When I was a teen, I had terrible periods. I had crippling cramps, I leaked blood onto my clothes and onto my bed sheets, and I had period diarrhea. And I had to miss school one to two days a month, and I remember sitting on the couch with my heating pads, thinking, "What's up with this?" When I ate food, I didn't leak saliva from my salivary glands. When I went for a walk, I didn't leak fluid from my knees, "joint fluid." Why was menstruation so different?
De moza, tiña uns menstruos horribles. Tiña unhas cambras paralizantes. Deitaba sangue na roupa e nas sabas e tiña diarrea menstrual. Perdía clase un ou dous días ao mes. Lembro sentarme no sofá cos panos quentes e pensar: Que está a pasar aquí? Cando comía, non producía saliva nas miñas glándulas salivares. Cando ía camiñar non segregaba sinovia nos xeonllos, "fluído articular". Por que a menstruación era tan distinta?
I wanted answers to these questions but there was no one for me to ask. My mother knew nothing about menstruation except that it was dirty and shameful and I shouldn't talk about it. I asked girlfriends and everybody spoke in euphemisms. And finally, when I got the courage to go to the doctor and talk about my heavy periods, I was told to eat liver.
Quería respostas para estas cuestións mais non tiña a quen preguntar. A miña nai non sabía nada sobre a regra agás que era sucio e vergoñento e que eu non debía falar diso. Pregunteilles ás amigas e todas falaban con eufemismos. Cando á fin tiven a coraxe de ir ao médico falar dos meus períodos penosos dixéronme que comese fígado.
(Laughter)
(Risos)
And when I went to the drug store to buy my menstrual products, my 48-pack of super maxi pads, back in the day when they were the size of a tissue box, each pad --
Cando ía a drogaría comprar os meus produtos para a regra, o paquete de 48 compresas extra grandes, cando cada compresa medía coma unha caixa de panos.
(Laughter)
(Risos)
You know what I'm talking about. You have no idea how far absorbent technology has come.
Xa sabedes de que estou a falar. Nin imaxinades canto avanzou a tecnoloxía absorbente.
(Laughter)
(Risos)
I used to have to buy my menstrual products in the feminine hygiene aisle. And I remember standing there, thinking, "Well, why don't I buy toilet paper in the anal hygiene aisle?"
Adoitaba comprar os meus produtos menstruais no corredor de hixiene feminina. Lembro estar alí de pé pensando: "E por que o papel hixiénico non está no de hixiene anal?"
(Laughter)
(Risos)
Like, what's up with that? Why can't we talk about periods? And it's not about the blood, as Freud would have you say, because if it were, there would be an ear, nose and throat surgeon up here right now, talking about the taboos of nose bleeds, right? And it's not even about periods, because otherwise, when we got rid of our toxic, shameful periods when we became menopausal, we'd be elevated to a higher social status.
É dicir, que sucede? Por que non podemos falar dos períodos? E non é polo sangue, como diría Freud, porque se así fose aquí estaría un otorrinolaringólogo falando dos tabús do sangrado de nariz, non é? Nin sequera se trata do período en si. Daquela, ao librarnos dos tóxicos e vergoñentos períodos, ao chegar a menopausa, pasaríamos a un maiorstatus social.
(Laughter)
(Risos)
(Applause)
(Aplausos)
It's just a patriarchal society is invested in oppressing women, and at different points in our lives, different things are used. And menstruation is used during what we in medicine call the reproductive years. It's been around since pretty much the beginning of time, many cultures thought that women could spoil crops or milk, or wilt flowers. And then when religion came along, purity myths only made that worse. And medicine wasn't any help. In the 1920s and '30s there was the idea that women elaborated something called a menotoxin. We could wilt flowers just by walking by.
Trátase dunha sociedade patriarcal dedicada a oprimir as mulleres e usa cousas distintas en distintos momentos da nosa vida. A menstruación úsase durante o que en medicina chamamos idade fértil. Éche así case desde o inicio dos tempos. Moitas culturas creron as mulleres seren quen de toller cultivos, estragar o leite ou murchar as flores. Cando apareceu a relixión, os mitos da pureza fíxérono aínda peor. A medicina non era de grande axuda. Nas décadas de 1920 e 1930 dicíase que as mulleres elaboraban algo chamado menotoxina. Podiamos mirrar as flores tan só pasando á súa beira.
(Laughter)
(Risos)
And that's what happens when there's no diversity, right. Because there was no woman to put her hand up and go, "Well, actually, that doesn't happen." And when you can't talk about what's happening to your body, how do you break these myths? Because you don't even need to be a doctor to say that periods aren't toxic. If they were, why would an embryo implant in a toxic swill? And if we all had this secret menotoxin, we could be laying waste to crops and spoiling milk.
