Chapter 11 Psychology, Gender, and Health

Gonadotropin-releasing hormone (Gn-RH)

a hormone secreted by the hypothalamus that regulates the pituitary's secretion of hormones

Childbirth

- Childbirth, too, has been medicalized, with an emphasis on giving birth in a hospital equipped with fancy instruments and monitors. - 1960s the Lamaze method of childbirth became popular. It allows women to control the pain of childbirth and to give birth while fully awake, with little or no use of anesthetics. - With home birth, rates of obstetrical interventions are lower and rates of vaginal birth are much higher than with hospital birth - Planned home births can be a safe option for women and their babies when their risk of complications is low - each woman should make the many choices about childbirth methods and setting in consultation with her health care provider

Pregnancy

- 9 months of pregnancy are divided into three trimesters of 3 months each - FIRST TRIMESTER, the first issue is finding out that one is pregnant. Home pregnancy tests—which work by detecting human chorionic gonadotropin hormone (hCG) in urine --> most accurate if done with undiluted urine and after a period has been missed. - 1ST TRI - morning sickness --> 25% do not experience it - Fatigue - The levels of estrogen and progesterone sharply increase as the developing placenta vigorously produces both hormones. - research in fact shows that pregnancy is a time of neither heightened well-being nor heightened emotional turmoil - maternal-fetal attachment - worry about miscarriage - SECOND TRIMESTER: woman's belly begins to expand noticeably. fetus's movements; this experience of quickening can promote maternal-fetal attachment - may experience edema—water retention and swelling—in areas such as the ankles, feet, and hands. Psychologically, the second trimester tends to be relatively calm, with worries about miscarriage past. - THIRD TRIMESTER: belly—and the uterus inside it. expanded uterus puts pressure on the lungs, causing shortness of breath, and on the stomach, causing indigestion. - Medicalization: The process by which normal life events or situations are defined and treated as medical conditions in need of diagnosis and treatment. - pregnancy has been medicalized. As part of the process of medicalization, the physician is cast as the knowledgeable authority, and the woman may be treated as a child, lacking the knowledge and ability to make good decisions herself.

Breast Cancer

- About one out of every nine women in the United States has breast cancer at some time in her life; it is the most common form of cancer in this population. While it is rare in women under 25, a woman's chances of developing it increase every year after that age. Every year, about 41,000 women die of breast cancer in the United States - about 450 men die of it each year. - unclear how the risk for transgender men and women compares with that of cisgender women. Factors such as hormone therapy (i.e., receiving testosterone or estrogen) may increase risk for both transgender men and women. For transgender men, risk may also depend on whether and how much breast tissue patients have had removed - Given that breast tissue changes across the menstrual cycle, premenopausal women should do the breast exam midcycle (not during one's period). - Most breast lumps are benign. For example, some lumps may be cysts (fluid-filled sacs, also called fibrocystic disease or cystic mastitis) or fibroadenomas.

Menopause

- As women age, their ovaries also age and reduce their production of estrogen --> ovulation and menstruation ceases - After 12 months of AMENORRHEA (the absence of menstrual periods), a woman is considered to be menopausal - On average, menopause (the cessation of menstruation) begins around age 51. Symptoms: vasomotor symptoms (e.g., "hot flashes," night sweats), vaginal dryness, and sleep difficulties. - Study: About 60% to 80% of those women reported experiencing vasomotor symptoms, peaking just before actual menopause --> the rates are highest among African American women - the study found that sleep difficulties occur in nearly 40% of women during the menopausal transition - evidence indicates that depression incidence is no higher during menopause than at other times in a woman's life - For women who do experience depression during the transition to menopause, vasomotor symptoms and sleep difficulties appear to be responsible

