Tagged Menstruation

Meet the Super Flasher: Some Menopausal Women Suffer Years of Hot Flashes


Credit Kim Murton

What kind of hot flasher are you?

The hot flash — that sudden feeling of warmth that can leave a woman flushed and drenched in sweat — has long been considered the defining symptom of menopause. But new research shows that the timing and duration of hot flashes can vary significantly from woman to woman, and that women appear to fall evenly into four hot-flash categories.

Some women, called “early onset” hot flashers, begin to experience hot flashes long before menopause. Symptoms can begin five to 10 years before a woman’s last period, but the symptoms stop with the end of the menstrual cycle.

Then there are women who don’t experience their first hot flash until after menopause, the “late onset” hot flasher. And some women fall into a group the researchers called the “lucky few.” Some of these women never experience a single hot flash, whereas others briefly suffer only a few flashes when they stop menstruating.

And then there are the “super flashers.” This unlucky group includes one in four midlife women. The super flasher begins to experience hot flashes relatively early in life, similar to the early onset group. But her unpleasant symptoms continue well past menopause, like those in the late onset group. Her symptoms can last 20 years or more.

The findings come from the Study of Women’s Health Across the Nation, or SWAN, a 22-year-old study that has been tracking the physical, biological and psychological health of 3,302 women from a variety of racial and ethnic backgrounds. The study is being conducted at seven research centers around the country and is paid for by the National Institutes of Health.

“It explodes our typical myth around hot flashes, that they just last for a few years and everyone follows the same pattern,” said Rebecca Thurston, the senior author and a professor of psychiatry and epidemiologist at the University of Pittsburgh. “We may be able to better help women once we know in what category they are more likely to fall.”

That includes women like Lynn Moran, a 70-year-old retired financial planning assistant who lives near Pittsburgh and falls into the “super flasher” category. She remembers having her first hot flash around the age of 47. While the symptoms were subtle at first, soon the hot flashes became more bothersome. “It was enough to wake me up out of a sound sleep,” she said. “I wasn’t sleeping well because they were coming all night long and during the day. I was just miserable.”

Ms. Moran began hormone therapy, which helped but did not eliminate the symptoms. But when medical studies began to show health risks associated with the treatment, her doctor advised her to stop using hormones. She waited another 18 months until she retired, then stopped taking hormones in 2005.

The hot flashes “came back with a vengeance” and haven’t stopped since.

“I still have them. I still laugh about them,” she said, noting that she may experience several hot flashes a day. “I’ll be trying to get ready to go somewhere, curling my hair and have to redo everything and dry my hair again because I’ll be drenched. My makeup will literally run down my face. Here I am, 70 years old, complaining of hot flashes.”

Dr. Thurston notes that understanding variations on hot flashes is important to understanding women’s health in midlife. A 2012 study, published in the journal Obstetrics and Gynecology, suggested that the timing and duration of hot flashes may be an indicator of a woman’s cardiovascular health. The study found that frequent hot flashes were associated with higher cholesterol markers, particularly in thin women.

The latest findings from the SWAN study identified some patterns around the four subsets of women who experienced varying degrees of hot flashes. Women were distributed about equally among the groups, meaning 75 percent of women experienced some degree of hot flashes, while only 25 percent escaped the symptom.

Women in the early onset group were more likely to be white and obese. Women in the late onset group tended to be smokers. The lucky few women who had no hot flashes or only a few were more often Asian women and women in better health. The super flashers were more likely to be African-American, to be in poorer health and to consume alcohol. But the researchers cautioned that while they identified some statistical trends in each group, it’s important to note that each subset of hot flashers included a variety of women representing all races, ethnicities, body weights and health categories. No one factor appeared to determine a woman’s risk for any hot flash category.

For instance, while African-American women were three times as likely to be in the super flashers group, they represented only 40 percent of that group. The remaining 60 percent were white women, some Asian women and other groups.

Dr. Thurston said it is important that doctors understand that 75 percent of women have hot flashes in midlife and that they persist in at least one in four..

“It flies in the face of the traditional wisdom that women have these symptoms for three to five years around the final menstrual period,” she said. “We now know that is patently wrong.”

New York City Bill to Call For Free Tampons in Public Restrooms, Shelters and Jails


Credit iStock

New York City Council members are joining a growing national movement to improve access to feminine products, and this Tuesday will introduce proposals for free tampons and pads in city public restrooms, homeless shelters and correctional facilities.

