Its more than just a period… PERIOD!

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[00:00:29] Hello friends and welcome to the Ask Nurse Alice podcast,

[00:00:51] the show where all things health and wellness take center stage.

[00:00:54] I'm your host, Alice Benjamin, clinical nurse specialist and family nurse practitioner,

[00:00:58] and I like to talk to people before they become my patients.

[00:01:01] And on today's show we're going to take a deeper dive into a topic that touches millions of lives.

[00:01:07] Yet millions remain silent as are expected to remain graceful about Mother Nature's monthly visitor,

[00:01:12] which for some of us is more like clots, cramps and chaos.

[00:01:17] Okay, I'm talking about the real impact of menstrual symptoms.

[00:01:22] Now you might think it's just about having a bad period, but imagine this.

[00:01:26] Imagine not being able to get out of bed, missing work,

[00:01:30] struggling with heavy bleeding and having severe mood changes,

[00:01:33] and feeling fatigued all the time because of your menstrual cycle.

[00:01:37] Enough suffering and silence.

[00:01:39] Today we're going to challenge the misconception that severe menstrual symptoms are simply a part of quote, unquote, normal life.

[00:01:47] And instead we're going to explore the medical conditions that can underlie these challenges

[00:01:51] and are worthy of attention along with workplace accommodations.

[00:01:56] We'll discuss severe menstrual symptoms and about the impact on the quality of life.

[00:02:01] This isn't just a personal issue but more of a societal one,

[00:02:05] one that demands attention, understanding and compassion.

[00:02:10] And listen, don't worry fellas, this is helpful for you too.

[00:02:13] The better you understand the lady in your life, whether it's your mother, your wife, daughter, aunt,

[00:02:18] friend, co-worker, whoever she may be, she'll appreciate you and the effort she may to be more understanding.

[00:02:25] So whether you're suffering and silence or someone who is,

[00:02:29] or you're just interested in learning more about how can we support menstrual health in our communities and workplaces,

[00:02:35] this episode is for you.

[00:02:36] Let's start from the beginning, shall we?

[00:02:38] So let's set the scene.

[00:02:39] Whether it's Auntie Flo, your monthly visitor, your period, your cycle, whatever you'd like to label this.

[00:02:46] While many people experience mild discomfort during their menstrual cycle,

[00:02:51] for others it can be quite debilitating.

[00:02:53] The menstrual cycle is a regulated complex and delicate interplay of hormones.

[00:02:59] These hormones orchestrate the cycle's various phases from the preparation of the uterine lining

[00:03:05] to its shedding during menstruation if pregnancy doesn't occur.

[00:03:08] Menstruation is influenced by a complex interplay of hormones.

[00:03:12] And while some discomfort like cramping is common,

[00:03:14] some symptoms can signal underlying conditions such as endometriosis, anomyosis or uterine fibroids.

[00:03:23] These can cause excruciating pain, heavy bleeding, constipation, fatigue and so much more.

[00:03:30] And while you might not recognize it, these symptoms are actually more common than what many people think.

[00:03:37] So first a little vocabulary because it's important that we identify these symptoms

[00:03:41] and call them by the correct terminology.

[00:03:43] So it's understood that these are real medical terms, real medical symptoms and real medical diagnosis.

[00:03:52] Okay? Worthy of a discussion, worthy of diagnosis, worthy of treatment

[00:03:59] and worthy of us having this conversation so we can prove upon menstrual health.

[00:04:04] Let's start.

[00:04:04] So there's menoragia.

[00:04:06] This refers to excessively heavy or prolonged menstrual bleeding that can be debilitating

[00:04:11] causing severe blood loss, anemia and fatigue.

[00:04:14] Then there's dysmenorrhea which are painful periods, premenstrual dysphoric disorder.

[00:04:21] This is a severe form of menstrual syndrome that can cause extreme mood shifts and physical symptoms.

[00:04:26] It can significantly impair one's daily life.

[00:04:30] Then there's menstrual migraines.

[00:04:32] So hormonal changes during the menstrual cycle can trigger migraines

[00:04:36] which are severe headaches often accompanied by nausea, vomiting and sensitivity to light and sound.

[00:04:42] Menstrual migraines.

[00:04:44] These are hormonal changes during the menstrual cycle which can trigger migraines

[00:04:48] which are severe headaches accompanied by nausea, vomiting and sensitivity to light and sound.

[00:04:54] Then there's iron deficiency anemia.

[00:04:57] And this happens because of the frequent or heavy periods

[00:05:00] which can lead to a significant amount of blood loss resulting in iron deficiency anemia.

[00:05:06] And this is characterized by fatigue, weakness and pale skin.

[00:05:10] So for me sometimes the best way to explain what's going on medically is to tell a story.

[00:05:15] So story time.

[00:05:17] Okay, let's take Janice who has endometriosis.

[00:05:21] Endometriosis is a painful disorder where tissue similar to the tissue that normally lies in the inside of the uterus, the endometrium,

[00:05:29] this tissue grows outside of the uterus.

[00:05:32] It can cause severe pain especially during menstrual periods and lead to infertility.

[00:05:37] This affects about one in 10 women of reproductive age

[00:05:40] and yet the average time of diagnosis can be as long as seven years

[00:05:44] and that's because symptoms are often normalized.

[00:05:47] Getting diagnosed with endometriosis can take a long time.

[00:05:51] The main reason is that symptoms are very similar to symptoms of other conditions.

[00:05:55] And so there's a lot of reasons that can cause period pain, painful sex and pain going to the toilet

[00:06:01] and these all have to be ruled out before we get to the diagnosis and endometriosis.

