We Need to Talk about Periods
In healthcare education we are bombarded with new information from all angles and so it is understandable that many important issues fall by the wayside. In ‘We Need To Talk About…’ I hope to give the floor to issues members of the student body care about through interviews with students and others.
It’s not a surprise to anyone that Women’s Health, and associated issues, is an oft neglected part of medicine. One area of women’s health that is very present in public discourse now is periods. However, within healthcare education, this conversation is still lacking. So, what conversations should be happening and why aren’t they? I conducted three interviews to look at these questions.
Lulu
“I’m Lulu Lyons and I’m a fifth-year medical student … I’m on the Medical Women’s Federation committee which is a national and a global charity. I’m the med student rep for the UK but I was also the Barts rep.”
Israh
“My name is Israh Goodall and I’ve been a midwife for 12 years working in the UK and many years spent working in eight organisations around the world. I’m also an expedition leader, where I take groups out into wilderness areas.”
Ben
“My name is Ben Butch, I live in London, I am 26 years old, and I identify as non-binary.”
All three interviewees brought unique experiences of their own feelings and the how feelings of others have influenced them. Israh opened up about her first period and her mother’s reaction:
“I have a really strong memory of her dropping down. So, I was sitting down, but she went down on her knees beside me…just saying… this is extraordinary and I’m so proud of you”
She went on to talk about how her mother had wanted to throw her a party but Israh was “a teenager… living in the UK… had experienced high school and all of the shame around periods” and so she said no. Shame also factors into Ben’s early experiences:
“I didn’t tell anyone; it was a secret for so long and everyone was so happy about it and I was like ‘why are you so happy this is a burden for the rest of your life'”
Lulu told me about the symptoms she experiences around her periods and how her friends “always thought [she] was exaggerating until they lived with [her]” and that by understanding how much everyone’s experience is different we will “be kinder to each other”. And this variation wasn’t just in physical symptoms but in personal feelings. Ben spoke about the huge difference between theirs and their wife’s feelings:
“I really dislike having a period, but my wife absolutely loves them, like, with periods this is the best time ever, I feel like the most amazing person right now”
“Sometimes you don’t even call a period a period, you’re just like ‘oh are you on your thing’”
Lulu talked about barriers to us having conversations about periods, and how this starts from a young age:
“It’s dirty, it’s embarrassing, like, so many girls are bullied at because of it… 91% of girls are worried about going to school on their period… It’s damaging to confidence and self-esteem”
And this language about periods being dirty is pervasive, even when we talk about menstrual hygiene there are subtle implications there.
“There’s a day called menstrual hygiene day… but even that… makes it sound dirty”
The word hygiene is seen again when we talk about feminine hygiene products. Considering we get lectured at least three times on all the methods of contraception but never about different period products this is a conversation that is lacking in medical education.
“Back to the stigma thing, I think advertising is terrible for it. You can buy perfumed tampons, like you should be putting perfume in your vagina, that’s just not what you do.“
“They so afraid of being dirty that they use a wipe, those wipes have got chemicals in them”
This second quote from Israh linked into another issue that emerges when we don’t talk about appropriate menstrual products.
“The other thing is environmental issues… I think has got to be part of the education now”
Israh believes that as healthcare professionals are often an early point of contact for young people struggling with their periods we should have the knowledge base to help them make choices that are good for the environment.
But how do we combat this stigma to be able to have open conversations about periods? Ben has been using their performance work to celebrate periods.
“I do a builder, and I strip to pony and at the end I pull out a tampon. A giant one”
“It would be amazing if medical literature went beyond the physical”
Israh uses the metaphor of the seasons to explain how the four phases of the menstrual cycle can change a woman’s body:
Winter: “When you bleed, when you think about winter, it’s such a similar thing… You just want to go into yourself”
Spring: “There’s a new rush of life coming through… and you look at spring and that’s exactly what happens”
Summer: “Then as you go into summer… when you ovulate is when you’ve obviously got the most energy because your hormones ready to go.”
Autumn: “By the end of summer they’re like…I’ve over socialised and they need to go into autumn and shed and go quieter.”
Both Israh and Lulu discussed how we’re not told about anything outside of bleeding and that it’s the ‘missing element’ in education about periods.
A key element of the experience outside of bleeding is pain. Its management is a complicated issue as you can see from these quotes.
