“Ingredients: Rayon and/or Cotton Fiber. Polyester or Cotton String, Polysorbate 20.” Those are the ingredients in my tampon of choice, “Playtex Sport’ unscented tampons. My “U by Kotex” menstrual pads don’t list any ingredients anywhere on the box. Even though I use these products every month, and have used them for YEARS, and will use them for years to come, I’ve never considered what ingredients I’m putting inside of my body.

Organic Ingredients?

If you’ve ever listened to literally any podcast with women on it, you’ve probably heard an ad for Lola. Lola is a subscription-based period product company that uses 100% organic tampons. With Lola and other organic cotton period products becoming popular, there’s been a lot of talk about what ingredients are in menstrual products and whether or not they are safe for us.

Several years ago the Menstrual Products Right to Know Act of 2017 was created. This act proposed that manufacturers had to list all of the ingredients of period products on the box so consumers could be one hundred percent informed. I didn’t realize this wasn’t already enforced, and because the pads I use don’t list ingredients, it seems this act didn’t get passed, so it’s hard to know what you are putting in or close to your body each month.

Finding Research on these Ingredients

From all of the research that I’ve done, it seems people are very unclear about which chemicals in period products are actually bad for us. I found numerous conflicting reports about similar ingredients, so honestly, I’m still not sure which ingredients are truly “good” or “bad.” It is important to note, however, that most of the articles I found talking about how toxic tampon and pad ingredients are were written five or more years ago. This shows that more research needs to be done on this topic so we can have more conclusive and definitive answers. I think part of the reason extensive research on this topic hasn’t been done is that there is such a stigma surrounding menstruation and so much shame in talking about it. We need to talk about periods, and we need to get that research done! But I digress…

Toxic Shock Syndrome

If you use 100% organic period products, obviously you don’t need to worry about any chemicals in your body. Although organic cotton period products don’t have chemicals in them, it is still possible to get Toxic Shock Syndrome from leaving a tampon in for too long. Don’t get lulled into a false sense of security and leave your tampon in for more than eight hours. You’ll still be at risk for TSS, even if your products are organic. Menstrual cups are also recommended as alternatives for tampons and pads that are full of chemicals. Most menstrual cups are made of body-safe silicone or rubber, last for up to 12 hours, and don’t have the same chemicals in them that tampons do.

From what I’ve found, it seems chlorine, dioxin, BPA, rayon, and “fragrance” are the most harmful chemicals overall. Although there are some misconceptions about chlorine and rayon used in tampons.

Chlorine 

This was used for bleaching tampons in the 1990s, but actual chlorine is no longer used. All brands use chlorine-free bleaching agents to clean their products, and according to the FDA, this is safe. When it comes to tampon production, “bleaching” is used to clean and purify the fibers of cotton or rayon used in the product. The tampon being “bleached” white isn’t the goal or reason for using chlorine in this part of the process.

Bleaching is done to reduce the levels of dioxins in these products. Dioxins are “chemically-related compounds that are persistent environmental pollutants.” What does that mean? Dioxins are a grouping of dangerous chemicals present in our environment that can be very damaging if high levels of exposure persist. Through these chlorine-free bleaching methods, the levels of dioxins in tampons are severely lessened to a supposedly safe level, and the levels of dioxins in our environment pose a much greater threat than those in our tampons.

BPA 

Bisphenol A (BPA) is a chemical found in plastic. You probably see refillable water bottles advertised as “BPA-free”— this is that same thing. BPA has been linked to disrupt hormones and cause other health issues. BPA would only be present in your applicators and not in the actual tampon itself, so look for BPA-free applicators, or use cardboard applicators or applicator-free tampons instead if this is a concern.

Rayon 

This showed up as a “bad” chemical in a lot of my research, but I also found just as many sources saying it’s okay. According to Tampax’s website and the FDA, the rayon used in menstrual products is completely safe. Rayon has been called unsafe because it’s a synthetic material, so people fear that it could increase the likelihood of toxic shock syndrome if any rayon fibers are left behind in the body. This is hasn’t been proven, and just as I said before, even organic tampons can still cause TSS.

Fragrance

You should never use ANY vagina products that list “fragrance” as an ingredient. Fragrances will not only disrupt your vaginal pH, which can lead to infections but products are not required to list what exactly goes into that “fragrance.” Always get unscented tampons, pads, or toilet paper, and stay away from vaginal hygiene products.

Oh and that polysorbate 20 that was one of the ingredients in my tampons? It’s apparently used in a lot of skincare/makeup/hygiene products to help with odor and is “supposedly” not harmful for your body.

Like I said before, it’s hard to know what levels of which chemicals are actually safe for our bodies because of the lack of scientific research done to regulate these products and all of the conflicting information out there. It seems that cotton and rayon tampons are okay, but if knowing completely what ingredients are in your menstrual products is important to you, using 100% organic cotton tampons or a menstrual cup would be the safest. These products don’t use chemicals found in other tampons, and they are fragrance-free.

As I mentioned before, the conflicting reports on ingredients I found while doing research just further show that menstrual hygiene and women’s health needs to be a priority so we can be fully informed on what we’re putting into our bodies.

