Death To The Pe­riod

Pull the plug on your monthly red tide – your ca­reer could thank you

Women's Health (South Africa) - - CONTENTS - BY LAU­REN CLARK

108

Sit­ting at my desk, I look com­posed, but I’m about to pass out. Or at least, that’s how it feels. Pain from my lower torso is paralysing every inch of my body. A col­league asks me a ques­tion, but I can’t work out what her lips are say­ing – my brain, func­tion­ing three sec­onds ago, has turned to mush and I have a des­per­ate urge to vomit, cry and curl up for a long nap. I take a few more deep breaths and start to feel hu­man again, un­til the next flow of agony. What’s hap­pen­ing to me? Noth­ing more se­ri­ous than it be­ing my time of the month. And yet this painful episode – and the week of suf­fer­ing that sur­rounds it – re­minds me why it’s my first pe­riod in six months. Like a grow­ing num­ber of women, I de­cide ex­actly when I have my pe­riod – and for me, that’s not very of­ten. I con­trol mine by run­ning sev­eral com­bined pill packs to­gether in a row, only stop­ping to al­low for in­fre­quent with­drawal bleed­ing that forces me to scram­ble to the back of the bath­room cab­i­net for a tam­pon. Oth­ers choose the pro­gesto­gen-only pill or a lon­gact­ing re­versible con­tra­cep­tive (LARC), such as the im­plant, in­jec­tion or in­trauter­ine de­vice (more com­monly known as an IUD), all of which can make pe­ri­ods less heavy or less fre­quent or stop them al­to­gether. I started tak­ing hor­mones every day nine years ago, at the age of 15, to ease ex­cru­ci­at­ing, heavy bleeds. As a re­sult, I’ve had far, far fewer pe­ri­ods than my peers have had in that same time. “That’s un­nat­u­ral,” and, “It’s not good for you,” are just some of the com­ments peo­ple have made. But I’ve only felt the ben­e­fits: free­dom, con­trol and lack of dis­trac­tion. And I’m not alone. In 2016, New York City passed a bill that pulled the plug on tam­pon tax and sparked a global con­ver­sa­tion about the woes of pay­ing ex­tra for our anatomy. One way to cut your tam­pon budget? Skip your pe­riod.

Ac­cord­ing to a study in the South African Jour­nal of Ob­stet­rics and Gy­nae­col­ogy, 89 per­cent of young fe­males (18 to 24 years) are us­ing con­tra­cep­tion tools – with 26 per­cent opt­ing for in­jecta­bles, which can lessen or com­pletely stem the monthly flow. “Af­ter one year of us­ing the in­jec­tions, up to 50 per­cent of women ex­pe­ri­ence amen­or­rhea (a halt in pe­ri­ods),” says Dr Jireh Ser­fontein, a sex­ual health physi­cian at My Sex­ual Health. With longer use, up to 80 per­cent of women have zero flow. LARCs, which last longer and re­quire less main­te­nance, are be­com­ing more pop­u­lar. “There’s been a huge change in the past five years in the sorts of con­tra­cep­tion women ask for,” says sex­ual and re­pro­duc­tive health ex­pert Dr Jane Dick­son. “The em­pha­sis has changed to IUDs – they’re con­ve­nient be­cause once they’ve been fit­ted you can for­get about them. More women are run­ning their pill packs to­gether too, thanks to an in­crease in aware­ness that it’s safe to do so.”

