Menstrual Magic

The curse, the red tide, my period, my monthly, my friend, on the rag, on the spurt, and on and on. All the jokes, all the whining, all the bitching, all the unfair media portrayal, the cultural stigma, the fear, the shame…menstruation gets such a bad rep that, at the very least, I felt it deserved to be paired with a word like “magical” for a refreshing change of pace, if for no other reason than its very complexity. Do you have any idea how many hormones are involved in your monthly menstrual cycle? Take a guess: 2 hormones? 3? 4? I can’t even tell you. Our lecture today covered the ups and downs of the 5 major hormones that are involved, but the lecturer kept slipping in little comments like: “and of course, prostaglandins, and inhibin, and [insert other hormone names that I wasn’t even able to catch] also play a part, but I’m not going to get into that today.” Damn straight it’s magical. It’s absolutely amazing! If we ever tried to reproduce the entire cycle in a laboratory setting, there’s no way in hell we’d ever be able to get it right. Do you have any idea how many things are all happening at once? It’s a bit mind boggling.

Mind-boggled. Yup, that’s pretty much how I feel right now. This semester is going to be a TON of work. I have so much on my plate already that I don’t even know where to start (hence, this delightful post: why start in on your homework when you can procrastinate and post to your blog instead?). And as for the menstrual cycle…this is something we studied in nursing school, and I had a hard time grasping it then. This is something I’m going to have to go over again and again and again until I know it forward and backwards, because it’s so damn important (and so damn complex). This is the reason and the beginning, the why and the how, of pregnancy. The hypothalamic-pituitary-ovarian axis, the follicular phase, the proliferative phase, the secretory phase, the luteal phase…all these names for something that your body does automatically, naturally, without fuss and often with very few mistakes, every single month for most of your adult life.

Lecture today was great. The guest lecturer was smart and sassy and a lot of fun—material that could have been really boring was actually made fascinating, which says a lot. And lots of little fun facts tossed in for good measure. For example, did you know that bleeding is not actually necessary at all during the cycle if you’re on birth control? Because of the presence of progesterone from the very beginning of the cycle, the lining of the endometrium doesn’t ever proliferate very much at all, but just stays steady at about 2 mm of development, and can stay that way for quite some time, if you ever want to just go through a few pill packs back to back and skip the week of placebos that allow for bleeding. In fact, apparently the only reason the placebo week was structured into the pill cycle was because of a decision made by a very Catholic man in the 1950s, who felt that monthly bleeding was necessary in order to help remind women of Eve, and the fact that they’re women, I guess. There’s a new pill out now that will charge you an arm and a leg for the privilege of only bleeding four times a year (Seasonale), but you might as well save some money and just take your regular pills back to back (although talk to your midwife/health care provider about it first, of course).

Another interesting fun fact: the Morning After Pill (aka EC or Emergency Contraception) really truly IS birth control, and not an abortifacient, and yes, I already knew this, but now I understand why. EC is basically just pure progesterone, and it works best during the follicular phase of the cycle, where the sudden burst of incoming progesterone is enough to prevent the release of leutenizing hormone that triggers ovulation. In other words, EC works best if it’s taken before ovulation occurs, in order to prevent ovulation. However, if ovulation has already occurred, the surge in progesterone may slow down fallopian tube motility and therefore possibly prevent implantation (in which case, I guess I could see how conservatives could potentially argue that this prevention of implantation is in fact the killing of a baby, but I do think it’s a rather thin argument). However, the little fun fact I didn’t realize is this: as soon as you’re pregnant (i.e., as soon as the trophoblast has implanted), the corpus luteum begins to make progesterone in vast quantities, and if you happen to take EC at this point in the cycle, it won’t disturb or prevent the pregnancy in any way whatsoever. In other words, if you’re already pregnant (i.e., the trophoblast has already implanted), EC does not end or harm your pregnancy in any way. In other words, it’s NOT an abortifacient. As soon as that trophoblast implants, the corpus luteum is working its ass off to produce massive amounts of progesterone anyway just to keep the pregnancy afloat until the placenta can take over hormone duty; a little extra squirt of EC progesterone at this time does NOTHING to disrupt this. FYI. (Why do I feel that if more people actually understood how EC worked, so many of the objections to it would just disappear, and the FDA might finally get around to approving it for over-the-counter use? Righto. Get the word out, ladies.)

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