I remember hearing about “That First Trip” to the gynecologist when I was younger. I wasn’t exactly sure what happened at the gynecologist, I just knew you had to take your pants off in front of some doctor, and this doctor had to stick things inside you to make sure you were healthy. I thought going to the gynecologist was guaranteed to be painful and uncomfortable, and my first trip to the gynecologist was something I was afraid of. When the time for my first visit came I was really nervous, but I was pleased to find all the mystique and scary rumors surrounding my visit were nothing like my actual positive experience.

What is a gynecologist?

A gynecologist is “a physician who specializes in treating diseases of the female reproductive organs and providing well-woman health care that focuses primarily on the reproductive organs.” Gynecologists provide patients with birth control, information about sexual health, menstruation, fertility, as well as treat conditions or vaginal health concerns, and provide Pap smears.

If someone hasn’t already made a visit to the gynecologist well into puberty, it is recommended that you start going for Pap smears either once you become sexually active or once you turn 21. A Pap smear is a test that gynecologists do to test for cervical cancer and overall cervical health. 

What to expect at the gynecologist

After checking in, you’ll be led into an examination room and the nurse will ask you if you have any questions for the doctor. This is a good time to voice any questions or concerns about your sexual health. Asking about contraception, STD tests, pain during sex, or any other sexual health concerns are all things you should feel comfortable asking your gynecologist. For example, I’ve asked my gynecologist how and why some antibiotics make birth control pills less effective.

People often feel uncomfortable talking about sex, but giving you information on your sexual health is what the gynecologist is there for. Even if it seems scary, it is totally normal and important to voice any questions or concerns you have while you are at the office and the doctor can take a look at anything they need to. You won’t be judged – it is literally the gynecologist’s job to help you! 

Asking lots of questions

You can also ask your gynecologist general questions about sexual health and birth control, even if they don’t apply to you. You can inquire about birth control methods you don’t use but have read about, or you could ask about managing emotional health along with sexual health in a relationship. I know that at Planned Parenthood, for example, they always ask questions about your emotional well-being within your sexual relationships, and I just love that.  

Next, you’ll be asked to take your clothes off and wear a robe of some sort and wait until the doctor comes in. You’ll be left alone for a while, then the doctor will arrive. The doctor will likely ask if you have any questions or concerns you want to address, then they’ll start the exam. You’ll scoot your booty to the bottom of the examination table and place your feet in stirrups so your legs are spread nice and wide. The doctor will then place a speculum or a metal instrument into your vagina to hold the vaginal walls open so they can see your cervix. The gynecologist should have various sizes of speculums and will likely use the smallest one when it is your first visit. The doctor will then look at your cervix and take a small little brush to take a sample of your cells. The doctor may also put a finger or two into your vagina and feel around to make sure you have no unnecessary pain or pressure.

It’s not as scary as it seems

I know this all sounds really intense and vulnerable, but it truly is not as scary as it sounds. The most important thing is to try and keep your body relaxed. If you tense up your muscles while the doctor is doing their business, it might be more painful than if you stay relaxed. The actual Pap smear takes less than a minute, so you will only be uncomfortable for a short amount of time.

You can also ask your doctor to explain what they are doing for the exam before they do it. During my first visit, my gynecologist showed me the speculum before inserting it, told me he was using the smallest one and described how he was going to insert it before he did. This helped me feel prepared, relaxed, and overall more comfortable. This visit is about you and your health, so you should feel empowered to ask for what you need to be most comfortable.

How often to go to the gynecologist

While you’re at the visit, the gynecologist will likely also feel your breast tissue to make sure there are no abnormal lumps or anything like that. After that, you’ll have a final chance to ask any questions, then you’ll get dressed, schedule your next appointment, and be on your way.

Talk with your doctor about how often they think you need to get a Pap test, but for most people between the ages of 21 and 29, a test every three years is appropriate. For patients aged 30 to 64 a Pap test with an HPV test every 5 years is appropriate, and patients over 65 might not need Pap tests anymore. It is best to ask your doctor what they think is best for you and your body.

Although visiting the gynecologist isn’t always the most comfortable experience, I always feel good leaving my appointment knowing I’m in control of my sexual health. Knowing that my body is healthy and working correctly makes me feel good. 

If you’re anticipating your first visit to the gynecologist, take a deep breath, relax, and know that people get Pap smears done all the time. It’s important for your health, and after the first visit, you definitely won’t be as nervous.

You’ve likely heard about the menstrual cycle, also known as a period. Maybe you have a period, and even if you don’t, you definitely know someone who does. You probably know that once a month, the person having their period bleeds for about a week (sometimes more and sometimes less), shedding the uterine lining. Pads, tampons, or menstrual cups are used to collect blood and bloating or mood swings sometimes accompany this cycle. Although we know these stereotypical things about the menstrual cycle, how much do we know about ovulation?

Where does ovulation fit in the menstrual cycle?