THE HIS­TOR­I­CAL PE­RIOD

While few women en­joy hav­ing pe­ri­ods, there’s a be­lief that putting up with them is the nat­u­ral thing to do. As well as be­ing a sign that you’re not preg­nant, they’re a sig­ni­fier of health, right? “Pe­ri­ods are a strong sig­nal that your body is func­tion­ing as it should,” says Dr Ul­rike Sauer, a con­sul­tant in sex­ual and re­pro­duc­tive health. “Aside from preg­nancy, the most com­mon rea­sons women don’t get pe­ri­ods are that they’re un­der-eat­ing or over-ex­er­cis­ing. If a woman who isn’t on con­tra­cep­tion doesn’t bleed, it’s a sign that the womb lin­ing might have changed and that some­thing more se­ri­ous could be go­ing on.” Katie Ann Has­son, as­sis­tant pro­fes­sor of so­ci­ol­ogy and gen­der stud­ies, agrees that it’s a psy­cho­log­i­cal re­as­sur­ance and adds, “To some women, hav­ing a pe­riod is also an im­por­tant part of their sense of fem­i­nin­ity.” Well, what if I told you that it’s not ac­tu­ally nat­u­ral for you to have reg­u­lar pe­ri­ods? “Our bod­ies evolved to be al­most con­stantly preg­nant or breast­feed­ing once we hit pu­berty,” says Sauer. “Cen­turies ago, women would rarely bleed and most of our fe­male ances­tors died be­fore menopause.” In­deed, re­search has found that, to­day, modern Western women will have four times as many pe­ri­ods over the course of their lives as our ances­tors did. So, what does “nat­u­ral” even mean? The “pe­riod” you have when you take a break from the pill every three weeks isn’t nat­u­ral. “A ‘with­drawal bleed’ oc­curs when the lin­ing of the uterus sheds in re­sponse to the pill’s ar­ti­fi­cial hor­mones be­ing taken away; while a pe­riod is the lin­ing of the uterus re­spond­ing to the changes in nat­u­ral hor­mone lev­els that oc­cur when a woman is not preg­nant,” ex­plains gy­nae­col­o­gist Dr Kate Guthrie. “If you run packs to­gether, even­tu­ally you’ll get a ‘break­through bleed’, where the lin­ing builds up to a point where it needs to shed. This can be af­ter a cou­ple of weeks or up to sev­eral months de­pend­ing on the per­son and can be­come less fre­quent as your body adapts.” “If you’re not hav­ing a with­drawal bleed, it just means the womb lin­ing hasn’t built up to a level at which it needs to shed,’ says Dick­son. “You have a built-in pro­ges­terone pro­tec­tor that tells your body when it needs to bleed.” I’ve seen my body adapt from last­ing just two con­sec­u­tive pill packs be­fore spot­ting

QWHAT’S THE DEAL WITH BREAK­THROUGH BLEED­ING?

“The ma­jor down­side of skip­ping your pe­riod is that you might get break­through bleed­ing dur­ing the first few months,” says sex­ual health ex­pert Dr Jireh Ser­fontein. It’s caused by a build-up of the uterus lin­ing that needs to shed, but as your body adapts, you’ll have less of them. No rea­son to panic.

to not see­ing any­thing be­fore six months. There’s also a mis­con­cep­tion that reg­u­lar bleeds while on the pill con­firm you’re not ex­pect­ing. “You can’t rely on that – in the same way you can’t even if you’re not on the pill, as some women have pe­ri­ods when they’re preg­nant,” ex­plains Guthrie. “Sim­i­larly, the ab­sence of your with­drawal bleed could ei­ther be that you’re preg­nant or that there isn’t enough of a re­duc­tion in hor­mones to trig­ger a break­through bleed.” So, if a monthly bleed while on the pill is nei­ther real nor re­as­sur­ing, well, what’s the point? “It’s all set in his­tory and tra­di­tion,” ex­plains Dick­son. “The cre­ators of the pill de­signed it to be taken with a seven-day monthly break, even though they knew it wasn’t med­i­cally nec­es­sary. By mim­ick­ing a monthly pe­riod, they be­lieved it might be bet­ter ac­cepted by the church and other re­li­gious in­sti­tu­tions.” Gy­nae­col­o­gist – and de­vout Catholic – John Rock, along with bi­ol­o­gist Gre­gory Good­win Pin­cus, tried to main­tain as much men­strual “nor­mal­ity” in their in­ven­tion as pos­si­ble so it would se­cure FDA ap­proval, first in 1957 as pain re­lief and then in 1960 for con­tra­cep­tive use.

GO AGAINST THE FLOW

Yet to­day, when fem­i­nism has never felt stronger, many women re­main be­holden to a monthly bleed. But what if you knew the salary and pro­mo­tion gap would be 15 per­cent smaller, ac­cord­ing to Ital­ian re­searchers, if your men­strual symp­toms and pe­riod-re­lated ab­sen­teeism weren’t fac­tors? In a re­cent YouGov sur­vey, 52 per­cent of women said pe­ri­ods af­fected their abil­ity to work and a third of those said they’d had to take a sick day. Men­strual symp­toms are also

QDOES IT MAT­TER WHICH PILL I TAKE?

