Clots in the S-Bend
The difference between normal and common when it comes to your menstrual cycle – an East Asian medicine perspective
I write this entry from the south coast of Victoria, where I am experiencing one of my more painful and uncomfortable periods in recent months. I have arrived at a stage in my menstrual cycle awareness that I am better able to predict if it’s going to be a difficult one.
I am not a menstrual unicorn – I have a great herbalist doctor who supports me to improve my periods and overall cycle, but there are other factors that influence how it’s going to go. This month follows recovering from my first encounter with Covid, a significant increase in stress as I raced to set my clinic up before Christmas, an even more significant increase in icy G n Ts and Margaritas thanks to warm days, encouraging friends and the feeling of ‘aaaah. I’m on holidays!’ In the day before my period I threw myself into the ocean, icy cold in this part of the country, and allowed it to smack into me with force - it was delightful. Apart from the Covid bit, it was all really quite nice, and a worthwhile sacrifice.
From a Chinese medicine perspective, the uterus is known as an ‘extraordinary organ’ with extraordinary powers and vulnerabilities. It isn’t so keen on the cold, whether it is from being submerged in the freezing ocean or from a few too many of my mum’s chocolate orange ice-creams at Christmas. I thought I might pay for it, and I am: cramps, clots, heavy bleeding and dragging aches down my legs. At the least it offers me an opportunity to consider what women in Australia are educated to believe about what is normal in their periods. I am here to share that a lot of it isn’t normal and it isn’t healthy – but pretty much everything I am discussing here is incredibly common.
Unfortunately, what is also very common is not often talked about. Too often when brought up in the GP office, the catchphrase is to go on the pill. This is a great option for an oral contraceptive if you are willing to take hormones to prevent a pregnancy, however it is important to understand that while this method may* suppress symptoms by preventing periods altogether. it will not resolve them. When you bleed on the pill, this is not a period, this is what is known as a withdrawal bleed - and not the same thing.
I myself have sat in that GP chair semi-regularly since I was in my early 20s. The first time I told the heavily pregnant GP in front of me that I would like to go off the pill so I could better understand my cycle. She asked me ‘do you want a bubby?’ I had no fucking clue what a bubby was, I was 21! She then used quotation marks to patronise me that many young women came into her office wanting to ‘track their cycle’ with no awareness of the repercussions should they fall pregnant. I didn’t go off the pill.
Another time between my own pregnancies in my late twenties, my doctor suggested that a solution for my heavy bleeding was either to exercise more or to have a procedure known as ablation.* Neither appealed to me.
Another suggested the pill. As did another. Another suggested transexemic acid*.
Multitudes of friends and peers who have ‘finished’ having children have been advised to have hysterectomies.
Not a single one asked me whether I had unwanted signs outside of my period window, and none asked me if I experienced anything other than heavy bleeding or pain.
We are operating in a culture where no blood is the best blood, where as patients who only bleed for a day, or maybe spot for a few, I’m here to tell you that we are designed to bleed. An ideal period should be in the realm of a 27-30 day cycle, 3-5 days of bleeding fresh red liquid blood, not too heavy and not painful. They do exist, and they do change according to other influencing factors such as stress, weather, illness, diet and lifestyle.
Since beginning my journey studying Chinese medicine nearly 8 years ago, I have encountered the following symptoms – some experienced myself, some by my patients, some by family and friends who feel safe enough to share their experience. I am sharing them here to hopefully elucidate that these symptoms are common but they are not normal. A normal period lasts approximately 3-5 days and should be free flowing, without clots or pain.
Premenstrually:
Swollen, tender or even lumpy/lumpier breasts prior to bleeding
Irritability, tending toward rage, tears and frequent meltdowns
Extreme anxiety, depression and suicidal ideation*
Constipation, diarrhoea and sometimes the terrible two together
Migraines
Increased sex drive (ok not too shabby, but it’s nice to know there are some positives)
During menstruation:
Pain in the abdomen, pubic bone, perineum, anus, tops of the legs, inner thighs, back and hips. Pain can range from anywhere to sharp stabbing to a dull dragging ache
Gushing/flooding bleeding, needing to change pads/tampons/cups/underpants more than every two hours, anywhere between 1 mega day or up to 10 days
Scanty light bleeding lasting 1-2 days, or skipped periods altogether
Clots - some folk describe their clots as tiny strings or mucussy blobs, anywhere up to giant 50 cent piece sizes that ‘fall out’ when they stand or go to the toilet
Constipation, diarrhoea and sometimes the terrible two together, again!
Blood that is sticky and only visible when you wipe
Blood that can range between watery pink or brown through to purplish or black
I have had patients who tragically ‘don’t need’ to track their cycle on account for the pounding migraine that informs them that their period is a day away.