Medical Transition

- Before medical treatments can occur, assessment and referral by a mental health professional are required - For early adolescents, pubertal suppression is a medical option that delays the onset of pubertal changes. - pubertal suppression treatments can be stopped and the effects reversed. However, if the adolescent decides to transition, the process will be simpler after having prevented pubertal changes. For example, for a transgender man, mastectomy wouldn't be necessary because pubertal suppression would have prevented breast development. - Medical transition involves hormone therapy with estrogen (to feminize the body) or testosterone (to masculinize the body) and may also include hormone blockers (e.g., to block the secretion of endogenous testosterone in transgender women). This type of therapy is only partially reversible and is typically applied only with older adolescents (i.e., after age 16) and adults who are capable of making a definite decision about wanting to transition. Transgender men may choose hormone therapy with testosterone, which can lead to a deeper voice, growth in facial hair, growth of the clitoris or phallus, and a decrease in body fat percentage. The testosterone, which is usually injected, typically causes menstruation to stop. For transgender women, hormone therapy with estrogen results in breast growth, fewer erections, and increased body fat that creates feminine curves.

HPV and Cervical Cancer

- Cervical cancer (i.e., cancer of the cervix) is far less common than breast cancer in the United States - Cervical cancer is caused by the human papillomavirus (HPV). - While nearly all women will have an HPV infection at some point in their lives, most will not develop cancer. This is because most HPV infections do not involve the high-risk strains. - screening technique can be used to detect HPV infection in women. The Pap (short for Papanicolaou) test involves scraping cells from the opening of the cervix and examining those cells for abnormalities - Anyone with a cervix should have a Pap test done annually, up to age 65. If HPV is detected, it is typically advised simply to monitor the infection, since most infections will clear up on their own. If the infection does not go away on its own, gynecologists can treat the infection with a variety of procedures to prevent it from developing into cervical cancer - lesbian, bisexual, and queer women as well as transgender men who reported being discriminated against because of their gender expression were more than three times less likely to get regular Pap tests - being sexually active with anyone, regardless of their gender, increases risk for HPV infection. - Cervical cancer risk is higher among women of color than among White women - The incidence of cervical cancer is highest among Latinas, and the death rate from it highest among Black women. These racial/ethnic disparities may also stem from the cost of HPV screening. - two vaccines—Gardasil and Cervarix—to prevent infection with two strains of HPV that cause 70% of cases of cervical cancer - all children (regardless of gender) be vaccinated against HPV beginning at age 11 or 12 - public health efforts to vaccinate boys and men were initially weaker than the efforts to vaccinate girls and women, this trend appears to be changing. - Men can develop oral, anal, or genital cancers from high-risk HPV, but their risk of developing cancer from HPV is lower than women's. - The United States has very low HPV vaccination rates, with only 37.6% of girls and 13.9% of boys getting vaccinated

Women and the Health Care System

- Criticisms: 1. The physician-patient relationship reflects the subordinate status of women in society, with the physician (usually male) having power and control over the female patient. 2. Historically, the medical profession actively discriminated against women as practitioners. 3. Medical care offered to women is often inadequate, irresponsible, or uncaring. As many as 70% of hysterectomies (surgical removal of the uterus) are unnecessary. women's physical health problems are likely to be misdiagnosed as psychological. 4. Medical research conducted on women is often irresponsible or simply missing. For example, far more contraceptives have been developed for women than for men, and thus the health risks associated with them have been borne disproportionately by women. Class and ethnicity are also factors relating to irresponsible medical research. For example, the initial field trials for the birth control pill, whose risk was unknown at the time, were conducted among poor women in Puerto Rico.

Contraception

- Each year in the United States more than 600,000 teenage girls become pregnant. About 2 in 10 White women and about 4 in 10 Black and Latina women become pregnant by age 20. - around $600 per year for oral contraceptives - about 10% of women at risk of unintended pregnancy (i.e., sexually active and not wanting to get pregnant) use no method of contraception - Among 15- to 19-year-olds, this proportion is 18% - some contraceptive methods (e.g., the pill, IUD) have numerous benefits beyond avoiding unintended pregnancy, such as reducing dysmenorrhea, excessive menstrual bleeding, and acne

Abortion Stats

- In the United States, 42% of unintended pregnancies end in abortion - about 56 million abortions are performed worldwide - In the United States, the abortion rate continues to decline; there were 926,200 abortions performed in 2014 - About three-quarters of the American women who choose abortion are low-income. because federal (and most state) Medicaid funds cannot be used to pay for an abortion, low-income women often struggle to find the cash to pay for an abortion, which is typically around $500 during the first trimester.

