0:00:01.042,0:00:04.292
When I was a teen, I had terrible periods.

0:00:04.750,0:00:06.476
I had crippling cramps,

0:00:06.500,0:00:10.309
I leaked blood onto my clothes[br]and onto my bed sheets,

0:00:10.333,0:00:12.333
and I had period diarrhea.

0:00:12.792,0:00:15.768
And I had to miss school[br]one to two days a month,

0:00:15.792,0:00:20.309
and I remember sitting on the couch[br]with my heating pads, thinking,

0:00:20.333,0:00:22.893
"What's up with this?"

0:00:22.917,0:00:27.434
When I ate food, I didn't leak saliva[br]from my salivary glands.

0:00:27.458,0:00:28.726
When I went for a walk,

0:00:28.750,0:00:32.101
I didn't leak join fluid from my knees.

0:00:32.125,0:00:36.351
Why was menstruation so different?

0:00:36.375,0:00:38.351
I wanted answers to these questions

0:00:38.375,0:00:40.143
but there was no one for me to ask.

0:00:40.167,0:00:42.351
My mother knew nothing about menstruation

0:00:42.375,0:00:46.059
except that it was dirty and shameful[br]and I shouldn't talk about it.

0:00:46.083,0:00:47.934
I asked girlfriends

0:00:47.958,0:00:50.643
and everybody spoke in euphemisms.

0:00:50.667,0:00:53.893
And finally, when I got the courage[br]to go to the doctor

0:00:53.917,0:00:55.768
and talk about my heavy periods,

0:00:55.792,0:00:57.893
I was told to eat liver.

0:00:57.917,0:01:00.226
(Laughter)

0:01:00.250,0:01:05.226
And when I went to the drug store[br]to buy my menstrual products,

0:01:05.250,0:01:08.684
my 48-pack of super maxi pads,

0:01:08.708,0:01:12.059
back in the day when they were the size[br]of a tissue box, each pad --

0:01:12.083,0:01:13.101
(Laughter)

0:01:13.125,0:01:14.726
You know what I'm talking about.

0:01:14.750,0:01:17.434
You have no idea how far[br]absorbent technology has come.

0:01:17.458,0:01:19.768
(Laughter)

0:01:19.792,0:01:22.476
I used to have to buy[br]my menstrual products

0:01:22.500,0:01:25.893
in the feminine hygiene aisle.

0:01:25.917,0:01:27.893
And I remember standing there, thinking,

0:01:27.917,0:01:30.934
"Well, why don't I buy toilet paper[br]in the anal hygiene aisle?"

0:01:30.958,0:01:31.976
(Laughter)

0:01:32.000,0:01:33.268
Like, what's up with that?

0:01:33.292,0:01:36.393
Why can't we talk about periods?

0:01:36.417,0:01:40.559
And it's not about the blood,[br]as Freud would have you say,

0:01:40.583,0:01:41.851
because if it were,

0:01:41.875,0:01:45.018
there would be an ear, nose[br]and throat surgeon up here right now,

0:01:45.042,0:01:47.976
talking about the taboos[br]of nose bleeds, right?

0:01:48.000,0:01:50.476
And it's not even about periods,

0:01:50.500,0:01:53.601
because otherwise, when we got rid[br]of our toxic, shameful periods

0:01:53.625,0:01:55.059
when we became menopausal,

0:01:55.083,0:01:57.768
we'd be elevated[br]to a higher social status.

0:01:57.792,0:02:00.059
(Laughter)

0:02:00.083,0:02:04.934
(Applause)

0:02:04.958,0:02:08.518
It's just the patriarchal societies[br]invested in oppressing women,

0:02:08.542,0:02:11.601
and at different points in our lives[br]different things are used.

0:02:11.625,0:02:12.893
And menstruation is used

0:02:12.917,0:02:15.934
during what we in medicine call[br]the reproductive years.

0:02:15.958,0:02:18.976
It's been around since[br]pretty much the beginning of time,

0:02:19.000,0:02:22.059
many cultures thought[br]that women could spoil crops

0:02:22.083,0:02:24.768
or milk or wilt flowers.

