Talk:Menstrual cycle

Loose ends

See Talk:Menstrual cycle/Archive 3 for earlier commentary on Wikipedia:Featured article review/Menstrual cycle/archive2. SandyGeorgia (Talk) 17:52, 21 March 2021 (UTC)

Starting a section to look at what's left to do. SandyGeorgia (Talk) 15:57, 11 March 2021 (UTC)

From Talk:Menstrual cycle/Archive 3#Some thoughts on content

Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones.Graham Beards (talk) 14:19, 8 March 2021 (UTC)

I like your second and third sentences ... what if we add something like that? I won’t try myself, since my iPad editing is probably making everyone unhappy. SandyGeorgia (Talk) 15:39, 8 March 2021 (UTC)

I can't see anything on the menstrual cycle in Alosco and Stern. Graham Beards (talk) 14:30, 8 March 2021 (UTC)

• [1] Else-Quest N, Hyde JS (2021). "Psychology, gender, and health: psychological aspects of the menstrual cycle". The psychology of women and gender: half the human experience + (10th ed.). Los Angeles: SAGE publications. ISBN 978-1-544-39360-5.
• [2] Morgan KN, Kantarci K, Asthana S, Gleason CE (2019). "Neurocognition in menopause and reproductive disorders". In Alosco ML, Stern RA (eds.). The Oxford Handbook of Adult Cognitive Disorders. United States: Oxford University Press. ISBN 978-0-190-66412-1.

Where do we stand on this? SandyGeorgia (Talk) 15:57, 11 March 2021 (UTC)

• We're still using a source about the luteal phase (Wendy Biggs and Robin Demuth) for the 80% of women that don't experience disruption to daily life, but implying that it's about the entire menstrual cycle. As menstruation is not part of the luteal phase, I doubt that is correct. FemkeMilene (talk) 17:06, 11 March 2021 (UTC)

Can you find a better source? Graham Beards (talk) 17:40, 11 March 2021 (UTC)

This might be useful if we can precis the salient conclusions.

• Iacovides S, Avidon I, Baker FC (2015). "What we know about primary dysmenorrhea today: a critical review". Human Reproduction Update. 21 (6): 762–78. doi:10.1093/humupd/dmv039. PMID 26346058.

-Graham Beards (talk) 17:53, 11 March 2021 (UTC)

(Graham asked me to comment on the 80%/most issue, on my talk page). I see the above paper is on pain and its consequences, rather than on other impacts on life/health that don't necessarily have a source in pain or cramping. I'm really not sure how to solve the issue, though I see the lead says 80% and the body say 20% (for the opposite) so that's not consistent. Would it help to say "four out of every five" which is the same but sounds suitably less precise?

The article currently claims "about 67.2% of adolescents" get dysmenorrhea. This cites a primary research paper that interviewed 198 girls age 13-19 from two slum areas in New Delhi, India. The 67.2% figure is only appropriate for referring to the sample under study (i.e., 133 girls), not for interpreting in the wider population. We need a secondary source that gives the figure for the population, and the figure is more likely to be "about two thirds of adolescents" than a percentage to three significant figures. -- Colin°^Talk 15:44, 12 March 2021 (UTC)

And the New Delhi primary source is 2008. Fiddlesticks. I thought we had cleaned out all of the junk that found its way in to this article via menstruation and disease model, and am now worried that we need to take a closer look. I will look through every source in the article when I am home again (traveling now). SandyGeorgia (Talk) 15:56, 12 March 2021 (UTC)

Thank you both. I think we have got the (rather complex) endocrinology correct now and it is properly sourced Sandy. It's just this little bit of epidemiology, which I have been asked to include (against my better judgement) that is a problem. The Lead and the Body are saying the same, it's just one statement says how many "do" and the other says how many "don't". (I can't see how that crept; I don't think it was me). I agree with Colin that we need a simple ratio that is globally applicable and from a WP:MEDRS source. If we can't find a source, I think we should delete the statement.Graham Beards (talk) 16:27, 12 March 2021 (UTC)

It will still help (me, at least) going forward if I go through and do what I usually do ... put a type=Review, etc., on every (Pubmed) source so I know which I have checked. SandyGeorgia (Talk) 16:39, 12 March 2021 (UTC)

I think it's good that the 80% figure was removed. It was inaccurate as is. Things like tender breasts, cramps, bloating, feeling tired, irritability and mood changes do disrupt most women's lives at one or more points during their cycle. I would think that obvious. Disrupting their daily life and being severe enough to stop them from going about their typical day are two different things. I imagine that is why the Hong Ju, Mark Jones, Gita Mishra source[3] says "severe pain limiting daily activities is less common" and this source[4] (Wendy Biggs and Robin Demuth) says "substantial disruption." These sources use the words "limiting" and "substantial disruption." A woman can have disruption because of her period without it being substantial disruption. And then there's the inconsistency on what qualifies as PMS (also mentioned in the PMS section back up on the page).[5] Regardless, according to these and other sources, most women will get one or more painful symptoms during their cycle/near or during their period. These are enough of an issue for the women to take medication for it. The reality that many women need to take medication for it, most commonly for cramps, is indicative that the symptom has disrupted the woman's daily life. The menstrual health section said, "Painful cramping in the abdomen, back, or upper thighs can occur during the first few days of menstruation. Severe uterine pain during menstruation is known as dysmenorrhea, and it is most common among adolescents and younger women (affecting about 67.2% of adolescents)." That's disrupting daily life, and 67% is not a minority. I know that this information has been reworked, but I'm commenting on the adolescent thing in the case we come about a better source for it.