Transgender Persons and the Health Care System

- Issues: 1. Research on transgender health issues is limited. there is a serious need for evidence-based research on pubertal suppression and gender-affirming therapies for transgender persons, including hormonal therapy and surgical therapy. 2. Of the existing medical research, transgender persons are often objectified and/or misgendered. 3. Structural factors—such as poverty, incarceration, and gaps in insurance coverage—limit access to health care for multiply marginalized groups. 4. Discrimination and prejudice create barriers to health care for many transgender persons. The Network for LGBT Health Equity study found that 19% of respondents reported that they'd been denied health care because of their gender identity and that 28% had experienced verbal harassment in a medical setting 5. Access to gender-affirming therapy is limited by the shortage of medical doctors who are knowledgeable about and comfortable providing care to transgender persons. One national survey found that nearly two-thirds of transgender persons reported that their doctors were unaware of transgender health needs. Currently, most medical school curricula do not address transgender health issues.

Trans Health Issues

- Major barriers to adequate health care for trans people include social barriers such as the experience of discrimination from health care providers (who need better education about trans issues), structural barriers such as insufficient insurance coverage, and geographical barriers such as living in a rural community with reduced access to adequate health care.

Menstrual Cramps

- Menstrual cramps are caused by prostaglandins, hormone-like substances produced by many tissues of the body, including the lining of the uterus (Deligeoroglou, 2000). Prostaglandins cause smooth muscle to contract and can affect the size of blood vessels. Women with severe menstrual pain have unusually high levels of prostaglandins. The high levels cause intense and painful uterine contractions; these contractions in turn choke off some of the uterus's supply of oxygen-carrying blood, which only increases the pain. Prostaglandins may also cause greater sensitivity in nerve endings. The combination of the uterine contractions, lack of oxygen, and heightened nerve sensitivity produces cramps. - As a result of this analysis of the causes of cramps, antiprostaglandin drugs are now used in treatment. The drug is mefanamic acid and is sold under brand names such as Ponstel. Other, similar drugs are Motrin, Naprosyn, and Anaprox.

Miscarriage

- Miscarriage refers the spontaneous demise of a fetus before the 20th week of pregnancy; after 20 weeks, this is referred to as a stillbirth. About half of all fertilized eggs die, but most of those miscarriages happen before a woman has missed a period. About 20% of known pregnancies end in miscarriage, most often during the first trimester. - painful cramping and unusually heavy bleeding - miscarriage is most often the result of a genetic defect or chromosomal abnormality that prevents the fetus from developing normally. Most women who miscarry go on to carry a healthy pregnancy to term. - anxiety, depression, and even posttraumatic stress disorder are common and may last for 6 to 12 months or longer

Breast Cancer Treatment

- Most often, some form of mastectomy (i.e., surgical removal of breast tissue) is performed. In RADICAL MASTECTOMY, the most aggressive form of this treatment, the entire breast as well as the lymph nodes and underlying muscles are removed. This method is more likely to be used if the cancer has spread to the muscle and lymph nodes. In modified radical mastectomy, the entire breast and lymph nodes, but not the muscles, are removed. In simple mastectomy, only the breast, and possibly a few lymph nodes, is removed. In partial mastectomy, or LUMPECTOMY, only the lump and some surrounding tissue are removed. - while breast cancer is more common among higher-income women, lower-income women and women of color have higher rates of mortality from it - White and higher-income women = greater access to diagnostic tools, like mammography. for lower-income women and women of color, who have reduced access to mammography, breast cancer diagnosed at later stages = increased mortality. - Although clinics like Planned Parenthood provide free or reduced rates for mammography, women in rural communities are often geographically isolated from such facilities. - about 30% to 40% of women report feeling increased depression and anxiety around the time of diagnosis - While the majority of studies show good adjustment after mastectomy, lumpectomy is associated with better body image and sexual functioning postsurgery than more radical surgeries - While the peer support groups provided no benefits to quality of life (compared with no intervention), the education intervention provided both immediate and long-term benefits with quality of life. - For women who become depressed, cognitive behavioral therapy with a trained therapist is very effective --> This form of therapy has been shown to result in lower depressive symptoms even 5 years later - The cancer survivor group did not differ from the controls on measures of depression and well-being, indicating good overall adjustment. The researchers went beyond studying possible problems of adjustment, also considering the possibility of posttraumatic growth. Posttraumatic growth refers to positive life changes following highly stressful experiences and appears to develop soon after a breast cancer diagnosis. more posttraumatic growth than the controls, particularly in relationships with others, appreciation of life, and spiritual growth. Humans are resilient.

