This article was originally written on Medium but it’s a very C-Lab thing so I am bringing it here.
I woke up today with a message from a dear friend. He is quite busy, the good dad, husband, and entrepreneur type who juggles many balls. The fact that he is busy means that he often sends me links to articles I might enjoy reading without much explanation or even a comment. Sometimes I click on the link and sometimes I let it pass. Today, I clicked.
The article he shared with me was this one: https://www.theguardian.com/lifeandstyle/2023/oct/16/my-self-worth-plummeted-every-month-the-hidden-disorder-that-can-ruin-womens-lives?CMP=Share_iOSApp_Other
I have decided to write about it because it is time we start looking at our “pathologies” as part of a context. We are not raised in a vacuum and looking into “our issues” as if this were the case is only perpetuating a very partial — and dare I say — problematic view of menstrual cycle-related problems.
I’ll share parts of the article written for “The Guardian” and add comments below. The excerpts will be in Italics.
“In 2016, Emily, now 33, was diagnosed with premenstrual dysphoric disorder (PMDD), a little-known hormone-based condition that affects a staggering number of women: about one in 20 of those who have periods suffer with it worldwide. Symptoms include depression, anxiety and irritability, as well as reduced motivation, focus and libido. It can also be life-threatening: 34% of women with PMDD have attempted suicide, according to the International Association for Premenstrual Disorders (IAPMD). Emily’s symptoms began when she started her period at age 13. It would take until she was 26 to get a diagnosis. This is not uncommon — the average wait for a diagnosis is 12 years, according to the IAPMD. Emily spent three years on hormone treatments such as triptorelin, goserelin, progesterone and oestrogen, until 2019, when she was offered a hysterectomy as a last resort.”
I’d like to start by saying that when women find some type of support or recognition that they are not “crazy” “or making stuff up” in regard to the symptoms they feel, it can be tremendously relieving. On a very basic level, feeling heard and seen regulates our nervous systems so I can absolutely see how finding support networks or even having a diagnosis can be life-changing. With this in mind, my remarks below are not directed in any way towards people who are trying to shine some light in the still deeply misunderstood topic of the menstrual cycle. What I hope to do is to bring an eagle-eye view to how we are looking at these issues and how shifting our perspective is not only important but necessary.
Let’s start this “perspective-shifting journey” by making it clear that when a girl first gets her period she starts being cyclical. What that means, in a very simplified way, is that her operating system is not linear and therefore she is not meant to operate in the world in the same way as bodies that produce testosterone. Male bodies.
This very simple distinction is still deeply overlooked by modern-day culture and has tremendous consequences on a woman’s life as we will explore below.
“In very simple terms, PMDD is a “glitch”, says Laura Murphy, who works for the IAPMD, and has also had PMDD (she waited 17 years before she received her diagnosis). “A malfunction in the brain causes an abnormal negative severe reaction to those fluctuating hormones,” she says.
PMDD symptoms occur during the second, or luteal, stage of the menstrual cycle — which begins at around day 15 in a 28-day cycle, between ovulation and the start of the period. “I would be living my life, feeling motivated and able to concentrate, for five or six days,” says Emily. “Then I would start to descend into being really tired and anxious. I wouldn’t be able to concentrate and would feel really frustrated with myself. My self-worth would plummet … When I got my diagnosis, we were able to identify patterns when I was engaging in self-harm or suicidal behaviour — and it was always a few days before my period.” It took more than a year on a waiting list for Emily to get her hysterectomy — which she spent in a psychiatric hospital, as she and her doctors agreed it “would be the safest thing to do”.
Let’s start by looking deeper into the sentence “A malfunction in the brain causes an abnormal negative severe reaction to those fluctuating hormones”. I’d say what we are calling a malfunction in the brain is a by-product of the misunderstanding I mentioned above. I’ll explain. The world that we currently live in and have for a very long time is the result of a testosterone-driven mind. Testosterone doesn’t cycle in the body in the same way that the female hormones do. Men have a 24-hour cycle, where their testosterone levels are highest in the morning and lowest in the night. That seems to match quite well the rhythm of the work day.