When we use the words "disrupt daily life", we have to be careful to not report this as occurring in a minority of women. The Wendy Biggs and Robin Demuth source says "without substantial disruption", which is not the same thing as "no disruption." It's just that a minority of women experience symptoms that significantly limit/interfere with their daily activities. So, based on the sources, it's probably more prudent to alter "During their menstrual cycle, some women experience problems that disrupt daily life" so that we have it saying "During their menstrual cycle, many women experience painful symptoms." If we re-add the "no disruption to daily life" phrasing at some point, it should be altered so that we have it saying "no substantial disruption to daily life" or "no significant disruption to daily life." By the way, I think "cramps" should replace "acne" in the introduction. Cramps are the most common of the symptoms. "Acne" (mentioned in this[6] discussion back up on the page) isn't as serious a concern as the others (for most women, I'd say). ApproximateLand (talk) 23:59, 12 March 2021 (UTC)

Thanks you for these useful comments, which I will keep in mind if any further chnages to that (tricky) paragraph are made. I have replaced Acne in the Lead as you suggested.Graham Beards (talk) 08:01, 13 March 2021 (UTC)

The penultimate sentence needs to be rewritten now that we're focussing on the women with problems again. I came up blank in terms of good prose. FemkeMilene (talk) 09:43, 13 March 2021 (UTC)

Of which section? Graham Beards (talk) 10:11, 13 March 2021 (UTC)

The last paragraph of the lede. Directly after the sentence you just improved. FemkeMilene (talk) 10:17, 13 March 2021 (UTC)

OK. Graham Beards (talk) 10:56, 13 March 2021 (UTC)

Thank you, Graham Beards. ApproximateLand (talk) 17:45, 13 March 2021 (UTC)

We seem to have gone backwards, to again focusing on what TWO sources say are 20 to 32% of women, medicalizing the cycle, while we have lost the specificity that (68 to) 80% of women do not experience disruption in their daily lives— what is stated clearly in two sources. This article is not PMS, and most women do not have PMS, yet we introduce now what is 20% of women prominently in the lead. My understanding early on was that GandyDancer, Graham, Femke and I all objected to this. We need to go back to what the sources say about 80% (in one source, expressed as 20-32 in the other) of women, as “some women” is too vague and we are leaving the impression that menstruation is more than a bother to a lot of women. Why are we using PMS sources rather than menstrual cycle sources? I thought this section had highlighted sources that specifically discuss the cycle so that we could get away from medical disorders that affect “some”? Or, as Femke says, we are “focusing on the women with problems again” even though a) that is borderline offtopic, and b) those women are a minority. I hope we can stick to sources about the menstrual cycle and not get into the netherlands of every medical issue that affects a minority to the point of undue attention: yes, having to use products to contain flow is a “bother”, but the medical definition of disruption to daily life means something entirely different. Shall we examine the sources originally provided by WAID, listed above, and use them if helpful to get away from PMS, which is not what this article is about? We have a high quality recent source that says:

Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones.Graham Beards (talk) 14:19, 8 March 2021 (UTC)

so there is no need to get off into medical conditions affecting the minority— particularly when we are sourcing those statements to articles about PMS. SandyGeorgia (Talk) 13:52, 13 March 2021 (UTC)

One of those sources only refers to the luteal phase not the full cycle so we only have one source. Graham Beards (talk) 13:59, 13 March 2021 (UTC)

All four of the sources used in those two sentences of the final para of the lead are PMS sources; we are opening the door again for the article to become about medicalization of the reproductive cycle, while giving undue attention to a minority. At minimum, we might move that out of the lead, but I also suggest we should be using Else-Quest if anything. SandyGeorgia (Talk) 14:34, 13 March 2021 (UTC)

I think we should delete all of it but I anticipate a lot of opposition. By using Else-Quest, do you mean the take home message I wrote above? Graham Beards (talk) 14:41, 13 March 2021 (UTC)

Or similar; I am unsure if that commentary was based on a quick glance or if you would want to expand it. It is a source specific to the cycle, and if we preferences sources about individual conditions (even in the lead, even when they affect a minority), that could end with re-medicalizing the entire article again. As to delete or just leave out of the lead, we should gather other opinions. I am unsure why we are focusing on PMS as opposed to any other medical condition that can affect a part of the cycle. Graham, PMID 26346058 which you found demonstrates the issue(s) well (is it really a reproductive cycle issue?) and offers an explanation for why menstruation is merely a “bother”, but not disruptive, for most women. SandyGeorgia (Talk) 14:50, 13 March 2021 (UTC)

The first thing I noticed in that paper was the enormous range in those affected ("between 45 and 95%") and this paragraph "few affected women seek medical treatment, despite the substantial distress experienced, as many consider the pain to be a normal part of the menstrual cycle rather than a disorder". It didn't have the answer to my question; for how many women is it a minor disruption? (Or a "bother" as you put it). I didn't pursue it further because it was leading me astray down the medicalization path. We should certainly move away from PMS.Graham Beards (talk) 17:01, 13 March 2021 (UTC)