[00:06:06] And the only way to truly diagnose endometriosis is through laparoscopy

[00:06:11] which is a direct visualization with confirmed biopsy.

[00:06:14] Okay, so there's Janice in her whole situation with endometriosis in her presentation.

[00:06:20] Now let's take into account Emily.

[00:06:22] Emily who's symptoms started in her teens with extreme cramps and fatigue

[00:06:27] that made it impossible sometimes to attend school and work.

[00:06:31] It wasn't until her late 20s when she was diagnosed with adenomyosis.

[00:06:36] Adenomyosis is a gynecological condition that occurs when the lining of the uterus

[00:06:40] called the endometrial tissue grows into the uterine wall's muscular wall.

[00:06:46] This causes the uterus to thicken and that can lead to heavy menstrual bleeding and pain.

[00:06:51] So in healthy women of childbearing age,

[00:06:53] the uterine lining builds up on the inside of the uterus

[00:06:56] and sheds every month during menstruation.

[00:06:59] So in this situation it builds up and it doesn't go anywhere and it thickens the lining.

[00:07:04] Now, so that's Emily.

[00:07:06] Emily has her whole situation with adenomyosis and symptoms so similar to Janice, right?

[00:07:14] But let's take someone else. Then there's Joyce.

[00:07:16] So Joyce who's had very heavy bleeding, pelvic pressure and cramps

[00:07:20] for the full five days of her period.

[00:07:22] She didn't know but she had uterine fibroids.

[00:07:25] She didn't know this for several years and just so you know,

[00:07:28] uterine fibroids are cancerous growths in the uterus that often appear

[00:07:32] during childbearing years and they can cause heavy bleeding, prolonged menstrual periods,

[00:07:37] pelvic pain and pressure on the bladder and the bowel.

[00:07:41] And only about one third of fibroids are large enough to be detected

[00:07:45] by a healthcare provider during a physical exam.

[00:07:48] So they often go undiagnosed and the slow growth of these fibroids

[00:07:54] can actually play a role in why diagnosis is delayed as well.

[00:07:57] They can grow so slowly that symptoms may start so gradually

[00:08:01] that a woman gets used to having bad periods or a distended stomach

[00:08:05] or having to pee more frequently.

[00:08:06] This is something where I just must have a bad period.

[00:08:09] So women have been conditioned to normalize this, suck it up,

[00:08:14] take it to the chin, just take that L and just deal with it for lack of better words.

[00:08:18] But here we have three different women, three different causes

[00:08:22] for their discomfort in their bleeding but outwardly they're having many of the same symptoms

[00:08:28] and because it's related to their periods, because this is a taboo topic, they just deal with it.

[00:08:33] Now three different women, three different reasons for having, having bleeding with menstruation

[00:08:38] all of whom thought they just had to deal with it because this was mother nature

[00:08:43] and none of them knew to ask if this bleeding was heavy.

[00:08:46] They didn't know what to ask or how to compare it to

[00:08:50] because these type of conversations aren't encouraged.

[00:08:53] We're something that oh it's your period because we don't want anybody to know

[00:08:57] we're supposed to be discreet.

[00:08:58] Even the commercials you see on TV, very discreet exchanges with the pads and the tampons

[00:09:03] and as if nothing ever happened.

[00:09:05] Baby life is happening.

[00:09:07] This period is happening.

[00:09:08] These cramps are happening.

[00:09:09] This bladder pain, this back pain, it's all happening.

[00:09:12] And so what's wrong with talking about it?

[00:09:15] I'm just saying and if I may insert myself for a moment

[00:09:18] although I am the healthcare provider as a nurse practitioner,

[00:09:21] I still am a health consumer and I have a personal story.

[00:09:23] I've had fibroids.

[00:09:25] I've had fibroids removed and I've had fibroids go back.

[00:09:28] I've always had heavy periods since my early 20s

[00:09:31] and I thought that it was something that I had to deal with

[00:09:33] and then listen, it took more than 15 years for me to discover that I had fibroids.

[00:09:39] I think that's something and hindsight is always 2020

[00:09:42] and even as a healthcare provider, why didn't I think of that?

[00:09:45] I guess even as a provider you're trusting that your healthcare professional

[00:09:49] or your OBGYN person is going to talk to you about it

[00:09:52] but it seems like the focus most of the times when it comes to your woman's reproductive health

[00:09:57] is family planning, prevention of unplanned pregnancies,

[00:10:01] your breast exams or mammograms and a pap smear

[00:10:04] which obviously is screening for cervical cancer

[00:10:07] because the fibroids are inside

[00:10:09] and perhaps mine were large enough to be palpated,

[00:10:12] there was no indication for my provider to then take me to the next step.

[00:10:16] And when I described my bleeding, I would say,

[00:10:18] yes, heavy, then here come the questions.

[00:10:20] How many pads did you soak in an hour or two hours?

[00:10:24] I would size with the clots and you...

[00:10:25] It's very subjective but it wasn't until my later years

[00:10:29] that I guess I met the criteria and was more vocal about it

[00:10:32] and the reason why I found out that I had fibroids

[00:10:35] is that I was in the process of freezing my eggs.

[00:10:39] I wanted to harvest and save eggs

[00:10:43] in the event that I would remarry and decide to have children

[00:10:45] and part of that workup process, they do all blood tests,

[00:10:49] screening, scans and blah, blah, blah

[00:10:51] and I learned that I had fibroids.

[00:10:54] As you can see, hindsight's always 2020

[00:10:55] and even we as healthcare providers,

[00:10:57] I didn't even really advocate for myself.

[00:10:58] I thought that I had to deal with heavy periods

[00:10:59] and heavy clots.

