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?
當我仲係少女嗰陣 啲月經嚇死人 經痛非常厲害 嗰啲經血漏到落衫同床單度 同時行經期間有肚瀉 每月都有一兩日返唔到學 我仲記得拎住個暖墊,坐喺沙發到諗 「咩事啫?」 我食嘢,口水腺都唔會流出啲口水 去散步 膝頭唔會漏啲關節液出嚟 點解啲月經就咁衰漏曬出嚟?
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.
我想知點解 但係冇人問到答案 我媽咪乜都唔知 仲叫我唔好同人哋提起月經 呢啲污糟邋遢、又唔見得人嘅嘢 我問過啲女仔朋友 個個都講得好婉轉 最後,我提起勇氣去搵醫生 講畀佢聽我啲月經流得好犀利 醫生就話叫我去食啲肝
(Laughter)
(笑聲)
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 --
當我去藥房買月經用品 我用嘅 48 包、超特大護墊—— 嗰時每塊仲係紙巾盒咁大
(Laughter)
(笑聲)
You know what I'm talking about. You have no idea how far absorbent technology has come.
你明我講咩啦 你諗唔到啲吸水能力進步咗咁多
(Laughter)
(笑聲)
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?"
我以前買啲月經用品 要去女性衛生嗰行 我記得當時企咗係到諗 「點解我唔係喺 肛門衛生嗰行買廁紙呢?」
(Laughter)
(笑聲)
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.
做乜啫? 點解唔講得月經啫? 正如弗洛伊德所講咁,唔關啲血事 因為如果係 依家就會喺耳鼻喉醫生面前企喺到 講起流鼻血嘅禁忌,係咪? 甚至係唔關月經事 如果係咁,當我哋到咗更年期 擺脫咗又毒又可恥嘅月經 我哋應該就可以升到更高嘅社會階層
(Laughter)
(笑聲)
(Applause)
(掌聲)
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.
只因為係父權社會 喺女性唔同生命嘅階段 利用不同手段壓榨佢哋 利用月經係一種手段 醫學上,女性出現月經 係喺生殖年齡 自古以嚟已經係咁 好多文化都認為 女性會破壞啲農作物 牛奶、或者令啲花枯萎 加埋宗教 純真嘅傳說,就令情況更壞 呢種情況,啲藥物完全冇幫助 喺 1920 同 1930 年間 仲有種想法 女人會喺月經度產生一種毒素 行過就會令啲花枯萎
(Laughter)
(笑聲)
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.
咁就係缺乏多樣性社會會發生嘅事 因為當時冇女人會企出嚟話 「其實,冇咁嘅事發生過。」 當你講唔出身體正在發生緊咩嘢事 又點能夠打破呢啲無稽嘅傳說呢? 本來就唔需要醫生話你知 月經係冇毒嘅 如果係有 點解仲將啲胚胎植入餿水度? 如果我哋都有呢種神秘嘅月經毒素 我哋就可以糟蹋莊稼同破壞牛奶啦
(Laughter)
(笑聲)
Why would we have not used our X-Women powers to get the vote sooner?
點解唔早啲用女性嘅超能力去拎選票
(Laughter)
(笑聲)
(Applause)
(掌聲)
Even now, when I tweet about period diarrhea, as one does,
就算係依家 當我喺推特到講起經期有肚瀉 呢樣嘢
(Laughter)
(笑聲)
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.
我提到佢會影響 28% 嘅女性 每次,都會有人同我講 「我以為得自己係咁。」 呢啲令女性羞恥嘅文化,就係有效到 令女性都唔可以分享自己嘅經歷
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.
所以我開始諗 「如果每個人都好似婦科醫生 咁了解月經嘅話會點? 唔係會好好咩?」 然後你哋就會知我知嘅嘢 你就會知到月經 係哺乳類動物中非常獨特嘅現象 大部分哺乳類動物都有發情期 人類、部分靈長類動物 部分蝙蝠 象鼩、刺鼠都會有月經 而且月經就係大腦刺激卵巢 去產生卵子 釋放出嚟嘅雌激素 令到開始建立子宮內膜 一層一層,好似磚頭咁 當起咗太高嘅磚牆 又冇足夠嘅水泥會點? 咁就唔穩陣啦
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.
但妳排卵時會發生咩事呢? 一種妊娠激素會釋放出嚟 令子宮準備好受孕 作用同水泥一樣,令啲磚頭黐實 轉變係 令到內膜更適合被植入受孕嘅卵子 如果未有懷孕 (嗖一聲) 內膜就會出咗嚟 血管會出血,嗰啲就係月經啦 我成日都覺得呢點好有趣 因為發情期 令子宮裡層準備好嘅最後信號 實際上嚟自胚胎 但行經 呢啲決定就嚟自子宮 就好似程式咁 注入咗我哋嘅生殖器嗰度
(Cheering and applause)
(歡呼聲、掌聲)
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.
