Talk:Menstrual cycle/Archive 4

See also Wikipedia:Featured article review/Menstrual cycle/archive2, continued from Talk:Menstrual cycle/Archive 3

Catamenial epilepsy

I think this article should mention catamenial epilepsy. That wiki article was created way back in 2009, and barely tweaked since. However, it is quite a significant problem, related to the menstrual cycle. According to this article "Catamenial epilepsy is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy." There are plenty other reviews and such on PubMed, including this one from Cochrane. There's also Catamenial migraine aka Menstrual migraine. Googling has also uncovered Catamenial pneumothorax (and Catamenial hemothorax), which are much rarer. -- Colin°^Talk 17:01, 22 March 2021 (UTC)

Thanks Colin and I agree with you. A link is certainly warranted. Perhaps we should wait until the endocrinology has been externally reviewed before adding a section to the article or should we add it now? It need not be very long and it might get more views on the parent article. Graham Beards (talk) 18:51, 22 March 2021 (UTC)

I prefer the idea of waiting for the endocrinologist before we add new material, lest we end up confusing someone who may not know how to pull up older versions. But defer to Clayoquot, who is in touch. SandyGeorgia (Talk) 18:55, 22 March 2021 (UTC)

Yes that could be an issue. Graham Beards (talk) 18:59, 22 March 2021 (UTC)

I don't think she will have anything to say about epilepsy. Please go ahead and add it. Thanks for asking! Clayoquot (talk | contribs) 19:15, 22 March 2021 (UTC)

Thanks again, Graham (Clayoquot, how's it coming?)

Graham, here are we switching terminology mid-stream? which correspond to the perimenstrual, ovulatory and the luteal phases? That is, will layreaders know how the word perimenstrual relates to our previously defined terminology for the phases ? SandyGeorgia (Talk) 17:29, 24 March 2021 (UTC)

Good point. I'll revisit. Graham Beards (talk) 17:34, 24 March 2021 (UTC)

Can we give an indication of how common this is for women with epilepsy (e.g., "around 40% of women with epilepsy", or is "common in women with epilepsy"). I don't think we need "gender-specific", as (a) the reader already expects a gender-specific health issue in this article and (b) we mention "women" and "their menstrual cycle".

I'm not sure it is correct to define this as a "neurological condition" in its own right. Andrew Herzog appears to be an authority wrt references in the literature, and their recent papers Catamenial epilepsy: definition, prevalence pathophysiology and treatment and Catamenial epilepsy: Update on prevalence, pathophysiology and treatment say "When the periodicity of seizure exacerbation aligns itself with that of the menstrual cycle, it is designated as catamenial epilepsy" and "Catamenial epilepsy refers to the cyclic exacerbation of seizures in relation to the menstrual cycle". So it looks more like the term is used to describe the cyclical exacerbation, rather than to establish a separate disorder. Indeed we may be over-emphasising the "occur only" aspect by mentioning it first, as this source suggests that "this form is not very common". Perhaps it would be simpler to just say "exacerbation" per the definition. It is not an everyday word, though Epilepsy Foundation's lay article uses it repeatedly, suggesting perhaps it is the most apt. -- Colin°^Talk 18:06, 24 March 2021 (UTC)

So it's a problem of definition. Can we use the sentence from the parent article? "Catamenial epilepsy is a form of epilepsy in women where seizures are exacerbated during certain phases of the menstrual cycle. Seizures may rarely occur only during certain parts of the cycle, but are more commonly only more frequent." Graham Beards (talk) 18:21, 24 March 2021 (UTC)

The ILAE classification of seizures and epilepsy disorders doesn't include "Catamenial epilepsy". It would seem to be a secondary characteristic of whatever epilepsy disorder you have, in the same way as "refractory epilepsy" could be about any kind of epilepsy. I've had a go at rewriting the paragraph based on the source (though I've read a number of others). I've simplified things a bit because there is a daughter article. I don't think the reader here needs to learn C1, C2 and C3 or that two drugs are kinds of gonadotropin‐releasing hormone (GnRH) analogues. I also think we don't need to tell the reader, at this point in the article, that progesterone and estrogen are hormones.

Around 40% of women with epilepsy find that their seizures occur more frequently at certain phases of their menstrual cycle. This catamenial epilepsy may be due a drop in progesterone if it occurs during the luteal phase or around menstruation, or may be due to a surge in estrogen if it occurs at ovulation. Women who have regular periods can take medication just before and during menstruation. Options include progesterone supplements, increasing the dose of their regular anticonvulsant drug, or temporarily adding an anticonvulsant such as clobazam or acetazolamide. If this is ineffective, or when a woman's menstrual cycle is irregular, then treatment is to stop the menstrual cycle occurring. This may be achieved using medroxyprogesterone, triptorelin or goserelin, or by sustained use of oral contraceptives.

What do you think? -- Colin°^Talk 20:03, 24 March 2021 (UTC)

I like its readability. There is a missing “to” ... may be due a drop in progesterone ... SandyGeorgia (Talk) 20:11, 24 March 2021 (UTC)

It's much, much better than my version. We don't need to repeat "may be due to". Is the sustained used of HC in the citation? If not, does anyone know of a source before I look for one? Graham Beards (talk) 20:34, 24 March 2021 (UTC)

I have replaced the text. I couldn't live with my version any longer. Graham Beards (talk) 21:00, 24 March 2021 (UTC)

You goofball! (When Colin tunes in, he gets it going, huh ? :) Well, at least we have me for correcting wayward spaces; what a team! SandyGeorgia (Talk) 21:05, 24 March 2021 (UTC)

It is in the source. Just search for "sustained oral contraceptives", and elsewhere in that source paragraph mentions their use if "intermittent cyclic treatments are not effective". It is teamwork. -- Colin°^Talk 21:10, 24 March 2021 (UTC)

Comments from CeMCOR

Here's a progress update from my "More expert comments coming" section above. I've been talking with two experts from the Centre for Menstrual Cycle and Ovulation Research. One of them is my friend Jerilynn Prior, Professor of Endocrinology and Metabolism at UBC. They've identified some issues and we're working together on making them into actionable comments with MEDRS sources. We'll probably be done sometime next week. The comments will probably be around 1) adding two or three sentences about anovulation, 2) hormone levels, 3) effects of hormonal birth control, and 4) factual consistency issues.

• One comment on the factual consistency issues is ready now: The article says in one place that ovulation happens 34-36 hours after the LH surge, and in another place it says that ovulation happens 10-12 hours after the peak in LH levels.

Clayoquot (talk | contribs) 19:58, 24 March 2021 (UTC)

The least we could do for her in return is clean up her bio <groan> ... sheesh, that’s painful to look at. Thanks, Clayoquot; I added a note to the FAR about a week delay. SandyGeorgia (Talk) 20:15, 24 March 2021 (UTC)

Thanks Clayoquot. That's a good catch; the difference between the start of the LH surge and the peak LH level. I'll revisit that tomorrow, unless anyone else beats me to it. Thanks again. Graham Beards (talk) 20:43, 24 March 2021 (UTC)

With regards to ovulation, one source (Reed) says it occurs 10–12 hours after the LH peak, whereas Tortora says 9 hours. As Reed is a more recent publication, I have used the 10-12 hour range.Graham Beards (talk) 09:25, 25 March 2021 (UTC)

Great, thanks! Clayoquot (talk | contribs) 05:43, 28 March 2021 (UTC)

• I've received a bunch of suggestions from CeMCOR and will implement some as edits with "(from CeMCOR)" in the edit summary. I will also add comments from them in this section - anything I put in this section is from them. They ended up sending me a wider variety of issues than I was expecting. Clayoquot (talk | contribs) 06:11, 28 March 2021 (UTC)

• BTW if anyone has questions for the CeMCOR people, please post them here and I will relay questions promptly. Clayoquot (talk | contribs) 05:29, 29 March 2021 (UTC)

