Dealing with Your Period: Damming the Crimson Tide

Sorry for not posting last week. I was feeling really shitty and just needed to take a sick day from life.  I don't know if I've mentioned this or not, but my husband and I recently moved from San Francisco to Portland, 600 miles from my whole family.  It's been hard, and while PDX is starting to feel more homey, I still miss the Bay Area and all the people there a lot.

Also I'm beginning to think that this whole once-a-week update thing isn't quite working for me.  Sometimes I'll run across something interesting and think, "Hey, I should put that on the Vagina Blog," and then come Friday I'll have totes forgotten about it.  So I'm going to try being more spontaneous with posting - keep doing at least one planned post a week but also have articles and videos and stuff in between as I find them.

Moving on. I posted recently about the mechanics of getting your period.  Now we're going to spend some time talking about what the hell you can do about it, starting with "feminine hygiene products," aka things you put in or near your vagina to keep you from ruining your cute new jeans.

Pads!

He is just so excited about all this.

Pads (aka maxi pads or sanitary napkins, which is a terrible association IMHO) are probably the first period product any of us uses.  They're these oblong sheets of cotton or similarly absorbent material, lined with plastic on the bottom and a bit of adhesive strip.  You stick them on your underwear and they absorb menstrual blood as it seeps out of your body.  Some of them, like our cheerful friend up there, have little "wings" that wrap around the edges of your undies to help prevent leaking over the side. Others have little channels or grooves around the perimeter that help redirect fluid to the center and away from the edges.

Pros:

• Super easy to use. Just stick 'em on and go.
• Good for people who have cramps.
• No risk of TSS (we'll get to that in a second).
• Tons of sizes and styles available.

Cons:

• Can sometimes feel like you're wearing a diaper, and they can show in tight clothing.
• Bulky to carry around.
• Prone to leaking over the edges.
• Hard to play sports or be active while wearing them. You definitely can't swim.
• Not useable if you wear thong or g-string underwear.
• Sometimes they smell, and since you can't flush them, that smell lingers around the trashcan where you dispose of them.

Tampons!

I have never been this cute while covered in blood.

When I discovered tampons as a teenager, it was incredibly liberating. Personally, I hated the feeling of wearing a pad, being all paranoid that someone would point it out, and worrying that it would leak (because at Catholic school, we wore skirts, and that would have been AWFUL).  Tampons are these little cylinders of cotton or other absorbent material that you stick up you vagina where they absorb menstrual fluid as it comes out of your cervix.  Tampons can be inserted directly or with the aid of an applicator (either plastic or cardboard, both very common in the US). Most of them have a little string on the bottom to help with pulling it out.  

Pros:

• When properly inserted, they're practically impossible to feel. And there is no way for someone else to tell you're using one.
• You can swim with one in, and they won't come loose during exercise or other vigorous activity.
• Unlike pads, tampons are flushable (though that's not recommended if you have older pipes). NEVER FLUSH A PLASTIC APPLICATOR. Those things need to be thrown into a trashcan.

Cons:

• There's a bit of a learning curve as you get used to using them.  Some women with smaller vaginal openings, or those with atypical hymens, can find them difficult if not impossible to insert.  Some women are also just uncomfortable "shoving something up there".
• You can't tell when it's "full" just by looking at it, as you can with a pad.
• Can be uncomfortable upon insertion, removal, or while using.  
• There is a very small risk of developing TSS or toxic shock syndrome from leaving a tampon in too long. TSS occurs when certain forms of Staphylococcus bacteria release toxins into the body, causing fever, rash, vomiting, and diarrhea.  It's estimated that only 3-4 out of every 100,000 tampons users will suffer from TSS in a given year, so the odds are very slim.

Menstrual Cups

A beautiful rainbow of things you cram up your vag.

"What's that?" I hear you say, "A third option?"  Yep.  Menstrual cups are becoming more and more common in Europe but haven't made much headway in the US, but they're a great alternative to tampons and pads.  Menstrual cups are silicon or latex cups that you insert into your vagina, over your cervix, where they catch menstrual fluid as it comes out.  They don't absorb anything, just hold it, and need to be removed, rinsed, and reinserted very 12 hours or so.

