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Blog for the University of Illinois Laboratory for Evolutionary Endocrinology. We discuss academic life, goings on in the lab, and current research.

Kate Clancy
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April 12, 2011
04:15 AM
404 views

LabEvoEndo Journal Club: Dana Ahern presents on PMDD

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This is the third guest post of the LabEvoEndo Journal Club, a new series for the LabEvoEndo blog meant to highlight student contributions to the lab (first post here, second post here). The author is Honors Anthropology Junior Dana Ahern. Dana has been in my lab since her sophomore year.

* * *
I’d like to start this blog post with a little background on progesterone. Progesterone is fascinating and it affects a lot more than just the menstrual cycle. We are starting to understand just how big of an impact progesterone has, and the research project I am working on is beginning to show some of the potential applications of progesterone in medicine. These applications include improving recovery time after traumatic brain injury and strokes, as well as helping us understand postpartum depression (PPD) and premenstrual dysphoric disorder (PMDD).

PMDD is similar in mechanism with postpartum depression, although the exact mechanism is still being researched. Some research suggests a hormonal influence, as allopregnanolone, an offshoot neuroregulator of progesterone, modulates GABA, which is a neurotransmitter related to mood and anxiety. Too much GABA results in increased anxiety and mood related issues, so it is a logical conclusion that the drop in progesterone during the late luteal phase of the menstrual cycle would result in excess GABA and therefore symptoms of PMDD.

The article we discussed looked at PET scans of 12 women with and 12 women without a diagnosis of PMDD, taking scans during the follicular phase and the late luteal phase of their menstrual cycles. The women in the study were screened for two months with mood surveys and then taken in for a day of PET scans and blood/urine samples, once during the follicular phase and once during the late luteal phase, when the symptoms of PMDD would have begun. PMDD can affect certain brain functions, so they were using the PET scan to detect brain dysfunction, such as one study the article looked at that showed frontal lobe dysfunction associated with PMDD.

The hormone measurements didn’t show anything significant and PET scans showed increased cerebellum activity from follicular to late luteal phase in PMDD women only. The cerebellum has many GABA receptors, which is a possible explanation of this, but in journal club, we wondered if it is the lack of modulation after a drop in the progesterone, or if there is something going on with the number of receptors, such as perhaps some sort of diminished sensitivity to allopregnanolone.

In journal club, we discussed some of the problems we had with this study. Someone brought up the small sample size and too few collection times for samples and scan. The fact that only one cycle was measured impacted the study. Kate also mentioned that blood hormones are a less useful measure than salivary hormone measurements. Finally, while the article states that the cause of PMDD is an overactive cerebellum in women suffering from PMDD, they never really reach a definite reason for what is causing the increased action. Ultimately, the article would have benefitted from examining the hormones more closely and more often.

Reference

Rapkin AJ, Berman SM, Mandelkern MA, Silverman DH, Morgan M, & London ED (2011). Neuroimaging evidence of cerebellar involvement in premenstrual dysphoric disorder. Biological psychiatry, 69 (4), 374-80 PMID: 21092938This post was written by Kathryn Clancy for the Laboratory for Evolutionary Endocrinology Blog. Except as noted, it is (C)Kathryn Clancy and licensed under a Creative Commons License. The opinions on this blog are the opinions of the blog author only, not the author's employer or colleagues.... Read more »

Rapkin AJ, Berman SM, Mandelkern MA, Silverman DH, Morgan M, & London ED. (2011) Neuroimaging evidence of cerebellar involvement in premenstrual dysphoric disorder. Biological psychiatry, 69(4), 374-80. PMID: 21092938

April 4, 2011
12:03 PM
594 views

LabEvoEndo Journal Club: Sophia Bodnar presents on cervical cancer

by Kate Clancy in Laboratory for Evolutionary Endocrinology

Student blogging on cervical cancer and immunology, particular in understanding variation in cytokines, chemokines, and proportions of columnar vs squamous cervical cells.... Read more »

Hwang LY, Scott ME, Ma Y, & Moscicki AB. (2011) Higher levels of cervicovaginal inflammatory and regulatory cytokines and chemokines in healthy young women with immature cervical epithelium. Journal of reproductive immunology, 88(1), 66-71. PMID: 21051089

March 24, 2011
03:21 PM
560 views

LabEvoEndo Journal Club: Laura Klein presents on food allergies

by Kate Clancy in Laboratory for Evolutionary Endocrinology

Undergraduate Laura Klein reviews an article on food allergies.... Read more »

Christie L, Hine RJ, Parker JG, & Burks W. (2002) Food allergies in children affect nutrient intake and growth. Journal of the American Dietetic Association, 102(11), 1648-51. PMID: 12449289

Fernandez-Rivas, M, & Miles, S. (2007) Chapter 1. Food allergies: Clinical and Psychosocial Perspectives. Plant Food Allergens. info:/