• The lead currently says, Naturally occurring hormones drive the cycles; the cyclical rise and fall of the hormone estrogen prompts the production and growth of oocytes (immature egg cells.. It is more accurate to say that FSH promotes the growth of oocytes. In fact, later in the article it states “Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated.” Clayoquot (talk | contribs) 06:10, 28 March 2021 (UTC)

Thanks. I have swapped the hormones. Graham Beards (talk) 07:31, 28 March 2021 (UTC)

• Re: The hormone progesterone stimulates the uterus lining to thicken to accommodate an embryo, It’s actually estrogen that thickens the lining. Progesterone causes differentiation into a secretory organ that is receptive to implantation. 05:27, 29 March 2021 (UTC)

I have made the correction. Graham Beards (talk) 15:59, 29 March 2021 (UTC)

• Re: Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity., It’s not clear which hormones are being referred to here. Hormones that stop follicles from growing? Clayoquot (talk | contribs) 05:27, 29 March 2021 (UTC)

I have deleted the opening phrase. Graham Beards (talk) 15:55, 29 March 2021 (UTC)

• Re: The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy. After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle.[38] These hormones also prepare the mammary glands for milk[a] production.[38] Seems like this discussion of the placenta does not belong in this article. Clayoquot (talk | contribs) 05:27, 29 March 2021 (UTC)

It explains why the cycle stops in pregnancy. I don't think we say this elsewhere.Graham Beards (talk) 09:29, 29 March 2021 (UTC)

Commentary

Clayoquot, this edit could be discussed. The text removed was a good summary of a high quality source. SandyGeorgia (Talk) 05:16, 4 April 2021 (UTC)

Sure. I will self-revert and start a discussion. Clayoquot (talk | contribs) 05:37, 4 April 2021 (UTC)

These edits introduce estradiol without defining it (or linking it); the text earlier explained that estradiol is an estrogen. SandyGeorgia (Talk) 05:20, 4 April 2021 (UTC)

I added a wikilink and description of estradiol. Previous versions said that "the estrogens initiate the formation of a new layer." I will confirm, but my interpretation of CeMCOR's comment is that the previous wording wasn't accurate. I think they were saying that the stuff that initiates the formation of the new layer is estradiol, not other types of estrogen. Clayoquot (talk | contribs) 05:46, 4 April 2021 (UTC)

They may be more accustomed to original writing, while we have to stick to what sources say, and keep our text attached to those sources. We may need to slow down and discuss what our sources say, versus what their opinions are. After the holiday may be a better time. SandyGeorgia (Talk) 05:56, 4 April 2021 (UTC)

In this edit, I am not seeing (?) where in the article this is repeated: “For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.” SandyGeorgia (Talk) 05:25, 4 April 2021 (UTC)

The text repeated ideas that were given within the same paragraph:

• "From the time of ovulation until progesterone withdrawal has caused menstruation to begin, the process typically takes about two weeks" is equivalent to "The luteal phase is about the same length in most individuals (average 14 days)". Those two sentences were in the same paragraph and said the same thing.
• "the follicular phase often varies in length from cycle to cycle" is equivalent to "the follicular phase tends to show much more variability". Both phrases were in the same paragraph. Clayoquot (talk | contribs) 05:54, 4 April 2021 (UTC)

Those are not saying the same as the sentence I questioned; perhaps they are accustomed to writing for a higher level audience, while Graham was bringing things down to the reading level we need to attain on Wikipedia. SandyGeorgia (Talk) 05:58, 4 April 2021 (UTC)

My second bullet point addressed the first half of the sentence you questioned. Regarding the second half of that sentence, CeMCOR asked for "the length of her luteal phase will be fairly consistent from cycle to cycle." removed. I believe (but will confirm) that they requested this because they believe luteal phase lengths vary more than the original text suggested. However, I'm too tired to track down sourcing for the variability right now so I will self-revert. Clayoquot (talk | contribs) 06:13, 4 April 2021 (UTC)

This edit separated text from its citation. SandyGeorgia (Talk) 05:28, 4 April 2021 (UTC)

I don't see where text was separated from its citation through that edit. Which citation are you referring to? Clayoquot (talk | contribs) 05:59, 4 April 2021 (UTC)

The first paragraph of the luteal phase. The final sentence has been detached from its citation. When text is re-arranged, or new paras created, citations have to be re-attached. (I also think the paras are choppy now, but will leave sorting all of this to Graham while I am in church— and maybe he is, too :) SandyGeorgia (Talk) 06:02, 4 April 2021 (UTC)

Clayoquot, I don’t understand this edit; this is helpful text. Perhaps the CemCOR people are used to writing for a different audience. Perhaps we could slow this process down and discuss all of their suggestions? SandyGeorgia (Talk) 05:39, 4 April 2021 (UTC)

It may be better to slow down and make sure we are all on the same page; I am concerned about these edits. Slow and steady wins the race. Tony1 has always set the example for how to work together on fine tuning text, as explained in this article where he is the unnamed language mentor.

• Elnathan R (April 2021). "English is the language of science - but precision is tough as a non-native speaker". Nature. doi:10.1038/d41586-021-00899-y. PMID 33795862.

Perhaps more querying back-and-forth would help here, as we are losing some critical text, and introducing some confusion. I was thinking that waiting until after the Easter holiday might be a good idea. I’m particularly concerned that we keep text associated with its citation, as this is a featured article. The way Tony1 always worked with me— and that I found very helpful— was via inserting inline hidden comments when there was confusion, so I could consult the sources and clarify. If the problem was larger than could be resolved via inlines, then he would query talk. Maybe we can try some of his style here to make for less work in the longrun? SandyGeorgia (Talk) 06:08, 4 April 2021 (UTC)

Hi Sandy. I appreciate your suggestion and your attention to detail. I've just self-reverted all my changes from tonight so that we can start fresh with a different approach. I need to go to bed and will happily wait until after Easter. Best, Clayoquot (talk | contribs) 06:23, 4 April 2021 (UTC)

That was more than you needed to do; thanks for that! We are having gorgeous weather, and looking forward to getting out finally and attending services for the first in a year, so I seriously appreciate that we can take all this up later. All the best, SandyGeorgia (Talk) 06:35, 4 April 2021 (UTC)

Clayoquot, I remember when I got expert off-wiki feedback on ketogenic diet I was able to apply their suggestions based on the sources I had to hand, as main author, rather than having to modify someone else's writing, which is much harder. Just a random idea, are you able to share (with permission) the feedback you got directly with Graham and perhaps Sandy too by email? Then you can all appreciate the suggestions that have been made, and collaborate better on a solution? I'm not trying to cut you out of the loop, just increase the ability for all to understand the editing.

We had a virtual Easter service via youtube. Goodness, when was the last time we could all sing together in a congregation? It's not the same at home. Like Sandy, we have a sunny 14°C spring day here, so I shall be going out to enjoy it (tomorrow will be 10°C colder, and might even snow). And I have a chocolate egg! -- Colin°^Talk 11:28, 4 April 2021 (UTC)

It would be optimal if Graham could have access to the commentary, as he has to hand all the sources and could probably work through them quickly. I don’t need the commentary, as I don’t want to get in the way, and I have neither the knowledge nor the sources that Graham does.

We are having an outdoor, socially distanced but full service, which is quite exciting after a year, so I’m off for a beautiful day! SandyGeorgia (Talk) 14:34, 4 April 2021 (UTC)

I'm concerned the changes might not be found (verifiable) in the citations. Can we deal with each comment one at a time? It's the way reviews are usually done here. We might even disagree with the external reviewers :-) Graham Beards (talk) 16:38, 4 April 2021 (UTC)

Thanks everyone for the suggestions. What they've done is pasted the article in to a Word document and revised it with Tracked Changes and comments. It sounded like a great idea at a time but trying to triage the changes and convert them back into Wikipedia is kind of horrible. I'll think and talk with them some more about ways to move forward.

