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When I was a teen, I had terrible periods.

2
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I had crippling cramps,

3
00:00:06,500 --> 00:00:10,309
I leaked blood onto my clothes
and onto my bed sheets,

4
00:00:10,333 --> 00:00:12,333
and I had period diarrhea.

5
00:00:12,792 --> 00:00:15,768
And I had to miss school
one to two days a month,

6
00:00:15,792 --> 00:00:20,309
and I remember sitting on the couch
with my heating pads, thinking,

7
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"What's up with this?"

8
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When I ate food, I didn't leak saliva
from my salivary glands.

9
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When I went for a walk,

10
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I didn't leak join fluid from my knees, 
"joint fluid."

11
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Why was menstruation so different?

12
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I wanted answers to these questions

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but there was no one for me to ask.

14
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My mother knew nothing about menstruation

15
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except that it was dirty and shameful
and I shouldn't talk about it.

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I asked girlfriends

17
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and everybody spoke in euphemisms.

18
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And finally, when I got the courage
to go to the doctor

19
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and talk about my heavy periods,

20
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I was told to eat liver.

21
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(Laughter)

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And when I went to the drug store
to buy my menstrual products,

23
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my 48-pack of super maxi pads,

24
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back in the day when they were the size
of a tissue box, each pad --

25
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(Laughter)

26
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You know what I'm talking about.

27
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You have no idea how far
absorbent technology has come.

28
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(Laughter)

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I used to have to buy
my menstrual products

30
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in the feminine hygiene aisle.

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And I remember standing there, thinking,

32
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"Well, why don't I buy toilet paper
in the anal hygiene aisle?"

33
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(Laughter)

34
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Like, what's up with that?

35
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Why can't we talk about periods?

36
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And it's not about the blood,
as Freud would have you say,

37
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because if it were,

38
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there would be an ear, nose
and throat surgeon up here right now,

39
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talking about the taboos
of nose bleeds, right?

40
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And it's not even about periods,

41
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because otherwise, when we got rid
of our toxic, shameful periods

42
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when we became menopausal,

43
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we'd be elevated
to a higher social status.

44
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(Laughter)

45
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(Applause)

46
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It's just a patriarchal society is
invested in oppressing women,

47
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and at different points in our lives,
different things are used.

48
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And menstruation is used

49
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during what we in medicine call
the reproductive years.

50
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It's been around since
pretty much the beginning of time,

51
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many cultures thought
that women could spoil crops

52
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or milk, or wilt flowers.

53
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And then when religion came along,

54
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purity myths only made that worse.

55
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And medicine wasn't any help.

56
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In the 1920s and '30s

57
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there was the idea that women elaborated
something called a menotoxin.

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We could wilt flowers just by walking by.

59
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(Laughter)

60
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And that's what happens
when there's no diversity, right.

61
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Because there was no woman
to put her hand up and go,

62
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"Well, actually, that doesn't happen."

63
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And when you can't talk
about what's happening to your body,

64
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how do you break these myths?

65
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Because you don't even need to be a doctor

66
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to say that periods aren't toxic.

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If they were, why would an embryo
implant in a toxic swill?

68
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And if we all had this secret menotoxin,

69
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we could be laying waste
to crops and spoiling milk.

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(Laughter)

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Why would we have not used
our x-women powers to get the vote sooner?

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(Laughter)

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(Applause)

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Even now,

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when I tweet about period diarrhea,

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as one does,

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(Laughter)

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I mention that it affects
28 percent of women.

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And every single time,
someone approaches me and says,

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"I thought I was the only one."

81
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That's how effective
that culture of shame is,

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that women can't even share
their experiences.

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So I began to think,

84
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"Well, what if everybody knew
about periods like a gynecologist?

85
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Wouldn't that be great?"

86
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Then you would all know what I know,

87
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you'd know that menstruation

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is a pretty unique
phenomenon among mammals.

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Most mammals have estrus.

90
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Humans, some primates,

91
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some bats,

92
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the elephant shrew
and the spiny mouse menstruate.