0:02:24.792,0:02:26.518
And then when religion came along,

0:02:26.542,0:02:29.143
purity myths only made that worse.

0:02:29.167,0:02:31.476
And medicine wasn't any help.

0:02:31.500,0:02:33.143
In the 1920s and '30s

0:02:33.167,0:02:37.684
there was the idea that women elaborated[br]something called a menotoxin.

0:02:37.708,0:02:40.268
We could wilt flowers just by walking by.

0:02:40.292,0:02:41.393
(Laughter)

0:02:41.417,0:02:44.143
And that's what happens[br]when there's no diversity, right.

0:02:44.167,0:02:46.684
Because there was no woman[br]to put her hand up and go,

0:02:46.708,0:02:49.167
"Well, actually, that doesn't happen."

0:02:50.000,0:02:52.976
And when you can't talk[br]about what's happening to your body,

0:02:53.000,0:02:55.018
how do you break these myths?

0:02:55.042,0:02:57.059
Because you don't even need to be a doctor

0:02:57.083,0:02:58.976
to say that periods aren't toxic.

0:02:59.000,0:03:03.708
If they were, why would an embryo[br]implant in a toxic swill?

0:03:04.708,0:03:08.268
And if we all had this secret menotoxin,

0:03:08.292,0:03:11.559
we could be laying waste[br]to crops and spoiling milk.

0:03:11.583,0:03:12.601
(Laughter)

0:03:12.625,0:03:16.601
Why would we have not used[br]our x-women powers to get the vote sooner?

0:03:16.625,0:03:18.809
(Laughter)

0:03:18.833,0:03:23.393
(Applause)

0:03:23.417,0:03:24.684
Even now,

0:03:24.708,0:03:26.934
when I tweet about period diarrhea,

0:03:26.958,0:03:28.226
as one does,

0:03:28.250,0:03:30.184
(Laughter)

0:03:30.208,0:03:33.976
I mention that it affects[br]28 percent of women.

0:03:34.000,0:03:37.684
And every single time,[br]someone approaches me and says,

0:03:37.708,0:03:40.851
"I thought I was the only one."

0:03:40.875,0:03:43.518
That's how effective[br]that culture of shame is,

0:03:43.542,0:03:47.309
that women can't even share[br]their experiences.

0:03:47.333,0:03:48.768
So I began to think,

0:03:48.792,0:03:52.143
"Well, what if everybody knew[br]about periods like a gynecologist?

0:03:52.167,0:03:53.851
Wouldn't that be great?"

0:03:53.875,0:03:55.601
Then you would all know what I know,

0:03:55.625,0:03:56.976
you'd know that menstruation

0:03:57.000,0:03:59.476
is a pretty unique[br]phenomenon among mammals.

0:03:59.500,0:04:01.476
Most mammals have estrus.

0:04:01.500,0:04:04.309
Humans, some primates,

0:04:04.333,0:04:05.601
some bats,

0:04:05.625,0:04:08.851
the elephant shrew[br]and the spiny mouse menstruate.

0:04:08.875,0:04:12.351
And with menstruation what happens is[br]the brain triggers the ovary

0:04:12.375,0:04:14.476
to start producing an egg.

0:04:14.500,0:04:15.768
Estrogen is released

0:04:15.792,0:04:18.226
and it starts to build up[br]the lining of the uterus,

0:04:18.250,0:04:20.393
cell upon cell, like bricks.

0:04:20.417,0:04:23.601
And what happens if you build[br]a brick wall too high without mortar?

0:04:23.625,0:04:24.893
Well, it's unstable.

0:04:24.917,0:04:26.518
So what happens when you ovulate?

0:04:26.542,0:04:28.684
You release a hormone called progesterone,

0:04:28.708,0:04:32.976
which is progestational,[br]it gets the uterus ready.

0:04:33.000,0:04:36.226
It acts like a mortar[br]and it holds those bricks together.

