When I share information in my gynecology and obstetrics practice and on social media, one of the most common responses I get from women is, How did I not know that?
And I hear this from women of all ages.
Many women have experienced medical gaslighting — having their symptoms dismissed and being told their lived experience is imagined. Women tell me this makes them feel uniquely broken, as if something is wrong with their body only.
This happened again last week when I answered a question in the Well section about options for a teen who doesn’t want periods. When explaining some of the treatments, and how they could help with cramping and unpredictability, I mentioned they may also help other symptoms like menstrual diarrhea.
To those among us who do not get their periods: Yes, that’s a thing.
Menstrual diarrhea is experienced by more than 25 percent of otherwise healthy women who menstruate, and yet I didn’t realize how abnormal or how dismissed so many women with menstrual diarrhea felt because it is rarely — if ever — discussed. Even in the doctor’s office.
So I tweeted about my own experience and within 24 hours the tweet had close to 20,000 likes, and that’s not counting the public responses and private messages.
Menstrual taboos are very real. They are also an effective way to oppress half the population. Menstrual shame keeps women from knowing how their bodies works.
Whether it is being cruel to a teen who has leaked blood onto her clothes at school or a woman excluded from religious services, the implication is clear — there is something dirty about menstruation.
The squeamishness is not about blood, it’s about menstrual blood. After all, we don’t shame people for bloody noses, right?
Add diarrhea on top of blood, and who is going to talk publicly about that? (Well, other than me.) You might as well bring in the fainting couch for the non-menstruating public.
The response to my tweet caused me to think about my own experience with my reproductive tract and what that tells us about education, choice and trusting people to make decisions about their own bodies.
Many people assume that because I discuss reproductive health so freely, I must have had a very body-positive upbringing. But it was quite the opposite. As far as my mother was concerned, I may as well have had doll genitalia (i.e. none). Among the things I was told about my body: there would be “blood from down there,” tampons were evil and sex was even worse.
It is easy to judge mothers like mine harshly, but her generation and every generation before had been taught next to nothing about their own physiology. Speaking directly about menstruation or vaginas? That would be unladylike.
As a teen, when my mother woke up covered in blood with her first period, she thought she was dying. Her own mother laughed and pointed. Not exactly a warm welcome to the sisterhood.
Thank God for Judy Blume.
I had the privilege of a decent class on the body and menstruation in grade six, and access to a public library with a wonderful librarian. I checked out books about the human body and — after reading “Are You There God? It’s Me, Margaret” — prepared myself.
But I wasn’t prepared for the crippling cramps and horrible diarrhea. The girls in my class who had already started their periods had never mentioned either and my mother had nothing to offer. So I missed school one or two days each month.
My periods were catastrophically heavy. I tried to donate blood when I was 18, but was declined because the point of care test suggested I had an iron deficiency. I would learn later that the cause was my periods, but my doctor just said heavy periods and cramps were “normal.” Her prescription? Eat liver.
I want to blame that doctor for dismissing me, but I have complex feelings. After all, she was my mother’s age and had probably trained in the 1960s. What would she have been taught about menstruation? Probably very little, beyond the fact that it existed.
Medicine was very invested for a long time in concepts of “female complaints” being weak or hysterical. Imagine you are a woman in your medical training in the 1960s and everything you hear about the female body is associated with weakness, nevermind the culture of purity?
My understanding of my own period changed when I started medical school. I was 20 years old (yes, 20), so I received quality information about the body very early, relatively speaking. I learned that it wasn’t normal to bleed or cramp the way I did and that these things could be treated.
I also learned what may have caused the diarrhea — prostaglandins, which are substances released during menstruation that, among other things, help the uterus contract — but only because I had learned in another lecture that prostaglandins could also cause diarrhea.
I put two and two together. After class I asked the professor if prostaglandins from menstruation could also cause diarrhea?
“I don’t see why not,” he said. (And I later confirmed in my training that my theory was correct, but as menstrual diarrhea is essentially unstudied, other inflammatory substances may also be involved.)
Armed with facts, I sneaked into one of the OB/GYN clinics and took three sample packs of the birth control pills. I’d learned they might treat my heavy periods and cramps and that they reduced prostaglandin production, so I hypothesized they might also help my diarrhea.
I was right. I never had an overly bothersome period again.
It shouldn’t be that hard for anyone — no one should need to attend medical school or risk arrest for breaking and entering to feel better — and yet, it often still is.
The lack of women in medicine meant the medical canon about menstruation was first created by literally the least informed people: those who had never had a period.
And while a doctor doesn’t need to have a symptom or condition to treat it effectively, if medicine is erroneously downplaying the significance of menstrual symptoms, having one or two women around who could have said, “Well, actually … ” might have made a big difference in how we treat women medically.
If we educate women about menstruation, they can make choices that work for them — whether it’s finding the right menstrual product, knowing when symptoms might warrant treatment or investigation, or knowing when to advocate for themselves if they are not being heard. And if oral contraceptives were over-the-counter — which we know is safe — many people could start first-line therapy if they so chose.
Even just arming people with the knowledge of why their bodies behave in certain ways and giving them the freedom to talk about it without shame is potent medicine.