~~~
My passion for menstrual health is to educate and help my patients (and their friends, their daughters, their mothers, sisters and all those who bleed) to experience a closer relationship with their menstrual cycle. The period isn’t something to dread (even though some of them are absolute arsehats) but a part of a bigger picture of the cyclical nature of our bodies. A period isn’t just whacked in there as a stop point to note ‘no pregnancy’ – it has a whole lot more to offer than that. It helps us to track the ebb and flow of energy and inspiration through our monthly season. In the lead up to bleeding, it’s not uncommon to feel a little more withdrawn, some people find this is a wonderful time to be creative and work on personal projects. By asking patients about the colour, texture and flow of their bleed, we can ascertain what needs to be done in order to ensure an optimum bleed.
One of my favourite experiences in clinic is the mischievous glee I experience when patients arrive (sometimes throwing soft furnishings at me in their wake), exclaiming indignantly ‘thanks to you, I had NO idea my period was arriving and I wasn’t ready!’ Ha! In your face! That will teach you to track your cycle.
What can help?
Everyone is different! I cannot emphasise that enough! However I have found there are a few things we can do in our everyday lives that support a more comfortable and restful bleed. A lot of this advice has to do with when you are not bleeding. I like to think of the period as the season of Winter. This is where things are a little quiet and dormant, and we are making the most of what we harvested in the warmer months to support us.
In the week before your bleed (autumn):
Stay warm. I too love me a lil’ cropped jumper but please, please keep your kidneys and uterus WARM! That means avoiding bathing in cold water, exposing your belly and lower back to the elements when it’s cold and/or windy, particularly in the lead up to your bleed.
Eat warm things! If you need to smash a sugary treat in the lead up to bleeding, can I suggest a warm chocolate pudding over the tub of ice cream? Cold tends to contract and may contribute to increased pain. It’s a great idea to up iron rich foods to prepare for blood loss (think leafy greens, bone broth, meaty stews).
If you tend toward feeling a bit on the shittier side premenstrually, some high energy cardio can help: boxing, running, dancing, orgasms – get that qi moving! But like everything, in moderation: try not to overdo it as you also need to conserve energy. Gentle yin-type movement (like yoga with the lights down) can be the perfect way to take that energy inward.
Acupuncture and shiatsu may be beneficial to help prepare the body prepare for the bleed and reduce stagnation that may be contributing to clots and pain.
During your bleed (winter):
Follow steps one and two above.
Give yourself permission to go to bed a little earlier and sleep a little later, if you can.
Engage in gentle exercise – walking, gentle yoga, qi gong or dancing. No need to push hard.
Take help where you can – let a colleage cover for you, see if someone else can cook dinner on day 1.
Orgasms – some people find that orgasms can decrease cramping.
In the week after your bleed (spring):
This may be a good time to increase your exercise intensity.
Avoid saying yes to things that you may regret in a couple of weeks time as you head into your autumn/winter phase.
Acupuncture following a bleed may assist in restoring energy lost from menstruation.
Orgasms – it’s spring! Time to get that energy up and out!
Mid cycle/ovulation – this is different for everyone, however a normal mid cycle is approximately day 13-16 (summer):
You guessed it – acupuncture. Do you need it? Probably not essential if you’re feeling good, but acupuncture is a wonderful tool to support health promotion and regulate the body’s systems. Chinese medicine operates on prevention before we need the cure.
Orgasms, orgasms, orgasms! It’s summer! You’re at peak cycle!
What if I don’t feel like *any of the above*? That’s absolutely ok. You do you. What I have found to help myself the most is to consider my body like a cute little boutique farm. I am a terrible gardener so I have had to learn a lot about seasons and soil to even halfway understand this method. Simplistically, we need to harvest in summer, store in autumn, conserve in winter and plant in spring.
However, if we over harvest in spring, by the time we get to autumn we have run out of food to store and by winter we’re starving without the resources to support us through to the next planting season. So as you move through your cycle, ask yourself – is this the time to expend energy or conserve it? It takes practice, and often a few seasons to understand the topography of your own farm.
And if you feel like something just isn’t right – please, get in touch. If something is askew, a combination of biomedical support from a gynaecologist as well as East Asian medicine can do wonders for your cycle – and not just the bleeding part.
Please note that the above entry is not intended as medical advice, and nor is it a direct critique on surgical or pharmaceutical interventions, which in the right circumstances are necessary and can be life-saving. If you are concerned about your menstrual health, please get in touch with a registered medical provider that you trust. You are entitled to seek support and feel heard. If your medical provider dismisses your complaints, don’t lose heart. We are all learning in a culture not set up to understand menstrual health.
Book an appointment to discuss your menstrual health with Lucy here.
*Terms
Hysterectomy: the partial or total surgical removal of the uterus; it may also include removal of the cervix, ovaries, fallopian tubes and/or other surrounding structures.
Ablation: a procedure that uses a wire heated by electricity to remove the lining of the uterus. This procedure is contraindicated for females wishing to fall pregnant.
Transexemic acid: a pharmaceutical used to prevent excessive blood loss by helping the blood to clot.
Withdrawal bleed: When taking the sugar pills the withdrawal of hormones in your body cause the lining of your uterus to shed.
Resources:
*Lifeline: 13 11 14
Period Queen by Lucy Peach
Period Power by Masie Hill