Flow: The Cultural Story of Menstruation (27 page)

Chapter 12

WHEN GOOD PERIODS GO BAD

W
E ARE NOT WHAT YOU’D CALL ESPECIALLY ghoulish or morbid. When finding ourselves in places such as, say, the Mutter Museum of anatomical oddities and pathological specimens in Philadelphia (home of preserved conjoined twins in a jar, a five-foot-long human colon, and the world’s largest ovarian cyst), we tend to grow pale and feel an urgent need to be elsewhere. Nevertheless, we harbor a secret, sneaking fascination with that rarest of conditions, the oddest of medical oddities: vicarious menstruation.

Vicarious menstruation is a genuinely weird physical condition in which monthly bleeding occurs from parts of the female body … that aren’t the uterus! This is not to be confused with stigmata, the inexplicable appearance of cuts and sores on the hands, feet, and sides of certain saints and martyrs, corresponding to the Five Wounds of Christ. Vicarious menstruation happens well outside the realm of religious mysticism, and is in fact related to the menstrual cycle. Once a month, blood painlessly, eerily flows for a few days from the lungs, breasts, fingers, elbows, mouth, ears, or even eyes, and then mysteriously stops.

Talk about embarrassing!

The organ most implicated in vicarious menstruation is the nose. One typical case, reported in 1908, involved a fifteen-year-old girl who bled heavily from her nose every month. The doctor “plugged the nares with absorbent cotton” and then prescribed regular dosings of the herb apocynum. Plugging those nares apparently did the trick, as the doctor triumphantly reported several months later that his patient had grown “lazy, fat and saucy, with normal menstruation.”

Feeling a bit saucy ourselves, we would like to point out that bleeding from the nares, or nostrils, every month isn’t as totally out there as it might first appear to the uninitiated. In fact, mucous membrane normally tends to be pretty responsive to estrogen, leading to the observation that many women routinely experience pronounced rhinorrhea before their periods. Rhinorrhea, which admittedly sounds as if one has begun to resemble a large, horned African mammal, is in fact plain old nasal swelling and congestion; and believe it or not, it’s so common, it’s considered a routine symptom of PMS.

Another explanation of one kind of vicarious menstruation involves surgical error. During common procedures like cesarean section, fibroid removal, or episiotomy, tiny shards from the uterine lining can be inadvertently implanted in the incision. Instead of peacefully dying, these bits of living tissue, pieces from one’s own uterus, can on occasion settle down in their new home and even flourish. Next thing you know, they’re acting as if it’s business as usual, continuing to menstruate each month, as they respond to the ebb and flow of hormones.

Vicarious menstruation is one of those Ripley’s Believe It or Not events that’s good to trot out during long car rides or boring dinner parties. While few women actually experience it, this is by no means to say that there aren’t all kinds of things that can and often do go wrong with menstruation. Some menstrual problems are mildly annoying, whereas others are extremely painful, messy, and downright dangerous. Some problems are as common as dirt, and others can even kill you. And still others, it can be argued, have changed history.

England’s Queen Mary the First (funnily enough, nicknamed “Bloody Mary” for the way she went after those pesky Protestants) never menstruated and was technically barren. Without a male heir, the throne eventually went to her half sister, Elizabeth—thereby changing the history of England forever. Visionary French heroine and eventual saint Joan of Arc died at twenty, without ever having had a period. Feminist/ anarchist Emma Goldman had a lifetime of painful menstruation, and experienced what appears to have been stress-induced premature menarche, fleeing the pogroms by swimming through icy waters. Were these women warriors affected by menstrual pathologies? We’ll obviously never know … but it’s an interesting new lens through which to view history, no?

One of the most typical menstrual problems is when women of reproductive age just stop menstruating altogether, or don’t even start in the first place. This is called amenorrhea and can be caused by any number of routine and benign factors, such as pregnancy or breast-feeding. It can also be caused by pseudocyesis, or “hysterical pregnancy.” This occurs when a woman is so absolutely convinced she’s pregnant, she can literally go for years without having a period—and some have.

Primary amenorrhea happens when an adolescent female still hasn’t started to menstruate, long after her peers have started skulking off to the bathroom during math class. And for those of you with searing memories of not getting your period until you were fourteen, fifteen, even sixteen, you can stop worrying: you definitely did not have pri-mary amenorrhea. Medically, “normal” is anywhere between nine and seventeen. It’s only after a female hits eighteen sans period that she’s said to have primary amenorrhea.

Primary amenorrhea can be caused by an underlying developmental problem brought on by severe stress or malnutrition. Funnily enough, it can be triggered by not only extreme weight loss caused by anorexia or bulimia, but morbid obesity, as well. It can also be caused by an underlying physiological condition, such as malfunctioning ovaries, the lack of a uterus, or some other genetic abnormality. In fact, many women with primary amenorrhea actually have an undiagnosed form of hermaphroditism that can be treated, once it’s been detected.

Secondary amenorrhea occurs when a woman of reproductive age simply stops menstruating. The exact causes are still somewhat up in the air, although it seems to be triggered by hormonal imbalances, as well as by loss of weight and body fat. Amenorrhea can be brought on by rigorous athletic training or extreme dieting and, as a result, frequently affects athletes, models, ballet dancers, and women with eating disorders. Scarily, years of not menstruating can lead to significant bone loss and bone mineral density, especially in the lower spine.

But how does it work, anyway? What’s the correlation between weight loss, athletic endeavor, and no periods?

To figure it out, let’s first take out our calculators for our favorite piece of math trivia. When a woman loses 10 to 15 percent of her overall weight, she’s actually losing up to one-third of her body fat. That, my friends, is a lot of fat! One theory suggests that since estrogen isn’t just produced by the ovaries and adrenal glands, but by fatty tissue, such a drop in fat levels would mean a drop in one’s estrogen levels, as well … causing menstruation to stop.

