Women's Bodies, Women's Wisdom (38 page)

Two weeks later, I did another endometrial biopsy. The tissue was normal endometrium, consistent with the first phase of her menstrual cycle. Darlene was ecstatic and cried with relief. She then went on to have a completely normal period. In the ensuing months her periods were normal, too, and have remained that way. During these months she changed her biochemistry through biofeedback, which she practiced for her insomnia, headaches, and intense anxiety. Realizing that her marriage had not been healthy for her, she separated from her husband, began divorce proceedings, and entered into a love affair where her sexual needs were addressed, which turned out to be deeply healing for her.

Three years later, when Darlene came in for her annual exam, she told me that she was developing a feeling of power around her men strual cycle that was new and very exciting for her. “My breasts get bigger,” she said, “I feel powerful, and I walk around like I know the secrets of the universe. I think my family has been terrified of my power for years. I can remember feeling it even when I was a little girl. Although having this power seems new, it also seems like something I’ve known for a long time.” Darlene has reclaimed her connection to the universal feminine and her sexuality. By doing so, she has broken a cycle of irregular bleeding that was generations deep within her family.

HEAVY PERIODS (MENORRHAGIA)

Some women bleed so heavily during their periods that they rou tinely bleed through one or two tampons and a pad worn at the same time. Their blood may even soak through their clothing. Some are un able to leave the house during certain days of their periods because the bleeding is so heavy. One of my patients decided to have a hysterec tomy after she bled through her clothes into the upholstery of her air plane seat on two different business trips to Europe.

This kind of heavy bleeding is called menorrhagia. Women with menorrhagia have periods at regular intervals, but the periods are heavy. Over time, menorrhagia may lead to anemia (a low red blood cell count) if a woman doesn’t get enough iron in her diet or if her body can’t replace the blood she loses each month. Menorrhagia can be caused by fibroids, endometriosis, or adenomyosis. Rarely, it is associated with a thyroid problem. Some women bleed heavily for no obvious reason.

Chronically heavy periods can be related to chronic stress over second-chakra issues, including creativity, relationships, money, and control of others. One of my patients who sometimes had very heavy periods noted that her periods became heavy when she was upset and needed to weep. “When I bleed like that,” she said, “I feel like it’s the lower part of my body weeping for the losses I have suffered in my life.” When she took the time to pay attention to the different problems she was having and let herself feel her disappointments and pain, her periods were normal. Another patient, who had bad cramps every month and bled profusely, began to think of the uterine pain as related to her strong need for creative space in her own life. She began to set aside one hour a day to do sculpture. Each time she did, she got in touch with the sheer joy of creating for its own sake, and her pelvic pain and bleeding gradually lessened each month.

Adenomyosis, a common cause of pain and heavy bleeding, is a condition in which the glands that normally grow in only the lining of the uterus— the endometrium—grow deeply into the walls of the uterus. (Sometimes called “internal endometriosis,” adenomyosis is often present along with fibroids and/or endometriosis, but not always.) This condition can result in bleeding into the uterine wall with each menstrual period. The uterine wall becomes spongy and engorged with blood, producing a condition in which the uterine muscles can’t contract normally to decrease the bleeding.

A diagnosis of adenomyosis is usually suspected from a woman’s history and from a characteristic boggy-feeling uterus on pelvic examination. A definitive diagnosis can be made, however, only by magnetic resonance imaging (MRI) or by a biopsy of the uterine wall, which entails surgically removing a piece of the uterus or the entire uterus.

