Let's Talk About Menstruation
May. 9th, 2019 06:05 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
tealinIt's been almost a year since my Very Important Food Poisoning, and I've learned a lot of stuff I should have learned when I was a teenager. In the interest of abolishing the stupid taboos that kept me in ignorance, and hopefully reaching some people who may still be in ignorance, I'm going to share what's happened to me and what I've learned.
But it's about periods. You know, that evolutionarily baffling thing where a sexually mature human female sheds perfectly good blood and tissue because she failed to get pregnant that month. (Seriously, is that the best system, Nature?) This makes people squeamish so I'm putting it behind a cut, but this squeamishness is precisely the problem, so I encourage you to put on your Grownup Pants and educate yourself about what is normal, what is definitely not normal, and what 'birth control' actually means. So much of my life I was hobbled by a condition that was entirely treatable, but I never sought treatment because I didn't know it wasn't normal. This ignorance can't be allowed to continue.
Like most people I know, I got the bog standard sex ed in Grade 5: The uterus builds up a lining to prepare for a fertilised egg; should no fertilised egg be forthcoming, it sheds the lining and starts afresh. This cycle lasts roughly 28 days, and all you really know about it is that you bleed for 3-7 days. Some people bleed more, some less; some cycles are shorter, or longer; sometimes it's late or you miss one for no good reason so don't panic; some people get terrible cramps and others don't; here's your sample packet of tampons and have fun.
Mine started when I was 15. Supposedly this is when you have a real heart-to-heart connection with your mum as she introduces you to the Ways of Womanhood, but mine was not really a family that talked about things, so in the nicest possible way she threw me a packet of pads with the advice to ask her if I had any questions. Well, my sex ed class had left me with very few questions, so that was that. It wasn't something that came up with friends, either – talking about your periods seems like something you'd do with a gang of girlfriends at a sleepover while painting your nails, which was my vision of hell. The two close friends I had were much more interested in writing Hunchback fanfic, and I had no intent to change that. So I had little interest in comparing notes on biological functions and, really, no one to compare notes with.
I found my periods hard to deal with, and despite years of practising I never got the hang of them: I assumed that was a Grownup Lady thing that everyone else had figured out, like dating and high heels and the point of designer handbags. They were very regular, slightly but not abnormally on the long side, and more or less pain-free, so as far as I could tell, perfectly normal. That I couldn't get on top of this basic fact of womanhood was entirely in keeping with my general failures in that department, so I tried my best to work around it and get on with getting things done.
Then I ate a bad lamb burger last May, which, in a roundabout way, landed me in hospital where blood tests were done. The stomach upset was a passing thing and the blood tests came back normal, but in looking over the printout I noticed they had me down as anaemic. My doctor several years previously had told me I was 'mildly anaemic, and should look into taking iron supplements,' which I had been doing, as well as going out of my way to eat dark leafy greens and red meat, hence the lamb burger. I supposed I wasn't taking enough, so against all environmental and health advice, I made mince a regular part of my diet and thought I had that base covered.
A few months later I woke up with terrible abdominal cramps, so I phoned the NHS helpline who walked me though a questionnaire to determine if it was appendicitis and therefore an emergency (it wasn't). Part of it went like this:
By the time I saw the doctor later that day, the cramps had gone away. We had a chat about general health and I brought up the blood report from the hospital which had me down as anaemic despite my efforts to ingest more iron. Could this be related to my periods which were, I was beginning to suspect, unusually heavy? She asked me to describe them. I did. She said, 'Why hadn't you come in before?' Because I didn't want to burden the overstretched NHS. Because I thought this was just my cross to bear. Because I didn't know it wasn't normal.
She put me on prescription-strength iron supplements to get me back to normal levels, and booked an appointment to get a hormonal implant which should, hopefully, get the periods under control, as well as an ultrasound to see if there was anything untoward happening down below.
I've just had my six-month checkup to see how everything is going. The implant has not stopped my periods entirely, as it was suggested it might, because my misogynistic French Canadian bastard uterus isn't going to back down that easily. But I am no longer imprisoned to within a 30-second dash for the toilet three days a month, and my iron levels are back to normal, which, I can tell you, feels freaking amazing. Other aspects of the hormonal imbalance are being rectified too: I'm sleeping better, am getting some of my hair back, and (topical and temporary stresses notwithstanding) am noticeably less anxious. Turns out medical science sometimes knows what it's doing.
And so I come to you with the knowledge I have gained this year. Roll up and be educated, yo.
