Women’s Reproductive Health 101

I’ve written a lot of posts on women’s health over the years, but Crystal is a wealth of knowledge and passionate about this topic too. I hope you enjoy today’s post! And go follow her on instagram for more inspiration, knowledge, strategies and tools!

Robyn has written some wonderful blog posts on menstruation, reproductive health, birth control, and hormones. All of those can be found here. And she recently wrote a very comprehensive post on what your period can tell you about your health. My hope for this post is to share some gems from those posts along with other resources I find helpful and put them all in one place for an easy reference on all things female. I hope this is helpful!

It’s confession time

I honestly didn’t know much women’s health until I heard Robyn on a podcast last year and I was like… say whaaaat?! For many personal reasons I have been off “the pill” for about 10 years. It’s not something I really thought about, but still… how did I not know this information? Apparently, I’m not the only one in the dark because I’ve had several clients tell me they were also unaware and no doctor had ever explained to them how the birth control pill actually works.

1. So how does “the pill” work?

When you bleed on the pill (or any hormonal contraception) you are experiencing a withdrawal bleed aka not a “real period.” A withdrawal bleed is different from your body’s own physiological period. The synthetic hormones alter your body’s natural hormone levels to keep you from ovulating which prevents pregnancy. When you take the placebo pills at the end of the pill pack, your hormone levels drop. This mimics what would happen if the egg was unfertilized in a natural cycle and induces a “withdrawal bleed.” Getting your period on the pill doesn’t necessarily mean you would also get your period off the pill. This is especially true if you weren’t menstruating regularly before you started taking birth control. This information alone was really enlightening for me so I hope it is for you too. And my hope is that you feel empowered by this information and post.

A few other important things I’ve learned…

• Low dose birth control (meaning low levels of estrogen are in the pill) may cause spotting.
• Lack of sex drive and absence of vaginal discharge throughout the month can be a sign of low estrogen.
• During menopause, when the ovaries stop producing estrogen, adipose tissue (fat) in the stomach area typically increases which helps minimize the symptoms caused by estrogen depletion – this is a GOOD thing and it’s a normal change in the body!
• An increase in hunger prior to your period is 100% normal. This typically occurs sometime in the week prior and/or days leading up to menstruation. The body is working hard and it needs energy. This is just one of the many reasons that hunger fluctuates, especially for women. It’s also another reason to honor your hunger.
• The average female needs much more energy than the media, My Fitness Pal, and other outside resources make her believe. Although I don’t talk specific calories and that’s not the point – I do think it can be helpful to give some perspective. We’re talking more than 1,600, 1,800 and likely 2,000 calories for most women. Bottom line: our bodies need more energy than we often think.

2. Comparison

Ahhh comparison. Something I’m pretty sure every female has experienced. (If not, my hat goes off to you!) From an evolutionary perspective, comparing ourselves to others makes sense. We lived and traveled in small groups, so to belong was to survive. Being different could have meant being left behind. Therefore, some comparison is quite normal and a part of what it means to be human. Unfortunately, the society we live in has amplified this. And thanks to social media, we have constant reminders about what other people look like and what they’re doing.

Do you find yourself stuck in comparison mode?

Instead of beating ourselves up and going down “the black hole to misery,” let’s take a look at some other ways to cope with these feelings.

1. Diffuse the thoughts by saying something like: “I am having the thought that…” Frame it like this so that you’re observing the thought vs judging it. This can lessen your emotional reaction to it. Alternatively, you can try: “Thank you mind, how very informative.” or “Ah yes, the comparison story again, thanks so much, Mind!” This might feel awkward or artificial at first, but the more you do it, the more it will help. These are techniques from Acceptance and Commitment Therapy aka ACT. (Great book on that here.) The idea is that it doesn’t matter if a thought is true or not. It’s more about whether or not the thought is helpful. Acknowledging rather than pushing away a thought helps us take away that emotional response and can be a great way to interrupt a cycle of negative thinking.
2. Another helpful technique is taking a negative thought and reframing it. Robyn has written about this both here and here. This might look like: Negative thought –> She’s working out, so I should be too. If I don’t, I’m lazy and failing. She’s better than me. Reframe –> The best form of self care at this point in my journey is rest. My body is under a lot of stress and needs to heal. This aligns with my goals to have a healthy and flexible relationship with movement and my body.
3. An action step I’d highly recommend is to take a break from social media and/or unfollow accounts that don’t serve you. If you aren’t ready to take a break, limiting the amount of time you spend using social media is a good place to start.

