-
When I was a teen, I had terrible periods.
-
I had crippling cramps,
-
I leaked blood onto my clothes
and onto my bed sheets,
-
and I had period diarrhea.
-
And I had to miss school
one to two days a month,
-
and I remember sitting on the couch
with my heating pads, thinking,
-
"What's up with this?"
-
When I ate food, I didn't leak saliva
from my salivary glands.
-
When I went for a walk,
-
I didn't leak join fluid from my knees,
"joint fluid."
-
Why was menstruation so different?
-
I wanted answers to these questions
-
but there was no one for me to ask.
-
My mother knew nothing about menstruation
-
except that it was dirty and shameful
and I shouldn't talk about it.
-
I asked girlfriends
-
and everybody spoke in euphemisms.
-
And finally, when I got the courage
to go to the doctor
-
and talk about my heavy periods,
-
I was told to eat liver.
-
(Laughter)
-
And when I went to the drug store
to buy my menstrual products,
-
my 48-pack of super maxi pads,
-
back in the day when they were the size
of a tissue box, each pad --
-
(Laughter)
-
You know what I'm talking about.
-
You have no idea how far
absorbent technology has come.
-
(Laughter)
-
I used to have to buy
my menstrual products
-
in the feminine hygiene aisle.
-
And I remember standing there, thinking,
-
"Well, why don't I buy toilet paper
in the anal hygiene aisle?"
-
(Laughter)
-
Like, what's up with that?
-
Why can't we talk about periods?
-
And it's not about the blood,
as Freud would have you say,
-
because if it were,
-
there would be an ear, nose
and throat surgeon up here right now,
-
talking about the taboos
of nose bleeds, right?
-
And it's not even about periods,
-
because otherwise, when we got rid
of our toxic, shameful periods
-
when we became menopausal,
-
we'd be elevated
to a higher social status.
-
(Laughter)
-
(Applause)
-
It's just a patriarchal society is
invested in oppressing women,
-
and at different points in our lives,
different things are used.
-
And menstruation is used
-
during what we in medicine call
the reproductive years.
-
It's been around since
pretty much the beginning of time,
-
many cultures thought
that women could spoil crops
-
or milk, or wilt flowers.
-
And then when religion came along,
-
purity myths only made that worse.
-
And medicine wasn't any help.
-
In the 1920s and '30s
-
there was the idea that women elaborated
something called a menotoxin.
-
We could wilt flowers just by walking by.
-
(Laughter)
-
And that's what happens
when there's no diversity, right.
-
Because there was no woman
to put her hand up and go,
-
"Well, actually, that doesn't happen."
-
And when you can't talk
about what's happening to your body,
-
how do you break these myths?
-
Because you don't even need to be a doctor
-
to say that periods aren't toxic.
-
If they were, why would an embryo
implant in a toxic swill?
-
And if we all had this secret menotoxin,
-
we could be laying waste
to crops and spoiling milk.
-
(Laughter)
-
Why would we have not used
our x-women powers to get the vote sooner?
-
(Laughter)
-
(Applause)
-
Even now,
-
when I tweet about period diarrhea,
-
as one does,
-
(Laughter)
-
I mention that it affects
28 percent of women.
-
And every single time,
someone approaches me and says,
-
"I thought I was the only one."
-
That's how effective
that culture of shame is,
-
that women can't even share
their experiences.
-
So I began to think,
-
"Well, what if everybody knew
about periods like a gynecologist?
-
Wouldn't that be great?"
-
Then you would all know what I know,
-
you'd know that menstruation
-
is a pretty unique
phenomenon among mammals.
-
Most mammals have estrus.
-
Humans, some primates,
-
some bats,
-
the elephant shrew
and the spiny mouse menstruate.
-
And with menstruation what happens is
the brain triggers the ovary
-
to start producing an egg.
-
Estrogen is released
-
and it starts to build up
the lining of the uterus,
-
cell upon cell, like bricks.
-
And what happens if you build
a brick wall too high without mortar?
-
Well, it's unstable.
-
So what happens when you ovulate?
-
You release a hormone called progesterone,
-
which is progestational,
it gets the uterus ready.
-
It acts like a mortar
and it holds those bricks together.
-
It also causes some changes
-
to make the lining more hospitable
for implantation.
-
If there's no pregnancy,
-
the lining comes out,
-
there's bleeding from the blood vessels
and that's the period.
-
And I always find this point
really interesting.
-
Because with estrus,
-
the final signaling to get
the lining of the uterus ready
-
actually comes from the embryo.
-
But with menstruation,
-
that choice comes from the ovary.
-
It's as if choice is coded in
to our reproductive tracts.
-
(Cheering and applause)
-
OK, so now we know why the blood is there.
-
And it's a pretty significant amount.
-
It's 30 to 90 milliliters of blood,
-
which is one to three ounces,
-
and it can be more,
-
I know it seems like it's more
a lot of the times.
-
I know.
-
So why do we have so much blood?
-
And why doesn't it just stay there
till the next cycle, right?
-
Like, you didn't get pregnant,
so why can't it hang around?
-
Well imagine if each month it got thicker
and thicker and thicker, right,
-
like, imagine what tsunami
period that would be.
-
(Laughter)
-
We can't reabsorb it
because it's too much.
-
And it's too much because we need
a thick uterine lining
-
for a very specific reason.
-
Pregnancy exerts a significant
biological toll on our bodies.