Ovulation typically occurs about halfway through the menstrual cycle, releasing an egg through the fallopian tubes and waiting to meet up with sperm for fertilization. The typical menstrual cycle lasts between 28 and 32 days, so ovulation will occur between days 10 and 19, or about two weeks before your period. When someone is ovulating, that means they are most fertile because their egg has been released from the ovary and is essentially waiting to be fertilized. 

Although ovulation occurs within the female reproductive system, there are external signs that indicate when someone is ovulating. During this time water retention, changes in mood due to fluctuating hormones, and cramps can all occur. These are fairly typical and well-known signs. There are a few more, less obvious signs of ovulation as well.

How can you track ovulation?

During ovulation, the cervix, the area at the top of the vaginal canal connecting the vagina and the womb, becomes higher, softer, and more open. If you are someone wanting to track your ovulation, you can technically feel your cervix. A lot of people also note having a higher sex drive while ovulating, which makes sense because ovulation is the prime time to get pregnant if that is something you are trying to do. During ovulation, your cervical mucus or discharge might also change slightly. When ovulating, cervical mucus will be slightly stretchy and clear, which helps carry the sperm along to the egg. Tender breasts can also be a sign of ovulation because of the hormone fluctuations experienced at this time.

Besides these bodily changes, there have been studies proving a few other changes. Studies have shown that women who are ovulating are more likely to wear red or pink. Additionally, studies have shown that women’s voices often sound slightly higher when they are most fertile, and their natural scent is more appealing to potential sex partners. An increased sense of smell has also been cited as a sign of ovulation. Similar to your scent being more attractive to potential partners, you are more likely to pick up on their pheromones as well. Although all of these changes have been noted in various studies, they are often so subtle that you likely won’t pick up on them yourself.

How does birth control affect ovulating?

With all this talk of ovulation, it’s also important to note that some people don’t ovulate. If you are pregnant, on hormonal birth control pills, or if you are experiencing menopause, you won’t ovulate. Some women also don’t ovulate while breastfeeding, but some can. Additionally, other hormonal imbalances or medical conditions can prevent ovulation.

The human body is a truly complex landscape and taking a closer look at the menstrual cycle proves just how complex our bodies are. Although not everyone ovulates and not everyone shares every ovulation symptom, it is good to be educated and know what our bodies are up to.

The vagina is an absolutely amazing organ. It can bring life into this world, it helps facilitate your menstrual cycle to let you know your body is working properly, it can be used for sex and pleasure, and it’s totally self-cleaning. And since it’s a self-cleaning organ, that means vaginal hygiene products are totally unnecessary.

Why do vaginal hygiene products exist?

If your vagina is self-cleaning, then why do “feminine hygiene products” like Summer’s Eve and other brands exist? To be perfectly blunt, these products exist to make you think your vagina’s natural discharge and odor is dirty and unnatural so you’ll want to buy feminine hygiene wipes and douches to “cleanse” yourself. Not only do vaginal hygiene products use people’s insecurities and shame regarding their vaginal odor to make money, but these products also are harmful to your vagina’s health and can throw off your vagina’s pH balance, leading to infections or other complications.

The vagina is a self-cleaning organ, using discharge to flush out any bad bacteria. Discharge is one hundred percent normal and essential for your vaginal health. A specific odor likely accompanies this discharge, and for some reason, people are made to feel ashamed of the way their vagina smells. Vaginal odor is also completely normal and healthy. In fact, a person’s vaginal odor will likely change throughout their menstrual cycle, and can also change depending on diet. The only time you should be concerned about your discharge or vaginal odor is if either one changes drastically. If your discharge changes color or consistency and your vaginal odor change significantly, consult your doctor. You could have an infection.

Cleaning your vulva versus vagina

Although the vagina cleans itself, the vulva does not. Your vulva is the folds of skin (labia) on the outside of your body. The best way to clean your vulva is with warm water. Doctors also recommend warm water and mild soap. If you have very sensitive skin, unscented soap would work best, but again, just water is fine as well. Since all you need for a clean vulva and vagina is warm water, the chemicals in vaginal hygiene products can be harmful to users.

Summer’s Eve has a whole host of products such as cleansing wipes, sprays, cleansing wash, body powder, and douche products. It’s important to note that Summer’s Eve is not the only brand that sells these types of products. I am just using them as an example because they are very widely known and easily available. No matter the brand name, these products are unnecessary and can be harmful. 

Most importantly, do not douche

If you gather only one thing from this article, let it be this: do NOT douche. Douching is a method to wash out the vagina using a formula that is sprayed directly into the vagina. Douching products can contain water, vinegar, antiseptics, and fragrances, all of which can be harmful to your vaginal hygiene. People douche to wash out bad bacteria from the vagina and to feel “fresh and clean.” While you are washing out the bad bacteria, you also wash out the good bacteria your vagina needs to maintain a healthy pH balance. Side effects of douching include bacterial vaginosis, Pelvic Inflammatory Disease, pregnancy complications such as ectopic pregnancy, and an increased risk of cervical cancer.

Summer’s Eve website contains no ingredients for any of their products, which I find alarming. Through my research, I found one source that listed some ingredients, some of which include “fragrance” (which the product does not elaborate on what makes up this ingredient), methylisothiazolinone, methylchloroisothiazolinone, cocamidopropyl betaine, and many more. For a full list of ingredients you could of course look at the products in the store. However, if I am using something to clean my vulva or vagina, I would like to be able to pronounce it.