Over in my multi-cultural household, we will be marking the end of Passover tonight with pasta. Tomorrow there will be dim sum, an Easter egg hunt, and in the evening my husband and I will probably be congratulating each other on having survived a four-day weekend with two young children :) Clayoquot (talk | contribs) 19:27, 4 April 2021 (UTC)

Your Word document experience is a bit similar to mine when I discussed an article with an expert. They loved Wikipedia but didn't want to edit on it (such as the talk page) and were more familiar with Word documents. Fortunately they only used the comment feature to underline text and write about it, rather than making edits to the text. I had to explain on a couple of points that I couldn't follow through with a suggestion because I couldn't find a source to back it up, and that was fine because it wasn't a big point. I think there was one sentence I removed because "That's not really the case any more" -- something hard to determine from the literature because people don't necessarily document things they no longer do. It was a great input to the process and reassurance. -- Colin°^Talk 10:52, 5 April 2021 (UTC)

Clayoquot, thanks again for your ongoing effort here, and I hope your family survived the four days of little ones (with too much sugar on board?) with fun to boot!

I have encountered similar problems multiple times in attempting to work on articles with academics, who are accustomed to sharing Word documents and working in Google docs. I have stopped trying; it just doesn't work, as they don't always understand that we need a MEDRS citation for each piece, we can't just use our own (even if professional) views, and we have to consider things like DUE weight and community consensus, so that working on talk pages is best. They usually don't want to learn Wikipedia ways, which is understandable and a bit of an insurmountable problem we have. I spent WEEKS training up two promising academics for medical editing, and got nothing in return. Once I had completed the articles that interested them, the fruits of my labor were not returned, and they pretty much don't edit at all now. It's discouraging. While Wikipedia seems to be a hard model for academics to adapt to, the method that Colin mentions might be the most helpful. That is, if they were to instead mark up a Word document with comments, but provide a MEDRS-compliant source for each suggested change, it would be less work for you. It seems like the way they proceeded left you with a lot to sort, and your effort is appreciated! SandyGeorgia (Talk) 15:35, 5 April 2021 (UTC)

Thanks again everyone. I had a good chat with the CeMCOR people today. We've decided the best way forward is to provide Talk page comments, and can do that towards the end of next week if that's OK. They very much appreciate Wikipedia's role as an educational resource and are grateful for the efforts of the volunteers here to provide quality information on women's health. Clayoquot (talk | contribs) 22:35, 7 April 2021 (UTC)

Clayoquot based on your chat with them, is it your sense that the remaining issues can be resolved outside of FAR, or should the FAR remain open? Wondering what to update at the FAR page, or whether we can move towards closing and resolving the rest post-FAR ... Best regards, SandyGeorgia (Talk) 14:45, 9 April 2021 (UTC)

The only concern I have is whether closing the FAR would introduce a bias against making further changes. With the FAs that are on my watchlist, I've noticed that page watchers sometimes revert with edit summaries that basically say the article shouldn't be messed with because it's an FA. Clayoquot (talk | contribs) 17:48, 9 April 2021 (UTC)

I'll continue watching the article to ensure that any edits that improve the article are accepted. Graham Beards (talk) 18:27, 9 April 2021 (UTC)

Excellent! OK, given Graham's comment I have no issues with however you want to proceed. Clayoquot (talk | contribs) 18:41, 9 April 2021 (UTC)

Nikkimaria tends to close FARs on the weekend; would holding off another week before entering declarations help? SandyGeorgia (Talk) 19:47, 9 April 2021 (UTC)

Possibly. If there's no reason to rush to close the FAR, it makes sense to get all the edits in before more people look at it. Clayoquot (talk | contribs) 04:06, 10 April 2021 (UTC)

ovulatory menstrual cycle

• As this is by far the more common in adult women, excluding those at perimenopause, do we need to distinguish the normal (ovulatory) cycle from the anovulatory cycle? In other words do we need "ovulatory menstrual cycle" instead of just "menstrual cycle"? Graham Beards (talk) 17:59, 29 March 2021 (UTC)

• I have started a section on Anovulatory cycles. We need more WP:MEDRS sources for this. There doesn't seem to be that much on PubMed. Graham Beards (talk) 18:39, 29 March 2021 (UTC)

• Thank you for doing this! The CeMCOR people say anovulation is a really important issue. The Routledge handbook chapter that I cited here has lots of relevant information on its health implications. If you email me I can send you a PDF of the chapter. Clayoquot (talk | contribs) 22:43, 29 March 2021 (UTC)

You don't seem to have the email option checked in your preferences but there's an email link on my User Page (top right). Thanks. Graham Beards (talk) 08:53, 30 March 2021 (UTC)

When Graham gets the source, and you all get caught up on new content and review, I am curious to understand why "anovulation is a really important issue" if MEDRS sources on PubMed are limited, as Graham says. We need to make sure that Wikipedia due weight is kept in sync in the article, recognizing that Wikipedia follows, doesn't lead. Since I don't have the sources, please ignore me as needed :) Bst, SandyGeorgia (Talk) 13:19, 30 March 2021 (UTC)

Unless there are any more comments from our expert, I think we are pretty much done here.Graham Beards (talk) 10:11, 31 March 2021 (UTC)

Prior citation

In trying to set up the Prior citation to be consistent with the other citations, encountering some problems. It is now given as:

• Prior, Jerilynn C. (2020). "The menstrual cycle: Its biology in the context of silent ovulatory disturbances". In Ussher, Jane M.; Chrisler, Joan C.; Perz, Janette (eds.). Routledge International Handbook of Women's Sexual and Reproductive Health. Abingdon, Oxon: Routledge. ISBN 978-1-351-03562-0. OCLC 1121130010.

  That ISBN goes nowhere on ISBN finder.

  Other websites give the date as 2020.

  Are we using the hardback, an e-book, are there different editions ? Unsure why the ISBN doesn't work.

  It is linking to worldcat, when we should only link the title if it goes to a free full version or actual content. The ISBN would take us to a way to locate or purchase the book.

  Amazon.com gives a different ISBN, and indicates first edition.

For consistency, the citation would be in this format:

• Prior JC (2020). "The menstrual cycle: its biology in the context of silent ovulatory disturbances". In Ussher JM, Chrisler JC, Perz J (eds.). Routledge International Handbook of Women's Sexual and Reproductive Health (1st ed.). Abingdon, Oxon: Routledge. ISBN 978-1-351-03562-0. OCLC 1121130010.

but the ISBN needs to be corrected, and we need page numbers for each instance where we are citing it. If we are using an e-book that does not have page nos, then we need section headings. I can set up the sfns to incorporate either page nos or section headings, but first have to get the basic citation fixed. SandyGeorgia (Talk) 23:08, 29 March 2021 (UTC)

Thanks Sandy. I'm using a PDF file of the printed book that the author emailed to me. I apologize for the ISBN confusion - I didn't realize that there are different numbers for the ebook vs print book. The copyright page in the PDF file that I have gives the ISBN for the "hbk" as 978-1-138-49026-0 , and the year as 2020. Does this help? I will add page numbers once the basic citation is fixed. I can try to do this if you prefer, but if you're offering to fix it you will probably do it better. Clayoquot (talk | contribs) 23:19, 29 March 2021 (UTC)

THanks, will fix ... don't worry about this -- you keep writing, and I will put in SFNs with a ? in the page field, and you can just fill in the page at any time. Bst, SandyGeorgia (Talk) 23:22, 29 March 2021 (UTC)

OK, they're in, like this:

• {{sfn|Prior|2020|p=?}}

You can just substitute the ? with page no. If there is a page range instead, it would look like this:

• {{sfn|Prior|2020|pp=?}}

I don't know if you have worked with sfns before ... when the page number is the same, it automatically works like a named ref and groups them together, so don't worry about the usual named ref issue. Just plug a number in to each instance of Prior. SandyGeorgia (Talk) 23:31, 29 March 2021 (UTC)

Page numbers added. Thanks! Clayoquot (talk | contribs) 23:46, 29 March 2021 (UTC)

Looks good! (For over a decade, I hated sfns with a passion, but I have come to realize how much cleaner and easier they are.) Bst, SandyGeorgia (Talk) 23:49, 29 March 2021 (UTC)

Ovulation

I've run through this subsection. Two things I can't resolve by myself. Experts might guess, but non-experts need greater precision:

(1) "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy."