Dysmenorrhea

- Painful cramps during menstruation are called dysmenorrhea. Some women get menstrual cramps regularly, some women get them some of the time, and some women don't get them at all. For those who do experience dysmenorrhea, the menstrual phase can be a challenging time. It is very difficult for a person who does not experience severe dysmenorrhea to understand precisely how it feels to those who do experience it. Traditional medical remedies have not been completely successful in treating the problem. Over-the-counter drugs such as Midol help some people some of the time, but they do not help everyone. For some, healthy habits—such as adequate sleep, exercise, and a healthy diet—and managing stress may be helpful in limiting the pain.

Abortion and Psyc

- Reviews of research on the psychological outcomes of legal abortion indicate that mental health problems are rare and that, in fact, most women are more distressed before the abortion than after it - One large study found that the risk for psychiatric disorder did not increase in the year following abortion, but did increase following childbirth - A well-conducted study of ethnically diverse women obtaining an abortion found that women felt more regret, sadness, and anger about the pregnancy than they did about the abortion - those women reported feeling more relief and happiness about having an abortion than about having an unwanted pregnancy - Among women who had made efforts to avoid getting pregnant (e.g., using contraception), who had difficulty making the decision, or who felt their partner was not supportive of their choice, there were higher levels of negative emotions after the abortion (relative to other women who'd obtained an abortion). Nonetheless, 95% of the women reported feeling that having an abortion was the right choice for them, even if they also felt some negative emotions. - in 23 out of 33 states with laws requiring pre-abortion counseling, the laws required conveying medically inaccurate and blatantly false information that, in turn, interfered with women's ability to give informed consent - One study compared women who obtained a legal abortion just before the gestational limit in their state to women who were denied an abortion for seeking one after the limit (Biggs et al., 2017). It found that women who were denied an abortion experienced more mental health problems (such as depression and low self-esteem) initially, but that the two groups were comparable 5 years later. - serious long-term psychological consequences for children whose mothers would have preferred to have an abortion. - children in the study group did less well in school and were more likely to drop out. At age 16, the boys (but not the girls) in the study group more frequently rated themselves as feeling neglected or rejected by their mothers and felt that their mothers were less satisfied with them. When in their early 20s, the study group reported less job satisfaction, more conflicts with coworkers and supervisors, and fewer and less satisfying friendships

Treating Menopausal Symptoms

- Some menopausal symptoms appear to be related either to low estrogen levels or to hormonal imbalance. Evidence for this point of view comes from the success of ESTROGEN REPLACEMENT THERAPY (ERT, such as Premarin) and HORMONE REPLACEMENT THERAPY (HRT, such as Prempro), which involves both estrogen and progesterone, and possibly testosterone as well. HRT is successful in relieving low-estrogen menopausal symptoms such as hot flashes, night sweats, osteoporosis (brittle bones), vaginal discharges, and vaginal dryness - Osteoporosis increases the risk of broken bones, such as hip fractures, which may lead to death. Also, 80% of people with osteoporosis are women - HRT increases the risk for heart disease, breast cancer, and endometrial cancer, particularly for older women or after extended use - National Institutes of Health (NIH) stopped clinical trial of the HRT drug Prempro with menopausal women. did not stop the other treatment group in the study, who were taking ERT only. women in the HRT group had a higher incidence of heart attack, stroke, breast cancer, and blood clots, compared with the placebo control group. That is, HRT was increasing rather than decreasing the rates of heart attack and stroke. The study was investigating long-term use of HRT and stopped the HRT group at 5 years. Short-term use of HRT for 1 or 2 years is probably safe for most women. - Women who are otherwise at risk for heart disease, stroke, or endometrial or breast cancers—for example, women who are overweight or who have a family history of one of these diseases—are generally advised to consider alternatives to HRT