For women, things are very different. Our cycles are about 28 days long and guess what? The cocktail of hormones in our bodies varies tremendously. Think day and night. Black and white, sky and earth. All these metaphors would work very well to point to the different qualities of experience that a woman goes through every month. There is an important detail. This is part of a woman’s design. It is ON PURPOSE. Not a mistake. Why do I say that? Well, because the way we have been defining women’s “pathologies” is based on the judgement placed on top of this oscillating energy. Which is absolutely normal! (again, they are only pathologies if we consider a male body as the normal body).
The cycling of oestrogen, testosterone and progesterone — very different hormones, by the way — makes a woman…cyclical.
The follicular phase of the cycle is meant to be an increasingly more active phase in which a woman has incrementally more energy and is more “outward”. Testosterone and oestrogen are a dynamic duo so near ovulation the woman would be the closest to “normal” she can ever be. Or should I say, closer to the way males show up in the world?
To make it even clearer: a woman has high oestrogen and testosterone for about 5 days of her 28-day cycle. This is the only window where a woman “behaving like a man” is in actual alignment to whats happening with her body hormonally.
After ovulation, we start the luteal phase. This phase of the cycle has a different queen hormone: progesterone. Progesterone’s role is very different to oestrogen’s role and it has a very calming effect. It is a relaxing hormone. But wait? That doesn’t make sense, you might think. Why do women feel stressed out and why do PMS and other “pathologies” such as premenstrual dysphoric disorder show up in this exact phase when the body should be feeling more relaxed and our minds should be calmer?
Well, glad you asked.
The answer to the question is hidden in the excerpt of the article pasted below. Read carefully the part in bold.
“About 60–70% of women with PMDD respond to SSRI antidepressants, according to the National Institute of Health. After she started taking the SSRI sertraline in January, Laura Becker, 26, from Wisconsin, saw significant improvements in her PMDD symptoms. “My emotional dysregulation has significantly decreased, and I have been able to work and function relatively normally throughout the entire cycle,” she says. “I still have symptoms but they are not as extreme or overwhelming as before.” Other treatments include combined oral contraceptives and hormone treatments such as gonadotropin-releasing hormone agonists, which suppress oestrogen production and stop periods, causing a process called chemical menopause.”
If women don’t have male bodies with 24-hour cycles of testosterone BUT believe that they should be operating in the same way as men because, well, that is still what everyone seems to expect of them, then of course they will want to “work and function relatively normally throughout the cycle”. The catch is, they are NOT working and functioning relatively normally with the interventions mentioned above. What they are doing is trying extremely hard to adapt their cyclical nature to what the world is asking of them: that they function in a more linear fashion, just like a man.
“Jasmine Gibson is a business owner in Baltimore, US. Her therapist thought her symptoms were bipolar disorder. Then, she found some articles about PMDD online. Reading them “was like a lightbulb moment,” she says. “My psychiatrist didn’t know about PMDD, and she wasn’t sure about diagnosing me with it. But when I went to see a gynaecologist and took my records of my symptoms, she got it straight away.”
Three years before her diagnosis, Emily had asked her psychiatrist if her symptoms could be hormone-related. “I remember her saying, ‘Wouldn’t it be nice if it were just that?’ I took that as gospel and never mentioned it again,” she says. “I don’t blame that particular psychiatrist, but it just shows the lack of education and awareness around PMDD.”
Reilly says: “A lot of the time I hear from patients that they recognise the hormones, and they then have to convince the doctor or clinician. Doctors can be dismissive.” Anecdotally, he says, a lot of PMDD researchers have experienced it themselves too — “It comes down to women who have experienced PMDD to drive the research.”
The paragraphs above just highlight the depth of lack of understanding we are talking about. The fact that we still separate “mind and hormones” is a big problem. Hormones impact everything. I mean EVERYTHING. Our thoughts our emotions, our impulse to action, our desire for rest, etc.
Now, if you have one body that is fueled by testosterone — a super doing hormone — and another body that, just like the tides in the ocean, ebbs and flows with “doing and resting hormones”, what do you think it would happen if the “resting hormone” didn’t have room to exist?
Ha! You got it. At least I hope you did. It would backfire.
You see, progesterone invites rest and relaxation but when that doesn’t happen she gets angry! The chemical explanation for that is simple: Progesterone doesn’t like stress hormones very much, so the more cortisol you have in your body, the less progesterone (calming hormone) you will have.
On the other hand, oestrogen is much more okay with some stress and the phase in the cycle when women have both oestrogen AND testosterone (close to ovulation) she feels invincible.