[00:11:00] I just was on those always pads, number five overnight.

[00:11:04] I swore it felt like I needed diapers sometime

[00:11:06] and then I just didn't want to leave the house.

[00:11:09] I didn't want to leave the house on the days

[00:11:10] that I would try to work my schedule around my period,

[00:11:14] make sure that I didn't have to go anywhere.

[00:11:15] I just wanted to be home.

[00:11:17] I didn't really want to move.

[00:11:18] I just wasn't even trusting sometimes the pads

[00:11:21] because it would be so heavy and I was afraid

[00:11:24] that I would have an accident as a nurse

[00:11:26] to draw on your feet for 12 hours during the day,

[00:11:28] take, rip and run in, taking care of people moving

[00:11:31] and listen, I was slow as molasses on those days

[00:11:33] because I just was concerned that, oh my gosh,

[00:11:35] this feels uncomfortable.

[00:11:36] My tummy hurts, I'm cramping, my back hurts,

[00:11:39] I'm bleeding.

[00:11:40] I don't want to have an accident when I strain.

[00:11:43] There's a gush of blood.

[00:11:45] Like, okay, sorry guys, sounds a little gross

[00:11:47] but it is what it is and if I'm,

[00:11:48] that's what this episode is about, right?

[00:11:50] We're unleashing the shackles of shame and tabooness

[00:11:55] and allowing us to talk about it

[00:11:56] and giving everyone else permission to talk about it

[00:11:58] by talking about my own personal experience.

[00:12:00] And not a good feeling.

[00:12:02] I didn't want to be at work.

[00:12:03] I actually didn't want to go anywhere.

[00:12:04] So it was negatively impacting my life

[00:12:06] and because of the cramps,

[00:12:08] I would always take some type of medication.

[00:12:10] I'd try to decrease any type of external stimuli

[00:12:13] because I just wanted to relax.

[00:12:14] I just wanted a warm compress on my belly

[00:12:16] and I just wanted to lay down.

[00:12:18] That's all I wanted to do.

[00:12:19] Now, you can see by the description of that,

[00:12:22] there are some serious impacts here

[00:12:24] that we don't always acknowledge

[00:12:26] and quite honestly, we don't want to talk about these things

[00:12:29] unless you have like a really close bestie

[00:12:30] that you could talk to, maybe that person.

[00:12:32] I'm having this conversation with you all now

[00:12:34] but obviously I'm in a room by myself recording,

[00:12:37] talking into a camera.

[00:12:38] So pretty easy to have that conversation.

[00:12:40] I don't know how easy it is to have that conversation

[00:12:42] in a group of women unless we're all supporting one another

[00:12:45] and giving each other permission to tell our stories

[00:12:48] by sharing our stories.

[00:12:49] But these mental symptoms are very important to identify

[00:12:54] and very important to share with your healthcare provider

[00:12:58] because you don't have to suffer in silence.

[00:13:01] There is screening that can be done,

[00:13:03] testing that can be done to figure out

[00:13:04] what is the underlying cause of it

[00:13:06] and try to remedy or repair that as much as possible.

[00:13:10] So let's make sure we acknowledge these things

[00:13:12] because ignoring these symptoms

[00:13:13] can actually lead to some very significant consequences

[00:13:16] not only physically but emotionally and economically.

[00:13:20] So let's get into some other statistics here.

[00:13:22] So the prevalence of it, okay?

[00:13:24] It's estimated that about 20 to 30% of women

[00:13:27] of reproductive age experience heavy menstrual bleeding,

[00:13:30] myself included.

[00:13:31] Iron deficiency an anemia.

[00:13:33] Now this is something that I also have experienced.

[00:13:37] So approximately 60% of women with heavy bleeding suffer

[00:13:40] from iron deficiency anemia,

[00:13:42] a condition that can cause fatigue, weakness

[00:13:45] and shortness of breath.

[00:13:46] Now when I would go and get my blood work tested,

[00:13:49] they're like, gosh, Alisha, really an anemic?

[00:13:50] I'm like, am I really?

[00:13:53] And then I just once I learned I had fibroids,

[00:13:55] I'm like, huh, and it's heavy bleeding.

[00:13:56] I'm like, I wonder, wonder what my lab values are like

[00:14:00] before my period and after my period.

[00:14:03] And so with the help of my healthcare provider,

[00:14:05] we did some timed blood tests.

[00:14:07] And sure enough, I was taking iron every day

[00:14:09] and my levels, my blood levels will be just fine.

[00:14:13] Iron levels just fine right until my period.

[00:14:15] Then after my period, boom, the numbers dropped.

[00:14:19] And so even though we identified that my anemia

[00:14:23] is related to my cycle, it's not like you just take iron

[00:14:26] on the days that you have your cycle,

[00:14:27] you need to keep this built up.

[00:14:28] And it actually even resulted in me at one point

[00:14:30] needing to get an iron infusion

[00:14:32] because it was that significant.

[00:14:33] That was until I had my fibroids removed

[00:14:37] to remedy some of that.

[00:14:38] But you can see iron deficiency and anemia.

[00:14:40] You get really fatigued and really tired.

[00:14:42] You're always cold just in case you didn't know.

[00:14:44] And side note, fun facts, not so fun,

[00:14:47] but people who chew ice for unknown reasons

[00:14:51] tend to have, there tends to be a correlation

[00:14:53] of that anemia.

[00:14:54] So if you see someone who just likes to chew ice,

[00:14:56] ask them, do you have anemia?

[00:14:58] Also work and school absence studies show

[00:15:00] that women with heavy menstrual bleeding

[00:15:02] are more likely to miss school and work

[00:15:04] one to two days of absence per menstrual cycle.

