It's been a red-letter couple weeks for menstruation-related media. First came Olivia Goldhill's call for funding for period-pain research in Quartz, followed by news of a policy in China's Anhui province to institute a "paid menstrual leave" program.
In many ways, stories like this are positive, simply because they challenge the notion that periods are inherently wrong and shameful and should never be discussed. We live in a world, after all, where children grow up thinking menstrual blood is blue, legislators are silenced for using the word "vagina" during session, and, from a young age, we're taught to speak about periods in euphemisms ("ladies don't discuss that time of the month"). Judy Blume's classic Are You There God? It's Me, Margaret was published 46 years ago, but still serves as "Periods 101" for many girls -- a testament not only to the timelessness of her writing, but also to how little this discussion has progressed over the past few decades.
At the same time, though, both stories reveal a deeper problem with the way we discuss menstruation. The stigma surrounding periods, it turns out, cuts both ways: While menstruation isn't taken seriously as an actual medical condition, it's also seen as being so serious, it can render some women unable to function.
Welcome to the Period Paradox.
Our culture of shame has enabled the medical community to dismiss what is, for many, the very real and even debilitating issue of period pain. Up to 90% of girls and women experience some type of menstrual pain, with about 20-25% experiencing moderate to severe pain. Yet all too often, doctors don't prescribe or suggest anything beyond taking an extra dose of ibuprofen to treat symptoms of menstruation. The other two commonly offered remedies -- the oral contraceptive pill or IUD -- may alleviate severe pain for many, but don't work for everyone; for some people, there are simply no effective treatments. And even if you are one of the lucky ones who respond well to hormonal adjustments, there is no guarantee that your insurance company will cover your "birth control" -- regardless of its intended purpose. Surgery is one possible treatment for endometriosis -- a condition where tissue similar to uterine lining grows outside of the uterus, resulting in severe pain -- but for many of the 176 million people worldwide who suffer from the condition, even surgery does not alleviate the pain.
As Goldhill's story correctly pointed out, treatments are insufficient in part because of limited research into period pain -- a natural byproduct of a culture that's stigmatized the menstrual process. This gap in research is not only a public health issue, but problematic from a research ethics perspective. The ethical principle of justice dictates that the benefits and burdens of research should be shared. This includes, for example, determining which areas of research to fund, taking into consideration the seriousness and fatality of the health conditions being studied, as well as the number of people affected by the condition. In the case of period pain, the lack of research funding for a condition that affects more than half the population at one stage in their lives is hardly a fair use of resources.
Laura Payne, Ph.D., an assistant adjunct professor at the UCLA Pediatric Pain and Palliative Care Program, points to several reasons for the limited research on menstrual pain. "It's possible that because it seems so common, it may not [be seen to] warrant further investigation," says Dr. Payne, who is also the principal investigator for a National Institutes of Health (NIH)-funded research project examining mechanisms of menstrual pain.
There's also the fact that women's health issues in general are not treated as seriously. According to Dr. Payne, most basic scientific research has been carried out on male rats, and only recently has there been a push to focus on including female rats.
Not all of the issues stem from stigmas; as Dr. Payne notes, "Personally, I think that research has been lacking because research on menstruation is really challenging." The menstrual cycle is a multifaceted process that requires "a very careful approach including multiple assessments of hormones [and] attempts to pinpoint ovulation," which can be burdensome for both researchers and research participants. Yet she also acknowledges that it's "also conceivable that, decades ago, discussing one's menstrual cycle was seen as inappropriate and perhaps there is some carryover from those days."
Dr. Payne does note that "times are changing" in terms of NIH-funded research into menstrual pain. For one thing, a number of high-profile academic articles published recently demonstrate that painful menstruation may share common features with other chronic pain problems; for example, abnormalities in how pain is processed in the brain. There is also a hypothesis that painful menstruation may be an early indicator that a person could potentially develop more serious chronic pain problems in the future.
But while this progress is promising, it doesn't change the fact that on a systemic level, the medical community hasn't adequately treated or researched the symptoms of menstruation.
Which raises the question: How do we get period pain to be taken seriously without letting it define and restrict us?
There are myriad examples of our culture dismissing women outright because of their periods. The most egregious recent example of this was, of course, Donald Trump rebuffing Megyn Kelly's debate questioning of him by remarking, "There was blood coming out of her eyes, blood coming out of her wherever." But the list hardly ends there. Menstrual symptoms have been used to justify keeping women out of everything from the military to the Supreme Court to the Oval Office. Being a complex, multifaceted biological process and something that affects most women at some stage in their lives, periods have been used as a lazy means of systemic oppression -- an easy way to automatically disqualify women from all manners of ranks and positions.
The story about China's new policy taps into this damning stereotype. While ostensibly progressive, the policy requires a "certificate from a legal medical institute or hospital," exists largely in name only, and is not without criticism. In addition to requiring you to disclose your menstrual and fertility cycles to your employer, there is also the possibility that it could result in increased discrimination against hiring women -- not to mention potentially reinforcing the notion that periods incapacitate all women, all the time.
Periods do not have to be -- nor should they be -- an all-or-nothing issue. As far-fetched as it sounds, it is entirely possible to adequately fund research into menstrual pain and take it seriously as a medical condition without undermining women's capacity to fully function in society.
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