Ramblings of a hopeless lesbian!

Suzanne Sadedin, Ph.D. in evolutionary biology from Monash University

I’m so glad you asked. Seriously. The answer to this question is one of the most illuminating and disturbing stories in human evolutionary biology, and almost nobody knows about it. And so, O my friends, gather close, and hear the extraordinary tale of:

HOW THE WOMAN GOT HER PERIOD

Contrary to popular belief, most mammals do not menstruate. In fact, it’s a feature exclusive to the higher primates and certain bats*. What’s more, modern women menstruate vastly more than any other animal. And it’s bloody stupid (sorry). A shameful waste of nutrients, disabling, and a dead giveaway to any nearby predators. To understand why we do it, you must first understand that you have been lied to, throughout your life, about the most intimate relationship you will ever experience: the mother-fetus bond.

Isn’t pregnancy beautiful? Look at any book about it. There’s the future mother, one hand resting gently on her belly. Her eyes misty with love and wonder. You sense she will do anything to nurture and protect this baby. And when you flip open the book, you read about more about this glorious symbiosis, the absolute altruism of female physiology designing a perfect environment for the growth of her child.

If you’ve actually been pregnant, you might know that the real story has some wrinkles. Those moments of sheer unadulterated altruism exist, but they’re interspersed with weeks or months of overwhelming nausea, exhaustion, crippling backache, incontinence, blood pressure issues and anxiety that you’ll be among the 15% of women who experience life-threatening complications.

From the perspective of most mammals, this is just crazy. Most mammals sail through pregnancy quite cheerfully, dodging predators and catching prey, even if they’re delivering litters of 12. So what makes us so special? The answer lies in our bizarre placenta. In most mammals, the placenta, which is part of the fetus, just interfaces with the surface of the mother’s blood vessels, allowing nutrients to cross to the little darling. Marsupials don’t even let their fetuses get to the blood: they merely secrete a sort of milk through the uterine wall. Only a few mammalian groups, including primates and mice, have evolved what is known as a “hemochorial” placenta, and ours is possibly the nastiest of all.

Inside the uterus we have a thick layer of endometrial tissue, which contains only tiny blood vessels. The endometrium seals off our main blood supply from the newly implanted embryo. The growing placenta literally burrows through this layer, rips into arterial walls and re-wires them to channel blood straight to the hungry embryo. It delves deep into the surrounding tissues, razes them and pumps the arteries full of hormones so they expand into the space created. It paralyzes these arteries so the mother cannot even constrict them.

What this means is that the growing fetus now has direct, unrestricted access to its mother’s blood supply. It can manufacture hormones and use them to manipulate her. It can, for instance, increase her blood sugar, dilate her arteries, and inflate her blood pressure to provide itself with more nutrients. And it does. Some fetal cells find their way through the placenta and into the mother’s bloodstream. They will grow in her blood and organs, and even in her brain, for the rest of her life, making her a genetic chimera**.

This might seem rather disrespectful. In fact, it’s sibling rivalry at its evolutionary best. You see, mother and fetus have quite distinct evolutionary interests. The mother ‘wants’ to dedicate approximately equal resources to all her surviving children, including possible future children, and none to those who will die. The fetus ‘wants’ to survive, and take as much as it can get. (The quotes are to indicate that this isn’t about what they consciously want, but about what evolution tends to optimize.)

There’s also a third player here – the father, whose interests align still less with the mother’s because her other offspring may not be his. Through a process called genomic imprinting, certain fetal genes inherited from the father can activate in the placenta. These genes ruthlessly promote the welfare of the offspring at the mother’s expense.

How did we come to acquire this ravenous hemochorial placenta which gives our fetuses and their fathers such unusual power? Whilst we can see some trend toward increasingly invasive placentae within primates, the full answer is lost in the mists of time. Uteri do not fossilize well.

The consequences, however, are clear. Normal mammalian pregnancy is a well-ordered affair because the mother is a despot. Her offspring live or die at her will; she controls their nutrient supply, and she can expel or reabsorb them any time. Human pregnancy, on the other hand, is run by committee – and not just any committee, but one whose members often have very different, competing interests and share only partial information. It’s a tug-of-war that not infrequently deteriorates to a tussle and, occasionally, to outright warfare. Many potentially lethal disorders, such as ectopic pregnancy, gestational diabetes, and pre-eclampsia can be traced to mis-steps in this intimate game.

