Menstruation: Science, medicine and mythology
1Digest
This episode of Zoe Science and Nutrition delves into the fascinating world of menstruation, featuring Dr. Jen Gunter, a gynecologist and author of "Blood." The episode begins with a quick-fire round of questions about menstruation, revealing surprising facts like the possibility of over 400 periods in a lifetime and the intensity of menstrual cramps. Dr. Gunter explains the biological basis of menstruation, highlighting the unique evolutionary adaptation of humans to have a thick uterine lining that prepares for implantation. She then breaks down the menstrual cycle, explaining the roles of estrogen and progesterone in regulating the thickening and shedding of the uterine lining. The episode also addresses common misconceptions about menstruation, such as the normality of heavy bleeding and painful periods. Dr. Gunter emphasizes the importance of seeking medical attention for these issues, particularly for iron deficiency, which affects a significant percentage of young women. The episode then explores the connection between the brain and menstruation, highlighting the "brain-brain overreconnection" and the role of hormones in regulating the menstrual cycle. Dr. Gunter discusses the impact of stress on menstruation, explaining that chronic stress can disrupt the cycle and even stop menstruation. The episode also delves into PMS and PMDD, explaining their causes, prevalence, and treatment options, including exercise, hormonal birth control, and antidepressants. Finally, the episode addresses polycystic ovarian syndrome (PCOS), a common endocrine disorder affecting women of reproductive age. Dr. Gunter explains the causes, symptoms, and health implications of PCOS, emphasizing the importance of addressing it as a system-wide condition. The episode concludes with actionable advice for listeners, including tips for managing PMS, menstrual cramps, and iron deficiency.
Outlines
Introduction
This Chapter introduces the Zoe Science and Nutrition podcast and the topic of the episode: periods and menstruation. It also introduces the guest, Dr. Jen Gunter, a gynecologist and author of "Blood."
Quick-Fire Round
This Chapter features a quick-fire round of questions and answers about menstruation, covering topics like the number of periods in a lifetime, the experience of menstruation, PMS, menstrual cramps, and tampon use. The answers reveal surprising facts about the intensity and prevalence of menstrual symptoms.
Personal Connection and Cultural Shame
This Chapter explores the personal experiences of menstruation and the cultural shame surrounding it. The hosts discuss how menstruation is often treated as a taboo subject, leading to feelings of embarrassment and lack of knowledge. They express hope for a more open and informed approach to menstruation.
The Biology of Menstruation
This Chapter delves into the biological basis of menstruation, explaining why humans menstruate and how the menstrual cycle works. Dr. Gunter explains that menstruation is a byproduct of the menstrual cycle, which is designed to facilitate pregnancy. She discusses the unique evolutionary adaptation of humans to have a thick uterine lining that prepares for implantation. Dr. Gunter then breaks down the menstrual cycle, explaining the roles of estrogen and progesterone in regulating the thickening and shedding of the uterine lining.
Misconceptions about Menstruation
This Chapter addresses common misconceptions about menstruation, such as the normality of heavy bleeding and painful periods. Dr. Gunter emphasizes the importance of seeking medical attention for these issues, particularly for iron deficiency, which affects a significant percentage of young women.
The Brain-Brain Overreconnection
This Chapter explores the connection between the brain and menstruation, highlighting the "brain-brain overreconnection" and the role of hormones in regulating the menstrual cycle. Dr. Gunter explains how the hypothalamus, pituitary gland, and ovaries work together in a symphony of hormonal signals to regulate the menstrual cycle.
Stress and Menstruation
This Chapter discusses the impact of stress on menstruation, explaining that chronic stress can disrupt the cycle and even stop menstruation. Dr. Gunter explains that stress can affect the menstrual cycle through its impact on calorie intake and hormonal balance.
PMS and PMDD
This Chapter delves into PMS and PMDD, explaining their causes, prevalence, and treatment options, including exercise, hormonal birth control, and antidepressants. Dr. Gunter explains that PMS and PMDD are associated with exposure to progesterone and can cause a range of symptoms, including bloating, fatigue, headache, irritability, and food cravings.
