Victoria Louise Newton

Hormonal contraception and regulation of menstruation: a study of young women's attitudes towards ‘having a period’

Background Irregular bleeding is one of the most common side effects of hormonal contraception and a key reason for the discontinuation of hormonal methods. Study design A qualitative study in which 12 young women volunteered to be interviewed in depth, along with six focus group discussions (23 participants). The study had two main research objectives: to document and investigate what young women think and feel about menstruation and contraception, and to explore young womens preferences regarding the intersection of contraceptives and bleeding patterns. Results Although participants held a broad view that menstruation can be an inconvenience, they did ascribe positive values to having a regular bleed. Bleeding was seen as a signifier of non-pregnancy and also an innate part of being a woman. A preference for a ‘natural’ menstruating body was a strong theme, and the idea of selecting a hormonal contraceptive that might stop the bleeding was not overly popular, unless the young woman suffered with painful natural menstruation. Contraceptives that mimicked the menstrual cycle were acceptable to most, suggesting that cyclic bleeding still holds a symbolic function for women. Conclusions When counselling young women about the effect of different contraceptive modalities on their bleeding, practitioners should explore how the women feel about their bleeding, including how they might feel if their bleeding stopped or if they experienced erratic bleeding patterns. Practitioners also need to recognise the subjective understanding of the ‘natural body’ as held by some women, and in these cases to support them in their seeking out of non-hormonal methods of contraception.

Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions

The etonogestrel contraceptive implant (Implanon®, Nexplanon®) is widely recognised as a reliable and cost-effective form of contraception.1 However, continuation rates are of concern as the method loses cost effectiveness when discontinued early. It has been calculated that 60% of implant removals are for irregular or unpredictable bleeding.2 Guidelines for standard practice in implant provision emphasise the importance of adequate counselling about side effects, especially bleeding irregularities, before implant insertion.3 In our recently published study4 ,5 we showed that even in cases where young women have been made aware of the possibility of irregular bleeding, the clinicians messages are not always fully absorbed. In this study the women each had their own interpretations of the advice they had been given, and individualised responses to their experience of side effects. It was confirmed that the predominant reason for requests for implant removal was irregular bleeding. It was also evident that: 1 The women had not been prepared for the reality of prolonged bleeding or irregular bleeding patterns, even when they could recall being informed about these at their initial consultation. 2 They often persevered with their implants, waiting for the bleeding pattern ‘to settle’, so often tolerated significant amounts of discomfort and inconvenience. 3 Bleeding in conjunction with other side effects was particularly problematic. Patients are often advised to ‘persevere’ with the method in …

Time frames and self-hurting: that was then, this is now

In this article, we explore the different time frames through which 25 adults who have used non-suicidal self-hurting throughout their lives evaluate their experiences. Participants in the study on which this article is based were drawn from a non-clinical population recruited mainly through dedicated websites. All were interviewed in 2008 in South London. The participants all used time frames to structure their narratives about their use of self-hurting. Short time frames placed around the act of self-hurting itself let them focus on the immediate effects, including pleasure. Longer time frames enabled them to reflect on the causes of self-hurting, as a way of managing emotions and difficult social situations, and introduced consideration of the risks involved, such as escalation in use and fear of discovery. Looking back through a longer time frame, participants recognised how their use of self-hurting changed over time with some ceasing to use it and others using it less frequently. Reflecting on the use of self-hurting across their life span, some participants expressed regrets, but the majority described it as an important way of coping with intense feelings and intolerable situations, which could be seen as reasonable under the circumstances. Participant’s selection and use of time frames, whether short-, medium- or long-term, orientated towards the past, the present or the future had an important impact on how they assessed the balance between the risks and benefits of this behaviour and the shifting compromises that they made between them. Future research could focus on the use of time frames in different settings and on the likely consequences of choosing short-, medium- or long-term lens for calculating risk. In applied clinical settings it would be useful to find out whether strategies to encourage clients to see their behaviour and construct narratives bracketed by different time frames has therapeutic potential.

Folklore and advertising: an examination of traditional themes and motifs in British twenty-first-century television advertising campaigns

Abstract Many current TV advertisements contain folktale material, and valuable research into this material has been carried out by Burns, Sullenberger, and Dégh. However, since the advertisements are constantly changing and evolving to keep pace with the needs of new products and consumer needs, studies quickly become outdated and can never remain definitive. The topic therefore is revisited here in order to reveal some ways in which folkloric material is being manipulated in order to appeal to consumer audiences of the twenty-first century.

