Posted inFeminism

“Have you tried contraception?” On menstrual health, mental health, and male doctors

It’s June. Or it’s February. Or it’s July. Or March. Or October. I’m home for Christmas. Or on holiday with my boyfriend. Or hovering in the stairwell of the library, whispering into my phone. Occasionally, I’m in the GP surgery, masked and distanced, sticky with hand sanitiser and shame. On one particularly memorable occasion I’m in A&E, sandwiched between an older woman in handcuffs, and a pair of young men who keep laughing at my phone calls. 

It doesn’t matter where I am, or what time of the year it is, or even what time of the month it is.

I am sick, tired, and disgusted with the way I am being treated. Both treated as in dealt with, and treated as in given medical care. Except I can’t say I feel very cared for.

“It sounds like it’s an issue, with, you know…down there.” 

“It’s not worth pursuing diagnosis as your pain isn’t totally debilitating.”

“This doesn’t sound like an issue we can help with. Try going back to your GP.” 

“I hear you’re having a few little waterworks problems.” 

“Have you tried contraception?” 

“Have you tried mindfulness?”

“Have you tried the college counsellor?” 

“Tummy ache.”

“My dog had these antibiotics when he had a UTI and they worked fine.” 

“We can’t tell you which coil you’ll have fitted ‘til you reach the appointment.”

“It’s not a miscarriage, by the way.”

I’m asked about ‘waterworks’ by two male doctors, one of whom is holding an ultrasound probe to my exposed abdomen, after I’ve been struck by a repeat kidney infection. The remarks about endometriosis, and the offhand mention of miscarriages, come after I’ve lost so much abnormal menstrual blood that I’ve been on an IV drip. The ‘down there’ and ‘dog’ comments are made a few months later by a bored-sounding duty doctor who yawns down the phone. When I hang up I go and cry for an hour, hot water bottle between my legs, unable to move without crying in pain. I complain about his treatment to a friend a week or two later. “Oh, him,” she says disdainfully. “I’ve seen him.” 

I feel most familiar with my body as a ‘female’ body when it is in pain, and specifically, when that pain is being ignored, belittled, or demeaned. Over the two and a bit decades of my life, I’ve suffered repeatedly from health problems euphemistically referred to as ‘women’s issues’, a term which is not only belittling but inaccurate — after all, many trans men and nonbinary people suffer from menstrual and hormonal problems, and not all women are affected in the same way. Personally, I’ve spent my life stuck between two extremes — I’ve inherited a family propensity for heavy, painful periods, but I also experienced hypothalamic amenorrhea — the temporary loss of my period and fertility — linked to an eating disorder in my teens. Since my periods returned at university, I’ve suffered with irregularity, agonising cramps to the point of fainting, recurrent UTIs and kidney infections, ovulation pain, intolerance to certain substances such as those used in drugstore lube, and abnormal bleeding including one experience which required an embarrassing email to college requesting a new mattress. Writing this is, in a way, humiliating — do I really want to tell my fellow students I’m allergic to lube? — but equally, it’s cathartic. The hyper-euphemistic notion of ‘women’s issues’ or ‘feminine hygeine products’ (are periods unclean?), the inability for cisgender male doctors to even mention the vagina (see: ‘you know…down there’), and the general hush-hush treatment of menstruation is entirely unfounded and creates a sense of medical shame where there should be none. After all, it’s not exactly an uncommon issue. According to Women’s Health Concern, 80% of women experience period pain, and in 5% to 10% the pain is severe enough to disrupt their life, an indicator of dysmenorrhea, the technical term for extreme period pain. Some studies put this number even higher. And a YouGov study from 2016 reported that 57% of working women who suffer from period pain say it has affected their ability to work, with the majority of them reluctant or unable to share this information with their employer. 

After the aforementioned A&E incident, I get a phone call from my mum. “Every time I had a period, I wanted to die,” she says tearfully. The average menstruating person will experience periods every month for approximately forty years of their life. Forty years of agony not taken seriously, forty years of being ignored. 

Mental health and menstrual health are intrinsically connected. The menstrual cycle, as a time of intense hormonal fluctuation, is also a time of vulnerability, as anyone who has experienced PMS or its lesser known relative PMDD (Premenstrual Dysphoric Disorder) can attest to. PMDD in particular, which affects 3-5% of menstruating people, mimics the symptoms of severe depression, including a heightened propensity to suicidal thoughts. And yet it is rarely discussed — I only found out about its existence through a friend. 

Poor medical treatment, or poor treatment by an employer when confronted with belittled health issues, can also have negative effects on mental wellbeing. A tweet from January 2021 asking women to like if they’d ‘ever been ignored, gaslit, accused of exaggerating or told its all in your head by a doctor when you sought help for a medical problem’ currently has 32.9k likes. Beneath it, and across social media, women and non-binary people have shared often distressing stories of medical mistreatment or marginalisation by male doctors. Reading some of them, I found myself relating, and was struck by the implication that those who suffer from menstrual issues are ‘hysterical’. The word hysteria, or uncontrollable emotion and panic, actually derives from the ancient Greek hystera or womb, reflecting the pervasive belief that women’s health complaints derive from either their hormones, or a state of mental imbalance. This connection between madness and menstruation has a long history encompassing the ancient idea that the womb ‘wandered’ around the body, the witch trials, and the nineteenth century ‘rest cure’, famously dramatised by Charlotte Perkins Gilman in her short horror story The Yellow Wallpaper. It’s this long tradition of medical violence against women which today’s medical establishment falls into when it refuses to take menstrual health seriously. When it refuses to believe that patients may know their own bodies, and be able to detect when something is wrong, particularly on an intimate and sensitive level.