[00:15:06] That makes sense.

[00:15:07] I would say for me, that's probably the first two days

[00:15:09] of my period because I don't want to go anywhere.

[00:15:11] Out of the five days,

[00:15:12] the first two days are like the worst.

[00:15:15] I swear it doesn't even feel like a heavy bleed.

[00:15:17] It feels like a hemorrhage.

[00:15:18] That's what it feels like sometimes.

[00:15:19] Sorry guys, it may sound gross,

[00:15:22] but if I have to be honest with describing

[00:15:25] what my symptoms are,

[00:15:26] if I want my healthcare provider

[00:15:27] to understand the severity and my perception

[00:15:31] of what I'm going through.

[00:15:32] Also your quality of life.

[00:15:33] So according to a survey about 50% of women

[00:15:36] with heavy menstrual bleeding report,

[00:15:39] it significantly impacts her quality of life,

[00:15:41] impacting physical activities,

[00:15:42] emotional health and social interactions.

[00:15:45] True statement.

[00:15:46] Now before we dive deeper,

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[00:16:31] Don't just make a difference,

[00:16:32] broadcast it.

[00:16:40] I remember in middle school going to swim classes.

[00:16:44] We had swim classes as part of our PE.

[00:16:46] Listen, when it was period time, I was not...

[00:16:48] I did not trust the tampon.

[00:16:50] I said this little thing,

[00:16:52] this ain't gonna do it.

[00:16:52] And see that's even at that early of an age,

[00:16:55] I was having challenges, embarrassment

[00:16:58] and didn't want to talk about it.

[00:16:59] I just took the L and just took the absence

[00:17:01] or the non-participation for PE that day

[00:17:03] because I was on my period.

[00:17:04] I didn't even feel comfortable

[00:17:06] talking to my instructor about it.

[00:17:07] And also quite honestly,

[00:17:09] there's some myths out there

[00:17:10] or the perception that,

[00:17:12] oh, it's just your period.

[00:17:13] All you got to do is this.

[00:17:14] One of the easy things you can do is this or do that.

[00:17:17] So whenever I see something that says,

[00:17:19] five easy things you can do for your period.

[00:17:21] They make it seem like it's so easy,

[00:17:22] but it is not easy.

[00:17:23] It is not easy.

[00:17:25] It's not just even the menstruation itself.

[00:17:27] It's the process.

[00:17:28] First, I'm already not feeling well

[00:17:30] because I'm having this physical thing happen to me.

[00:17:32] Right? So I feel like it's taking over my body.

[00:17:34] I got to go to the bathroom every two to three hours

[00:17:37] just to check and make sure things are right.

[00:17:39] I've changed my pad.

[00:17:41] And so it's also making sure that you're able to

[00:17:43] discreetly carry your pads or your tampons with you.

[00:17:47] Heaven forbid, there's enough toilet tissue

[00:17:50] that the toilet flushes and you have

[00:17:52] soap and water in there for you can wash your hands

[00:17:54] and a trash place where you can throw away

[00:17:57] your used items out being seen anywhere.

[00:18:00] Like that's all whole headache.

[00:18:02] Don't be a worker at school somewhere

[00:18:04] where the bathroom is not convenient for you

[00:18:06] or you got to ask for permission,

[00:18:08] especially if you're in a class all day.

[00:18:09] Your teacher will be like,

[00:18:10] why do you keep going to the bathroom?

[00:18:11] Ma'am, you should understand.

[00:18:13] But it's even still,

[00:18:14] it's like women sometimes don't even understand women

[00:18:16] unless we say like, I'm on my cycle.

[00:18:19] And that's literally how we do it.

[00:18:20] We whisper it because we're so claimed or embarrassed by it.

[00:18:24] There's also treatment costs.

[00:18:26] So there's an economic burden of managing

[00:18:29] heavy menstrual bleeding,

[00:18:30] which includes like the treatments of medications,

[00:18:32] surgeries sometimes, right?

[00:18:33] I mentioned that I had my fibroids removed,

[00:18:36] which is a myoectomy.

[00:18:37] So I had a portion of my fibroids removed.

[00:18:40] Sometimes people have resorted to a complete hysterectomy.

[00:18:44] Many people hesitant to get their uterus removed

[00:18:47] or maybe they're still young and they're having fibroids

[00:18:50] and they're told that they're,

[00:18:51] in order to solve all this,

[00:18:52] just get your uterus removed,

[00:18:53] but you're still wanting to bear children.

[00:18:55] I just want you to know,

[00:18:56] you don't necessarily have to have

[00:18:57] your complete uterus removed.

[00:18:59] Sometimes you can do my myomectomy

[00:19:01] where they remove the fibroids.

[00:19:02] There are also medications and cauterization

[00:19:05] and other things that they can do.

[00:19:06] So it's worth talking to your OBGYN

[00:19:10] or your fertility specialist,

[00:19:12] whoever is working with you on this,

[00:19:14] but also get a second opinion.

[00:19:16] The economic burden of managing

[00:19:18] your heavy menstrual period

[00:19:20] includes medications, surgeries,

[00:19:22] outpatient visits,

[00:19:23] and those can be substantial sometimes.

[00:19:25] And so the direct annual healthcare costs

[00:19:27] for women with heavy menstrual bleeding

[00:19:29] are significantly higher

[00:19:30] compared to those without this condition.

[00:19:33] There's also surgical interventions

[00:19:35] up to 20% of women with heavy menstrual bleeding

[00:19:38] eventually undergo hysterectomy

[00:19:41] as part of their treatment.