“Because if you’re in pain and it’s debilitating … and it’s affecting your work and it’s affecting how you feel then it should be managed and taken note.” – Lulu
“Pain relief, it’s brilliant in the moment we think, wow, we can kind of get on with our normal thing, but we then bereft ourselves of the opportunity to lie down and to do the things that our body needs to do, to replenish” – Israh
And this isn’t necessarily limited to physical pain. I asked Ben about their gender dysphoria around the time of their periods:
“They totally contribute. My dysphoria kind of, skyrockets, just before or during, it’s because your body changes so much”
Which reminded me of how much Israh and Lulu spoke about how our experiences are so much more than bleeding but the physical changes should be recognised because they can affect how someone feels about themselves.
“When it’s mainstream I feel like, what about us? What about me?”
“Cause there’s always the thing of you should embrace your womanly body and it’s like ‘urgh, stop it’ when the mainstream media is promoting period positivity, and like you should embrace your womanly body and this is the natural womanly thing to do.”
“I think it’s difficult when people call periods a woman’s thing or if you have a period you’re a woman, so what does that mean if you don’t have a period, does that make you not a woman?”
These quotes are from Ben talking about how mainstream activism can sometimes make them feel. They also told me about how healthcare experiences they’ve had have reflected this assumption about periods - from being told “I wasn’t expecting to do this today because of your name” when they went in for a smear test to being questioned if they were really Ben on a phone call consultation recently. But it’s about more than just asking people, it’s about how we’re approaching what could be a painful topic for someone:
“Instead of just saying ‘do you still get a period’… when people ask do you still get your periods, I feel there should be some acknowledgement that ‘oh I understand this might be an uncomfortable topic for you'”
Lulu and I reflected on our lack of education while at medical school around gender and the assumptions we make:
“If we don’t feel comfortable with it how are we going to make a patient feel comfortable and confident… we’re meant to be there giving them confidence and support… I think boys should be educated from a young age when girls are because eventually they’re going to have female friends who don’t have menstrual cycles and guys who do”
Israh also tries to include boys in her education around periods on the expeditions she runs:
“They are absolutely desperate to know what happens to women’s bodies beyond just the language of… she’s got PMS, we better leave her alone…. We need to adapt the way we’re managing gender, we shouldn’t be afraid of bringing in the language of cycles, because we all need to know about it”
“When we’re addressing stigma, we need to know the society we’re addressing it in”
I spent a lot of my interview with Israh listening to her talk about how her experiences in different cultures has shaped her views.
“I was brought up Muslim and lived in many different countries… I had this kind of tradition of Islam, but also my parents had kind of come through the sixties”
Personally, I’ve always felt there’s an assumption that certain cultures choosing to treat women differently while on their period could contribute to stigma. Israh had a different feeling based on her upbringing:
“In Islam, you don’t pray when you are bleeding and that was the way it was done… my understanding of it was it was something to be proud of, it wasn’t that you were dirty so you couldn’t pray… it felt like you were going through your own prayer cycle and you had your own space during that time”
Israh has spent time is a multitude of communities whilst learning about their practices, including northern America tribes where the whole village was involved in celebrating someone’s first period to northern Pakistan where she was privileged to spend some time in a place called the Red Tent
“I’ve always promised that I would never talk about everything I saw, but actually the things that I did see were an example to me that actually women, when we are given space to take care of each other, really do nurture and empower each other.”
Final Comments
Lulu
“Stigma, education, and not alienating people… and don’t feel weird or embarrassed to talk about it because it’s not weird and it’s not embarrassing”
Israh
“I actually hope that in the future, it isn’t that unusual that a doctor would say… you know, you’re about to bleed…maybe you could put somethings into motion to take care of yourself over the next few days”
Ben
“Just say what’s your pronouns, that’s all you have to do. It makes the experience so much better.”
If you want to find out more...
Websites & Organisations
Medical Women’s Federation - medicalwomensfederation.org.uk
Women’s Environmental Network - wen.org.uk
The Red School - redschool.net
Check out this Guardian article about policy work the red school was involved in: https://www.theguardian.com/lifeandstyle/2016/mar/02/uk-company-introduce-period-policy-female-staff
Books
Period Power by Maisie Hill
@rubyyyjones
@prinxlydia – check out their etsy shop (https://www.etsy.com/uk/shop/PrinxLydia?ref=simple-shop-header-name&listing_id=862543093) Which includes a zine for people who have periods
@theperiodmovement
Interviewees
Israh - israhgoodall.com/
Ben - @benjaminbutch (Instagram)
