Rewriting the narrative of female reproductive health

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Let me paint a picture for you. A 15 year old girl is sitting in a doctor’s office, wide-eyed with a tightening knot of shame in her gut as she hastily shakes her head at the question ‘are you sexually active?’. Her parent or guardian explains to the doctor that she has been struggling with severe mood swings, acne and very heavy, painful periods ever since her cycle started. Best case scenario, the doctor sends them away, saying it will settle down in a few years. Most likely option, the doctor will prescribe a hormonal contraceptive pill to smooth out the symptoms. Worst case scenario, a long term antibiotic will be thrown into the mix to take care of the acne. No discussion of possible side effects, no advice on how to naturally support the body in tandem with the medication. Just a piece of paper and off they go.

Sound familiar? Maybe this was you as a teenager, maybe it was your teenage daughter or your sister. This is a story that plays out again and again all over the world to countless women. In fact, ‘nine in 10 women who receive contraception from the GP or pharmacies take either the combined pill or “mini pill” – a total of more than 3.1 million women in England in 2017-18’. (https://www.theguardian.com/uk-news/2019/mar/07/revealed-pill-still-most-popular-prescribed-contraceptive-in-england). Don’t get me wrong, I’m not writing this to bash or shame doctors, they’re doing the best they can with the information they are taught. I’m writing this to provide one more voice that raises the question of how women’s health, especially reproductive and hormonal health, is systemically dismissed and ill-understood.

When I interview women about their hormonal health issues - women in their 20s, 30s and 40s, when they should be fertile, reproductively healthy and hormonally balanced - this exact story (or a very close variation of it) is almost always at the start of their narrative. Fast forward a few years and the underlying cause of whatever symptom they were prescribed hormonal contraception for has worsened, and there are no clear channels of support. Women with PCOS, thyroid problems, low progesterone, adrenal fatigue, PMS or PMDD learn to live with and accept these conditions as their natural state of being.

So what is it that impedes our endocrine system from functioning properly? Unfortunately, many things. Dysregulated blood sugar (caused by eating too many refined carbohydrates and also chronic stress) is a huge factor in hormonal balance as excess insulin disrupts ovulation. What’s more, overloaded fat cells (which become overloaded from excess blood sugar) secrete oestrogen and can cause oestrogen dominance over progesterone, the most common form of hormonal imbalance in women (https://floliving.com/upgrade_flo/sugar-and-your-hormones/). Stress and exhaustion are unsurprisingly another huge factor in hormonal imbalance as our adrenals become hugely overstimulated and will prioritise production of cortisol over progesterone in order to ensure survival (https://amosinstitute.com/blog/pregnenolone-steal-and-the-stress-effect.html). Next on the list is overexposure to toxins and endocrine disruptors in our environment (cosmetics, cleaning products, pollution etc.), which not only can increase oestrogen dominance through the effect of xenoestrogens in certain products, but blocks the body’s elimination pathways which need to be clear in order to move carcinogenic forms of oestrogen out of the bloodstream. (These factors deserve many articles worth of explanation each, but I’ll be concise today.)

Finally, and as you might have guessed, most crucially for this discussion, we have hormonal contraception. As Christiane Northrup, MD so aptly explains in the foreword to Alisa Viti’s WomanCode, using hormonal contraception to treat any symptom of hormonal imbalance is like placing a piece of sticky tape over the warning light on a car’s dashboard. You don’t see the indication of the problem anymore, but boy is it still there. And boy can you bet it’s going to get worse if you don’t address it. Many things happen to our bodies when we start taking synthetic hormones to worsen existing imbalances. As I’ve said, the symptoms are masked, so whatever underlying problem was causing the symptoms will worsen unchecked, as we don’t tend to investigate health problems we can no longer feel the effect of (thanks body for telling us when something is wrong!). But what’s more, the synthetic hormones simultaneously have an antibiotic effect on our gut (meaning our gut flora gets out of balance, leaving us more vulnerable to infection and yeast overgrowth) (https://www.floliving.com/2-hidden-side-effects-of-the-birth-control-pill/) and also cause deficiency in essential micronutrients including B12 and various minerals (https://universityhealthnews.com/daily/nutrition/side-effects-of-birth-control-pills-include-nutrient-depletion/). This doesn’t even begin to cover the most regularly discussed side effects of hormonal contraceptive use such as weight gain and muscle loss (https://www.floliving.com/2-hidden-side-effects-of-the-birth-control-pill/) and problems with mood ranging from ‘occasional feelings of impending doom’ (anonymous interviewee) and full blown clinical depression. Essentially, the hormonal contraceptive pill is one of the most powerful and potentially harmful drugs in western medicine, and yet is one of the most commonly prescribed.