January 31, 2011
03:40 PM
397 views

Iron-deficiency is not something you get just for being a lady

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This post uses literature review, my own empirical research, and a new paper to demonstrate that menstrual cycling does not impact iron status in women. This goes against a major, prevailing medical notion and inhibits appropriate diagnosis in anemic women.... Read more »

Bergström E, Hernell O, Persson LA, & Vessby B. (1995) Serum lipid values in adolescents are related to family history, infant feeding, and physical growth. Atherosclerosis, 117(1), 1-13. PMID: 8546746

Clancy, K., Nenko, I., & Jasienska, G. (2006) Menstruation does not cause anemia: Endometrial thickness correlates positively with erythrocyte count and hemoglobin concentration in premenopausal women. American Journal of Human Biology, 18(5), 710-713. DOI: 10.1002/ajhb.20538

Kepczyk, M. (1999) A prospective, multidisciplinary evaluation of premenopausal women with iron-deficiency anemia. The American Journal of Gastroenterology, 94(1), 109-115. DOI: 10.1016/S0002-9270(98)00661-3

Miller EM. (2010) Maternal hemoglobin depletion in a settled northern Kenyan pastoral population. American journal of human biology : the official journal of the Human Biology Council, 22(6), 768-74. PMID: 20721981

January 4, 2011
03:51 PM
470 views

Around the web: cognitive sex differences

by Kate Clancy in Laboratory for Evolutionary Endocrinology

A dissection and link round-up about cognitive sex differences.... Read more »

Connellan, J. (2000) Sex differences in human neonatal social perception. Infant Behavior and Development, 23(1), 113-118. DOI: 10.1016/S0163-6383(00)00032-1

Hyde, J. (2005) The Gender Similarities Hypothesis. American Psychologist, 60(6), 581-592. DOI: 10.1037/0003-066X.60.6.581

October 6, 2010
04:10 PM
421 views

My IVF story: after conception, being preggers

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This is the second of a four part series on IVF, pregnancy and labor.... Read more »

Davidson, R., Roberts, S., Wotton, C., & Goldacre, M. (2010) Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study. BMC Pulmonary Medicine, 10(1), 14. DOI: 10.1186/1471-2466-10-14

Decker, E., Engelmann, G., Findeisen, A., Gerner, P., Laass, M., Ney, D., Posovszky, C., Hoy, L., & Hornef, M. (2010) Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children. PEDIATRICS, 125(6). DOI: 10.1542/peds.2009-2260

de Groot LC, Boekholt HA, Spaaij CK, van Raaij JM, Drijvers JJ, van der Heijden LJ, van der Heide D, & Hautvast JG. (1994) Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy. The American journal of clinical nutrition, 59(4), 827-32. PMID: 8147326

Johnstone, F., Prescott, R., Steel, J., Mao, J., Chambers, S., & Muir, N. (1996) Clinical and ultrasound prediction of macrosomia in diabetic pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology, 103(8), 747-754. DOI: 10.1111/j.1471-0528.1996.tb09868.x

Roduit, C., Scholtens, S., de Jongste, J., Wijga, A., Gerritsen, J., Postma, D., Brunekreef, B., Hoekstra, M., Aalberse, R., & Smit, H. (2009) Asthma at 8 years of age in children born by caesarean section. Thorax, 64(2), 107-113. DOI: 10.1136/thx.2008.100875

August 31, 2010
01:47 PM
500 views

Adolescent Menstrual Variation and Oral Contraceptives

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This post reviews current knowledge about adolescent menstrual cycling and oral contraceptive use, making recommendations for future research.... Read more »

American Academy of Pediatrics Committee on Adolescence, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, & Breech LL. (2006) Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics, 118(5), 2245-50. PMID: 17079600

Andrist LC, Arias RD, Nucatola D, Kaunitz AM, Musselman BL, Reiter S, Boulanger J, Dominguez L, & Emmert S. (2004) Women's and providers' attitudes toward menstrual suppression with extended use of oral contraceptives. Contraception, 70(5), 359-63. PMID: 15504373

APTER, D. (1997) Development of the Hypothalamic-Pituitary-Ovarian Axis. Annals of the New York Academy of Sciences, 816(1 Adolescent Gy), 9-21. DOI: 10.1111/j.1749-6632.1997.tb52125.x

Christo, K., Cord, J., Mendes, N., Miller, K., Goldstein, M., Klibanski, A., & Misra, M. (2008) Acylated ghrelin and leptin in adolescent athletes with amenorrhea, eumenorrheic athletes and controls: a cross-sectional study. Clinical Endocrinology, 69(4), 628-633. DOI: 10.1111/j.1365-2265.2008.03237.x

Cromer BA, Bonny AE, Stager M, Lazebnik R, Rome E, Ziegler J, Camlin-Shingler K, & Secic M. (2008) Bone mineral density in adolescent females using injectable or oral contraceptives: a 24-month prospective study. Fertility and sterility, 90(6), 2060-7. PMID: 18222431