Psychological Aspects of the Menstrual Cycle

- Study Approach: ask women to report retrospectively their symptoms and moods at various phases of the cycle. studies are useless because retrospective accounts, particularly of such subjective phenomena as moods in relation to one's menstrual cycle, are unreliable and have not been demonstrated to correlate with other indicators of premenstrual symptoms - Another study approach: ask women to complete daily diaries throughout the cycle. The results showed that fluctuations in some of the women's moods (e.g., sadness, irritability) were greater during the menstrual and premenstrual phases than during midcycle. Yet these effects were very small. By contrast, women's reports of stress, health, and social support had much larger correlations with their mood fluctuations. And while women's reports of feeling like they wanted to cry were higher during the premenstrual and menstrual phases, there were no differences in actual crying. In sum, the results of the research suggest that there are small fluctuations in mood corresponding to the phases of the menstrual cycle, at least in some women, but that factors such as stress, health, and social support are more important.

Biological Aspects of the Menstrual Cycle

- The average female person is born with about 400,000 follicles in her ovaries, each containing an ovum. During a menstrual cycle, one egg is released from a follicle, traveling down the fallopian tube for possible fertilization and implantation in the uterus. - follicle - the capsule of cells surrounding an egg in the ovary - ovum- an egg

The Social Construction of PMS

- The diversity of women's premenstrual experiences across cultures and history supports a feminist interpretation that premenstrual syndrome is socially constructed - the expression of emotions is carefully regulated by gendered display rules - while many women feel angry or irritable, expressing or even feeling these emotions is a serious deviation from social norms. This creates the need for a socially acceptable explanation for their emotions. Enter PMS. - From a psychological or social constructionist point of view, PMS can be seen as an attribution for particular emotions. - A woman experiences or expresses a particular emotion. To what does she attribute it? If the emotion is a socially unacceptable one, such as anger or irritability, she and others seek a socially acceptable attribution, and society makes PMS a readily available attribution. Magically, she isn't really angry; she is just in that temporary state of insanity, PMS. With a single stroke of attribution, her emotion no longer violates social norms, but at the same time, any real feelings of true anger she may have, perhaps toward her husband or her boss, are also brushed away. So, while her anger becomes temporarily acceptable, it remains impotent and ineffectual.

Abortion

- The most commonly used abortion method is surgical abortion (more specifically, VACUUM ASPIRATION). outpatient basis with a local anesthetic. takes only about 10 minutes and woman stays in the doctor's office for a few hours. woman prepared as she would be for a pelvic exam, and an instrument is inserted into the vagina to open her cervix. Next, a tube is inserted through the cervical opening until one end is in the uterus. The other end is attached to a suction-producing machine, and the contents of the uterus, including the fetal tissue, are sucked out. Vacuum aspiration is a very safe procedure and is safer than pregnancy. - Within the first 10 weeks of pregnancy, a woman may choose a medical abortion - This involves taking a medication (typically, MIFEPRISTINE). The medication causes the lining of the uterus to be sloughed off. About 31% of abortions in the United States are medical abortions

Cyclic Phases (continued)

- The regulation of the menstrual cycle involves interactions among the levels of these hormones. The pituitary secretes FSH, which signals the ovaries to increase production of estrogen and to bring several follicles to maturity, thus initiating the follicular phase. The resulting high level of estrogen, through the feedback loop, signals the pituitary to decrease production of FSH and to begin production of LH, whose chief function is to trigger ovulation. Temporarily, FSH and LH induce even more estrogen production, which further lowers the amount of FSH. At this point the level of LH spikes, causing the follicle to rupture and release the egg. The corpus luteum then forms in the ruptured follicle. The corpus luteum is a major source of progesterone. When progesterone levels are sufficiently high, they will, through the negative feedback loop, inhibit production of LH and simultaneously stimulate the production of FSH, beginning the cycle over again. - Estrogen has a number of functions and effects in the body. It maintains the lining of the vagina and uterus and provides the initial stimulation for breast growth. Its nonreproductive functions include increasing water content and thickness of skin and slowing growth rate. At the beginning and the end of the menstrual cycle, estrogen is at a low level. In between these two times, it reaches two peaks, one immediately prior to and during ovulation, the other in the middle of the luteal phase (Figure 11.2). Progesterone is especially important in preparing the uterus for implantation of the fertilized ovum and maintaining pregnancy. Because the corpus luteum is a major source of progesterone, progesterone level peaks during the luteal phase and is otherwise low.

