Flow: The book about menstruation

By Karen Jeynes

Flow is to inform and educate all those who menstruate. It covers:

What menstruation is and why it happens.
What is healthy, how to keep things clean, and how to take control of your menstruation.
What could go wrong, and what to look out for.
Important facts and answers significant questions.
How society sees menstruation, what different cultures have to say etc.
Concerns for those who are just starting to menstruate. 
Problematic opinions that get spouted on social media.
Period politics.

• Language: English
• Publisher: Kwela
• Release date: Aug 6, 2021
• ISBN: 9780795710124

Karen Jeynes

Karen Jeynes has worked as a writer for the screen, and is best known as the head writer for the political satire ZANews: Puppet Nation. She headed up the ZANews site, and won the Bookmark for best online editorial. She has written for stage, radio, film and online. She segued her TV writing and research into work as a fact checker and researcher. 

Book preview

9780795710124_FC

Candice Chirwa, Karen Jeynes, Pontsho Pilane

with Dr Ilana Johnson, Tariq Hoosen and Claire Fourie

Kwela Books

For Sindi

When we started writing this book, Dr Sindi van Zyl was our co-author, champion, and the magic ingredient that brought us all together. We hope that the book honours the ideals she embodied: of providing people with knowledge about their health and their bodies, in order to empower them, help them make decisions, and live better, happier lives.

Authors’ notes

My Fellow Menstruators, finally, a book on menstruation. Yes. Your eyes are not deceiving you. You can finally rely on a book to answer all your period questions, but also school you on a natural, biological and fundamental bodily process. Period pain? Covered. Period conditions? We got you. How to deal with period discrimination in the workplace? Don’t worry about it! The reason why I am so into Menstrual Activism is because the outcome of empowering people and speaking out about our periods will lead to Period Positivity. And having a period positive world simply means that we have individuals who do not feel afraid to talk about something that is a part of them. I really do hope this book will edulift (educate and uplift) the masses into feeling motivated and inspired into being period positive humans. Let’s go with the Flo. – Candice

A few years ago, I wrote and researched a piece on whether or not South African schoolgirls were missing school due to a lack of sanitary pads. The most inspiring – and heart-breaking – part of the answer was all the plans that people were making to get to school anyway. Messy, potentially dangerous plans, with newspapers and socks, but plans nonetheless. During this research, I was struck by how difficult people found it discussing this topic. I started looking out for it, and noticing how many people looked horrified if I asked in a busy production room if anyone had a tampon, or brought up the problems I was having due to my period at a braai. I started thinking deeply about when, why and how we were talking about menstruation. And I became more and more convinced that we weren’t talking enough, in the right way, or to the right people. I hope that this book can become part of bigger conversations about menstruation. Whether you pick it up because you’re hitting puberty yourself, struggling with periods, or simply wanting to understand more about what menstruation really is, I hope you find information in these pages. I hope you find yourself in these pages. So, let’s dive in. – Karen

It all started with a few of questions. Why is it so expensive to menstruate? What about people who have less, how do they afford this? Why am I always trying to hide a tampon or pad when I need to get it changed? Why am I so ashamed of menstruating? Why do I hate the word so much? Why the hell does it hurt so much?! And this is why we are here today. This is why this book exists. I wish I had answers to all these questions and more when I was thirteen years old, when I got my first period. I wish I didn’t spend over a decade of my life shrinking and shaming myself into silence about menstruation. This book is for all of us – those who love their period, those who dread it and those who simply want to learn more and lift the veil of stigma surrounding menstruation. This book is my contribution to menstrual justice. May we all, one day, soon, be #FreeToBleed. – Pontsho

About this book

Menstruation is a complicated thing, a physical process, that has physical, emotional and social impacts. It’s often hard or impossible to separate those out. We’ve broadly divided this book into physical, psychological and political aspects of menstruation. But we have also embraced the joyous messiness, so each section will undoubtedly contain aspects that fall under the other headings too. That’s why there’s also a fantastic index at the back if you want to look up something quickly or go back to read something again later on.

SECTION 1

THE PHYSICAL

Chapter 1

What is menstruation?

