“Do not be too moral. You may cheat yourself out of much life. Aim above morality. Be not simply good; be good for something.” –Thoreau

16 May 2015

Let's Talk About Our Periods

You read the title correctly.

Yes. I am going to talk about MENSTRUATION. At great length and in detail.

Why? Because nobody ever does it.

Women make up roughly half of the world's population, and we have spent most of our lives menstruating. Our periods are as regular as the moon and as unexceptional as sneezing.

And yet...

We can't seem to talk about it. We can't even say the word menstruation. We use euphemisms like "women's problems" and "monthly visitor" and "Aunt Flo." (Gag me.) Both men and women get nervous and restless whenever period-related issues come up-- and they come up, on average, every 28 days for 38 years. If a woman lives to be 76, she'll spend half her life dealing with menstruation. It is absurd to avoid a topic which affects half the world's population for half of their lives on Earth.

And, anyway, it isn't just women who are affected by menstruation. We live with men, and men experience some of the realities of our periods too. They might notice a change in mood, appetite, or sleepiness. Women are often in pain during some part of the menstrual cycle, and that can require assistance. Men might be sent out for pads or tampons, or called upon to assist their daughters when they begin menstruating for the first time. Heterosexual men might choose not have sex with a woman while she's menstruating (although, of course, it is perfectly safe). If a couple is trying to prevent or create a baby, they both need to understand how the menstrual cycle works. Unfortunately, they just don't. Very few women and even fewer men have adequate information about menstruation.

On the whole, we like to pretend that our periods don't exist. That's just dumb.

This will be part one of a two-part post on the topic.
Here are a few important things to know about menstruation.

1) This is a uterus:


2) The menstrual cycle has four parts. Part one is called the follicular phase, and this is when an egg begins to prepare for release from the ovary. This phase varies a lot in length from woman to woman, and even from cycle to cycle. A woman is only fertile during the last part of this phase, for the five days leading up to egg release. Part two is ovulation, when the egg is released from the ovary and begins to travel through the fallopian tubes to the uterus. This phase is very fertile, but only lasts 1-2 days. Part three is the luteal phase when an egg has not been fertilized (if it is fertilized, we call this "conception"). This phase is very consistent in length-- around two weeks for most women-- and causes a spike in both progesterone and estrogen hormones, which quickly drop again until a woman's body starts to menstruate. Part four is menses. This is when the body sheds all the uterine lining it created to sustain a fertilized egg. Menses last, on average, 3-6 days. We call this our "period."

3) To be clear: the average woman is fertile for approximately 10-18 days out of every 28. If a woman is very regular-- meaning her cycle comes consistently and her menses last the same number of days each time-- then it can be possible to track her fertility, either to promote or prevent pregnancy. Some women even use thermometers to measure their temperature every day, in hopes of better predicting ovulation. This method can work for creating a pregnancy, but as far as preventing one... well, it sucks. Our bodies just aren't predictable enough to rely on this method for birth control. With normal practice and normal sexual activity, the fertility awareness method will result in a 25% pregnancy rate. 25 out of 100 people using this method will get pregnant every year. So I can't, and no doctor should, in good conscience, recommend this method if a couple really wants to prevent pregnancy. But knowing more about how menstruation works will allow both men and women to make an educated decision about it. The more you know, the more effective the method will be.

4) The blood released during menses is actually the lining of the uterus. It's made up of mostly tissue, a relatively small amount of liquid blood, and also some mucus. If that sounds gross to you... yeah, I guess, get over it. This happens to most every woman you know every single month. A woman's menses can include what look like blood clots, but these are actually clumps of solid uterine tissue or solid bits of mucus stained by blood. The menses can be bright red, but it can also be every shade of copper and brown, sometimes nearly black, and even occasionally yellow. It can come lightly, heavily, or start and stop. And this is all normal. What isn't normal is an extremely heavy flow, which we tend to think of as "blow-out" periods. These wreck your clothing through pads and tampons, cause anemia, and/or last more than seven days, and they are caused by menorrhagia. For young girls, this is pretty freaky stuff-- they are generally expecting a liquid stream of bright red blood, and that's not what they are going to get. And how are they supposed to find out whether something is amiss? If we don't speak openly about this very normal part of adult womanhood, how can expect our girls to feel comfortable asking us questions? We need to tell them what normal looks and feels like, so they can recognize if something is wrong.

5) Unless you are experiencing menopause, it is not normal to miss a period. For women, our periods are one of the most obvious indicators of our physical health. Missing more than three is called amenorrhea, and it is a serious health concern at any age. Irregular menses can be the result of a lot of issues-- pregnancy (of course), but also very high stress, anxiety disorders and/or clinical depression, infections in other parts of the body, high blood pressure, high cholesterol, pre-diabetes, sexually transmitted disease, medication side effects, issues with blood circulation, hormonal imbalances, very low or very high body weight, and a whole host of serious reproductive concerns. Men out there, take note: If your female loved one is missing her period, or it is too light or too heavy, or it is causing her unusual pain or illness, something could be wrong. Don't blow off these symptoms as "women's problems." Don't brush aside her feelings by calling them "dramatics" or "PMS."

Someone you love may be ill.

Part two of this series is coming up. In the meantime, let comedian Cameron Esposito tell you even more about what a period really feels like. It is NSFW, but so amazingly funny.

Questions? Comments? See you soon.