El-Khayat, H., Soliman, N., Tomoum, H., Omran, M., El-Wakad, A., & Shatla, R. (2008) Reproductive hormonal changes and catamenial pattern in adolescent females with epilepsy. Epilepsia, 49(9), 1619-1626. DOI: 10.1111/j.1528-1167.2008.01622.x

GERSCHULTZ, K., SUCATO, G., HENNON, T., MURRAY, P., & GOLD, M. (2007) Extended Cycling of Combined Hormonal Contraceptives in Adolescents: Physician Views and Prescribing Practices. Journal of Adolescent Health, 40(2), 151-157. DOI: 10.1016/j.jadohealth.2006.09.013

Morimatsu, Y., Matsubara, S., Watanabe, T., Hashimoto, Y., Matsui, T., Asada, K., & Suzuki, M. (2009) Future recovery of the normal menstrual cycle in adolescent patients with secondary amenorrhea. Journal of Obstetrics and Gynaecology Research, 35(3), 545-550. DOI: 10.1111/j.1447-0756.2009.01014.x

Omar H, Kives S, & Allen L. (2005) Extended use of the oral contraceptive pill--is it an acceptable option for the adolescent?. Journal of pediatric and adolescent gynecology, 18(4), 285-8. PMID: 16171734

Singer, K., Rosenthal, A., & Kasa-Vubu, J. (2009) Elevated Testosterone and Hypergonadotropism in Active Adolescents of Normal Weight with Oligomenorrhea. Journal of Pediatric and Adolescent Gynecology, 22(5), 323-327. DOI: 10.1016/j.jpag.2008.12.010

August 3, 2010
04:50 PM
408 views

Which is more safe: home birth or hospital birth?

by Kate Clancy in Laboratory for Evolutionary Endocrinology

An anthropologist's take on the current AJOG article and Lancet editorial on home birth and infant mortality... Read more »

Wax, J., Lucas, F., Lamont, M., Pinette, M., Cartin, A., & Blackstone, J. (2010) Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2010.05.028

Editorial staff. (2010) Home birth--proceed with caution. Lancet, 376(9738), 303. PMID: 20674705

February 26, 2010
04:34 PM
423 views

Premenstrual syndrome: understanding origin and variation

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This post explains variation in behavior through the menstrual cycle, hormonal variation, and problematizes the assumption that progesterone withdrawal explains premenstrual syndrome.... Read more »

Beckley EH, & Finn DA. (2007) Inhibition of progesterone metabolism mimics the effect of progesterone withdrawal on forced swim test immobility. Pharmacology, biochemistry, and behavior, 87(4), 412-9. PMID: 17597197

Brinton RD, Thompson RF, Foy MR, Baudry M, Wang J, Finch CE, Morgan TE, Pike CJ, Mack WJ, Stanczyk FZ.... (2008) Progesterone receptors: form and function in brain. Frontiers in neuroendocrinology, 29(2), 313-39. PMID: 18374402

Gracia CR, Freeman EW, Sammel MD, Lin H, Sheng L, & Frye C. (2009) Allopregnanolone levels before and after selective serotonin reuptake inhibitor treatment of premenstrual symptoms. Journal of clinical psychopharmacology, 29(4), 403-5. PMID: 19593190

Maguire, J., & Mody, I. (2008) GABAAR Plasticity during Pregnancy: Relevance to Postpartum Depression. Neuron, 59(2), 207-213. DOI: 10.1016/j.neuron.2008.06.019

Monteleone, P. (2000) Allopregnanolone concentrations and premenstrual syndrome. European Journal of Endocrinology, 142(3), 269-273. DOI: 10.1530/eje.0.1420269

Nappi, R. (2001) Serum allopregnanolone in women with postpartum “blues”. Obstetrics , 97(1), 77-80. DOI: 10.1016/S0029-7844(00)01112-1

Chapman, J., McIntyre, M., Lipson, S., & Ellison, P. (2009) Weight change and ovarian steroid profiles in young women. Fertility and Sterility, 91(3), 858-861. DOI: 10.1016/j.fertnstert.2007.12.081

ELLISON, P. (1993) Population variation in ovarian function. The Lancet, 342(8868), 433-434. DOI: 10.1016/0140-6736(93)92845-K

Ellison PT, Panter-Brick C, Lipson SF, & O'Rourke MT. (1993) The ecological context of human ovarian function. Human reproduction (Oxford, England), 8(12), 2248-58. PMID: 8150934

Jasieńska G, & Ellison PT. (1998) Physical work causes suppression of ovarian function in women. Proceedings. Biological sciences / The Royal Society, 265(1408), 1847-51. PMID: 9802241

Lager, C., & Ellison, P. (1990) Effect of moderate weight loss on ovarian function assessed by salivary progesterone measurements. American Journal of Human Biology, 2(3), 303-312. DOI: 10.1002/ajhb.1310020312