Does it mean: "During the first few months of pregnancy, the corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation."?

Or does it mean: "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at *ovulation during the first few months of pregnancy*."?

Probably the former, so it could be fixed.

In either case, consider "... at slightly higher levels than those ...".

It's the former, thanks Tony. Graham Beards (talk) 09:28, 4 April 2021 (UTC)

(2) "After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."

Backreference ambiguity: is it just hCG that stimulates ..., or is it both "these hormones" and "hCG" that stimulate ...?

To clarify, either: "the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG); these stimulate the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."

Or: "the placenta secretes high levels of these hormones – along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."

Tony (talk) 06:54, 4 April 2021 (UTC)

It's the latter, thanks Tony for these comments and for your edits, which have improved the article. Graham Beards (talk) 09:28, 4 April 2021 (UTC)

Loose ends

See Talk:Menstrual cycle/Archive 3 and [[Talk:Menstrual cycle/Archive 4 for earlier commentary on Wikipedia:Featured article review/Menstrual cycle/archive2. SandyGeorgia (Talk) 14:04, 18 April 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)

That is not a quotation from the source. It is WAID's summary.Graham Beards (talk) 08:43, 22 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)

I know that WhatamIdoing said "I think that something along these lines would be a fair summary of the Else–Quest book". I saw "fair summary." She also said "This is from the 10th edition (last month!), 978-1544393605, pp. 258–261." She seems to consider the text to be supported by the source. I read the pages and agree with the summary. So I know what it says. What I'm trying to understand is why you think WhatamIdoing's summary is inaccurate. Per WP:LIMITED, it is not "too close paraphrasing." I also added "the menstruation phase" at the same exact time you made your most recent post.[22][23]. As for "Is there any point in my continuing to argue with you." No, not when you continue to be rude to me, don't listen to others, including WhatamIdoing, and water down what references say. You're right, that's not improving the page. ApproximateLand (talk) 22:23, 21 March 2021 (UTC)

You used a substantial portion of WhatamIdoing's summary, with the edit summary "added synopsis of Else-Quest (See Talk Page)". [24]. But I can't use any of her summary? I'd rather hear from her now. ApproximateLand (talk) 22:36, 21 March 2021 (UTC)

I didn't, I have a PDF copy of the salient pages of the 9th edition and I made use of WAID's suggestion. And yes, I think we heard enough from you. Graham Beards (talk) 22:48, 21 March 2021 (UTC)

You didn't, but you "made use of WAID's suggestion"? Okay then. "We heard enough from you." Now who's speaking for others? Either way, I won't be silenced by you. I can choose to not put much stock into what you say, which is what I will do, considering some concerning comments you've made on this talk page. ApproximateLand (talk) 22:57, 21 March 2021 (UTC)

Conclusion: Graham used WAID's summary and consulted the source to make sure text conformed to source as he adjusted wording and corrected other changes. No other sources have been provided; IMO, it looks good so far. WhatamIdoing how are we doing with this version? SandyGeorgia (Talk) 23:47, 21 March 2021 (UTC)

Yes, Graham Beards used the wording "has not been confirmed", which conflicts with what is known about premenstrual syndrome and premenstrual dysphoric disorder and is not supported by the source. I then corrected the phrasing and added some information he excluded. He then made some more changes[25] in name of WP:PARAPHRASE (and probably to also change "limited evidence", and regardless of the WP:LIMITED area on the same page). Good idea to ask WhatamIdoing how's everything so far. ApproximateLand (talk) 00:01, 22 March 2021 (UTC)

It what way was it a "correction"? You haven't read the source. Graham Beards (talk) 08:48, 22 March 2021 (UTC)

I already addressed that higher up. How many times must I say that "has not been confirmed" is not only not in the source, the source outright says that the data suggests that the menstrual cycle contributes to mood changes? And I had access to the source the whole time yesterday.[26] Both versions. ApproximateLand (talk) 08:57, 22 March 2021 (UTC)

WAID, Graham is using the 9th edition and you have the 10th. I added pages= 258 to 61. When you look in, could you confirm that we have the right page nos, and that everything is verifiable from those pages (else add sfns as needed). SandyGeorgia (Talk) 00:21, 22 March 2021 (UTC)

I have compared the two editions and for our purpose they the same apart from the page numbers. In the 9th edition the text is on pages 250 to 253, whereas in the 10th edition the range is 258–61. Graham Beards (talk) 08:23, 22 March 2021 (UTC)

For those interested in what our Wikipedia page says right now, with the phrasing of "little evidence", vs. what WhatamIdoing said vs. what the source says, this[27] edition of it (and on page 259) says that "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." It also discusses speculation that high levels of estrogen (at ovulation) might be associated with positive moods and that low levels of estrogen and progesterone premenstrually might be associated with negative moods, but that these speculations have a history of being criticized (pointing out, for example, that correlation does not imply causation). It says that "in other words, 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 the mood." It says a bunch of other stuff too, including the idea that the reverse may be true (that psychological factors may affect hormone levels and menstrual cycle phase).

Menstrual cycle mood changes are also associated with perimenopause and menopause. Yesterday, I read portions of this[28] ref ("Lewis's Medical-Surgical Nursing EBook: Assessment and Management of Clinical Problems"), all of this[29] ref (Cognition and mood in perimenopause: A systematic review and meta-analysis), this[30] ref (Menopausal Symptoms and Their Management), this[31] ref (Management of the Perimenopause), and this[32] ref (Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms). The last reference (a 2018 review) is more directly about the subject (menstrual cycle mood changes) and has one section dedicated to mood, and it would seem this is all academics know so far about mood in terms of the menstrual cycle and aging. These are the most recent references I've located about mood in terms of the menstrual cycle and aging, but I might have overlooked something. ApproximateLand (talk) 08:53, 22 March 2021 (UTC)

The article says "limited evidence". It does not say "no evidence". Weber et al says "these results cannot necessarily be generalized beyond the studies included in this review." Delamater and Santoro, is a case study, which we do not usually accept as WP:MEDRS but I agree it has some value. Amanda Allshouse, et al, does not specifically address the psychological aspects, but give a more general account. Graham Beards (talk) 09:26, 22 March 2021 (UTC)

Yes, I read and saw all of that and we agree that the Delamater and Santoro ref "has some value." What I appreciate about the references is that they all looked at what is out there now. I don't know if anything better is out there on this beyond the 2018 review. ApproximateLand (talk) 09:30, 22 March 2021 (UTC)

As for our Wikipedia page, it actually does say "little evidence" right now.[33] "Limited evidence" is the phrasing I used. ApproximateLand (talk) 09:38, 22 March 2021 (UTC)

Please do not write dishonest edit summaries and delete my comments when I point this out [34]. Yes, I agree we have have problem with the lack of sources and I have said this often. This is why why are focusing on the chapter from the 2021 book. It seems to me that you object to my use of the expression "little evidence" and that's pretty much it. Graham Beards (talk) 09:40, 22 March 2021 (UTC)

I said I disagree with you on the edit summary thing. You brought it to my talk page. I am allowed to read and delete it per WP:Talk. There was no need to bring it to this article talk page. The tension between the two of us is high enough as it is. Let it go.