Pros:

• Nothing to throw away! A menstrual cup can last up to 10 years if taken care of properly, and there are disposable versions that are designed so you only need one for your whole period.  So not only are you not cluttering your trashcan with smelly pads or clogging your pipes with tampons, you're also keeping tons of waste out of landfills each year.
• Because they're reusable, you don't have to buy new ones every month, saving you money in the long run.  Even disposable, single-cycle cups are generally cheaper than a box of tampons or pads.
• They have a great capacity than pads or tampons and, as mentioned above, only need to be removed every 12 hours (as opposed to 6-8 for pads or tampons).
• In addition to absorbing menstrual fluid, tampons also absorb all the healthy natural lubrication that your vagina produces, and can leave you feeling dry and irritated. Cups don't absorb anything, they just collect menstrual fluid, so your vag is free to lubricate and self-clean as normal.

Cons:

• Menstrual cups are more expensive upfront than a box of tampons or pads.  While they will pay for themselves over time, the initial investment can feel like a lot of money.
• There's a much bigger learning curve compared to tampons or pads, and some women have a lot of difficulty inserting or removing a cup.  Using a different size or brand, or using a lubricant for insertion, can help with this but there's always a chance you just won't be able to / comfortable with using one.
• I don't meant to scare you, but I've read stories where a girl just freaking could NOT get her cup out and had to go the ER.  It happens.
• It can take some time to get used to wearing one, as they feel different from tampons.  You shouldn't really be able to feel it if it's inserted properly, but sometimes you just can.  Most menstrual cups have a little pull stick on the bottom to help get it out, and trimming this down (or getting on that has a ball or a ring on the bottom instead) can help make it more comfortable.
• "The Squick Factor." Using a menstrual cups means you get pretty up close and personal with your vagina and with your menstrual fluid.  Getting the cup in and out can require some rooting around inside yourself, which not everyone is comfortable with. You also have to empty and rinse the cup every 12 hours, which means coming in direct contact with the blood and tissue that comes out of your body during your period.  Some of us just get grossed out by it. Oh well.
• Can be hard to find, especially in the US. We're a "disposable economy", preferring to use and then throw away rather than clean and reuse.  For this reason it's often tough to find menstrual cups, though  I've seen them at places like Fred Meyer and Trader Joe's. MenstrualCup.co is a great resource for researching which cup might be right for you, and they ship all over the world.

No matter what type of "feminine hygiene product" you choose to use, ALWAYS HAVE BACKUP. Carry extra pads, panty liners (which are like mini pads, more comfortable but less absorbent), and/or tampons in your purse or bag or backpack, because you never know when you're going to have a leak.  If you choose to use a cup, carry tampons or pantyliners anyway as you get used to it, just in case you need them.  I recommend actually having a backup in every purse or bag you carry with you regularly, because there is nothing worse than your period starting unexpectedly, or springing a leak, and being trapped in the bathroom without any. Making a tampon out of toilet paper sucks.

On that note, carry extras also means you can help out someone else who gets stranded with an unexpected feminine emergency (femergency, if you will).  We've all been there, so help a sister out.

All about your period.

I've told my husband several times that menstruation is proof that God does exist, and He hates women.  It hurts, it's kinda gross*, and it makes some of us feel absolutely insane for about a week every month.

Seriously, this isn't fun.

Maybe not every girl feels that way about her period, but I do. Mother Nature's a jerk.

Anyway, let's put my opinions aside, and examine the mechanics of this whole thing.

We've talked a bit about hormones and their effects on puberty, and hormones are also the key players in menstruation.  The menstrual cycle ranges from 21-35 days in adult women, with a wider time variation in adolescents - like 20-45 days.  There are 4 stages of the menstrual cycle, of which a woman's period is only part.

1. Follicular phase
During this phase, there's a rise in FSH (follicle stimulating hormone, which we talked about last post), which stimulates follicles in the ovaries - hence the name of this phase.  These follicles secrete increasing amounts of estradiol and estrogen, which cause a new layer of endometrium to develop; the lining of the uterus will grow and thicken, preparing for potential implantation of a fertilized egg.  The estrogen also stimulates your cervix to create a different kind of mucus.  If you're tracking your cycles as a method of birth control or trying to conceive, this change in mucus is a good indicator that ovulation is about to start.