Particularly as a university student, gynaecological health can be hard to navigate, not least because of inadequate sex education at school, and the lack of accessible medical information. From the first night of freshers week, students are more likely to experience casual sex with its associated risks and rewards, experimentations with alcohol and drugs become more common, while dietary and exercise habits change. Under the stresses of university, exhaustion runs rife, mental health is hard to manage, and psychosomatic problems can be develop — I highly recommend Dania Kamal Aryf’s article on ‘Emotional Contagion’ in the Cherwell for a harrowing insight into Oxford’s mental health pandemic. For many, it’s also the first time we navigate the labyrinthine healthcare system alone — I have plenty of love for the NHS, but none for its collapsing infrastructure. In this context, experiencing medical gaslighting — when a doctor seeks to convince a patient that they are overdramatising and health issues are ‘all in their heads’ — can be particularly traumatic. Even if there is no underlying issue, it’s exhausting to be shunted between hospital departments and waiting lists and GP references for months at a time with little to no contact and certainly no diagnostic progress, as I have. I’m sick of being in pain, but more than that, I’m sick of my pain being trivialised and ignored by those who are meant to help me. 

And it is pain — as noted above, dysmenorrhea can be debilitating, whilst more serious conditions like endometriosis and PCOS can be life changing. Even ovulation can be agonising for many sufferers of mittelschmerz, experienced by approximately one in five. Yet for many cisgender men, including doctors, a period is just a bit of blood and perhaps some stomach ache. Additionally, it can be incredibly difficult to discuss intimate issues with doctors, especially those of a different gender, when one is afraid of being ignored or shamed. There are multiple barriers to discussing sexual health with doctors, including discomfort, lack of training, and time limits, which various studies have found are compounded by gender-related issues. Take the issue of painful sex, which at least 10% of British women experience, according to a 2017 study. A UK survey from 2017 showed that painful sex lasting three or more months of the year was reported by 7.5% of sexually active women. 7.5% seems like a small number, but based on the UK’s population size, that equates to over two million. How can these women, like those who suffer from agonising and debilitating menstrual pain, be able to lead a fulfilling and satisfying life when they are unable to confidently seek care? 

Surely in order to improve the quality of life of those who suffer from ‘women’s issues’, we have to change the way we think about menstrual, hormonal, and gynaecological health?  

Where do we start? Well, a small suggestion for the medical establishment. Let’s leave the whole ‘hysteria’ thing in the past, and start taking patients seriously, shall we? Members of the medical profession, especially those who will be tackling sensitive issues such as gynaecological or urological care, need to be taught better communication skills. I believe doctors should face mandatory training for how to speak to female patients, as well as those who fall under the trans umbrella, in order to prevent belittling or demeaning language. So many people with eating disorders have stories of doctors congratulating them for weight fluctuations in a way that has actually contributed to their mental ill health. The offhand comment by a doctor can put you off seeking medical treatment and make you feel incredibly uncomfortable or unsafe. We need a revolution in the way doctors treat patients from groups traditionally marginalised by the medical establishment.

Moreover, doctors and hospitals could approach health more holistically. Not only are mental and menstrual health related, but seeing disconnected therapists, gynaecologists, dieticians, physios, and uncoordinated GPs can be an exhausting and expensive experience. Issues from dysmenorrhea to diet are intimately connected and it’s important that both patients and professionals are aware of this. I’ve often wished that doctors would honour the fact that I know my body better than anyone else, and acknowledge that I have the right to pursue or refuse diagnosis or treatment. For example, the seemingly one size fits all policy of prescribing the pill has come under increasing scrutiny in recent years, as high numbers of people report severe mood related side effects with hormonal contraception. More information about alternate forms of contraception and alternate treatments for painful menstruation could be made widely available, rather than the ubiquitous ‘have you tried the pill’ response women receive regarding all health concerns.

Employers and educational institutions also require innovation in how they treat issues of menstrual and gynaecological health. Legislation permitting menstrual leave already exists in several countries, predominantly in Asia rather than Europe and the Americas, after it was first implemented in Japan in 1947. The broader implementation of paid menstrual leave and the destigmatisation thereof could not only boost mental and physical health, but actually boost productivity by increasing the effectiveness of work done by menstruating employees. Free period products in inclusive bathrooms is yet another simple yet life-changing initiative, especially in areas with high levels of period poverty. 

Over the past couple of years, as the pandemic has placed increasing pressure on the medical system, with many NHS services going online, routine services cancelled, and waiting lists soaring to a record high, it seems that healthcare issues which traditionally effect women have slipped between the cracks. And yet that doesn’t mean they’ve gone away, they’ve simply, once again, been ignored and forgotten about. I’m far from the only person to experience the effects of this first hand. When receptionists reassure me they’ll ‘follow up’ on that scan (spoiler, they won’t), or the GP tells me for the tenth time that ‘you could always go on contraception’, I want to scream.

I suppose at least then I can get a diagnosis for hysteria.

(Illustration by Marcelina Jagielka)