[00:19:42] Productivity loss,

[00:19:43] women with severe menstrual periods

[00:19:45] miss up to nine days of work annually

[00:19:48] impacting productivity and personal growth

[00:19:50] and that loss of productivity

[00:19:52] is estimated to cost several hundred million dollars

[00:19:56] annually in some countries.

[00:19:58] There's also psychological impact.

[00:20:00] Heavy menstrual bleeding is associated

[00:20:01] with an increased rates of anxiety and depression.

[00:20:04] Yeah, it feels like it.

[00:20:05] And approximately 30% of women

[00:20:07] with this condition report psychological distress.

[00:20:10] This brings up a very important aspect of our discussion

[00:20:13] and that's workplace accommodations

[00:20:15] and what employers understand about this.

[00:20:18] Employers should recognize

[00:20:19] that menstrual health is a legitimate medical concern.

[00:20:22] Simple accommodations like a flexible work hours

[00:20:26] or the option to work from home

[00:20:27] during severe symptoms.

[00:20:29] Those can make a very substantial difference

[00:20:31] in employees performance and being.

[00:20:33] So, I talked about three ladies earlier.

[00:20:35] I'm going to take the case of Emily

[00:20:37] fortunately experienced some positive changes

[00:20:39] in her work that helped her manage her symptoms.

[00:20:42] After being open with her employer about her diagnosis

[00:20:45] her employer allowed her to work from home

[00:20:48] on days where she had severe symptoms.

[00:20:50] So it helped her to maintain productivity

[00:20:53] without her having to push through the pain

[00:20:55] and then also without pushing her out the door

[00:20:57] of a job that she really enjoyed.

[00:20:59] And quite frankly, she needed to support herself.

[00:21:01] So that's great when you have a job

[00:21:03] that allows for work at home

[00:21:05] but what happens if you don't have one

[00:21:07] as a healthcare provider

[00:21:08] as an RN in the emergency room

[00:21:10] or nurse practitioner emergency room?

[00:21:12] A little harder to plan or manage your bathroom breaks.

[00:21:16] You can but sometimes if a patient's in need

[00:21:19] it's hard to step away from that.

[00:21:20] So women who experience heavy menstrual bleeding

[00:21:23] and finding impacts their ability to work

[00:21:25] have several options and accommodations

[00:21:27] that can be considered to help manage her symptoms

[00:21:30] and maintain their work productivity

[00:21:32] in exchange employers particularly in environments

[00:21:35] that support employee health and wellbeing

[00:21:37] may offer various accommodations

[00:21:40] under workplace policies or legal framework

[00:21:42] such as the Americans with Disabilities Act

[00:21:44] in the United States.

[00:21:45] Now let me explain the American with Disabilities Act

[00:21:49] provides protections

[00:21:50] and requires employers make a reasonable accommodations

[00:21:53] for employees with disabilities.

[00:21:55] So under the ADA, a disability is defined as a physical

[00:21:58] or mental impairment

[00:22:00] that substantially limits one or more major life activities

[00:22:03] and this can include chronic health conditions

[00:22:06] which when active affect a person's ability

[00:22:09] to perform certain tasks.

[00:22:11] So heavy menstrual bleeding

[00:22:12] which can be of significant pain, fatigue

[00:22:15] and other symptoms

[00:22:16] that impacts a woman's daily activities

[00:22:18] could potentially be considered a disability

[00:22:20] under the ADA

[00:22:21] if it substantially limits

[00:22:23] one or more of her major life activities.

[00:22:25] This means that the employer may be required

[00:22:28] to provide reasonable accommodations

[00:22:29] to a woman with severe menstrual bleeding

[00:22:32] if it is considered a disability.

[00:22:33] Now, I already know some of you are like

[00:22:35] nurse house took this too far

[00:22:37] having your period is not a disability.

[00:22:39] This is something that can feel subjective

[00:22:42] but there are definitely elements of objectivity in this

[00:22:47] because not that the employer needs to see the period

[00:22:51] but as a healthcare provider

[00:22:53] I can have this discussion with the patient.

[00:22:55] I can also with our battery

[00:22:58] so first off we want to assess the patient

[00:23:01] and make sure that we've taken

[00:23:02] we've identified the cause of their severe bleeding

[00:23:05] and get them treated.

[00:23:06] No, as part of that there is objective

[00:23:08] they palpated the uterus

[00:23:10] to see if I can feel fibroids

[00:23:12] maybe there's some protrusion of the lower abdomen.

[00:23:15] I've done some musculoskeletal testing

[00:23:18] which pain is recreated during this time of menstruation.

[00:23:22] So there are things that I as a healthcare provider

[00:23:24] can objectively observe

[00:23:26] and then there's subjective things.

[00:23:28] So the migraines, the pains, the headaches, the nausea

[00:23:31] the sensations that the woman is feeling

[00:23:33] and who am I to say that?

[00:23:34] No, you're not feeling that.

[00:23:35] Now if these things collectively do impact

[00:23:38] the person's ability to focus, concentrate

[00:23:41] affects their mobility because when they move

[00:23:43] and they strain or lift or push or pull

[00:23:45] there's a gush of bleeding.

[00:23:47] There is enough information there for me to say that yes

[00:23:49] you can intermittently deem menstruation

[00:23:54] as a disability.

[00:23:55] For example, most women are not on their periods

[00:23:58] in the entire month

[00:23:59] but during the times of their period

[00:24:01] that may be the time where they have some type

[00:24:02] of intermittent medical leave

[00:24:04] that covers them during that period of time.

[00:24:06] We considered a disability.