I also found that Summer’s Eve cleansing wipes contain octoxynol-9, which is a spermicide. There is no warning on the packaging that discloses this information. The wipes are not viable forms of contraception, however, it is unclear if the octoxynol-9 is strong enough in the wipes to affect someone’s ability to get pregnant. 

Your vagina’s smell is normal!

This is no joke! Your vagina doesn’t need to be flushed out with water and other chemicals. Your vagina is not smelly or dirty. This harmful narrative that vaginas are dirty and smell bad is incredibly harmful to your physical and mental health. Being told that your vagina is dirty and literally needs to be flushed out with fragrances in order to be clean and desirable harms positive self-image and feeling good in one’s body. I understand wanting to feel clean or wanting to “freshen up” before a sexual encounter, but as mentioned above, all you need is water for that. No chemicals or artificial scents are necessary.

I’m here to tell you that the messages sold to us by these hygiene companies are lies. There is science to prove how harmful these products are and to reiterate that vaginal odor is normal and healthy! Your vagina is not supposed to smell like flowers or baby powder. You are not a flower or a baby. Your vagina should smell like vagina! 

 

In this great year of 2021, there are many ways to manage your period. From pads, to tampons, to the period sponge, to period-proof underwear, you are bound to find an option that makes managing your period fit with your lifestyle and preferences. Menstrual cups have been gaining a lot of popularity in the last few years, and there’s so much to explore with this environmentally friendly invention.

When were menstrual cups invented?

Although menstrual cups have only become extremely popular recently, they were first invented in 1884! They didn’t hit the market until much later, but the first design was invented then. This first model, known as the Improved Menstrual Receptacle, was invented by Hiram Farr, and was designed to hold several cups of blood at a time. This first design never actually hit the market, but big thanks to Hiram Farr for designing this revolutionary device.

In 1937 American actress Leona Chalmers patented another menstrual cup design, and actually followed through on trying to get it to hit the market. This menstrual cup was similar to the menstrual cups we have today, but it was made from latex rubber. After a few redesigns, this menstrual cup was sold by the company Tassette until the 60s, then they went out of business. Menstrual cups made a comeback in the 1980s with the brand The Keeper and starting in 2003 with the Diva Cup, menstrual cups have become more and more popular.  

How do menstrual cups work?

Menstrual cups have clearly been around for a long time, proving they must in fact be an excellent idea. I first heard of menstrual cups a few years ago when I first learned about the Diva Cup. Unlike the early menstrual cup designs, Diva Cup and other modern brands are made of silicone. Not only is the allergy risk of silicone much lower than latex, but it is also super soft and easy to clean. There are many menstrual cup brands available—Diva Cup, Keeper Cup (that same brand from the 80s!), Moon Cup, Lunette Cup, Lena Cup, Lily Cup, plus some disposable cups or discs. Although there are many brands to choose from, they essentially all work the same.

Menstrual cups are made of flexible silicone material and are shaped like a small bell or cup with a little stem on the end. You place them inside of your vagina right below your cervix and they catch your menstrual blood. You use the short stem on the end to pull them out to empty and clean. Menstrual cups can be left in anywhere from 6 to 12 hours, and need to be rinsed and washed when emptied. When emptying your menstrual cup throughout the day, dump out the blood and wash it with unscented antibacterial soap and water before putting it back in. Some menstrual cup brands also sell cleaning wipes so you can clean your menstrual cup if you’re using a public restroom and can’t wash it thoroughly in a shared sink. Wipe that baby down in the privacy of your stall, pop it back in, and you’re good to go.

How do I use a menstrual cup?

There are different sizes of menstrual cups based on if you just got your period or have had any children. Some menstrual cup brands have more detailed size finders on their websites, and that can be a useful tool to find one that works for you.

To insert your menstrual cup, wash your hands and sit or stand. Similar to putting a tampon in for the first time, this might take a few tries, so you should give yourself plenty of time to get it properly inserted. If your vagina isn’t already slick with a lot of period blood, it might be helpful to use some lubricant to help slide it into place. Be sure to use water-based lube if you do so because other lubes are not silicone compatible and could eat away at the cup over time. 

Relax your muscles and body as much as you can, pinch the top of the cup (most brands come with their own set of instructions on the box and recommend pinching it so the top is a “C” shape), then gently guide the cup into your vagina. You will have to get really comfy with yourself here because you need to put your fingers into your vagina to get the cup in place. Once it’s far up in there, slightly rotate the cup and let go of the top of it and it should suction into place. If the cup is inserted properly, you shouldn’t be able to feel it. As I mentioned, this may take a few tries, so be patient with yourself. The first time you wear it, you may even want to wear a liner or pad just to make sure you don’t leak and see if it was inserted properly.

What about emptying and cleaning?

When it’s time to empty your cup, you’ll have to bear down a bit and activate those pelvic floor muscles. Reach your hand into your vagina and gently pull on the little stem at the bottom of the cup and it should slide out. You’ll have to pinch the cup slightly to loosen the suction at the top of the cup that keeps it in place. If you don’t break the suction it could be very painful to pull out.

