Although females are obviously not the only humans to bleed, this week’s message focuses specifically on menstrual blood.   

Clearly, most of this info is going to speak more to those who have periods. BUT, if you have females in your lives, I suggest you keep reading. And if it makes you squeamish, that is even a better reason to continue on. It takes all of us to destigmitize the conversation around such a normal part of the female existence.

A couple years ago, I watched a man execute most of Ironman Wisconsin with a tampon up his nose. It was a bit comical but I personally commended his willingness to use a very absorbent and functional piece of cotton to stop his continual nose bleed. “Tampon guy” quickly became a local social media legend post-race. 

It is fascinating that this man can be celebrated for smartly stopping bleeding with a piece of visible cotton, while menstruating females have been conditioned to believe that we must discreetly hide the fact that we bleed, sliding (unused) tampons into pockets or up sleeves to travel to bathrooms. 

Yet, roughly 1.9 billion people menstruate each month. The average cycle is 24-38 days over 40 years, with bleeding lasting from 2-7 days. Do the math– if you bleed for five days monthly over 40 years that is 2,400 days, or roughly six and half years of your life. That is a lot of days spent bleeding. 

I am guessing that if you are an active female you have either experienced or wondered if today will be the day you embarrassingly bleed heavily during a workout. In fact, I had this very fear personally realized during a past swim. After finishing, I pushed myself up to exit my lane and felt that oh-so-familiar “gush” (sorry, there is literally no better word). And when I stood up I looked down in horror to find a small puddle of water diluted blood starting to form at my feet. So, I did what any absolutely humiliated person would do—I put my legs together and ran to the locker room. Then I got the hell out of there as soon as I could after containing the bleeding. 

Yes. We bleed. And, in perimenopause it can be quite unpredictable (making situations like mine a much more frequent risk). And even though I can empathize that it can be super embarrassing, I also know that regular menstruation (bleeding) is normal and healthy. Rather than trying to run away from your cycle, it is important to connect with your body so that you can truly know how you feel while bleeding. And if you start missing periods, please do not settle with the “ease” that accompanies not bleeding regularly. If you are not pregnant, or in the menopause transition, cessation of menstruation can indicate a multitude of problems. These can include (especially for athletes), but are not limited to, Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S)

Like all bodily fluids I have mentioned in this series thus far, blood happens. Here are a few ways to navigate it all:

  • Track your cycle. Pay attention to changes in the frequency, flow, and color of your period in order to be an advocate for yourself when you suspect that something is “off.” 
  • Research and try different ways to manage your bleeding in each period. Many of those who menstruate have forwent the use of tampons for menstrual cups or discs. Others are experimenting with new brands of period panties. Some are choosing the implanted progestin intrauterine device (IUD) to help control heavy menstrual bleeding (HMB). For extreme cases of HMB, athletes may consider endometrial ablation. Although many people do have some relief, it is important to note that getting an ablation does not guarantee cessation of menstruation. In ~60% of cases women still bleed post ablation, with roughly 10% of the total cases not having any change at all. 
  • Be aware of the drawbacks of traditional routines used to manipulate the menstrual cycle. For years the common practice by physicians was to over-prescribe oral contraceptive (OC) pills to “control” heavy bleeding. There are many known potential negative side effects of the OCP, with new research emerging. And, for the athletes—some research shows that using an oral contraceptive pill can have negative impacts on training and performance gains as well. 
  • Get your iron levels checked regularly. Iron is essential to energy. Due to monthly bleeding, women who bleed are at an increased risk to have iron deficiency, as well as anemia.
  • Push back against the social pressure to hide the fact that you bleed. Make small changes in how you talk about your period. Carry that unused piece of cotton to the bathroom without discreetly sliding it up your sleeve. 
  • Support ending period poverty. According to Medical News Today, period poverty is defined as a lack of access to menstrual products, education, hygiene facilities, waste management, or a combination of these. It affects an estimated 500 million people worldwide. Many of you know I support this cause locally— let me know if you would like to donate!

No one is going to claim that bleeding is fun (menstrual, or otherwise). But, I hope that being reminded that having a period is as normal as breathing, you can reframe how you see your menstrual cycle. 

Cheers (from your blood sister),