2. Ovulation
During ovulation, one of those follicles that got all stimulated during the follicular phase will rupture and release its egg, around 12 days after the end of your last period.  There is a huge rise in LH (luteinizing hormone) lasting about 48 hours, which is what causes the follicle to burst.  It appears to be random whether the left or right ovary is involved in ovulation, and sometimes both will release an egg.**  After being released from the ovary, the egg gets swept down the fallopian tube by the little cilia inside it.  If the egg isn't fertilized in a day or two, it will disintegrate or dissolve in the fallopian tube.  If it is fertilized, the egg will immediately begin development and continue its journey, reaching the uterus in about 3 days and implanting in about 3 more.

For some of us, ovulation comes alongside a pain called mittelschmerz ("middle pain" in German), which is pain in the lower abdomen and pelvis.  There are many things that can cause this pain: swelling ovarian follicles, the egg breaking through the ovary wall, contraction of the fallopian tubes as they move the egg along, muscle contractions in the ovary and its ligaments, or blood and other fluids released from the egg follicle as it ruptures.  For some women, the pain is so localized that they can tell which ovary is releasing an egg that month.

3.  Luteal phase
After ovulation, FSH and LH cause the ovarian follicle to develop into this structure called the corpus luteum (hence luteal phase), which releases high levels of progesterone that causes the uterine lining or endometrium to thicken.  If the egg is fertilized, the corpus luteum will continue to release progesterone, maintaining the thick lining of the uterus until the placenta grows to take over the job, at which the corpus luteum decays to become a little lump of scar tissue on the follicle (each ovarian follicle only gets to be the star once).

If the egg is not fertilized, the corpus luteum will stop progesterone production and decay after about 14 days, turning into scar tissue.  The sudden drop in progesterone is what causes the uterine lining to slough off during menstruation.

4. Menstruation
I think this tumblr post defines it best:

Seriously though your period is like coming home one day and finding that your spouse has constructed this entire new baby bedroom inside your house and you have to tell them “Sweetie we don’t have a baby” and then your spouse FLIPS THE FUCK OUT like “The FUCK do you mean we don’t have a baby I DID ALL THIS WORK” and then they spend the next week tearing the whole room apart and throwing it out into the street and screaming at you and then finally when the room is completely gutted they calm down and say “It’s okay hon we’ll have a baby next month” and then they start building the room again AND THIS SHIT KEEPS GOING FOR THE REST OF YOUR LIFE UNTIL YOU HIT LIKE 50 AND THEN YOUR SPOUSE LEAVES YOU BUT NOT BEFORE SETTING THE WHOLE HOUSE ON FIRE SO IT’S NEVER THE SAME AGAIN


The average period lasts between 3 to 5 days and the first couple days are often accompanied by painful cramping ... just everywhere.  All those hormones running around your system can make you kind of crazy (I cry at insurance commercials).  Sorry.  Daily Grace has some tips for survival:

That's it for this week. Stay tuned  for more period survival tips.

*I don't mean to say that having a period is gross - it's a natural process that most women experience and it's just something our bodies do.  It's nothing to be ashamed of or repulsed by. It just trips my own personal
"ick factor." I just find blood gross, even when it's my own, and especially when it's leaking from a place in my body that I'd rather only be used for fun things.

** If both of these eggs get fertilized, they result in fraternal twins.  Fun fact: my dad is a fraternal twin.  Identical (or maternal) twins result when a single egg is fertilized and then splits in two during early development.

Puberty and hormones!

Thanks for putting up with my hiatus last week. The move went well, even with an unexpected new kitty to bring along.  Just a reminder that I'm not going to be posting next Friday either, as it's my BFF's wedding.

So, now, onto today's post topic: puberty and the hormones that cause it.

Hormones are, at their most basic level, chemical signals from one part of your body that tell another part of your body to do something. Organs, glands, and even individual cells can produce hormones, and these hormones can have any effect from changing your metabolism to signalling fight-or-flight response to causing mood swings.  They're the little buggers responsible for PMS (and the menstrual cycle in general), growth spurts, and of course puberty.

Puberty is a progression of physical changes in which a child's body matures into an adult body, capable of reproduction.  Most girls hit puberty between ages 10 and 12, and finish it between 15 and 17.  Within this window, a girl will start menstruating and develop breasts and pubic hair, as well as experience growth spurts and the hardening of the long bones (like the femur in your thigh).

