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Everyone who experiences periods has probably worried about them at some point. And I’m not talking the have-I-just-bled-onto-this-cushion worry, but the ‘is it supposed to hurt like this?’ ‘Is there supposed to be so much blood?’ ‘Is this normal?’ kind of worry. The trouble is, there’s a lot that’s still not known about what exactly constitutes a ‘normal’ period. Crazy heavy period? Normal. Cycles bizarrely short? Normal. In debilitating pain? Normal… At least, if you ask most doctors, that is. Medicine does wonders, there’s no denying that, but when it comes to specifically female illnesses and disorders, it can sometimes feel like we’re stuck in the pre-enlightenment days of medicine. It can be surprisingly hard to know when something’s actually wrong, what it is that’s screwing up, and how to fix it. I say ‘surprisingly’, but we live in a world in which old men never have to lose their hard-ons (here’s lookin’ at you, viagra) but there’s still no cure for your run-of-the-mill period cramps, so what I really mean is infuriatingly, maddeningly, outrageously. What I mean is, these disorders are so hard to identify and treat because medicine hasn’t tried hard enough. What I mean is, your pain is taken less seriously if you are female/have female reproductive organs.
I’m going to go over some of the most common menstruation-related hormonal imbalances and disorders and how to identify them. If you think you have any of these, go to your doctor. Go to your doctor and advocate for yourself. I really can’t stress this enough. If you think something’s wrong, don’t let them shoo you out the door with an eye roll and a dismissive comment about how ‘it’s just period pain’.
Last week we gave a little break down of what your cycle should look like, what your hormones will usually be doing at each point in their cycle, and how you can expect to be feeling at various points during the month. If you’re unfamiliar with what should be happening at various points in your cycle it can be hard to pinpoint when something’s off, so go check that piece out first!
This stuff isn’t super fun to talk about and it can be downright anxiety-inducting, but it’s must-have info, so stick with us.
So first up, we’ve got Endometriosis. This is one of the likely causes of heavy and/or painful periods. This one can affect people in drastically different ways. While an estimated 25% of people who have it don’t experience any pain, some people experience such pain that it totally prevents them from living their lives as normal.
Endometriosis is caused when the layer of tissue which normally grows inside the uterus – the endometrium – grows outside it instead, often on the ovaries, fallopian tubes, and other surrounding tissue. These cells still react to the menstrual cycle, meaning they bleed, but the body has no way of expelling that blood, the way it does when this process is happening where it’s supposed to: inside the uterus.
As mentioned, endometriosis can mostly be categorised as really F-ing painful. The majority of women who suffer from it will experience particularly painful periods, around half will experience pain even when they are not menstruating, bleeding throughout the month (when not actually menstruating), and pain during sex is also a common symptom.
Endometriosis takes, on average, seven and a half years to diagnose – and that’s from the first visit to the doctor. Yeah, not from the time your first symptom crops up, but from the first time you go to seek help. Seven. And a half. Years.
The medical profession is as susceptible to misogynistic bias as any other, and there’s a shocking number of women suffering unnecessarily because doctors send them home saying ‘it’s just period pain.’ The only way to be definitively diagnosed with endometriosis is to have a laparoscopy – basically a mini camera goes into your body through a small cut, enabling the doctors to have a mosey around your organs and see what’s causing your problems.
Endometriosis is thought to be hereditary, as having a family member with a history of the disease can put you at a higher risk – yet still, many people suffering from it are the first or only known case in their family. So the research is a bit useless/nonexistent. Yay. Let’s move onto treatments, shall we?
Unfortunately, there’s no known cure for endometriosis, and it can be difficult to treat. (No shit it’s difficult to treat when you’re treating sufferers like hysterical hypochondriacs who just need to accept that periods suck). Treatments include taking paracetamol and ibuprofen – which, if you have mad painful periods, I’d hazard a guess you’re already doing, thanks doc. Many doctors recommend various forms of hormonal birth control. If you have particularly bad case you may be recommended for certain surgeries, such as cutting away patches of the endometrial tissue or even removing some or all of the reproductive organs – in the case of removing the uterus, this is known as a hysterectomy.