0:04:36.250,0:04:38.643
It also causes some changes

0:04:38.667,0:04:42.351
to make the lining more hospitable[br]for implantation.

0:04:42.375,0:04:44.518
If there's no pregnancy,

0:04:44.542,0:04:45.851
the lining comes out,

0:04:45.875,0:04:48.976
there's bleeding from the blood vessels[br]and that's the period.

0:04:49.000,0:04:51.309
And I always find this point[br]really interesting.

0:04:51.333,0:04:52.851
Because with estrus,

0:04:52.875,0:04:56.059
the final signaling to get[br]the lining of the uterus ready

0:04:56.083,0:04:58.809
actually comes from the embryo.

0:04:58.833,0:05:00.643
But with menstruation,

0:05:00.667,0:05:03.268
that choice comes from the ovary.

0:05:03.292,0:05:07.018
It's as if choice is coded in[br]to our reproductive tracts.

0:05:07.042,0:05:13.917
(Cheering and applause)

0:05:15.625,0:05:18.184
OK, so now we know why the blood is there.

0:05:18.208,0:05:19.976
And it's a pretty significant amount.

0:05:20.000,0:05:22.018
It's 30 to 90 milliliters of blood,

0:05:22.042,0:05:23.601
which is one to three ounces,

0:05:23.625,0:05:24.893
and it can be more,

0:05:24.917,0:05:28.018
I know it seems like it's more[br]a lot of the times.

0:05:28.042,0:05:29.309
I know.

0:05:29.333,0:05:31.226
So why do we have so much blood?

0:05:31.250,0:05:34.434
And why doesn't it just stay there[br]till the next cycle, right?

0:05:34.458,0:05:37.268
Like, you didn't get pregnant,[br]so why can't it hang around?

0:05:37.292,0:05:40.934
Well imagine if each month it got thicker[br]and thicker and thicker, right,

0:05:40.958,0:05:43.684
like, imagine what tsunami[br]period that would be.

0:05:43.708,0:05:45.351
(Laughter)

0:05:45.375,0:05:47.684
We can't reabsorb it[br]because it's too much.

0:05:47.708,0:05:50.809
And it's too much because we need[br]a thick uterine lining

0:05:50.833,0:05:53.643
for a very specific reason.

0:05:53.667,0:05:59.143
Pregnancy exerts a significant[br]biological toll on our bodies.

0:05:59.167,0:06:00.809
There is maternal mortality,

0:06:00.833,0:06:02.476
there is the toll of breastfeeding

0:06:02.500,0:06:06.559
and there is the toll of raising a child[br]until it is independent.

0:06:06.583,0:06:07.851
And evolution --

0:06:07.875,0:06:10.893
(Laughter)

0:06:10.917,0:06:13.143
That goes on longer[br]for some of us than others.

0:06:13.167,0:06:15.643
(Laughter)

0:06:15.667,0:06:19.101
But evolution knows[br]about risk-benefit ratio.

0:06:19.125,0:06:23.726
And so evolution wants to maximize[br]the chance of a beneficial outcome.

0:06:23.750,0:06:26.559
And how do you maximize the chance[br]of a beneficial outcome?

0:06:26.583,0:06:28.768
You try to get the highest[br]quality embryos.

0:06:28.792,0:06:31.018
And how do you get[br]the highest quality embryos?

0:06:31.042,0:06:32.893
You make them work for it.

0:06:32.917,0:06:35.351
You give them an obstacle course.

0:06:35.375,0:06:38.726
So over the millennia[br]that we have evolved,

0:06:38.750,0:06:41.393
it's been a little bit[br]like an arms race in the uterus,

0:06:41.417,0:06:43.893
the lining getting thicker[br]and thicker and thicker,

0:06:43.917,0:06:45.684
and the embryo getting more invasive

0:06:45.708,0:06:47.185
until we reached this [unclear]

0:06:47.209,0:06:49.976
with the lining[br]of the uterus that we have.

0:06:50.000,0:06:51.726
So we have this thick uterine lining

0:06:51.750,0:06:53.934
and now it's got to come out,

0:06:53.958,0:06:56.059
and how do you stop bleeding?