We like the feeling of the follicular (the pre-ovulation) phase because it is the phase in which our bodies can actually work WITH the system and we don’t need to have an internal fight. Our bodies are totally okay (most of the time) with the “to-do-list” of a 24-hour day during that phase of the cycle. Our capitalist model, however, requires us to be okay with this “do-do-do” the whole cycle. By now I imagine you got the sense of the size of our problem. A woman works, works, works in the follicular phase and says “I’m normal” then she doesn’t want to “work, work, work” at the Luteal phase and thinks “I’m NOT normal”. Then she takes medication to be “normal” and the vicious cycle continues.
The problem is, of course, NOT with the woman. She is totally in synch with her cycle when she feels very different in the follicular and luteal phases. They are like the sun and moon. Day and night. Summer and Winter. So sadly our interventions are helping women stay in “perpetual summer” and feel “normal” when she was never meant to do that. She was always meant to be in flow.
If we take a meta-view I’ll say that a big part of our societal problems stem from this “perpetual summer” mindset. Humans are not meant to go-go. We are meant to make space for pause, reflection and rest. The amazing thing is that a woman’s body has that intelligence inbuilt in it and, if utilized, would work as an incredible reminder of how we should flow as a culture.
Our society names pathology what is a natural expression of the body when trying to scream at us “Listen to me”. But we don’t listen. We listen to culture and to the inhumane pressures of our capitalist model and we “fix” our bodies so they can better cope with the crazy pressures of the outside world.
But women are paying the price. As the Guardian article makes clear. Fertility-related “pathologies” are many. Endometriosis, for example, affects almost 1 million women in Australia alone, a country of 12.7 million women.
I can’t say that for sure but I do believe that if we lived in a world in which the rhythm of the female body was understood and she was able to honour both her “doing and resting phases” we would see much less “fertility-related pathologies”. Not only that, I also believe we would have, as a result, systems that would be much more respectful of life itself and the rhythm of nature.
To close, I invite you to read the words below with a different frame of mind. Imagine, for a moment, that this woman’s body is NOT wrong. That what she is describing below is exactly what her body needs her to do. Notice how hard she tries to behave like the “normal” body.
“She becomes “depressed, hopeless and immersed in flashbacks for about five to seven days every month” before her period begins. “It is a different state of consciousness,” she says. “I try to sleep as much as possible … it feels dangerous to be awake.” She doesn’t “feel comfortable attending work or interacting with other people because I am constantly tearful, lack energy, and don’t want to ruin anything for my career. I’ve missed a lot of opportunities over the years due to this.”
Gibson has also struggled in her work life. “I would be trying to be productive and just hit a wall. I would look at deadlines and literally watch them pass, and be physically unable to do the work,” she says.”
Gibson’s efforts are the efforts of many women. Not all of us suffer debilitating symptoms like the ones described above but most of us have a sense of “having to push through” in the luteal phase of the cycle. The way this shows up in a woman’s life varies tremendously. The energy seen in “PMS” is the energy that points to the tension between what my body is asking me to do and what the system (work, house, etc) requires me to do. Just like a twisted hose that once untwisted lets water go everywhere, the tension generated by a calming hormone asking us to slow down (progesterone) and the overproduction of cortisol as a by-product of our fast-paced lives (cortisol decreases progesterone) has us explode.
Dear reader, this might be pushing the write-reader relationship a bit too far but I’ll risk it because I think it is important. If any of what I have shared above makes sense to you, even if on an intuitive level, please share this article. Do some research. Start looking at the “pathologies” of the menstrual cycle with a curious mind and don’t take all you read at face value.
Our modern-day world still has very little research on the topic but there is good stuff out there, like this research, for example https://www.mpg.de/20964081/1013-nepf-the-menstrual-rhythm-of-the-brain-149575-x?c=2249
Be careful with how you interpret research that you do find as they usually tend to support the “normal” body theory. Which, as described above, is the source of a lot of confusion. But if you do read whatever you find through the lenses offered here in this piece that suggests that maybe, just maybe, women’s bodies haven’t been created to flow differently from men’s bodies by mistake. Maybe it wasn’t an “Ops” kind of situation. Maybe it was always meant to be this way. One body that moves in a more linear fashion, and another body that moves in a more cyclical fashion.
What would these complementary minds/bodies be able to create together? A world that values all seasons and not just summer is my guess.