E4: 7 Domains of Periods

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 have come," or they might say, "My period has come." But all over the world, in many cultures, people use other words.

Now, in the United States, actually, we often use, "My period has come," but there are lots of other words that women might use for that. My mother used "falling off the roof." Now, I don't get that one. I've often heard patients say, "My friend has come." But here are some other words or phrases that women use. It's a visit from Aunt Flo. It's on the rag. I think that's really ugly, so I never would use that one. Lady business. Well, there's a lot of lady business, so that's not very specific. Time of the month is very common. The red badge of courage, maybe. Moon time. That's kind of touchy-feely, granola-y. Crimson tide. I really feel if women have a crimson tide they should come and see me so it isn't so tide-y. Girl flu. Mother Nature's gift. That's kind of sarcastic.

It turns out that around the world, many cultures use other words. In fact, one study looked and found more than 5,000 different slang or euphemistic expressions or phrases for their periods.

In terms of cultures, in Chinese culture, about 91% of Chinese actually use euphemisms for the period. They don't use that word, "period" or "menses." They use euphemisms. By contrast, only half of Costa Ricans have any euphemisms or other words. They must use the word menses or period.

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.

Women should understand what their periods are about or how often they should happen, what you can do to make it easier on yourself and others. So, I want to make sure that women actually understand their periods. For mothers who didn't talk to their children, for girls who didn't learn about their periods in high school or in junior high, for adult women who still think it's falling off the roof and have no clue what's really going on, having the knowledge and access to information, good information like The Scope, for information about your periods is important.

Well, let's go a little bit further and talk about why we have our periods in the first place. We as mammals have a process of building up the uterus lining so that we can grow our babies inside.

Why Women Have Periods

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.

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.

So, women have chosen now to change the way their periods would naturally be because periods can be difficult, and they can be long, and they can be annoying.

Women also can use birth control pills to decide when they want to have their period. So, if you are an athlete and you happen to be competing and you don't want to have your period when you're competing, you're getting married and you're going on your honeymoon and don't want to have your period on your honeymoon, there are ways that you can actually control when your period is going to happen, and you can modify how much flow. So, many women may choose contraceptive methods not for their contraception, but because of the way they modify their period.

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.

 

Dr. Jones: Chloé, are you ready?

Chloé: I'm so ready. Let's do this.

Dr. Jones: Okay. Let's do it.

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 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.

 

Okay. We finished up with that medical mystery, which this week was no periods, and we're going to move on to the next segment, which is actually about periods.

Menstrual Products Are a Billion-dollar Industry

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. There are products. I have to say the products that women use are kept in a part of the store where everyone can see them, but most men have never bought women's products for their partners. And I've had medical students who have never, ever seen a tampon.

Women's products are unique to them, not always shared with their partners, but women always want to have them. They carry it around in their big purses, but not everyone actually gets a chance to see them. So, menstrual products are a huge billion-dollar industry, but we still don't talk about it very much.

The disaster for every woman is the summer picnic wearing white pants, and that period starts with a bang, or more a "whoosh," and there you are in white pants. This is every woman's fear. And we amplify that by always showing women as pristine around the time of their periods.

There was article in "The New York Times." It looked at women around the world and what products they used, and one woman used this long skirt made out of goatskin that had many different colors. And if a woman bled during that time, the goatskin would absorb it, and you couldn't tell because there were all these colors in the goatskin. And if the goatskin didn't clean up well, you could get another goatskin.

Anyway, the long and the short of it is 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 look at women in white and I just think about mistakes, overflow, or something. I think that we should be more real that this is a perfectly natural phenomenon.

There are profound taboos across the world about women's blood, and what bad things can happen, mostly not to women because we're used to it, but to men. And we have to separate women from men because women's blood might harm them in some way. I'd say, "You go, girls."

I think it's this effort. If you're going to have to actually have a commercial or some kind of ad that they don't really want you to think this is really about that. A man could flip through and see the commercial but not see anything that would affect and disturb his delicate sensibility about this topic. Guys are not okay with red.

If I saw it on a menstrual . . . let's say they had a pad with some red on it and it showed that it catches the overflow so you never have a mistake, I'd say, "Wow, I want to buy that product." If they showed the red but showed how it never ever makes errors . . . they do that with training pants. They do that with diapers and training pants. They show liquid. They pour liquid, and they show that you can't overflow, but overflow is a big deal for women, but never, ever will they do the same thing for women.

If they showed me that, they poured a bunch of red liquid, or let's say, for the purposes of the delicate men in the audience, they made it blue and it never overflowed, I'd say, "I want that. Give me that one."

I'm always worried, "Do I have enough pads for my next period? Where have I stashed them? Do I have them in my purse? Do they have them in the house?"

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

Now, I am an expert in all the physiology of women's reproduction. That's what I trained in. That's what I do. I can't say that I'm an expert in the cultural norms in all the cultures of the world, but there have been some that actually really affected my practice of medicine.

One was in the Orthodox Jewish culture, women are not supposed to be in the bed with their husbands when they're having their period and for about 10 days after. Now, this is a pretty long time for people who are trying to get pregnant. So, people would come to me to try to shorten their periods so that they might actually be able to have sex with their husbands during the time when they were ovulating.

This particular norm allows women to have a break from their marital responsibilities while they're having their periods. There are even some beds that spring apart if a woman has her period in the middle of the night. She can separate herself from her husband.