Surgical Transition

- These treatments are irreversible and should be chosen only by a mature adolescent over the legal age of consent or an adult. The typical requirement is that the individual lives as a member of the gender with which they identify for at least 12 months, to ensure that the transition is truly workable and desirable. - "Top surgeries" involve surgical treatments to alter the chest. Some transgender men choose to undergo reconstructive chest surgery, which involves the removal of breasts. Some transgender women choose to undergo breast augmentation. - "Bottom surgeries" involve surgical treatments to alter the genitals or internal reproductive organs. For transgender women, these surgeries may include penectomy (removal of the penis), orchiectomy (removal of the testes), vaginoplasty (creation of a vagina from the skin of the penis), clitoroplasty (creation of a clitoris), and vulvoplasty (other surgery to create a female-appearing vulva). For transgender men, bottom surgeries might include removal of the uterus (hysterectomy), fallopian tubes, and ovaries; metoidioplasty or phalloplasty (to create a penis); and scrotoplasty (creation of a scrotum and insertion of artificial testes). Metoidioplasty involves releasing the clitoris, which enlarges with hormone therapy, to create a penis, whereas phalloplasty involves creation of a penis from tissue such as the forearm. These penis-creating surgeries are difficult and often not completely successful, so many transgender men decide against them. - the adjustment of transgender people who choose surgical transition is significantly better following surgery - 86% of transgender women were satisfied with their surgery to create a vagina, and 89% of transgender men were satisfied with their surgery to create a penis

Follicle-Stimulating Hormone (FSH)

- a hormone secreted by the pituitary that stimulates follicle and egg development

Luteinizing Hormone (LH)

- a hormone secreted by the pituitary that triggers ovulation

Health Issues at the Intersection of Gender, Ethnicity, and Class

- although pregnancy and childbirth are relatively safe in the United States—only 1 woman in 3,700 dies from them—an African woman's chance of dying from pregnancy or childbirth is 1 in 16 and an Asian woman's is 1 in 65 - In the United States, boys and men have a higher death rate than girls and women at every age, from conception to old age. More male than female fetuses are conceived, yet more male fetuses also die before birth. At age 100, women outnumber men by a 5:1 ratio. A baby born in the United States today is expected to live approximately 79 years - However, life expectancy varies considerably at the intersection of gender and race/ethnicity. For example, the average life expectancy is approximately 81 years for White women and 77 years for White men, but 78 years for Black women and 72 years for Black men. - Suicide and homicide are more common among men than women, yet heart disease and cancer are the top two causes of death for both women and men in all ethnic groups. - women of color experience higher rates of infant mortality than White women. This in turn is related to higher rates of low-birth-weight babies among women of color. And this in turn is related to more frequent adolescent childbearing among people of color. That is, adolescent mothers are more likely to have low-birth-weight babies, who have a higher death rate. - Chronic diseases are more prevalent among women of color than among White women. Examples include diabetes, high blood pressure, and heart disease. - Women of color are overrepresented among the poor. We have, then, a combination of sexism, racism, and poverty contributing to reduced access to necessary health care. This in turn creates more health problems for these women. There is an urgent need for equal access to health care. - another health risk for multiply marginalized women: stereotypes and discrimination. Stereotype threat and incidents of discrimination may be chronic, repeated stressors that pose serious risks to one's health, particularly for women of color and poor women.