好啦,依家我哋知道點解嗰到會出血 都幾多血 係 30 到 90 毫升嘅血液 即係一到三盎司咁多 而且仲可以更多啲 好多時都係會更多 係咁 點解我哋會有咁多血? 點解佢唔留喺到,等到下個週期? 即係,我都冇懷孕,點解佢唔留低? 每個月令到子宮內膜越嚟越厚 咁你想像下 月經就會像海嘯咁樣排出嚟
(Laughter)
(笑聲)
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 --
實在有太多,唔可以再吸收返啲月經 我哋需要個厚嘅子宮內膜 係有個特別原因嘅 因為懷孕對我哋身體 會造成嚴重嘅生物損害 所以會有孕產婦死亡率 喂母乳對母親係有傷害 同時將個細路湊大嘅代價都好大 呢個係人類進化過程
(Laughter)
(笑聲)
That goes on longer for some of us than others.
有啲人仲要等耐啲
(Laughter)
(笑聲)
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.
但演化過程好清楚風險同利益嘅比例 所以想提升得到最好結果嘅機會 咁點樣可以做到呢? 就係嘗試得到最高質素嘅胚胎 咁點先得到最高質素嘅胚胎? 就係要佢哋努力去爭取 畀個障礙賽佢哋玩 經過咗幾千年嘅進化 子宮嘅變化,好似軍備競賽咁 內膜變厚啲,又厚啲,再厚啲 胚胎亦變得更具攻擊性 要中和呢個情況 就需要個厚嘅子宫内膜包圍著胚胎
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.
因此形成厚嘅子宮厚內膜 同埋佢點可以脫落 咁你點樣止血呢? 止鼻血,你會捻住個鼻 如果隻腳整損咗,你會壓住個傷口 用壓力去阻止出血 當我哋嚟經期 子宮內膜會釋放出一種物質 叫做前列腺素嘅化學物質 同其他發炎症介質 佢哋會令到子宮抽筋 佢哋會擠壓血管止血 改變咗子宮嘅血流狀況 會引起發炎,加劇咗啲痛楚
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.
你就會問︰「咁又會有幾大壓力呢?」 有啲研究得到啲好勇敢嘅女性肯犧牲 喺自己個子宮度 放入壓力導管 放足一個月經週期—— 主保佑佢哋,所以我哋先可以知道 呢啲咁重要嘅知識 因為喺月經期間 子宮所產生嘅壓力 係 120 毫米水銀 你就會問「係咩嚟嘅?」 呢個數字其實就等同 你第二階段分娩 身體內所產生嘅壓力
(Audience gasps)
(觀眾喘氣)
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?
係嘛 對於你哋嗰啲人,未試過自然分娩 噉咪當血壓袖帶 比原先無咁緊 但都係好緊 你都好想佢放鬆 咁都會令件事好唔同,係咪 如果你開始諗經期嘅痛楚 我哋唔能夠話人冇去上堂 就會經歷第二階段分娩嘅痛楚 係件懦弱嘅事嚟 我哋會話「哇,你咁痛都忍得﹗」
(Laughter)
(笑聲)
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.
我哋唔會阻止有陣痛嘅媽媽 去食止痛藥,係咪? 重要嘅係,我哋要將呢種痛楚 稱為「典型」而唔係「正常」 因為當叫佢正常 就會好容易忽略咗佢 唔講佢哋係咪典型 我哋都應該要處理佢
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.
我哋有啲方法應付經痛 其中一種使用經皮神經電刺激器 你可以放喺衫入面用 佢會向神經同肌肉發出電脈衝 冇人知佢點可以止痛 但我哋覺得可能係閘門控制嘅影響 即係反刺激 同你整親嗰陣會捽下自己一樣 震動比痛楚更快到達你嘅大腦
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.
我哋亦都有藥物治療 叫非類固醇消炎止痛藥 功用係阻止釋放前列腺素 可以減少八成女性經痛 亦會減少三到四成月經流量 同時幫助到經期肚瀉 仲有激素可以避孕 令我哋有個薄啲嘅子宮內膜 因此會少咗前列腺素 少咗血,咁就少咗抽筋啦
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.
如果呢啲療法對你都冇效—— 其實用字好重要 因為我哋唔會令療法無效 只係療法對我哋無效 如果療法對你無效 你可能就係其中一個 對非類固醇消炎止痛藥 有抗藥性嘅人 我哋唔係好明白 但係有啲複雜嘅機制 解釋點解對部分女性無效 亦都可能有另外一個原因 引致你有經痛 你可能患有子宮內膜異位症 子宮內膜喺骨盆腔內生長 引起炎症、疤痕組織同粘連 可能有其他我哋唔係好明嘅機制 由於非常複雜嘅生物學機制 忍受痛楚嘅程度可能因人而異 但我哋要靠講出嚟搵出原因
It shouldn't be an act of feminism to know how your body works. It shouldn't --
想要知道自己身體嘅運作 唔應該屬於係女權主義嘅行為 絶對唔係——
(Applause)
(掌聲)
It shouldn't be an act of feminism to ask for help when you're suffering. The era of menstrual taboos is over.
因為痛楚而需要求助 唔應該係女權主義嘅行為 月經係禁忌嘅時代已經結束咗
(Cheers and applause)
(歡呼、掌聲)
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.
呢到唯一嘅詛咒 就係過往說服咗一半人 天賦予我哋依家嘅生物機制 令到物種永存 係污穢兼有毒嘅破壞物質 咁我係唔會容忍
(Applause)
(掌聲)
And the way we break that curse? It's knowledge.
我哋要打破詛咒嘅方式? 係知識
Thank you.
多謝
(Cheers and applause)
(歡呼、掌聲)