My concern about how to report on the mood material is noted higher up on the page, with the time stamp of 20:08 yesterday.

You said that the 2018 review "does not specifically address the psychological aspects, but gives a more general account." The review talks about increased risk of depressive symptoms. It says, "Women in the highest symptom class (LC1) reported a high intensity of most symptoms, including physical and psychological symptoms such as depression and anxiety, followed by women with moderate intensity of most symptoms (LC2)." ApproximateLand (talk) 09:55, 22 March 2021 (UTC)

And your suggestion to improve the wording is? Graham Beards (talk) 09:59, 22 March 2021 (UTC)

This[35] so far. Thank you. I don't know how we should include information about mood in terms of the menstrual cycle and aging. I know I don't think we should include a lot about it. We can wait and see what others have say about it. ApproximateLand (talk) 10:03, 22 March 2021 (UTC)

Is that it? You have wasted hours of my life over one word? Graham Beards (talk) 10:07, 22 March 2021 (UTC)

Why are you so hostile toward me? Do you care to explain? Because I really want to know how I've wasted hours of your life by bringing up issues with phrasing and information you initially excluded, changing the phrasing (not just one word) and adding material myself, and commenting on concerns I have about how we report on this and what I think may be the best routes forward any more than anyone else on this page. Stop treating me differently. If others get to list references and give their thoughts on the refs and what they think may be the best route forward, waiting to hear from others, so do I. ApproximateLand (talk) 10:16, 22 March 2021 (UTC)

"Why are you so hostile toward me?" Because you are the perpetrator of one of the worst cases of disruption I have seen during my 14 years here. You start off by posting walls of text that have nothing to offer apart from lessons in verbosity. You pretend to have read sources that you haven't. You mistake an edit suggestion for a quotation from a source and argue about it until the cows come home. You post a deceitful edit summary and are dismissive when asked not to do so. You pretend other editors support you when they have not said they do. You act innocent and naive as in your "do you care to explain?" comment which is in complete contrast to your comments. The list goes on. I have collected the diffs, which I will save for use elsewhere if needed. As of this timestamp I will not respond to any of your comments.Graham Beards (talk) 10:46, 22 March 2021 (UTC)

I started off with a post that you thanked me for. My posts have been as long and about as long as others on this talk page. The proof of this in the archives and on this talk page. After some objection to text that had been worked out and because you didn't like how I replied, you started treating me like the enemy. Femkemilene told you not to bite me, but you continue to do so. You said, "Because you are the perpetrator of one of the worst cases of disruption I have seen during my 14 years here." Absolutely not. It's such an extreme thing for you to say, considering the vandals and other kinds of disruptive users on this website, that I think you haven't been around enough. The fact that I corrected your incorrect use of "has not been confirmed" is indicative that I read sources. I don't pretend to read sources. Seeing as the rest of what you said is more ridiculous conjecture and falls under WP:Personal attacks, I won't engage with it. If you really aren't going to respond to my comments any longer, that's a blessing to me. ApproximateLand (talk) 11:01, 22 March 2021 (UTC)

I share some of Graham's concerns over how this discussion has progressed. You have been pushing to overemphasize PMS and non-PMS perimenstrual symptoms beyond what the sources appear to support. WhatamIdoing (talk) 19:14, 22 March 2021 (UTC)

Thanks, WAID. I thought I was following when you said " 'Little evidence' is the wrong approach. There is 'evidence against' mood swings being a general problem", but this conversation left me doubting if I, too, misunderstood. So, the progression has been:

1. Graham added "not confirmed by research"
2. which became "limited evidence"
3. then "little evidence" and
4. back to "limited" per long talk discussion.

What is wrong with the original "not confirmed by research"? Or maybe, "not supported by research"? SandyGeorgia (Talk) 19:26, 22 March 2021 (UTC)

"You have been pushing to overemphasize PMS and non-PMS perimenstrual symptoms beyond what the sources appear to support." What a stunningly odd reply. I think New Sheriff in Town (below me) has said all that needs to be said on that, and much more diplomatically than I would have said it. ApproximateLand (talk) 01:17, 23 March 2021 (UTC)

Arbcom block, [36] SandyGeorgia (Talk) 01:06, 23 April 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)

Addressed already by Graham. SandyGeorgia (Talk) 23:57, 21 March 2021 (UTC)

Update: I've asked her for clarifications on her comments. So still waiting. Clayoquot (talk | contribs) 00:41, 22 March 2021 (UTC)

Thanks, Clayoquot, no hurry! SandyGeorgia (Talk) 00:44, 22 March 2021 (UTC)

Clayoquot, thank you for this. ApproximateLand (talk) 09:19, 22 March 2021 (UTC)

Clayoquot and Graham; when you are all done working through the CeMCOR comments, I will go back and deal with wikilinking on first occurrence, consistency in citations, etc etc (MOS-y stuff), but for now will stay out of your way so editing can proceed without too many cooks in the kitchen. Let me know when the coast is clear :) SandyGeorgia (Talk) 16:04, 29 March 2021 (UTC)

Will do. Thanks Sandy.Graham Beards (talk) 16:31, 29 March 2021 (UTC)

Clayoquot let me know if all or your comments are in, as then I will do another pass on MOS issues. SandyGeorgia (Talk) 12:44, 31 March 2021 (UTC)

There were more comments from CeMCOR that I expected, and it's also taking me much longer than I expected to transform comments into policy-and-guideline compliant edits or Talk page items. So I'm afraid I'm only around 25% done and will also be busy IRL over the next few days. The good news is that these people are really engaged and they love it, and the article is getting much stronger. I have another Zoom call with them on April 7th to go over issues they raised that I have questions on. I think the process will take another two or three weeks if that's OK? Clayoquot (talk | contribs) 16:02, 31 March 2021 (UTC)

That's not a problem-- I just don't want to start messing with things like wikilinking on first occurrence if text is still in transition. Thanks for all this effort, and please thank "your people", Clayoquot. SandyGeorgia (Talk) 16:24, 31 March 2021 (UTC)

Lead citations

I was waiting for work to finish before raising this, as the lead could be changing, but ... Citations in leads raise concerns at FAC. Do we need all of these lead cites? I was going to reduce some, but some of the citations in the lead are not in the body. SandyGeorgia (Talk) 13:07, 18 April 2021 (UTC)

I think most, if not all, can go. I have moved the solitary ones to the Body. --Graham Beards (talk) 13:37, 18 April 2021 (UTC)

Tortora 943 (current fn 7) is not used in the body ... unless it is combined? SandyGeorgia (Talk) 13:46, 18 April 2021 (UTC)

Fixed, thanks. --Graham Beards (talk) 14:15, 18 April 2021 (UTC)

More comments from CeMCOR

Here are the remaining comments from CeMCOR. I've put them below verbatim and have done only a cursory checking of sources. References to (Prior, 2020) refer to a book chapter that is already in the article bibliography. Have fun! Clayoquot (talk | contribs) 01:09, 14 April 2021 (UTC)

Lead

1. Replace "The menstrual cycle can be modified by hormonal birth control" with “The bleed of the uterine cycle can be modified by…” Reason: “menstrual cycle modified by” implies that the “ovarian cycle is modified,” – when in reality, the ovarian cycle is suppressed by hormonal birth control.

   I don't agree with this. To me a "suppression" is a "modification". Graham Beards (talk) 08:56, 14 April 2021 (UTC)

Ovarian cycle

1. Regarding the footnote, "Progesterone levels exceed those of estrogen (estradiol) by a thousand-fold", Progesterone levels are hundred-fold higher than estrogen, not a thousand-fold. It’s true that the units of progesterone (nmols) are a thousand-fold larger unit than units of estrogen (pmols) – as in Prior's chapter. But when considering ABSOULTE levels of the hormones, there is only a 100x difference between a normal progesterone reading of 80 nmol/L compared to a 800 pmol/L (0.8 nmol/L) reading for estradiol. Happy to discuss further.

