Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Our Bodies, Ourselves (7 page)
BLOOD IN THE BOARDROOM
i ask her if she's got a tampon i could use she says
oh honey, what a hassle for you sure I do
uou know i do
i say
it ain't no hassle, no, it ain't no mess right now it's the only power that i possess
these businessmen got the money they got the instruments of death but i can make life i can make breath
âAni DiFranco,
“Blood in the Boardroom”
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“Fem-care advertising is so sterilized and so removed from what a period is,” Elissa Stein, coauthor (with Susan Kim) of Flow: The Cultural Story of Menstruation, told the New York Times. “You never see a bathroom, you never see a woman using a product. They never show someone having cramps or her face breaking out or tearfulâit's always happy, playful, sporty women.”
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Indeed, we often feel obligated to apologize when discussing menstruation. For many women, there is much more to the menstrual experience than bleeding. Our experiences, both physical and emotional, range widely and sometimes are connected to our religion or culture.
We may have certain traditions around menstruation, passed down through our familiesâeven if the tradition is as simple as what kind of product to use or how best to wash out a bloodstain.
I don't have any bad feelings about it or get upset when I get my period. It's a sign that I'm not pregnant, which makes me happy, because I'm in college right now and I'm not at the stage where I want any kids yet.
The menstrual cycle is governed by hormones that rise and fall in rhythmic patterns. These hormones influence the physical and emotional changes you may experience during your cycles. Some women notice few changes; some experience increased energy and creativity; others experience mood changes (some positive, some negative) and body changes (swollen breasts, for example). Some women have cramps, while others do not. One woman reports happily:
I wasn't the biggest fan of my period, but then I discovered that I have the most incredible orgasms while I'm menstruating!
Women can have a variety of physical sensations and emotional experiences for several days before menstruation and sometimes during the first few days of menstrual flow. These are caused by the normal hormone fluctuations of the menstrual cycle and are not a sign of a hormone imbalance. Among the more negative changes are mood swings, fatigue, depression, bloating, breast tenderness, and headaches. Sometimes these premenstrual experiences are mild, but sometimes they disrupt our lives significantly.
I get upsetâsad about simple thingsâwhen I get my period.
Some of us experience mood changes before our periods, including some level of depression
and emotional irritability. Some of us find that issues that have been with us all along become more pronounced at this time. Others see our moods as authentic expressions of feelings we don't usually feel able, comfortable enough, or secure enough to show. Some women are able to cope with premenstrual mood changes, while others find the intensity of the symptoms and frustrations intolerable.
For some women, certain self-care and nonmedical techniques can help with mood changes. Approaches that have proved useful in a few studies include exercise, calcium, vitamin B6 supplementation (although too much B6 can have serious side effects), and the herb
Vitex agnus-castus
(chasteberry). Approaches that have worked for some women and are still under study include dietary changes such as limiting salt, sugar, caffeine (especially coffee), red meat, and alcohol; massage; reflexology; chiropractic manipulation; biofeedback; yoga; guided imagery; photic stimulation; acupuncture; and bright light therapy.
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A small but significant number of women do experience extreme premenstrual depression that interferes with work, social interactions, and general well-being. In these instances, recognition and care are critical. If premenstrual depression interferes noticeably with your daily life (you don't want to get out of bed, you miss work, or you have suicidal thoughts) and nonmedical approaches are not helpful, seek advice from your primary care provider, your ob-gyn, or a mental health professional.
Medical treatments for premenstrual depression include using hormonal contraception continuously, so that there is no menstruation, or taking antidepressant medications called SSRIs. However, there are questions about the effectiveness and safety of SSRIs. (For more information, see
“Depression and Other Mental Health Challenges During Pregnancy.”
)
Women experience many different levels of menstrual-related cramping, from no cramps to severe ones. A particular constellation of symptoms, including cramping and often nausea and diarrhea, may be caused by excess production and release of prostaglandins.
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(One form of prostaglandins, which are hormonelike chemicals found throughout the body, causes contractions of both the uterine and the intestinal muscles.) With too many prostaglandins, the usually painless rhythmic contractions of the uterus during menstruation become longer and tighter at the tightening phase, keeping oxygen from the muscles. It is this lack of oxygen that we experience as pain. Anticipation often worsens the pain by making us tense up. It's not clear why some women have more uterine prostaglandins than others, but this sort of menstrual cramping is actually a sign of normal hormone cycling and ovulation.
I've always had cramps during my period and sometimes they made me pretty miserable. When my periods returned after I gave birth, my attitude toward cramps changed. Having felt labor contractions, I had an awareness that the cramping was actually just my muscle contracting. I still have moments when menstrual cramps suck (yay for ibuprofen), but I also have moments when I feel them, tune in, breathe, and feel powerful.
There are two types of dysmenorrhea (dismen-or-EE-yah): primary dysmenorrhea is painful cramping (with or without nausea and diarrhea) not associated with any other pelvic disorder; secondary dysmenorrhea is pain associated with another pelvic problem such as endometriosis, pelvic inflammatory disease, or fibroids. Primary dysmenorrhea is more common and typically starts in the teen years; the pain resolves after a few days of bleeding.
TERMS FOR PREMENSTRUAL CHANGES
The term “PMs,” which stands for premenstrual syndrome, is often used with words like “symptoms” and “treatments,” as though premenstrual changes are an illness. Some women do experience debilitating discomfort, pain, or mood changes in the days before menstruation. But the label PMS suggests that most women must suffer a “syndrome” each month. This does not reflect the real and significant variation in women's experiences.