SandyGeorgia, did you read what I said? Why do you say "minority" and "medicalizing the cycle" when reporting on common facets of it? In the PMS section back up on the page, Graham Beards quoted information from the Wendy Biggs and Robin Demuth source. One thing it says is "Up to 80 percent of women report one or more physical, psychological, or behavioral symptoms during the luteal phase of their menstrual cycle without experiencing substantial disruption to their daily functioning." It says "without experiencing substantial disruption", not "without experiencing any disruption." The Hong Ju, Mark Jones, Gita Mishra source[7] says that dysmenorrhea, what our Wikipedia article alternatively calls menstrual cramps, "is a common menstrual complaint with a major impact on women's quality of life, work productivity, and health-care utilization." It says that "the prevalence of dysmenorrhea varies between 16% and 91% in women of reproductive age, with severe pain in 2%–29% of the women studied." So dysmenorrhea is common. Menstrual cramping is painful and happens near or during the woman's period. While estimates vary, it occurs in most teenage girls and women during their cycle, not in a minority. These cramps do typically disrupt teenage girls' and women's lives enough to, as one of the sources says, result in a complaint about the cramps affecting their quality of life. Disruption does not need to be debilitating to be disruption. Many teenage girls and women take medication for the cramps. If these cramps did not disrupt their lives at all, they would not need the medication. There are other menstrual cycle symptoms, such as bloating and irritability, that are common. Women can also get these symptoms during their cycle without the symptoms being diagnosed as PMS. Our PMS article mentions this.[8] Graham Beards has also quoted a piece from a source that says "few affected women seek medical treatment, despite the substantial distress experienced, as many consider the pain to be a normal part of the menstrual cycle rather than a disorder." Well, as substantial distress is substantial, I wouldn't say that's not disruption. I object to removing the information on pain or other troubles that teenage girls and women commonly experience during the cycle. This isn't medicalizing the topic. It's a medical facet of a biological topic. It's just a reality that comes with the cycle. If concerned about focusing on the luteal phase, one suggestion I have is to say "During the luteal phase of their menstrual cycle, some women experience problems that disrupt daily life." I still think "some" should be "many" or that we should just remove "disrupt daily life" and replace the sentence with "During their menstrual cycle, many women experience painful symptoms." We could also say "During the luteal phase of their menstrual cycle, many women experience painful symptoms." ApproximateLand (talk) 17:45, 13 March 2021 (UTC)

Hold on. Can we stop going around in circles? We have already agreed that medical problems associated with menstruation belong in menstruation and not here. Could somebody point out any issues associated the follicular, secretory and luteal phases that are important enough to be mentioned? And backed up with reliable sources and not opinions. Also, given this article is around 99% about endocrinology, I am amazed that no one has checked what I have written about the complex interplay of hormones — or at least said they have read it and it's correct. Graham Beards (talk) 19:32, 13 March 2021 (UTC)

Graham Beards, please be patient with me. You've been a tremendous help with the page and I also want to help. What I think should be in the article aside, please know that I'm not commenting from a personal viewpoint. As to "We have already agreed that medical problems associated with menstruation belong in menstruation and not here." But the cycle is intrinsically linked to those problems ("80 percent of women report one or more physical, psychological, or behavioral symptoms during the luteal phase of their menstrual cycle") and should be mentioned on this page too. They already are, and the article would have excluded pertinent information if it weren't on the page. That is all I support including on the page about issues that teenage girls and women have during their cycle. We don't need to go into any unnecessary depth about menstruation or anything else. I've looked at refs on this topic today. I read all of the reviews that have been discussed here and others (a Turkish one too), and then I took a look at what books have say. A couple of books have been mentioned on this discussion page. As to what I read, well, there's this ref.[9] It's a Nancy Caroline's Emergency Care in the Streets Advantage Package (Canadian Edition) ref and says, "Some women may experience abdominal pain and cramping in the middle of the menstrual cycle. This pain and its accompanying symptoms result from the physiologic rupture of an ovarian follicle and are collectively called mittelschmerz (German for middle pain). In most cases, the pain is not severe; it may last only a few minutes or as long as 48 hours (average, 6 to 8 hours). Signs and symptoms include sharp, cramping pain in the lower abdomen, localized to one side, beginning midcycle, with a history of similar pain episodes during previous periods. The pain may also be reported as switching sides from month to month. The condition itself is not serious, and the pain can be relieved by over-the-counter analgesics."

The ref also says, "Dysmenorrhea is painful menses. It is classified into two categories: primary and secondary. Primary dysmenorrhea occurs with the advent of the menstrual flow and normally lasts for the first 1 to 2 days with gradual relief. Mild cramping is normal, but some women experience severe cramping, with pain originating in the area of the pubic symphysis and radiating downward to the vulva and outward to the thighs. Primary dysmenorrhea accounts for approximately 80% of patients presenting with painful menses and accompanies a regular period. Secondary dysmenorrhea is pain that is present before, during, and after the menstrual flow. It is generally organic in nature (not hormonal) and may signal an underlying illness or structural abnormality. As with PMS, prehospital treatment is largely supportive." So this source (not too dissimilar to others on the subject) is saying what I've said. These symptoms are common, may or may not be characterized as PMS, and while, in most women, they are not severe enough to substantially affect their daily routine, pain is involved and medication is needed for many of these women. And so I'm concerned about having this page misdirect readers by making them believe that there is no menstrual pain or other discomfort, or no issue with pain or other discomfort, for most women at certain points during their cycle. While something like menstrual cramps won't be debilitating for most women, they are enough of a problem in that the pain can last for hours, especially without medication. What I keep seeing with the 80% figure is acknowledgement that at least 80% of women experience some sort of pain or other discomfort at some points during their cycle, with some of the references acknowledging the issues with diagnosing all or some of these as PMS.