In between periods, you can disinfect your menstrual cup by washing it with soap and water, and some people even boil their cup in hot water between cycles. Since your menstrual cup sits below the cervix, it won’t get lost inside your body, and even if it feels like it’s stuck, you can get it out! If you really have trouble getting it out, go visit your doctor and they can easily help you and give you some tips on how to get it out easier next time. 

Menstrual cups are a great option for people to manage their periods. You can reuse them for several years, so they are a fairly cheap option because you get a lot of bang for your buck. They are also good for the environment because they’re less wasteful than tampons or pads. If you’re interested in using a menstrual cup, check out some of the brands’ websites and find a size that works for you. 

Polycystic ovary syndrome is a hormonal condition that affects people with female reproductive organs. Polycystic ovary syndrome, or PCOS, can cause enlarged ovaries, abnormally long menstrual cycles, intense pelvic pain, excess hair growth, and loss of fertility. This syndrome affects about 10 million people worldwide, but the exact cause is unknown.

What is PCOS?

People are usually diagnosed with PCOS after puberty or when they are young adults—once their reproductive organs are up and running. PCOS is caused by an imbalance in androgens, insulin, and progesterone, but the exact cause of this imbalance is unknown. Doctors believe PCOS can be hereditary, can be caused by excess insulin in the body, low-grade inflammation, and excess androgens. This hormonal imbalance affects the ovaries and menstrual cycle, among other things. 

All people have a certain level of androgens (known as “male hormones”), but people with PCOS can have higher levels of androgens than the average person, which causes some of the symptoms of PCOS like acne, unwanted hair, and irregular menstrual cycles. Insulin also affects this syndome. If someone produces too much insulin, this causes an excess of androgens, which causes problems in the ovaries. And finally, if someone isn’t producing enough progesterone, this can also lead to problems with your menstrual cycle because progesterone is a hormone essential for your period. Even though this condition affects your ovaries, many people with PCOS don’t actually have cysts on their ovaries but do indeed have complications with this part of their body. Cysts on the ovaries are possible, however, and are caused by follicles or fluids on the ovaries that enlarge them and restrict their function.

What are the symptoms of PCOS?

Unfortunately, PCOS has a lot of symptoms, but fortunately, they can be managed in a number of ways. Many people with the syndrome experience long last periods with pelvic pain that is present even when they’re not menstruating. Excess hair growth known as hirsutism is another symptom due to the increased androgen levels. This excess hair can be on the face, back, chest, and other parts of the body. Infertility is also a big symptom of PCOS, although people can undergo hormone therapy if they have trouble conceiving, and many women with the syndrome can still conceive naturally. Other symptoms include weight gain, fatigue, thinning hair, acne, mood changes, headaches caused by hormonal changes, and sleep problems. 

How can I treat my PCOS?

Because of the varying insulin levels and weight gain that can accompany PCOS, doctors recommend weight loss and a healthy diet to help treat it and avoid diabetes and high blood pressure. The varying hormone levels do make it hard to lose weight and keep it off with PCOS, but doctors say even a five percent weight loss will help treat the syndrome and manage insulin levels. Additionally, doctors may treat PCOS with hormonal birth control to help regulate your period and lower your androgen levels which will help with the excess hair growth.

A drug called metformin can also be used to treat polycystic ovary syndrome. Metformin isn’t approved by the FDA for treating this syndrome, but it is often prescribed to help lower insulin and androgen levels. This drug can also improve menstrual cycles and help with weight management. It won’t treat the excess hair growth though. Because this drug isn’t approved by the FDA, it’s important to have an in-depth discussion with your doctor about taking metformin. Another drug called clomiphene is also used to treat PCOS because it helps induce ovulation, which can help with fertility issues. There are also many products specifically made to treat excess hair growth. 

Getting support for your diagnosis

Although PCOS is a serious syndrome with many symptoms, there are many options for treating it and managing it. If you experience any of the symptoms mentioned above, see your doctor and they can help diagnose you with a blood test to check your hormones, as well as a pelvic exam and ultrasound. 

Polycystic ovary syndrome affects a lot of women and can cause serious problems such as infertility and diabetes if untreated. The PCOS Awareness Association has a bunch of wonderful resources on their website such as in-depth information on each PCOS symptom, as well as specialists who treat PCOS. Although there is no cure for this syndrome, there are many ways to treat it and manage the symptoms. If you have PCOS, talk to your doctor about ways to manage it and know that you are not alone.

It’s good to be educated about our bodies every month of the year, but with Endometriosis Awareness Month observed in March, it’s an excellent time to learn about this condition that up to 10 percent of people with uteruses have—endometriosis.

What is endometriosis?

Endometriosis is when the tissue that lines your uterus grows outside of your uterus as well. This tissue is called the endometrium. During your menstrual cycle, the endometrium tissue builds up, sheds if you have no fertilized eggs, then leaves your body through your period. When this tissue grows outside of the uterus, it still builds up as part of your menstrual cycle, but then it has nowhere to shed and exit the body. Endometriosis develops over time, usually several years after your first period, and affects up to 10 percent of people with uteruses ages 25-40.

