Reproductive health shouldn’t be a secret.
Since I was 14-years-old and had to get on birth control to combat my monstrous menstrual cycles, I have had a passion for learning about women’s reproductive health. I think what makes this topic so interesting to me is that 1) I am a biological woman and our bodies are policed like crazy, and 2) vaginas are treated as this mysterious, risqué thing. But the fact is that there is nothing scandalous about this subject. It’s a natural process that affects everyone on earth, not just women. But because of the stigma surrounding reproductive health, many men and women go their entire lives uneducated about the very mechanisms that are responsible for their existence. For this reason, I wrote this post to highlight some important reproductive health facts and to combat some common myths. I am sharing some of my personal experiences as well.
Two things to keep in mind while reading this:
- I am not a medical professional. While I have some public health credentials, I am far from qualified to give more than general information. See a your OB/Gyn or primary care doctor if you have medical questions.
- This post focuses on women’s reproductive health, but men’s reproductive health is just as important. Both men and women should understand one another’s health, but I don’t think that I can adequately cover both subjects in one post.
Let’s begin with what “reproductive health” tends to center around–periods. The crimson wave, Aunt Flo, period, etc. are all euphemisms for “that time of the month.” Many people probably think of the menstrual cycle as the 3 to 7 days of bleeding aka menstruation, but it is actually a longer period of time that lasts on average from 21 to 35 days and follows the lifecycle of an egg. The menstrual cycle lasts from the first day of one period until the first day of the next and has 4 phases:
- Menstrual Phase
- Follicular Phase
- Ovulation Phase
- Luteal Phase
As stated before, the menstrual phase is the first stage when a woman has her period. The second stage, the follicular phase, starts at the same time as the menstrual phase. This is when the body releases follicle-stimulating hormone (FSH) to signal to the ovaries to produce follicles which contain immature eggs. The healthiest of the eggs will fully mature, and it is typically only one egg. During this phase, estrogen increases and thickens the uterine lining to create a supportive environment for a fertilized egg.
The next phase is the ovulation phase in which a woman has about a 25 percent chance of getting pregnant if she has perfectly-timed, unprotected sex. Ovulation happens about 2 weeks after the first day of a period and only lasts about 24 hours. So there is a short window to try to fertilize the matured egg before it dissolves. Ovulation happens when the body begins making luteinizing hormone (LH), releasing the matured egg from the ovary through the fallopian tube and into the uterus. Ovulation prediction kits (OPKs) work by detecting a peak in LH levels.
The fourth and final phase is the luteal phase and lasts 14 days on average. At this time, the body increases production of progesterone and estrogen which will help a fertilized egg implant. If the egg implants and a woman gets pregnant, her body will produce the hormone human chorionic gonadotropin (HCG), and a pregnancy test will detect the rise in HCG and give a positive result. If the egg is not fertilized or implanted, there is no pregnancy, progesterone and estrogen levels drop, and the next period will begin, starting a new menstrual cycle.
Now is a good time to discuss some myths surrounding menstrual cycles and pregnancy. First, some common myths about implantation are:
- Implantation bleeding definitely exists, and
- Implantation can happen after receiving a positive pregnancy test
There is no proof that implantation bleeding is a thing. A lot of people believe that implantation bleeding came about as a result of confirmation bias. Basically, some women experience light spotting before receiving a positive pregnancy test and believe it to be a result of an implanting embryo. But light bleeding is common both before the beginning of a period and in the early stages of pregnancy, and there is no scientific study that confirms the existence of implantation bleeding.
On that same note, many women who experience cramping early in pregnancy are told that it is just from implantation. However, that is impossible since implantation must occur before a woman can be pregnant in the first place. Cramping is likely due to the stretching of the uterus as it makes room for the baby to grow.
Another pervasive myth is that Plan B, or the morning-after pill, works by aborting a fetus. This is absolutely false. Plan B contains a synthetic form of the progesterone hormone. It can be taken within 72 hours of unprotected sex and is most effective if taken within 24 hours. Plan B works by stopping either the release of an egg (ovulation), fertilization, or implantation. This means that Plan B only works in the stages preceding a pregnancy. If Plan B is taken after implantation, it will have no effect. Remember how progesterone released in the luteal phase will support a growing embryo? That’s why Plan B will not harm a fetus. Because its active ingredient is progestin, it would likely only encourage the growth of an already implanted embryo.
A final myth, and one that is hurtful to many women, is that miscarriages and chemical pregnancies (early miscarriages) must somehow be the fault of the pregnant woman. The fact is that miscarriages often happen due to a genetic abnormality in the embryo or fetus that makes it incompatible with life. Roughly 1 in 4 pregnancies will end in miscarriage with most being chemical pregnancies.
Fertility Tracking and Contraception
It wasn’t until I tried to get pregnant that I tracked my fertility, but I wish I had done it sooner. Fertility tracking isn’t just for women who are trying to have a baby. It’s beneficial for every woman to better understand her reproductive system. There are a lot of useful apps that make tracking easy. My favorite is Ovia, and I have also heard good things about Fertility Friend and Glow. Some people prefer using an old-school calendar or planner. Whatever method you choose, tracking the four stages of your menstrual cycle will help you learn your body’s rhythm and more easily spot if something is off that you want to speak to your doctor about.
About 64.9 percent of US women use some form of contraception. These include oral contraceptives aka the pill, long-acting reversible contraceptives (LARCs), sterilization, and condoms. I was on birth control from 2004 to 2018, initially to treat heavy periods that severely impacted my life. I couldn’t go to school for several days each month, I was anemic, and I would get sick with migraines and nausea. It wasn’t until recently that I learned that I have a fibroid on my cervix which could be a contributor to my issues. But for 14 years, I relied heavily on hormonal birth control to help me function. The two types I used were the pill and the Depo-Provera shot, which is a type of LARC.
My experience with Depo was mostly negative. I used it for about 2 years during undergrad, and it caused me to have wild mood swings. When I transitioned from the shot, I needed to take estrogen to get my body to jumpstart its natural production again. Many women use Depo without any issue, but for me, it wasn’t a good fit. Fortunately, I had a wonderful gynecologist who I had been seeing since I was 14. She took note of my concerns and guided me to stop the shot and move on to something else. Prior to Depo, I had used a 28-day pill to manage my periods. I had only switched to Depo due to the allure of stopping my period altogether, so my doctor suggested a happy medium with a 90-day pill known as Seasonique. Four periods per year sounded good to me, and I stuck with that until last year when I decided to get off birth control completely. To my pleasant surprise, getting off Seasonique was easy and my body settled into a manageable 29-day cycle, something I had never experienced before.
Every woman’s experience with contraception is different, and what works for one person may not work for the next. I don’t believe that any one option–pill, shot, IUD, implant, sterilization–is better than another. It comes down to personal preference and health. The best advice I can give is to listen to your body and talk candidly with your doctor if any concerns arise.
My hope is that women’s reproductive health continues to be discussed more openly. Women should have access to the care and information that they need to make informed decisions. Fertility and birth control should not be taboo topics, and vagina is not a dirty word.