Friday, June 15th 2012
Birth control pills via nateOne on Flickr Creative Commons.
I am slowly working on a book chapter on adolescent hormonal contraception, based on this blog post and conference presentation. I wanted to share some findings for your perusal. I’ve intentionally left out much analysis in favor of keeping things open-ended.
I’ve been curious about whether there are general guidelines out there for medical doctors in prescribing hormonal contraception to girls. Do they discuss the consequences of adult concentrations of hormones on girls’ immature hypothalamic-pituitary-ovarian axis? To the fact that hormonal contraception is almost exclusively tested on adult women in their twenties, thirties and forties? Do they discuss discontinuation rates, side effects?
In my first sweep of the literature, not really.
Today I’ll share with you a document by the CDC entitled U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (this appears to be the most recent version). This is based on the WHO Medical Eligibility Criteria for Contraceptive Use, 4th edition. You can access a copy of this yourself here.
According to its summary statement, the purpose of this document is to “assist health-care providers when they counsel women, men, and couples about contraceptive method choice” (p. 3). They also emphasize later in the document that it is not intended to inform on off-label use, just contraceptive use, of contraceptives. And I do appreciate the existence of this document at all, and the hard work that must have gone into it, from the research that went into the literature, the literature that was reviewed, the experts that made determinations about what constitutes acceptable risk, and the work of putting the whole thing together. I’m glad this exists.
The way this document is organized is that each appendix looks at one type of hormonal contraceptive, and the possible contraindications for taking it if you have a particular characteristic or medical condition. So “age” is a category for some appendices, and sometimes within a characteristic like smoking or condition like migraines, age is a sub-category.
So first, I also want to give the experts on this panel a giant shout-out for the following two statements, in the category “vaginal bleeding patterns:”
On vaginal bleeding patterns: “Irregular menstrual bleeding patterns are common among healthy women.”
On adolescent menstrual cycles: “Menstrual irregularities are common in postmenarche and perimenopause and might complicate the use of [fertility awareness-based] methods.”
Yes, this! This is something many doctors do know, yet somehow it doesn’t always get conveyed to patients… or when it is conveyed to patients, the patients are unsatisfied with the explanation and want a prescription to become “regular.” I would love for all of us to think on what it would take to produce better doctor-patient communication in a way that gets fewer women on hormonal contraception if the only reason they are on it is because they think they need a “regulator.”
Adolescents: We Are More than Our Bone Mineral Density
I read through the “age” sections in each appendix to see what contraindications were expressed, and I put it together in a handy little table for you. Here are the recommendation categories used so that you understand what the table means.
- A condition for which there is no restriction for the use of the contraceptive method.
- A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.
- A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.
- A condition that represents an unacceptable health risk if the contraceptive method is used.
I also searched the document for the following words: girls, juvenile, adolescent, and young. Girls turned up a handful of hits, but only in the references, juvenile did not appear at all, adolescent appeared three times in the document, and young only twice. I’ll share the three adolescent and two young findings.
Page 11: Bone mineral density is lower in adolescent girls using combined hormonal contraceptives, but bone mineral density may not predict postmenopausal fracture risk.
Page 34: Bone mineral density and fracture risk is unknown in adolescents using depo medroxyprogesterone acetate, or Depo Provera.
Page 37: Obese adolescents are more likely to gain weight than nonobese adolescents on depo medroxyprogesterone acetate.
Page 54: I will share this quote on the use of intra-uterine devices, because I think the wording is interesting, as well as the lack of a citation: “Concern exists about both the risk for expulsion from nulliparity and for STIs from sexual behavior in younger age groups.”
Page 77: Younger women are more likely to regret sterilization than older women.
So there you have it. Two discussions of bone mineral density, one on weight gain, one uncited concern about IUD expulsion or STIs, and mention of a study that younger women may regret sterilization.
What do you make of this? What other concerns might an adolescent have who is considering hormonal contraception? What research should be done to better understand this age group? And finally, what would it take to produce recommendations that take into account non-contraceptive uses of hormonal contraception (this seems especially important to me to produce more inclusive criteria that looks at off-label use, but also people with different sexual identities)?
Wednesday, June 6th 2012
Which came first, the chicken or the egg? You have to break a few eggs to make an omelet... oh, forget it. I'm out of cliches. By Public Domain Photos.
Scicurious recently identified exactly where the whole “all scientists need to get off their butts and do outreach” meme sticks in my craw: not only are we overworked, but these behaviors go unrewarded. And in what is so far a very thoughtful comment thread, Katie PhD made the point that this is a chicken and egg problem: we need people to step forward and do outreach, but we also need to make it worth their while… which will only be recognized and understood when more people do outreach. While there are more and more scientists engaging in outreach right now, the majority of the folks doing outreach – at least blog outreach, relevant as this is a blog – are grad students, postdocs, or junior faculty (of course we have some old people grand mentors as well). Danielle Lee suggested that we junior folks are just tired of waiting for the old folks to come around:
“We’re tired of the status quo that can feel unfair, unwelcoming and unappreciative of younger/creative/innovative/inventive talent. Science academia is wanting/expecting each of us to be perfectly adept at doing EVERYTHING perfectly…well everything but having a personal life. And being good Generation X/Y-ers that we are, we’re not buying that crap.
“It’s exhausting and unfair and isn’t getting us/society anywhere. People are still getting left out and excluded from science and new opportunities. It’s not scientists’ fault. We know that; but it is the culture of science’s fault and I sense a culture shift on the horizon.…”
The thinking that I do in this space is incredibly valuable to my development as a scholar, puts me in conversation with anthropologists I may never have otherwise met, and communicates science to a broader audience. Two of my blog posts are in science writing anthologies, a third turned into a manuscript that turned into a journal article that will be out in September, a fourth is being turned into a manuscript over the next few weeks to submit to another peer-reviewed journal. I love the direction my research is going in and the ways in which the mentorship and support I receive among this community bolsters me.