What are the symptoms?

Since everyone’s bodies are so different, endometriosis symptoms can be mild to severe and vary for everyone depending on their body. The severity of your symptoms does not indicate the severity of the actual tissue buildup. This tissue can grow on your ovaries, bowel, and pelvis, and comes with a wide variety of symptoms. Because this tissue is building up and isn’t shedding, it can become increasingly painful over time. The most common endometriosis symptom is pelvic pain and cramps. This pain and cramping hit you in the same areas you might feel period cramps, but it’s much more intense. This cramping can be just during your period, but for some people, there’s constant pelvic pain. These cramps aren’t like normal period cramps. Some people experience cramps so intense they can’t go to work or function normally.

In addition to painful periods, other symptoms include pain during or after sexual intercourse, pain with bowel movements or peeing, as well as diarrhea, constipation, and bloating, heavy bleeding during your period, or bleeding between periods, and in some cases, infertility. About 30 to 40 percent of people with endometriosis experience fertility issues. These issues can be discussed with your doctor, and there are options to maximize your fertility with endometriosis.

Because the tissue can grow in several places in your body, it can affect these places in different ways. Another symptom is developing scars on your ovaries and pelvis, as well as adhesions or tissues growing so that they bind your organs together. Because the symptoms are so general, endometriosis can be hard to diagnose initially. People can be misdiagnosed with Pelvic Inflammatory Disease, ovarian cysts, or even Irritable Bowel Syndrome.

Are there treatment options?

Although endometriosis is not curable, there are several different treatment options. The growth of your endometrium outside of the womb is due to varying levels of estrogen in your body. Your changing hormones during your menstrual cycle that promote the growth and shedding of your uterine lining are the exact hormones promoting the growth of this tissue as well. Remember, the only difference is this tissue has nowhere to go once it’s grown. Hormone therapy or hormonal contraception can be used as an effective treatment. Hormonal birth control pills are a popular treatment for endometriosis because they shut down ovulation. If you’re not ovulating, your uterine lining is not building up to shed, so it should stop the growth of this tissue outside of the uterus as well. Any hormones that help stop menstruation could help treat endometriosis. Gonadotropin-releasing hormone agonists and antagonists can be used to treat endometriosis as well. GnRH is used to essentially create early menopause by stopping the production of estrogen in the body. Because it puts you in an early menopause, side effects would include vaginal dryness and hot flashes. This treatment sounds intense, and I’d guess it would likely be used for severe cases. Danazol is another medication that can stop your period and help stop the growth of endometrium tissue. These treatment options can help with pain and help stop tissue growth, but they don’t necessarily help with fertility.

If you are wanting to get pregnant or have a severe case of endometriosis and hormones haven’t helped, surgery is another option. During the surgery, the excess tissue growing outside of the uterus is removed. The surgery is called laparoscopy, uses lasers, and is minimally invasive. Again, this is the only treatment option that can help improve fertility. In extremely severe cases, and if you are not wanting to get pregnant, you could also have a total hysterectomy. This is a surgery to remove your uterus and cervix. This is usually only recommended for severe cases or for someone who knows they do not want to get pregnant. Once your uterus and cervix are removed, you won’t be able to get pregnant because your uterus will be gone.

What is the cause of endometriosis?

The exact cause of endometriosis is not known, which can be frustrating. One theory is that during menstruation the blood flows back into the fallopian tubes, causing build-up, while another theory suggests that hormones transform cells outside of the uterus into ones similar to those inside the uterus, confusing the body. If you experience any of the symptoms listed above, or even just have incredibly painful periods, go see your gynecologist. They will likely do a physical exam and an ultrasound to see what your uterine tissue looks like. Once diagnosed, your doctor will discuss the severity of your case with you. If left untreated, endometriosis can get worse over time because of the continuation of tissue building up. Once your doctor tells you the severity (minimal, mild, moderate, or severe) you can work together to discuss treatment options. Although endometriosis isn’t curable, you can still live a relatively pain-free life with it. If you are planning on having a family and want to maintain your fertility, be sure to mention that to your doctor.

If you suspect you have endometriosis or have incredibly painful periods, speak up and talk to your doctor about it. Intense period pain isn’t normal or something you should live with! It can indicate there’s a deeper issue going on. Talk with your doctor to find a solution.

There are many birth control options available for people these days, which is great because you can find a method that works best for you and your lifestyle. Condoms, hormonal birth control pills, IUDs, Nuva Ring, the shot, the implant—the list goes on and on. One of the most popular forms of birth control is the hormonal birth control pill.

A refresher on the hormonal birth control pill

Typically, the hormonal birth control pill uses either a combination of estrogen and progestin, or just progestin to shut down ovulation in your body so you don’t release an egg for fertilization. These hormones are naturally occurring in your body, and the pill just provides you with amounts of these hormones so your body essentially thinks it’s pregnant and doesn’t ovulate. These pills also thicken your cervical mucus so if an egg is released, your womb isn’t in a state where implantation could occur. The pill needs to be taken every day at the same time to be most effective. Even missing one pill can cause some people to get pregnant, so the pill isn’t the best option for someone with a super unpredictable schedule, someone who travels between time zones frequently, or someone who just isn’t punctual. Not brag, but I could win an award for taking my pill on time.

