(check out Part 1 for the down-low on PCOS)
Dana Alloy is an evidence-based reproductive health researcher at UCL and Women's health educator dedicated to helping women understand their periods. Her interests are in menstrual health disorders, the intersection of menstrual health and women’s fitness, and gender bias in healthcare. She believes that knowledge is power. The more you understand your body, the better you can advocate for yourself.
- Dana's episode on the Bodcast podcast: Blood, Sweat, and PCOS
- Menstrual Cycle and Fat Loss - TEDx by James Smith, Personal Trainer
- What is Endometriosis?
- What is PMDD?
- What is Hypothalamic Amenorrhea?
Rachel: Hello, Peaches! And welcome to another episode of No Peach Left Behind! This one is going to be short and sweet. Dana and I talk about #periodproblems. We discuss 4 main disorders that you probably didn't learn about in school but that can definitely throw off your cycle and have a serious impact on people's lives, your life. So, without further ado, let’s go…
Rachel: OK. Now that we've said all we had to say about resting and stuff, let's go back and just talk again about the major hormonal imbalances or I guess we could say disorders that you can have, because you said there's about three other big ones that you wanted to go over, not just PCOS.
Dana: Yeah, so there's four that I wish that all girls, when they got their period, we're like, "Just so you know, these things exist". Like the same way we know that like you can have a heart attack or appendicitis. These are just easily understood topics. And so it's important to me to sort of be re-educating and re-writing how we discuss this just so that more women don't have to suffer in silence and sort of blindly suffer without knowing this. So PCOS, as we talked about, worst named, worst diagnostic criteria, but basically is about irregular periods that are related to testosterone or just general androgen excess. PCOS tends to be over-diagnosed, under-diagnosed in some populations, but the main one, I think, that goes under-diagnosed is Hypothalamic Amenorrhea, which is a very long name. That essentially means that you're eating too little compared to how much you're exercising. That's it.
So another thing that happens is people get this label and they're like, "I have this crazy thing called Hypothalamic Amenorrhea!" And actually, just means you need to eat more or exercise less compared to how much you're eating. Essentially, women are walking around with this without even realizing it because, you know, some people are just happy not to have a period. Right? You're like, "yeah, I haven't had a period in months. It's great." You know, "as long as I'm not having pregnancy scares every month, good riddance. Goodbye, PMS." Or you could have this, you could just have irregular periods. Another thing is that people end up getting diagnosed with all sorts of other things, like most commonly PCOS, when really what they need is to eat more and or exercise less.
And, you know, as we said, like ovulation is really important. The menstrual cycle is really important to women's overall health, to your heart health and bone density and things like this. And so it's important to sort of redo this because your body's essentially telling you it's in fight or flight mode because it's in so big of an energy deficit that it couldn't produce. And it's like shutting down what it's considering, like the extraneous functions, like producing life so that you can just function. That's not great. You want your body to be in this like safe state where it's able to do all of the things that it's able to do without having to pick and choose from functions because you're not feeding it enough. That being said, it also shouldn't be a scary diagnosis. I see Instagram influencers all the time talking about their infertility journey and how they finally got their period back when really it just required an increase in calories. And that's not for everyone. There's obviously larger infertility issues, but a larger proportion of women are just suffering from Hypothalamic Amenorrhea. And so I just think it needs to be talked about more that like low touch solution to a whole bunch of period issues that exist, eat more calories or exercise less intensely compared to how much you're eating. And that just is swept under the rug far too often, in my opinion.
So, yeah, if you're not having periods, that's one thing to consider. There's a lot of evidence for increasing complex carbs. So if you know, your mental health creates a lot of anxiety around just like having to eat more increased calories. A place I always suggest starting along with working with, you know, practitioner, therapist around those issues, is to just focus on complex carbs like sweet potatoes and grains, other things that can help with this without making you feel like you are doing too much. So yeah, so that's Hypothalamic Amenorrhea. Any questions with that one?