But I’m tired. I share the exhaustion and consternation felt by Sci, Danielle, and others, even while I also share the drive to engage more scientists in outreach. As regular readers may remember, this past year was my third year review for my tenure-track position at the University of Illinois. And it went well. But I do need to, in the words of my committee, “re-budget my time” towards traditional research publications to build the strongest possible case for tenure. I need to write more grants. I need to publish more, and not in the hit-publish-in-Wordpress sort of way.
There was a silver lining. My third year review letter contained language that agreed that my blog constitutes a kind of non-traditional, peer-reviewed writing. The letter applauded my efforts in outreach, over and over again. And so while my next year on the tenure track will surely be focused on my trying to find balance between research, teaching and outreach efforts, I now have written insurance from higher ups at my university that my outreach is considered valuable and aids my path to tenure.
What’s more, in the last year or two the tenure document at the University of Illinois, called Communication Number 9, has been modified to include a public engagement section. This means that our degree of public engagement will be evaluated in the tenure process, alongside our other scholarly efforts. And I think we know that if something counts for tenure, the university values it, and more faculty are going to start doing it.
A critical view of this shift might include the observation that outreach is yet another professional activity for which faculty are not trained, nor are they compensated. This shift did not include an increase in the number of hours in the day, nor a decrease in research or teaching expectations, and so finding time for all of these activities remains a challenge. And at many institutions, an excellent teaching or outreach record will never trump a moderate research record. A critical view of this shift, then, might lead to putting the new tenure requirements through a shredder, or perhaps using it as kindling in one’s wood stove. Of course, I am not saying that I look at these requirements from that particular perspective, oh no. But I am also not saying that these changes particularly ease my own concerns, and we need to push for clearer mentorship and instruction on how to apportion our time and energy rather than accept our job increasing in hours.
It’s still on us, then, to do what we think is right, what fits with our priorities, what makes us happy, and what is most consistent with our view of scholarship. It’s possible that even with the excellent, constructive mentoring I have started to receive from my senior colleagues my “re-budgeting” efforts over the next few years will not be considered substantial enough. I’m not actually worried, yet it’s always possible. But if I haven’t convinced my colleagues by that time that my path is a worthy one, I have made and refined the tools I need to carve out a path somewhere else, and that’s enough for me to keep chipping away at this one right now.
Last year I attended the Purdue Conference for Pre-Tenure Women, and it forced me to acknowledge my impostor syndrome, to confront my fears about radical scholarship, and to take myself seriously enough to have a real plan for tenure (they’ve scheduled next year’s, and yes, you need to go – talk to your department head about at least covering registration if not travel, and tell them I said they are a jerk if they don’t help you out). Go back to that post and read it again. Bring your whole self to your job, have a plan, be a radical. Don’t wait for someone else to carve a path you can follow – you have peer mentors who are carving paths and are just as confused as you are. Take comfort and strength from them. I have also found senior allies by continuing to do my job the way I think it should be done and by being very, very lucky. They provide an added boost when my junior colleagues and I are looking around helplessly for answers.
I take the calls to redefine our work lives from Sci, Danielle, and many others very seriously. Public outreach isn’t about adding more hours to your job. It’s about redefining the hours you have and pushing others to recognize the value you bring to your field – even my own university understands this, perhaps leads on this, given the “re-budgeting” language they used in my third year review. A twenty-first century academic is going to have to cause some discomfort to move twentieth century academia along, and true to our science, I think we can provide empirical evidence of the worth of our paths.
Thursday, May 31st 2012
I’ve accumulated a number of interesting readings over the last few weeks, most related in at least some way to ladybusiness, and I thought I would give my readers a chance to procrastinate too.
Parenting
- PhD in Parenting: 4 Ways Parents Can Help Break Down Society’s Gender Assumptions. This is the fourth in a four-part series on society, gender and kids. Annie does a great job being thoughtful about where parents can intervene, and how to have a healthy perspective on what we can and cannot do about kids’ need to conform. As a parent to a four year old girl, I’ve got a bit of a post related to these topics brewing myself.
- Geek Mom: Mayim Bialik, You Disappoint Me. Marziah explains what it means to be a role model, and the difference between passive, personal beliefs and pushing them on others. A post I hope Bialik reads before continuing to promote not vaccinating her children.
Delight in science
Boobs
- Big Think Blog: “Breast” Behavior: A Q&A with Katie Hinde. Kayt Sukel interviews brilliant lactation biologist Katie Hinde (I can say this because she is a friend and book co-editor, and also because it is true). Katie shares her perspective on the current breastfeeding Mommy Warz.
- The Primate Diaries: Out of the Mouth of Babes. Eric Michael Johnson also covers this current topic, providing some comparative depth by looking at some of our primate relatives and their breastfeeding practices. Nathaniel Gold also made the fantastic chimpanzee Time cover.
Don’t look away (for two very different reasons)
- Wine & Bowties: Where Children Sleep. Provocative, often jarring images of the conditions in which children across the world sleep.
- Io9: The mouth of a child is a terrifying thing to behold. Am I weird that I found this picture fascinating? I can’t wait to show this to my kid, because she is really interested in teeth right now. Oh, before you click, I should tell you it’s the skull of a small child with part of the jaw cut away so you can see the adult teeth sitting on top of the baby teeth, ready to descend.
Feminism