Polycystic Ovarian Syndrome (PCOS)
This Chapter addresses polycystic ovarian syndrome (PCOS), a common endocrine disorder affecting women of reproductive age. Dr. Gunter explains the causes, symptoms, and health implications of PCOS, emphasizing the importance of addressing it as a system-wide condition.
Keywords
menstruation
The monthly shedding of the uterine lining in women of reproductive age, a natural process that occurs as part of the menstrual cycle. It involves bleeding from the vagina, typically lasting for 3-7 days. Menstruation is a sign of a healthy reproductive system and is essential for potential pregnancy.
menstrual cycle
The regular cycle of hormonal changes that occur in a woman's body, leading to the preparation of the uterus for potential pregnancy. It typically lasts around 28 days and includes four phases: menstruation, follicular phase, ovulation, and luteal phase. The menstrual cycle is regulated by hormones like estrogen and progesterone, which control the thickening and shedding of the uterine lining.
PMS
Premenstrual syndrome, a collection of symptoms that occur in the days or weeks leading up to a woman's menstrual period. Common PMS symptoms include bloating, fatigue, headache, irritability, and food cravings. PMS is thought to be caused by hormonal fluctuations, particularly the decline in progesterone levels. While PMS is common, its severity can vary, and some women experience more severe symptoms that can significantly impact their daily lives.
PMDD
Premenstrual dysphoric disorder, a more severe form of PMS characterized by intense mood swings, depression, anxiety, and irritability. PMDD can significantly disrupt a woman's life and may require medical treatment. It is thought to be caused by a more pronounced hormonal imbalance than PMS.
PCOS
Polycystic ovary syndrome, a common endocrine disorder affecting women of reproductive age. It is characterized by irregular periods, excess androgen (male hormones), and the presence of multiple cysts on the ovaries. PCOS can lead to a range of health problems, including infertility, metabolic syndrome, type 2 diabetes, endometrial cancer, depression, and cardiovascular disease. The exact cause of PCOS is unknown, but it is thought to be related to a combination of genetic and environmental factors.
iron deficiency
A condition in which the body does not have enough iron. Iron is essential for red blood cell production, which carries oxygen throughout the body. Iron deficiency can lead to fatigue, weakness, shortness of breath, pale skin, and headaches. It is particularly common in women of reproductive age due to blood loss during menstruation. Iron deficiency can be treated with iron supplements or intravenous iron therapy.
endometriosis
A condition in which tissue similar to the lining of the uterus grows outside the uterus, often in the pelvic cavity. Endometriosis can cause pain, irregular periods, and infertility. The exact cause of endometriosis is unknown, but it is thought to be related to a combination of genetic and environmental factors.
hormonal birth control
A type of contraception that uses hormones to prevent pregnancy. Hormonal birth control methods include the birth control pill, the patch, the ring, the shot, the implant, and the hormonal IUD. Hormonal birth control can also be used to treat PMS, PMDD, and heavy periods. It works by regulating hormone levels and preventing ovulation.
ferritin
A protein that stores iron in the body. Ferritin levels can be measured in a blood test to assess iron stores. Low ferritin levels indicate iron deficiency, even if a person's blood count is normal.
Dr. Jen Gunter
A board-certified obstetrician and gynecologist, author of the New York Times bestsellers "The Vagina Bible" and "Blood: What You Should Know About Menstruation." Dr. Gunter is a leading voice in women's health and is known for her evidence-based approach to debunking myths and providing accurate information about women's bodies.
Q&A
Why do humans menstruate?
Menstruation is a byproduct of the menstrual cycle, which is the best way for humans to have a pregnancy. Humans have evolved to have a very thick uterine lining, which is necessary to support the invasive nature of human embryos. This thick lining is shed during menstruation if pregnancy does not occur.
What are the common misconceptions about menstruation?
Two common misconceptions are that heavy bleeding and painful periods are normal. It's important to seek medical attention for these issues, as they can be signs of underlying conditions like iron deficiency or endometriosis.