Rachel: No, I feel like one is really straightforward, right? Like the only reason that even exists as a problem is probably because women are so encouraged to like, you know, be skinny and be thin and exercise and, and don't eat as much and all that stuff. So I feel like that's very straightforward. Everyone just, just do what I do. Don't exercise and eat as much as you want. Who cares? Don't do that. Don't do that. But yeah, I can definitely see how that, that's a big problem for a lot of people, especially when you're at that stage of your life where you want to get pregnant now. And maybe you've been ignoring your period health cause you know, who cares? Right? And then until you need it and then it's like, "oh, shit. Now I have to change my whole lifestyle."
Dana: Right. Exactly. And so while it is something that is like reversible, treatable, for sure, it does take some time. And also, like, at the expense of what, in terms of your long-term health for, you know, what you've lost due to not ovulating, not having healthy menstrual cycle. But also it's an interesting thing to like look at what society wants women to be versus how your body is actually the healthiest. And so it's just a good place to sort of assess what is my thought process and my intention for my behaviors. Is it because I want to be my healthiest self? Or is it because I want to be my skinniest self? What is my priority? And again, like, I never want to put a judgment on any woman's behavior. We have so much of that in the world. There's no need for additional judgment anywhere. So, like, yeah, if you're like, "the patriarchy sucks and I want to be skinny for X, Y, Z reasons", I feel you. But it's just an interesting conversation to have with yourself. Where does my health stand as a priority with all of the other things I want to do or I'm being told I should be doing?
Rachel: Yeah, I think it comes down to at the end of the day, like, are you going to put yourself first or are you going to put, you know, all of society's expectations and other people's expectations first? Cause that's kind of what it is, right?
Dana: So well said. Yeah.
Rachel: Everyone wants to be, like, attractive and stuff. But like, at the end of the day, if it means that you're not going to be healthy then... Is it worth it?
Dana: Right. Yeah. So that's Hypothalamic Amenorrhea. I guess the other one that I would talk about, which I know is very near and dear to your team's heart, is Endometriosis. Which I'm sure has been discussed at length. But just if you're a first-time listener, Endo[metriosis] is a disorder that's associated with pain and inflammation. And I think it really just encapsulates everything that's wrong about how society considers women's health and women's pain and women's periods. Because painful periods have been written off as just people being complainers. Like back to what you were saying in the beginning about how PMS is like, is PMS even real? Like people just are constantly questioning women's health experiences.
But honestly, if men had Endo[metriosis], it would be the most researched problem in history. The actual biological mechanisms is like something out of a horror film. So when you have endometrial tissue, the lining that sheds with your period, what’s excreted when you have a period, what you see in your pad. That tissue, instead of being excreted, grows outside of your endometrium where it's supposed to be and instead grows in and around your other organs, but then it can't shed. So it just causes really painful adhesions. It can be your uterus, your colon, your bladder, even your appendix. Like, I swear men would be bragging if they could handle one day of walking around with Endo[metriosis]. And yet we just are completely accepting of the fact that roughly 10 percent of women are walking around grinning and bearing it, having this crazy thing happen to their body on a monthly basis.
Dana: And are having really heavy bleeding or super debilitating symptoms, and just deal. In my opinion, it's the most under-emphasized illness in history. So I'm sure more of the science will be covered in other podcasts and different aspects of Endo[metriosis]. But I just think it's important to say, like if you are having a hard time with your period or you're just having pain at all, like a lot of times gut issues, these get crossed over. Like people think your period issues are gut and that your gut are period issues. Look into Endo[metriosis] because the time for diagnosis around the world is seven to fifteen years. Like I think in the US it's eight and a half. But yeah, I mean, it's wild. It goes under diagnosed for so long. So just be aware that the diagnosis around this is such an issue and that people aren't taken seriously. And this is very much a very real thing and it deserves medical attention. And at this point, individual advocacy is really important because the systems aren't advocating for women with us yet. And it's changing, but it's just an important thing to be aware of.
