👩 WOMEN’S DAY_ Ignorance About Menstruation Puts Women’s Health at Risk
Jordan
Rosenfeld, Medium, Feb 27, 2018
How
cultural stigmas around bleeding have made their way into modern medicine
cultural stigmas around bleeding have made their way into modern medicine
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Photo:
Marjan_Apostologic via Getty Images |
In 2006,
LaToya began having really bad periods. Some as long as 16 days. They were so
heavy that she compared the gush to having her water break in labor, and they
were accompanied by terrible pelvic pain that the 39-year-old from Brooklyn,
New York, described as feeling “like someone had stabbed me with a hot poker in
my vagina, my uterus/lower abdominal area, and my rectum.” It hurt to sit down,
it hurt to stand up — and forget running or jumping.
Bleeding was so constant and irregular that she felt faint all the time and
experienced “instances of brain fog and memory loss.” LaToya had to take time
off work and feared going out (in case she didn’t have enough sanitary
supplies) or, worse, visiting someone else’s house, where she was embarrassed
she might ruin their furniture with breakthrough bleeding.
LaToya began having really bad periods. Some as long as 16 days. They were so
heavy that she compared the gush to having her water break in labor, and they
were accompanied by terrible pelvic pain that the 39-year-old from Brooklyn,
New York, described as feeling “like someone had stabbed me with a hot poker in
my vagina, my uterus/lower abdominal area, and my rectum.” It hurt to sit down,
it hurt to stand up — and forget running or jumping.
Bleeding was so constant and irregular that she felt faint all the time and
experienced “instances of brain fog and memory loss.” LaToya had to take time
off work and feared going out (in case she didn’t have enough sanitary
supplies) or, worse, visiting someone else’s house, where she was embarrassed
she might ruin their furniture with breakthrough bleeding.
Talking
with other women about their periods didn’t help much, since they weren’t
having the severity of symptoms that she was.
with other women about their periods didn’t help much, since they weren’t
having the severity of symptoms that she was.
While
LaToya’s gynecologist diagnosed her with a fibroid, the doctor’s only advice
other than birth control (which didn’t fit with LaToya’s desire to grow her
family) was to “watch and wait,” she says. Yet her symptoms only worsened to
the point where she sometimes feared she would black out from pain. “Sometimes
I didn’t know how I was going to go on living if this was my new normal,”
LaToya says.
LaToya’s gynecologist diagnosed her with a fibroid, the doctor’s only advice
other than birth control (which didn’t fit with LaToya’s desire to grow her
family) was to “watch and wait,” she says. Yet her symptoms only worsened to
the point where she sometimes feared she would black out from pain. “Sometimes
I didn’t know how I was going to go on living if this was my new normal,”
LaToya says.
She
became depressed and angry with her gynecologist. “She didn’t really listen to
me or acknowledge my pain and my experience.”
became depressed and angry with her gynecologist. “She didn’t really listen to
me or acknowledge my pain and my experience.”
Bleeding
men are revered. Blood spilled in war is heroic and earns men respect; blood
brothers show their deep, abiding loyalty with a slash of crimson between
palms. That reverence comes to a screeching halt the moment the blood is
pouring from between a woman’s legs.
men are revered. Blood spilled in war is heroic and earns men respect; blood
brothers show their deep, abiding loyalty with a slash of crimson between
palms. That reverence comes to a screeching halt the moment the blood is
pouring from between a woman’s legs.
Historically,
in many cultures — even in the Bible — menstruating
women were seen as unclean, dirty, evil. In one ridiculous extreme of the
attitude, 1920s doctor Béla Schick went so far as to try and prove there were
poisonous “menotoxins”
in women’s menstrual blood that could infect anyone who came in contact with it.
in many cultures — even in the Bible — menstruating
women were seen as unclean, dirty, evil. In one ridiculous extreme of the
attitude, 1920s doctor Béla Schick went so far as to try and prove there were
poisonous “menotoxins”
in women’s menstrual blood that could infect anyone who came in contact with it.