   Yes, of course - I only looked at the units. Graham Beards (talk) 08:56, 14 April 2021 (UTC)

Ovulation

1. The first paragraph, which starts with "At around 20 weeks into gestation..." should be moved to early in the previous (follicular phase) section immediately following the opening sentence: “ovaries contain a finite number of egg stem cells, granulosa cells and theca cells, which together form primordial follicles.” Reason: to expand on the concept of a “finite number of egg stem cells” in that paragraph. And improve the flow of this section by starting with the sentence “Ovulation occurs when a mature egg..”

   Yes, this is much better. Graham Beards (talk) 08:56, 14 April 2021 (UTC)

Luteal phase

1. Delete "The increased progesterone in the adrenal cortex starts to induce the production of estrogen." Reason: The vast majority of progesterone in the luteal phase is produced by the corpus luteum, not the adrenal cortex.

   I have deleted "in the adrenal cortex". Graham Beards (talk) 08:56, 14 April 2021 (UTC)

2. Replace "The luteal phase is about the same length in most individuals (average 14 days) whereas the follicular phase tends to show much more variability lasting from 10 to 16 days" with "The follicular phase can last as long as 19 days in adult women and even longer in teenagers, whereas the luteal phase is fairly stable at 10 to 16 days (average 14 days)." Reason: to be more accurate.

   Yes, thanks I have used this. Graham Beards (talk) 08:56, 14 April 2021 (UTC)

We need a WP:MEDRS source for the 19 day statement. Graham Beards (talk) 21:24, 14 April 2021 (UTC)

They found a review article saying that the normal length of the follicular phase ranges from 10 to 23 days with an average length of 15 days.[37] The review article is from 1995 so it's not an ideal source. My sense that it isn't super-important to include this detail if you're uneasy about the sourcing. Clayoquot (talk | contribs) 05:26, 18 April 2021 (UTC)

Also, they mentioned that some may consider the whole cycle to be the “follicular phase” if the cycle is anovulatory. Perhaps that's another reason to leave the wording on the length of the follicular phase intentionally vague. Clayoquot (talk | contribs) 05:37, 18 April 2021 (UTC)

I think we can leave it as "The follicular phase shortens significantly with age, lasting around 14 days in women aged 18–24 compared with 10 days in women aged 40–44.[25]"--Graham Beards (talk)

Menstruation

1. Replace "Menopause is preceded by a stage of hormonal changes and irregular cycles called perimenopause" with "Menopause is preceded by a stage of hormonal changes called perimenopause". Reason: cycles are still regular in the earlier stages of perimenopause. (Reference: Prior, 2020. Quote from the chapter: “cycles stay “regular” but gradually become shorter until they often average ≤25 days in very early perimenopause (Prior, Seifert-Klauss, & Hale, 2012)”)

   Yes, thanks. Graham Beards (talk) 08:56, 14 April 2021 (UTC)

Anovulatory cycles

1. Change heading to: “Ovulatory disturbances including anovulatory cycles.” Reason: the importance of ovulatory disturbances as described in (Prior, 2020)

   I don't agree with this. The source says "The concept of silent ovulatory disturbances is revolutionary", (my emphasis) so we would need more WP:MEDRS sources from other experts to accept this. Graham Beards (talk) 08:56, 14 April 2021 (UTC)

   Fair enough. Since the section talks about both anovulation and short luteal phases, how about if we either change the heading to "Anovulatory cycles and short luteal phases"? Or have one section on anovulation and one section on short luteal phases? Clayoquot (talk | contribs) 06:27, 18 April 2021 (UTC)

   I think a short section on short luteal phases might be warranted. I'll look for a WP:MEDRS source.--Graham Beards (talk) 12:38, 18 April 2021 (UTC)

2. Replace "In two thirds of average menstrual cycles ovulation occurs" with "Only two thirds of clinically normal menstrual cycles are ovulatory, or cycles in which ovulation occurs.” Reason: Better wording for the same citation.

   Yes, except I prefer "overtly" to "clinically" because we are not writing for medics.Graham Beards (talk) 08:56, 14 April 2021 (UTC)

3. After the first sentence, add "One third of cycles exhibit some form of subclinical ovulatory disturbance, either as anovulation (lack of ovulation) or a short luteal phase, in which in progesterone production is insufficient for normal physiology and fertility." Reason: as described in (Prior, 2020).

   Here, partly for the reason given above, I have added: "The other third of cycles lack ovulation or have a short luteal phase, in which in progesterone production is insufficient for normal physiology and fertility." I think "subclinical ovulatory disturbance" is too vague, a liitle too controversial for Wikipedia, and excessive medical language. Graham Beards (talk)

4. Replace "Cycles in which ovulation does not occur (anovulation)..." with "Ovulatory disturbances..."

   I disagree, for the reason given above. Graham Beards (talk) 09:04, 14 April 2021 (UTC)

5. Replace "Anovulation is not considered a disease but it could be related to an underlying condition such as polycystic ovary syndrome.[68]" with "Although anovulation is not considered a disease, it can be a sign of an underlying condition such as polycystic ovary syndrome.[68] Furthermore, persistent ovulatory disturbance has been linked to a greater risk of premature mortality. Both estradiol and progesterone are physiologically important for the health of all tissues including bone, brain, and the cardiovascular system.” Reason: to expand on the significance of ovulatory disturbances.

   I have changed this to "Although anovulation is not considered a disease, it can be a sign of an underlying condition such as polycystic ovary syndrome". I am not happy about adding the comment about mortality, which is from a primary study. Graham Beards (talk) 09:04, 14 April 2021 (UTC)

   The given source, by Wang Yi-Xin et al, is a primary study. If secondary sourcing isn't available for this claim, perhaps the introduction to the study could be used to support a statement about the diseases that are associated with irregular and long cycles? Clayoquot (talk | contribs) 01:09, 14 April 2021 (UTC)

   Yes it is a primary study and I don't think we should, or need to, use it. Graham Beards (talk) 09:04, 14 April 2021 (UTC)

6. I (Clayoquot) just realized we don't define "short luteal phase". A short luteal phase is shorter than 10 days. I will email Graham with the PDF of the full chapter. We should also adjust the wording in the Luteal phase section, which implies that luteal phases are never shorter than 10 days.

   I don't think "fairly consistent from cycle to cycle at 10 to 16 days (average 14 days)" implies that the phase is never shorter.--Graham Beards (talk) 12:41, 18 April 2021 (UTC)

7. Consider adding something about the effects of stress and exercise on the menstrual cycle. They suggested "It is normal for there to be silent ovulatory disturbances when women are under psychological, nutritional, or illness stress or if they are healthy, well-fed athletes who are increasing the intensity and duration of their sport training. All of these changes are reversible as the stressors decrease or, in the case of the woman athlete, as she becomes adapted to the increased training load." We might want to replace "silent ovulatory disturbances" with "anovulatory cycles or short luteal phases".

I have added "Anovulatory cycles or short luteal phases are normal when women are under stress or athletes increasing the intensity of training. All of these changes are reversible as the stressors decrease or, in the case of the athlete, as she adapts to the training" and renamed the heading to include short luteal phases.--Graham Beards (talk) 12:52, 18 April 2021 (UTC)

References

Menstrual health

1. Replace "Dysmenorrhea is frequently a source of pelvic pain,[69] causing cramps in the abdomen, back, or upper thighs that occur during the first few days of menstruation.[70]" with "Dysmenorrhea or period pain can[69] cause cramps in the abdomen, back, or upper thighs during the first few days of menstruation.[70] Debilitating period pain, however, is never normal, and can be a sign of something more serious such as endometriosis."