Rachel: Yeah, like you said this is a really big thing for our team at Peachyness, because our founder, Marine, has Endometriosis and it kind of got us both started on this journey because, you know, she started her company Peachyness and then she kind of me on to do the podcast. And I really agreed to do the podcast because I heard about her journey with Endometriosis. And, you know, she'd been dealing with this for like over ten years and finally got diagnosed. And I was like, this is crazy. Like, why didn't anyone tell me that this is something that could happen to me, first of all, because it could happen, it could be any of us could be going through it. Right? Cause there are some women who don't actually have pain during Endometriosis. Right? And then it's like later on when they're trying to get pregnant, that they find out that there's like this weird thing going on in their body. That nobody told them could happen and it's just wild.
That really opened my eyes a lot to the things that I don't know. There's so much that I don't know. And yeah, like you said, if anybody thinks that they're having a problem, then they should reach out to their doctor, try to do their own, you know, research, advocate for themselves. Because it's true. Like, I don't know why. For some reason, we're encouraged to just grin and bear. Like, some women have to be like the most badass human beings because, like, the pain tolerance of some people is like through the roof. we were talking to Jacy, she was in the first episode of the podcast, she had pain all the time. She had endometrial tissue, like in her liver, in a place you can't even imagine, like what? This is literally like a tiny little tumor that's growing on her liver that's like shedding every month. And like, we don't know anything about this. All they do is just give them the pill and hope for the best.
Dana: Yeah, it's shocking. It's really shocking. So I think, to end on more of a positive note, there is now. First of all, it just shows you what women can do. I mean, Marine's running a company, right? She is..
Rachel: She's a badass.
Dana: Adhesions growing throughout her body and she just running a company. And we need to think about it that way as opposed to like, "oh, my gosh, like this woman always complaining about her period." It is so much bigger than that. And also, the tide is turning like the more conversations like this that can be had on social media, there's so much about Endo[metriosis] now, so many support groups. Where it is, it requires sort of like a social movement in order for advocacy around this to happen. And that's happening. So the tide is turning. But if you hadn't heard about Endo[metriosis] before, now you do. And just hopefully that can contribute to the positive shift in things.
Rachel: Yeah, hopefully... I think you had one more?
Rachel: One more big, big guy that we should all know about.
Dana: PMDD. Have you heard of it before?
Rachel: Oh, I heard about it in the Bodcast. Oh, yeah, side note. OK. So for anybody listening to this. Dana was in the Bodcast podcast and she did an episode... What is it called? "Blood, Sweat and PCOS."
Rachel: So clever. Yeah. Anybody listening to this should definitely listen to that episode as well, because, you know, she talks about some stuff in there that we... I don't think we covered. So they complement each other, these two episodes. But yeah, I remember it was mentioned in that episode, PMDD, and I was the first time I'd ever heard of it. And I definitely looked into it and I was like, holy shit, I need to do an episode on that because that's crazy. Please, please go into it.
Dana: Sure. So PMDD stands for Premenstrual Dysphoric Disorder. It's essentially when you have really severe, they say like really severe PMS. But what's happening is that your hormone levels are shifting so drastically that it just causes an imbalance in your brain chemistry that can really affect how you experience things. So a lot of times it can be both physiological and psychological symptoms, but it's mostly characterized by the psychological effect of things that you can just have this huge come down from, you know, the shift of like a drop in estrogen, and it can create really significant mental health issues. Mental health has become such a hot topic, rightfully so, over the last few years in terms of people coming forward and talking about depression and anxiety and all sorts of different issues. But I think one place where it's still neglected is how your hormones influence your mental health. Serotonin and estrogen are linked, GABA and progesterone are linked, like, you know, we know this because hormone changes are associated with moodiness or being angry at your partner, that sort of stuff.
Dana: When you have these big shifts that are to an unhealthy extreme, it may be a cause of mental health issues. And I think, again, like if you're dealing with mental health issues and you're like, what is up? Or like sometimes I feel better than other times I just feel worse. Look at it as it relates to your cycle, because, again, very real. Very common. Rarely talked about. So just quick overview. Hypothalamic Amenorrhea is when you're not eating enough, and you may lose your periods. PCOS is when all sorts of different issues may cause you to have high androgens and irregular periods. Endo[metriosis] is this crazy pain and inflammatory disorder. And then PMDD is like the mood, hormones and mood disorder with really drastic symptoms around your menstrual cycle changes. And yeah, hopefully that sort of covers the span of shit you should have learned in sex ed.