While
those attitudes may seem egregious today, menstrual squeamishness still exists
as a source of comedy and disdain in popular
culture. How many times have you heard the joke “what bleeds for
seven days and doesn’t die” as a source of male laughter? Even in a time of period
activism and the
free-bleeding movement, menstrual products are still marketed with
an emphasis on discreet packaging, and women’s reproductive health is still
undertreated by the medical establishment.
those attitudes may seem egregious today, menstrual squeamishness still exists
as a source of comedy and disdain in popular
culture. How many times have you heard the joke “what bleeds for
seven days and doesn’t die” as a source of male laughter? Even in a time of period
activism and the
free-bleeding movement, menstrual products are still marketed with
an emphasis on discreet packaging, and women’s reproductive health is still
undertreated by the medical establishment.
These
long-held and slow-to-disappear stigmas are based on uneducated and oppressive
patriarchal attitudes that still make their way into modern medicine and are
dangerous to girls’ and women’s health. In extreme cases, such taboos prevent
women from getting diagnoses, treatment, or education about more serious health
conditions.
long-held and slow-to-disappear stigmas are based on uneducated and oppressive
patriarchal attitudes that still make their way into modern medicine and are
dangerous to girls’ and women’s health. In extreme cases, such taboos prevent
women from getting diagnoses, treatment, or education about more serious health
conditions.
Part of
the problem is that women’s health has not been studied in the kind of depth
that is needed, with researchers often citing the variability of women’s
menstrual cycles as reason to exclude them
from clinical
trials, most notably those on coronary heart disease (the number one
killer of women in the United States) and drug efficacy and safety.
the problem is that women’s health has not been studied in the kind of depth
that is needed, with researchers often citing the variability of women’s
menstrual cycles as reason to exclude them
from clinical
trials, most notably those on coronary heart disease (the number one
killer of women in the United States) and drug efficacy and safety.
Meghan
Cleary, a writer, speaker, and advocate specializing in clinical gender bias
and founder of the website Bad Periods,
a repository of research based on personal experience, finds the lack of
knowledge frustrating and insulting. “The NIH [National Institutes for Health]
didn’t require that women be included in medical studies until 1991, and that’s
only government studies,” she points out. “It was only in 2011 that they
figured out women present with heart attacks differently. There is very little
clinical information [about women’s bodies].”
Cleary, a writer, speaker, and advocate specializing in clinical gender bias
and founder of the website Bad Periods,
a repository of research based on personal experience, finds the lack of
knowledge frustrating and insulting. “The NIH [National Institutes for Health]
didn’t require that women be included in medical studies until 1991, and that’s
only government studies,” she points out. “It was only in 2011 that they
figured out women present with heart attacks differently. There is very little
clinical information [about women’s bodies].”
Marni
Sommers, associate professor of sociomedical sciences at Columbia University
who focuses on gender, health, and education in sub-Saharan Africa and
Southeast Asia, writes in a 2017 paper
published in BMJ Global Health, “In many societies, cultural taboos frequently
hinder open discussion around vaginal bleeding, restricting information and
early access to healthcare.”
Sommers, associate professor of sociomedical sciences at Columbia University
who focuses on gender, health, and education in sub-Saharan Africa and
Southeast Asia, writes in a 2017 paper
published in BMJ Global Health, “In many societies, cultural taboos frequently
hinder open discussion around vaginal bleeding, restricting information and
early access to healthcare.”
Sommers
and her co-authors are calling for greater attention to non-menstrual-bleeding
episodes, including those related to pregnancy, childbirth and postpartum,
miscarriage, cancers, and endometriosis.
and her co-authors are calling for greater attention to non-menstrual-bleeding
episodes, including those related to pregnancy, childbirth and postpartum,
miscarriage, cancers, and endometriosis.