ANAEMIA
Symptoms for anaemia include expected things like:
Iron
PERIODS
FIBROIDS
HORMONES
BIRTH CONTROL
Hormonal treatments are all classed as 'birth control' because they usually have a contraceptive effect. The politicisation of birth control gets me really steamed up: I know lots of women on some form or other of birth control, and they are all taking it for the regulation of troublesome periods, not for the purpose of being promiscuous without consequences, which seems to be how its religious opponents perceive it. In light of the conversation I had with my good Catholic parents after getting exactly the sort of medical 'birth control' they oppose being included in insurance packages, I think there is a lot of ignorance out there about what 'birth control' actually means. I sincerely believe if you called it 'hormone control' it would cease to be a hot-button issue, because hey, those women and their hormones, all in favour of controlling that, whoa! If a man were somehow to get his penis up my shrivelled asexual vagina, I would not get pregnant, but that is very much a side effect of my so-called 'birth control', whose primary function is to enable me to live a normal life. I'd like to give opponents of 'birth control' the runs for a week every month and see how quickly they reach for a cure – then we can talk about what is and isn't essential medicine.
Anyway, specifically around the treatment of menstrual dysfunction, there are several methods of hormonal treatment available:
YOU DON'T NEED TO SUFFER
and
THERE ARE OPTIONS
If you don't have a doctor, or your insurance doesn't cover """birth control""", there may be reproductive health clinics/charities in your area which could help. Planned Parenthood is of course the famous one (the vast majority of what they do is stuff like this, not abortions), but there are others. I leave it to you to Google your options. The first step is knowledge, which I hope you have gained here tonight!
But it's about periods. You know, that evolutionarily baffling thing where a sexually mature human female sheds perfectly good blood and tissue because she failed to get pregnant that month. (Seriously, is that the best system, Nature?) This makes people squeamish so I'm putting it behind a cut, but this squeamishness is precisely the problem, so I encourage you to put on your Grownup Pants and educate yourself about what is normal, what is definitely not normal, and what 'birth control' actually means. So much of my life I was hobbled by a condition that was entirely treatable, but I never sought treatment because I didn't know it wasn't normal. This ignorance can't be allowed to continue.
Like most people I know, I got the bog standard sex ed in Grade 5: The uterus builds up a lining to prepare for a fertilised egg; should no fertilised egg be forthcoming, it sheds the lining and starts afresh. This cycle lasts roughly 28 days, and all you really know about it is that you bleed for 3-7 days. Some people bleed more, some less; some cycles are shorter, or longer; sometimes it's late or you miss one for no good reason so don't panic; some people get terrible cramps and others don't; here's your sample packet of tampons and have fun.
Mine started when I was 15. Supposedly this is when you have a real heart-to-heart connection with your mum as she introduces you to the Ways of Womanhood, but mine was not really a family that talked about things, so in the nicest possible way she threw me a packet of pads with the advice to ask her if I had any questions. Well, my sex ed class had left me with very few questions, so that was that. It wasn't something that came up with friends, either – talking about your periods seems like something you'd do with a gang of girlfriends at a sleepover while painting your nails, which was my vision of hell. The two close friends I had were much more interested in writing Hunchback fanfic, and I had no intent to change that. So I had little interest in comparing notes on biological functions and, really, no one to compare notes with.
I found my periods hard to deal with, and despite years of practising I never got the hang of them: I assumed that was a Grownup Lady thing that everyone else had figured out, like dating and high heels and the point of designer handbags. They were very regular, slightly but not abnormally on the long side, and more or less pain-free, so as far as I could tell, perfectly normal. That I couldn't get on top of this basic fact of womanhood was entirely in keeping with my general failures in that department, so I tried my best to work around it and get on with getting things done.
Then I ate a bad lamb burger last May, which, in a roundabout way, landed me in hospital where blood tests were done. The stomach upset was a passing thing and the blood tests came back normal, but in looking over the printout I noticed they had me down as anaemic. My doctor several years previously had told me I was 'mildly anaemic, and should look into taking iron supplements,' which I had been doing, as well as going out of my way to eat dark leafy greens and red meat, hence the lamb burger. I supposed I wasn't taking enough, so against all environmental and health advice, I made mince a regular part of my diet and thought I had that base covered.
A few months later I woke up with terrible abdominal cramps, so I phoned the NHS helpline who walked me though a questionnaire to determine if it was appendicitis and therefore an emergency (it wasn't). Part of it went like this:
LADY: Do you usually get menstrual cramps?She advised me to phone my GP when the practice opened and get an appointment ASAP.
ME: No, not really, definitely not like this.
LADY: Are you on your period now?
ME: Yes.
LADY: Think of the last time you went to the toilet. Would you say the blood at the bottom of the cistern was larger than a 50p piece?
ME: Definitely, definitely larger.
