My Period: We’re getting personal about our periods. The path to menstrual equity starts with talking about it.
Trigger warning: This article discusses symptoms and treatment some readers may find distressing.
“Are you…eating ice?” my mom asked me quizzically one evening. My parents have one of those large, fancy fridges that makes crushed ice at the touch of a button and I was overcome by an intense, mouthwatering desire to fill a glass with crushed ice and gobble it down. Soon after, I’d regularly crunch ice cubes the same way you’d eat a packet of chips. The thought of my next ice cube fix would cause me to salivate and I’d hide my camel-like chewing from my horrified friends and family. Biting through sharp cubes of ice would send pain shooting through my back teeth but I didn’t care; I would continue crunching, wild-eyed and manic. Looking back, it sounds almost comical. What I didn’t know at the time was that I had developed pica — a strong compulsion to eat inedible objects — as a result of iron deficiency anemia and my extremely heavy periods. Eating ice would be just one of the many insidious symptoms that would take over my life throughout the next year. My physical and mental health would both be significantly impacted.
Nearly a year before my ice fixation took hold, I found myself standing at the sink in the office toilet cubicle, washing blood out of my linen dress. Panicked and covered in antibacterial hand soap, I rummaged through my arsenal of period products. I’d bled through my change of period pants. I had no more tampons left. I’d switched to a period cup but I knew it wouldn’t last long. I was bleeding through my period products on the hour. At the time, it was the heaviest period of my adult life. Right on cue, pain gripped my stomach, thighs and back. In my soaking wet dress, I slipped out the back door of the office and grabbed a two-hour train from London back to Manchester, where I live. Standing in the train aisle, my eyes dimmed. I felt weak and like I was about to pass out. A doctor on board asked me if I was okay. I wasn’t but I smiled and said I was. I would continue to bleed like this for 10 long days, every single month for the next year. I stopped leaving the house. A period this heavy should have sounded the alarm. Get this checked out. Sadly, it would take a long time before the cause was investigated.
Like many Black women, I have uterine fibroids: benign, non-cancerous growths that develop in and around the womb (approximately 80% of Black women will suffer from fibroids by the age of 50). Fibroids don’t always cause symptoms, although many people, like me, experience unbearable abdominal and back pain, and heavy and painful periods (known as menorrhagia) that last longer and are more frequent than average. Much like conditions such as endometriosis and PCOS, there is a high risk of developing iron deficiency anemia due to the heavy loss of menstrual blood. Pregnant women are also especially at risk. Black women are 50% more likely to develop iron deficiency anemia compared to other races due to the disproportionately high prevalence of fibroids. Various researchers have attributed this to high exposure to hormone-disrupting chemicals in Black beauty products, vitamin D deficiencies, dietary factors and elevated stress levels yet there is no single determining factor and, well, no one really knows why. Learning that additional factors such as systemic healthcare disparities and the under-diagnosis or delayed treatment of reproductive health issues may contribute to this heightened risk has been a hard pill to swallow.
Iron deficiency anemia is caused by a lack of iron in your blood, typically due to blood loss. Iron helps to make hemoglobin, which carries oxygen through our red blood cells. In simple terms, if you have fewer red blood cells than normal, your organs and tissues don’t get as much oxygen as they usually would. The symptoms, which can include tiredness and lack of energy, shortness of breath, heart palpitations, paler than usual skin and headaches, are treatable, however, serious complications can develop if the condition is left untreated. In the UK, there are 57,000 emergency hospital admissions each year due to iron deficiency anemia — in rare cases, it can be fatal.
My anemia was left untreated for more than a year and during that time my symptoms became progressively worse. I spoke to a doctor three times over the phone and was initially offered hormonal contraception and blood thinners to control the bleeding without identifying the underlying cause. It wasn’t until I was given a new doctor, a Black woman of a similar age to me, that I was referred to a specialist and underwent an ultrasound and a blood test. It was the first time I had felt directly impacted by the gender and racial biases in healthcare I’ve often reported on for R29 Unbothered. Is it a coincidence that it took a Black woman doctor to take me seriously? I don’t think so. “[The fibroids] are large but I’ve seen bigger,” she told me once I received the results of the ultrasound. “Let’s get you in for a blood test and wait for the results,” she said. So I waited.
Untreated anemia takes a lot from you. In my family, my nickname is “Goggins” after the former Navy SEAL David Goggins, who performs ridiculous endurance stunts, tells people to “stay hard!” and claims to have run an ultra-marathon on broken legs. It’s a playful nickname but it’s indicative of how much energy and resilience I usually have. It’s no exaggeration when I say that anemia took away my essence.
Anemia doesn’t just make you feel a little sleepy or cold; it is a molecular-level tiredness that I find hard to explain and the exhaustion altered how I interacted with the world around me. People close to me would remark that my “light had dimmed.” My hair began to fall out. I gained a lot of weight. “Why can’t I fight this?” I would ask myself in tears, on the verge of deep depression. “It’s just a period. People have gone through much worse. Get. Up.” In my worst moments, I believed the extreme pain and fatigue was an intrinsic part of the menstrual experience; that my biology meant I should be able to handle my period at its most debilitating. I now know that it was internalized misogyny that was goading me to ignore my symptoms and push through a serious medical issue. Due to my inherent need to prove that I am “Goggins-resilient,” I continued showing up with a smile at work, in life and for exercise. But I was fading fast. And I made it worse.