There is
still a long way to go toward education around women’s bleeding in less
developed countries. Religious norms, cultural taboos, poverty (which leads to
harder access to supplies), and lack of education create a climate of poor
health for women and girls, many of whom drop out of
school or can’t work due to issues related to stigmas, access, and
privacy around their periods.
still a long way to go toward education around women’s bleeding in less
developed countries. Religious norms, cultural taboos, poverty (which leads to
harder access to supplies), and lack of education create a climate of poor
health for women and girls, many of whom drop out of
school or can’t work due to issues related to stigmas, access, and
privacy around their periods.
Another
of Sommer’s studies,
published in the journal Conflict and Health, describes a condition most of us
world never even have to think about: refugee girls and women, who may spend
weeks in transit fleeing conflicts or long periods of time in refugee camps
where aid workers may not be fully educated about how to talk to them about
their needs.
of Sommer’s studies,
published in the journal Conflict and Health, describes a condition most of us
world never even have to think about: refugee girls and women, who may spend
weeks in transit fleeing conflicts or long periods of time in refugee camps
where aid workers may not be fully educated about how to talk to them about
their needs.
“If a
girl or woman is walking three to five days across countries or borders to get
someplace safe, the last thing she may have thought about when fleeing her home
is ‘Did I bring cloths to manage my period?’” Sommer told me by phone.
“Whenever I see pictures of women and girls coming across in boats, I think,
‘How are they managing [their periods]?’”
girl or woman is walking three to five days across countries or borders to get
someplace safe, the last thing she may have thought about when fleeing her home
is ‘Did I bring cloths to manage my period?’” Sommer told me by phone.
“Whenever I see pictures of women and girls coming across in boats, I think,
‘How are they managing [their periods]?’”
Even here
at home, the medical establishment has a long way to go in understanding common
disorders that cause bleeding in women.
at home, the medical establishment has a long way to go in understanding common
disorders that cause bleeding in women.
In July
2016, a 42-year-old woman in Oakland, California, named Sarah thought her
normal, typically five-day-long period was at its end. Suddenly she began
bleeding anew, filling a pad or tampon every 15 minutes, as compared to once
every four to eight hours during a regular period.
2016, a 42-year-old woman in Oakland, California, named Sarah thought her
normal, typically five-day-long period was at its end. Suddenly she began
bleeding anew, filling a pad or tampon every 15 minutes, as compared to once
every four to eight hours during a regular period.
She
planted herself on the toilet, where, she says, “Blood was coming out of me
like a faucet. It was just pouring out.” This included huge blood clots, one as
big as “half of my head.” Eventually Sarah put herself into the bathtub to
free-bleed because it was easier than changing pads.
planted herself on the toilet, where, she says, “Blood was coming out of me
like a faucet. It was just pouring out.” This included huge blood clots, one as
big as “half of my head.” Eventually Sarah put herself into the bathtub to
free-bleed because it was easier than changing pads.
Dizzy and
weak, Sarah told herself that if it would just stop, she’d be okay. When it
didn’t, her husband took her to the ER.
weak, Sarah told herself that if it would just stop, she’d be okay. When it
didn’t, her husband took her to the ER.
Once
there, Sarah says she felt dismissed as overreacting to a heavy period. The
OB-GYN who attended to her advised that abnormal bleeding “just happens
sometimes” and to take Advil and go home. “I asked if it would come back, and
she said, ‘You’re probably fine.’”
there, Sarah says she felt dismissed as overreacting to a heavy period. The
OB-GYN who attended to her advised that abnormal bleeding “just happens
sometimes” and to take Advil and go home. “I asked if it would come back, and
she said, ‘You’re probably fine.’”
But the
next afternoon, Sarah’s bloody gush was back and not stopping. By the time her
husband took her to the ER again, she was fighting to stay conscious.
next afternoon, Sarah’s bloody gush was back and not stopping. By the time her
husband took her to the ER again, she was fighting to stay conscious.
“The
nurse told me that if I didn’t get a transfusion, I would probably die.”
nurse told me that if I didn’t get a transfusion, I would probably die.”
