00:00:13
When I was a teen, I had terrible periods.
00:00:16
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.
00:00:24
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,
00:00:32
"What's up with this?"
00:00:34
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 fluid from my knees,
"joint fluid."
00:00:44
Why was menstruation so different?
00:00:48
I wanted answers to these questions
00:00:50
but there was no one for me to ask.
00:00:52
My mother knew nothing about menstruation
00:00:54
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
00:01:05
and talk about my heavy periods,
00:01:07
I was told to eat liver.
00:01:09
(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.
00:01:26
You have no idea how far
absorbent technology has come.
00:01:29
(Laughter)
00:01:31
I used to have to buy
my menstrual products
00:01:34
in the feminine hygiene aisle.
00:01:37
And I remember standing there, thinking,
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"Well, why don't I buy toilet paper
in the anal hygiene aisle?"
00:01:42
(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,
00:01:57
talking about the taboos
of nose bleeds, right?
00:01:59
And it's not even about periods,
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because otherwise, when we got rid
of our toxic, shameful periods
00:02:05
when we became menopausal,
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we'd be elevated
to a higher social status.
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(Laughter)
00:02:12
(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,
00:02:38
purity myths only made that worse.
00:02:41
And medicine wasn't any help.
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In the 1920s and '30s
00:02:45
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)
00:02:53
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,
00:03:04
how do you break these myths?
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Because you don't even need to be a doctor
00:03:09
to say that periods aren't toxic.
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If they were, why would an embryo
implant in a toxic swill?
00:03:16
And if we all had this secret menotoxin,
00:03:20
we could be laying waste
to crops and spoiling milk.
00:03:23
(Laughter)
00:03:24
Why would we have not used
our X-Women powers to get the vote sooner?
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(Laughter)
00:03:30
(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)
00:03:42
I mention that it affects
28 percent of women.
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And every single time,
someone approaches me and says,
00:03:49
"I thought I was the only one."
00:03:52
That's how effective
that culture of shame is,
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that women can't even share
their experiences.
00:03:59
So I began to think,
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"Well, what if everybody knew
about periods like a gynecologist?
00:04:04
Wouldn't that be great?"
00:04:05
Then you would all know what I know,
00:04:07
you'd know that menstruation
00:04:08
is a pretty unique
phenomenon among mammals.
00:04:11
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.
00:04:20
And with menstruation what happens is
the brain triggers the ovary
00:04:24
to start producing an egg.
00:04:26
Estrogen is released
00:04:27
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.
00:04:36
So what happens when you ovulate?
00:04:38
You release a hormone called progesterone,
00:04:40
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
00:04:50
to make the lining more hospitable
for implantation.
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If there's no pregnancy,
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(Whoosh)
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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
00:05:08
actually comes from the embryo.
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But with menstruation,
00:05:12
that choice comes from the ovary.
00:05:15
It's as if choice is coded in
to our reproductive tracts.
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(Cheering and applause)
00:05:27
OK, so now we know why the blood is there.
00:05:30
And it's a pretty significant amount.
00:05:31
It's 30 to 90 milliliters of blood,
00:05:34
which is one to three ounces,
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and it can be more,
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and 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?
00:05:43
And why doesn't it just stay there
till the next cycle, right?
00:05:46
Like, you didn't get pregnant,
so why can't it hang around?
00:05:49
Well imagine if each month it got thicker
and thicker and thicker, right,
00:05:52
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.
00:05:59
And it's too much because we need
a thick uterine lining
00:06:02
for a very specific reason.
00:06:05
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
00:06:14
and there is the toll of raising a child
until it is independent.
00:06:18
And evolution --
00:06:19
(Laughter)
00:06:22
That goes on longer
for some of us than others.
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(Laughter)
00:06:27
But evolution knows
about risk-benefit ratio.
00:06:31
And so evolution wants to maximize
the chance of a beneficial outcome.
00:06:35
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?
00:06:43
You make them work for it.
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You give them an obstacle course.
00:06:47
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 reach this détente
00:06:59
with the lining
of the uterus that we have.
00:07:01
So we have this thick uterine lining
00:07:03
and now it's got to come out,
00:07:05
and how do you stop bleeding?
00:07:08
Well, you stop a nose bleed
by pinching it,
00:07:10
if you cut your leg,
you put pressure on it.
00:07:12
We stop bleeding with pressure.
00:07:14
When we menstruate,
00:07:16
the lining of the uterus
releases substances
00:07:18
that are made into chemicals
called prostaglandins
00:07:21
and other inflammatory mediators.
00:07:23
And they make the uterus cramp down,
00:07:25
they make it squeeze
on those blood vessels
00:07:27
to stop the bleeding.