Panter-Brick C, & Ellison PT. (1994) Seasonality of workloads and ovarian function in Nepali women. Annals of the New York Academy of Sciences, 234-5. PMID: 8154716

Rosetta L, Harrison GA, & Read GF. (1998) Ovarian impairments of female recreational distance runners during a season of training. Annals of human biology, 25(4), 345-57. PMID: 9667360

Cénac A, Maikibi DK, & Develoux M. (1987) Premenstrual syndrome in Sahelian Africa. A comparative study of 400 literate and illiterate women in Niger. Transactions of the Royal Society of Tropical Medicine and Hygiene, 81(4), 544-7. PMID: 3445335

Chaturvedi SK, & Chandra PS. (1991) Sociocultural aspects of menstrual attitudes and premenstrual experiences in India. Social science , 32(3), 349-51. PMID: 2024146

Marván ML, Díaz-Erosa M, & Montesinos A. (1998) Premenstrual symptoms in Mexican women with different educational levels. The Journal of psychology, 132(5), 517-26. PMID: 9729845

O'hara, M., & Swain, A. (1996) Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry, 8(1), 37-54. DOI: 10.3109/09540269609037816

July 23, 2009
12:02 PM
570 views

What does this anthropologist think about hormonal birth control? Part V

by Kate Clancy in Laboratory for Evolutionary Endocrinology

Last part in five part series on hormonal contraception, population variation, cultural conditioning, and behavior.... Read more »

Huang C, & Sedlack DL. (2001) Analysis of estrogenic hormones in municipal wastewater effluent and surface water using ELISA and GC/MS/MS. Environmental Toxicology and Chemistry, 20(1), 133-139.

July 20, 2009
03:51 PM
687 views

What does this anthropologist think about hormonal birth control? Part IV

by Kate Clancy in Laboratory for Evolutionary Endocrinology

This is part IV of V of my series on hormonal contraception. Please also see parts I, II, and III.Behavior and cognitionIn western culture, media, commercials, and magazines, the menstrual cycle is almost universally considered to be negative. Pharmaceutical companies advertise pills to improve mood, from SaraFem (this was another name for Prozac, targeted just to women), to Midol, to the new hormonal contraceptive Yaz (which has recently gotten in trouble for the way they promoted their mood improvement, if you look at their new ads). Different tampons and pads are advertised to reduce discomfort, improve sleep, reduce smell or the possibility of being ‘discovered.’That’s not to say there aren’t some at least moderately positive portrayals of menses: the coming-of-age feeling that comes with the first period, the relief that comes from getting a late period after a pregnancy scare. And if you can think of other positive portrayals, please do share them in the comments. That said, it’s no surprise that most people who study periods study it from a negative perspective. They tend to look for negative mood disturbances, for incidences of PMS, for variations in PMS or PMDD symptomology. Most of the studies I’ve read over the years have negative mood or stress questionnaires (like the Moos Menstrual Distress Questionnaire); they often preempt women to confirm symptoms by providing them with a list. Very few of them attempt to discover variation in positive emotions through the menstrual cycle.Notable examples to this are Emily Martin’s book The Woman in the Body (1980) and a smattering of articles. In 1994, Walker was interested in dispelling the notion that women’s experiences of their menstrual cycle had little cycle-to-cycle variation, and that these experiences were negative. What she found was that most women experience significant cycle-to-cycle variation, which she says means that hormones explain only a small amount of the variation in mood (Walker 1994). Walker also found more positive mood at midcycle and more negative mood premenstrually and menstrually. Brown et al (2008) also found increased positive well-being at midcycle. There is other evidence that menstrual cycle phase does not strongly predict mood: Mansfield et al (1989) found that women’s negative mood and arousal were more strongly predicted by the day of the week than menstrual cycle phase – negative mood and arousal decreased on weekends. I don’t know that I have enough information to agree or disagree with Walker’s conclusion that hormones explain a very small portion of mood, but I do think that hormones are important, and cultural conditioning is important. Which one is more important may not be as relevant to this discussion as just noticing that we need to pay attention to both. How do reproductive hormones impact behavior and cognition, if they do at all? Unfortunately, there just isn’t enough evidence for me to be comfortable with sharing much of an answer. There are potential mechanisms aplenty, particularly regarding estrogens. Shively and Bethea (2004) review monkey literature and, while they find consistent results regarding estrogen-cognition-mood relationships, they temper this finding because the sample sizes of most of the studies reviewed were quite small. Further, most of the studies involve inducing menopause, which means they are comparing monkeys essentially with and without estrogen, rather than measuring cognitive differences in monkeys with naturally occurring variation; this would be far more useful if we are at all interested in premenopausal women.The next question to ask is, what do we know of any impacts oral contraceptives may have on behavior or cognition? And again, the answer isn’t too satisfying. Brown et al (2008) found women on hormonal contraception reported more negative well-being than non-contracepting women. Walker (1994) found that the cycle-to-cycle variability she found in non-contracepting women was significantly reduced in contracepting women. Bancroft and Sartorius (1990) found significant variation in improvement or deterioration of libido on oral contraceptives: libido seemed to depend on which type of hormonal contraception, but results were also complicated by the fact that they found women who had negative experiences of hormonal contraception tended to stop using them, creating a data set that appeared more satisfied with their prescriptions than perhaps was the case. Joffe et al (2003) found that women with a history of depression were more likely to experience complications with contraceptives, and those with the potential to get early-onset premenstrual mood disturbance or dysmenorrhea saw an improvement. Finally, women who use both a barrier method and hormonal contraception report much higher sexual satisfaction than condom-only or hormone-only users (and in fact, hormone-only users had the lowest satisfaction) (Higgins et al. 2008).Where does this put us? Well, the relationships between hormones and mood and cognition are very complicated, and hormones only constitute part of the process. Culture, personality, heck, even day of the week is important. That said, the few results we have on oral contraceptives do seem to indicate that they have an impact on mood – some of this may be physiological, but some, such as the improvement in sexual satisfaction by dual users in the Higgins et al (2008), are more likely related to the calm afforded by feeling doubly protected from pregnancy rather than an effect of the estrogens or progestins. I would like to see further study on natural cycles and contracepting cycles on all sorts of behavioral and cognitive factors, and should oral contraceptives prove to negatively impact any of them, this should be a labeled side effect.My final part of the series will briefly discuss my own opinion on hormonal contraceptives, as well as information on other contraception options available.ReferencesBancroft J, & Sartorius N (1990). The effects of oral contraceptives on well-being and sexuality Oxford Reviews of Reproductive Biology, 12, 57-92 DOI: 2075004Brown, S., Morrison, L., Larkspur, L., Marsh, A., & Nicolaisen, N. (2008). Well-Being, Sleep, Exercise Patterns, and the Menstrual Cycle: A Comparison of Natural Hormones, Oral Contraceptives and Depo-Provera Women & Health, 47 (1), 105-121 DOI: 10.1300/J013v47n01_06Higgins, J., Hoffman, S., Graham, C., & Sanders, S. (2008). Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women's Well-Being and Sexuality Study Sexual Health, 5 (4) DOI: 10.1071/SH08021... Read more »