Illustrated Encyclopedia of Sex, Cadillac Publishing Company

At the same time, there’s evidence that amenorrhea among female athletes isn’t just about fat levels. It could be that the production of endorphins, the naturally occurring “happy drug” the brain produces after intense exercise, somehow inhibits luteinizing hormone production up in the pituitary gland. Or it might instead have something to do with stress—not just the physical type, but the kind brought on by the intense focus and competition of serious sports. Some researchers make a convincing argument that emotional stress appears to be a predisposing factor for most cases of not just amenorrhea, but other kinds of menstrual disorders, as well, whether you’re a serious athlete in training or just a regular ol’ slug-a-bed, like the rest of us.

Fibroids occur in anywhere from 20 to 40 percent of all menstruating women, although most of us aren’t even aware that they’re there.

The flip side of amenorrhea is “menorrhagia,” or excessive menstrual flow. Since average flow is anywhere up to six or so tablespoons’ worth, anything more than that, or a flow that lasts longer than seven days, may indicate a problem. Menorrhagia is pretty common among IUD users. “Metrorrhagia” means bleeding outside of the normal time of one’s cycle. Both metrorrhagia and menorrhagia can be caused by any one of a number of factors, benign or distinctly unfriendly—fibroids, cervical polyps, endometriosis, even heart disease—and should be checked out by one’s doctor.

About one-fifth of all cases of irregular menstruation in women under forty are due to pelvic inflammatory disease, or, more snappily, PID. PID occurs when an infection contracted in, say, the vagina travels upward to the fallopian tubes and then up into the abdominal cavity. PID not only causes weird patterns of bleeding, it can be incredibly painful, dangerous, and potentially deadly. Luckily, it can be handled with antibiotics, although treatment often takes time.

There are other common causes for crazy, out-of-control menstrual flow. Myomas are a kind of tumor, and the most common are benign uterine fibroids. Fibroids occur in anywhere from 20 to 40 percent of all menstruating women, although most of us aren’t even aware that they’re there. No one seems to be exactly sure where they come from, although they seem to run in families. In addition, African-American women seem more prone to fibroids than other women.

While fibroids aren’t caused by the menstrual cycle, their growth is stimulated by estrogen … and take it from us, boy, can they grow! The largest one in recorded history topped out at 143 pounds back in 1888. Needless to say, fibroids can be amazingly uncomfortable and also cause heavy bleeding for days on end. A woman can even start hemorrhaging and eventually develop anemia, in which case a doctor may very well recommend dilation and curettage, more commonly called a D&C. In a D&C, the cervix is dilated, or opened up; then a curette, a long rod with a sharp loop at the end, is inserted and used to carefully scrape out the lining of the uterus. A D&C requires general anesthesia if one is undergoing it or, in our case, even describing it. A woman may also opt for surgical removal of the fibroids or having the entire endometrium cauterized.

One thing to keep in mind: as far as some health-care providers are concerned, menstrual flow abnormalities are just a part of life for certain women. Certainly, once you hit your forties all bets are off: by then, most women normally experience heavier flow and wildly irregular cycles. Unless the problem itself poses an actual health threat or seems to indicate a bigger underlying problem, some doctors won’t even prescribe treatment. They will instead suggest one merely hang tough until it all ends, i.e., menopause. While this may work fine for some women, it’s just not an option for others. Furthermore, this doesn’t mean you shouldn’t seek out medical advice if you find you’re mysteriously bleeding like a stuck pig for days on end.

There’s a depressing fact that we ourselves never enjoy thinking about, which is that excessive or unusual bleeding can also be a sign of cancer. If you haven’t already, please do everyone a favor and start getting in the habit of scheduling that regular Pap test! Not to sound like your mother or anything, but getting checked regularly for cervical cancer has got to be at least as important as having one’s teeth examined, taxes filed, or winter woollies dry-cleaned.

Scientists have known for more than a hundred years that there’s also a correlation between menstruation and epilepsy; studies have shown that seizures occur in 72 percent of females with epilepsy when they’re bleeding. The most notorious of menstruating epileptics may well have been Massachusetts spinster/crazed ax murderess Lizzie Borden, made famous by the annoyingly catchy rhyme:

Lizzie Borden tookan ax

And gave her mother forty whacks

And when she saw what she had done

She gave her father forty-one.

In fact, thirty-three-year-old Lizzie probably suffered from epilepsy of the temporal lobe, only had seizures when she was having her period, and most likely did kill both her father and stepmother during one such crazed menstrual bout. This is not to make Lizzie appear to be some kind of hapless victim of her uterus; there seemed to be quite a few unresolved hostility issues in the Borden household to begin with, as evidenced by at least one previous murder attempt. Nevertheless, Lizzie was acquitted of all charges, due to a combination of inept police work, flabby prosecution, and the overriding disbelief in 1892 that a nice girl could do such an awful thing. Lizzie’s seizures eventually stopped when she hit menopause: a happy ending for Lizzie, if not for her parents.

Menstruation can routinely aggravate various chronic illnesses and disorders, causing flare-ups and outbreaks: migraines, insomnia, asthma, arthritis. These almost always die down again once flow is over. During one’s period, chronic infections like shingles or herpes are more likely to rouse themselves from dormancy and make an unwelcome appearance; diabetics find they have a harder time controlling their condition. And during the premenstrual time, all kinds of diseases, like pneumonia, hepatitis, scarlet fever, and the flu, tend to occur more frequently.

“And what about all that blood loss?” we hear you ask. What about anemia, the specter of which has been used to terrify girls into eating disgusting platefuls of liver and other organ meats since time immemorial? What about leaching all that precious iron, month after month, year after year?