[00:24:08] So it's important to note that whether

[00:24:09] heavy menstrual bleeding qualifies as a disability

[00:24:11] under the ADA might depend on the individual circumstance

[00:24:15] and the interpretation may vary.

[00:24:16] Employees usually need to engage in what is known

[00:24:18] as an interactive process

[00:24:20] and that is with their employer

[00:24:22] to determine appropriate accommodation

[00:24:23] based on their specific health needs.

[00:24:25] Just as much as the patient is going to come

[00:24:27] talk to me as a healthcare provider

[00:24:28] explain the symptoms revolving around their period

[00:24:31] and how it impacts our quality of life

[00:24:33] also should be having a discussion with their employer.

[00:24:36] Now I get it.

[00:24:36] Some of y'all employers will look at you like

[00:24:38] what you're kidding, right?

[00:24:40] And so that's where we as healthcare providers

[00:24:42] can come in because we can help

[00:24:44] with the documentation that is necessary

[00:24:46] to provide your employer

[00:24:48] so they can make those accommodations.

[00:24:49] And let me tell you what some of these accommodations

[00:24:51] could be, right?

[00:24:52] So it could be that you just need flexible working hours

[00:24:55] during your menstrual cycle.

[00:24:57] So adjusting work hours to start later

[00:24:59] or finish earlier

[00:25:00] can help manage your energy levels, right?

[00:25:03] Especially if you have anemia

[00:25:04] because you might feel fatigued

[00:25:05] and other symptoms, right?

[00:25:07] Especially on heavier days

[00:25:08] or providing more frequent breaks,

[00:25:10] you need to go to the bathroom breaks.

[00:25:12] Also telecommuting, working from home on days

[00:25:14] when symptoms are particular severe

[00:25:16] can help manage discomfort without taking a full breath, right?

[00:25:19] So being in the comfort of your home

[00:25:21] and more comfortable seating and chairs lesson.

[00:25:24] During your work and if you need to lay down horizontally

[00:25:27] who am I?

[00:25:27] Who am I saying you can't?

[00:25:29] As long as you're getting the work done, right?

[00:25:30] There you go.

[00:25:31] Break adjustments.

[00:25:32] So additional or longer breaks might be needed

[00:25:34] to help manage the fatigue and pain

[00:25:36] or allow for the rest or medication as needed.

[00:25:39] So you might work somewhere

[00:25:40] where the bathroom is not close by.

[00:25:41] So perhaps during your cycle time

[00:25:43] you could be reassigned to an area

[00:25:46] that has a bathroom close by

[00:25:48] or if there is no bathroom at where you work

[00:25:50] maybe there's the time off.

[00:25:52] There's something that we can think about there.

[00:25:54] Also part-time or modified work duties.

[00:25:57] So temporarily reducing work hours

[00:25:59] or modifying job responsibilities

[00:26:01] that are physically demanding can also be helpful

[00:26:03] for some women

[00:26:05] when they push pull or exert themselves

[00:26:07] that stress can cause increased blood outflow.

[00:26:10] I'm going to say it sometimes people like a gush

[00:26:13] very uncomfortable feeling.

[00:26:14] Also accessibility to restrooms.

[00:26:16] Ensuring easy access to restrooms can alleviate stress

[00:26:20] and help manage hygiene and comfort

[00:26:22] related to heavy menstrual bleeding.

[00:26:24] There might be leave policies

[00:26:26] so utilizing sick leave or short-term disability

[00:26:29] or other leave policies

[00:26:31] designed to accommodate medical needs without penalty.

[00:26:35] You should not be penalized.

[00:26:36] I have seen commonly used is intermittent medical leave.

[00:26:39] There's also health services and support at work.

[00:26:42] Maybe you can access to on-site health services

[00:26:44] or support groups

[00:26:45] that can provide immediate relief

[00:26:46] for information for you.

[00:26:48] An ergonomic workstation

[00:26:50] maybe comfortable seating

[00:26:51] and the option to stand or sit as needed

[00:26:53] can alleviate discomfort

[00:26:55] because if you're having back pain abdominal pain

[00:26:58] you may want to be able to

[00:27:00] change your position more frequently.

[00:27:02] Also awareness and training

[00:27:04] educational programs for managers and colleagues

[00:27:06] can foster a supportive work environment

[00:27:08] where women feel more comfortable

[00:27:10] seeking accommodations

[00:27:11] and then insurance and health benefits.

[00:27:13] Ensuring that health plans covered treatments

[00:27:15] for conditions like menoragia

[00:27:17] including medications,

[00:27:18] therapies, treatments and surgeries.

[00:27:20] That's important.

[00:27:21] So these are examples of accommodations

[00:27:24] which can really improve quality of life

[00:27:27] but what can be done

[00:27:28] for fostering an understanding of others?

[00:27:31] First want to say education is key

[00:27:33] and talking about it

[00:27:35] is going to be one of the first things

[00:27:36] that we need to do.

[00:27:37] So raising awareness.

[00:27:38] Now as healthcare professionals

[00:27:40] I think sometimes we can overlook these things

[00:27:42] because it's perhaps

[00:27:43] it's not a serious relative to right

[00:27:45] if someone is bleeding

[00:27:47] I'm probably more concerned about the gunshot

[00:27:48] victim bleeding

[00:27:50] versus the woman who's bleeding from her menstrual cycle

[00:27:53] doesn't make a right.

[00:27:54] Both lives are important.

[00:27:55] Their perception and their symptoms are both important.

[00:27:57] I guess just in the emergency mindset

[00:28:00] the gunshot wound obviously seems more lethal

[00:28:04] but doesn't mean that I should dismiss

[00:28:05] or not treat the woman who's bleeding

[00:28:07] having excessive bleeding during her period.