Provider-based barriers to provision of intrauterine contraception in general practice

Objectives Intrauterine contraception (IUC) is highly effective, safe and long-lasting, but is not a popular method of contraception among British women. This study examined barriers to the uptake of IUC in general practice in England. Method A sequential mixed-method approach to explore the views of practitioners regarding the provision of IUC. We e-surveyed 208 practitioners from 69 practices in a region of England and subsequently interviewed 14 practitioners from eight practices. Results Just under half of general practitioners (GPs) (46.8%; 58/124), and only 8.2% (4/49) of nurses reported being trained to fit IUC. Lack of knowledge of IUC was a barrier to fitting, and also to recommending IUC, especially by practitioners who were not trained to fit. There was discordance between reported knowledge of eligibility for IUC and the likelihood of recommending IUC. Respondents were less likely to recommend IUC to young, nulliparous women, women who had experienced a previous ectopic pregnancy, a recent sexually transmitted infection (STI), or an abnormal cervical smear. The qualitative data indicate that risk aversion and limited training, together with practitioners’ assessments that women are uninterested, may lead to IUC being precluded as a suitable method. Conclusions Increased practitioner education, for those not trained to fit IUC, may remove a barrier to the uptake of IUC in general practice. More research is required on the discordance between the practitioners’ views on the characteristics of women considered suitable for IUC, and the criteria set out in the UK Medical Eligibility Criteria (UKMEC) guidelines.

On the Blob: Young Adulthood and Menstrual Lore

This chapter will use data from the study to examine the different ways in which young people learn about menstruation. It will focus on menstruation as discussed in the vernacular language of adolescents.

The Curse: Popular Histories and Cultural Knowledge

This chapter explores the contemporary vernacular knowledge about menstruation—what might otherwise be called ‘folklore’—that was reported by my respondents. At the same time, I shall place it in deeper historical context. The topics to be covered include beliefs concerning menstruating women and the preparation of food, ‘taboos’ surrounding sex during menstruation, understandings of the lunar cycle and menstruation, and tales about menstrual synchrony. I shall conclude by considering the role of menstrual lore and vernacular knowledge in shaping contemporary attitudes towards the menstruating body and menstruating women.

Positioning Periods in Context: Contemporary Discourses and Dilemmas

This chapter examines the interplay between menstruation as a biological fact and as a social construct. The subjective experience of menstruation, and menstruation, as reflected in popular belief, has been little studied. There have, by contrast, been many discussions focusing on the menarche and the physical, emotional, and social changes young women experience at puberty, on the prevalence and treatment of Pre-Menstrual Syndrome, and on the problems caused by the medicalization of menstruation.

Closed for Maintenance: Backstage Spaces, and Selling Shame

This chapter discusses the structures which determine and influence the production and reproduction of menstrual etiquette. Drawing on the conceptualization of social control found in Michel Foucault’s Madness and Civilisation (1971) and Discipline and Punish (1977), power does not flow down from individuals, but is held and exercised within networks. Within these networks, social control can be exercised through the observation and sequestration of problematic individuals and behaviour. In Foucault’s terms, bodily functions, such as menstruation are ‘confined’ within appropriate boundaries, and kept there by discourses that compel us to carry out activities in their proper place and to do the accepted thing. How symbolically-marked boundaries connect and interact with each other helps to construct our concepts of female and the feminine, and what ‘normal’ behaviour, appearance, and experience equate to. Susan Bordo puts this as follows:Apparently, trivial activities such toilet habits, polite etiquette and table manners can thus be viewed as modes of social control. Sanitary products are rigorously kept from the public gaze, and just as ‘any landscape is composed of both the seen and the unseen; what is hidden may be as telling as what is on display’ (Rebecca Ginsburg 1996, p. 374). These spatial regulations impress attitudes of appropriate behaviour on us and impel us to conform to societal values. However, the same levels of privacy have not always been demanded of the human body as in contemporary society; it is worth reiterating here that each culture and historical period has had its own ways of viewing the body. With regard to the growth of privacy, Deborah Lupton remarks:Hence, as everyday social life became more regulated, so too did our relationship to the body and its processes. Mary Douglas draws parallels between society and the body:What is expelled from the boundaries of our bodies can thus be seen as problematic, if not utterly undesirable. In the historical development of privacy around the body, ‘containing one’s body boundaries and exerting more control over the disbursement of one’s bodily fluids became a central aspect of proper deportment’ (Lupton 1998, p. 78).

‘Auntie’s Come to Tea’: Menstrual Euphemism

This chapter deals with how people find ways to talk about a subject, which is still deemed ‘sensitive’ in mainstream society. Although such talk may be difficult for many people, vernacular language, which is the focus of this chapter, is one means of articulating this ‘sensitive’ subject. I shall focus on this language in order to explore how menstrual euphemisms and slang not only provide a conversational way around a difficult topic, but also help to shape, and are shaped by, societal views of menstruation.