   We need a citation for this. Graham Beards (talk) 09:09, 14 April 2021 (UTC)

   I have added "Debilitating period pain is not normal and can be a sign of something severe such as endometriosis." Graham Beards (talk) 09:18, 15 April 2021 (UTC)

2. Replace the paragraph that begins with "There is limited evidence to support the common belief that the menstrual cycle affects women's moods..." with "Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. Changes to the brain have also been observed throughout the menstrual cycle but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. In fact, a recent review study concluded that methodologically-sound studies do not appear to demonstrate significant effects of menstrual cycle phase on cognitive performance.” Reason: The new paragraph is more neutrally worded  -- without the odd mention of unclean and self-fulfilling prophecy -- and is supported by recent review studies.

   I have added this except for "In fact, a recent review study concluded that methodologically-sound studies do not appear to demonstrate significant effects of menstrual cycle phase on cognitive performance", which is editorializing ("in fact", "methodologically-sound" ) uses the vague word "recent" and cites a primary study. Graham Beards (talk) 09:09, 14 April 2021 (UTC)

   The second source, by Pletzer et al, is a primary study but has an introduction section that could possibly be useful. Clayoquot (talk | contribs) 01:09, 14 April 2021 (UTC)

   I also find the stuff about unclean/shameful being a self-fulfilling prophecy is odd. A self-fulfilling prophecy is a prophecy that turns out to be accurate, and what is accurate about menstruation being unclean or shameful? Clayoquot (talk | contribs) 01:09, 14 April 2021 (UTC)

References

Thanks for these comments Clayoquot and the time you have taken to collate them. I will answer them point by point during the day. My progress will be determined by how busy I am IRL – it's unpredictable these days. Best. Graham Beards (talk) 07:46, 14 April 2021 (UTC)

I have made these changes [38] in light of these helpful comments. I have not fully taken on board the comments regarding "ovulatory disturbances". I think these would give undue weight in an encyclopedia article. Graham Beards (talk) 09:23, 14 April 2021 (UTC)

I have made WP:CITEVAR adjustments for consistency, so we end up here. These edits have introduced two primary sources (one very old) and removed good text from Else-Quest. We need to get back some of what Else-Quest had, and why are we adding old primary sources? Perhaps we need to have WhatamIdoing revisit the wording on Else-Quest, but I don’t agree with removing it entirely. SandyGeorgia (Talk) 13:33, 14 April 2021 (UTC)

I have restored the text from Else-Quest (which I didn't mean to delete). I can't find a WP:MEDRS source for the 19-day long follicular cycle. Graham Beards (talk) 13:45, 14 April 2021 (UTC)

Thanks, Graham; do we need to have the 19-day-long follicular cycle if it is never mentioned in secondary sources? And we have still lost all of this text which we labored over above; There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles. The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or unclean could be a self-fulfilling prophecy.. If some don’t like the wording, then we can have WhatamIdoing revisit her longer version above, but leaving this content out completely leads us back to the medicalization of a condition which is not problematic for most women, with some of that being influenced by environmental and societal factors. We have a good source on this and should be using it; perhaps we can revisit WAID’s longer version (above) for refining the wording. SandyGeorgia (Talk) 13:57, 14 April 2021 (UTC)

WhatamIdoing’s longer summary of Else-Quest was: SandyGeorgia (Talk) 14:00, 14 April 2021 (UTC)

• 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.

I would be OK with putting that back in verbatim. Graham Beards (talk) 14:10, 14 April 2021 (UTC)

I have changed my mind. I don't think this helps in a physiology article. Graham Beards (talk) 13:45, 18 April 2021 (UTC)

Will wait for WAID. SandyGeorgia (Talk) 14:59, 14 April 2021 (UTC)

FYI, I've pointed CeMCOR to this discussion and they are looking for secondary sources to fill the gaps that have been identified. Thanks everyone for all the fantastic work. Clayoquot (talk | contribs) 06:19, 15 April 2021 (UTC)

Just got some emails from the CeMCOR people. They are OK with re-adding the sentence "There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles." Regarding The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or unclean could be a self-fulfilling prophecy, they agree with the general idea but found the wording jarring and incongruous with the rest of the article. They've suggested as a replacement (which we could of course play around with), "There are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding." Clayoquot (talk | contribs) 21:39, 16 April 2021 (UTC)

I think we can do better than that; will focus on it tomorrow or next day, depending on what others say. To me the key points are societal and cultural factors that predispose some to a self-fulfilling prophecy, although I understand why the previous wording was seen as jarring. On the other hand, that wording does reflect the experience for women in other parts of the world, and we do need to globalize. Clayoquot, I am glad they are reading here, but I hope they are understanding some basics of Wikipedia, with respect to due weight, and that we find the best and highest quality secondary sources and summarize what they say ... rather than decide what we want to say and then go out and find a secondary source to support it. I am worried that we are starting to lose a tight focus on the highest quality secondary sources, with more and more lesser quality sources creeping in as we seek to add sources to support desired additions. Several iterations ago we had a very tight focus, and as focus wanders, we open the door to all kinds of undue additions. SandyGeorgia (Talk) 23:21, 16 April 2021 (UTC)

Hi Sandy. We talked a lot about due weight, and I went back and forth with them quite a bit to advise them on what kind of feedback we can use. At some point I decided that instead of making myself the the sole arbiter of their comments it was time to bring their comments to the group so the group could decide what to do with them. I perhaps should have emphasized that in posting their comments to this Talk page, I'm just trying to serve as the courier and I am not advocating that we accept all comments. The mixture of "good point" and "thanks but no thanks" responses that I've seen from Graham is about what I expected. If you disagree with extent to which suggestions from our external reviewers have been implemented, are you comfortable using the normal editing process to address those issues on a case-by-case basis, or are you suggesting a different process? Clayoquot (talk | contribs) 00:49, 17 April 2021 (UTC)

Clayoquot, we are fine :). I worked (hard) all day in the garden (spring that makes me happy, but tired), and probably sounded short(er) than intended. Best, SandyGeorgia (Talk) 01:51, 17 April 2021 (UTC)

Perhaps we should remind ourselves that this is a biology (physiology) article. We seem to be getting our knickers in a twist over this (final) point. The sentence is jarring because it is the sound of another voice and moves from physiology to sociology without any warning. I think the suggestion was a good one – as long as it is supported by the source(s). I don't think we need much on cultural issues in this article. BTW I enjoyed the expert review mainly for two reasons: (1) The suggestions – even the ones I did not think were needed – were interesting and helpful and (2) It was reassuring to see just how much we got right. So please pass on my best wishes and thanks. It would be good if we could wind this up now. --Graham Beards (talk) 16:24, 17 April 2021 (UTC)

Thanks Graham. I have a few more emails to summarize for this Talk page and will do so today. W.r.t. the replacement for the "self-fulfilling prophecy" sentence, I personally think CeMCOR's suggestion is entirely supported by the existing source. If anyone is interested in a second source, there is a book chapter by Prior that I could email, but it's from 2002. I will also pass along your comments. I'm very happy to hear that the expert review has been fun for you! Clayoquot (talk | contribs) 17:11, 17 April 2021 (UTC)

Thanks. --Graham Beards (talk) 17:15, 17 April 2021 (UTC)

I think it's important for the concept to be in the article. I don't care what the exact wording is.