Bancroft J, & Sartorius N. (1990) The effects of oral contraceptives on well-being and sexuality. Oxford Reviews of Reproductive Biology, 57-92. DOI: 2075004

Brown, S., Morrison, L., Larkspur, L., Marsh, A., & Nicolaisen, N. (2008) Well-Being, Sleep, Exercise Patterns, and the Menstrual Cycle: A Comparison of Natural Hormones, Oral Contraceptives and Depo-Provera. Women , 47(1), 105-121. DOI: 10.1300/J013v47n01_06

Higgins, J., Hoffman, S., Graham, C., & Sanders, S. (2008) Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women's Well-Being and Sexuality Study. Sexual Health, 5(4), 321. DOI: 10.1071/SH08021

Joffe, H., Cohen, L., & Harlow, B. (2003) Impact of oral contraceptive pill use on premenstrual mood: Predictors of improvement and deterioration. American Journal of Obstetrics and Gynecology, 189(6), 1523-1530. DOI: 10.1016/S0002-9378(03)00927-X

Mansfield PK, Hood KE, & Henderson J. (1989) Women and their husbands: mood and arousal fluctuations across the menstrual cycle and days of the week. Psychosomatic Medicine, 51(1), 66-80. DOI: 2928462

Shively, C, & Bethea C. (2004) Cognition, mood disorders, and sex hormones. ILAR J, 45(2), 189-199. DOI: 15111738

Walker, A. (1994) Mood and well-being in consecutive menstrual cycles. Psychology of Women Quarterly, 18(2), 271-290.

July 20, 2009
02:52 PM
622 views

What does this anthropologist think about hormonal contraception? Part IV

by Kate Clancy in Laboratory for Evolutionary Endocrinology

Fourth of a five-part series on hormonal contraception, from an anthropological standpoint. This part of the series is on behavior and cognitive changes associated with hormones.... Read more »

Bancroft J, & Sartorius N. (1990) The effects of oral contraceptives on well-being and sexuality. Oxford Reviews of Reproductive Biology, 57-92. DOI: 2075004

Brown, S., Morrison, L., Larkspur, L., Marsh, A., & Nicolaisen, N. (2008) Well-Being, Sleep, Exercise Patterns, and the Menstrual Cycle: A Comparison of Natural Hormones, Oral Contraceptives and Depo-Provera. Women , 47(1), 105-121. DOI: 10.1300/J013v47n01_06

Higgins, J., Hoffman, S., Graham, C., & Sanders, S. (2008) Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women's Well-Being and Sexuality Study. Sexual Health, 5(4), 321. DOI: 10.1071/SH08021

Joffe, H., Cohen, L., & Harlow, B. (2003) Impact of oral contraceptive pill use on premenstrual mood: Predictors of improvement and deterioration. American Journal of Obstetrics and Gynecology, 189(6), 1523-1530. DOI: 10.1016/S0002-9378(03)00927-X

Mansfield PK, Hood KE, & Henderson J. (1989) Women and their husbands: mood and arousal fluctuations across the menstrual cycle and days of the week. Psychosomatic Medicine, 51(1), 66-80. DOI: 2928462

Shively, C, & Bethea C. (2004) Cognition, mood disorders, and sex hormones. ILAR J, 45(2), 189-199. DOI: 15111738

Walker, A. (1994) Mood and well-being in consecutive menstrual cycles. Psychology of Women Quarterly, 18(2), 271-290.

