Autumn’s sunlight streamed brightly through the bare windows, stretching from ceiling to floor, sparsely spanning the interspace between outside and inside. Acutely modern, smooth, hardened plastic framed the view of London’s financial district, hiding the uniformity of cast concrete and Legolike shapes covered in lush carpets. Bare and clinical, cold metal and warm polished wood collided, as worlds collided in the boardroom. Modern taste!
And Sarah winced, a lancing, stabbing pain lashed at her abdomen, cramping and bending her slightly forwards. She steeled herself and smiled, weakly, through her bloodless lips, concealed by red lipstick, as a wave of nausea swept through her. She had to finish these negotiations and so she straightened up, continuing her line of argument. Damned she had better get through this before the migraine descended which would leave her no choice but to reach for the painkillers. Her reputation as a tough, professional but charming negotiator was at risk. Better take that painkiller now. She finished the argument, her client smiled and the other side indicated their agreement. She arranged for contracts to be reviewed and amended; they would meet in three days to sign contracts. ‘I hope nothing goes wrong!’, she thought.
Now she could make her way to the ladies toilets for some privacy, so she excused herself. Sarah made her way into the toilets, suddenly doubled over, feeling faint and so she fell to the floor, seeing blood on it. She panicked. Later she would discover that she had overflowed. Too much blood had flooded down, overwhelming her sanitary pad’s ability to absorb it. She would realise over the course of this period that she could not continue as before
Our society has expectations of women which ignore their unchangeable biological needs and cycles, leaving them alienated from healthy and sustainable relationships with themselves. This story, though fictional, is a composite constructed from the stories of women whom I have treated. It is unfortunately more widespread than we care to imagine. 1 in 5 women in the United States and the UK (in the age group 30-49) suffer from heavy menstrual bleeding – menorrhagia – which often sees them lose 10 to 25 times more blood than is expected and shockingly, the conventional medical treatment is often the surgical removal of the womb – hysterectomy.
The trend continues, an Actionaid 2017 survey found that 25% of UK women aged 16-39 don’t understand their menstrual cycles. This conversation is often simply not happening. 20% of women below 40 feel uncomfortable discussing their periods with their female friends, 21% with their mothers and partners. The number of women who do not feel comfortable discussing menstrual issues with fathers or a male friend, unsurprisingly doubles. In many homes and in some communities a discussion is just not possible. For women with menorrhagia, which they may often experience as embarrassing, the proportion of them who never discuss their periods will be even higher. For those whose period irregularities began at menarche – when periods started – their irregularity is the norm for them and if they don’t discuss it then they would never know. And I have met many who didn’t! Women are often walled up in isolation in their pain.
How is it possible in this climate for us to not have a conversation about women’s menstrual health? Do we have to wait until these numbers double? Women, the absolute bedrock of our society, have reproductive issues because of a collective neurosis which requires them to act without consideration of their natures, and we are not having a conversation. This is insanity!
The American Association of Reproductive Health Professionals commissioned a survey in 2005 which focussed upon assessing the desire for products to control periods and allow them to be timed more conveniently with our modern lifestyles. They found that most women view their periods as an annoying and inconvenient visitor and that roughly half of them showed interest in products which would allow them to control period frequency. This reveals a deep alienation from their natural cycles. In my clinical experience, I have regularly encountered these attitudes and have to work with women to enable them to get in touch with their cycles and the manner in which their bodies, moods, dreams and attitudes change with these natural biological tides. I have even encountered a worrying trend amongst Muslim women who use HRT to control their cycles from inconveniently interrupting their pilgrimages to Mecca. In my experience this alienation seems central to modern attitudes of women across cultures.
With this culture of alienation and dysfunctional lack of body connection, it is not surprising that there will be physical dysfunction, menstrual irregularities and illness are an expression of this. An inability to harmonise with our bodies and our environment will always result in disease, and learning to work in harmony with our bodies and environment will always yield the results of better health. So let us look at the menstrual cycle.
Menstrual cycles vary very much in length around an average of 28 days, they last from one period to the beginning of the other. The period refers to the vaginal bleeding which occurs when the womb releases its lining, which is built up monthly in two phases, in preparation for a possible pregnancy. After the womb lining is shed with bleeding during the period, another lining is generated and then stabilised under hormonal control, as the womb prepares for the descent of the egg – ovulation. There are changes in temperature and clear signals which indicate the change in cycle activity.
Installing a period tracker app on the phone and learning to use it is a great way for women to become familiar with the phases of their cycles. There is loads of information on these apps, so I won’t say too much. Also keeping dietary and feeling diaries will give interesting insights into the cycles of change. During the period dreams will change and become more vivid and women usually wish to slow down during this phase.
Period irregularities follow the nature of the cycle. Excessive bleeding is menorrhagia, more than 3 missed periods is amenorrhea, painful periods are dysmenorrhea and frequent short bleeding is termed metrorrhagia.
Hippocrates of Cos, the founder of what would survive as Greco-Arab medicine, surmised that the period serves a secondary role, helping the body clear toxic and irregular build ups in the body. For this reason it is generally considered unwise to merely stop menorrhagia or dysmenorrhea without resolving the root issues which are causing the irregularities. Addressing diet, lifestyle and possible emotional issues which are usually the drivers of menstrual irregularities are aspects which we can do something about.
So for Sarah to make her journey to health, she would first have to familiarise herself with her natural cycle, observing and understanding the changes and beginning to appreciate their significance. This will provide Sarah with the tools to actively understand and harmonise with what is occurring in her body. This is always the beginning of any authentic journey to health. So Sarah installed her app, armed herself with a feeling and food diary, bought some heavier pads and sought out a health practitioner willing to consider a view of health beyond the mere dispensing of painkillers, contraceptive pills and HRT, and prayed that she would never need a hysterectomy.
She resolved to share her journey to menstrual health with other women. When she turned up to my clinic and we chatted candidly about what she faced and the intricacies of her monthly courses. Watching the lightbulb moments happen is always a pleasure. So fictional Sarah who is the composite of many of those women who turn up, would now realise that the Sarah who began the journey would really need to change herself to address the dysharmonies which led her to that crisis on the office toilet floor.