0:06:56.083,0:06:58.476
Well, you stop a nose bleed[br]by pinching it,

0:06:58.500,0:07:00.809
if you cut your leg,[br]you put pressure on it.

0:07:00.833,0:07:02.684
We stop bleeding with pressure.

0:07:02.708,0:07:04.309
When we menstruate,

0:07:04.333,0:07:06.434
the lining of the uterus[br]releases substances

0:07:06.458,0:07:09.476
that are made into chemicals[br]called prostaglandins

0:07:09.500,0:07:11.726
and other inflammatory mediators.

0:07:11.750,0:07:13.768
And they make the uterus cramp down,

0:07:13.792,0:07:15.851
they make it squeeze[br]on those blood vessels

0:07:15.875,0:07:17.559
to stop the bleeding.

0:07:17.583,0:07:19.774
They might also change[br]blood flow to the uterus

0:07:19.798,0:07:22.851
and also cause inflammation[br]and that makes pain worse.

0:07:22.875,0:07:26.351
And so you say, "OK,[br]how much pressure is generated?"

0:07:26.375,0:07:29.434
And from studies[br]where some incredible women

0:07:29.458,0:07:31.476
have volunteered[br]to have pressure catheters

0:07:31.500,0:07:32.768
put in their uterus,

0:07:32.792,0:07:35.101
that they wear[br]their whole menstrual cycle --

0:07:35.125,0:07:38.268
God bless them, because[br]we wouldn't have this knowledge without,

0:07:38.292,0:07:40.226
and it's very important knowledge,

0:07:40.250,0:07:43.059
because the pressure[br]that's generated in the uterus

0:07:43.083,0:07:44.351
during menstruation

0:07:44.375,0:07:46.476
is 120 millimeters of mercury.

0:07:46.500,0:07:47.893
"What's that," you say.

0:07:47.917,0:07:50.726
Well, it's the amount of pressure[br]that's generated

0:07:50.750,0:07:53.268
during the second stage of labor[br]when you're pushing.

0:07:53.292,0:07:54.434
(Audience gasps)

0:07:54.458,0:07:55.726
Right.

0:07:55.750,0:07:58.893
Which, for those of you[br]who haven't had an unmedicated delivery,

0:07:58.917,0:08:01.309
that's what it's like[br]when the blood pressure cuff

0:08:01.333,0:08:03.619
is not quite as tight as it was[br]at the beginning,

0:08:03.643,0:08:05.018
but it's still pretty tight,

0:08:05.042,0:08:06.393
and you wish it would stop.

0:08:06.417,0:08:08.559
So that kind of makes it different, right,

0:08:08.583,0:08:12.476
if you start thinking[br]about the pain of menstruation --

0:08:12.500,0:08:15.101
We wouldn't say[br]if someone needed to miss school

0:08:15.125,0:08:17.934
because they were in the second stage[br]of labor and pushing,

0:08:17.958,0:08:19.309
we wouldn't call them weak,

0:08:19.333,0:08:22.101
we'd be like, "Oh my God,[br]you made it that far," right?

0:08:22.125,0:08:23.143
(Laughter)

0:08:23.167,0:08:25.601
And we wouldn't deny pain control

0:08:25.625,0:08:29.101
to women who have[br]typical pain of labor, right?

0:08:29.125,0:08:32.559
So it's important for us to call this pain[br]"typical" instead of "normal,"

0:08:32.583,0:08:35.518
because when we say it's normal,[br]it's easier to dismiss.

0:08:35.542,0:08:39.018
As opposed to saying it's typical[br]and we should address it.

0:08:39.042,0:08:43.518
And we do have some ways[br]to address menstrual pain.

0:08:43.542,0:08:45.643
One way is with something[br]called a TENS unit

0:08:45.667,0:08:47.476
which you can wear under your clothes

0:08:47.500,0:08:50.601
and it sends an electrical impulse[br]to the nerves and muscles

0:08:50.625,0:08:52.434
and no one really knows how it works,

0:08:52.458,0:08:54.976
but we think it might be[br]the gate theory of pain,

0:08:55.000,0:08:56.559
which is counterirritation.