These impediments to our hormonal function can cause or worsen any number of conditions including PCOS, endometriosis, underactive thyroid, adrenal fatigue, PMS, PMDD, painful periods and infertility or fertility problems.

I want to pause here and take a moment to say, to all female readers who are feeling alarmed at this information (whether because you are taking or have taken long term hormonal contraception or because your daughter is taking it) please don’t panic. I know this information is not widely available or spoken about in mainstream medical discourse, so don’t feel disheartened if you didn’t know this. Now you do. And now you can do something about it. The beautiful thing about the endocrine system is that it predictably falls out of balance and just as predictably comes back into balance when the appropriate steps (which are all within YOUR control and totally natural, yay!) are taken.

But to return to the question of rewriting the narrative of female reproductive health, what needs to happen for this story to cease to be repeated? First, is education. Of parents, of children and of medical professionals. Everything has a knock on effect when it comes to the destiny of our health, so starting as early as possible to inform yourself how to take care of your bodies and endocrine systems is the best way to ensure yourself and future generations hormonal smooth sailing. Thankfully, we are starting to see acknowledgment of how essential women’s hormonal health, especially their cycle, is as an indicator of overall health. Doctors must be educated in recognising symptoms of hormonal imbalance in young women as a sign of potentially much deeper health problems. As one recent study concluded, ‘It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patients.’ (https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign).

Second comes female self-advocacy for their bodies and health. As women we should never, ever feel pressured to be on hormonal contraception because of the inconveniece for a male partner of using a condom (what’s more, we should rarely ever be having unprotected sex regardless of using hormonal contraception). This is a common story I hear from women, that their partner just hates condoms. Frankly, I’d recommend switching partners over contraceptive if he won’t budge. Further to this, we have an almost reverent fear of the medical profession. I have heard so many accounts of women believing something was really wrong with their cycle or general health and being quickly dismissed because the doctor in question most likely did not have time or the specialised knowledge to diagnose what the problem was. So, ladies, I invite you all to be much more stubborn when you think something is just not how it should be. No one is an expert over your body except you. This also goes back to the question of education; do your research and figure out what tests you might need to ask for to get the answers you need. And when you get those answers, push for lifestyle treatment options over medical intervention first. If the lifestyle changes you need aren’t adequately supported by your primary care giver, seek out a certified functional medicine practitioner or someone like me (a certified hormonal health coach) who can support you with expert practical advice along with the emotional support to make huge habit changes. Just make sure whoever you turn to is clear on their scope of practice and will refer you back to the right doctor if needs be.

Finally, we need to be having discussions about this on high-level, wide reaching forums far more regularly and far more ostentatiously. The stigma and shame around reproductive health and hormonal issues that sees women still whispering to each other when they need to borrow a tampon or faking a migraine at work to go home, when they actually have an agonising UTI, must be shattered. The value of ‘sucking it up’ or stoicism which women have been conditioned to adopt, needs to be unlearned. We make ourselves and the problems we face smaller by doing so, and this value can be potentially deadly. I can draw upon a cautionary tale of this, tragically, from my own life. My mother was diagnosed with cervical cancer (a cancer for which, up until my family created a charity specifically for it (http://debbiefund.org/), there was no research going into a cure or treatment) when I was 12 and she died when I was 16. Her death was entirely avoidable, as she had 6 misread smear tests before it was detected. While this was medical negligence on a disgraceful level, there is a painful piece of this story which has to be admitted: my mother did not take responsibility for her health. She was symptomatic for a long time before her diagnosis, and yet chose to ignore it. Perhaps it was down to embarrassment. Perhaps it was that all-too-common sense of duty to ‘just get on with it’ which women seem to internalise early in life. Either way, the societal attitude towards women’s health has got to change.

Ok one more thing. Let’s call this a bonus: we need to differentiate between the cyclical health of women and the static view of health which is a wholly male medical narrative. We are not the same at every point in the month, levels of different hormones vary hugely throughout a cycle and therefore we cannot expect to feel exactly the same day to day. What’s more, we can harness this fact if we really embrace it and adapt our lifestyle, social and work habits to fall into rhythm with our naturally fluctuating female state.

I warmly invite you all to look at the story of your health and consciously decide to rewrite it. I encourage you to engage in the discussion and to educate your friends, daughters and colleagues. Really just anyone who will listen to you. And for the sake of all that is good in the world, make friends with your body and your cycle. Learn to greet your period with gratitude and joy every month. You’re not a disempowered woman if you have to deal with the inconvenience of menstruation and be mindful of barrier method contraception. Quite the opposite: it is powerful and beautiful to know your body and your cycle intimately and in leaning into this, you’ll shed any fear of unwanted pregnancy that may have driven you towards hormonal contraception in the first place.

I wish dearly that this reaches the minds of more than a few women, and men who care about the health of women. And above all, I am wishing you many years of healthy, joyful hormonal cycles.