The onset of puberty is signaled by an increased production of a hormone called gonadotropin-releasing hormone (GnRH), which is responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland.

Basically, a part of your brain called the hypothalamus releases a hormone (GnRH) that tells your pituitary gland to make other hormones (FSH and LH).  These two hormones zip straight to your ovaries and tell them to get started producing estrogen and progesterone.  A specific form of estrogen called estradiol is the dominant hormone in female puberty, and it promotes the growth of the breasts and utuerus.  FSH also tells your ovaries to kick it into gear, causing the maturation of the little follicles inside that will eventually release ovum during ovulation.

The first sign that puberty has started is breast development, which starts around 10.5 years old on average. A hard, tender lump will develop right under the areola and over the next 1.5-2 years will slowly approach their mature size and shape; that starter lump will generally fade back into the rest of the breast tissue at the end of this development.  The areola will also grow in size and darken in color, and the nipple - which is typically an "innie" in children - will change to an "outie."

Another early sign of puberty is the development of pubic hair, which occurs right around the same time, or sometimes even slightly before, the breasts start to grow.  The first pubic hairs usually grow on the labia and then spread up and over the mons pubis, eventually forming the "pubic triangle," and often grows on the top of the inner thighs and close to the abdomen as well.

Next, your lady bits start changing.  The walls of your vagina will go from a bright red to a duller pink, and will also thicken a bit.  Vaginal secretions will change in order to maintain the pH balance - which keeps all the naturally occurring microbes there happy and healthy and fighting infections.  The labia majora and minora will also grow and change in color; the clitoris will grow as well. Shortly after breast development begins, the uterus, ovaries, and ovary follicles increase in size as they prepare to start menstruation.  They reach full functioning size in about 2 years, which is when a girl will typically experience menarchy - that is, her first period... which is fun.

What, wasn't everyone's like this? No? Okay then...

Anywhere between ages 8 and 16 is normal for a girl to start her period, and the length of the menstrual cycle will be unpredictable for the first few years.  Just because you start having your period doesn't necessarily mean you're ovulating - 80% of girls don't actually ovulate for the first year of cycles, 50% for the first three years, and 10% for the first 6 years.  The full nitty-gritty details of menstruation will be covered in the next post (June 7).

Another delightful change in puberty is the shift in body proportion and body fat distribution.  Rising levels of estrogen cause the shape of the pelvic bone to change, widening the hips (which makes a wider birth canal).  Fat tissue rises to a higher percentage than that of males (about 6% more), popping up in the breasts, thighs, hips, butt, pubic mound, and upper arms. This higher level of fat is essential for maintaining and regulating the amounts of hormones needed for the menstrual cycle, which is why girls with low body fat and low weight tend to have more irregular periods.  Those same hormones that regulate the mentsrual cycle are also necessary for bone development, which is why irregular periods correlate highly with osteoporosis (weak and brittle bones).

Self-disclosure time: I'm in recovery from anorexia nervosa.  From age 16 to about 23, I was deeply engrossed in my eating disorder and greatly underweight.  Even on birth control, I had extremely irregular periods, often going 6 months or more without one.  Because of this, I have osteoporosis and osteopenia (which is basically pre-osteoporisis) despite being only in my late 20s.  I've been in recovery for about 4 years now, at a healthy weight and with regular periods (still on birth control) and my bone health is slowly improving, but the damage I did to myself is very real.  Not just to my bones, but to my heart, reproductive system, and other vital organs, which all suffered due to prolonged malnutrition.  I guess what I'm trying to say with this is... be good to yourselves, ladies.

Okay, where was I? Right. The many wonderful changes caused by puberty.

All those hormones running through your body will also change the composition of your sweat, which can make it smell different... which is why oh so many teenagers really can benefit from proper use of soap and deodorant.  These hormones can also cause your skin to produce more oil, leading to zits and full-on acne.  For some of us, these zits and BO will mostly go away as puberty ends, but many times some degree of body odor and break-out will continue into adulthood. Thanks, hormones. Really, you shouldn't have.

Tune in in two weeks for a roadmap of menstruation.ho