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  • Writer's pictureErin Stevens

Bloody Hell

various menstrual products
Fitting Halloween topic: buh-lood. Illustrator Warren Espejo

My period flooded into my life when I was 15, and I started birth control pills soon after to control the heaviness. After starting pills, no doctor EVER ASKED ME about my periods ever again to my recollection. Despite quickly soaking through super-level menstrual products onto my pants and sheets several times every period, I assumed “this is as good as it gets because I’m doing the helpful thing already, and my doctor didn't tell me about any other helpful things!” and went on my not-so-merry way until MEDICAL SCHOOL when I discovered my periods were in fact horrifically heavy and didn’t have to be that way. Enter the Mirena IUD, the life-changing miracle that would - after about 6 months of my body adjusting - result in the bliss of many years without periods until I decided to pull it out myself and try to have babies.

So what is a heavy period anyway? Classically, what's quoted as the upper limit of normal bleeding during menstruation is 80 mL. And of course we all know what that looks like in blood covering multiple menstrual products over the course of several days, right? Right? No? Even though we in the OB/Gyn world estimate blood loss after almost every procedure we do, I didn’t become good at understanding liquid volumes visually until I was breastpumping and heavily obsessed with my output.

Okay, so let’s take a look at a handy chart to figure out heaviness. Surely this will help.

But wait, maybe this doesn’t help at all. Maybe this is talking about regular pads and tampons and I’m always using supers. Maybe this chart is requiring me to overanalyze and overdocument. Maybe it gives space for 10 days of charting without mentioning that that’s too many days of bleeding (2-7 days is normal). Maybe it’s 2023 and I’m using a menstrual cup or disc or period panties which aren’t included here at all.

Many people will otherwise say, “well if someone thinks their bleeding is heavy, it’s heavy”. But what if you live in a society where talking about menstruation is taboo and you’re a shy teenager who’s just highly embarrassed by all this soaking through fabrics and having to tie a sweatshirt around your waist while praying that no one notices and your doctor literally never asks you about it? How can you decide that it’s heavy if you aren't presented with the opportunity and mental framework to assess this?

Let’s acknowledge for a minute how upsetting it is that most menstruators have no idea what’s normal or not for anything related to their periods despite this being a biological process that has occurred for roughly half the population for a large portion of our lives since the beginning of time.

My brother’s partner asked me the other day if there was a resource that I particularly like for assessment of menstrual flow or comparison of menstrual products for a project she’s working on, and I was a bit ashamed to say I didn’t have a go-to. I ask my patients detailed questions about their experiences, but that’s no way to educate the broader public and relies on someone getting to my office and being open to talking about their menses in the first place.

Based on my professional and personal experience (having used every type of menstrual product myself at this point - currently managing the non-miraculous bleeding profile of the Paragard IUD with the disc and menstrual underwear combo), here’s my attempt at a menstrual product comparison chart including notations for assessing bleeding level. You can use those generalizations or ballpark heaviness by looking at the amount of mL each product can hold and remembering that a total over 80 is shady.

Is this all-encompassing? No. Is it an exact science? Not at all. Might it help someone? Maybe? I don’t know. I hope so! But the absolute BEST thing we can do is TALK ABOUT PERIODS. Talk about the bleeding, the cramping, what products you use, the GI symptoms, the mood swings, and everything else with friends, romantic partners, family members, healthcare professionals, random passersby…you get it. Being open about the experience helps establish the range of normal so outliers can self-identify and seek help (side note: you can absolutely receive help to manage periods that are "normal" too!).

Some additional personal thoughts: I wish cups, discs, and period underwear had been around when I was a youth. No embarrassment of my next pad peeking out of my jeans pocket on my walk to the bathroom (not that this should be embarrassing, but it was to me in high school). No worries about packing pads or tampons for school or a visit to a friend’s house. No running out of products and having to shove toilet paper in my underwear. Partying out in the country where the bathroom plan is squatting in the bushes? Gotchu, boo. I wonder how different some times in my life would have been without extra anxiety focused on managing my period. The future is amazing!

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