Now it’s time for the next incredibly not-fun and under-researched illness! Polycystic ovary syndrome (or PCOS) is a condition in which your ovaries become enlarged and contain a number of fluid-filled sacs. These sacs contain eggs but are usually unable to release them – meaning it prevents ovulation from taking place. Again, it’s caused by hormone imbalances in the body, this time due to elevated androgens – the ‘male’ hormones. The main symptoms tend to be include very irregular or no periods. Other symptoms include excessive hair growth (hirsutism), weight gain, thinning hair or hair loss on head, oily skin or acne. PCOS is also linked to infertility but many women suffering from PCOS are still able to get pregnant with the right treatment.
It is thought that PCOS affects about 1 in 5 women but there aren’t any definitive numbers on the matter. Why? Well, an estimated half of sufferers exhibit little to no symptoms, but whether that’s due to a lack of education on the matter (people may be exhibiting symptoms but unaware of it) or a lack of recognitions of these symptoms on behalf of the doctors (failure to diagnose) is unclear. Let me know if you find a more satisfying answer.
The exact cause of PCOS is unknown, and there’s no known cure – what a surprise. But we do know some of the factors which increase your risk of developing it. Again, a family history of the condition is an indicator, but unfortunately not one you can control. Obesity puts you at a greater risk, as does not exercising. There are ways of treating the individual symptoms, however. Some people take meds for the hair growth, irregular periods, and fertility problems.
Next up, PMDD. PMDD stands for Premenstrual Dysphoric Disorder. It’s often confused with PMS (Premenstrual Syndrome), but it’s beginning to be recognised as an actual disorder you can seek help and get treatment for. Where PMS has become cultural shorthand for everything from a chocolate craving to snapping at a loved one to crying in Tesco, PMDD is a much more extreme version. It’s where the usual symptoms of hormone changes affecting mood and behaviour at particular points in your cycle are exacerbated to the point where your life cannot function as normal (whatever normal looks like to you). Emotional symptoms range from mood swings to suicidal thoughts, while physical symptoms include, muscle pain, breast pain or tenderness, and problems sleeping, to name a few.
The NHS doesn’t have any info specifically dedicated to this yet, but they do link you to the website of the mental health charity Mind, which indicates that it is starting to be taken seriously as a disorder. Hopefully by establishing a specific diagnosis (rather than just ‘a bad case of PMS’) it will help those who are truly suffering to get help, be it medication for moods, therapy, or hormone-controlling medication.
Sufferers report their PMDD symptoms taking over their lives for up to two weeks at a time – from the gradual decline in mood and behaviour, through the major depressive episode which could last about a week, to the recovery period of a few days. If that’s the case then it’s affecting a good 50% of your life – and definitely time to seek help.
The last hormone-induced disorder I’m going to cover here is Fibroids. Fibroids are non-cancerous growths which develop either inside the uterus or just outside of it. Now, it is possible to have fibroids and experience little to no symptoms. But if you do have them and aren’t quite so lucky, the symptoms tend to look pretty similar to those for endometriosis: heavy periods, pain during sex, and pain in your stomach or lower back. And the cherry on the top is that they can cause constipation. Similarly to other hormone-related conditions, fibroids can lead to complications with pregnancies or fertility. To be officially diagnosed with fibroids you’ll need an ultrasound.
And yet again, the cause of the things is not known. The NHS reckons they’re maybe linked to high levels of oestrogen, as they tend to shrink after menopause, when oestrogen levels decrease, and are more common in overweight or obese people who have periods due to higher levels of oestrogen.
Look, babe, you know your body better than anyone. If something doesn’t feel right to you for whatever reason, it can’t hurt going to the doctor. But I’d actively recommend it if you’re experiencing particularly painful or heavy periods. Similarly, if you’ve missed your period for 90 days or more (even if you aren’t having sex with cis men! There’s many reasons your periods could have stopped that have nothing to do with pregnancy and, while it could be nothing to worry about, it’s always worth being safe) or if a good chunk of your days each month are derailed by what seems to be a bad case of PMS, don’t suffer in silence.
I have exactly zero facts to back this up, but researching all these specifically female related illness and coming across the words ‘no cure’, ‘no known cause’, ‘poor diagnosis rates’ over and over again is making me pretty fucking mad so I’m gonna say it anyway. If these diseases and disorders were things men too suffered from, at the same rates, there would probably (definitely) be a cure. Just like there would be a definitive cure for period pain and free tampons coming out ya ears. But since that is not the world we live in, we’ve gotta have our own backs. If you are going to the doctor, be sure to advocate for yourself: be specific, don’t under-state your pain, and demand further testing if you think you need it.
Image credit @end_our_metriosis
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