This ref[10] (A Pocket Guide to Clinical Midwifery) says, "Although 80% of women report symptoms of PMS, only 20–32% have recurrent lifestyle modifications indicating a diagnosis of PMS (Schuiling & Likis, 2017)." And the Anatomy and Physiology - E-Book ref[11] says, "Dysmenorrhea, meaning 'painful menstruation', is the term used to describe menstrual cramps, the painful periods that affect 75% to 80% of women at some time during their reproductive years." ApproximateLand (talk) 04:01, 14 March 2021 (UTC)

This is unnecessarily long and does not attempt to address my questions. Your only valid concern is "this page misdirect(s) readers by making them believe that there is no menstrual pain or other discomfort, or no issue with pain or other discomfort". It doesn't. I suggest you direct your energy to improving menstruation. Graham Beards (talk) 10:25, 14 March 2021 (UTC)

Graham, how can we help on the endocrinology? I don't have the textbooks, and as best I can tell, we have no experienced editors who specialize in endocrinology. All I can offer is to research and read journal articles on topics if there is a specific section you want reviewed or checked, but agree that is where our focus should be now. Other than that, please let us know how we can help.

On the menstruation issue, I have re-read all of the sources, and they all seem to be saying similar (and that similarity seems to explain the wide variability in how "pain" is reported). A lot of the variability seems to be related to cultural factors, environmental factors, perception affected by family, issues like somatoform disorders and fibromyalgia, so there are many issues that can be explored at menstruation about different cultural and societal and environmental factors that lead to perception of pain. Best, SandyGeorgia (Talk) 17:28, 14 March 2021 (UTC)

I was being sarcastic. Despite our now having an excellent (even though I say it myself) explanation of the endocrinology, which is what the article is all about, we are still seeing walls of text on the Talk Page about a couple of sentences. You hit the nail on the head by saying "A lot of the variability seems to be related to cultural factors...", and this is why that stuff belongs in Menstruation. Regardless of the quality of our sources, we are not going to an agreement on any percentages that we quote. No one seems at all interested in how this amazing cycle works and I am left with the impression we should just focus on period pain.Graham Beards (talk) 17:58, 14 March 2021 (UTC)

Whew; I could not figure out why you seemed to be questioning your own high quality work and asking for it to be checked ... :0. And the majority of us do see and recognize it; thank you, Graham, for the great article. SandyGeorgia (Talk) 18:19, 14 March 2021 (UTC)

Graham Beards, I don't think I'm mistaken when I say that other users have also made long posts on this discussion page. My additional post was that long because I quoted portions of refs. You said that my post does not attempt to address your questions. What came up was a concern about the information that says "During their menstrual cycle, some women experience problems that disrupt daily life;[8] such problems can include cramps, tender breasts, bloating, tiredness, irritability, mood changes[9] and premenstrual syndrome. More severe problems such as premenstrual dysphoric disorder are experienced by 3 to 8% of women." My long post was about that. When I first posted, offering my thoughts on a topic I can help on, you thanked me. Now, even though a complaint was made about reporting on factual stuff, I get this response that characterizes me as just going off at the mouth. You said that my only valid concern is this page misdirects readers by making them believe that there is no menstrual pain or other discomfort, or no issue with pain or other discomfort. You said it doesn't. Yes, it doesn't yet because that information is still in the introduction and the menstrual health section, as it should be.

My valid concern is about not removing this information on some misguided belief that these symptoms occur in a minority of women or that reporting on them is medicalizing the menstrual cycle. My energy doesn't need to be directed to the menstruation page because I was as focused on text on this page as others were. It's painting editors with a broad brush to say that "no one seems at all interested in how this amazing cycle works." I am, and I know quite a bit about it. Others on this discussion page probably do too. However, when the final section on the discussion page is discussing the pain information or other symptoms, and another complaint is made about how we've reported on it after we seem to have resolved it, it's not unreasonable that others will comment on it too. I can help with information on other stuff. By the way, I don't see any good refs that a lot of the experienced pain can be attributed to culture or social environment. We know that the cramping has much to do with biology. But I have seen some things on the variability of some of the painful symptoms possibly being due to how the pain is expected to be perceived. Even the reality that "few affected women seek medical treatment, despite the substantial distress experienced, as many consider the pain to be a normal part of the menstrual cycle rather than a disorder" concerns perceptions. I agree that information like this should be elaborated on at the menstruation page rather than at this one. ApproximateLand (talk) 21:11, 14 March 2021 (UTC)

Sorry, please see WP:TLDR and WP:NOTAFORUM. Can you please stop posting essays. Graham Beards (talk) 22:08, 14 March 2021 (UTC)

Wow, rude much? Was the "We seem to have gone backwards" post by another user after we'd resolved the pain stuff not also an essay? My post is a violation of the WP:NOTAFORUM rule, but theirs isn't? My posts have been on-topic! No wonder people are backing away from trying to help at this page. When two editors just do what they want and talk over others offering their thoughts, what's the point? I suggest you listen to others, just like you listened to my first post. We can move on from the pain stuff now. It's fine the way it is. That is all I was saying. Sheesh. I maybe should have just said that with no explanation. ApproximateLand (talk) 22:21, 14 March 2021 (UTC)