3. Emotions

For the most part, our reaction to negative or uncomfortable emotions is…RUN! AVOID! NOT HAPPENING!…*visualizes turtle retreating into its shell*… My knee-jerk reaction to anything that doesn’t make me feel good is to not think about it. That being said, over the past few months I’ve been trying to change that knee-jerk reaction. Here are some things I’ve learned and found helpful:

• The best thing we can do is at least acknowledge what we are feeling. When we try and keep our emotions buried, they will come to the surface. And when that happens, it ain’t gonna be pretty. It honestly works. It doesn’t automatically make me feel great again, (that’s not the point) but it does calm my brain. I’m aware of what is happening and I’m not pretending like nothing has happened. Let’s use sadness as an example. Rather than pretend I’m not feeling sad or doing something to distract myself, I might just say, “I’m feeling sad.” Adding some type of mantra also helps. This might look like acknowledging the emotion by saying, “I’m feeling sad.” and following that with, “but, I am calm” or “but, I am safe” – anything that feels good to you! Even if you don’t 100% believe the mantra, it will still send your brain and body the message that you know what is going on and you’re going to be okay.

• When you are feeling overwhelmed, sad, depressed or anxious, ask yourself, “What do I need right now?” Oftentimes the answer is rest! I realize that might not be entirely possible 100% of the time. Just take a look at what’s on your plate. What’s going on in your life right now? Are you overcommitting yourself? Are you the person who says yes to everything? We can’t do it all and staying busy is often a way to cope with emotions we don’t know how/don’t want to deal with. If we’re busy, we can’t really think about much else. I know it’s hard to hear and not ideal, but feeling our emotions and sitting with them is very important for our mental and emotional well being. Not fun, but necessary!

Additional Resources: Women’s Emotions

While I was looking into women’s emotions I came across these articles I highly recommend reading:

This series on Women’s Emotions is so interesting and helpful. Some take home points include:

• Research shows that even as babies, females are wired for empathy, hearing others, being heard, observation, and reading emotions.
• When the menstrual cycle comes along—with an increase in estrogen the first two weeks followed by a drop on day 14 and another drop the week before your period—these shifts in estrogen produce changes in the brain that can create symptoms similar to depression or anxiety. Some women are more sensitive to these hormonal shifts than others.

This blog post by Jennifer Rollin, MSW, LCSW-C explains the link between emotional avoidance and eating disorders.

• People struggling with eating disorders often turn to their eating disorder behaviors in an unconscious effort to try to help themselves “feel better” and to cope with difficult emotions or circumstances. The reality is that eating disorder behaviors often DO provide short-term relief or satisfaction. But, they also produce long-term feelings of increased depression, loneliness, and misery.

This article by Margarita Tartakovsky, MS goes over strategies to stop numbing your emotions.

• These strategies include things like naming the feeling, carving out time to feel, accepting that the experience might be confusing, acknowledging that your feelings are worthy, and so much more!

4. BMI/IBW

Body Mass Index (BMI)

Non-diet RDs and many practitioners now recognize that BMI is essentially useless. It has been misused by the medical/health community to categorize people simply based on their weight and height, which tells us basically nothing about a person’s actual health. Luckily, the word is getting around that this is not a good indicator of health. We hope that it will stop being used to make assumptions about people’s food and exercise choices as the Health At Every Size community grows.

