By Dr Alison McAllister, ZRT Laboratory
ZRT is a company made up mostly of women. It’s not that we don’t have men working here, but 80% of our employees happen to be women. A combination of a company mostly of women, working in the health field, and having gone to medical school which tends to take away that filter that says “perhaps certain topics are off limits,” can lead to hilarious conversations like our one today on the favorite of all lady topics – periods! I am going to give you an inner look at a woman’s conversation about this topic, so if you are squeamish you might want to look away.
We’ve been talking about how times have changed with respect to how women culturally handle periods, how young girls learn to deal with them, how many funny misunderstandings are out there (sorry men, this usually reflects on you), and how things have changed with our own comfort with our periods and in general, society’s willingness to acknowledge that they exist.
What’s up with This Bleeding?
So, what are periods all about? The period is “that time (or period) of the month” where the lining of the uterus is shed due to the lack of a fertilized embryo and therefore does not need to support a pregnancy. The lining of the uterus is made up of mucosal tissue and has 2 layers that attach to the smooth muscle layer of the uterus. Estrogen makes it grow; progesterone helps it mature. Only a small group of mammals including humans, apes, monkeys, bats and elephant shrews shed this lining when pregnancy doesn’t occur. If pregnancy does occur, the endometrium serves as a nourishing pillow where the embryo is implanted and starts to grow.
Shedding of the uterine lining usually occurs at an average rate of 2-3 tbsp (40 mL) per cycle, although some women may have a much heavier flow (up to 540 mL). I don’t know about anyone reading this, but honestly, sometimes periods seem like you are just losing cups! If you have ever dropped food coloring into a bowl of water, you can imagine that even a small amount can look startling. So, that’s why when doctoring, we ask so many questions about how many pads, tampons, etc. a woman needs. A myth out there, that apparently needs to be addressed, is woman cannot “hold” her uterine lining inside for a convenient time. Sadly, nature gave us a cervix, but didn’t give the uterus a sphincter. Thus, women have absolutely no control over when or how long they bleed. It’s totally normal to soak 1-7 normal sized tampons or pads per period. Seriously though, there are women that do that on only the first day!
Too Much Bleeding
Which leads me to the fun topic of “why the heck am I bleeding so much?” Ladies, I hear you!!! Let’s just say it together – periods can suck. Heavy periods can suck A LOT; as in suck everything out of you! So, first, if you are bleeding so much that you are saturating a pad/tampon every hour please talk to your doctor. There are a couple of things that can be going on – well, there are more, but we are going to talk about just a couple.
- Too much endometrium, usually due to too much estrogen and/or not enough progesterone. ZRT tests this a couple of ways – we do saliva/blood spot at the peak of the luteal phase when progesterone should be at its highest. Guess what, a significant number of you have totally normal estrogen and too little progesterone. When we do our menstrual cycle mapping (28-day test) we see that some women make a TON of estrogen before ovulation and don’t produce very much progesterone after ovulation. This means that the endometrium has tons of growth, but not enough differentiation or maturing to stop the growth.
- Uterine structure issues. Hey, building a person is tricky and for some women, well, our moms didn’t get it quite right. Two uteruses, heart shaped, with septal divisions are unusual, but not rare. Add some fibroids (balls of muscle) or polyps (think skin tags) and our poor little uterus, which should clamp down and squeeze to help stop bleeding, can have problems. This leads to heavy flow as the uterus needs to be a round shape to be the most efficient at this. A lot of times these problems are picked up when we are teenagers, but sometimes come up later. Fibroids are super common and are one of the most common reasons for hysterectomies because of heavy bleeding. Where and how big these fibroids are can really influence bleeding.
- Adenomyosis. This is where the endometrium invades into the muscle. The uterine muscles have little influence on this bleeding, which can be prolific and painful. The uterine lining can also be much thicker than usual. Women are prone to this if they had an invading placenta during childbirth, if they have had multiple pregnancies, or if they’ve had uterine procedures (C-sections, surgical terminations, myomectomies).
- Bleeding disorders. I mention this one because sometimes the period is the first time a young lady might have been considered to have a risk. Von Willebrand’s is not uncommon and can cause profound bleeding.
- Anemia. What! You might be saying, how can anemia make me bleed more? Yes, nature’s cruel joke is that the more you bleed, the more anemic and iron deficient you are, which can make you bleed more. How’s that for a punch line? Turns out iron is needed to have good contractility of the muscles, so when you are losing blood, you are losing the ability to clamp down on that uterine lining and stop too much blood loss.
What Do We Do with All This Blood?
