Kirsten Karchmer wants women to know that premenstrual syndrome (PMS) is not normal.
It’s all a problem, she says: cramps, fatigue, mood swings, bloating, food cravings, acne. Maybe even a sickness. Over 17 million women in the United States say they’ve experienced significant and life-interrupting menstrual pain and PMS. So the symptoms are common, she says — but there is a difference between common and normal. If women see PMS as “normal,” they’re probably just going to put up with it: But it’s not, Karchmer says, and they shouldn’t.
Karchmer has spent years working with women to improve their period symptoms. In her new book, “Seeing Red: The One Book Every Woman Needs to Read. Period.,” out this week, she offers a game-plan for “biohacking” your period. Her strategy is entirely natural. She recommends analyzing your own daily routines — how much you sleep, what you eat, how you exercise, average stress levels — to come up with a personalized plan. With habit changes and herbal supplements, Karchmer says, she is typically able to help women get at least 80 percent of the way towards their “ideal” period.
Karchmer knows some people are going to be skeptical. She’s not a doctor — she specializes in Chinese medicine and acupuncture. But there is peer-reviewed evidence that changes to daily habits can have a significant impact on your period. So far, Karchmer says, pharmaceutical drugs have done relatively little to solve PMS. So women might as well try something different.
The first step, Karchmer says, is to actually talk about our periods. There are over 5,000 euphemisms for menstruation, she writes in the book: “my time of the month,” “on the rag,” “code red,” “bloody Mary,” “red wedding,” “mad cow disease.” If women can’t discuss our periods — clearly and without any kind of awkwardness or shame — solutions are going to be a lot harder to find, according to Karchmer.
This interview has been edited for length and clarity.
Caroline Kitchener: Is it still taboo to talk about your period?
Kirsten Karchmer: In the lead-up to the book coming out, I’ve been trying to have conversations about periods on social media, just to see what people think and believe right now. I might post something like, “Tell me about your worst menstrual day,” and someone will respond, “Why are we even talking about this in public?”
People don’t even like to name our period. We’ll call it “red tide,” “Aunt Flo,” “the curse” — I think that’s the most damning one. I’m always saying, your menstrual cycle is not a curse. It’s actually an instrument you can use to your advantage.
CK: Why are we so hesitant to talk about it?
KK: Well it goes way back. In the Bible, in Leviticus, it says, “Whenever a woman has her menstrual period, she will be ceremonially unclean for seven days.” And then in the third century, Aristotle says, “Women are the inferior species ... because they menstruate.”
CK: Are periods still seen that way — as something dirty that needs to be cleaned?
KK: Just look at television commercials for Tampax [as well as many other menstrual product companies], using this mysterious blue liquid instead of blood to show how absorbent the tampons are. It’s like they’re saying, “This stuff is so gross, we can’t even show you what it is.” You can also see evidence of this in the pharmacy or grocery store. All the terminology revolves around hygiene — “feminine hygiene products,” “sanitary pads” ... products will claim to “leave you feeling clean and free.”
All this sends a message to women: You’re disgusting. Your period is something dirty. And because women don’t feel comfortable talking about their periods, they’re not getting the help they need. They’re not demanding solutions for PMS and menstrual pain.
CK: Do we know roughly how many women experience debilitating period symptoms?
KK: Between 23 and 31 percent of women have PMS symptoms severe enough to impact their daily lives. Fifty-five percent have pain significant enough to require medication. I remember learning that and thinking — wait, what? It’s going to be really hard for women to move forward towards full equality if so many of us are sick and no one is even having a conversation about it.
CK: You use the word “sick” — and in the book, the word “epidemic” — to talk about menstrual pain and PMS. Why use that kind of language?
KK: Every day women tell me things like, “I can’t schedule board meetings on the week of my period because I could be passing out.” To me, that is a sickness. That is not a healthy state. I spoke recently to this one OB/GYN who was like, “We don’t like to use the term ‘sick.’” And I’m like, “Yeah, that’s the problem. You’re telling women that they’re fine so they’re just taking it.”