Treatment

Women whose menorrhagia does not respond to diet or who prefer other options can often be helped by a synthetic progestin to keep the bleeding under control. The usual regimen is 5 to 10 mg of Provera or Aygestin taken once or twice per day during the last two weeks of each menstrual cycle. Birth control pills also can work well in many cases. Natural progesterone, either applied as a skin cream or taken orally or vaginally, can also be used. The dosage depends upon the severity of the problem: For oral progesterone, I recommend 100 mg four times per day for the most severe cases, 50 mg two times per day for milder cases, from days fourteen to twenty-eight of the cycle. For progesterone cream (400 mg/ounce), I suggest half a teaspoon twice per day on the soft areas of the skin—breasts, neck, face, abdomen, inner thighs, inner arms, or hands. Vaginal gels of micronized progesterone are also available. The usual starting dose is 45 mg, either daily or every other day on days fourteen through twenty-eight of your cycle. Following the diet outlined in chapter 17 often de creases or eliminates the need for the progestin or progesterone over time. Some women have used this treatment for months or even years as an alternative to hysterectomy.

Prostaglandin inhibitors, such as ibuprofen (Advil or Motrin) or naproxen sodium (Aleve or Naprosyn), have also helped some women decrease menstrual bleeding.
⁷⁹
These are best taken one or two times per day for three to four days before the men strual cycle is due and continuing through the days of the period that are usually the heaviest.

Endometrial ablation, in which the lining of the uterus is removed either by electrocautery or by laser, is a surgical treatment for heavy bleeding in women whose menorrhagia has failed to respond to other treatments. This is an excellent alternative to hysterectomy and effectively controls heavy bleeding in more than 85 percent of cases. It can be done on an outpatient or overnight basis in the hospital.
⁸⁰
Women who opt for this procedure must be carefully screened beforehand to make sure that their condition is likely to respond, because it doesn’t work for all women. NovaSure is one type of endometrial ablation that has worked well for many (see
www.novasure.com
). Hysterectomy is also an option.

HEALING OUR MENSTRUAL HISTORY:
PREPARING OUR DAUGHTERS

Many women, like those about whom you’ve read in this chapter, have turned around their painful menstrual experiences and begun to reclaim their rightful heritage: their bodily, lunar, and cyclic creative wisdom. As a woman does this, she passes on to the next generation a more positive body image and relationship to her body. In this way, she frees herself and others from the patriarchal degradation of the feminine, and the possibility of healing all women’s cycles is greatly enhanced.

For too long, young girls have been introduced to the menstrual cycle solely in terms of sexual intercourse and the possibility of getting pregnant inadvertently. Most girls are not emotionally prepared to grasp the full responsibility and impact of their female sexuality until they know about and understand the workings of their own uterus, fallopian tubes, ovaries, and cyclic menstrual nature. Unfortunately, our culture’s advertising, merchandising, and media are saturated with sexualized images of young women and girls that undermine a girl’s healthy sexual self-image. The American Psychological Association’s Task Force on the Sexualization of Girls has issued a full report on this damaging trend.
⁸¹
We must educate ourselves and others about female sexuality. Fathers, too, can help. Though the primal need that fathers feel to protect their daughters from other men and boys stems directly from a patriarchal worldview in which men assume ownership over the women in their lives, it’s also true that knowing she is protected by a strong, loving father or father figure can be a boon to a young girl or woman if it helps her feel secure in her body and in her sexuality. Women who had adoring and supportive fathers are definitely given a leg up on thriving in the world. Far too often, however, this is not a woman’s experience. Many times her father was not around. And other times he was not supportive. Many women have told me about their fathers’ response when they reached menarche: “As soon as I got my period, things changed between us. He never hugged or cuddled me again. Our relationship was never the same.” One woman with a uter ine fibroid suddenly recalled her father yelling at her across the room when she was fourteen and all dressed up to go on a date, “You slut, you whore!” She hadn’t remembered this for years. She said that it had felt as if his words went right into her body and stayed there, affecting the way she felt about herself as a woman for the next twenty years. A lot has changed in the last two decades.

Reclaiming menstrual wisdom starts with women of all ages envisioning a new and more positive way of thinking and talking about the menstrual experience to ourselves, our daughters, our nieces, our loved ones, and the men in our families. Women who are attuned to their cyclic wisdom and who embrace it without shame or embarrassment go a long way toward helping the next generation move into their womanhood.