[00:28:10] So we got to talk about raise awareness

[00:28:11] let's be more sensitive and aware of what

[00:28:15] some women are going through because listen

[00:28:17] I don't know if these commercials are doing

[00:28:18] but I don't see anybody skipping

[00:28:20] dipping and hopping in the meadows

[00:28:22] after they've changed their pattern or tampon.

[00:28:25] That's what you see on the commercials

[00:28:26] did their dancing.

[00:28:27] They're like, hey, this is the thing.

[00:28:29] I'm good.

[00:28:30] Ma'am you are on your period

[00:28:32] and you're probably uncomfortable.

[00:28:33] Let's just be honest.

[00:28:35] And so these commercials are actually misleading

[00:28:37] and they give the impression to other people

[00:28:38] that this is not a serious matter

[00:28:40] and it is a serious matter.

[00:28:41] I'm not trying to be a party pooper

[00:28:42] but dang it's not that easy.

[00:28:45] People like, oh, it's just your period.

[00:28:47] You'll be fine.

[00:28:47] Just take this.

[00:28:48] Take a my doll or take a Motrin

[00:28:50] and then go lay down.

[00:28:51] Go eat some chocolate and like that's it.

[00:28:53] That's not it all the time.

[00:28:55] Okay.

[00:28:55] Now I know there are some funny memes

[00:28:57] and stories out there about how women

[00:28:58] are cranky moody irritable during their period.

[00:29:01] Yes.

[00:29:02] Yes.

[00:29:02] Because we don't feel good.

[00:29:04] But it's more than just giving me a fix of chocolate

[00:29:06] or giving me some food.

[00:29:08] It's more than that.

[00:29:09] Okay.

[00:29:09] If my symptoms have caused an imbalance in me physically,

[00:29:13] mentally, emotionally and it's something

[00:29:16] that should be taken seriously should be treated

[00:29:17] rather than just made fun of.

[00:29:19] Now do we like sweets?

[00:29:20] Yeah, I do like some sweets

[00:29:21] and I do want to eat

[00:29:22] but that's not going to be the end all be all

[00:29:23] just so you know.

[00:29:25] But education is key healthcare providers

[00:29:26] need to talk more openly

[00:29:28] and advocate for their patients

[00:29:30] when talking about menstrual health.

[00:29:32] Also, let's stop the whispers and remove the shame.

[00:29:35] Okay.

[00:29:35] This is a natural part of life

[00:29:37] and it shouldn't be taboo.

[00:29:38] So let's stop minimizing the symptoms.

[00:29:41] No one's running around like I said in these metals hop

[00:29:43] skipping jumping around gleefully.

[00:29:46] No, I don't know maybe one person is

[00:29:48] but majority isn't.

[00:29:48] I just say that because there's always one

[00:29:50] and nothing is easy or convenient about periods.

[00:29:53] There are several products out on the market

[00:29:55] that cater to women during their menstrual cycle.

[00:29:57] They try their best to make it convenient for us

[00:30:00] and as easy for us as less complicated for us

[00:30:04] because this can be a messy process.

[00:30:06] This is what it is.

[00:30:08] Okay.

[00:30:08] And so things that are quick, clean

[00:30:10] and easy to scream we like that

[00:30:12] because we don't be want to be tied up in the bathroom

[00:30:14] all day.

[00:30:14] We just don't

[00:30:16] but let's keep back to the raising awareness.

[00:30:18] Let's keep it 100

[00:30:19] so we can debunk these myths

[00:30:21] as I've shared with some of the things of you today

[00:30:23] and let's reduce the stigma

[00:30:24] and normalize seeking help.

[00:30:25] Okay.

[00:30:26] So message to all my people out there

[00:30:30] who are experiencing their menstrual cycle

[00:30:33] who are having uncomfortable symptoms.

[00:30:35] You don't have to wait to your annual well woman appointment.

[00:30:38] You don't have to wait for your physical

[00:30:40] shoot your provider a message

[00:30:41] through the message box.

[00:30:43] Maybe you do make an appointment

[00:30:45] because you haven't seen them for a while

[00:30:45] but talk to them about what your cycle is doing

[00:30:47] what it's like.

[00:30:48] There are some other things like why is it so heavy?

[00:30:51] Okay.

[00:30:51] It shouldn't necessarily be this heavy.

[00:30:53] Maybe you do need to advocate for yourself

[00:30:56] and ask for an ultrasound

[00:30:57] ask for some blood work

[00:30:59] those type of things ask them to do a pelvic exam

[00:31:02] and see if they can feel for any fibroids.

[00:31:04] Those are the things we have.

[00:31:05] I'm sorry y'all even got to ask that

[00:31:07] because health care providers should be doing it

[00:31:09] but we can't bring you

[00:31:10] we can't drag you into the appointment

[00:31:12] so it's a two way street here

[00:31:13] we got to do this together.

[00:31:14] I think today's discussion

[00:31:16] obviously is just a tip of the iceberg

[00:31:18] what I wanted to really bring about in this conversation

[00:31:22] was bringing it to the forefront making it okay

[00:31:25] to talk about our menstrual cycles.