ME [internally]: A 50p PIECE?! IS THAT WHAT A NORMAL PERIOD IS? Are you KIDDING ME?? I have a fistful of change ON A GOOD DAY. WHY HAS NO ONE EVER TOLD ME WHAT NORMAL LOOKS LIKE?!?
By the time I saw the doctor later that day, the cramps had gone away. We had a chat about general health and I brought up the blood report from the hospital which had me down as anaemic despite my efforts to ingest more iron. Could this be related to my periods which were, I was beginning to suspect, unusually heavy? She asked me to describe them. I did. She said, 'Why hadn't you come in before?' Because I didn't want to burden the overstretched NHS. Because I thought this was just my cross to bear. Because I didn't know it wasn't normal.
She put me on prescription-strength iron supplements to get me back to normal levels, and booked an appointment to get a hormonal implant which should, hopefully, get the periods under control, as well as an ultrasound to see if there was anything untoward happening down below.
I've just had my six-month checkup to see how everything is going. The implant has not stopped my periods entirely, as it was suggested it might, because my misogynistic French Canadian bastard uterus isn't going to back down that easily. But I am no longer imprisoned to within a 30-second dash for the toilet three days a month, and my iron levels are back to normal, which, I can tell you, feels freaking amazing. Other aspects of the hormonal imbalance are being rectified too: I'm sleeping better, am getting some of my hair back, and (topical and temporary stresses notwithstanding) am noticeably less anxious. Turns out medical science sometimes knows what it's doing.
And so I come to you with the knowledge I have gained this year. Roll up and be educated, yo.
ANAEMIA
Symptoms for anaemia include expected things like:
- low energy or lack of stamina
- poor circulation
- pale complexion
- light-headedness
a tendency to sigh at romantic poetry and swoon at the attention of attractive menHey you know what a world looks like before there were ways to treat hyperactive periods? Victorian novels!
- feeling cold all the time
- thinning hair
- heart palpitations
- headaches
- tinnitus
- a craving for non-food items like ice or dirt (this is called 'pica')
- restless leg syndrome
Iron
- Nutritional iron comes from dark leafy greens (ie. spinach, kale), legumes, and red meat. There is also some iron added to most commercial flour.
- This is fine for maintaining normal iron levels, but if you're trying to catch up on lost iron, you're going to need help. The human body is bad at absorbing iron from non-food sources so you have to overcompensate.
- The iron supplements you can buy at a drugstore are about 15mg; the prescription ones are 200mg. If you're trying to replace iron, you want a prescription. 15mg is basically useless.
- It will make your poo green and smell like a cowpat, and can upset your stomach, but it is worth it to be a fully-functioning human being again.
- Calcium blocks iron absorption, so try to have your iron (either nutritional or supplemental) at least 2 hours after or 1 hour before consuming dairy, eggs, or anything else high in calcium. Tea has a similar effect.
- On the other hand, Vitamin C helps absorption of iron, so swap that glass of milk for orange juice or take a C tablet with your iron pill.
PERIODS
- A normal amount of blood in the toilet is, indeed, the size of a 50p piece (that's about half again as big as a quarter, for you US/Canadians)
- I tried to find out what 'normal' was in volume, and all I could find was one site that said a normal period releases 30-100mL of material (30mL is a tablespoon; 100mL is a little less than half a cup). I couldn't tell if this was per day or for the whole span of the period but my impression was the latter.
- If you are losing a tablespoon or more an hour and your sleep is interrupted several times a night to dash to the loo and you estimate you probably lose a pint and a half of blood every month, that is NOT NORMAL. Talk to your doctor.
- If you lose a lot of liquid blood, especially bright red blood, aside from the blobby tissue, talk to your doctor.
- If you have very painful cramps that interfere with everyday life, talk to your doctor.
- If your period is very long (7-9 days or more) or irregular, talk to your doctor.
- If you are talking to your doctor, and it is going to take some time to figure out what course of treatment is best for you, ask for tranexamic acid in the meantime. Tranexamic acid is a coagulant which they give to haemophiliacs, but it also does wonders at limiting the amount of blood you lose on your period. You will still shed the uterine lining, but not bleed so much. This will help you catch up on your iron. Tranexamic acid gave me my first taste of freedom. I love tranexamic acid and I can't believe I never heard of it until an ex-doctor friend suggested it.
FIBROIDS
- Your uterus can get knots of dense tissue called fibroids. Medicine doesn't really know much about them, but they seem to be encouraged by estrogen (more about hormones below). Most women get fibroids at some point in their life without even knowing they have them, and they are usually harmless in themselves. However ...