Four days
in the hospital, six transfusions, and several CT scans, ultrasounds, and blood
tests later, doctors had no answers for her except a burst ovarian cyst, which
explained her pain but not her bleeding, and an abnormally thick endometrium,
for which they had no explanation. They put her on birth control pills, which
eventually slowed (though didn’t completely stop) the bleeding. “[I] took matters
into my own hands,” Sarah says, adding acupuncture and Chinese medicine, which
helped some.
in the hospital, six transfusions, and several CT scans, ultrasounds, and blood
tests later, doctors had no answers for her except a burst ovarian cyst, which
explained her pain but not her bleeding, and an abnormally thick endometrium,
for which they had no explanation. They put her on birth control pills, which
eventually slowed (though didn’t completely stop) the bleeding. “[I] took matters
into my own hands,” Sarah says, adding acupuncture and Chinese medicine, which
helped some.
It would
be several more months until Sarah got answers. She would have to demand them
from her doctor.
be several more months until Sarah got answers. She would have to demand them
from her doctor.
These
kinds of stories come as no surprise to Cleary, who herself spent years trying
to get accurately diagnosed with life-altering endometriosis. “Anything that is
below the belly button on women gets put in the ‘gyno ghetto,’” Cleary says.
“Anything having to do with your period automatically is not as valued,” Cleary
adds.
kinds of stories come as no surprise to Cleary, who herself spent years trying
to get accurately diagnosed with life-altering endometriosis. “Anything that is
below the belly button on women gets put in the ‘gyno ghetto,’” Cleary says.
“Anything having to do with your period automatically is not as valued,” Cleary
adds.
And all
of these issues are significantly worse in women of color, particularly black
women, who, compared to white women, have heavier
menstrual bleeding, triple the risk of postpartum death due to blood
loss or blood clots, and three times
the likelihood of developing fibroids that are symptomatic, among
other conditions.
of these issues are significantly worse in women of color, particularly black
women, who, compared to white women, have heavier
menstrual bleeding, triple the risk of postpartum death due to blood
loss or blood clots, and three times
the likelihood of developing fibroids that are symptomatic, among
other conditions.
However,
many of the issues associated with vaginal bleeding and pelvic pain are not
actually related to menstruation, Cleary points out. “They’re
endocrine-related. Even though you’re bleeding out of your vagina during your
period, it’s not 100 percent a period problem. You have a fibroid in your body
because your endocrine system is not processing extra estrogen, for example,”
she says.
many of the issues associated with vaginal bleeding and pelvic pain are not
actually related to menstruation, Cleary points out. “They’re
endocrine-related. Even though you’re bleeding out of your vagina during your
period, it’s not 100 percent a period problem. You have a fibroid in your body
because your endocrine system is not processing extra estrogen, for example,”
she says.
Many
women get their advice from their OB-GYNS, but Cleary is not a huge fan of the
way OB-GYNs are trained, believing their expertise too diffuse. “They may
deliver a baby on Monday, do a fibroid surgery on Tuesday, and then a
hysterectomy on Thursday. There’s no other specialty like that,” she says.
women get their advice from their OB-GYNS, but Cleary is not a huge fan of the
way OB-GYNs are trained, believing their expertise too diffuse. “They may
deliver a baby on Monday, do a fibroid surgery on Tuesday, and then a
hysterectomy on Thursday. There’s no other specialty like that,” she says.
LaToya
experienced that level of frustration with her OB-GYN, whose focus seemed to be
primarily on pregnant women. “I wish she would’ve admitted that [fibroids were]
outside of her specialty.”
experienced that level of frustration with her OB-GYN, whose focus seemed to be
primarily on pregnant women. “I wish she would’ve admitted that [fibroids were]
outside of her specialty.”
She
eventually did her own research to find a fibroid specialist, who insisted
LaToya immediately get blood transfusions, iron infusions, medications, and
eventually surgery, as her fibroid was not a watch-and-wait situation after
all. “We needed to get it out,” LaToya says. Since her surgery, in June 2016,
LaToya’s periods have returned to normal, and her pain is manageable with heat
and ibuprofen.
eventually did her own research to find a fibroid specialist, who insisted
LaToya immediately get blood transfusions, iron infusions, medications, and
eventually surgery, as her fibroid was not a watch-and-wait situation after
all. “We needed to get it out,” LaToya says. Since her surgery, in June 2016,
LaToya’s periods have returned to normal, and her pain is manageable with heat
and ibuprofen.