You probably have some ideas, or personal experience, about what menstruation is. Menstruation is a physical thing that happens to the bodies of about half the world’s population. But menstruation also affects you emotionally, has social and cultural meaning, and sometimes impacts on our human rights. And because it’s to do with our genitals, and blood, and some people think it’s gross or embarrassing, we don’t talk about it nearly enough. We deserve better, and so in this book we are going to be talking about menstruation a lot. All the time, in fact.

But let’s start at the beginning, and see if we can explain this simply. Let’s start with some physical facts.

Menstruation¹ is vaginal bleeding that occurs as part of a monthly cycle. Every month, your body prepares itself as though you’re going to become pregnant. If there isn’t a pregnancy after all, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods generally start between the ages of eleven and fourteen, and continue until menopause, at about age 50. They usually last from three to five days. As well as bleeding from the vagina, you might experience:

•Abdominal or pelvic cramping pain

•Lower back pain

•Bloating and sore breasts

•Food cravings

•Mood swings and irritability

•Headache and fatigue

Another important part of menstruation we should mention is premenstrual syndrome, or PMS, a group of symptoms that start before your period. PMS affects your emotions, physical health and behaviour. It’s very common, affecting more than 90 per cent of menstruators. Symptoms can start five to eleven days before menstruation, and typically go away once menstruation begins. PMS is related to changes in your hormone and serotonin levels at the beginning of the menstrual cycle.

Now, before we get into a whole lot more detail about everything we’ve just said, let’s have a quick anatomy lesson.

Knowing how all the parts fit together

Let’s start by looking at a typical female² reproductive anatomy, which includes parts inside and outside the body.

Starting from the outside, the external parts of the reproductive structure allow sperm to enter the body, protect the internal organs from infections and, of course, can contribute to your pleasure during sex.

The main external structures of the female reproductive system, collectively known as the vulva, are:

•Labia majora: The labia majora enclose and protect the other external reproductive organs. Literally translated as ‘large lips’, the labia majora are quite big and fleshy, and similar to the scrotum in a typical male reproductive structure. The labia majora contain glands that make sweat and glands that secrete oil. After puberty, the labia majora are covered in pubic³ hair.

•Labia minora: You might be able to guess this translation now, but your labia minora are your ‘small lips’. They can be very small, or they can be up to five centimetres wide. They are just inside the labia majora, and surround the openings to both the vagina (the canal that joins the lower part of the uterus to the outside of the body) and the urethra (the tube that carries urine from the bladder to the outside of the body).

•Bartholin’s glands: These glands are next to the vaginal opening and produce a fluid (mucus) secretion.

•Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion. The clitoris is covered by a fold of skin, called the prepuce. The clitoris is very sensitive to stimulation and can become erect.

Okay, so now let’s have a look at the internal reproductive organs:

•Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal.

•Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing foetus when you’re pregnant. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main part of the uterus, called the corpus. The corpus can easily expand and contract. A channel through the cervix allows sperm to enter and menstrual blood to exit.

•Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones.

•Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and are tunnels for the ova (egg cells) to travel from the ovaries to the uterus.

That’s a lot of information, but it really is important to understand how everything works. Especially if this is something happening inside your own body.

The psychologist says:

I don’t think we talk about menstruation enough – with children, teens and adults. Sadly, it is one of those topics that most people frown upon when it gets brought up, with a sense of shame associated with it. We need to be talking about it more, it needs to be more socially acceptable and form part of more discussions and decision making. There is often so much stress and worry about menstruation because we often feel like we can’t talk about it and that we need to figure things out ourselves. There is so much to figure out and to ‘know’ – do I use pads, tampons (‘what’s an applicator even’?). A menstrual cup? Eco-friendly products? Feminine wipes? There are so many products and variations out there. And then, in a more basic sense, what is even going on in my body? Why am I bleeding? Why is it so painful? We need more openness about menstruation.

The menstrual cycle

We tend to focus on menstruation itself, the days of bleeding, but in fact a menstrual cycle is an ongoing thing, with many phases to it. In fact, ‘menstrual’ comes from the word ‘mensis’, meaning month. The average menstrual cycle takes about 28 days and occurs in phases: the follicular phase, the ovulatory phase (ovulation), and the luteal phase. Don’t worry, we’re going to explain what all of that means.