Así ocorre cando non hai diversidade. Non había ningunha muller a levantar a man e dicir: "O certo é que iso non sucede". E cando non podes falar sobre o que pasa no teu corpo, como rompes eses mitos? Porque non precisas ser médico para negar a toxicidade do menstruo. Como se implantaría senón o embrión nun refugallo tóxico? Se todas tivésemos esa secreta menotoxina poderiamos ir devastando colleitas e derramando o leite.
(Laughter)
(Risos)
Why would we have not used our X-Women powers to get the vote sooner?
Por que non usariamos eses poderes de patrulla X para conseguir antes o voto?
(Laughter)
(Risos)
(Applause)
(Aplausos)
Even now, when I tweet about period diarrhea, as one does,
Mesmo agora, cando tuiteo sobre a diarrea menstrual, como fai calquera,
(Laughter)
(Risos)
I mention that it affects 28 percent of women. And every single time, someone approaches me and says, "I thought I was the only one." That's how effective that culture of shame is, that women can't even share their experiences.
comento que afecta a un 28 % das mulleres. A cada vez, alguén achégase e dime: "Coidaba que era a única". Así de efectiva é esta cultura da vergoña, as mulleres non poden sequera compartir as súas experiencias.
So I began to think, "Well, what if everybody knew about periods like a gynecologist? Wouldn't that be great?" Then you would all know what I know, you'd know that menstruation is a pretty unique phenomenon among mammals. Most mammals have estrus. Humans, some primates, some bats, the elephant shrew and the spiny mouse menstruate. And with menstruation what happens is the brain triggers the ovary to start producing an egg. Estrogen is released and it starts to build up the lining of the uterus, cell upon cell, like bricks. And what happens if you build a brick wall too high without mortar? Well, it's unstable.
De modo que comecei a cavilar: "E se todo o mundo soubese dos períodos coma un xinecólogo? Non sería xenial?" Daquela todos saberían o que eu sei. Como que a menstruación é un fenómeno moi particular entre os mamíferos. A maioría dos mamíferos teñen estro. Menstrúan os humanos, algúns primates, algúns morcegos, a musaraña elefante e o rato espiñento. O que sucede coa menstruación é que o cerebro induce ao ovario para comezar a producir un óvulo. Libérase o estróxeno e comeza a construír o revestimento do útero, célula sobre célula, coma os ladrillos. Que pasa se constrúes un muro demasiado alto sen cemento? É inestábel.
So what happens when you ovulate? You release a hormone called progesterone, which is progestational, it gets the uterus ready. It acts like a mortar and it holds those bricks together. It also causes some changes to make the lining more hospitable for implantation. If there's no pregnancy, (Whoosh) lining comes out, there's bleeding from the blood vessels and that's the period. And I always find this point really interesting. Because with estrus, the final signaling to get the lining of the uterus ready actually comes from the embryo. But with menstruation, that choice comes from the ovary. It's as if choice is coded in to our reproductive tracts.
Que sucede cando ovulas? Liberas unha hormona chamada proxesterona que é proxestacional, prepara o útero. Actúa coma o cemento e mantén os ladrillos pegados. Tamén provoca algunhas mudanzas que permiten ao revestimento ser máis hospitalario para a implantación. Se non hai embarazo, (Zas) o revestimento marcha, hai un sangrado desde os vasos sanguíneos e iso é o período. Sempre atopei este punto moi interesante. Porque co estro, o sinal último para preparar o útero de feito vén do embrión. Pero coa menstruación, esa elección vén do ovario. Como se a escolla estivese codificada no noso aparato reprodutor.
(Cheering and applause)
(Aclamacións e aplausos)
OK, so now we know why the blood is there. And it's a pretty significant amount. It's 30 to 90 milliliters of blood, which is one to three ounces, and it can be more, and I know it seems like it's more a lot of the times. I know. So why do we have so much blood? And why doesn't it just stay there till the next cycle, right? Like, you didn't get pregnant, so why can't it hang around? Well imagine if each month it got thicker and thicker and thicker, right, like, imagine what tsunami period that would be.
OK, agora sabemos por que hai sangue. Unha cantidade significativa. Son de 30 a 90 mililitros de sangue, que son entre 30 e 90 gramos. E pode ser máis, sei que parece máis moitas das veces. Eu ben o sei. Por que temos tanto sangue? Por que non agarda aí ata o ciclo seguinte? Non quedaches preñada, por que non pode ficar? Imaxina se cada mes engrosa e engrosa e engrosa, imaxina que período tsunami ía ser.