-
There is maternal mortality,
-
there is the toll of breastfeeding
-
and there is the toll of raising a child
until it is independent.
-
And evolution --
-
(Laughter)
-
That goes on longer
for some of us than others.
-
(Laughter)
-
But evolution knows
about risk-benefit ratio.
-
And so evolution wants to maximize
the chance of a beneficial outcome.
-
And how do you maximize the chance
of a beneficial outcome?
-
You try to get the highest
quality embryos.
-
And how do you get
the highest quality embryos?
-
You make them work for it.
-
You give them an obstacle course.
-
So over the millennia
that we have evolved,
-
it's been a little bit
like an arms race in the uterus,
-
the lining getting thicker
and thicker and thicker,
-
and the embryo getting more invasive
-
until we reached this [unclear]
-
with the lining
of the uterus that we have.
-
So we have this thick uterine lining
-
and now it's got to come out,
-
and how do you stop bleeding?
-
Well, you stop a nose bleed
by pinching it,
-
if you cut your leg,
you put pressure on it.
-
We stop bleeding with pressure.
-
When we menstruate,
-
the lining of the uterus
releases substances
-
that are made into chemicals
called prostaglandins
-
and other inflammatory mediators.
-
And they make the uterus cramp down,
-
they make it squeeze
on those blood vessels
-
to stop the bleeding.
-
They might also change
blood flow to the uterus
-
and also cause inflammation
and that makes pain worse.
-
And so you say, "OK,
how much pressure is generated?"
-
And from studies
where some incredible women
-
have volunteered
to have pressure catheters
-
put in their uterus,
-
that they wear
their whole menstrual cycle --
-
God bless them, because
we wouldn't have this knowledge without,
-
and it's very important knowledge,
-
because the pressure
that's generated in the uterus
-
during menstruation
-
is 120 millimeters of mercury.
-
"What's that," you say.
-
Well, it's the amount of pressure
that's generated
-
during the second stage of labor
when you're pushing.
-
(Audience gasps)
-
Right.
-
Which, for those of you
who haven't had an unmedicated delivery,
-
that's what it's like
when the blood pressure cuff
-
is not quite as tight as it was
at the beginning,
-
but it's still pretty tight,
-
and you wish it would stop.
-
So that kind of makes it different, right,
-
if you start thinking
about the pain of menstruation --
-
We wouldn't say
if someone needed to miss school
-
because they were in the second stage
of labor and pushing,
-
we wouldn't call them weak,
-
we'd be like, "Oh my God,
you made it that far," right?
-
(Laughter)
-
And we wouldn't deny pain control
-
to women who have
typical pain of labor, right?
-
So it's important for us to call this pain
"typical" instead of "normal,"
-
because when we say it's normal,
it's easier to dismiss.
-
As opposed to saying it's typical
and we should address it.
-
And we do have some ways
to address menstrual pain.
-
One way is with something
called a TENS unit
-
which you can wear under your clothes
-
and it sends an electrical impulse
to the nerves and muscles
-
and no one really knows how it works,
-
but we think it might be
the gate theory of pain,
-
which is counterirritation.
-
It's the same reason why,
if you hurt yourself, you rub it.
-
Vibration travels faster
to your brain than pain does.
-
We also have medications
-
called nonsteroidal
anti-inflammatory medications.
-
And what they do is they block
the release of prostaglandins.
-
They can reduce menstrual pain
for 80 percent of women.
-
They also reduce the volume of blood
by 30 to 40 percent
-
and they can help with period diarrhea.
-
And we also have hormonal contraception,
-
which gives us a thinner
lining of the uterus
-
so there's less prostaglandins produced
-
and with less blood,
there's less need for cramping.
-
Now, if those treatments fail you
-
and it's important to use
that word choice,
-
because we never fail the treatment,
-
the treatment fails us.
-
If that treatment fails you,
-
you could be amongst the people
-
who have a resistance
to nonsteroidal anti-inflammatories.
-
We don't quite understand,
-
but there are some complex mechanisms
-
why those medications
just don't work for some women.
-
It's also possible that you could have
-
another reason for painful periods.
-
You could have a condition
called endometriosis,
-
where the lining of the uterus
is growing in the pelvic cavity,
-
causing inflammation
and scar tissue, and adhesions.
-
And there may be other mechanisms
we don't quite understand yet,
-
because it's a possibility
that pain thresholds could be different
-
due to very complex biological mechanisms.
-
But we're only going to find that out
by taking about it.
-
It's shouldn't be an act of feminism
-
to know how your body works.
-
It shouldn't --
-
(Applause)
-
It shouldn't be an act of feminism
-
to ask for help when you're suffering.
-
The era of menstrual taboos is over.
-
(Cheers and applause)
-
The only curse here
-
is the ability to convince
half the population
-
that the very biological machinery
that perpetuates the species,
-
that gives everything that we have,
-
is somehow dirty or toxic.
-
And I'm not going to stand for it.
-
(Applause)
-
And the way we break that curse?
-
It's knowledge.
-
Thank you.
-
(Cheers and applause)
Erin Gregory
The English transcript was updated on 2/11/20:
0:29 - 0:32
I didn't leak join fluid from my knees,
"joint fluid."
-->
I didn't leak fluid from my knees,
"joint fluid."
and,
10:22 - 10:26
But we're only going to find that out
by taking about it.
-->
But we're only going to find that out
by talking about it.