Why can't we talk about periods?

"It shouldn't be an act of feminism to know how your body works," says gynecologist and author Jen Gunter. In this revelatory talk, she explains how menstrual shame silences and represses -- and leads to the spread of harmful misinformation and the mismanagement of pain. Declaring the era of the menstrual taboos over, she delivers a clear, much-needed lesson on the once-mysterious mechanics of the uterus.

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,

(Whoosh)

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,

and 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 reach this détente

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.

"Well 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 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)