Jerilynn C. Prior BA, MD, FRCPC
It seems it would be a ‘no-brainer’ in this era of information overload and constant connection to the internet, that it is important to learn about menstrual cycles. It might also be essential to learn how to prevent unwanted pregnancy and avoid sexually transmitted diseases (STDs).
Apparently not everyone agrees. In some States and Provinces in North America, sharing information or inviting learning-focused discussions about menstruation is now against the law for elementary or high school teachers. It is likely in these same places that pads and tampons are taxed and too expensive for many young women+ (including gender diverse folks) to afford—something now under the rally cry of “period poverty.” I well recall carefully folding toilet paper and pinning it into my panties. A recent open-access, free online book discusses the history of menstruation activism; Marie Tomlinson just published The Menstrual Movement in the Media: Reducing Stigma and Tackling Social Inequalities.
In some areas, public all-sex or unisex toilets (euphemistically still called ‘washrooms’ or ‘bathrooms’) are widely available. Thanks to years of lobbying, taxes on pads, and tampons have been abolished in some jurisdictions. Women+-founded and run companies make re-usable pads, special panties or menstrual cups. And in other places, period products are free in all women+’s toilets (and in some men’s too) in all high schools and universities.
However, even with government funded online or facilitated training of trainers in menstruation, as in the laudable Endometriosis Network Canada’s, module, “What you need to know, period,” the teaching is limited to managing menstruation, cramps and premenstrual experiences. This is an important step forward because it is necessary to de-sensitize potential teachers/knowledge-facilitators to the strong taboo and stigma surrounding periods. Even talking about menstrual flow intrudes with feelings of disgust, nausea, and shame, given our culture’s careful and universal biases. These anti-menstruation cultural stigma must be overcome—overcoming taboo is, in itself, great progress.
Talking about the blood and fluid of menstrual flow, commonly called ‘the period,’ however, should only be the first part of a wider discussion of the menstrual cycle.The menstrual cycle is the whole approximately month-apart phenomenon that is the amazing way our women+’s bodies do two things—provide us with the essential estrogen and hopefully progesterone that we need to be healthy and prepare us for potential pregnancy.
What needs to be taught about the menstrual cycle?
First of all, that the whole, complex menstrual cycle process is normal. Women+ also need to learn that menstrual cycles and especially the luteal phase following ovulation, are highly variable in response to changes in a given woman’s environment1—social, economic, political, physical (as in air, water, temperature, toxins, illness and exercise). Why? Because, it is unhealthy to become pregnant, for both the parent and fetus, for a woman+ who is being abused or who lives where the air is not fit to breathe. When the collective stressors are intense or a person has not yet matured to regular menstruation, they develop what is called “hypothalamic, functional amenorrhea” meaning no period for 3-6 or more months. This amazing and protective adaptation is then wrongly treated as a disease. These individuals are “treated” with The Pill that causes whole-reproduction-suppressing high levels of estrogen and a little progestin. Unfortunately, the stressors that are causing amenorrhea2 are usually either assumed (such as being told to stop what is really healthy running) or these life disrupting threats are simply ignored.
What should women+ expect to experience during a healthy menstrual cycle?
The reality is that we don’t really know what are the expected menstrual cycle experiences. The Centre for Menstrual Cycle and Ovulation Research (CeMCOR) has been working with medical students and volunteer researchers for over twenty years to discover and describe healthy and expected cycle experiences. Using the Menstrual Cycle Diary© items recorded over a year by 53 healthy community-dwelling premenopausal women+ who were initially happy, non-smoking and proven normally cycling and ovulating3, we have already shown that fluid retention increases at the end of the cycle and surprisingly peaks on the first day of flow4. In addition, women+’s interest in sex is not altered by the hormonal changes of the cycle5. It took over a decade to get that study published. Why? Because most in experts in female sexuality believe women+ get horny before the estrogen mid-cycle peak. NOT! Rather, healthy women+’s interest in sex is significantly related to their feelings of self-worth and energy5.