Since the pill is such an effective method (99% effective when taken perfectly), it is a popular option. It’s also popular because it’s non-invasive, can be stopped at any time, is covered in full by most insurance or is fairly inexpensive if it’s not, and doesn’t affect your fertility. Starting in late 2019, studies have begun to help develop a birth control pill that just needs to be taken once a month. What? Sounds too good to be true, right?

How would a once-a-month pill work?

Because of the stomach’s acids and the way our bodies take in and digest medicine, the pill, and most other medications, needs to be taken daily. Doctors at Brigham and Women’s Hospital and MIT discovered a new design for a slow releasing pill while doing research on drugs for HIV and malaria treatment. After doing some research on these other drugs, the team discovered this same design would work for birth control bills. With this once a month design, the birth control hormones for the month are distributed on six little “arms” extending from the center of the whole pill. When the pill capsule is open and spread out inside your body, it looks like a little starfish with six arms full of hormones. The pill is made out of body-safe polyurethane and is taken all folded up in a capsule. Once in the body, its arms will spread out and slowly release the hormones over a period of 29 days. This is the same cycle for most birth control pills, you would just take this one capsule at the beginning of the month and be good to go until 29 days later.

The initial trials on this capsule design were tested on pigs, and the results were really promising. The little legs of the starfish design broke off and passed safely through the body after the hormones were released, and the starfish didn’t obstruct anything from entering or leaving the body either. Pigs have more similar insides to humans than rats, so the positive results in pigs were a good sign. The scientists behind this hope to build artificial stomachs next, and eventually begin testing on humans.

When could this birth control pill be released?

If this birth control ends up being developed, in theory, it should be as effective as the daily pill, that is if the user is taking it at the same time every month. One of the complaints of the daily pill is having to remember to take it at the same time every day, but I would argue that remembering to take a pill at the same time just once a month might be harder to remember because it’s not part of your daily routine. Birth control options that you must take orally, or even the shot, is most effective when taken on time. So this design might make birth control seem like less of a hassle for some women, but it might be harder for others to remember to take it.

Human trials haven’t even begun yet, so it will likely be several more years until this type of pill is available on the market. Either way, it’s incredibly exciting that people have more options for how they want to take their birth control and be in charge of their reproductive health.

February is Teen Dating Violence Awareness Month. People of all ages are unfortunately subject to dating violence, but February is the time of year dedicated specifically to education and awareness around teen dating violence. Dating violence is using a pattern of aggressive or manipulative behaviors to control someone in the partnership. Dating violence could be physical, but it could also be emotional, psychological, or financial. Statistically, one in 10 teenagers will experience some sort of dating violence from a partner between the ages of 12 and 19. Since teenage years are when many people start with their first romantic and sexual relationships, it’s super important to teach consent from an early age. Although people of all ages experience dating violence, and it, unfortunately, happens all year round, you can use February as an opportunity to attend events or speak with a teen in your life about dating violence.

What is consent?

Consent is agreeing to participate in any activity, sexual or otherwise. Consent is a simple idea in theory – communicating if you do or do not want to participate in something. Oftentimes we get nervous talking about consent, especially in sexual situations. There used to be this idea that consent should be taught with a “No means no!” approach, but in some cases of dating violence, a victim might not literally say “no,” but they still do not consent to what is happening. If you don’t want something to be happening but you don’t say no because you’re scared, in shock, or overwhelmed, that doesn’t mean you consent. Rather than a “no means no,” approach, many sex educators are strong proponents of the “enthusiastic yes!” I’m also a fan of this approach to consent. An enthusiastic yes basically means there is no question about whether or not everyone wants to participate in what’s happening. The consent is incredibly clear and enthusiastic.

Healthy vs. abusive relationships

Consent is all about communication. Consent should be ongoing and can be revoked at any time. Just because you kissed someone once does not mean that you have to kiss them again if you don’t want to. Flirting does not imply consent. Wearing a sexy outfit does not imply consent. If you’ve been with a partner for years and had sex with them many, many times, you’re still allowed to not consent to sex with them if you’re not feeling it. If your partner reacts negatively or makes you feel bad for revoking consent, that is a major red flag. If your partner coerces you into any sexual activity, that is also not consent! If you say no and they keep begging you or try to convince you that you should participate, that is not consent! The National Domestic Violence Hotline has amazing resources for teens and adults, including lists of what a healthy vs. abusive relationship looks like, as well as resources for teens to connect with if they need help. 

Consent can be as simple as allowing someone to hug you, or consenting to being in a relationship in the first place. It obviously comes into play in an extremely important way with sex. You are allowed to say no and revoke consent at any time, and that does not make you a bad person. Young girls are cultured to be agreeable and kind, and oftentimes they can feel like they’re being mean or rude if they turn someone down. Prioritize yourself and your comfort level. 