00:07:29
They might also change
blood flow to the uterus
00:07:31
and also cause inflammation
and that makes pain worse.
00:07:34
And so you say, "OK,
how much pressure is generated?"
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And from studies
where some incredible women
00:07:41
have volunteered
to have pressure catheters
00:07:43
put in their uterus
00:07:44
that they wear
their whole menstrual cycle --
00:07:47
God bless them, because
we wouldn't have this knowledge without,
00:07:50
and it's very important knowledge,
00:07:52
because the pressure
that's generated in the uterus
00:07:55
during menstruation
00:07:56
is 120 millimeters of mercury.
00:07:58
"Well what's that," you say.
00:07:59
Well, it's the amount of pressure
that's generated
00:08:02
during the second stage of labor
when you're pushing.
00:08:05
(Audience gasps)
00:08:06
Right.
00:08:07
Which, for those of you
who haven't had an unmedicated delivery,
00:08:10
that's what it's like
when the blood pressure cuff
00:08:13
is not quite as tight as it was
at the beginning,
00:08:15
but it's still pretty tight,
00:08:17
and you wish it would stop.
00:08:18
So that kind of makes it different, right?
00:08:20
If you start thinking
about the pain of menstruation,
00:08:24
we wouldn't say
if someone needed to miss school
00:08:27
because they were in the second stage
of labor and pushing,
00:08:29
we wouldn't call them weak.
00:08:31
We'd be like, "Oh my God,
you made it that far," right?
00:08:34
(Laughter)
00:08:35
And we wouldn't deny pain control
00:08:37
to women who have
typical pain of labor, right?
00:08:41
So it's important for us to call this pain
"typical" instead of "normal,"
00:08:44
because when we say it's normal,
it's easier to dismiss.
00:08:47
As opposed to saying it's typical,
and we should address it.
00:08:51
And we do have some ways
to address menstrual pain.
00:08:55
One way is with something
called a TENS unit,
00:08:57
which you can wear under your clothes
00:08:59
and it sends an electrical impulse
to the nerves and muscles
00:09:02
and no one really knows how it works,
00:09:04
but we think it might be
the gate theory of pain,
00:09:06
which is counterirritation.
00:09:08
It's the same reason why,
if you hurt yourself, you rub it.
00:09:12
Vibration travels faster
to your brain than pain does.
00:09:16
We also have medications
00:09:17
called nonsteroidal
anti-inflammatory medications.
00:09:20
And what they do is they block
the release of prostaglandins.
00:09:24
They can reduce menstrual pain
for 80 percent of women.
00:09:28
They also reduce the volume of blood
by 30 to 40 percent
00:09:31
and they can help with period diarrhea.
00:09:34
And we also have hormonal contraception,
00:09:36
which gives us a thinner
lining of the uterus,
00:09:39
so there's less prostaglandins produced
00:09:41
and with less blood,
there's less need for cramping.
00:09:44
Now, if those treatments fail you --
00:09:47
and it's important to use
that word choice,
00:09:49
because we never fail the treatment,
00:09:52
the treatment fails us.
00:09:54
If that treatment fails you,
00:09:57
you could be amongst the people
00:09:58
who have a resistance
to nonsteroidal anti-inflammatories.
00:10:02
We don't quite understand,
00:10:04
but there are some complex mechanisms
00:10:06
why those medications
just don't work for some women.
00:10:09
It's also possible that you could have
00:10:13
another reason for painful periods.
00:10:15
You could have a condition
called endometriosis,
00:10:18
where the lining of the uterus
is growing in the pelvic cavity,
00:10:21
causing inflammation
and scar tissue and adhesions.
00:10:25
And there may be other mechanisms
we don't quite understand yet,
00:10:28
because it's a possibility
that pain thresholds could be different
00:10:31
due to very complex biological mechanisms.
00:10:34
But we're only going to find that out
by talking about it.
00:10:37
It shouldn't be an act of feminism
00:10:40
to know how your body works.
00:10:42
It shouldn't --
00:10:44
(Applause)
00:10:49
It shouldn't be an act of feminism
00:10:53
to ask for help when you're suffering.
00:10:57
The era of menstrual taboos is over.
00:11:02
(Cheers and applause)
00:11:07
The only curse here
00:11:09
is the ability to convince
half the population
00:11:13
that the very biological machinery
that perpetuates the species,
00:11:17
that gives everything that we have,
00:11:20
is somehow dirty or toxic.
00:11:22
And I'm not going to stand for it.
00:11:25
(Applause)
00:11:30
And the way we break that curse?
00:11:33
It's knowledge.
00:11:34
Thank you.
00:11:36
(Cheers and applause)
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