Treating Menstrual Cycle Problems the Interdisciplinary Way

by Heather Shupp

By the time they make it to the Kinsey Institute for Research in Sex, Gender, and Reproduction's Menstrual Cycle Clinic, women suffering from menstrual cycle problems have been through a lot--medically and emotionally. Most of the clinic's patients have been from doctor to doctor and have received a variety of treatments, including Prozac, yet the symptoms persist: mood changes, pain, heavy bleeding.

"The medical profession is in some confusion about how to treat menstrual cycle problems," says Dr. John Bancroft, a clinical professor of psychiatry at Indiana University Bloomington, director of the Kinsey Institute, and one of the two doctors working in the Menstrual Cycle Clinic. "There is some literature showing what treatments do help, but what hasn't been done is to really identify which treatments are likely to benefit which women."

What is different about the Kinsey Institute's Menstrual Cycle Clinic is its interdisciplinary approach. "We're taking into account the woman's hormonal cycle and its relevance to her menstrual problem, but we're also looking at other factors that might be relevant," Bancroft explains. Although a psychiatrist by training, Bancroft spent twenty years working in a reproductive biology unit at the University of Edinburgh in Scotland before coming to the Kinsey Institute in 1995. "I regard myself as a sort of interdisciplinarian," he says, "my strength being in breadth rather than depth."

Because the Menstrual Cycle Clinic's treatment approach takes into account issues of gynecology, reproductive biology, and psychology, "the clinic provides a type of care that is not really recognized or available through the present health care system," Bancroft says. "It offers a kind of expertise that is in danger of being squeezed out by the system so that women will end up getting the treatment that happens to be met by their insurance or is readily available rather than the treatment they actually need."

Determining what treatment each individual woman does need is the difficult part. Bancroft and Dr. Diana Ebling, a physician at the IU Health Center who works with Bancroft in the clinic, recognize three factors as potentially relevant to each woman's particular problem. These three factors--the impact of the ovarian hormonal cycle, menstruation, and vulnerability (other elements in a woman's life such as stress, relationship problems, or a tendency to get depressed)- can interact in different ways for each woman. To enable Bancroft and Ebling to determine which factors are having the greatest effect in each case, patients are asked to complete a menstrual health questionnaire on their first visit, then to track various symptoms daily for two months. With this information, the doctors can advise patients about the most effective forms of treatment.

Recommended treatment can include medication or various self-help techniques, or both. Bancroft and Ebling may recommend oral contraceptives, medications to regulate abnormal bleeding, or antidepressants, or they may advise a women to discontinue use of oral contraceptives. They also provide patients with information on self-help techniques including stress-reduction activities and modification of diet and exercise.

While menstrual cycle problems are notoriously difficult to treat, the clinic is able to substantially improve the condition for the majority of women who seek help. The key to this success is the lengthy period of evaluation and data collection before treatment is prescribed. Although Bancroft, who ran a similar clinic in Edinburgh for sixteen years, has become quite skilled in matching treatments to symptoms, he would like to go further in identifying the best indicators for each woman. Bancroft hopes to conduct a study in which women with menstrual cycle problems are randomly assigned to one of two treatments, both known to be effective in some cases. Such a study would help confirm prog-nostic indicators that he has gleaned from earlier data.

Although the Menstrual Cycle Clinic, which has been operating one morning a week in the IU Health Center on the Bloomington campus since December 1996, offers a unique and effective approach to treating a set of particularly thorny health problems, it has yet to reach capacity. Unlike most other services at the center, the clinic is open to the general public as well as to IU students. Bancroft has been making an effort to introduce the clinic and its unusual program to local physicians, and to dispel any misgivings physicians may have that they will lose patients to the clinic. "We don't accept patients for long-term care, and therefore we're not going to take patients away from their usual physicians," Bancroft explains. "We're providing a kind of diagnostic/consultation service."

Bancroft is also working to address another factor that may be limiting the number of women seeking help at the clinic: the fees, while reasonable, often are not covered by health insurance companies. Bancroft, together with others at the Kinsey Institute, is putting together a proposal to approach private foundations about underwriting the cost of the clinic so that it could offer free care. Currently, the clinic is partially supported through charges to patients but is substantially underwritten by the Kinsey Institute budget. Bancroft is also considering adding management of menopause and menopausal problems, an area in which he also has extensive experience, to the clinic's services.

While running clinics that reach out into the community and provide effective help for reproductive health­related problems is something Bancroft has done for years, it is relatively new for the Kinsey Institute. Yet the application of knowledge of reproductive health and sexuality to solving problems is central to the institute's mission. For Bancroft, applying his specialized knowledge to helping women is intellectually and personally satisfying. "The problems are difficult in any case, and it is a challenge to try and grapple with them," he says. "But as a man, there is the added challenge of understanding something quintessentially female." Kinsey