Rachel: Yes. Yeah. Thank you for that awesome summary. Yes. These are all things that are, are huge. And I'm hoping to go into a little bit more as the podcast progresses, especially like PMDD, because, like I said, I just found out about that. And I was watching like this tiny, like little mini documentary or something where these women who have PMDD were talking about it and their experiences. And this is not a small thing like these women had suicidal thoughts when they experience like this is extreme drop in hormones. And like there are women who literally tried to commit suicide, multiple times, because of this, like this is real.
Dana: Yeah, well, it's a massive crash. So you're like riding high. And then all of a sudden you're just like robbed of all of that. And it makes sense that your brain crashes. But we really need to be more just cognizant of how many people are going through this and what a significant and severe effect it can have on someone's life.
Rachel: Yeah. Building off what you've already said, and how like the tide is kind of turning with Endometriosis and like people are advocating more for women's health and stuff. And, you know, I saw on your Instagram that you did have a post about like, I think you were talking about maybe with your boyfriend or something, talking to him about periods and stuff. And I really liked that idea because, you know, I have two older brothers and I feel like they had such a advantage having a younger sister who, like, you know, has been going through periods and stuff where now when they go into relationships with women and, they kind of know what to expect. They're not surprised by anything like they'll go to the store and buy like tampons and pads, you know, because it's not like a surprise or anything. Whereas I think a lot of men who don't have, like, that kind of female presence in their life before they go out into the world,
Rachel: They don't know what they're doing. And so, yeah, I think it is really important for us to be able to talk about this with men, because I feel like at least for most of our lives, we're like encouraged to kind of hide this aspect of ourselves, not just from ourselves, but from like men as well, like to shelter them from it for some reason? I don't know.
Dana: Yeah, it's called like menstrual etiquette in anthropology. There's this specific way that you conduct yourself and how you share or don't share about menstruation, which is just bullshit. I think in terms of men and periods, it has been the highlight of this whole journey for me, second only to like being able to help women feel better and be healthier in their lives. It's just how much the men in my life have supported this. They're so interested. So like anyone who thinks that men are grossed out by this, the amount of guy friends, acquaintances at like a bar, like anyone who pulled me aside and being like, "OK, so I hear you do this thing. And I have this one question." Like, I feel like I get comments the way that I would assume a sex therapist would. And I wasn't expecting that to happen. Like I thought. You know, I've always had an interest in period health. And as I became more and more public and vocal about it, I was like, "oh, gosh, like, this is gonna be so embarrassing with the men in my life." I'm still feeling sort of the societal implications of the stigma...
Dana: In that regard. And they just love it. They just want to chat. So I think that's really great. But the second thing that has been really eye-opening for me is how much it has helped me in my intimate relationships in terms of being able to, you know, because once you're like, "yeah, this is my job, this is what I talk about", it makes it possible to just discuss that more in a personal setting as well. It's added an extra level of being able to just feel close to someone and understood and not feel like you're hiding something. Like, I never felt like I was hiding this part of myself until I wasn't. And then it felt like it just level up-ed to my relationship in a way that I wasn't expecting. And maybe that's naive of me. I am the period queen. I should have been like, "Of course it will help." But I was like, "wow, this is amazing, how this is happening." So I just think that if I felt that way, like there's probably a lot of other women who are like, "ah, that's so cringe, I would never bring this up with my boyfriend."
Dana: Just try it. You will be so surprised, because just being able to be more open with your partner in this way has been so surprising to me or even just with my brother, like, he helps me with a lot of work stuff. And so he has been so enlightened from this process, but it just made our relationship closer. Like having to hide any part of yourself, even if it's something silly and stupid, just changes the dynamic. And so I don't think a lot of people realize how much that they are keeping this under wraps and what that just does to your general interaction with someone, even if it's subconscious, even if it's unconscious. And so, yeah, I highly recommend and it's also just, it provides for a lot of funny questions and I just think it's fun.