- Depending where they are, they can give you very painful cramps, or increase the surface area of your uterus resulting in increased tissue buildup and heavy periods.
- If there is a particularly troublesome fibroid in the inside surface of the uterus, it can usually be removed with a simple outpatient surgery.
- Fibroids in less accessible locations can be treated hormonally.
- Fibroids don't usually develop into cancer, but can indicate a hormonal imbalance that is associated with cancers, so it's good to have them looked into.
HORMONES
- There are two peacetime Lady Hormones: estrogen and progesterone. (Pregnancy brings on others but I'm not going there.)
- Estrogen builds up the uterine lining, progesterone releases it.
- They alternate in the cycle and the presence of one theoretically blocks the other.
- These can get out of balance, not least because progesterone gets converted into cortisol in times of stress. Excess estrogen is associated with anxiety, so this can become a self-perpetuating cycle. Yay nature!
- Treatment of dysfunctional periods usually involves bolstering and/or suppressing one hormone or the other to get things back towards the ideal balance.
- Excess estrogen is associated with higher risk of breast and ovarian cancer and post-menopausal hypothyroidism
- Symptoms of excess estrogen closely resemble those of hypothyroidism so is prone to misdiagnosis
BIRTH CONTROL
Hormonal treatments are all classed as 'birth control' because they usually have a contraceptive effect. The politicisation of birth control gets me really steamed up: I know lots of women on some form or other of birth control, and they are all taking it for the regulation of troublesome periods, not for the purpose of being promiscuous without consequences, which seems to be how its religious opponents perceive it. In light of the conversation I had with my good Catholic parents after getting exactly the sort of medical 'birth control' they oppose being included in insurance packages, I think there is a lot of ignorance out there about what 'birth control' actually means. I sincerely believe if you called it 'hormone control' it would cease to be a hot-button issue, because hey, those women and their hormones, all in favour of controlling that, whoa! If a man were somehow to get his penis up my shrivelled asexual vagina, I would not get pregnant, but that is very much a side effect of my so-called 'birth control', whose primary function is to enable me to live a normal life. I'd like to give opponents of 'birth control' the runs for a week every month and see how quickly they reach for a cure – then we can talk about what is and isn't essential medicine.
Anyway, specifically around the treatment of menstrual dysfunction, there are several methods of hormonal treatment available:
- oral contraceptives (the Pill)
- intra-uterine devices (IUDs)
- slow-release subdermal hormonal implant
- injections
YOU DON'T NEED TO SUFFER
and
THERE ARE OPTIONS
If you don't have a doctor, or your insurance doesn't cover """birth control""", there may be reproductive health clinics/charities in your area which could help. Planned Parenthood is of course the famous one (the vast majority of what they do is stuff like this, not abortions), but there are others. I leave it to you to Google your options. The first step is knowledge, which I hope you have gained here tonight!
no subject
Date: 2019-05-09 09:51 pm (UTC)Ok, ARE YOU KIDDING ME?! Even NOW with the IUD to, as they told you, possibly make it go away, its still semi-frequently bigger than a 50p piece! And Jesus christ on a crutch, in the year+ with the fibroid, I was going through 2-3 max pads a day and if I don't get up in the middle of the night, even the night pads couldn't cope. Before the fibroid, I suspect its similar to yours in that its also way more than a 50p piece at least in the first 2-3 days! I should probably get my iron levels checked again. Last time 6+ months ago was a bit low but still in normal range apparently, but been getting tired again and the tinnitus has NOT let up.
I suppose I need to eat all the red meat and more red pills until then. Actually, I need to find a new GP at the new place. I still haven't told my old GP I moved since I'm still waiting to get an appointment with ENT about the tinnitus issue! Oops... :P
no subject
Date: 2019-05-09 10:03 pm (UTC)My period has been doing the fandango since I got my implant; it's settled into something like a bunch of mini-periods rather than one monster one, but when it was resembling an actual monthly thing I was still well over the 50p mark those first few days. The ultrasound revealed that I have an unusually large uterus and 'more fibroids than I can count' (in the nurse's words) so that probably explains a few things, volume-wise ...
no subject
Date: 2019-05-09 10:23 pm (UTC)I'm going to get ENT sorted first then find a closer GP at new place for the blood test.
no subject
Date: 2019-05-11 09:52 am (UTC)no subject
Date: 2019-05-11 10:25 am (UTC)no subject
Date: 2019-05-11 09:58 am (UTC)no subject
Date: 2019-05-11 10:27 am (UTC)I have a pile of pill bottles in the kitchen next to the water jug, and honestly, I only remember to take them because right now I need to take my antihistamine to be able to feel vaguely human so they're all there in the same place. :P