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When I was a teen, I had terrible periods.

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I had crippling cramps,

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I leaked blood onto my clothes
and onto my bed sheets,

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and I had period diarrhea.

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And I had to miss school
one to two days a month,

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and I remember sitting on the couch
with my heating pads, thinking,

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"What's up with this?"

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

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When I went for a walk,

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

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Why was menstruation so different?

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I wanted answers to these questions

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but there was no one for me to ask.

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My mother knew nothing about menstruation

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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

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and everybody spoke in euphemisms.

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

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and talk about my heavy periods,

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I was told to eat liver.

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(Laughter)

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

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my 48-pack of super maxi pads,

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

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(Laughter)

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You know what I'm talking about.

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You have no idea how far
absorbent technology has come.

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(Laughter)

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I used to have to buy
my menstrual products

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in the feminine hygiene aisle.

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And I remember standing there, thinking,

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

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(Laughter)

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Like, what's up with that?

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Why can't we talk about periods?

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

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because if it were,

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

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talking about the taboos
of nose bleeds, right?

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And it's not even about periods,

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

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when we became menopausal,

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we'd be elevated
to a higher social status.

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(Laughter)

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(Applause)

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

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

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And menstruation is used

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during what we in medicine call
the reproductive years.

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

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many cultures thought
that women could spoil crops

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or milk, or wilt flowers.

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And then when religion came along,

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purity myths only made that worse.

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And medicine wasn't any help.

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In the 1920s and '30s

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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.

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(Laughter)

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

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

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

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

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how do you break these myths?

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Because you don't even need to be a doctor

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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?

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And if we all had this secret menotoxin,

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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."

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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,

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

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Wouldn't that be great?"

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Then you would all know what I know,

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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.

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Humans, some primates,

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some bats,

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the elephant shrew
and the spiny mouse menstruate.

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And with menstruation what happens is
the brain triggers the ovary

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to start producing an egg.

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Estrogen is released

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

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cell upon cell, like bricks.

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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.

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So what happens when you ovulate?

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You release a hormone called progesterone,

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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.

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It also causes some changes

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to make the lining more hospitable
for implantation.

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If there's no pregnancy,

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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,

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the final signaling to get
the lining of the uterus ready

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actually comes from the embryo.

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But with menstruation,

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that choice comes from the ovary.

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

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(Cheering and applause)

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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.

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It's 30 to 90 milliliters of blood,

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which is one to three ounces,

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and it can be more,

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

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I know.

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So why do we have so much blood?

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

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

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

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like, imagine what tsunami
period that would be.

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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,

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there is the toll of breastfeeding

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

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And evolution --

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(Laughter)

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That goes on longer
for some of us than others.

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(Laughter)

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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.

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And how do you get
the highest quality embryos?

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You make them work for it.

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You give them an obstacle course.

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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,

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and the embryo getting more invasive

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until we reached this [unclear]

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with the lining
of the uterus that we have.

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So we have this thick uterine lining

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and now it's got to come out,

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and how do you stop bleeding?

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Well, you stop a nose bleed
by pinching it,

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

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We stop bleeding with pressure.

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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

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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?"

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And from studies
where some incredible women

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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,

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and it's very important knowledge,

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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

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

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(Audience gasps)

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Right.

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

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

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

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but it's still pretty tight,

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and you wish it would stop.

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So that kind of makes it different, right,

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if you start thinking
about the pain of menstruation --

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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,

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

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(Laughter)

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And we wouldn't deny pain control

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to women who have
typical pain of labor, right?

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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.

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

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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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which you can wear under your clothes

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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,

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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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We also have medications

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called nonsteroidal
anti-inflammatory medications.

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And what they do is they block
the release of prostaglandins.

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They can reduce menstrual pain
for 80 percent of women.

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They also reduce the volume of blood
by 30 to 40 percent

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and they can help with period diarrhea.

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And we also have hormonal contraception,

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which gives us a thinner
lining of the uterus

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so there's less prostaglandins produced

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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.

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If that treatment fails you,

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you could be amongst the people

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who have a resistance
to nonsteroidal anti-inflammatories.

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We don't quite understand,

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but there are some complex mechanisms

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why those medications
just don't work for some women.

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It's also possible that you could have

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another reason for painful periods.

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You could have a condition
called endometriosis,

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where the lining of the uterus
is growing in the pelvic cavity,

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causing inflammation
and scar tissue, and adhesions.

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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

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to know how your body works.

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It shouldn't --

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(Applause)

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It shouldn't be an act of feminism

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to ask for help when you're suffering.

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The era of menstrual taboos is over.

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(Cheers and applause)

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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,

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that gives everything that we have,

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is somehow dirty or toxic.

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And I'm not going to stand for it.

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(Applause)

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And the way we break that curse?

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It's knowledge.

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Thank you.

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(Cheers and applause)