In
Sarah’s case, it was the ultrasound tech who revealed the fibroids her doctor
had previously ruled out. Sarah recalls, “I said, ‘No, you’re mistaken. My
doctor said I don’t have fibroids.’ The tech looked up at me and said, ‘Yeah,
you do, and they’re big.’”
Sarah’s case, it was the ultrasound tech who revealed the fibroids her doctor
had previously ruled out. Sarah recalls, “I said, ‘No, you’re mistaken. My
doctor said I don’t have fibroids.’ The tech looked up at me and said, ‘Yeah,
you do, and they’re big.’”
Her
OB-GYN still didn’t mention the fibroids in the follow-up call until Sarah
reported the tech’s results. Stammering and defensive, the doctor had no choice
but to admit she had looked only at Sarah’s ovaries and endometrium.
OB-GYN still didn’t mention the fibroids in the follow-up call until Sarah
reported the tech’s results. Stammering and defensive, the doctor had no choice
but to admit she had looked only at Sarah’s ovaries and endometrium.
“I was pissed
at her. Why did she miss that? How did the tech see it clear as day, and this
woman, who has an education and is a practicing doctor, how did she overlook
that? How did she tell me to my face, ‘You do not have fibroids’?” Sarah says.
at her. Why did she miss that? How did the tech see it clear as day, and this
woman, who has an education and is a practicing doctor, how did she overlook
that? How did she tell me to my face, ‘You do not have fibroids’?” Sarah says.
In a
world that treats almost all vaginal bleeding as menstruation-related (and even
just women being hysterical), Cleary encourages those with such conditions as
endometriosis, polycystic ovary syndrome (PCOS), interstitial cystitis, and the
like to talk to their care providers “not in gynecological terms, but organ
dysfunction, pain, blood loss, and anemia,” because that’s what it takes to be
treated seriously.
world that treats almost all vaginal bleeding as menstruation-related (and even
just women being hysterical), Cleary encourages those with such conditions as
endometriosis, polycystic ovary syndrome (PCOS), interstitial cystitis, and the
like to talk to their care providers “not in gynecological terms, but organ
dysfunction, pain, blood loss, and anemia,” because that’s what it takes to be
treated seriously.
“I think
a lot of it just seems to come back down to the fact that menstruation and
breastfeeding and functions of that nature are problematic because women do
them. It ties back to misogyny,” says psychologist Ingrid Johnston-Robledo, who
co-authored a paper
titled “The Menstrual Mark: Menstruation as Social Stigma.”
a lot of it just seems to come back down to the fact that menstruation and
breastfeeding and functions of that nature are problematic because women do
them. It ties back to misogyny,” says psychologist Ingrid Johnston-Robledo, who
co-authored a paper
titled “The Menstrual Mark: Menstruation as Social Stigma.”
She
quotes from Gloria Steinem’s famous article for Ms., “If Men
Could Menstruate.” Steinem writes, “Clearly, menstruation would become an
enviable, worthy, masculine event…Men would brag about how long and how much.”
Instead,
women with means and resources must advocate for and educate themselves. On
behalf of women without such resources, Sommer and her colleagues are pushing
the field to do more research on menstruation and other types of vaginal
bleeding “and all the implications for going to school and work and their
ability to function and perform.”
women with means and resources must advocate for and educate themselves. On
behalf of women without such resources, Sommer and her colleagues are pushing
the field to do more research on menstruation and other types of vaginal
bleeding “and all the implications for going to school and work and their
ability to function and perform.”
Despite
everything, Sommer remains in awe of women’s strength through these challenges:
“I’ve been struck by the extraordinary resilience of girls and women to
silently endure despite it all.”
everything, Sommer remains in awe of women’s strength through these challenges:
“I’ve been struck by the extraordinary resilience of girls and women to
silently endure despite it all.”