At the end of her period and this waiting time, a woman can go to a ritual bath called a mikvah. And these are places in big cities that have a large Orthodox Jewish population where women go. They get to be in this big bath area. Their hair is combed and they get a chance to have this beautiful restful time before they return to their marital bed.

Some women may see this as something that is exclusionary, but some women might see this as a pretty cool idea. That particular cultural norm is one that's not very harmful to women, although it can get in the way of you trying to get pregnant.

Other cultural norms can be much more harmful to women. There are a number of cultures in which there is a menstrual hut where women are excluded from being in the home or they're excluded from going to places of worship when they're having their period.

It isn't just the period. It's when women bleed it all. And certainly, the concept of the menstrual hut is not uncommon in North Africa, not uncommon in Nepal.

If women are bleeding and told that they have to go out to a menstrual hut . . . which may also have the other animals that the family keeps. So, it's really they're going to the barn. Should this bleeding be associated with the birth of a child, they are unattended, bleeding alone in a place that's not clean, and women may bleed to death under these circumstances. So, this menstrual taboo separating women from their family, separating women from their places of worship, may be harmful to women.

 

Dr. Jones: Today, we're going to be talking with Polly Wiessner who is a professor in anthropology here 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 parts of the country.

Prof. Wiessner: In other countries, yes.

Dr. Jones: In other countries, yes, of course. 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.

Dr. Jones: That sounds . . . I want that. I wanted that.

Prof. Wiessner: Yes, 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: Whoa. 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. And I haven't had the chance, but I'd like to record what they talk about one day.

Dr. Jones: Oh, I think that would be fabulous.

Prof. Wiessner: Yeah. 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.

Dr. Jones: Well, I really like that concept of group celebration. I don't like the idea of women being put away during their menses alone because sometimes bad things happen and sometimes women aren't having their period. They're miscarrying. Maybe they're even giving birth, and women who give birth alone are much more likely to die or their babies to die.

So, on the one hand, I think the group celebration is fantastic, and I like the idea of everybody having their periods together so they can go hang out. I wonder who does the cooking. Maybe the grandmas after they're having their own periods, but . . .

Prof. Wiessner: Well, I think not everyone does, but it's been shown in college dorms that women tend to cycle together. But for pregnancy, women are really protected. There's no risk of giving birth alone. And if women start to miscarry or something, people recognize that.

Dr. Jones: Well, Polly, thank you. Thank you very much. We're really interested in both the biology, and the science, and the medicine, but the cultural and emotional aspects of periods as well. And you've given us a little view on another couple of cultures and their take on it. Thank you.

Prof. Wiessner: Yes.

Most Women Have Emotional Responses to Their Period

If every woman on the planet has periods, 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.

Adolescents who don't understand it, who can barely control their emotions anyway, may get particularly difficult during their period.

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.

Most women have some emotional response to their period. For me, most of my life when my period came, I was so glad that I wasn't pregnant. I was very glad when I wanted to be pregnant, but all the other times I've met my period with a sense of relief.

Many women, in the time before their period, have some emotional changes. Maybe they're more irritable or they're not sleeping as well. And for some folks, this really gets in the way of their emotional life.

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.

• First of all, you can then identify why you're feeling both irritable or depressed. You can talk about it with the people around you and say, "I'm just not feeling myself right now."
• You don't have to go into all the details of why you're not feeling quite yourself, but being emotionally intelligent enough to say, "I recognize where I am in my cycle. I understand why I'm feeling this way, and I know things that can help me." What helps?
• Make sure you eat well.
• Make sure you're getting exercise. Be aware that going outside for a walk when you're about to get totally crabby would be a very adaptive response to not feeling like the person that you want to be.
• Now, for women who are totally difficult and have a very difficult time, there are medications that can help women with premenstrual dysphoric disorder, or PMDD. This is a real medical problem because these women really lose time out of their lives when they feel so anxious, depressed, or irritable. There's medication for this. Birth control. Some birth control methods can actually help decrease symptoms of PMS, and there are other medications. So, you should be aware that you have it. Be aware that it's getting in the way of your life.

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 most women, if they're lucky, their period is met with a sense of relief, a sense of understanding that they're not pregnant, and that's a good thing. But for women with PMS and women who've been attempting to become pregnant, this particular process can be devastating. So, be aware of what you are experiencing, and don't be alone with this. Ask people to help you when you're depressed if you were trying to get pregnant. Don't be alone with this.

And, if it's really getting in the way of your life, we can help. There are medications. There are therapies and mindfulness. There are things that can make you feel better in the emotional domain around your periods.

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 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.

This will be good, it could be bad, but it's definitely part of them, and it's not always something that they share how they fundamentally feel about their periods, their femaleness, their non-femaleness if they don't feel that way. So, it's going to be unique and we won't always know how women feel about their periods.

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 close down their lives 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. Remember when blood comes out, that bright red comes from iron, and iron is an 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. This is important because this is a reminder that you're starting all over the natural hormonal cycle starting today with your period. So, give yourself a little time if this is a time that's difficult for you.
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.

So, thanks for hanging in with us, and check in with us again wherever you get your podcasts. If you need to balance all this women's stuff out, check out our podcast on men's health. It's called "Who Cares About Men's Health" wherever you get your podcasts.

I'm going to leave you with a haiku. Are you ready?

 

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