“Not re­ally. Monopha­sic pills, like Yas­min, have the same amount of hor­mones per pill, whereas tripha­sic pills, like Trigestrel, mimic your body’s nat­u­ral hor­monal fluc­tu­a­tions,” says sex­ual health ex­pert Dr Jireh Ser­fontein. Es­sen­tially, you’re more likely to be spot­ting on tripha­sic pills and less likely to on monopha­sic ones. But as your body adapts, this could hap­pen less fre­quently. one of the main rea­sons girls miss school. So through­out your life, your pe­riod could re­ally af­fect your ed­u­ca­tion and ca­reer. “Sup­press­ing your pe­riod means you can skip the mood swings, headaches, PMS and dis­rup­tion to your life – many women per­form less well dur­ing ex­ams and in sport – and for those with en­dometrio­sis it can make life more man­age­able,” says Guthrie. I, for one, no­tice my pro­duc­tiv­ity dips at work, thanks to pain dis­rupt­ing my sleep and the fact that I spend chunks of the day keeled over in a toi­let cu­bi­cle. But now, 58 years af­ter the pill changed ev­ery­thing for women, there’s still con­fu­sion sur­round­ing its long-term safety. “Hor­monal con­tra­cep­tion has pros and cons,” says Sauer. A 2014 study pub­lished in the jour­nal Can­cer Re­search dis­cov­ered a 50 per­cent in­creased risk of de­vel­op­ing breast can­cer while us­ing the com­bined oral pill, while a 2007 study pub­lished in the med­i­cal jour­nal The Lancet found that be­ing on it for five years or more dou­bled your risk of cer­vi­cal can­cer. Should we be wor­ried? “You are slightly more likely to de­velop breast can­cer, but only when you’re on the pill, not once you stop – there’s no lin­ger­ing ef­fect 10 years af­ter or into your fifties and six­ties,” says John Guille­baud, emer­i­tus pro­fes­sor of fam­ily plan­ning and re­pro­duc­tive health. “Most pill-tak­ers are un­der 35, the age when breast can­cer is very rare any­way, so a 50 per­cent in­crease on top of ex­tremely small num­bers leaves to­tal cases in this sce­nario still very low.” The hor­mone doses in the present-day pill are much smaller than they used to be. “When it was first in­vented it con­tained 100mg of oe­stro­gen, which is what past re­search on in­creased breast can­cer risk has been based on,” ex­plains Guthrie. “Now it

QDO I NEED TO HAVE MY PE­RIOD AT LEAST FOUR TIMES A YEAR?

Short answer? No. “There’s no sci­en­tific ev­i­dence that sup­ports this,” says sex­ual health ex­pert Dr Jireh Ser­fontein. only con­tains 20mg, so fu­ture stud­ies may find there’s even less of a link or none at all.” This lower dose of oe­stro­gen means blood­clot risk has been low­ered even fur­ther too. “Throm­bo­sis is much more likely dur­ing preg­nancy or in the weeks af­ter you’ve given birth,” says Sauer. There’s ev­i­dence that the pill can, in fact, be pro­tec­tive against can­cer. “A woman tak­ing it is less likely to get can­cer than a woman whose part­ner uses con­doms be­cause it re­duces risk of ovar­ian, large bowel, en­dome­trial and rec­tal can­cer while in use and for 10 years af­ter,” says Guille­baud. A 2008 study pub­lished in the The Lancet es­ti­mated that the pill may have stopped around 100 000 women dy­ing of ovar­ian can­cer as it sup­presses ac­tiv­ity and dis­rup­tion to the sur­face of the ovaries – a num­ber that out­weighs the in­creased risk for other types of can­cer linked to tak­ing it. Dick­son agrees, point­ing out that other fac­tors can play a much more sig­nif­i­cant role in can­cer risk. “Be­ing over­weight, smok­ing and fam­ily his­tory pose a much greater risk to your health than tak­ing the pill,” she says. Then there were last year’s head­lines claim­ing that the pill has psy­cho­log­i­cal, as well as phys­i­cal ef­fects, up­ping de­pres­sion by 23 per­cent. “In a small mi­nor­ity it can lead to de­pres­sion or se­vere mood changes,” says Guille­baud. “But de­pres­sion is sadly very com­mon and what the study ac­tu­ally found was that out of every 123 pill-tak­ers with de­pres­sion, only 23 could truly blame their con­tra­cep­tive. The other 100 would have ex­pected to be di­ag­nosed any­way.” There are other neg­a­tive side-ef­fects as­so­ci­ated with the pill, in­clud­ing the risk for stroke, changes in eye­sight and even an ab­nor­mal growth (for more on the last bit, check out our web­site). But these are rare cases and you should chat to your doc if you sus­pect some­thing’s up.