Gender and Infectious Disease

- crucial to consider not only biological aspects of gender but also psychological aspects of gender when analyzing gender and infectious disease - biological aspects of gender can influence immune responses - Pregnancy is also included here; for example, during the 2009 H1N1 (swine flu) pandemic, pregnant women in their third trimester were especially vulnerable to the disease - Psychological aspects of gender can also influence infectious disease transmission and outcomes; these aspects include gender norms and behaviors, gendered division of labor, and gendered access to and control over resources and decisions.

Cyclic Phases

- regulated by hormones that act in a negative feedback loop with one another - so the production of a hormone increases to a high level, producing a specific physiological change. The level is then reduced through the negative feedback loop. Here we are concerned with two basic groups of hormones—those produced by the ovaries, most importantly estrogen and progesterone, and those produced by the pituitary gland, most importantly follicle-stimulating hormone (FSH) and luteinizing hormone (LH). - We also need to consider regulation of the pituitary by the hypothalamus, an important region of the brain on its lower side (Figure 11.3), by gonadotropin-releasing hormone (Gn-RH). The overall pattern of the negative feedback loop is that the activity of the ovary, including its production of estrogen and progesterone, is regulated by the pituitary, which in turn is regulated by the hypothalamus, which is sensitive to the levels of estrogen produced by the ovaries.

Psychological Aspects of the Menstrual Cycle Continued

- the data simply demonstrate a correlation between cycle phase or hormone levels and mood, but they cannot tell us that hormones actually cause or influence mood. Indeed, we could just as easily conclude from these data that the direction of causality is the reverse—that psychological factors affect hormone levels and menstrual cycle phase. - One approach in responding to the issue about correlational data involves examining how oral contraceptives—which involve altering the monthly cycles of estrogen and/or progesterone—might shape the links between moods and menstrual phase. Oral contraceptives may be monophasic (pills that provide a steady high dose of both estrogen and progestin, a synthetic progesterone, for 20 or 21 days) or triphasic (pills that provide 15 days of estrogen, followed by 5 days of estrogen-progestin, similar to the natural cycle, but at higher levels). A review of such studies found that women taking triphasic pills show the same kinds of mood changes as women not taking any oral contraceptives (Oinonen & Mazmanian, 2001). Because triphasic pills produce an artificial hormone cycle that parallels the natural one, these findings suggest that monthly hormone fluctuations may be linked to mood fluctuations. Moreover, monophasic pill women tend to show greater mood stability compared with triphasic pill and nonpill women. Therefore, it appears that the steady high level of both hormones leads to a steady level of mood. - A second criticism of this area of research is that the term premenstrual syndrome (PMS) is poorly defined. For example, the range of symptoms is broad, including a variety of physical, psychological, and behavioral features. In addition, which days of the cycle count as "premenstrual"? It would be worthwhile to know what proportion of women experience premenstrual symptoms, but because the concept is so poorly defined, estimates of this proportion vary from 25% to 80% (Stanton et al., 2002). In view of the vagueness of the definition, it is not surprising that these estimates are not consistent, and until the "syndrome" is more clearly defined, we can have no really accurate estimate of its incidence. At least from these data it seems fair to conclude that premenstrual syndrome is far from universal among women. - many American Indian women believe that menstruation is a time of centering and balancing oneself. The menstrual flow out of the body washes away impurities and the negative things that have occurred during the month. Reflecting their close connection to nature, American Indian women refer to the menstrual period as being "on the moon," which is considered a positive time.

A review of qualitative research on women's experiences of miscarriage revealed four major themes:

1. What I feel. Women described a need for recognition and acknowledgment of their emotions and physical symptoms. 2. Care for me, communicate with me. Women described a need for communication and information about the physical and emotional aspects of miscarriage and what to expect. They reported that the lack of information made them feel helpless and that the situation was out of their control. 3. Me, my baby, and others. A loss of the rights and identity associated with motherhood and a sense of personal failure were described. Women felt that others didn't respond sensitively to the miscarriage, so they were reluctant to discuss it. 4. Help me cope with the future. Women wanted guidance on how to move forward after the loss and reported that the most helpful support came from other women who had miscarried.

