccumulating in lakes and rivers. (The FDA was also very quick to dismiss the idea that the dioxins in tampons can cause TSS or possibly cancer, but even without the dioxins, tampons are still perfectly capable of causing TSS on their own, just by being such a lovely, squidgy vector for bacteria and infetion). Sadly, dioxin is a very persistent chemical, and even though companies now use chlorine-free bleaching processes, the damage has already been done. Our children and grandchildren will be drinking and eating trace amounts of dioxin in their water and food for decades to come, thanks to the toxic feminine hygiene industry. And I ask you this: why is it necessary that the cotton and rayon of pads and tampons be bleached in the first place? They’re not sterile products that are used for surgery or wounds; they don’t have to be bleached.

Anyway, to make a long story short, my initial reaction to my friend’s cotton pads was “eeewwww!!”, however, it didn’t take long for her arguments to make sense to me: 1) I was broke, and the idea of saving $200 a year not spending that money on pads was very appealing, and 2) I have always been trying to find ways to make my environmental footprint on this earth a little bit lighter, and using cloth pads seemed like a really simple thing to change, which actually has a very large cumulative impact. So I purchased a starter kit of reuseable cloth pads to take care of all my monthly needs and voila!, I was hooked. I’ll let others extol the virtues of free-bleeding, but for my own part, there was something deliciously empowering about taking this aspect of my life out of commercial, profit-driven hands, and into my own capable, human hands. There was also something immensely satisfying about blowing raspberries at the TV screen whenever an ad for tampons came on, and feeling smug and pleased with the knowledge that while other women spent money on pads every month, I didn’t! Course, this method required a certain non-squeamishness when it came to blood, and a willingness to wear heavy cloth pads in my underwear once a month (which did, I must admit, feel like I had a phone book between my legs every now and then), and of course I had to soak them and launder them appropriately. For about two years, this routine suited me just fine (and cloth pads are great, and continue to work well for millions of women around the world)…but then…THEN…I discovered the joys of the Keeper.

Believe me, once I was finally sold on the beauty and sustainability of cloth pads, I was a true-blue, born-again convert, however, I have found that I prefer the Keeper to cloth pads, which means that in my book, it’s really very VERY good. This little cup is a latex product that fits inside of your vagina and functions a lot like an OB tampon, collecting your menstrual flow without drying out your vaginal walls. It requires insertion with your fingers, and periodic emptying (your collected flow can be conveniently emptied into the toilet, then the Keeper can be wiped off and reinserted); I must admit, it does take a little bit of effort to learn how to get it in and out, but once you master it, this is by far the easiest form of menstrual protection I have ever used, AND it’s ecologically friendly, sustainable, reuseable, and relatively cheap, given that you only have to buy one, and then you’re set for the next 10 years. Another beauty of using a menstrual cup is the fact that you don’t have to change your cup nearly as often as you have to change a tampon. On light days, towards the end of my bleeding cycle, I can happily put my Keeper in during my morning shower, and leave it in all day, and forget that it’s even there. And then, at the end of your cycle, all you have to do is wash it out with antibacterial soap, let it soak overnight in a bowl of water mixed with a tablespoon of hydrogen peroxide, white vinegar or tea tree oil, and that’s it. So, for those of you who like functionality of tampons (and the lack of phone-book-between-your-legs), but would also like to stop feeding the fat purse of the toxic feminine hygiene industry, and do our planet a major favor, a menstrual cup is definitely the way to go. The Mooncup and Divacup are also every bit as fantastic as the Keeper, they’re just made out of silicone instead of latex, so for those of you with latex allergies, rest assured, there are menstrual cups out there for you, too!

That’s pretty much the end of my schpiel. I know that what works for some women certainly won’t work for all women, but I urge you to think about your menstrual choices. Once you start using alternative methods, you begin to wonder why you ever needed a 7th-grade introduction to feminine hygiene products in the first place. I started using alternative methods about five years ago, and I haven’t once looked back.

For further reading:

The Wise Wound by Shuttle, Redgrove & Drabble.

The Woman in the Body by Emily Martin.