[00:31:28] For some your menstrual cycle is easy peasy

[00:31:31] two three days light and that's it

[00:31:33] for some of us including myself

[00:31:35] is cramps, clots and chaos

[00:31:37] throwing confusion if you want to in there

[00:31:39] or throwing a little crazy if you want to in there

[00:31:41] it's just it is a string of days

[00:31:43] which is very unpleasant to me

[00:31:45] and I understand that this is a part of the circle of life

[00:31:49] as far as women being able to get pregnant

[00:31:53] and have children

[00:31:54] but especially during the time when you are a family planning

[00:31:58] and that's not the case and you're just living life

[00:32:00] and maybe you're single don't even have a partner

[00:32:02] and you're just living life

[00:32:04] I don't want to suffer

[00:32:05] I'm not going to suffer in silence

[00:32:06] for so long I should have started with you

[00:32:08] it was over 20 years

[00:32:09] before I figured out why I had fibroids

[00:32:12] that's crazy

[00:32:13] don't if you're a health care provider

[00:32:14] and you listen to this

[00:32:15] please don't be that person

[00:32:16] okay we need to be more openly

[00:32:18] and think about this

[00:32:19] if a woman comes in

[00:32:20] and she has abdominal pain

[00:32:22] heavy bleeding

[00:32:23] or things like that

[00:32:24] we should ask these things also

[00:32:25] let me say this

[00:32:26] don't wait for someone to volunteer that information

[00:32:29] if you have anyone who's of childbearing age

[00:32:31] you need to ask them

[00:32:32] when was your last menstrual period

[00:32:33] how many days was it

[00:32:34] and to describe their menstrual cycle

[00:32:37] okay and then ask them

[00:32:38] when's the last time you had a pap smear

[00:32:40] have you had any other diagnostic exams

[00:32:42] any gynecological medical history

[00:32:44] we should know about

[00:32:45] endometriosis

[00:32:46] PCOS

[00:32:47] fibroids

[00:32:47] we just need to ask

[00:32:49] sometimes people forget to mention things

[00:32:50] it's not like don't ask

[00:32:52] if they don't say anything like oh cool

[00:32:53] there's nothing

[00:32:54] no that's not the case

[00:32:55] that's how that works

[00:32:56] I kind of self-talking myself here

[00:32:57] and talking to the providers

[00:32:58] but this really is for everyone

[00:33:00] I want everyone who's listening to this

[00:33:02] under the command of my voice to know

[00:33:04] it is okay to talk about your period

[00:33:07] anti flow

[00:33:07] cycle

[00:33:08] monthly visitor

[00:33:09] whatever you want to call

[00:33:11] this time of the month

[00:33:12] where we are going through our menstrual cycle

[00:33:15] that's fine call whatever you want to

[00:33:16] my goal for you is that

[00:33:18] as you're going through this

[00:33:20] that it is something that

[00:33:21] you're able to find as much comfort in

[00:33:24] alleviate any unnecessary symptoms

[00:33:28] or feelings because if you are having bleeding

[00:33:30] migraines back pains

[00:33:32] bladder pains

[00:33:33] all of those things

[00:33:34] touch your healthcare provider

[00:33:35] there are things that we can do to

[00:33:37] better identify the causes

[00:33:38] try to find some treatment

[00:33:40] options for you

[00:33:41] and as well help you and assist you

[00:33:43] with the other aspects of your life

[00:33:45] maybe you need accommodations of work

[00:33:46] maybe your provider needs to write you a note

[00:33:49] fill out some paperwork

[00:33:50] whatever the case may be

[00:33:51] but leverage your healthcare provider

[00:33:53] to get you the resources and accommodations

[00:33:55] you need at work

[00:33:56] so you can be productive

[00:33:58] whether you continue to work at work

[00:34:00] or you work at home

[00:34:01] work remote

[00:34:01] whatever shorter days

[00:34:02] whatever

[00:34:03] we want you to be able to have a fruitful life

[00:34:05] and still to remain productive

[00:34:07] and to not be hindered by the fact that you're a woman

[00:34:10] and you have to deal with a cycle

[00:34:11] okay

[00:34:12] yeah

[00:34:12] so that was this episode

[00:34:13] that's what that's about

[00:34:14] so when you know more you

[00:34:15] when you know better

[00:34:16] you do better

[00:34:17] and I think in this

[00:34:18] there's

[00:34:19] we covered some terminology

[00:34:20] we talked about some stories

[00:34:22] about menstrual cycle

[00:34:24] and some of the discomforts

[00:34:25] if you will

[00:34:26] unpleasantries of it

[00:34:28] and I hope that helps

[00:34:29] I hope someone was able to get some information

[00:34:31] from that

[00:34:32] that they can apply

[00:34:33] to a situation going on

[00:34:34] their life

[00:34:35] for the better

[00:34:36] so I'm Nurse Alice

[00:34:37] I love talking to people

[00:34:38] before they become my patients

[00:34:40] and I want to thank you so much

[00:34:41] for listening to the Ask Nurse Alice podcast

[00:34:43] as I talk about all things

[00:34:44] health and wellness

[00:34:45] as they take center stage

[00:34:47] while I give you that TLC

[00:34:48] that you need to hear

[00:34:49] before the injury

[00:34:51] before the insult

[00:34:52] and before the trauma

[00:34:53] and before you become my patient

[00:34:55] so make sure to visit

[00:34:56] asknursals.com

[00:34:57] a trusted source

[00:34:58] for health and wellness information

[00:35:00] equipped with blogs

[00:35:01] articles

[00:35:02] information

[00:35:03] tips

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[00:35:06] with a wide range

[00:35:07] of health and medical topics

[00:35:09] you name it

[00:35:09] it's there

[00:35:11] so this wraps today's episode

[00:35:12] I hope you found the discussion helpful

[00:35:14] please take a moment to support us

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[00:35:32] thanks so much for listening

[00:35:34] I look forward to our next health conversation

[00:35:36] and until next time

[00:35:37] make good choices

[00:35:39] be kind to one another

[00:35:40] and live well my friends

[00:35:41] talk to you soon