I think it's important for this concept to be in this article precisely because this is supposed to be a (largely) biology/physiology article. The concept to be communicated is "If you think a woman is upset because of biology/physiology, then you are wrong." Dispelling myths about biology/physiology should happen in a biology/physiology article. WhatamIdoing (talk) 03:29, 21 April 2021 (UTC)

What wording do you suggest? --Graham Beards (talk) 10:17, 21 April 2021 (UTC)

This has been offered by the external review team, "There are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding."--Graham Beards (talk) 10:22, 21 April 2021 (UTC)

That just ... doesn’t ... say anything. I will have a crack at it as soon as I can. The weather and real life have conspired against my editing for several days now ... we need to get more precisely at exactly what WAID is saying ... it is not the biology/physiology, rather societal and culture and environmental ... SandyGeorgia (Talk) 14:03, 21 April 2021 (UTC)

FWIW, the full thing that CeMCOR said was "I would add to the bit about mood that there are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding. In addition, it is easier for women as well as others to have “something safe to blame” when they are irritated or anxious or depressed related to the stresses of their dual or triple role “jobs,” are deeply troubled by negative sex biases in the workplace or society, or are also dealing with things like cramps or headaches that increase premenstrually. In adolescence and in perimenopause, there is evidence that the hormonal changes of the menstrual cycle (in particular, higher estradiol and lower progesterone levels) are related to women’s tendency to be moody. In addition, in perimenopause, rapid downward swings of estradiol (that are common and also associated with hot flushes/flashes or night sweats) are now being associated with increased anxiety and depression... If you want a reference for a review of the association of downward swings in estradiol on VMS and mood, here it is.[39]"

I didn't bring this comment forward earlier because 1) There are some things in it that are not 100% in the sources that were provided or any source I'm familiar with, and 2) The source provided for most of this was a book chapter from 2002 - if the date doesn't bother you I can provide quotes and/or email the file. The gist of this that's important is that premenstrual mood changes are both society/culture and biology/physiology. Clayoquot (talk | contribs) 21:32, 21 April 2021 (UTC)

Menstrual health proposal

@Graham Beards, Colin, Clayoquot, and WhatamIdoing:, concerned that we still need to use our best source (Else-Quest) to better incorporate User:NikosGouliaros comments, I have combined various iterations of WhatamIdoing's posts, our previous text, our previous objections, and my own reading of Else-Quest to the following proposal (to replace the entire second paragraph of Menstrual health). SandyGeorgia (Talk) 00:29, 22 April 2021 (UTC)

Current text

Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. Changes to the brain have also been observed throughout the menstrual cycle but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle.

Proposed text

There are common culturally communicated beliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. These beliefs can result in a woman's normal and appropriate mood variation being attributed to the menstrual cycle in a self-fulfilling prophecy. 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. Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. Changes to the brain have also been observed throughout the menstrual cycle but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle. There are similar cultural beliefs about women's mood and personality during menopause; other than hot flashes and sleep difficulties, evidence does not support the stereotypes about symptoms during menopause.

Thanks Sandy. Do we need "in a self-fulfilling prophecy". It reads just as well without and it sounds a little like editorialising. --Graham Beards (talk) 07:55, 22 April 2021 (UTC)

If you decide to leave it out, it works. I wasn’t sure if you would want to get in to the menopause part (last sentence). SandyGeorgia (Talk) 12:23, 22 April 2021 (UTC)

I'm not sure about "stereotypes". Graham Beards (talk) 15:56, 22 April 2021 (UTC)

..and do we want to go down the HRT road? Isn't menopause a related but separate subject.--Graham Beards (talk) 17:02, 22 April 2021 (UTC)

Added text

There are common culturally communicated misbeliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. Often a woman's normal mood variation is falsely attributed to the menstrual cycle. 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. Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. Changes to the brain have also been observed throughout the menstrual cycle but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle.

References

Discussion

The added text might be fine, but it now contradicts the earlier part the section (repeated in the lead), which state firmly that "irritability, mood changes" are part of the cycle. That is sourced to a fact sheet. And contradicts later part of the section, which says "When menstruation begins, symptoms of PMS such as breast tenderness and irritability generally decrease", which is sourced to a "for teens" fact page on WebMD. -- Colin°^Talk 16:32, 22 April 2021 (UTC)

Thanks Colin. That non WP:MEDRS compliant factsheet was a leftover from a pre-review version of the article. I have dealt with the contradiction. [40] I think the new paragraph gives enough weight to mood changes. --Graham Beards (talk) 16:56, 22 April 2021 (UTC)

What about the second sentence? I wonder if the whole sentence can be dropped, because it is effectively saying the symptoms of a pre-menstruation syndrome generally end on menstruation. Well it wouldn't be pre- if it didn't. I don't think the WebMD teens page should be used. -- Colin°^Talk 07:24, 23 April 2021 (UTC)

Think I have solved the problem. [41]. --Graham Beards (talk)

New graph

During the menstrual cycle, levels of estradiol (an estrogen) vary by 200 percent. Levels of progesterone vary by over 1200 percent.

Clayoquot, the new graph adds uncited content in the caption (also content that is not covered anywhere in the article). I am uncertain if that content belongs in this article so leave it to Graham. SandyGeorgia (Talk) 12:43, 22 April 2021 (UTC)

It's a useful graph. I can add a citation. Graham Beards (talk) 15:32, 22 April 2021 (UTC)

Close

I am ready to recommend Close without FARC; anything else? SandyGeorgia (Talk) 18:12, 22 April 2021 (UTC)

I am ready Sandy. There will always be improvements to make, but I can't think of anything major we have omitted or got wrong.--Graham Beards (talk) 18:20, 22 April 2021 (UTC)

I'm good with that :) Clayoquot (talk | contribs) 19:51, 22 April 2021 (UTC)

TFA time? I think this article deserves some time in the spotlight now. FemkeMilene (talk) 19:59, 22 April 2021 (UTC)

Re TFA, we have to spread out our limited medical content ... I had planned for, and am hoping, that dementia with Lewy bodies will run on July 21 for Robin Williams 70th birthday, so perhaps this could run two months after that (eg September). SandyGeorgia (Talk) 22:57, 22 April 2021 (UTC)

Alternately, we could put if forward for May (if we move fast), and still have a two-month spread before July. SandyGeorgia (Talk) 03:00, 23 April 2021 (UTC)

Getting this into the WP:TFA spot light could be nice and help reduce taboos and misconceptions about the topic. So it's a great idea. A small concern I have about the WP:TFA process would be that some readers might click through to the article menstruation from here and then be disappointed/confused about the content there due to the overlap and messiness that we have talked about on the talk page here. Apart from that, well done to everyone involved in this article! You all put an incredible amount of time and attention to detail in. I liked in particular how external experts (non Wikipedians) were brought into the process. Well done! EMsmile (talk) 04:04, 23 April 2021 (UTC)

Femkemilene, we can't get Menstrual cycle scheduled for May if it doesn't close this week (we will likely miss the scheduling deadline, and Nikki typically runs through on Saturdays-- not always though). In that case, I recommend we go for September, so as to spread our medical content out to every two months, as we have nothing else medical to run TFA. (Congrats again on Earth!) SandyGeorgia (Talk) 18:47, 23 April 2021 (UTC)

May 9 is Mother's Day. It would be so cool to have it as TFA then. Clayoquot (talk | contribs) 18:55, 23 April 2021 (UTC)

Clayoquot There is already a request for Mother's Day ... I guess you and Gandydancer did not get my ping there? [42] I would not want to attempt to boot an article that has been at TFAR already for quite a few weeks, by trying to take that slot, and what is there seems like a good fit. SandyGeorgia (Talk) 19:06, 23 April 2021 (UTC)

PS, if you feel strongly about Mother's Day, we could consider holding off for a year ?? SandyGeorgia (Talk) 19:07, 23 April 2021 (UTC)

Oh right, I saw the ping but forgot about that! Not a perfect fit, but Menstrual Hygiene Day is May 28. There is also World Sexual Health Day on September 4. Clayoquot (talk | contribs) 19:19, 23 April 2021 (UTC)

@Gog the Mild: re Menstrual Hygiene Day on May 28. SandyGeorgia (Talk) 19:28, 23 April 2021 (UTC)