The curse, the red tide, my period, my monthly, my friend, on the rag, on the spurt, and on and on. All the jokes, all the whining, all the bitching, all the unfair media portrayal, the cultural stigma, the fear, the shame…menstruation gets such a bad rep that, at the very least, I felt it deserved to be paired with a word like “magical” for a refreshing change of pace, if for no other reason than its very complexity. Do you have any idea how many hormones are involved in your monthly menstrual cycle? Take a guess: 2 hormones? 3? 4? I can’t even tell you. Our lecture today covered the ups and downs of the 5 major hormones that are involved, but the lecturer kept slipping in little comments like: “and of course, prostaglandins, and inhibin, and [insert other hormone names that I wasn't even able to catch] also play a part, but I’m not going to get into that today.” Damn straight it’s magical. It’s absolutely amazing! If we ever tried to reproduce the entire cycle in a laboratory setting, there’s no way in hell we’d ever be able to get it right. Do you have any idea how many things are all happening at once? It’s a bit mind boggling.

Mind-boggled. Yup, that’s pretty much how I feel right now. This semester is going to be a TON of work. I have so much on my plate already that I don’t even know where to start (hence, this delightful post: why start in on your homework when you can procrastinate and post to your blog instead?). And as for the menstrual cycle…this is something we studied in nursing school, and I had a hard time grasping it then. This is something I’m going to have to go over again and again and again until I know it forward and backwards, because it’s so damn important (and so damn complex). This is the reason and the beginning, the why and the how, of pregnancy. The hypothalamic-pituitary-ovarian axis, the follicular phase, the proliferative phase, the secretory phase, the luteal phase…all these names for something that your body does automatically, naturally, without fuss and often with very few mistakes, every single month for most of your adult life.

Lecture today was great. The guest lecturer was smart and sassy and a lot of fun—material that could have been really boring was actually made fascinating, which says a lot. And lots of little fun facts tossed in for good measure. For example, did you know that bleeding is not actually necessary at all during the cycle if you’re on birth control? Because of the presence of progesterone from the very beginning of the cycle, the lining of the endometrium doesn’t ever proliferate very much at all, but just stays steady at about 2 mm of development, and can stay that way for quite some time, if you ever want to just go through a few pill packs back to back and skip the week of placebos that allow for bleeding. In fact, apparently the only reason the placebo week was structured into the pill cycle was because of a decision made by a very Catholic man in the 1950s, who felt that monthly bleeding was necessary in order to help remind women of Eve, and the fact that they’re women, I guess. There’s a new pill out now that will charge you an arm and a leg for the privilege of only bleeding four times a year (Seasonale), but you might as well save some money and just take your regular pills back to back (although talk to your midwife/health care provider about it first, of course).

Another interesting fun fact: the Morning After Pill (aka EC or Emergency Contraception) really truly IS birth control, and not an abortifacient, and yes, I already knew this, but now I understand why. EC is basically just pure progesterone, and it works best during the follicular phase of the cycle, where the sudden burst of incoming progesterone is enough to prevent the release of leutenizing hormone that triggers ovulation. In other words, EC works best if it’s taken before ovulation occurs, in order to prevent ovulation. However, if ovulation has already occurred, the surge in progesterone may slow down fallopian tube motility and therefore possibly prevent implantation (in which case, I guess I could see how conservatives could potentially argue that this prevention of implantation is in fact the killing of a baby, but I do think it’s a rather thin argument). However, the little fun fact I didn’t realize is this: as soon as you’re pregnant (i.e., as soon as the trophoblast has implanted), the corpus luteum begins to make progesterone in vast quantities, and if you happen to take EC at this point in the cycle, it won’t disturb or prevent the pregnancy in any way whatsoever. In other words, if you’re already pregnant (i.e., the trophoblast has already implanted), EC does not end or harm your pregnancy in any way. In other words, it’s NOT an abortifacient. As soon as that trophoblast implants, the corpus luteum is working its ass off to produce massive amounts of progesterone anyway just to keep the pregnancy afloat until the placenta can take over hormone duty; a little extra squirt of EC progesterone at this time does NOTHING to disrupt this. FYI. (Why do I feel that if more people actually understood how EC worked, so many of the objections to it would just disappear, and the FDA might finally get around to approving it for over-the-counter use? Righto. Get the word out, ladies.)