0:08:56.583,0:09:00.351
It's the same reason why,[br]if you hurt yourself, you rub it.

0:09:00.375,0:09:04.184
Vibration travels faster[br]to your brain than pain does.

0:09:04.208,0:09:05.559
We also have medications

0:09:05.583,0:09:08.351
called nonsteroidal[br]anti-inflammatory medications.

0:09:08.375,0:09:12.143
And what they do is they block[br]the release of prostaglandins.

0:09:12.167,0:09:16.059
They can reduce menstrual pain[br]for 80 percent of women.

0:09:16.083,0:09:19.851
They also reduce the volume of blood[br]by 30 to 40 percent

0:09:19.875,0:09:22.268
and they can help with period diarrhea.

0:09:22.292,0:09:24.851
And we also have hormonal contraception,

0:09:24.875,0:09:27.143
which gives us a thinner[br]lining of the uterus

0:09:27.167,0:09:29.476
so there's less prostaglandins produced

0:09:29.500,0:09:32.851
and with less blood,[br]there's less need for cramping.

0:09:32.875,0:09:35.643
Now, if those treatments fail you

0:09:35.667,0:09:37.893
and it's important to use[br]that word choice,

0:09:37.917,0:09:40.309
because we never fail the treatment,

0:09:40.333,0:09:42.934
the treatment fails us.

0:09:42.958,0:09:45.101
If that treatment fails you,

0:09:45.125,0:09:46.602
you could be amongst the people

0:09:46.626,0:09:50.684
who have a resistance[br]to nonsteroidal anti-inflammatories.

0:09:50.708,0:09:52.268
We don't quite understand,

0:09:52.292,0:09:54.393
but there are some complex mechanisms

0:09:54.417,0:09:57.976
why those medications[br]just don't work for some women.

0:09:58.000,0:10:01.309
It's also possible that you could have

0:10:01.333,0:10:03.726
another reason for painful periods.

0:10:03.750,0:10:06.434
You could have a condition[br]called endometriosis,

0:10:06.458,0:10:09.518
where the lining of the uterus[br]is growing in the pelvic cavity,

0:10:09.542,0:10:13.101
causing inflammation[br]and scar tissue, and adhesions.

0:10:13.125,0:10:16.518
And there may be other mechanisms[br]we don't quite understand yet,

0:10:16.542,0:10:19.726
because it's a possibility[br]that pain thresholds could be different

0:10:19.750,0:10:22.434
due to very complex biological mechanisms.

0:10:22.458,0:10:25.643
But we're only going to find that out[br]by taking about it.

0:10:25.667,0:10:28.768
It's shouldn't be an act of feminism

0:10:28.792,0:10:30.934
to know how your body works.

0:10:30.958,0:10:32.226
It shouldn't --

0:10:32.250,0:10:37.768
(Applause)

0:10:37.792,0:10:41.268
It shouldn't be an act of feminism

0:10:41.292,0:10:43.875
to ask for help when you're suffering.

0:10:45.250,0:10:49.833
The era of menstrual taboos is over.

0:10:50.583,0:10:55.309
(Cheers and applause)

0:10:55.333,0:10:57.476
The only curse here

0:10:57.500,0:11:01.101
is the ability to convince[br]half the population

0:11:01.125,0:11:05.518
that the very biological machinery[br]that perpetuates the species,

0:11:05.542,0:11:08.018
that gives everything that we have,

0:11:08.042,0:11:10.601
is somehow dirty or toxic.

0:11:10.625,0:11:13.184
And I'm not going to stand for it.

0:11:13.208,0:11:18.893
(Applause)

0:11:18.917,0:11:21.351
And the way we break that curse?

0:11:21.375,0:11:22.934
It's knowledge.

0:11:22.958,0:11:24.226
Thank you.

0:11:24.250,0:11:29.458
(Cheers and applause)