(Laughter)
(Risos)
We can't reabsorb it, because it's too much. And it's too much because we need a thick uterine lining for a very specific reason. Pregnancy exerts a significant biological toll on our bodies. There is maternal mortality, there is the toll of breastfeeding and there is the toll of raising a child until it is independent. And evolution --
Non podemos reabsorbelo porque é demasiado. É demasiado porque necesitamos un revestimento do útero groso por unha razón moi específica. O embarazo impón aos nosos corpos unha importante peaxe biolóxica. Está a mortalidade materna, a peaxe do aleitamento, e está a peaxe de criar un neno ata que é independente. E a evolución...
(Laughter)
(Risos)
That goes on longer for some of us than others.
A algunhas tárdanos máis ca a outras.
(Laughter)
(Risos)
But evolution knows about risk-benefit ratio. And so evolution wants to maximize the chance of a beneficial outcome. And how do you maximize the chance of a beneficial outcome? You try to get the highest quality embryos. And how do you get the highest quality embryos? You make them work for it. You give them an obstacle course. So over the millennia that we have evolved, it's been a little bit like an arms race in the uterus, the lining getting thicker and thicker and thicker, and the embryo getting more invasive until we reach this détente with the lining of the uterus that we have.
Pero a evolución coñece a proporción risco-beneficio. Pretende maximizar a oportunidade dun resultado beneficioso. Como se maximiza a posibilidade dun resultado beneficioso? Obtendo os embrións de maior calidade. Como consegues os embrións de maior calidade? Fas que se esforcen. Poslles unha carreira de obstáculos. Durante os milenios da nosa evolución semellou haber no útero unha carreira armamentística: un revestimento cada vez máis e máis e máis espeso e o embrión volvéndose máis invasivo ata que acadamos esta tregua co endometrio do útero que temos agora.
So we have this thick uterine lining and now it's got to come out, and how do you stop bleeding? Well, you stop a nose bleed by pinching it, if you cut your leg, you put pressure on it. We stop bleeding with pressure. When we menstruate, the lining of the uterus releases substances that are made into chemicals called prostaglandins and other inflammatory mediators. And they make the uterus cramp down, they make it squeeze on those blood vessels to stop the bleeding. They might also change blood flow to the uterus and also cause inflammation and that makes pain worse.
Temos este revestimento espeso e agora ten que saír. Como paras a hemorraxia? Podes deter o sangue do nariz beliscándoo. Se te cortas nunha perna, aplicas presión sobre ela. Paramos a hemorraxia con presión. Cando menstruamos, o endometrio libera substancias que se converten en produtosquímicos chamados prostaglandinas e outros mediadores inflamatorios. Estes fan que o útero se retorza, que aperte sobre eses vasos sanguíneos para deter a hemorraxia. Tamén pode variar o fluxo de sangue ao útero e pode causar inflamación, que intensifica a dor.
And so you say, "OK, how much pressure is generated?" And from studies where some incredible women have volunteered to have pressure catheters put in their uterus that they wear their whole menstrual cycle -- God bless them, because we wouldn't have this knowledge without, and it's very important knowledge, because the pressure that's generated in the uterus during menstruation is 120 millimeters of mercury. "Well what's that," you say. Well, it's the amount of pressure that's generated during the second stage of labor when you're pushing.
Preguntaredes: "canta presión se produce?" Hai uns estudos en que se presentaron voluntarias unhas mulleres incríbeis para pór no seu útero catéteres de presión durante todo o ciclo menstrual. Benditas sexan, non teriamos todo este coñecemento sen elas. Un coñecemento moi importante porque a presión que se xera no útero durante a menstruación é de 120 milímetros de mercurio. "Iso canto é?" preguntaredes. É a mesma presión que se produce cando estás empurrando na segunda fase do parto.
(Audience gasps)
(Murmurios do público)
Right. Which, for those of you who haven't had an unmedicated delivery, that's what it's like when the blood pressure cuff is not quite as tight as it was at the beginning, but it's still pretty tight, and you wish it would stop. So that kind of makes it different, right? If you start thinking about the pain of menstruation, we wouldn't say if someone needed to miss school because they were in the second stage of labor and pushing, we wouldn't call them weak. We'd be like, "Oh my God, you made it that far," right?
Logo ben. Para as que tivestes un parto medicalizado vén sendo coma cando o medidor de presión arterial xa non está tan apertado coma ao inicio pero mesmo así nótalo tenso e desexas que pare. Convérteo en algo diferente, non si? Se comezas a pensar na dor da menstruación, non criticarías se alguén ten que perder clases porque está na segunda fase do parto e empurrando, non lle chamarías feble. Diríamos: "Mi madriña, que lonxe chegaches!", certo?
