Nov 23, 2020

TRANSCRIPT

The following is a summary of this episode. For the full experience, we encourage you to subscribe and listen - it's more fun that way.

Periods—The One Thing Every Woman on the Planet Has

What is one thing that every woman on the planet has but nobody wants to talk about? It's periods, period. Actually, women talk about their periods a lot, but they don't use that word "menstruation." They don't say, "My menses has come," or they might say, "My period has come." But all over the world, in many cultures, people use other words. One study looked and found more than 5,000 different slang or euphemistic expressions or phrases for their periods.

What's my favorite? My favorite is the French who use les anglais ont débarqué, and that means "the English have landed." Now, that's quite a phrase for having your period come, and it tells you a lot about what the French think about the British.


Why Women Have Periods

We as mammals have a process of building up the uterus lining so that we can grow our babies inside. We are the only mammal, as humans, that actually sheds the lining in such an obvious way. The animals that we share our DNA with, and that's the higher primates, chimpanzees, gorillas, they usually don't bleed all that much unless they have a problem or a cancer, whereas humans, compared to all other species on the planet, bleed a fair bit, and they bleed when they're shedding the lining and getting ready to start a new menstrual cycle when they're not pregnant.

Now, this has been going on for millennia that we have been humans. However, thousands of years ago, women rarely had their periods because they rarely ovulated. When women were starving or breastfeeding, which we were most of the time when we were hunter-gatherers, we didn't have much periods. So we didn't bleed very much. But over the last couple hundred years, since the Industrial Revolution, we are mostly well fed. We don't breastfeed for four years.

Many of you know, who have periods, that you can modify your periods and make them lighter by using some contraceptive methods that are quite healthy. We know that women who use birth control pills have periods that are about 80% or half of their periods when they're not on birth control pills. And some IUDs have very light periods or no periods at all. Women may choose these methods specifically for the way they modify their periods. So periods can be lighter and less painful by using contraceptive methods.


Medical Mystery: Period Stopped

Okay. We're going to get ready for this week's medical mystery. And my producer, Chloé, is here in the studio and she's going to give me a person and some symptoms, and I'm going to try to figure it out.

Chloé: So this person just stopped having her period.

Dr. Jones: Okay. And she's how old?

Chloé: Late 20s.

Dr. Jones: Late 20s. First of all, has she gained or lost a lot of weight?

Chloé: So she hasn't had any weight loss. She hasn't been pregnant. She's, for the most part, had pretty normal periods.

Dr. Jones: Okay. How about exercise? Is she an endurance athlete or an elite athlete?

Chloé: She's not Olympian, but let's say she keeps active maybe a few, three hours a week of physical activity a week. Not much.

Dr. Jones: Okay. Not really very much. Okay. I'm not worried about that. All right. Now, has she had any surgery on her cervix or her uterus that might have caused a blockage or anything?

Chloé: No. No major surgeries.

Dr. Jones: Okay. Tell me about her past medical history. Has she had any serious medical illnesses?

Chloé: I'm going to say that she doesn't know because she doesn't talk to her family. So no medical history—no family medical history. No.

Dr. Jones: How about for herself, though? Her own medical history. Any severe medical illnesses in her past?

Chloé: So she had cancer when she was a teenager around maybe 14, 13 years old. She did get treatment. She did get cured, and her period did stop for a little bit after that, but it's back to normal, or it was until it stopped.

Dr. Jones: I have a very strong suspicion here, and here's how it goes. When periods stop, we think about outflow track, something having damaged the uterus or the cervix. That didn't happen to her.

We think about weight gain and weight loss or a lot of exercise. Elite athletes or endurance athletes can interrupt the process of getting ovulating, and she doesn't have that.

The biggest thing is she had chemotherapy for a cancer, which she's cured for, but we know that chemotherapy can damage the number of eggs that she has. And even though she got her periods back, she probably still didn't have that many eggs left. Now, she's run out.

I think she has premature ovarian failure. Her ovaries have run out of eggs, not at 50 when most women do, but early. What we're going to do is going to get a blood test. It's pretty simple. I'm going to get an FSH level, follicle-stimulating hormone. If it comes back elevated, meaning she doesn't have any eggs left, then we're going to talk about where do we go from here to help her with her estrogens and help her have a baby someday.


Menstrual Products Are a Billion-dollar Industry

"Do I have enough pads for my next period?" "Where have I stashed them?" "Do I have them in my purse?" "Do I have them in the house?"

Women have a lot of periods, and there's a whole industry that's been built up around this. There are methods that women use to control their menstrual flow or manage it. So menstrual products are a huge billion-dollar industry, but why do we always show commercials for women having their periods or women in these tight white pants when that's our ultimate fear? I think that we should be more real that this is a perfectly natural phenomenon.

And can you afford them? That's the financial aspect. The fact that you have to buy these products, and they can be pretty difficult. Not having the equipment, not having the protection can be pretty frustrating. Financially, not being able to afford your products can be very difficult. And there have been some movements around the country to try to make products for women who are homeless. When we think about women not being able to afford food, they certainly won't be able to afford their menstrual products. So being able to afford menstrual products is an important thing.


Cultural Aspects of Menstrual Periods

Polly Wiessner is a professor in anthropology at the University of Utah and at Arizona State who spent some time in two very different cultures. She's going to help us unwind some issues about periods in other countries.

Dr. Jones: Now, Polly, it's important for us to think about how long you've been following these cultures. Some people go for a two-week little trip to try to see stuff, but you've been following these cultures you're going to be talking about for how long?

Prof. Wiessner: I've worked with the Kalahari Bushmen for over 40 years and with the Enga of highland Papua New Guinea for 30 years, so a lot of experience.

Dr. Jones: Right. So you've seen a lot.