• The creator of the BMI scale was a Belgian mathematician who developed it as a way to look at trends in populations, not individuals. In the late 70’s, researchers began to use it to categorize weight and health status. Up until 1998, a “normal” BMI was considered 18.5-27.3. That was changed and lowered to 25, effectively categorizing millions of Americans as overweight, overnight. What?!
• Except at statistical extremes, BMI – or amount of body fat – only weakly predicts longevity.
• Negative health outcomes are often strongest at the lower <18.5 and higher >40 ends of the spectrum. Even at these extremes, death rates do not significantly differ from other BMIs.
• We do know that having a BMI under 18.5 typically does not occur naturally for the vast majority of people. In eating disorder recovery, part of treatment will involve weight restoration to at least this BMI. But again, this is just one part of a treatment plan.

Ideal Body Weight (IBW)

I have to get this off my chest… I literally despise this term. There is no consensus as to what IBW really represents or how to calculate it. IBW has no physiologic basis and there is no single weight that is ideal for any person of a given height.

Typically, IBW is calculated for women as: 100 pounds for the first 5 feet and an additional 5 pounds for every inch after that. For men it’s 106 pounds for the first 5 feet and an additional 6 pounds for every inch after that. For example, a woman who is 5 feet 2 inches would have an ideal body weight of 110 pounds. During my clinical rotation, we would calculate something called % IBW so the person’s actual weight compared to their IBW, but it didn’t mean anything. This percentage went on the medical note but we didn’t take any action based on that information unless the person was malnourished.

• I would like to point out that based on my own observations and clinical experience, as well as from speaking with other dietitians – being at your “IBW” often means there is disordered eating/over-exercising happening. It’s just an overall, low number for most people. I remember hearing Christy Harrison talk about when she learned about IBW during her dietetics training. At the time, her IBW was also her lowest weight, which she maintained during a time when her eating was the most disordered. I have to say the same is true for me, for Robyn, and for many others.
• IBW is also problematic in that many treatment centers will use it because it’s easy. They may even refer to it as “goal weight.” (Don’t get me started on the problem with goal weights, that could be a whole other post) This sets the patient up for more anxiety because, almost always, their body’s set point is higher than IBW. When they inevitably go over that number or get close to it the person’s fear amps up (understandably so) because they have been given this arbitrary number and believe that anything over that is too high. There are many things wrong with this and it’s something we are trying to change. Please know that if you were given a “goal weight” during treatment and there was no explanation for it, that number is likely to be 1) estimated and 2) too low for your body.

If we just take a moment to think about how many things are inherently wrong with these formulas and what is NOT taken into consideration, we can see that these calculations are not the best way to figure out anything about a person’s health. We really need to look at things like eating patterns, food and exercise beliefs, stress, sleep, mental health, support systems, socioeconomic status, access, education level, genetics, etc. to be able to truly understand a person’s health and what that means for them.

5. Books

These are some great books to check out if you haven’t already!

Appetites by Caroline Knapp
Body Kindness by Rebecca Scritchfield
Body of Truth by Harriet Brown
Eating in the Light of the Moon by Anita Johnston
How to Stop Feeling Like Sh*t: 14 Habits that Are Holding You Back from Happiness by Andrea Owen
Intuitive Eating by Elyse Resch and Evelyn Tribole
Rage Becomes Her by Soraya Chemaly
Self Compassion: The Proven Power of Being Kind to Yourself by Dr. Kristin Neff
The Sun and Her Flowers by Rupi Kaur

References:

Bacon L, Aphramor L. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal. 2011;10:9. doi:10.1186/1475-2891-10-9.

Brown H. Body Of Truth. Da Capo; 2016.

Flegal KM, Kit BK, Orpana H, Graubard BI. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA. 2013;309(1):71-82. doi:10.1001/jama.2012.113905.

Lemmens, HJ, Brodsky, JB, Bernstein, DP Estimating ideal body weight—a new formula. Obes Surg 2005; 15:1082–3

Pai, MP, Paloucek, FP The origin of the “ideal” body weight equations. Ann Pharmacother 2000; 34:1066–9