I’m every woman

I know you want to hear the song…

It’s time we talked about periods. The reason I say that is because well, if you’re a female, the menstrual cycle is a pretty big part of your life whatever it happens to be doing at this point in time. Then there’s the whole vegan-iron-anaemia thing. And it might just be me because I’ve been bothering the internet for a while with questions on the topic, but when I start to type “female athlete” into Google the first suggested search term is “female athlete triad” – of which a key element is menstrual cycle abnormalities. So if, like me, you’re a vegan woman who exercises frequently at a reasonably high intensity, you’ve probably already faced the issue of amenorrhea – if not in practice, then at least in theory.

Amenorrhea means the absence of menstruation, or monthly bleeding. It is understood that if you menstruate, you ovulate; if you ovulate, you are fertile and able to give birth; and if you give birth and thus new life, you participate in the continuation of the human species. So it’s kind of a big deal (more than the average sanitary towel advert would have you believe) and when menstruation stops, it freaks a lot of people out.

In fact, most people are positively aghast when they find out I haven’t had a period in about four years. Indeed, the topic has come up with more people that you might expect, the least random of which was my doctor who repeated “Four years?!” at me rather incredulously a number of times before sending me for a blood test (the day of which, ironically, I got my first period in four years – isn’t the human body wonderfully obscure at times?).

Anyway, the tests didn’t reveal anything sinister but my doctor still wants to monitor things. Now that fertility issues have been rules out, she is mainly concerned about the associated osteoporosis risk (another component of the Female Athlete Triad), but as a non-smoker who has spent years performing various types of weight-bearing exercise and avoiding alcohol, and a healthy vegan taking vitamin D supplements, I don’t really feel my bone health is of much concern to me. I did double-check with my GP that I had been compensating enough for the lack of menstruation, and she agreed.

However, if there are contraceptives on the market these days which suppress periods for several months at a time, how can the lack of menstruation really be such a concern?

I’ve been surprised by some reports that I have read which have summarised that in fact, modern women menstruate far more over the course of their lifetime than their ancestors, who died younger after a life spent child-bearing and breastfeeding. If you’ve been around this blog for a while you’ll know I’m not a fan of the “humans were like this thousands of years ago so we should be like that too” argument – it’s just not how evolution goes – so as interesting as that was, and as much as I believe the point about health risks associated with increased and more frequent bleeding, I’m not willing to let that convince me entirely.

What I do like is logic. One thing I knew was that the bleeding experienced whilst on most oral contraceptive pills was not actually a “real” period but a withdrawal symptom from not taking the additional hormones for 7 days. Of course you could argue that periods are simply the result of natural hormone fluctuations anyway in women not using hormonal contraceptives, but my point here is that the lack of bleeding in and of itself is not a problem.

Amenorrhea can be a sign of ill-health, of course, and it’s this underlying dysfunction which can be at the heart of later problems like osteoporosis. So we end up jumping the middle step and believing that it’s the lack of monthly bleeding which causes further disorders, even when underlying issues are ruled out. This article summarises things nicely, and reports that in fact 99% of female OB/GYNs believe that the suppression of monthly periods is perfectly healthy.

Of course, as with pretty much anything medical and especially relating to the female menstrual cycle, more research is always needed and everyone’s circumstances are different. Though a 2007 report by the Society for Menstrual Cycle Research is very sceptical, I think the point is to assess your own situation, inform yourself, and make whatever decision fits at the time.

With all that said, amenorrhea is a sign that something is amiss, and a serious sign at that. So if your period is AWOL, it is imperative to get the necessary tests done to rule out any fertility issues, bodyweight issues, or any other physical or mental health concerns. The fact is that our body is geared up to release hormones in such a way that we end up bleeding for a few days each month, and if that stops happening of its own accord, you have to question why. But if it stops happening for an identified reason, and that this reason is not of concern to your health (for example, you prefer to take a hormonal contraceptive which reduces your period frequency – particularly of interest to physically active and/or competitive females), then you have no cause for concern.

Of course, my conclusion is the result of personal experience and a bit of reading around the subject and speaking to various people in the medical field. I just thought I’d present my thoughts in a way that is perhaps a little more engaging than academic abstracts and association summaries, and I hope you’ve found it helpful. If you have any similar experiences or thoughts, I’d love to hear from you.