What does all this have to do with menstruation? We’re getting there.

From a female perspective, pregnancy is always a huge investment. Even more so if her species has a hemochorial placenta. Once that placenta is in place, she not only loses full control of her own hormones, she also risks hemorrhage when it comes out. So it makes sense that females want to screen embryos very, very carefully. Going through pregnancy with a weak, inviable or even sub-par fetus isn’t worth it.

That’s where the endometrium comes in. You’ve probably read about how the endometrium is this snuggly, welcoming environment just waiting to enfold the delicate young embryo in its nurturing embrace. In fact, it’s quite the reverse. Researchers, bless their curious little hearts, have tried to implant embryos all over the bodies of mice. The single most difficult place for them to grow was – the endometrium.

Far from offering a nurturing embrace, the endometrium is a lethal testing-ground which only the toughest embryos survive. The longer the female can delay that placenta reaching her bloodstream, the longer she has to decide if she wants to dispose of this embryo without significant cost. The embryo, in contrast, wants to implant its placenta as quickly as possible, both to obtain access to its mother’s rich blood, and to increase her stake in its survival. For this reason, the endometrium got thicker and tougher – and the fetal placenta got correspondingly more aggressive.

But this development posed a further problem: what to do when the embryo died or was stuck half-alive in the uterus? The blood supply to the endometrial surface must be restricted, or the embryo would simply attach the placenta there. But restricting the blood supply makes the tissue weakly responsive to hormonal signals from the mother – and potentially more responsive to signals from nearby embryos, who naturally would like to persuade the endometrium to be more friendly. In addition, this makes it vulnerable to infection, especially when it already contains dead and dying tissues.

The solution, for higher primates, was to slough off the whole superficial endometrium – dying embryos and all – after every ovulation that didn’t result in a healthy pregnancy. It’s not exactly brilliant, but it works, and most importantly, it’s easily achieved by making some alterations to a chemical pathway normally used by the fetus during pregnancy. In other words, it’s just the kind of effect natural selection is renowned for: odd, hackish solutions that work to solve proximate problems. It’s not quite as bad as it seems, because in nature, women would experience periods quite rarely – probably no more than a few tens of times in their lives between lactational amenorrhea and pregnancies***.

We don’t really know how our hyper-aggressive placenta is linked to the other traits that combine to make humanity unique. But these traits did emerge together somehow, and that means in some sense the ancients were perhaps right. When we metaphorically ‘ate the fruit of knowledge’ – when we began our journey toward science and technology that would separate us from innocent animals and also lead to our peculiar sense of sexual morality – perhaps that was the same time the unique suffering of menstruation, pregnancy and childbirth was inflicted on women. All thanks to the evolution of the hemochorial placenta.

Sonya Satveit is a survivor of infertility, miscarriages, PMS, and Post Partum Mood Disorders (esp Anxiety).  Fortunately she was able to solve all of her problems by balancing her hormones but had been more than a decade long journey of ups and downs.

She founded HormoneSoup.com in an effort to raise consciousness around hormone issues in women and spark conversation about using bio-identical hormones to treat issues such as miscarriages, infertility, postpartum mood disorder, and PMS.

Her newest project, Precision Medicine PCOS Program, is the first of its kind. Here she is to tell us more about this groundbreaking initiative that’s even got the support of the President of the United States.

Sonya, can you explain what Precision Medicine is?

So if we look at medicine today, it takes a one-size-fits-all approach and is focused on “standards of care” for the population in general.  For example if you get diagnosed with something like PCOS you’ll be offered a treatment similar to that of every other woman diagnosed with PCOS.

Precision medicine, in contrast, takes a customized approach to your health by looking at your specific genes and their interactions, your specific environment and lifestyle and then tailoring prevention and treatment to you. Your healthcare is personalized to you and so the term Personalized Medicine is also being used.

What involvement has the US Government had in Precision Medicine?

President Obama announced the Precision Medicine Initiative in an effort to bring precision medicine to many aspects of healthcare.  The PMI have stated that in the short term, they plan to bring a precision medicine focus to cancer research while over the long term the intention is to gather the genetic information from 1 million Americans who will volunteer to contribute their biological data to research.