Some things do not seem to regularly change across the menstrual cycle—these include feelings of self-worth and perceptions of ‘outside stress.’ (Both of those studies are still in the process of being published.) However, mild breast tenderness and swelling increase before flow, and appetite increases in the second half of an ovulatory cycle; these manuscripts are, again, still in the process of being published.
‘Premenstrual Syndrome’ is something we all know
Although everyone expects a woman+ to become moody, unhappy or just plain bitchy before flow, what do we really know about so-called PMS or premenstrual dysphoric disorder? Careful study shows that there are subtle but NO common nor severe emotional changes before flow in women+ with healthy, ovulatory cycles6. In addition, in the only population-based study of moods and the menstrual cycle, in which the cycle intent was not disclosed, there were almost no documented changes that could be called “premenstrual syndrome,”7. Further, if a woman+ is feeling sad or angry at ‘that time of the month’, even small increases in physical activity will help8.
Amazing menstrual cycle education in Chile
A few weeks ago, I received an email from someone I didn’t know who said they were traveling to Vancouver and that they worked on education about women+’s reproduction—could we get together? We did, and discovered that Pablo Valenzuela, MD, MHI; Paz Mieres Gonzalez, Nurse, M.Ed; and their educational organization, Escuela La Tribu (Tribu Academy) were doing amazing work educating healthcare providers and other professionals about women+’s menstrual cycles and health.
We quickly set up a time to meet with them, they presented their work, and we had an excellent visit with other interested people in person and connected by video conferencing with participants from as far away as Montreal. Early next year, I will also be doing a virtual masterclass with their students in Chile and Latin America, which will be translated into Spanish.
In picture: CeMCOR researchers and professionals from Tribu Academy at the CeMCOR offices in the Vancouver General Hospital building. From left to right–Sonia Shirin, Paz Mieres Gonzalez, Jerilynn Prior, Dharani Kalidasan, Pablo Valenzuela.
Understanding the uniqueness of women+, who are half the human race, seems not a matter of shame nor taboo but rather should be praised and supported in 2024. The Centre for Menstrual Cycle and Ovulation Research needs your support to continue to do this important work!
Sustain CeMCOR: https://www.cemcor.ubc.ca/donate
Reference List:
1. Prior JC. Adaptive, reversible, hypothalamic reproductive suppression: More than functional hypothalamic amenorrhea. Frontiers in Endocrinology 2022;13 doi: 10.3389/fendo.2022.893889
2. Williams NI, Berga SL, Cameron JL. Synergism between psychosocial and metabolic stressors: impact on reproductive function in cynomolgus monkeys. AmJPhysiol EndocrinolMetab 2007;293(1):E270-E76.
3. Prior JC, Vigna YM, Schechter MT, et al. Spinal bone loss and ovulatory disturbances. New Engl J Med1990;323(18):1221-27.
4. White CP, Hitchcock CL, Vigna YM, et al. Fluid Retention over the Menstrual Cycle: 1-Year Data from the Prospective Ovulation Cohort. Obstet Gynecol Int 2011;2011:138451. doi: 10.1155/2011/138451 [published Online First: 2011/08/17]
5. Macbeth AB, Goshtasebi A, Mercer GW, et al. Does Interest in Sex Peak at Mid-Cycle in Ovulatory Menstrual Cycles of Healthy, Community-Dwelling Women? An 11-month Prospective Observational Study. Women's Reproductive Health 2021;8(2):79-91. doi: 10.1080/23293691.2021.1901519
6. Harvey A, Hitchcock CL, Prior JC. Ovulation disturbances and mood across the menstrual cycles of healthy women. J PsychosomObstet Gynaecol 2009;30:207-14.
7. Ramcharan S, Love EJ, Frick GH, et al. The epidemiology of premenstrual symptoms in a population-based sample of 2,650 urban women: attributable risk and risk factors. Journal of Clinical Epidemiology 1992;45:377-92.
8. Prior JC, Vigna YM, Alojado N. Conditioning exercise decreases premenstrual symptoms - a prospective controlled three month trial. European Journal of Applied Physiology 1986;55:349-55.