I began to hear loud whirring and whooshing noises in my ear when, for reasons inconceivable to me now, I tried to keep up with my running routine despite my pain and struggles. I went to intense boxing classes and could see my pulse beating through my eyes. I developed pulsatile tinnitus which, in layman’s terms, means my iron levels were so low that my arteries had to work harder to supply more blood. I could literally hear the change in blood flow. The banging in my ears wasn’t initially identified as a symptom of anemia and I was told by another doctor that I would need an MRI scan of my brain and, potentially, a lumbar puncture. I spent 16 hours in the emergency room, terrified, only to be sent home without being looked over.
I developed excruciating pain in my head, neck and eyes that would wake me from my endless sleep. I couldn’t walk up the stairs without frightening dizzy spells and shortness of breath. I signed off work. I began to pass out multiple times a day: when standing up, in the shower, and moving my head from side to side. I’d see a kaleidoscope of jagged patterns, then complete darkness. The blackouts would last a few seconds and I’d be back in the room, scared to move. I called my doctor’s office and they checked me for meningitis and ear infections but found nothing and gave me a muscle relaxant to help me sleep. When I struggled to lift my head from my pillow to feed myself, I called 111 [a telephone service in the UK for people seeking urgent medical advice], terrified. The responder on the line didn’t know what to do.
“L’Oréal, I tried to reach you. You are severely anemic,” came a text from my doctor who had just got my blood test results back. “My colleague at a nearby hospital will be in contact to organize. If you are short of breath please do not drive.”
I was driven to the hospital and given intravenous iron infusions. Similar to the process of a blood transfusion, liquid iron was injected into my arm as a way to increase my body’s iron levels quickly. I was beyond curing myself with a carnivorous diet rich in red meat and broccoli; it was an emergency. The day I was admitted to hospital was day one of another heavy period and I felt as if I was slowly fading away. I was so grateful to the nurses for their intervention. However, a week later my iron levels plummeted drastically and I began passing out again. I found myself back in the hospital, waiting for another infusion.
The normal red blood cell count for a menstruating person is between 12 and 18 g/dL (though measurements can vary between different hospital laboratories). To put this in context, my red blood cell count at its lowest was 6 g/dL. Hemoglobin levels of less than 6.5 g/dL can be life-threatening. It’s still hard to accept that I let it get that bad.
Dr Shazia Malik, a consultant OBGYN for over 30 years and the UK medical director at Daye, a virtual women’s health clinic, audibly gasped when I shared my red blood cell count. Though I’ve dealt with heavy menstrual bleeding since my very first period, I hadn’t had any issues until now. What exactly makes a period heavy? I asked her.
“In clinical terms, [a heavy period] is losing more than 80 ml of blood per menstrual cycle — but the average person isn’t going to know what that looks or feels like,” she says. “There are a lot of women who are losing more than 80 ml who don’t consider their periods to be heavy, and other women will be anemic and are quite shocked when you tell them their periods are really heavy.”
Dr Malik should know. During her research at Cambridge University, the gynecologist had to collect used menstrual products and measure how much blood their users were losing per cycle. While she admits it was not the most enjoyable task, Dr Malik knows firsthand the toll of dysfunctional uterine bleeding.
“[Your period is heavy] if you’re waking up at night to put a night tampon or a night pad or your menstrual cup in, and you’re still waking up at night having to change it, you’re getting blood on the bedsheets. If you go out and you’re flooding [your clothing] and it affects your work. And specifically, if you’re having to change a super tampon more than once every hour or two hours,” Dr Malik explains. “If you’re passing big clots, bigger than a 50p piece [roughly the same size as a 50-cent piece], that’s not a good sign.”
Dr Malik shares that she notices her patients with uteruses feel “conditioned to put up with more” and as a result seek help for painful and heavy periods far later than they should. “Yes, the female body is designed to have a period every month, and yes, this means we are designed to be able to cope with that blood loss every month. But if it’s getting to the point where you’re exhausted, you’re tired, it’s affecting your hair growth, you’re short of breath, you’re always feeling sleepy, then that means the blood loss has gone beyond what your body can cope with.”
“Your periods are not meant to impact your quality of life,” Dr Malik reiterates, stressing that hormonal contraception can be “life-changing” for those with heavy, miserable periods. “And I think if we teach that to women from a young age, that while your periods are very normal and it’s okay to feel a bit under the weather as your period approaches and [during], if it’s impacting your day-to-day life, go and have a blood test.”
It’s been four months since I was in the hospital treating my anemia. I regret chastising myself for feeling weak when I needed to practice self-compassion. I am not bloody David Goggins! (And I doubt he could handle period pain, just saying.)
I’ve been prescribed blood thinners to minimize the bleeding and I have become religious about taking iron supplements every morning. My fitness levels are returning and, yes, I no longer crave ice. Though I am gradually feeling better, I am still grappling with the uncertainty of living with fibroids. Will I need to have surgery? Will my fertility be affected? Will I end up in hospital again?
Understandably then, I still hate my period. And no, my period isn’t divine. I don’t consider my monthly as Mother Nature’s gift, or my sacred connection to the moon. I will never be one of the smiling, rollerskating, dancing women in tampon commercials. Frankly, my period isn’t something I am happy to see pay a visit. But I am reminded that it was my hatred of my period — my eventual refusal to accept the disruption to my life as normal — that helped sound the alarm when the heavy bleeding became dangerous.
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This article was originally published on refinery29.com.