“This has been so taboo for so long, that no one even thought about it,” said Councilwoman Julissa Ferreras-Copeland, who spearheaded local efforts with a pilot project providing free pads and tampons in a high school in Queens that is being expanded to include 25 schools. “It’s just been something that it has never been O.K. to talk about.”

In addition, Ms. Ferreras-Copeland, Councilman Ydanis Rodriguez and the Council speaker, Melissa Mark-Viverito, will also introduce a resolution calling on the state legislature to stop taxing sanitary products. The state does not tax groceries, prescription drugs or condoms, but it still taxes tampons and sanitary pads. Earlier this month, the New York State Assembly passed a bill eliminating sales tax on tampons and pads, but the measure has yet to pass the Senate.

The proposals by members of the New York City Council are the latest in a series of efforts around the country that activists call “menstrual equity” — a movement that calls for feminine products to be treated the same as toilet paper and other necessities that are typically not taxed or are offered free in public spaces. Chicago rescinded city taxes on sanitary products earlier this month, California lawmakers are pushing for an end to tampon taxes and Canada scrapped the taxes last year. Efforts to make sanitary products available free in public facilities are underway in Wisconsin and Ohio.

Ms. Ferreras-Copeland said she can foresee potentially making free menstrual products available in the city’s public hospitals, parks and recreational centers, and at youth and community programs.

A bill requiring the New York City Department of Correction to provide all female inmates with pads or tampons “immediately” upon their request, and at the facility’s expense, is meant to improve the current way of allocating sanitary products, which is done according to an arcane formula that allots 144 pads a week to every 50 inmates, council members said.

That works out to about 12 pads per woman per cycle, which may not be sufficient, council members said. If a woman needs more than that, she must purchase them at her own expense at the commissary. The bill calls for eliminating the formula and providing either pads or tampons, immediately upon request.

Councilwoman Ferreras-Copeland called the formula “ridiculous,” saying that every woman has different needs. “You don’t ration toilet paper or ask for permission for more toilet paper,” she said. “You shouldn’t have to for these products.”

What all these programs may cost is not entirely clear. According to one estimate by the advocacy organization Free the Tampons, the annual cost of providing tampons and pads at restrooms in schools and businesses is less than $5 a year per woman or girl.

A program announced just last week to install tampon and pad dispensers in 25 public middle and high schools in New York City is estimated to cost $160,000 for a year, including the cost of replenishing the supply of products, according to Ms. Ferreras-Copeland’s office.

Women “cannot participate in society without some sort of menstrual product,” said Jennifer Weiss-Wolf, a writer and lawyer from Maplewood, N.J., who is a leading advocate for lifting tampon taxes and providing sanitary supplies in public restrooms and schools. “As a society, we have an interest in insuring that girls don’t fall behind in school and women aren’t unproductive at their jobs simply because they can’t afford these products.”

Earlier this year Representative Grace Meng, Democrat of New York, convinced federal officials who oversee the Federal Emergency Management Agency (FEMA) to allow its homeless assistance funds to cover feminine hygiene products, after she noticed the grants could not be used to purchase sanitary pads even though they cover other basic necessities items like toothpaste and diapers. Sanitary products will be added to the list of allowable purchases beginning in April.

Ms. Meng has also introduced legislation that would allow employees to use flexible spending account funds to buy feminine hygiene products. Right now the monies can be used to cover certain medical items like prescription eyeglasses and bandages, but not sanitary pads or tampons.

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Free the Tampons


Credit Kim Murton

Call it the period paradox. Everyone knows most girls and women menstruate, but even in the age of oversharing, periods are treated like a dirty little secret.

Now a growing number of advocates, entrepreneurs and female lawmakers are challenging the taboo, talking about menstruation publicly (and, yes, in mixed company). They want periods put squarely on the public agenda, and are demanding that businesses and government take menstruation into consideration when they design facilities, develop budgets, supply schools or create anti-poverty programs. And they want tampons in every public restroom. And they want them to be free.

For those who are squeamish about all this, the message is: Get used to it.

“I think many people, men and women, are probably a little uncomfortable thinking or talking about menstruation,” said Representative Grace Meng, Democrat of New York. “We’re thinking of how we can change the conversation.”

Earlier this year, Ms. Meng noticed that the Federal Emergency Management Agency did not allow homeless assistance funds to be used for feminine hygiene products, even though they covered soap, diapers, toothpaste and underwear. She appealed to the secretary of Homeland Security, Jeh Johnson, who oversees the agency. FEMA’s administrator, W. Craig Fugate, wrote back saying the items would be added to the list of allowable purchases. The new policy will be written in new manuals coming out in April, Ms. Meng said.