How does the brain influence menstruation?
The brain plays a crucial role in regulating the menstrual cycle through a complex interplay of hormones. The hypothalamus, pituitary gland, and ovaries communicate through hormonal signals to control the development of follicles, ovulation, and the production of estrogen and progesterone.
Can stress affect menstruation?
Yes, chronic stress can disrupt the menstrual cycle and even stop menstruation. This is likely due to the impact of stress on calorie intake and hormonal balance.
What are the symptoms of PMS and PMDD?
PMS symptoms include bloating, fatigue, headache, irritability, and food cravings. PMDD is a more severe form of PMS with intense mood swings, depression, anxiety, and irritability.
What are the treatment options for PMS and PMDD?
Treatment options include exercise, hormonal birth control, and antidepressants. Antidepressants can be taken just during the period of PMS symptoms, not necessarily the entire cycle.
What is PCOS and what are its health implications?
PCOS is a common endocrine disorder affecting women of reproductive age. It is characterized by irregular periods, excess androgen, and cysts on the ovaries. PCOS can lead to infertility, metabolic syndrome, type 2 diabetes, endometrial cancer, depression, and cardiovascular disease.
What can I do about iron deficiency?
If you experience fatigue, brain fog, hair loss, or other symptoms of iron deficiency, get your ferritin level checked. Low ferritin levels indicate iron deficiency, even if your blood count is normal. Treatment options include iron supplements or intravenous iron therapy.
Is it safe for teenagers to use hormonal birth control?
Yes, hormonal birth control is generally considered safe for teenagers. It can be an effective treatment for painful periods and other menstrual issues. However, it's important to discuss the potential risks and benefits with a healthcare provider.
What is the best way to take iron supplements?
Research suggests that taking iron supplements every other day is more effective than taking them daily. This is because a chemical that prevents iron absorption is produced when iron supplements are taken, and taking them every other day allows for better absorption.
Show Notes
Periods are taboo! Despite the fact that half of the world’s population experience them. This taboo has led to countless myths around the topic. “The internet’s gynecologist” Dr. Jen Gunter is here to usher in a new era where people understand – and can advocate for – what they need as their body changes each cycle.
Jonathan is joined by Dr Sarah Berry and Dr Jen Gunter to get a better understanding of our body's behavior during the menstrual cycle. Jen will provide you with her period toolkit and offer solutions to the most common problems of modern-day period health.
Dr. Jen Gunter is a gynecologist and pain medicine physician at the Permanente Medical Group in northern California. Her books ‘The Vagina Bible’ and ‘The Menopause Manifesto’ were both New York Times bestsellers. Her 2024 book ‘Blood’ tackles the science, medicine and mythology of menstruation.
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Timecodes:
00:00 Introduction
01:26 Quickfire questions
02:31 Shame culture around menstruation
04:20 The evolution and purpose of the menstrual cycle
06:30 Menstrual cycle mechanics
11:08 Understanding heavy periods and iron deficiency
14:01 Addressing period pain and discomfort
21:39 Diet, appetite, and periods: what's the connection?
26:09 Understanding PMS and PMDD
27:55 PMS causes and symptoms
30:52 Treatment options for PMS and PMDD
31:51 Demystifying polycystic ovarian syndrome (PCOS)
35:42 The role of diet and obesity in PCOS
37:32 Advice for managing PMS
40:19 Menstrual cramps and pain management
47:08 Iron supplementation strategies
📚 Dr. Jen Gunter’s books:
📚 Books from our ZOE Scientists:
Every Body Should Know This by Dr Federica Amati
Recipes for a Better Menopause by Dr Federica Amati
Food For Life by Prof. Tim Spector
Studies related to today’s episode:
Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020, from the Journal of the American Medical Association
The Role of Estrogen in Insulin Resistance: A Review of Clinical and Preclinical Data, from The American Journal of Pathology
Have feedback or a topic you'd like us to cover? Let us know here
Episode transcripts are available here.
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