Rachel: Yeah, it's true. It's like a big part of your life, too. And then to have to hide it, it builds shame, you know, because I also have to live with the stigma. Like my mom when she was teaching me about, like menstrual etiquette, a really big thing that she always gets upset about. If I, like, leave my dirty pads in the garbage or like, you know, you you wipe after you pee, you're gonna have blood on it. And so I can't put that in the garbage in the bathroom because she's like, "no, no, no, no. What if your brothers see? What if your father sees? Like, that's not appropriate." And it's like, well, they know I'm going through this. It's not, it's a secret. It's pretty obvious when I'm going through my period.
Dana: And like, "oh, what? They see my badass stem cells like,”
Dana: “Oh, no."
Rachel: Yeah, but that's the thing, it's like that constant feedback, right? Makes you feel shameful for this thing that you can even control. It's just a part of who you are. You have influence over it. Right. But you can't really control it.
Dana: Nor should you. Right? That is literally the ability to produce life. Yeah. It's crazy to me.
Rachel: Yeah, and I love how you said that, you know, guys have been approaching you now and they are actually asking you questions about these things because it's true, like there's no real, like, socially acceptable or societal like place for guys to ask about these things. Right?
Rachel: They're told that they don't need to know it. And then all of a sudden, it's like actually this is something that your partner is going to go through every month. You should really know something about it.
Dana: Yeah, they're like, "wait. So when? When are they not able to get pregnant? When is their sex drive higher?" I'm like, "oh God. Here we go."
Rachel: It's so good. Yeah, it's like, "oh okay, cool, so if we have sex during this part of her cycle, we're definitely not gonna have a baby. Cool."
Dana: Yeah, it's so good. It's so funny. And I love then when I hear the men in my life explain it to each other. When they're like, "Yeah, dude. So, like, there's this thing called ovulation and it makes them really hot."
Rachel: Oh, my God. I need that. I need that to be a podcast. I need that to be something publicized because that would be hilarious.
Dana: Yeah, yeah. Oh, my gosh, I love it.
Rachel: Once I started the podcast, too, I'm not going to lie, it was a thought that occurred to me like, "oh, crap. Probably guys are gonna hear this and they're gonna hear me talking about like my period and like, you know, random stuff and they're probably going to think that's weird." And now I'm like, "oh, maybe that's actually not that weird."
Dana: No, I think if there's anything that this has taught me, it's that there's nothing that's more attractive or respected than just openness and vulnerability and like being so confident in yourself that you feel no shame in who you are and what happens to your body. Yeah, I think I definitely discounted this. I came into this sort of with my sunglasses on and hood up like, "nobody notice that this is me doing this". And am now, like, "I am here. Let me talk to you about all my symptoms." So, yeah.
Dana: It's really empowering.
Rachel: I love that. I think there was a few other things we wanted to talk about, but I think we should just end it here because we, we've already covered a lot of really good juicy stuff. Is there anything else, though, that you want to add before we wrap it up?
Dana: Just that my whole decision to get into this was because I wanted to be a source of information for other people who menstruate and may need help, so feel free to reach out to me on Instagram [@dana.alloy] or on my website [danaalloy.com] if there's any way that I can be of service to you. And best of luck to all my menstruators out there navigating this crazy world.
Rachel: Awesome, awesome. Thank you so much for being on the podcast, this has been amazing and I'm really excited to see people's responses and reactions to it. All right. So, anyway, goodbye, everyone.
Rachel: Thank you so much for listening to No Peach Left Behind. That was the end of this little mini-series with Dana about hormones and menstrual cycles.
If you think, or you know, you have any of these period disorders - Endometriosis, Hypothalamic Amenorrhea, PMDD, or PCOS - please share your story with us. We are collecting Vulva stories through our IG @just.peachyness. You can also leave a voice message through Anchor, our podcast host. We would love to hear your beautiful voices.
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