Tell us about the Precision Medicine PCOS Program!

Our myAva Precision Medicine PCOS Program is the first initiative to bring precision medicine to women’s health specifically focused on PCOS! Precision medicine is in the early stages and there is currently no precision medicine protocol designed specifically for women diagnosed with PCOS.   We know women with PCOS have trouble getting answers and there is so little funding for research.  Women with PCOS have grown tired of waiting for better diagnostic and treatment options.

For the first time ever we are going to be taking a comprehensive molecular picture of each woman so we can personalize her care rather than take the cookie-cutter approach to her health.

We are gathering and analyzing a lot of data for each woman including her genetic and transcriptomic profile, 200+ proteins, 200+ metabolites, as well as her gut and vaginal microbiome.  We are gathering activity tracker and sensor information and because we believe in a truly patient centric approach we will be gathering data from the patient herself such as how she feels about her quality of life, etc.  The benefit is that we will start to track changes over time, which I think is empowering to a woman to have access to ALL of her own data and lets her participate fully in her own care.

The goal of our Precision PCOS Program is to optimize the health of each woman by detecting early stages of disease, informing interventions (hopefully before the disease such as diabetes or cardiovascular disease becomes chronic) and identifying prevention strategies (ie: nutrition, fitness and lifestyle interventions) based on each woman’s own molecular profile.   It’s a complete customization of healthcare.

Why did you choose to focus on PCOS for your first project?

A couple of things impacted my decision to focus on PCOS for our first program.  Through my experience blogging at Hormone Soup I have made vast connections in women’s health and developed an amazing network that involves patients, patient advocates, providers and organizations, including the PCOS Community.  I have come to believe that there is no other patient community more underserved than the PCOS community.

Over the years I have done a ton of research into women’s endocrine health as well as the latest innovations in medicine and I became particularly fascinated with precision medicine.   Advances have already led to powerful new discoveries and that excites me!  This is a transformation in how we look at disease and how we look at health and is just at the beginning.  I think PCOS patients deserve to be at the forefront of this kind of healthcare.  We know there are genetic underpinnings to PCOS, it is both a metabolic and endocrine health issue and I think it really is a perfect use case for precision medicine.

What has been the reaction with the pilot group of women so far?

It’s been amazing, truly Angela.  We are close to finalizing our initial group of 10 Atlanta area women with PCOS who are going to make up our Patient Advisory Panel.  It is imperative to me that a healthcare program has the input of the people who are going to use it!  As we began to recruit patients, I have heard story after heartbreaking story from women.  These women have been through so much and they are so excited that we are attempting to change the status quo in the treatment of PCOS.  A lot of PCOS patients have felt ignored for so long and are more than willing to get involved both as patients and advisors and share their data and experiences to help the entire PCOS Community.

When you expect to see your first results?

Once we start the program we will see our first results in 90 days.  We will be analyzing the women’s molecular profile every 90 days so we will begin measuring any changes based on interventions at 180 days and beyond.

How do you anticipate the Precision Medicine PCOS Program will change the future of health care for women with PCOS?

Once we get through a couple of cycles of results with the first 10 women and have a chance for them to advise and help us “get it right”, we will begin to scale the program and offer it more broadly.  To me it’s important to deliver what will be good for women but it’s also got to work for physicians and other healthcare providers.  If we can make it good for patients and good for doctors then we have a win-win situation.

I really believe in the power of the patient because that’s how I got started and look where it’s taken me.  If we support one another and raise each other up we can effect some significant changes.  And change is going to come from us, the patients – there’s no calvary coming to save us – we have to work together.

“I want to create a movement in women’s health by raising the bar on the standard of care for women with PCOS.”

I think this is achieved by striving to achieve a new level of patient centered healthcare for women that includes the latest innovations happening in healthcare.  Based on what I’m hearing from women with PCOS, even slight improvements are significant for them.  My vision isn’t small and with the amazing team of collaborators working with me and the support I’m receiving from the PCOS community, we have the potential to change the future of healthcare for women with PCOS!

Anything else you would like our readers to know? Any way others can support your initiative?