Menstrual Cycle 4 Stages

1. menstrual phase - beginning on day 1. The first phase is the menstrual phase, beginning on day 1. Yet, physiologically speaking, it actually represents the end of the cycle. 2. extending from about day 4 to day 14 is the follicular phase. During the follicular phase, a follicle matures and swells. The follicular phase ends when the follicle ruptures and releases the egg; this marks ovulation and the beginning of the ovulatory phase. 3. The next phase is the luteal phase, during which a group of reddish-yellow cells, called the corpus luteum, forms in the ruptured follicle. 4. the menstrual phase begins again, marked by menstruation, when the endometrium (i.e., the inner lining) of the uterus, which had built up in preparation for nourishing a fertilized egg, is sloughed off. The days we provide are approximate, because every person's menstrual cycle (more specifically, their menstrual and follicular phases) varies in length. In general, if an egg is not fertilized, menstruation begins 14 days after ovulation.

Stages of Childbirth

1. the cervix must dilate to 10 centimeters. It is important to remember that there is much variability from one birth to the next; just as every woman is unique, so is every birth. Some women may take a few days to dilate the first 2 to 3 centimeters, perhaps feeling nothing, while others may dilate more quickly. Getting from 3 to 10 centimeters is more intense, however, and can often take 8 hours or longer - uterine contractions are fueled by the release of the hormone oxytocin - At the start of labor, these contractions typically feel like menstrual cramps, until they begin to rise and fall at regular, predictable intervals. The pain of the contractions becomes intense and can be made worse by anxiety and dehydration. For some women, medical pain management is helpful at this stage. - A doula provides continuous physical, emotional, and informational support to a woman before, during, and shortly after childbirth 2. actual delivery of the baby 3. delivery of the placenta—occurs. This usually takes only a few minutes and involves much less effort than the previous two stages. - Postpartum depression occurs in up to 19% of mothers, and women with a history of depression are at highest risk. prevalence is higher among lower-income women, who also have reduced access to treatment.

Practical Implications

1. the magnitude of the mood shift depends on the individual woman. Certainly in practical situations, the magnitude of the mood shift is most significant. 2. in making practical decisions about hiring people, performance is certainly more crucial than mood. Research on performance—such as intellectual or athletic performance—generally shows no fluctuations over the cycle . Research has found no fluctuations in academic performance, problem solving, memory, or creative thinking. Thus there is no evidence of cycle fluctuations in the kinds of performance that are important on the job. - Some studies have found menstrual cycle fluctuations in three-dimensional spatial ability. Spatial test performance is highest during menstruation, when estradiol and progesterone levels are low. Interestingly, spatial performance is positively correlated with women's testosterone levels and negatively correlated with their estradiol levels. one study found that women's spatial scores during the menstrual phase did not differ significantly from men's. SUMMARY: research suggests that menstrual cycle changes in hormone levels are linked to mood fluctuations in at least some women. Women show substantial variability in these menstrual cycle-mood relationships. there is no evidence of fluctuation in performance. The existing research has many problems: Most of it is correlational in nature, and expectations complicate interpretations. Cultural factors may also contribute to mood shifts.

Gender and Infectious Diseases Continued

The WHO researchers described how biological and psychological aspects of gender can influence disease transmission and outcomes at four levels: 1. Vulnerability to infectious disease. Gender can affect our risk and vulnerability to specific infectious diseases, particularly through the gendered division of labor. 2. Exposure to pathogens. Gender can influence our exposure to infectious disease. For example, because the female role typically includes caring for sick relatives, women are more often exposed to pathogens. 3. Response to illness. Gender can impact how individuals respond to illness, especially in obtaining access to health care. sons may be valued more which = take to doctor and not daughter. men may also control wives access to health care. 4. Effectiveness of public health interventions. To be effective, public health interventions must be targeted and communicated in a way that is sensitive to gender. For example, if women are expected to be responsible for carrying out aspects of a public health intervention—such as changes in cleaning the home, preparing food, or caring for children—then public health officials need to communicate directly with those women. In some countries, this may involve taking into account restrictions on women's access to public spaces as well as their lower literacy rates.