Similarly, there is debate about the term and diagnosis “premenstrual dysphoric disorder” (PMDD), which is used to describe a severe form of premenstrual depression. Some critics argue that the term, created by the American Psychiatric Association in 1993, pathologizes menstrual changes by giving women the label of a specific psychiatric “disorder,” and reinforces the idea that women are “crazy” once a month and should not be in positions involving great authority or stress.
“When you start calling PMDDâand by extension PMSâa psychiatric disorder, what are you saying about the women of this world?” asks Nada Stotland, a past president of the American Psychiatric Association and professor of psychiatry at Rush Medical College in Chicago. “This reinforces prejudices people already have about women being moody and unreliable.” According to Stotland, the majority of women who go to PMS clinics have symptoms that are not, in fact, related to their periods. “Most suffer from depression every day. Others have anxiety and personality disorders. Some are in psychological pain because they are being abused.”
Severe premenstrual depression is rare. Pharmaceutical companies whose medications are approved by the FDA for anyone with a PMDD diagnosis sometimes create marketing materials that encourage overuse of this diagnosis. The Bayer pharmaceutical company had to run corrective advertisements to make up for ads that implied that simple irritability and other common premenstrual discomforts were PMDD and should be treated with its birth control pill, Yaz.
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Its corrective ads explained that PMDD is both rare and severe. In another instance of the possible overuse of a PMDD diagnosis, the European Medicines Evaluation Agency refused to approve drugs for PMDD, raising concerns that women “with less severe premenstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short-and long-term use of fluoxitine [Prozac].”
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Nonmedical approaches that help some women include Chinese herbs provided by an experienced practitioner of Chinese medicine, applying wet or dry heat over the abdomen, taking omega-3 fatty acids, learning to self-apply acupressure points, and taking ginger supplements.
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If these methods do not work, consider seeing your health-care provider. Prescription-strength
nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, birth control pills, other forms of hormonal contraceptives, and the Mirena intrauterine device can diminish severe menstrual cramps for most women.
You may experience a very heavy period if you did not ovulate during a cycle. This happens to all women occasionally and occurs more often in the teen years, during perimenopause, during times of stress, and after any pregnancy. Heavy periods can also occur if you have fibroids, are using certain IUDs for birth control (the Mirena IUD actually reduces cramps and bleeding), or have an inherited bleeding disorder. The most common inherited bleeding disorder, von Willebrand disease (VWD), affects about 1 to 2 percent of the U.S. population and runs in families. While it is often difficult to diagnose, and there is no cure, VWD can be treated. (For more information, see
“Von Willebrand Disease.”
)
Irregular bleedingâoff-schedule menstrual flowâcan also be caused by recurrently not ovulating, which can be age-related (again, more common in early teens and perimenopause) or from some health problems or severe stress. Bleeding in early pregnancy, which may or may not progress to miscarriage, can sometimes be confused with a menstrual period and can be light or heavy.
If you have heavy periods and/or irregular bleeding, it's a good idea to talk with a health-care provider, because these can signal serious health problems. (See
“What Menstrual Cycles Reveal About Your Health.”
) Keeping a menstrual calendar can help you develop awareness of what a typical flow is for you. (See “Charting Your Menstrual Cycles,” below.)
Primary amenorrhea is the condition of never having had a period by the latest age at which menstruation usually starts (sixteen). Secondary amenorrhea is missing periods after having had at least one. Oligomenorrhea is infrequent, erratic periods. Some causes of amenorrhea and oligomenorrhea are pregnancy; menopause; breastfeeding; heavy athletic training; emotional factors; stress; current or recent use of hormonal birth control methods; excessive dieting, anorexia, or starvation; use of some medications, including chemotherapy; obstruction or malformation of the genital tract; hormone imbalance; cysts or tumors; chronic illness; and chromosomal conditions. Sometimes amenorrhea or oligomenorrhea is caused by a combination of several of these factors.
Many women find it helpful to keep a menstrual calendar or a special fertility awareness chart. By doing so, we can get to know our bodies, learn what is normal for us, and become advocates for and authorities about our own health. You can use a print or online calendar or diary to chart when you bleed, whether and when you have vaginal secretions, and whether you have a range of physical or emotional experiences (including pain or cramps, heavier or lighter flow, or changes in sexual desire, energy level or mood, breasts, or general physical health). You can find menstrual charts online at the Taking Care of Your Fertility website, tcoyf.com.
One way of charting your menstrual cycles is to use the fertility awareness method (FAM).
In addition to being a good tool to assess your gynecological health, FAM is a scientifically validated method of natural birth control and pregnancy achievement. It is based on observing and charting body signs such as changes in the cervical fluid and in the color, size, and shape of the cervix that reflect whether a woman is fertile on any given day.
FAM Is Based on the Following Scientific Principles:
⢠Your menstrual cycle can basically be divided into three phases: the preovulatory infertile phase, the fertile phase, and the postovulatory infertile phase. You can determine which phase you are in by observing the three primary fertility signs: early morning (waking, or basal body) temperature, cervical fluid, and cervical position.
⢠The menstrual cycle is under the direct influence of estrogen and progesterone, and the body provides daily signs about the status of these hormones. Estrogen dominates the first part of the cycle; progesterone dominates the latter. Another hormone, called luteinizing hormone (LH), is the catalyst that propels the ovary to release the egg. LH is the hormone measured in ovulation predictor kits.
⢠Ovulation (the release of an egg) occurs once per cycle. During ovulation, one or more eggs are released. An egg can survive for twelve to twenty-four hours. If a second egg is released in one cycle (as in the case of fraternal twins), it will be released within twenty-four hours of the first.