93
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And with menstruation what happens is
the brain triggers the ovary

94
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to start producing an egg.

95
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Estrogen is released

96
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and it starts to build up
the lining of the uterus,

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cell upon cell, like bricks.

98
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And what happens if you build
a brick wall too high without mortar?

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Well, it's unstable.

100
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So what happens when you ovulate?

101
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You release a hormone called progesterone,

102
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which is progestational,
it gets the uterus ready.

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It acts like a mortar
and it holds those bricks together.

104
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It also causes some changes

105
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to make the lining more hospitable
for implantation.

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If there's no pregnancy,

107
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the lining comes out,

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there's bleeding from the blood vessels
and that's the period.

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And I always find this point
really interesting.

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Because with estrus,

111
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the final signaling to get
the lining of the uterus ready

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actually comes from the embryo.

113
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But with menstruation,

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that choice comes from the ovary.

115
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It's as if choice is coded in
to our reproductive tracts.

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(Cheering and applause)

117
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OK, so now we know why the blood is there.

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And it's a pretty significant amount.

119
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It's 30 to 90 milliliters of blood,

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which is one to three ounces,

121
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and it can be more,

122
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I know it seems like it's more
a lot of the times.

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I know.

124
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So why do we have so much blood?

125
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And why doesn't it just stay there
till the next cycle, right?

126
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Like, you didn't get pregnant,
so why can't it hang around?

127
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Well imagine if each month it got thicker
and thicker and thicker, right,

128
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like, imagine what tsunami
period that would be.

129
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(Laughter)

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We can't reabsorb it
because it's too much.

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And it's too much because we need
a thick uterine lining

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for a very specific reason.

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Pregnancy exerts a significant
biological toll on our bodies.

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There is maternal mortality,

135
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there is the toll of breastfeeding

136
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and there is the toll of raising a child
until it is independent.

137
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And evolution --

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(Laughter)

139
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That goes on longer
for some of us than others.

140
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(Laughter)

141
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But evolution knows
about risk-benefit ratio.

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And so evolution wants to maximize
the chance of a beneficial outcome.

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And how do you maximize the chance
of a beneficial outcome?

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You try to get the highest
quality embryos.

145
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And how do you get
the highest quality embryos?

146
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You make them work for it.

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You give them an obstacle course.

148
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So over the millennia
that we have evolved,

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it's been a little bit
like an arms race in the uterus,

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the lining getting thicker
and thicker and thicker,

151
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and the embryo getting more invasive

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until we reached this [unclear]

153
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with the lining
of the uterus that we have.

154
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So we have this thick uterine lining

155
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and now it's got to come out,

156
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and how do you stop bleeding?

157
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Well, you stop a nose bleed
by pinching it,

158
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if you cut your leg,
you put pressure on it.

159
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We stop bleeding with pressure.

160
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When we menstruate,

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the lining of the uterus
releases substances

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that are made into chemicals
called prostaglandins

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and other inflammatory mediators.

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And they make the uterus cramp down,

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they make it squeeze
on those blood vessels

166
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to stop the bleeding.

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They might also change
blood flow to the uterus

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and also cause inflammation
and that makes pain worse.

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And so you say, "OK,
how much pressure is generated?"

170
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And from studies
where some incredible women

171
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have volunteered
to have pressure catheters

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put in their uterus,

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that they wear
their whole menstrual cycle --

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God bless them, because
we wouldn't have this knowledge without,

175
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and it's very important knowledge,

176
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because the pressure
that's generated in the uterus

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during menstruation

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is 120 millimeters of mercury.

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"What's that," you say.

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Well, it's the amount of pressure
that's generated

181
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during the second stage of labor
when you're pushing.

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(Audience gasps)

183
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Right.

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Which, for those of you
who haven't had an unmedicated delivery,

185
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that's what it's like
when the blood pressure cuff

186
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is not quite as tight as it was
at the beginning,

187
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but it's still pretty tight,

188
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and you wish it would stop.