FAM­ILY PLAN­NING

But what does switch­ing off your ovaries mean for fer­til­ity? While, at 24, I’m not look­ing to have chil­dren any time soon, it’s a con­cern that does cross my mind. “It won’t make you in­fer­tile, but you can’t be sure how long it’ll take for your nat­u­ral cy­cle to re­turn,” warns ob­ste­tri­cian and gy­nae­col­o­gist Dr Shazia Ma­lik. She sug­gests com­ing off the pill or LARCs and us­ing con­doms six months be­fore you plan to start try­ing to al­low ovu­la­tion to get back to nor­mal. But not every woman will need that long. “With the ex­cep­tion of the in­jec­tion, which can take up to a year to wear off, your cy­cle should re­turn to nor­mal al­most straight away when you stop tak­ing con­tra­cep­tion,” says Guille­baud. “In fact, it could even make you more fer­tile. A 2002 study found that ex-pill tak­ers were more likely to fall preg­nant in the six months af­ter com­ing off the pill than those who’ve never used it.” And if you don’t want to get preg­nant just yet, run­ning your pill packs to­gether can ac­tu­ally make it more ef­fec­tive as a con­tra­cep­tive. “All the time you take the pill, your ovaries are asleep, but in the seven days you stop tak­ing it, your ovaries start to wake up again and be­gin ovu­lat­ing,” ex­plains Dick­son. Tak­ing it every day keeps your ovaries on snooze for weeks, if not months, mean­ing that you’re less likely to for­get to restart a pill pack and fall preg­nant.

OPT­ING OUT

Of course, while choos­ing not to have a monthly pe­riod be­comes more main­stream, it’s im­por­tant to con­sider what your mo­ti­va­tion re­ally is. It’s no se­cret that so­ci­ety is anti-bleed­ing. “Our cul­tural at­ti­tude is that men­stru­a­tion is dirty and shame­ful and that we should avoid it at all costs. We don’t talk openly in so­ci­ety about the nitty-gritty of our bleeds and we don’t have any ref­er­ence points for com­par­i­son,” says Has­son. “Tak­ing hor­mones to get away from it means that we of­ten don’t know our own healthy base­line.” Con­tra­cep­tion and painful bleeds are rea­sons enough to stop pe­ri­ods, but we shouldn’t be stop­ping our pe­ri­ods for the sake of it, points out Sauer. That said, con­tra­cep­tion is start­ing to re­flect a pe­riod-less life­style. Over in the US, the birth-con­trol pill is nor­mally 24 days on, with four days off, and a con­tin­u­ous pill, Ly­brel, was ap­proved there in 2007. With many of our fam­ily-plan­ning trends com­ing from the US, where there are huge funds for re­search and a very rigorous FDA, we may start to see those op­tions over here too – once our gov­ern­ment has caught up, that is. “The 21st-cen­tury way to take the pill is con­tin­u­ously or run­ning four packs in a row with what we call tri­cy­cling – in the fu­ture I be­lieve ev­ery­one will take it like this,” says Guille­baud. Dick­son adds that it’s about chang­ing a cul­ture. “Un­der­stand­ing that women can run their packs to­gether is of­ten against ev­ery­thing doc­tors have been taught” she says. “And many pa­tients aren’t told how con­tra­cep­tion can make their lives eas­ier.” Guthrie agrees: “The knowl­edge is there, but it hasn’t trick­led down into ac­tion yet,” she says. “GPs have it tough – they’re meant to know ev­ery­thing about ev­ery­thing – but so many women are sim­ply handed the pill and told to use it in the tra­di­tional way be­cause it’s quicker to ex­plain.” If be­ing on an equal foot­ing with men is the ideal, ditch­ing our pe­ri­ods might just al­low us to catch up in the work­place, not have to en­list a hot-wa­ter bot­tle to re­main calm enough not to kill any­one and be free to spend our cash on items other than san­i­tary wear. “Women should be able to con­trol their own lives,” says Guthrie. “Their bleeds should fit in with them, not the other way around.”

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