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Image: Tina Tiller
Image: Tina Tiller

SocietyJuly 20, 2022

Everything you ever wanted to know about periods, part two

Image: Tina Tiller
Image: Tina Tiller

You asked us all your burning period questions and we took them to the experts. Today: contraception, bleeding after birth and the ‘menstrual chaos’ of menopause. 

All week we are examining our relationship with menstruation in Aotearoa. Read more Bleed Week content here. 

If there’s one thing we’ve learned in researching for Bleed Week, it’s that everyone learned about periods in a different way. Some had a book left on their pillow from a period fairy, others had a tampon dunked in a glass of water in front of their class. Some relied entirely on Dolly Doctor and urban legends shared at sleepovers, and others never got taught anything at all. 

So we put the question out there – “what do you want to know about periods but have always been afraid to ask?” – and took your inquiries to a panel of experts across the country. 

Read part one here.

I suppress my period via the pill, but what happens to all those grumpy pent-up eggs?  

“The way the pill works as a contraceptive is that it inhibits ovulation,” says Michelle Wise, deputy head of the department of obstetrics and gynaecology at the University of Auckland. “So your eggs are still there in your ovaries but you are not ovulating, so there’s no opportunity for the sperm to swim up and fertilise the egg. The eggs are still there, they are just sitting there.” Still, that doesn’t mean that those who are on the pill will have more eggs left later in life than those who don’t. “It’s just a bit more complex than that,” says Wise. “It’s not like if you have 1,000 eggs but then you stop ovulation with the pill and when you turn 40 you will still have 1,000 eggs.” She describes them as “potential eggs” instead – “every time you ovulate, that potential egg is maturing into a follicle and eventually gets released and is able to be fertilised.” 

Is it dangerous to skip the sugar pills? Or was that myth invented by the pope to keep us subjugated? 

“It is completely safe,” says Wise, “recommended in fact.” In other countries such as the United States, contraceptive pills can be sold in packages with up to nine weeks of straight pills and no sugar pills. “We are shifting, finally, in New Zealand, to recommending it that way, which is back to back or a long cycle or whatever you want to call it.” The benefits are huge: four or five periods a year rather than 12 or 13, better contraceptive effect and less risk of low iron if you suffer from heavy periods. 

The biggest myth of all, says Wise, is the idea that if you miss your sugar pill your body will keep accumulating a thick lining month over month. “The whole point of the pill is that you are inhibiting ovulation, you are keeping your hormones the same everyday and so you aren’t seeing those natural hormonal changes that lead to the thickening of the lining,” says Wise. “The pill from day one is reducing that lining getting thickened, so when you get your period it should be less heavy and less painful.” 

The Combined Oral Contraceptive Pill (or the pill) and the progestogen-only pill (POP)

Why do I get no periods with my IUD? 

“This question probably related to the Mirena which has a little bar in the middle of it that releases a tiny bit of progesterone every single day for about five years,” says Wise. “That progesterone thins the lining in the first half of your cycle and at some point it gets so thin that there is just no lining to shed at all.” She says that about 20% of people with a Mirena in place don’t experience any bleeding at all. “That’s why it is such a good treatment for people with heavy periods, because it is the most effective and longest acting, you don’t have to take a pill everyday you just have it inserted and then it just sits there unbeknownst to you and everybody else for the next five years.” You can read more about IUDs in Aotearoa here

Is it true that your first period after having a baby is like that scene from The Shining? 

Unfortunately yes. “I think for most people the first period after giving birth or after miscarriage can be heavier or longer than usual,” says Wise. “I tell people to expect anything.” She explains that hormones shift “really fast” on birth, and that you can expect to bleed for 1-3 weeks, followed by a gap of around four weeks, followed by your abnormal The Shining lobby period, and then things should even out from there. 

How do our periods change as we age? 

“People who have been monitoring their periods in their 40s will notice that their cycle length actually shortens,” says Wise. “Initially they start to shorten but then as you get older it starts to lengthen again, and that is because your body will start skipping ovulation every now and again.” She explains that sometimes you might get a 28-day cycle and feel completely fine, and then other times you might go six, seven or eight weeks without a period. “Then one day you realise you’ve gone 12 months without a period. That is the official diagnosis of menopause.”

Does the age of menarche (first period) relate to age of starting menopause? 

In short, no. “There are so many factors that impact on your reproductive life that it would be hard to draw line from one thing to another,” says Wise. “We tend to look at average age of menarche and average age of menopause. In New Zealand the average age of menopause is 51, and the average age of menarche is roughly 13. Overall, there is all kind of sociological research that shows the age of menarche is actually going down year on year.” 

Image: Archi Banal

Does menopause really make you extremely hot? 

“The most common symptom of menopause is that you have hot flushes during the day or night sweats where you wake up in the middle of the night,” says Wise. “It is amazing to think that the body can keep you at a normal temperature of 37.1 all the time, so somehow menopause is interfering with that normal regulation but we don’t know exactly why.” All she can say for sure is that some of her peers are welcoming the added warmth. “All of my friends are actually enjoying that little bit of extra heat at the moment, because normally we’ve been cold our whole lives!”

What are the other symptoms of menopause? 

There’s a lot. Disrupted sleep. Skin changes. Joint aches. Mood changes. Low libido. “We send a lot of people off to sex therapists because it is a real transition as your hormone levels are reducing quite dramatically,” says Wise. “Dry vagina is really common because the oestrogen receptors in the vagina and the bladder really feel the oestrogen levels, so you will get symptoms such as feeling dry or painful sexual intercourse when you never had problems before and urinary symptoms where you might feel like you are getting a bladder infection.” 

Wise refers to the time leading up to menopause as a time of “menstrual chaos”. Some periods will be light and short, some will be heavy and long. The most important thing about menopause, says Wise, is to talk about it. “Most of this isn’t talked about at all. The message from me would be to not hesitate to raise it with your health practitioner. Anyone over 45 who is starting to notice changes in their periods, sleep and mood, could be in peri-menopause. So that would be my key message: to think about that and read more about that.”

Keep going!