189
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So that kind of makes it different, right,

190
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if you start thinking
about the pain of menstruation --

191
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We wouldn't say
if someone needed to miss school

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because they were in the second stage
of labor and pushing,

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we wouldn't call them weak,

194
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we'd be like, "Oh my God,
you made it that far," right?

195
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(Laughter)

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And we wouldn't deny pain control

197
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to women who have
typical pain of labor, right?

198
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So it's important for us to call this pain
"typical" instead of "normal,"

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because when we say it's normal,
it's easier to dismiss.

200
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As opposed to saying it's typical
and we should address it.

201
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And we do have some ways
to address menstrual pain.

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One way is with something
called a TENS unit

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00:08:45,667 --> 00:08:47,476
which you can wear under your clothes

204
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and it sends an electrical impulse
to the nerves and muscles

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and no one really knows how it works,

206
00:08:52,458 --> 00:08:54,976
but we think it might be
the gate theory of pain,

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which is counterirritation.

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It's the same reason why,
if you hurt yourself, you rub it.

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Vibration travels faster
to your brain than pain does.

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00:09:04,208 --> 00:09:05,559
We also have medications

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00:09:05,583 --> 00:09:08,351
called nonsteroidal
anti-inflammatory medications.

212
00:09:08,375 --> 00:09:12,143
And what they do is they block
the release of prostaglandins.

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00:09:12,167 --> 00:09:16,059
They can reduce menstrual pain
for 80 percent of women.

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00:09:16,083 --> 00:09:19,851
They also reduce the volume of blood
by 30 to 40 percent

215
00:09:19,875 --> 00:09:22,268
and they can help with period diarrhea.

216
00:09:22,292 --> 00:09:24,851
And we also have hormonal contraception,

217
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which gives us a thinner
lining of the uterus

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00:09:27,167 --> 00:09:29,476
so there's less prostaglandins produced

219
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and with less blood,
there's less need for cramping.

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Now, if those treatments fail you

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and it's important to use
that word choice,

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because we never fail the treatment,

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the treatment fails us.

224
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If that treatment fails you,

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you could be amongst the people

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00:09:46,626 --> 00:09:50,684
who have a resistance
to nonsteroidal anti-inflammatories.

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We don't quite understand,

228
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but there are some complex mechanisms

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00:09:54,417 --> 00:09:57,976
why those medications
just don't work for some women.

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It's also possible that you could have

231
00:10:01,333 --> 00:10:03,726
another reason for painful periods.

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You could have a condition
called endometriosis,

233
00:10:06,458 --> 00:10:09,518
where the lining of the uterus
is growing in the pelvic cavity,

234
00:10:09,542 --> 00:10:13,101
causing inflammation
and scar tissue, and adhesions.

235
00:10:13,125 --> 00:10:16,518
And there may be other mechanisms
we don't quite understand yet,

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because it's a possibility
that pain thresholds could be different

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due to very complex biological mechanisms.

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But we're only going to find that out
by taking about it.

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It's shouldn't be an act of feminism

240
00:10:28,792 --> 00:10:30,934
to know how your body works.

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It shouldn't --

242
00:10:32,250 --> 00:10:37,768
(Applause)

243
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It shouldn't be an act of feminism

244
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to ask for help when you're suffering.

245
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The era of menstrual taboos is over.

246
00:10:50,583 --> 00:10:55,309
(Cheers and applause)

247
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The only curse here

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is the ability to convince
half the population

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that the very biological machinery
that perpetuates the species,

250
00:11:05,542 --> 00:11:08,018
that gives everything that we have,

251
00:11:08,042 --> 00:11:10,601
is somehow dirty or toxic.

252
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And I'm not going to stand for it.

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(Applause)

254
00:11:18,917 --> 00:11:21,351
And the way we break that curse?

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00:11:21,375 --> 00:11:22,934
It's knowledge.

256
00:11:22,958 --> 00:11:24,226
Thank you.

257
00:11:24,250 --> 00:11:29,458
(Cheers and applause)