July 17, 2009
08:15 AM
628 views

What does this anthropologist think about hormonal birth control? Part III

by Kate Clancy in Laboratory for Evolutionary Endocrinology

In parts I and II of this series, I discussed the basic no-nos around contraception, the reason some advocate its continuous use, and what constitutes a normal menstrual cycle. Today, I'll explain a bit about population variation in reproductive function, and how it may relate to the conversation.Population variationBoth the efficacy of hormonal contraception and its non-contraceptive benefits are reduced if women do not take their prescriptions properly, and there are many reasons women do this: poor education regarding what constitutes ‘perfect use,’ ambivalence about their choice of contraception, or dissatisfaction regarding side effects. Baerwald and colleagues found different degrees of suppressed ovulation depending on when contraceptives were started; if hormonal contraception was initiated at or before ovarian follicles had reached 10mm, suppression occurred in all cases, but became increasingly less likely as follicles increased in size (Baerwald et al. 2006). One of the methods of initiating hormonal contraceptives involves the idea of a ‘Sunday Start’ where women start taking the medication the first Sunday after their last menses, rather than on the first day of menses. The reasoning is that it is easier to keep track of pills (or patches or rings) when one starts each week on a Sunday rather than on whatever day menses happens to begin. Unfortunately, significant follicular growth can occur between menses and the start of the contraception, depending on the individual and the day menses began. This can mean a woman can think she is protected from pregnancy for that cycle, but has ovulated and thus at a much greater risk for unwanted pregnancy. If a woman stops and starts – due to difficulties obtaining her prescription, traveling, or dissatisfaction with the brand of contraceptive she chooses – she may have many ovulatory cycles, or at the least many cycles where her follicles are growing and regressing. My worry is that this could lead to polycystic ovaries or even mutations during tissue remodeling that could lead to ovarian cancer (this is a hypothesis, not an observation or statement of empirical evidence).Other reasons a woman may not stay on hormonal contraception and thus may not have ‘perfect use’ is that her normal range of variation in endogenous hormones is different from the American norm. Women from developing countries tend to have lower circulating levels of reproductive hormones (for examples directly related to contraception, see Bentley 1996; Ellison 1990; Vitzthum et al. 2004); this means their responsiveness to the exogenous hormones of contraceptives will be different, just like with overweight American women but at the other end of the spectrum. Bentley (1996) reports significant interpopulation variation in pharmacokinetic properties of hormonal contraceptives; this means that different women have different physiological responses to hormones, even when taking the same dose. She also reviewed the literature regarding interpopulation variation in side effects experienced by women on hormonal contraception (Bentley 1996). Vitzthum and colleagues (2001) report shorter duration of menses for samples of Bolivian versus Chicago women, and significantly lower endogenous hormone concentrations in Bolivian versus Chicago women (Vitzthum et al. 2004). The penultimate paragraph of the 2004 article is the most telling:“The present study also reaffirms the conclusion of others that hormonal contraceptive dosages designed for U.S. women and other industrialized countries may be excessively high for women in developing countries, resulting in severe side-effects leading to discontinuation and, potentially, unplanned pregnancy. We have often heard Bolivian women and health workers express concern about negative experiences with hormonal contraceptives. Contrary to arguments that noncompliance is more a matter of education than biology, these data succinctly support the reports of these women that negative sequelae of hormonal contraceptives are more than an imagined problem.”Thus we have Bentley’s review of variation in effects on contraception, several decades of literature on population variation in ovarian function via ecology, and anecdotal evidence from the mouths of women from developing countries; put together, they tell a story about a broad spectrum of women who may respond differently to hormonal contraceptives. On Monday I'll cover whether hormonal contraceptives create any behavior or cognition changes in those who take them.ReferencesBaerwald A, Olatunbosun O, & Pierson R (2006). Effects of oral contraceptives administered at defined stages of ovarian follicular development Fertility and Sterility, 86 (1), 27-35Bentley GR. 1996. Evidence for interpopulation variation in normal ovarian function and consequences for hormonal contraception. In: Rosetta LaM-T, C.G.N., editor. Variability in human fertility. Cambridge, UK: Cambridge University Press. p 46-65.Ellison PT (1990). Human ovarian function and reproductive ecology: new hypotheses American Anthropologist, 94 (2), 933-952Vitzthum VJ, Spielvogel H, Caceres E, & Miller A (2001). Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss Contraception, 64, 319-325Vitzthum VJ, Spielvogel H, & Thornburg J (2004). Interpopulational differences in progesterone levels during conception and implantation in humans Proceedings of the National Academy of Sciences, 101 (6), 1443-1448This post was written by Kathryn Clancy for the Laboratory for Evolutionary Endocrinology Blog. Except as noted, it is (C)Kathryn Clancy and licensed under a Creative Commons License. The opinions on this blog are the opinions of the blog author only, not the author's employer or colleagues.... Read more »