For many girls in this society, puberty has been a time of loss. When my oldest daughter was eleven and I was tucking her into bed one night, she told me that she was worried about something. She had a sore growth on her chest that was scaring her. She wanted me to check it. I did and found a small nipple budding on the left—the first sign of puberty. I told her that it was normal and that she had nothing to worry about. I congratulated her!

Later, unable to sleep, she came into my room and said, “Can we talk?” I said, “Of course,” and asked what was troubling her. She burst into tears and said, “I don’t want to grow up.” I held her and told her that I remembered feeling the same way. I hadn’t thought about it for years. But now, with her in my arms, perched on the brink of puberty, I remembered the deep sadness I had felt about growing up. I recalled never wanting to leave home and never wanting my life to change. We sat on my bed while I shared this with her and held her.

After a while, I asked her if she wanted to talk about this with her father, and she said yes. She asked, “Dad, were you ever sad about growing up?” He responded, “Not until the last few years.” All of us laughed together at his reply. After a few more minutes of acknowledging my daughter’s feelings about puberty, she thanked us and went hap pily off to bed. This experience was a great example for me of how our emotions, when we respect and express them, quite naturally move through the body and are released.

My daughter didn’t bring up the subject again but knew that she could. When she got her period at the age of fourteen she was well prepared and enjoyed getting flowers from her father and a special doll and book from me. Our celebration of our daughter’s coming of age could not have taken place if I hadn’t appreciated the fact that at some deep, inarticulate level, she knew that moving from the innocence of girlhood to puberty was not an entirely happy prospect in a culture in which the female body is a commodity. As we work together to create new rites of passage for women, we must acknowledge that moving forward also means letting go and grieving over what we are losing.

Clearly we cannot take our daughters into a space where we have never been. We cannot provide healing for them in areas in which we’re still deeply wounded ourselves. If we still carry generations of shame about the processes of our female bodies, we cannot hope to pass on to our daughters a genuine sense of love for our own bodies. But the minute we decide to address this whole area, think about it in new ways, and begin the process of reclaiming our menstrual wisdom, the entire map changes. We can begin to create new ceremonies and new rites of passage for ourselves and for our daughters while at this same time working through our old programming and pain.

The good news is that this is now happening all over the planet. In the United States, for example, a group of menstrual health advocates has founded the member-run Red Web Foundation, (
www.redwebfoundation.org
), which is dedicated to supporting a positive societal view of girls’ and women’s bodies and menstrual cycles, first bleeding through last, and creating physical, emotional, and spiritual well-being. This foundation provides a wide range of resources for introducing girls to their first menstrual cycle in an empowering way as well as educating women of all ages about the positive aspects of their cycles.

The Red Web Foundation was inspired by the pioneering work of the late Tamara Slayton, founder of the Menstrual Health Foundation. Tamara taught me that most girls are not emotionally prepared for a full-fledged understanding of their sexuality until they have first connected their own creativity to their menstrual cycles. To that end, she often taught menstrual empowerment through doll making and other creative arts. Though there are dozens of ways to celebrate a girl’s coming-of-age within her own family, there’s nothing more powerful than doing this in community—with other girls and their families. This gives the celebration clout and meaning that it otherwise lacks. When a girl is surrounded by her ever-important peer group for a coming-of-age celebration (by the way, it’s not necessary that she have her first period to do this), her own hesitancy and embarrassment fall away and she feels embraced by the larger community in a powerful way. Remember, adolescence is all about learning how to fit in with peers. Nothing is more important to an adolescent girl. (For a full curriculum on how to deliver a workshop for girls on menstruation empowerment, go to
www.kesakivel.com
.)

Most of us will not have the opportunity to participate in a menar cheal celebration with a large group. But we can still honor our daughter’s first period with a special dinner, shopping trip, flowers, or special gift. It’s also important to include her father. All of us have an innate need for ritual and recognition. (I’ve come to the conclusion that the fiftieth birthday is really a belated coming-of-age ceremony for the baby boom women who were never celebrated during their adolescence but for whom, at fifty, all the passion, power, and ebullience of adolescence come roaring back.)