@ApproximateLand :). Welcome to Wikipedia, and thanks for trying to help here. Graham is right that shorter messages are way more convincing; I'm definitely too tired after a day of work to read long posts like the one you posted above. @Graham; ApproximateLand is new around here; don't bite :) (I do appreciate you may be tired after your heroic work here). FemkeMilene (talk) 22:36, 14 March 2021 (UTC)

Thank you, Femkemilene! I'll try to keep my posts more succinct in the future on Wikipedia. ApproximateLand (talk) 22:40, 14 March 2021 (UTC)

Identifying reviews

Done,[12] and I standardized journal articles to sentence case, as we had a mix (book titles use title case). SandyGeorgia (Talk) 00:27, 13 March 2021 (UTC)

Thanks. Graham Beards (talk) 08:01, 13 March 2021 (UTC)

I have replaced most of the sources that are journal articles but are not reviews by book sources.[13]. I have left four journal article sources in the Evolution section because these are the papers cited by our main source Emera D et al. I included them as a courtesy to our readers to save them having to look them up. Graham Beards (talk) 10:42, 16 March 2021 (UTC)

Thanks again, Graham (agree re Evolution section). SandyGeorgia (Talk) 14:04, 16 March 2021 (UTC)

Usage of the wording "on day 14"

I've asked a friend of mine who is an endocrinologist what she thinks of the article now and had the following conversation with her: She said "Looks pretty good! Apart from the “ovulation occurs around day 14” statement. It should be “.. occurs around 14 days before onset of menses” - a different thing!". I replied "I am trying to understand which sentence(s) you are saying needs changing. So I did a word search for "Day " in the article and found it mentioned a few times, e.g. "Around day fourteen, the egg is released from the ovary" Would you argue against the usage of things like Day 1, Day 14 etc. altogether?" Her reply: "It’s fine to use day 1 etc for most things, but the day the egg is released is dependent on how long a women’s cycle is, and is only day 14 if a woman has a 28 day cycle.". So I am wondering if we should clarify this? That the "Day 14" statement only applies to women who have a 28-cycle day? It might otherwise be taken as a given that for all women it's on Day 14. EMsmile (talk) 04:12, 15 March 2021 (UTC)

No not really because we say "around" not "on". "Luteinising hormone initiates ovulation at around day 14 and stimulates the formation of the corpus luteum.{{sfn|Tortora|2017|p=944}}" The luteal phase is usually bang on 14 days, whereas the follicular phase tends to show much more variability lasting from 10 to 16 days. This is what your friend is referring to. So "around Day 14" is close enough for most women. Thanks for the feedback.Graham Beards (talk) 08:43, 15 March 2021 (UTC)

Agree ... I searched and searched for the problem mentioned by EMsmile, and couldn’t find it, as we are always careful to be reflecting the average, with either “around”, “about”, or “average” wording. It seems we have this covered, as we are reflecting an average 28-day cycle, but EMsmile it is awesome that you found an endocrinologist to review the article and that she liked it! That is great news!

If people would look over and comment on the section just above this as to whether they are happy with each instance of where we use a non-review source, we would be moving closer to wrapping up loose ends. (I flagged up each use of review vs. non-review, and no one has commented except Graham.) I think I have all the MOS issues covered. SandyGeorgia (Talk) 16:06, 15 March 2021 (UTC)

Bits and pieces

I encouraged my endocronologist friend to take a further look at the article, and here is some more feedback from her:

• So in the follicular phase “Antral follicles “ are used in the paragraph prior to them being defined. Suggest moving “The follicular phase is the first part of the ovarian cycle and it ends with the completion of the antral follicles.[15] Meiosis (cell division) remains incomplete in the egg cells until the antral follicle is formed. “ lower down in that section
• There’s a fair bit of repetition, maybe that’s a necessity? But sometimes they say different things, eg the trigger for menstruation.
• “ Breastfeeding women can experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles can resume.[38]”

Grammar problem. End with: “or resumption of normal menstrual cycles”. EMsmile (talk) 12:46, 16 March 2021 (UTC)

Thank you both for this. I have made these changes. [14]. Graham Beards (talk) 14:10, 16 March 2021 (UTC)

Thanks to all three ... awesome that an endocrinologist looked in. SandyGeorgia (Talk) 14:13, 16 March 2021 (UTC)

Still pending

Previous discussions archived for length, see Talk:Menstrual cycle/Archive 3. SandyGeorgia (Talk) 21:13, 21 March 2021 (UTC)

It is perchance that I am obtuse, so if I am misunderstanding the posts of others, please spell it out for me Dummies 101 style, but we still seem to have one thing pending.

NikosGouliaros asked for some information on psychological aspects. WhatamIdoing came up with Else-Quest, a 2021 source,[15] which was summarized to two sentences by Graham. Femkemilene pointed out that we are still using sources about menstruation (UNDUE and off-topic here in my opinion, but I digress), and I note that we still haven't used WAID's source which specifically addresses the menstrual cycle (as opposed to menstruation). In that same discussion, Graham produced yet another recent review which explains the variance in menstruation literature (again answering the UNDUE aspect of adding menstruation issues as affected by environmental, cultural, societal factors and comorbidities here), and yet somehow we still never got back to the menstrual cycle source provided by WAID. We seem to have forgotten a piece amid other discussions; or am I missing something?