CK: How do women react when you say that period pain is a sickness?
KK: Online, when I’ve suggested that this kind of pain is not normal, some women have lost it on me. They were like, “What are you talking about, yes it is, almost everybody has it.” But there is a big difference between common and normal. The distinction is — can it be fixed? And is it problematic? If you can get rid of PMS and cramping, but you keep talking about it as normal, then no one is inspired to do anything about it.
CK: In the book, you talk about the “ideal” cycle or period. What does that look like?
KK: I always hesitate to use the word “perfect” or “ideal” because I think that, in general, we as women have enough challenges, trying to be perfect. But I do think it’s helpful to know the kind of cycle you’re aspiring to. You’re looking for a 28-day cycle, ovulating on cycle day 14, clear and stretchy cervical discharge, no PMS whatsoever, soaking a tampon or a pad every four hours. No cramping, no clotting, no spotting, fresh red blood.
CK: Is that attainable for most women?
KK: I would say the majority of women can get 80 to 85 percent of the way.
CK: How do you get there, in your opinion?
KK: Your menstrual cycle is the sum of your habits. To have the most healthy cycle, you have to do a few different things: You have to sleep. You have to do the type and frequency of exercise that your body can tolerate and has resources for. You need to eat the right kind of food for the specific problems that you are experiencing. You need to manage stress on a daily basis.
CK: How do these habits and daily routines affect our bleeding?
KK: Let’s talk about exercise first. Every time you contract your muscles when you are running or sprinting or squatting, those muscles need blood for oxygen and nutrients. So when you’re exercising a whole bunch, you’re essentially using a lot of blood. So if you’re not bleeding enough in your cycle, you might need to back off.
Then let’s look at sleep: When you have inadequate sleep, that impacts your cortisol levels, which impacts your other sex hormones, like estrogen and progesterone. And without sufficient progesterone, you’ll have cycle irregularity.
CK: Almost one in three women take hormonal birth control because they’ve been told that will help with their period — and for a lot of women, it does. Why not just go that route?
KK: When we use oral contraceptives for menstrual management, nothing is changing on the back end. Say you only have one day of menstrual blood, and you have really bad emotional problems before your period. You start taking birth control, and you feel better.
The habits that were causing those symptoms haven’t changed, and the impact on the person’s body continues to perpetuate. You’re missing an opportunity to — no pun intended — check under the hood every month.
CK: What can we learn from irregularities in our cycle?
KK: Any deviation from the ideal menstrual cycle gives us information. I’ll see lots of women who look perfectly healthy, and then I’ll ask, “How’s your period?” and they’ll say, “Oh it’s a nightmare — I’m hemorrhaging for three days, I’m so depressed before my period.” And then they’ll be like, “Oh, but that’s completely normal.”
The first step is asking yourself: If my menstrual cycle is far from the ideal, how are these things related to my habits? You can do some light back-diagnosing by yourself. But it’s important to remember that the whole thing is highly personalized. At each turn, each person will need to look at the results and ask themselves more questions. As certain symptoms are improving, there should always be new questions.
CK: If women want to follow your advice, and start doing something about their period pain — what is the first thing they should do?
KK: Track. Once you know exactly how your cycle looks and your habits you can start looking for relationships. This will allow you to tweak what you are doing and see what levers can make the biggest impact on your cycle.
Start by tracking all of your symptoms including cycle length, cervical discharge, days of bleeding, color of blood, volume of blood, presence or intensity of cramping, PMS and exactly what kind of symptoms you have. (There are more than 40 symptoms associated with PMS.)
Now start tracking your habits. Track hours of sleep, amount of alcohol, water, a general idea of what you are eating (including servings of vegetables per day), how stressed you feel, your energy levels without caffeine, glasses of water/day (blood is mostly water) and your mood. Often just by tracking these habits you can begin to see some important areas to start working on.