Baerwald A, Olatunbosun O, & Pierson R. (2006) Effects of oral contraceptives administered at defined stages of ovarian follicular development. Fertility and Sterility, 86(1), 27-35.

Ellison PT. (1990) Human ovarian function and reproductive ecology: new hypotheses. American Anthropologist, 94(2), 933-952.

Vitzthum VJ, Spielvogel H, Caceres E, & Miller A. (2001) Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss. Contraception, 319-325.

Vitzthum VJ, Spielvogel H, & Thornburg J. (2004) Interpopulational differences in progesterone levels during conception and implantation in humans. Proceedings of the National Academy of Sciences, 101(6), 1443-1448.

July 17, 2009
07:17 AM
587 views

What does this anthropologist think about hormonal contraception? Part III

by Kate Clancy in Laboratory for Evolutionary Endocrinology

Part three of my ongoing series on hormonal contraception and reproductive function, from the perspective of anthropology.... Read more »

Baerwald A, Olatunbosun O, & Pierson R. (2006) Effects of oral contraceptives administered at defined stages of ovarian follicular development. Fertility and Sterility, 86(1), 27-35.

Ellison PT. (1990) Human ovarian function and reproductive ecology: new hypotheses. American Anthropologist, 94(2), 933-952.

Vitzthum VJ, Spielvogel H, Caceres E, & Miller A. (2001) Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss. Contraception, 319-325.

Vitzthum VJ, Spielvogel H, & Thornburg J. (2004) Interpopulational differences in progesterone levels during conception and implantation in humans. Proceedings of the National Academy of Sciences, 101(6), 1443-1448.