(Laughter)
(Risos)
And we wouldn't deny pain control to women who have typical pain of labor, right? So it's important for us to call this pain "typical" instead of "normal," because when we say it's normal, it's easier to dismiss. As opposed to saying it's typical, and we should address it.
E non negariamos o control da dor a mulleres con dor típica de parto, non é? É importante que lle chamemos "típica" a esta dor e non "normal" porque cando dicimos normal, é doado ignorala. Por contra, ao dicir que é típica debemos abordala.
And we do have some ways to address menstrual pain. One way is with something called a TENS unit, which you can wear under your clothes and it sends an electrical impulse to the nerves and muscles and no one really knows how it works, but we think it might be the gate theory of pain, which is counterirritation. It's the same reason why, if you hurt yourself, you rub it. Vibration travels faster to your brain than pain does.
Temos varios modos de atender a dor menstrual. Un é o que chamamos unidade TENS que podes levar baixo a roupa e que envía impulsos eléctricos aos nervios e músculos. Ninguén sabe ben como funciona pero cremos que se debe á teoría da comporta da dor, que é a revulsión. A mesma razón pola que cando te mancas, refrégaste. As vibracións viaxan cara ao cerebro máis rápidas cá dor.
We also have medications called nonsteroidal anti-inflammatory medications. And what they do is they block the release of prostaglandins. They can reduce menstrual pain for 80 percent of women. They also reduce the volume of blood by 30 to 40 percent and they can help with period diarrhea. And we also have hormonal contraception, which gives us a thinner lining of the uterus, so there's less prostaglandins produced and with less blood, there's less need for cramping.
Tamén temos medicamentos, os antiinflamatorios non-esteroides. O que fan é bloquear a liberación de prostaglandinas. Poden reducir a dor menstrual no 80 por cento das mulleres. Tamén reducen o volume de sangue entre un 30 e un 40 por cento e poden axudar coa diarrea menstrual. Tamén temos a contracepción hormonal, que nos dá un endometrio máis fino e que por tanto produce menos prostaglandinas. Con menos sangue, menos necesidade de cambras.
Now, if those treatments fail you -- and it's important to use that word choice, because we never fail the treatment, the treatment fails us. If that treatment fails you, you could be amongst the people who have a resistance to nonsteroidal anti-inflammatories. We don't quite understand, but there are some complex mechanisms why those medications just don't work for some women. It's also possible that you could have another reason for painful periods. You could have a condition called endometriosis, where the lining of the uterus is growing in the pelvic cavity, causing inflammation and scar tissue and adhesions. And there may be other mechanisms we don't quite understand yet, because it's a possibility that pain thresholds could be different due to very complex biological mechanisms. But we're only going to find that out by talking about it.
Agora, se eses tratamentos vos fallan... Éche moi importante a elección do termo porque nós nunca lle fallamos ao tratamento, o tratamento fállanos a nós. Se o tratamento falla, podes estar entre as persoas que teñen resistencia aos antiinflamatorios non-esteroides. Non o comprendemos ben aínda, xa que hai varios mecanismos complexos, por que esas medicacións non funcionan con algunhas mulleres. Pode ser tamén que haxa outros motivos para esas regras dolorosas. Podes padecer o que chamamos endometriose, que fai que a capa co útero creza na cavidade pelviana, causando inflamación, cicatrices e adherencias. E pode haber outros mecanismos que aínda non entendemos ben, porque cabe a posibilidade de que o limiar de dor sexa diferente debido a complexos mecanismos biolóxicos. Pero só poderemos descubrilo se falamos sobre isto.
It shouldn't be an act of feminism to know how your body works. It shouldn't --
Non debería ser un acto de feminismo saber como funciona o noso corpo. Non debería...
(Applause)
(Aplausos)
It shouldn't be an act of feminism to ask for help when you're suffering. The era of menstrual taboos is over.
Non debería ser un acto de feminismo pedir axuda cando estás a sufrir. A era dos tabús menstruais acabou.
(Cheers and applause)
(Aclamacións e aplausos)
The only curse here is the ability to convince half the population that the very biological machinery that perpetuates the species, that gives everything that we have, is somehow dirty or toxic. And I'm not going to stand for it.
A única maldición aquí é a capacidade de convencer a metade da poboación de que a mesma maquinaria biolóxica que perpetúa a especie, que nos dá todo o que temos, dalgunha maneira é sucia ou tóxica. E non o vou consentir.
(Applause)
(Aplausos)
And the way we break that curse? It's knowledge.
Como rompemos esa maldición? Con coñecemento.
Thank you.
Moitas grazas.
(Cheers and applause)
(Salva de aplausos)