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– A woman without menstruation is a luxurious woman – said gynecologist Dr. Tomasz Zając on the TV program and caused a media storm. Commenting on the periodgate scandal for MedTvoiLokony, the doctor claims that the hate he experienced is the result of the fact that for liberal American women menstruation is like a ball and for traditional Polish women it is a testimony of femininity. He argues that it is worth getting rid of menstruation. And explains how to do it.
Doctor, luxury is amenorrhea?
Not everyone correctly read my statement in the “Question for breakfast”. I meant the announcement of changes that may come soon. Professor Leszek Kołakowski, who has passed away for eight years, was and is my great idol. What he wrote and what he said allows me not only to better understand, but also to interpret the surrounding reality. To this day, I remember his mini lecture on luxury, that we associate the word luxury with immorality. And something exclusive, available only to a few. In times when you used to go to wells with a bucket, a tap with running water was a luxury. Similarly, a cell phone, Viagra and even the birth control pill were considered luxurious until recently. Time makes what we dreamed about yesterday, today is within our reach and becomes the norm.
More and more women in the West use the luxury you are talking about, but Polish women are stopping something from doing so. We still treat menstruation as an attribute of femininity?
Yes, that’s why in talking about the facts and myths about menstruation, I wanted to initiate a broader discussion. Show that a professionally active woman of the XNUMXst century does not have to treat menstruation as a sign given by nature. He can choose whether he wants it or not. Polish women have to jump out of the legend they were surrounded by all the years. Menstruation is not a symbol of femininity. It is also a myth that women feel better after their period. Naturally, if they suffer from PMS (premenstrual syndrome), i.e. mood swings, headaches, changes in appetite, they will feel better after menstruation. We do not have to associate amenorrhea with pregnancy or menopause, but with comfort.
You said “it’s a myth that you have to menstruate”. Is it against nature?
It’s less natural than we think. I am waiting all the time for a zoologist who will give me the example of a female mammal who menstruates (i.e. bleeds every month) – humans are the only species. And it is worth considering why. Hypothetically, if we were to function like animals, the woman might not have had her first period. She would be fertilized immediately after the first ovulation, and after pregnancy and breastfeeding, this pattern would be repeated. Women in pre-industrial societies had ten times fewer periods in their lifetime than women in civilized countries today, but they gave birth to more children and breastfed for a long time. With the invention of the contraceptive pill, things changed. Sex has ceased to be purely procreative and has become part of our culture. Women, on the other hand, gained the right to control their own fertility. They generally give birth late and have four times fewer children than their great-grandmothers. To sum up: there are not so many pregnancies anymore, but there are periods …
It has even been calculated that the average woman menstruates 6 years throughout her life, that is, for 2190 days!
Fortunately, today we know that it does not have to be. Neither menstruate nor bear too many babies. Each pregnancy is an enormous effort for the female body, and the risk of complications increases with the number of births. Therefore, it is much safer to achieve menstrual periods by other means. This perspective has been popularized in Western Europe for years. The slogan “blood free life” is a beautiful message for all women. Those who value sport and want to be active every day, not just 21 days a month. They swim, ride horses, practice ballet. But also those who want to be available all the time in their professional life. Many businesswomen experienced double stress during the presentation. She wondered how it would fall out and what it looked like. She stood as straight as a string and twisted inside with pain. Women are strong enough to deal with it on a daily basis. Question: what for?
Besides comfort, it’s about health. Why can menstruation be harmful for most of your life?
First, studies show that women’s blood levels of iron and hemoglobin lower than in men may interfere with the transport of oxygen from the lungs to the tissues of the entire body. Anemia is found more often in menstruating women. Interestingly, the progestin-containing IUD has been registered in the United States not as a contraceptive, but as a treatment for heavy, hemorrhagic periods leading to anemia. Secondly, the consequence of heavy and long periods may be: endometrial mucosa hyperplasia, polyps, and in old age it may provoke endometrial cancer.
What options are there for women who want to get rid of menstruation?
If they want to preserve fertility, the best method is to take hormones that will block menstruation on a permanent basis. This type of blockade can be obtained by taking birth control pills continuously. Taking tablets from another package postpones the date of the so-called withdrawal bleeding, in this way menstruation may be postponed completely or it will appear in a residual form in the form of spotting.
Can we also use long-term contraception methods, e.g. a hormonal contraceptive device?
Yes, it is a very good solution, both for women who have had children and not. The IUD is T-shaped and is placed inside the uterus for three or five years. The hormone secreted locally – progestogen suppresses menstruation but does not inhibit ovulation. Its main task is to thicken the mucus in the cervix, which makes it difficult for sperm cells to move and thus get into the egg and fertilize. This method is completely reversible – fertility should return already during the first cycle after the removal of the IUD.
Will the contraceptive hormone insert work for all women?
No, contraindications include a distorted uterus, abnormal cytology or unexplained profuse bleeding. Each time before inserting the IUD, the doctor should conduct a detailed interview or conduct additional tests. It will certainly work for women who live “on the run” or who travel a lot and who sometimes forget to take hormonal pills regularly. If we take pills 365 days a year and we tend to forget, we will not avoid pregnancy. The IUD has one more advantage over the contraceptive pill – it has a lower risk of thrombotic changes. In gynecological recommendations, it is acceptable even for women who have had thrombotic events.
What about implants and contraceptive injections?
These methods are definitely less popular and less effective in stopping menstruation. The contraceptive implant placed under the skin on the inside of the arm for 3-5 years results in a lot of irregular bleeding. Its action can be compared to a large contraceptive pill that is slowly absorbed. It inhibits both ovulation and menstruation in 1 in 5 women. Likewise, a contraceptive injection in the form of a “depot”, which contains a large dose of the progestogen, a hormone similar to progesterone. Its use is associated with the need to come for injections every three months, it can affect mood swings or weight gain, and it also causes irregular spotting. Thus, bleeding control is weaker with these two methods of contraception than with the others.
You also mentioned thermal ablation on your TV show. What is this procedure?
It is a medical procedure that treats endometrial hyperplasia or troublesome bleeding periods, if the patient has contraindications to all other methods available. It consists in the fact that the device inserted into the uterine cavity thermally heats and destroys its mucosa, and the altered tissues are removed. This method is insulating, so the decision to undergo thermal ablation should be made very carefully in a situation where we already have children or are not planning them. The final solution is the operation to remove the uterus, i.e. a hysterectomy, indicated primarily by uterine fibroids causing abnormal bleeding.
More and more countries are opting for menstrual leaves. What do you think about this way of dealing with menstruation?
Taking time off to bleed is really overkill. This is evidence of an extreme attachment to menstruation and an attempt to make sacred of it. I have been working with women for 36 years and I can say that I am slowly getting to know their psyche. Perhaps this type of leave will give them the opportunity to take a break from the mass of additional duties that they are burdened with on a daily basis. On the other hand, such a solution may pose a risk of discrimination. If the employer has a choice of one employee who is available for the entire month and another who is not necessarily available, then you know who to choose. It’s a risky path. Menstruation is really a very poor attribute of femininity, and life is worth and must be made easier.
About the famous TV performance by Dr. Tomasz Zając
Tomasz Zając, MD, PhD – specialist in gynecology, obstetrics and ultrasonography, works at the newMed Specialist Clinic.