How to handle this bleeding is such a challenge. Holy cow, this takes time my friends. I’m an old pro at having periods; I have long and heavy periods, a history of gigantic fibroids (shout out to Dr. Jenna Murray for reconstructing my uterus and letting me have my daughter), and I am still figuring things out. Which leads me to the funny conversation today at ZRT – MENSTRUAL CUPS. I’m a bit obsessed—seriously, I’ve bought 3 different brands in the last week. As a woman who really struggles with periods, I really, really love menstrual cups. They changed my period experience from something I dreaded to just a blip on the calendar.
What are menstrual cups? Well, they are little cups (about 1 inch in diameter, 1 inch long) that are inserted into the vagina and form a seal with the vaginal walls and catch the blood. You guys – ok ladies, if you haven’t tried one – DO IT! Now let’s dive into your options! We have a lot more available to us now than the original soft cup/Instead™ and the Diva™. The Soft cup™/Instead™/Flex cup™ has worked for me for years. It’s made it so that my period doesn’t consume my life. I recently found a company that is making a silicone version of one called the Lumma Cup™ from Brazil and I bought it. I love that it’s not disposable and it was great. Now, this led me to looking at all the true cups – the Lumma™ is more of a disk – and there are SO, SO MANY! Check for a forum and resources. I want to have lunch with these ladies – they are great and boy, we could have such great period conversations. They have a quiz that can help you figure out what one might work for you.
Cups are getting so popular that we are even seeing Tampax™ get into the game. Diva cup™ and Saalt™ are both available at Target, so really you can easily find one to try (Putacupinit has coupons; use them because you might have to try a couple). Why do I love them? They easily catch 2-4 times the blood volume as a tampon. Which means instead of changing a tampon every 2-3 hours, you might get away with dumping them every 6-12 hours. Less bathroom time – hurray! Less vaginal dryness and irritation – double hurray! Plus, sex is possible in some of these versions – so hurray for less period hassles in general!
A Couple of Menstrual Cup Myths That I Want to Address
- Yes, you can use one with your IUD, but make sure to break the suction before pulling it out and take care not to pull on the strings.
- Yes, you can use the cups if you have never had sex. As soon as a girl has a sense of her period and has comfort with her body, she can use a menstrual cup. She might want to experiment with different folds to make the cup smaller upon insertion and fold it a bit upon removal, but it will work.
- No, the cup can’t get lost up there. Now, if you have a high cervix it might seem like it, but I promise, it won’t be lost. Try bearing down like you are having a bowel movement and/or squatting, to push your cervix and the cup lower into the vagina. Also, don’t panic; it will come out.
- Yes, you can poop with them in and you are not going to force them out. If that is a concern, you are likely constipated and need to take some magnesium, fiber, or vitamin C and drink more water, but hey, that’s a different blog.
- Yes, you might have less cramping with the menstrual cups. What? I KNOW! I’m not sure of the mechanism, but my guess is that some cervixes just hate being poked by tampons. Since the cervix is not bothered by the cups, I’m thinking that is why many women notice less cramping. Have I convinced you yet?
There are other benefits with the cups as well – no plastics, no herbicides or pesticides in the cotton (yes, that is a real thing), decrease in waste, cheaper over time, less vaginal microflora disruption. Now, you must be willing to try a couple of cups. You might need a different one for your heavier days vs. your lighter days to start with. You might also find some really don’t work for you. For instance, you might find that you have a very high or very low cervix that can cause some discomfort or some very funny contortions as you learn to insert or remove them. You might find that you hate the little stem or that you really like one cup for working out, but another for days that are more mellow. Basically, you have to learn, but once you find one that works, I think that most women can successfully incorporate them into their period gear.
Underwear That Can Help
Have you tried period underwear? I haven’t tried these yet but hear great things about THINX™ as well as Modibodi™ underwear. I think these would have been amazing for me as a young girl and absolutely great for a woman who is perimenopausal and dealing with surprise periods. There are more and more brands out there, so let me know your favorites. For me, they would be back-ups, but for those of you lucky enough to have light periods I hear you can go an entire day. Get some for your young teens in your life who are figuring things out.
So, I’m with you with the heavy periods. Check your hormones, get help if you need it, and change how you handle them. I haven’t addressed therapeutics on things to try to decrease the flow – that will be another blog. But in the meantime, you can imagine all the docs here at ZRT having a laugh over the shapes, colors and stories of dealing with periods and lady-land. We have to be in it together because boy, it really can be a bear. Treat yourself to a nice new pair of period panties and, as for me, I have an eye out to try a rainbow-colored menstrual cup next cycle. I’ll let you know how it went.