How to talk about consent

There’s this idea that giving consent isn’t sexy because it “ruins the moment.” Do you know what ruins the moment more? Being forced to do something you don’t want to do. And if your partner is a decent human being with empathy, they should be jazzed to know that everyone involved is 100% excited about what’s happening. Consent is sexy! Simply ask your partner, “Is this okay?” as you slowly start doing something else. Ask them what they like. Have them tell you what they want you to do. Make it flirty and fun and sexy! Make a “Want, Will, Won’t List” – a list of things you want to do, things you will try, and things you absolutely won’t do. Talk about it together. Most importantly, make sure you pay attention to your partner’s answer and respond accordingly. 

Consent doesn’t have to be verbal, but when you are physical with someone for the first few times, it probably would be most comforting to be verbal since you don’t know each other’s body language well yet. After you’ve been in a relationship with someone perhaps you’ll understand their cues better and you can consent with nonverbal reactions. You could also have some fun and make up some sort of code word or code signal to nonverbally consent with your partner. Make consent part of the sexual activity you’re doing. Open communication is key to consenting. 

I once had a friend who told me if you and your partner can’t talk about having sex, then you aren’t ready to have sex with them. I love this advice, however, with dating violence, not everyone is given that choice. That’s why it’s important to teach consent from a young age so teenagers and adults feel comfortable and confident setting their boundaries. 

Talking with your teen about consent and relationships

Additionally, talk with your teenagers about healthy relationships. Literally, every romantic comedy ever exhibits unhealthy relationship patterns and spins them as romantic. Relentlessly asking a girl out when she repeatedly says no thank you? Unhealthy. Showing up in a woman’s yard playing loud music to get her attention when she told you no thanks? Unhealthy. Showing up at a woman’s house or work or school because you want to run into her? Unhealthy. In fact, that is stalking. Calling and texting incessantly because they want to know where you are? Unhealthy. So much television and movies, and even music, romanticize these incredibly unhealthy behaviors so they become so normal that if they happen to us we think it’s okay. 

If you or your teenager want to learn more about unhealthy relationship patterns, The National Domestic Abuse Hotline and RAINN are both excellent resources for education and also for survivors.

A few years ago I kept seeing ads for a medicine called Truvada for PrEP that helps prevent the spread of HIV through sex. Amazing! I even wrote an article about it! Now, several years later, another option is on the market called Descovy for PrEP.

What is PrEP?

PrEP stands for pre-exposure prophylaxis, and is a once daily pill taken to help lower the risk of getting HIV through sex. HIV is NOT the same thing as AIDs. HIV is a virus that takes over cells in the body of an infected person and weakens the immune system, making it impossible for the virus to get cleared out of the infected person. HIV can be spread through certain bodily fluids such as blood, semen, pre-seminal fluid or pre-cum, rectal fluids, vaginal fluids, and breast milk. People can become infected with HIV by sharing a needle or having unprotected sex with someone who is infected with HIV.

AIDS is the final stage of HIV. A person is diagnosed with AIDS if or when their immune system is no longer working the way it should. HIV turns into AIDS if the virus is untreated and weakens the immune system over time.\

How does Descovy work with PrEP?

Someone who is HIV negative, but has a partner who is HIV positive would be a great candidate for Descovy, because it prevents the spread of HIV through sex. Descovy works almost exactly as Truvada does, however, there is one main difference in the medications. Descovy is not for people assigned female at birth, as no clinical trials have been done on these participants. Truvada trials have been done on people assigned female at birth, however, you should consult your doctor before becoming pregnant or breastfeeding while on Truvada, as HIV can be spread through breast milk. But back to Descovy!

Before taking Descovy, you must receive a negative HIV test. Once you start taking your prescription, it is recommended to get tested about every three months for STDs, including HIV. Other STDs can make you more likely to contract HIV, so regular testing along with taking PrEP regularly is the way to go. Descovy lowers the chance of getting HIV through sex, however, it doesn’t prevent any other STDs, again making those regular tests oh so important. If you take Descovy and have a monogamous partner who also knows their STD status, you likely wouldn’t need to be tested as often. 

What are the side effects of Descovy?

When used correctly in a clinical trial, 99.7% of participants stayed HIV negative. Heck yeah! As with any medication, there are some potential side effects. The side effects for Descovy and Truvada are nearly identical. Side effects for Descovy include the possibility of worsening Hepatitis B, so be sure to tell your health care provider all of your current medications and health status before starting Descovy. Side effects also include potential kidney problems, too much lactic acid in your blood, as well as liver problems. More mild side effects include nausea or headache. 

The Descovy website has a bunch of detailed information on how to find a healthcare provider to help you determine if Descovy is right for you, as well as ways to stay on top of your daily pill intake, including a daily pill tracker to help you never miss a dose. There is also information on the cost and coverage for Descovy on their website

Having more options for PrEP medications and HIV prevention through sex is huge and exciting! Again, Descovy is not for people assigned female at birth, but it’s a great option for other people at risk of being exposed to HIV. If you think Descovy is a good option for you or your partner(s), visit their website to find a recommended healthcare provider.