July 16, 2009
02:46 PM
607 views

What does this anthropologist think about hormonal birth control? Part II

by Kate Clancy in Laboratory for Evolutionary Endocrinology

So I've covered a bit of my bias against hormonal contraception ads, and the basic no-nos. But one of the things you may have heard a lot lately is that women don't "need" a period, or even that it is "useless." I'd like to spend a little time unpacking this in the second part of my series.What is normal?Recently, in the beginning of an evolutionary medicine volume, I read in the editors’ opening comments that there is “nothing biologically normal” about monthly menses, as a way to put forward the idea that women should take continuous oral contraceptives (Stearns and Koella 2008, p. 4). Nothing biologically normal? Whether we like it or not, frequent menses in the United States is biologically normal, due to the fact that we eat a lot and don’t move around much at all. We’re at the far end of the spectrum of variation in reproductive function, but we have not fallen off the end of the continuum. On the one hand, I appreciate the attempt of the authors to try to shake things up and introduce the possibility that American physiology is not the global standard, but any body that responds appropriately to its ecology is, by definition, normal. Does this appropriate and evolutionary response to environment have its own consequences? Yes; you can lay the blame for the increased incidence of reproductive cancers in developed countries mostly on the flexible responsiveness and resource allocation capabilities of our reproductive systems. Your genes are important in determining your chances of breast cancer, but so are cumulated years of cheese fries and driving to work. (And before you think this is some sort of diatribe against overweight folks, plenty of normal weight folks – normal for Americans – have more unhealthy eating patterns than overweight folks. It’s not how you look but how you live, even when in broad strokes evidence can initially suggest it’s about the weight one carries.)Here is the reason Stearns and Koella (2008), and Eaton (Eaton et al. 1994; Eaton et al. 2002), and others have been advocating continuous hormonal contraceptive use: it may decrease reproductive cancer rates. Let’s take a step back and first understand the context under which the human female reproductive system evolved: once upon a time we were eating less and moving more. Age at menarche (that’s when we get our first menstrual period) used to be much later, menses itself wasn’t particularly heavy or cumbersome, and few cycles were ovulatory (meaning that an egg is released for possible fertilization). Soon after reaching menarche (as in, within a few years) a woman has her first child. She breastfeeds intensively for the first few years, but continues to breastfeed at least occasionally for four years, maybe more. At some point towards the end of breastfeeding, or sometimes not even until breastfeeding was done, she would resume cycling, and in a few cycles likely get pregnant again.This pattern would continue, with some variations based on miscarriages, increasing age, seasonal variation in food availability, and other issues, until the woman hit menopause. Of course, for many women, their lives ended around that point or even before, but some number of women certainly survived to be grandmothers, if observation of current forager populations is any indication. This means that for most of a woman’s reproductive life she was pregnant or breastfeeding, and cycling only occasionally. Strassmann has a great analysis of this and comparison between populations (Strassmann 1997): the punchline is that an industrialized woman of today has around 400 menstrual cycles, while our ancestors, if modern foragers are an indication, had 50-100.Now let’s look at today’s industrialized, or developed-country woman: like men, she eats more and moves around less, largely because she is in school or working rather than getting her own food. She hits menarche earlier, and menses are more frequent and copious than her ancestors, which creates lots of tissue remodeling in the endometrium (the lining of the uterus). Many of her cycles are ovulatory, necessitating frequent tissue remodeling for the ovaries. She may cycle for years before having her first child, even decades, and with those frequent cycles come a higher exposure to endogenous (coming from within the body rather than a pill) sex steroids like estradiol and progesterone. Even if she breastfeeds for years, she will likely resume menstrual cycling sooner than her ancestors because she is better fed. She will probably have fewer pregnancies and births than her ancestors, which means more cycles in between pregnancies. She will most likely make it to menopause and beyond; because she is so much more likely to make it past menopause we are far more likely to notice the negative effects of all that hormone exposure, in the form of reproductive cancers.So while I disagree with the idea that there is “nothing biologically normal” about frequent menstrual cycles, I certainly agree that they are not doing us any favors. But is it the reproductive system that is at fault or the lifestyle? Should we artificially suppress the system in order to promote health, or make changes to the way we live? I’m sure the answer lies somewhere in between, at least as we move towards building more sustainable neighborhoods and taking better care of our environment in developed countries.The third part of this series will address population variation in reproductive function, and how this impacts the efficacy and side effect incidence of hormonal contraceptives.ReferencesEaton SB, Pike MC, Short RV, Lee NC, Trussell J, Hatcher RA, Wood JW, Worthman CM, Blurton-Jones NG, Konner MJ, Hill KR, & Bailey R (1994). Women's reproductive cancers in evolutionary context Quarterley Review of Biology, 69 (3), 353-367Eaton, S.B., Strassmann, B.I., Nesse, R.M., Neel, J.V., Ewald, P.W., Williams, G.C., Weder, A.B., Eaton III, S.B., Lindeberg, S., Konner, M.J., Mysterud, I., & Cordain, L. (2002). Evolutionary health promotion Preventive Medicine, 34, 109-118Stearns S, and Koella J, editors. 2008. Evolution in health and disease. 2nd ed. Oxford: Oxford University Press.Strassmann, BI (1997). The biology of menstruation in Homo sapiens: Total lifetime menses, fecundity, and nonsynchrony in a natural-fertility population Current Anthropology, 38 (1), 123-129 DOI: A1997WD24700015This post was written by Kathryn Clancy for the Laboratory for Evolutionary Endocrinology Blog. Except as noted, it is (C)Kathryn Clancy and licensed under a Creative Commons License. The opinions on this blog are the opinions of the blog author only, not the author's employer or colleagues.... Read more »

Eaton SB, Pike MC, Short RV, Lee NC, Trussell J, Hatcher RA, Wood JW, Worthman CM, Blurton-Jones NG, Konner MJ.... (1994) Women's reproductive cancers in evolutionary context. Quarterley Review of Biology, 69(3), 353-367.

Eaton, S.B., Strassmann, B.I., Nesse, R.M., Neel, J.V., Ewald, P.W., Williams, G.C., Weder, A.B., Eaton III, S.B., Lindeberg, S., Konner, M.J.... (2002) Evolutionary health promotion. Preventive Medicine, 109-118.

Strassmann, BI. (1997) The biology of menstruation in Homo sapiens: Total lifetime menses, fecundity, and nonsynchrony in a natural-fertility population. Current Anthropology, 38(1), 123-129. DOI: A1997WD24700015

July 16, 2009
01:47 PM
610 views

What does this anthropologist think about hormonal contraception? Part II

by Kate Clancy in Laboratory for Evolutionary Endocrinology

The second part in the series on biological anthropology, ecology, variation, and hormonal contraception.... Read more »

Eaton SB, Pike MC, Short RV, Lee NC, Trussell J, Hatcher RA, Wood JW, Worthman CM, Blurton-Jones NG, Konner MJ.... (1994) Women's reproductive cancers in evolutionary context. Quarterley Review of Biology, 69(3), 353-367.

Eaton, S.B., Strassmann, B.I., Nesse, R.M., Neel, J.V., Ewald, P.W., Williams, G.C., Weder, A.B., Eaton III, S.B., Lindeberg, S., Konner, M.J.... (2002) Evolutionary health promotion. Preventive Medicine, 109-118.

Strassmann, BI. (1997) The biology of menstruation in Homo sapiens: Total lifetime menses, fecundity, and nonsynchrony in a natural-fertility population. Current Anthropology, 38(1), 123-129. DOI: A1997WD24700015

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