Prof. Wiessner: Yeah. One could say that human beings, culturally, what they elaborate on the most is food, sex, and things related to body fluids. So you have an enormous amount of variation. But I'll talk about menstruation in the two societies where I work, which have really diametrically opposite views. But in most cases, with menstrual blood in many societies, it is assumed that men have to be careful about it.

So, in the Bushmen, there's a lot of ritual around a girl's first menstruation. Menstruation is supposed to show the transition to adulthood. It's supposed to promote health, fertility, and so on. When she's finished menstruating . . . and she has to go through all these taboos with food, with not touching the ground, not seeing the sun, which is scorching and drying. When she's finished, she gets a ritual bath and then her face is painted with red okra so she looks beautiful, and she's showered with gifts and beads.

And come out and really praised in all possible ways. But after that, there are very few beliefs about menstrual blood, except a woman who is menstruating cannot touch a man's hunting equipment or go near a hunter because it's believed to interfere with his hunting success.

Dr. Jones: How about the Enga? How about the people in New Guinea?

Prof. Wiessner: Oh, the Enga, it's just opposite. They believe that female menstrual blood contaminates men, and if men have contact with menstrual blood, or if men take food cooked by a menstruating woman, they will decline in strength, get weak, and their wits will be greatly diminished. And so that's why they have men's and women's houses.

In the women's houses, you have a room where men can go in the front and a place where women sleep at the back. When they menstruate, they have to retire and sit in the pig stalls, and then they go out at night or when they're not likely to see people.

However, as you know, women tend to menstruate at the same time, so I think sometimes they have a lot of fun together because they don't have to do much work in that time. They get some rest. Then when they come out, however, in some parts of Enga, the women, to dispose of their menstrual wastes, go to the forest and they do all sorts of rituals that will promote their husbands' prowess in warfare, hunting success, success in exchange. So they are able to use their menstrual blood to benefit men if they handle the aspect of staying away and contamination properly.

You see, the beliefs are very different, but they always have some beliefs of how menstrual blood can affect men and beliefs about menstrual blood promoting fertility, the health, everything, the beauty of women.


Most Women Have Emotional Responses to Their Period

Most women would say they feel different before their period is coming. This may be very difficult emotionally because they may be angry. They may be frustrated because they have pain and they lose time from work. Maybe they're more irritable or they're not sleeping as well.

Adolescents who don't understand it, who can barely control their emotions anyway, may get particularly difficult during their period. And I've seen a number of patients who are developmentally delayed for whom having a period is frightening. Blood is frightening, and the emotional changes lead them to be uncontrollable in their family environment, and their parents may actually bring them to me to stop their periods.

Premenstrual syndrome is common, and it is troublesome for women and the people who live with them. Recognizing that you have this and you have a predictable emotional pattern in the week before your period is very important.

  • Identify why you're feeling irritable or depressed
  • Understand what helps you feel better
  • Eat well
  • Get exercise
  • There are medications that can help with premenstrual dysphoric disorder, or PMDD

Another emotional response to the menses, to the period, is for people who try desperately to become pregnant, and the sign that the period is coming is a sign that they have not succeeded. Women who've been through an enormous input of time and effort and physical trouble by doing an IVF cycle, understanding that their in vitro fertilization process has not worked, because their period has come, can bring a profound sense of failure and depression.


Periods Are a Biological Rhythm of Life

For many women, even though their periods can be frustrating, no matter what their periods might be and what their social and cultural norms may be, their period is a reminder monthly that they are female, that they are fertile. And all around the world, having your period is a reminder of this incredible gift that we have to be able to have children.

Many women say, "This is part of what every woman does on the planet. It ties me to my mother and to my daughter." It's something we share. It's part of the biological rhythm of life. And it's a rather profound rhythm, this monthly lunar rhythm. So it makes us often feel like we're part of something much bigger, and isn't that the very core of spirituality?

But where do you find and keep your spiritual home when you live in a body you don't believe in? For women or men who are going to be trans men, the period is a reminder that this is a body they don't love. This is a future and a foundation that they don't share. So every woman is going to have a very unique and special relationship with her periods.

So the spiritual domain is a powerful one because, certainly, many faiths tell us how we should feel about our periods, but we should feel the way that we feel about our own bodies.


"Anything You Can Do, I Can Do Bleeding"

I don't want our listeners to think, men and women, that because women have periods that actually closes down their life and they bleed to death and things are awful, because, in fact, women do their whole lives bleeding. So there's a great song, "Anything you can do, I can do better," and anything you can do, I can do bleeding. Women carrying on their lives while they're doing this menstrual thing and you don't know.

So, ladies, let's think about three things that are good for you during your period.

  1. When blood comes out, that bright red comes from iron. Iron is important supplement in your diet. Most women actually don't eat enough iron, and you can get iron through meat. If you're not a meat-eater, you can take it through leafy vegetables. And if you're having difficulty with both of those, then adding a supplement that has some iron can be useful to keep your iron up, particularly if you have heavy periods.

  2. You should take care of yourself. This is a time that's very personal to you. If it means that you need some time out and you need a little quiet time, if you have really crampy periods, give yourself a break already and take some time for yourself. If that means going for a walk, it turns out that exercise makes period cramps not so bad. So go for a walk. Take some time for yourself.

  3. You should celebrate yourself. Every woman on the planet has periods. It's not such a bad thing. It could be bad, but it's not necessarily a bad thing. Celebrate this as a sign of your femininity. It's a sign of potential fertility, even if you don't want children, and it is a sign of your overall physical health. It means that you're young. You're not an old lady. You're not a little kid. You're a real live woman and good on you.


Health Haiku

Sad when it shows up
Happy when it stops or not
Red can rule our lives

For Patients