I’d love for your readers to stay connected by signing up for updates about our Precision Medicine PCOS Program at www.myava.com or reach out to me directly at www.HormoneSoup.com.

SOURCE: PCOS NUTRITION CENTER

So there was a lot of misinformation, and just a huge lack of the nitty gritty stuff, when I was in school and I see a lot of young kids on forums asking if something is normal or worrying about stuff and adults who have wondered their whole lives if other people feel the same on their periods. 

Here’s some stuff about periods people might not talk about;

It can smell. But using scented pads isn’t a great idea, the chemicals in the perfume cause irritation. But here’s the thing; vaginas smell. All of them. All the time. Right now. YOU notice the smell because it’s literally part of you, but other people don’t. If it’s a foul smell and very strong you should speak with a gynecologist, but the average day-to-day odor is normal and doesn’t mean you’re dirty. 

Diarrhea all day every day.

 Or, alternately, constipation all day every day. 

ALSO alternatively, a healthy mix of both sprinkled randomly across the days of your period like too much nutmeg where no one asked nutmeg to be. 

Your first period might not look like a period at first. It might look, well, brown, and lead you to other conclusions about what’s going on in your skivvies. Then it might not come again the next month and show up on a totally different week when it does. Mine came like A LOT. It was very heavy and I bled through a pair of jeans in the middle of school it was so heavy. I didn’t know what it was and thought I was bleeding from my butt because my liar teacher said a period would only be a ‘tablespoon’. Tablespoon of lies. 

At some point your probably going to stain the back of the toilet seat with blood. That doesn’t mean your bleeding too much, or that your dirty, but it’s a tid bit of information I wish I knew as a kid so I could have known to look for it when using public restrooms or at friend’s houses. 

Period farts. 

Having sex on your period isn’t gross or dirty or wrong. Put an old towel down on the bed and have at it.

The feelings you have on your period are entirely valid and not imagined or unimportant because of your period. Whether or not your feelings are heightened by PMS they are still your feelings and should be respected. 

The ‘average’ period is anywhere from 3-10 days with any variation in flow. You shouldn’t be concerned because your period isn’t the same as your friends is, only if it changes from what’s average for you. There isn’t such a thing as a ‘normal period’ you need to fit into.

If you wear a disposable pad there will be a point where it’s going to unstick at some corner and when you pull it off it’s going to pull some of your pubic hair with it. This is going to suck. I am very sorry. 

If you wear a tampon there is going to be a point you will squeeze it out of yourself when you use the bathroom. Just change your tampon each time you go. Please listen to me on this. 

Swamp butt.

You will get blood stained thighs at some point. It’s going to cake onto your skin and make a mess just everywhere. 

The cashier doesn’t care about you buying pads/tampons/etc, they just had a guy buy 4 pounds of carrots, a box of Xtra Large ribbed condoms and cherry scented lube. Your pads are not on their radar of things to care about.

Washing Your Junk:

When you shower (if you want a bath i’d shower before hand or dont wash in the bath itself and shower after to get clean) remember you are not actually washing inside of your vagina, you’re washing the skin around it (labia, clitoris, all those good bits). Using a soft wash cloth with either very mild unscented soap or just warm water.  Seriously, stop putting washing products inside yourself; You do not need to wash the inside of your vagina and doing so can cause infections. Unless given products by your doctor there is no need to douche or use creams or wipes or other stuff like that. They’re lies sold to you to make you think you smell bad. 

 You know how your parents said ‘wipe front to back’?Same with washing, you don’t want to drag butt germs all over your vagina. Don’t do it. 

Some people find that trimming, or shaving, their pubic hair helps them control odor, or makes wearing sanitary products more comfortable, but it isn’t required and is personal preference with different individuals. There is no health benefit to shaving or trimming your pubic hair and it will not make you cleaner than if you didn’t shave. 

Wearing light breathable cotton undies during your period will help eliminate odor and not give you swamp butt. Especially in the summer. 

Washing after sex is a great idea and not just because it’s romantic. If you’ve ever had period sex before you will k n o w but if you have not I am going to just ask you to take my word for it and plan a shower afterwards. 

The Bortle scale is a nine-level numeric scale that measures the night sky’s brightness of a particular location.