I would add something from Else-Quest myself, but google preview only lets me see the first page. I suggest we still need to address the issue raised by NikosGouliaros, and WAID's source is a good one for doing that; would someone add a few sentences under Menstrual health, or alternately, email me the chapter if possible? SandyGeorgia (Talk) 15:02, 16 March 2021 (UTC)

• Else-Quest N, Hyde JS (2021). "Psychology, gender, and health: psychological aspects of the menstrual cycle". The psychology of women and gender: half the human experience + (10th ed.). Los Angeles: SAGE publications. ISBN 978-1-544-39360-5.

I think that we shouldn't make a firm distinction between the cycle and each phase. If you have problems in Phase X of the cycle, then you logically do "have problems in...the cycle". It would be a problem to tot up the numbers for each phase (because some women will have problems in more than one phase), but I think it's fine to say that women who have problems during the luteal phase (e.g., PMS) or menstrual phase (e.g., cramps) are women who have problems during the menstrual cycle. WhatamIdoing (talk) 23:49, 16 March 2021 (UTC)

Yes, that makes sense.Graham Beards (talk) 10:37, 17 March 2021 (UTC)

But my question is, are we adding something to address NikosG’s request, and from Else-Quest, a source explicitly about the topic ? Did we lose track of that in the other discussion, or is there a different reason we haven’t added it? SandyGeorgia (Talk) 10:49, 17 March 2021 (UTC)

It's partly because this Talk Page has become rather difficult to keep track of. (Well done for archiving some of it Sandy). I wasn't planing to add anything and I don't have a copy of the source with me in any case. I was hoping WAID might be better placed to add something if we are certain it is needed. I would avoid anything about "mood swings" like the plague. Graham Beards (talk) 11:40, 17 March 2021 (UTC)

We probably should add something.

The other thing that's been on my mind is that there's a difference between "has a symptom" and "has a problem". The reported symptoms include things that some women would not count as problems, such as (temporarily) larger breasts. WhatamIdoing (talk) 02:15, 20 March 2021 (UTC)

Until the cat walks across them. I got hold of the pages from Else-Quest, and was going to propose something after Clayoquot’s endocrinologist goes through on that, but maybe you can do this part. SandyGeorgia (Talk) 02:25, 20 March 2021 (UTC)

I think that something along these lines would be a fair summary of the Else–Quest book. I'm not sure where to put this, so I'll leave it here. This is from the 10th edition (last month!), 978-1544393605, pp. 258–261:

There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a "very small" increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle.

The culturally communicated belief that the premenstrual time is associated with poor mood or that menstruation is a painful, shameful, or unclean experience may be a self-fulfilling prophecy. The belief can cause women to feel worse. It can also result in people, including the affected woman, attributing a woman's normal and appropriate mood variation to the menstrual cycle, so that a premenstrual woman who feels angry about a real problem can be dismissed by herself and others as merely suffering from hormones.

Non-psychological changes are also small and uncommon. Athletic performance does not vary with hormones. General intellectual performance, including overall academic performance, problem-solving ability, memory, or creative thinking, does not vary during the menstrual cycle. Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.

The only concern I have about what the book says is that I think they are silently excluding serious menstrual-related medical problems, without directly stating it. If you're curled up in bed because the cramps are so bad, then your athletic performance is probably going to be pretty limited today. But I think that adding the obvious disclaimer would violate NOR (unless we found another source). WhatamIdoing (talk) 03:10, 20 March 2021 (UTC)

Graham wants to “avoid mood swings like the plague” ... I noticed the wording “shifts in behavior” in the source. SandyGeorgia (Talk) 03:17, 20 March 2021 (UTC)

The book specifically mentions sadness and irritability, but I don't remember any specific behaviors being named for that point. Also, it specifically says that while some women are slightly more likely to "feel like" crying, they are not actually more likely to do it (so, no actual shift in behavior, just in mood for that point).

One thing to be careful about is that variability in fluctuation (many vs few changes per hour/day/week) is not quite the same as variability in mood (more likely to be sad/mad/glad/afraid/surprised/disgusted during certain weeks). I don't think that the sources are always very careful about describing those, possibly because they are trying very hard to avoid using the term mood swings. Speaking of which, "mood swing", aside from not being in this source, is probably not the right overall tone. It seems to imply that the change in mood is sudden and unwarranted. WhatamIdoing (talk) 05:34, 20 March 2021 (UTC)

It all comes across as rather wishy-washy and lacking solid facts. Is there no hard evidence for any of this? I would not like see a section based on little more than speculation added to an article in which we have been so careful to get the facts right.Graham Beards (talk) 07:41, 20 March 2021 (UTC)

Graham, can that be fixed by keeping it very short, as you originally did ? As in ... There is a perception of X, but little evidence. SandyGeorgia (Talk) 15:43, 20 March 2021 (UTC)

Yes, I think it could be covered in two or three sentences and that would be consistent with the current summary style.Graham Beards (talk) 16:15, 20 March 2021 (UTC)

"Little evidence" is the wrong approach. There is "evidence against" mood swings being a general problem. WhatamIdoing (talk) 18:30, 20 March 2021 (UTC)

OK, I would like us to get into three sentences ... 1) perception that exists, 2) evidence does not support, but there are 3) other cultural and environmental influences, and 4) other factors are more significant in perception. If we wanted more, plenty of other sources indicate other medical comorbidities have an influence, but I think a lot of that belongs better at menstruation. SandyGeorgia (Talk) 18:43, 20 March 2021 (UTC)

On the general subject: Compared to, say, chemistry, behavioral health is always going to be a bit on the wishy-washy side. This is partly because of the difficulty of drawing conclusions about emotions and behavior. So, imagine that I was grumpy the other day. (I was.)