“Menstruation is something women cannot control,” said Ms. Meng, adding that she has heard reports of homeless women who use rags or soil their clothes because they don’t have access to appropriate hygiene products. “Menstrual products should not be treated as luxury items.”

In New York City, Councilwoman Julissa Ferreras-Copeland has initiated a pilot project to install a free tampon-dispensing machine in the girls’ restroom at the High School for Arts and Business in Corona, Queens, with the goal of eventually having free machines in all of the city’s middle schools and high schools. The machines and sanitary supplies are being donated by Hospeco, a Cleveland-based personal care products supplier.

Other initiatives are emerging around the country. In Wisconsin, legislators have introduced a bill that would make free sanitary products available in restrooms in all public state buildings, including schools.

In Columbus, Ohio, Councilwoman Elizabeth Brown wants restrooms at the city’s recreation centers and community swimming pools similarly supplied, as well as the public schools. “Girls who get their period shouldn’t have to go to the nurse’s office,” Ms. Brown said. “The underlying message with that is, ‘something’s wrong with me.’ Certainly we can all agree that having your period is not a monthly illness.”

At George School, a private school in Newtown, Pa., Vienna Vernose, a senior, was upset after a boy reacted by saying “ew” when a tampon fell from her backpack. She talked about it with male and female classmates in her Women’s History Seminar, who decided to form the Menstrual Product Equality campaign, setting out bowls filled with tampons in public areas during the school’s open house. Signs next to the bowls read, “These are here for anyone who needs them. Never be ashamed of your body and what it needs.”

“Tampons and pads should be treated just like toilet paper — they’re the equivalent,” said Nancy Kramer, an entrepreneur from Columbus, Ohio, who started Free the Tampons, a campaign to make feminine products accessible in all restrooms. She said the cost of stocking restrooms at a school or business with sanitary supplies works out to $4.67 per girl per year. “Menstruation is a normal bodily function, and it should be treated like that.”

While most states exempt nonluxury items like groceries and prescription drugs from sales taxes because they are considered necessities, critics note that the vast majority of states still tax sanitary products. So far, some 55,000 people have signed the online petition started by Cosmopolitan magazine, urging these taxes be lifted.

State legislators in California, New York and a handful of other states have introduced legislation to lift sales taxes on sanitary products in those states. So has the city of Chicago. Canada lifted taxes on sanitary products last year, though a similar campaign in Britain failed.

“Basically we are being taxed for being women,” said Cristina Garcia, a California legislator. Linda B. Rosenthal, a New York State assemblywoman, called the taxes “a regressive tax on women and their bodies.” Notably, items that are not subject to the tax include condoms and sunscreen.

Ms. Meng has introduced federal legislation that would allow women to buy feminine hygiene products with flexible spending account funds, which can be used to cover certain medical and dental costs, prescription drugs, prescription eyeglasses and items like bandages — but not sanitary pads or tampons.

For women to publicly demand menstrual supplies as a basic right is a sea change in thinking, said Chris Bobel, president of the Society for Menstrual Cycle Research and an associate professor of women’s and gender studies at the University of Massachusetts, Boston. “The message to women has been: ‘Menstruation is your problem, ladies,’” she said. “‘Your job is to render it invisible.’”

Jennifer Weiss-Wolf, a writer and lawyer from Maplewood, N.J., who is involved in the push for lifting taxes and providing supplies in public restrooms and schools, said her ‘Aha’ moment came when young women in her town launched a tampon collection drive for the local food pantry, as part of a group called Girls Helping Girls. Period.

A medium-size package of sanitary products can cost between $7 and $10, plus tax, and a woman could use one package per cycle— making them a significant expense for poor women and girls. Yet food pantries do not receive a regular donated supply of sanitary pads, said Margarette Purvis, president and chief executive of Food Bank for New York City. She said her organization receives the products sporadically, usually when a retailer has torn packages that cannot be sold.

“It’s something the state should maybe take into consideration for those of us who are really struggling, even though it’s probably the last thing on their minds,” said Lakeisha Adams, a 39-year-old Queens mother of four who relies on public assistance, and says she has had to borrow money from relatives to buy menstrual products.

“I grew up with five brothers, so I know it’s something a lot of men just don’t want to hear about,” said Ms. Adams. “But it’s one of the most important things for a woman to have available.”

Indeed, many men will go to great lengths to avoid the subject, said Ms. Kramer, the organizer of the Free the Tampons campaign.

“They stick their fingers in their ears, ‘la-la-la, don’t talk to me about it,’ until I say, ‘Do you have a daughter? Then you need to listen to this.’”


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