You also need to know that there are four major hormones (chemicals that stimulate or regulate the activity of cells or organs) involved in the menstrual cycle: follicle-stimulating hormone, luteinising hormone, oestrogen and progesterone.

Follicular (egg making) phase of the menstrual cycle

This phase starts on day one of your period. During the follicular phase of the menstrual cycle, your body is busy doing all of this:

•Two hormones, follicle-stimulating hormone (FSH) and luteinising hormone (LH), are released from the brain and travel in the blood to the ovaries.

•The hormones stimulate the growth of about 15 to 20 eggs in the ovaries, each in its own ‘shell’, called a follicle.

•These hormones (FSH and LH) also trigger an increase in the production of the female hormone oestrogen.

•As oestrogen levels rise, like a switch, it turns off the production of follicle-stimulating hormone. This careful balance of hormones allows the body to limit the number of follicles that mature.

•As the follicular phase progresses, one follicle in one ovary becomes dominant and continues to mature. This dominant follicle suppresses all of the other follicles in the group. As a result, they stop growing and die. The dominant follicle continues to produce oestrogen.

Ovulatory (peak fertility) phase of the menstrual cycle

The ovulatory phase, or ovulation, starts about fourteen days into your period. The ovulatory phase is the midpoint of the menstrual cycle, with the next menstrual period starting about two weeks later. During this phase, the following events occur:

•The rise in oestrogen from the dominant follicle triggers a surge in the amount of luteinising hormone that is produced by the brain.

•This causes the dominant follicle to release its egg from the ovary.

•As the egg is released (a process called ovulation), it is captured by finger-like projections on the end of the fallopian tubes (fimbriae). The fimbriae sweep the egg into the tube.

•Also, during this phase, there is an increase in the amount and thickness of mucus produced by the cervix (lower part of the uterus). If a woman has intercourse during this time, the thick mucus captures the man’s sperm, nourishes it, and helps it to move towards the egg for fertilisation.

Luteal (pregnancy or period) phase of the menstrual cycle

The luteal phase of the menstrual cycle begins right after ovulation and involves the following processes:

•Once it releases its egg, the empty follicle develops into a new structure called the corpus luteum.

•The corpus luteum secretes the hormone progesterone. Progesterone prepares the uterus for a fertilised egg to implant.

•If intercourse has taken place and sperm has fertilised the egg (a process called conception), the fertilised egg (embryo) will travel through the fallopian tube to implant in the uterus. This is now a pregnancy.

•If the egg is not fertilised, it passes through the uterus. Not needed to support a pregnancy, the lining of the uterus breaks down and sheds, and the next menstrual period begins.

How many eggs are there?

At birth, there are approximately one million to two million eggs. By puberty, only about 300 000 remain. Of these, only about 500 will be ovulated. Any remaining eggs gradually die out at menopause.

A few quick things to say here about the menstrual cycle: unfortunately, your period doesn’t start on the first of the month and stick neatly to a calendar. Everyone will have their own cycle, and it may vary slightly over time. Nobody can control when their cycle happens, as much as they might really want to.

Let’s talk more about this whole puberty thing

Puberty is the time when your body develops from a child body to an adult body. Your body grows faster during this time than at any other time apart from when you’re a baby. It’s important to understand these changes, and also to remember that everyone is going to go through puberty and has to deal with a lot of change. Usually, puberty starts between the ages of eight and thirteen in people assigned female at birth, and nine and fourteen in people assigned male at birth. When your body is ready, your pituitary gland (a pea-shaped gland at the bottom of your brain) starts to release hormones.

The age you are when you first get your period depends on a bunch of factors, like your genetics, body mass index (BMI), the foods you eat, how much exercise you get, and even where you live.

You’ll also start growing pubic hair and go through a growth spurt for about two to three years – some people grow as much as ten centimetres a year. By the end of this, you’ll be pretty much your adult height. You’ll notice other changes too, like changes in your body shape and, of course, acne, and body odour.

Just as those hormones change the way your body looks on the outside, they also create changes to how you feel on the inside. During puberty, you might be confused, or experience strong emotions that you’ve never had before. You might be overly sensitive or become upset easily. Some kids