Was I grumpy because of 'hormones'? Or, you know, because of the ten thousand other reasons that humans might feel grumpy? Let's say that the proximate cause of my grumpiness because I didn't sleep well. Okay, but why didn't I sleep well? Could my imperfect sleep have been caused by 'hormones'? No, let's say that I didn't sleep well because my back hurt. (It did.) Fine, but why did my back hurt?

Pain tolerance and joint laxity probably vary with 'hormones' (and pain tolerance definitely varies with sleep status). So could it be that the menstrual cycle made my back a little unstable and made me more sensitive to pain, which made me not sleep well, which made me grumpy? That's going to be really hard to discover with normal measurement systems, and if you made that connection, you'd run into another problem: you'd be wrong. The actual reason my back hurt is because I sat at a desk to play a computer game last week. (Using a computer at a desk never ends well for me. I'm almost over it now.)

What we have, as reported in this source, is that the studies are mostly bad (e.g., selective memory/retrospective surveys). The better surveys are daily self-reports, which show "very small" changes in mood over the course of the menstrual cycle. They didn't give specific examples, but if you imagine that it's normal to feel sad for 100 hours a year, then maybe those 100 hours are distributed slightly unevenly, so that instead of exactly 25 hours per year falling into each of the four weeks of the cycle, maybe the distribution is 25+24+25+26 instead. A couple combine self-reports (there isn't an objective biological test for mood...) with hormone tests. Those find no close correlation between self-reported mood and hormone status. Some work on mood and hormonal contraception proves the role of hormones: women on monophasic pills have a more steady mood than women on triphasic pills; ergo, hormone changes cause (some, usually small) mood changes in some women.

Put in less encyclopedic, less formal language: if a woman is upset (and you somehow happen to know that it's "that time"), it's very unlikely that "hormones" have anything to do with it. There are a small number of women for whom this isn't true, but the overall story from this book is that mood variation due to the menstrual cycle just isn't a clinically detectable thing for most women, including women who have been "taught" that they experience this. However, again, I think they're talking about basically healthy women. Premenstrual exacerbation of mental illness is a thing, too. WhatamIdoing (talk) 19:13, 20 March 2021 (UTC)

I have added a synopsis based on our discussions. [16]. Graham Beards (talk) 13:28, 21 March 2021 (UTC)

With that edit, it appears that neither you nor SandyGeorgia have fully taken WhatamIdoing's statements on board. WhatamIdoing told us "Um, of course the menstrual cycle has an effect on psychological status? Because if it didn't, then PMS and PMDD wouldn't be a thing. As for sources that we could use, it's tough. You might consider [The Psychology of Women and Gender reference], which says that mood effects are 'very small', seen in both pre-menstrual and menstrual phases, and that external 'factors such as stress, health, and social support are more important'. There is evidence for a hormonal effect, and it also indicates that the effects that are self-reported might be culturally conditioned (e.g., through movies that say women are 'supposed to' have PMS, through stress caused by menstrual taboos, etc.)" WhatamIdoing quoted part of the source saying, "There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a 'very small' increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels." WhatamIdoing said, "Also, it specifically says that while some women are slightly more likely to 'feel like' crying, they are not actually more likely to do it (so, no actual shift in behavior, just in mood for that point)." WhatamIdoing said, " 'Little evidence' is the wrong approach. There is 'evidence against' mood swings being a general problem." And even so the article tells us that the menstrual cycle affecting women's moods "has not been confirmed by research." Use of "has not been confirmed" is very different from "much of the research is weak" and "very small", especially when we consider that premenstrual dysphoric disorder, which concerns the menstrual cycle, is a real thing that affects women's moods/affects them psychologically.[17] The Psychology of Women and Gender reference also says that "spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.", but this has been left out of the article. The source says "general intellectual performance", not "intellectual performance." It just feels like you focused on "culture may be causing this" speculation even though that is what is unproven.

And taking into consideration the lengthy posts (including WhatamIdoing's) before this, please don't complain about the length of this post (which is mostly quoting WhatamIdoing). Please respond to my concern, which is that we are not being accurate when reporting on this. ApproximateLand (talk) 18:16, 21 March 2021 (UTC)

I am sure WAID can speak for themselves and there is no to need repeat their comments – just refer to them.Graham Beards (talk) 18:46, 21 March 2021 (UTC)

I am sure that quoting WhatamIdoing is not speaking for WhatamIdoing. I am also sure that you can stop telling me how to reply. I assume that Template:Talk quote inline exists because it is acceptable to quote people. I refuse to be be treated differently than long-term editors. I reworked the material into something more accurate/truer to the reference.[18][19] ApproximateLand (talk) 19:00, 21 March 2021 (UTC)

Are you checking that your additions are supported by the citation given (i.e. the page number) and there is no close paraphrasing? At the end of the source (p. 254 of the 9th edition) it says "Importantly, there is no fluctuation in performance, " (my emphasis). Lastly, could you share the quality sources and standard works that you refer to in this edit summary [20]. I have struggled to find acceptable sources for this section. Graham Beards (talk) 19:27, 21 March 2021 (UTC)

Graham, do we need to change/expand the range, pp. 258–61? Or convert Else-Quest to sfns? Will worry about this once WAID has weighed in ... just noting so I don't forget. Thanks so much for all you have done for this article; your efforts are appreciated! SandyGeorgia (Talk) 19:32, 21 March 2021 (UTC)

I think we have reached the stage where we need sfns for verifiability and consistency.Graham Beards (talk) 19:36, 21 March 2021 (UTC)

I moved in sfn referencing for Else-Quest here;[21] pages will need to be refined, expanded, specified, but can wait for WAID's feedback. SandyGeorgia (Talk) 19:53, 21 March 2021 (UTC)

I am checking that my additions are supported by the citation given. Besides this, WhatamIdoing provided us with a big quote higher up on the page from the source. The WP:LIMITED area of WP:PARAPHRASE says, "Close paraphrasing is also permitted when there are only a limited number of ways to say the same thing. This may be the case when there is no reasonable way to avoid using technical terms, and may also be the case with simple statements of fact." This is why some phrasing we added is awfully close to the source's phrasing. In regards to quality sources, I was referring to the references that exist saying what WhatamIdoing has said, but more about premenstrual syndrome and premenstrual dysphoric disorder. The data may be limited on mood changes, but acceptable sources say these mood changes exist for many women. References like those seen in the premenstrual syndrome page report these mood changes as fact. The Psychology of Women and Gender reference says "there appears to be a 'very small' increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle." So it's confirming evidence of mood changes because of the cycle. I'm concerned about relying on this one source when taking into consideration all the other references saying mood swings happen because of premenstrual syndrome (and, worse, premenstrual dysphoric disorder). The reference says "there is a common belief", but that common "belief" is found in acceptable sources. Whether or not some of the mood changes are because of societal expectation, they happen. I'm okay with us saying that the data on mood changes is limited or weak at this point. I only disagree with saying "has not been confirmed". ApproximateLand (talk) 20:08, 21 March 2021 (UTC)

You are misplacing the burden of proof. Do you know about Bertand Russell's teapot? Graham Beards (talk) 20:20, 21 March 2021 (UTC)

How am I misplacing the burden of proof? The references say what they say. The quote from the reference is right there higher up for all to see. And WhatamIdoing said, "The only concern I have about what the book says is that I think they are silently excluding serious menstrual-related medical problems, without directly stating it." ApproximateLand (talk) 20:24, 21 March 2021 (UTC)

The data supporting the view that there is a teapot in an orbit around the Sun somewhere between Mars and Jupiter is limited and weak. But I think "has not been confirmed" is a more honest statement. So you don't have any other sources, and why are you talking for WAID again? Graham Beards (talk) 20:41, 21 March 2021 (UTC)

I've stuck to what the references say, as has WhatamIdoing, thankfully. Sticking to what the references say is much better than wanting to "avoid anything about 'mood swings' like the plague" because of a personal viewpoint. I don't know where you got the idea that quoting what WhatamIdoing had said is speaking for WhatamIdoing, but it's just something else we disagree on. I don't need to provide you with more refs when they are easily found in pages like the premenstrual syndrome page, and from recent discussions on this page (now archived), and when we already have a reference that does not support your "has not been confirmed" phrasing. That is not what the ref says at all. It wasn't a paraphrase of the ref. It is vastly different to "there appears to be a 'very small' increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle." ApproximateLand (talk) 20:53, 21 March 2021 (UTC)

You are confusing my opposition to an expression with opposition to the concept. The expression "mood swings" has become a dismissive cliché that I suggested we should avoid (like the plague). Your addition "While spatial reasoning ability increases, this is probably because of the lower levels of estrogen and progesterone during that point of the cycle", seems to come from nowhere. What point are you referring to, and on what page of the source is this. Is it the paragraph about increased testosterone and reduced oestradiol?Graham Beards (talk) 21:41, 21 March 2021 (UTC)

My addition of "While spatial reasoning ability increases, this is probably because of the lower levels of estrogen and progesterone during that point of the cycle" comes straight from the source, which says, "Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time." WhatamIdoing quoted it higher up on the page, in this subsection (with the page numbers 258–261). You want me to use the reference's exact wording after you pointed to WP:PARAPHRASE higher up and I had to point to the WP:LIMITED area of WP:PARAPHRASE? Sure, we can do that. I think we should wait for further comments from WhatamIdoing. ApproximateLand (talk) 21:50, 21 March 2021 (UTC)

(edit conflict) So it doesn't come straight from the source at all. It comes from WAID's quotation above, which you haven't checked for accuracy before adding it to the article using, it seems, too close paraphrasing except you left out the all important "during the menstruation phase". Is there any point in my continuing to argue with you. I am only interested in improving the article, and it's not happening. Graham Beards (talk) 22:11, 21 March 2021 (UTC)

More expert comments coming

Just a heads up that in the next few days, I'll be sending some comments on this article from a friend who is an endocrinology professor at UBC. Clayoquot (talk | contribs) 22:28, 18 March 2021 (UTC)

Thanks, Clayoquot for the heads up. I finally got full access to the source mentioned above; I will hold off on proposed wording until we hear back from you. SandyGeorgia (Talk) 22:48, 18 March 2021 (UTC)