What is normal?

‘They had no idea that normal didn’t exist for me anymore. Normal had been smashed on the rocks beneath the bridge.’
Cat Clarke, Undone

Luckily for me, I have picked a field of work that fascinates me. Working in medicine is never boring and, since starting medical school in 2004, it has managed to keep me interested for nearly 15 years! And it’s not just the nuts and bolts of medicine that grab my attention, not just the diagnosis and treatment or even the people themselves – there are areas that are much harder to define but contribute just as much to our overall health that I find equally, if not more, fascinating. These include how pain is experienced differently by different people, how illness behaviours change how we respond to disease and treatment, and how women’s health problems are perceived both by medics and patients.

To me, women’s health seems almost like the last bastion of the Patriarchy within our health care system. Even the name no longer fits our increasingly diverse society, excluding and discouraging gender diversity. Although this is slowly changing, you only need remember the backlash Cancer Research suffered following their promotion in June 2018 that rightly encouraged cervical screening for ‘everyone with a cervix’ rather than that simpler but more exclusionary ‘women’ to see how far we still have to go.

And, sadly, people seeking help for period-related symptoms or because of problems ‘down there’ still often receive stereotypically dismissive or patronising advice from their doctors and so don’t always receive the help that they are looking for. Too many people have stories of their concerns being dismissed by a medical practitioner or just being offered contraception as a sort of fix-all. In response, I can only apologise for my profession and express a hope that this is improving, but it has created a culture that discourages people from looking for help for these issues and, instead, just managing or coping with their symptoms alone.

This enforced autonomy is a double-edged sword. For the most part, I think that taking agency for our bodies and understanding their functions is hugely important. GOTN recently wrote a brilliant post about discharge, irregular periods and how learning what is normal for her has helped her recognise and respond to change.

‘My constant vigilance over my body has given me the confidence to walk into a doctor’s surgery and explain that this thing – this change – is significant. It’s not normal for me.’

In general, I am hugely in favour of this approach. Each of us is an individual and our bodies do work in unique and interesting/annoying ways. We may be taught that a menstrual cycle lasts 28 days and is associated with x, y and z symptoms for this or that amount of time, but very few people actually have that textbook cycle. Our bleeding time, pain levels and associated mood changes are all different, to name a few possible variations.

This is why it is so important to talk about our health and share stories about periods and discharge and other ‘women’s problems’ that have previously been so taboo. How else can we know and accept what could be our normal? How else can we understand that variation between people is not only possible but normal?

But I described this autonomy as a double-edged sword as there are downsides to accepting too much variation – there is a risk of normalising too much, particularly in the context of health problems that are already routinely diminished and underestimated by the medical profession. You only need to look at fact that it takes 4-10 years to diagnose endometriosis or read the articles expressing surprise that periods could actually be painful to realise that medicine is not always on our side.

It’s a pretty toxic mix – professionals dismissing concerns, true experiences being kept secret or only talked about in hushed voices, and a patient group who accept ‘their normal’ or avoid seeking help for fear of the exact dismissal that I’ve already mentioned.

Or, to put it another way, I worry a lot that we have got so used to adjusting to our own normal that we end up accommodating for some seriously abnormal conditions.

Despite being pretty rude about my fellow medics earlier in this post, there are, of course, exceptions to this unfortunate rule and I have worked with and studied under some extraordinary GPs and gynaecologists who have demonstrated the compassion and empathy that is missing from that stereotypically awful consultation.

One particular gynaecologist had a huge impact on my medical practice, and life in general if I’m honest, as I will never forget what he had to say about patients who were referred to him with problems with their periods. He was both horrified and baffled by the severity and duration of their symptoms and what they had put up with before referral. Mansplaining wasn’t yet a term when I was at med school but this gynaecologist acknowledged that while his cis male opinion on periods didn’t invalidate or diminish the experiences of the people having them, he felt very strongly that a period that negatively impacts a person’s quality of life and ability to function as they would for the rest of the month was not a healthy period and was worthy of referral to gynaecology for assessment.

Pain so crippling that you are unable to work, bleeding so severe that you are nervous leaving the house; in his opinion, these were completely unacceptable symptoms and he was astonished at how many people just managed with them as their normal.

And it is too easy to do. Exposing 40 wrote 2 years ago about exactly this experience and exactly this acceptance of her normal. She began suffering with such significant floods of bleeding that she would change her work schedule to ensure she’d be at home and described wrapping herself up in towels as a nappy to prevent her bleeding from staining, well, everything. She also told me that she often suffered with bleeding between periods after PIV sex. And yet she didn’t see a doctor!

‘If I was pushed to say why I didn’t walk the five minutes across the park at the end of my road to my GP, I would probably say it was because I had found my way of dealing with it. Or that going to the doctors because of heavy periods when we see so much about the NHS being at breaking point was just, well, a bit lame.’

But it wasn’t lame – E40’s bleeding was abnormal and she needed minor surgery to remove a number of polyps that had caused the change and worsening of her bleeding. Now, as discussed in a recent update, her menstrual cycle has settled into a much more reasonable pattern!

So what is my point? Should we be accepting variation as normal or not? And where are the limits?

This is why the fact that we are discussing our health so much more is so vital, both individually, on social media and through memes such as this new one Sub-Bee has launched, Menstruation Matters. We need to know that variety is normal but, crucially, know what changes are worrying and warrant further review.

Have the symptoms changed significantly or are they new? Are you struggling to cope? Are you having to make big adjustments to accommodate your symptoms? Are you regularly taking time off work? Are you bleeding between periods or after sex? If the answer to any of these questions was yes, it might be worth a discussion with a doctor to make certain it was safe to accept this as normal. Just because our health problems are often dismissed doesn’t mean that we should just accept ill health!

And I want to finish with the screening question that my gynaecologist mentor taught me to ask all patients who were concerned about their periods: fashion choices aside, would you be comfortable wearing white trousers during your period? And if not, why not? Because we should be able to, if we wanted. We should be able to do anything we want!

Menstruation Matters

23 thoughts on “What is normal?

  1. Fantastic post. I would say you must be a fabulous doctor!! I’ve known women who had problem periods and many did just what you say—they found a way to deal with it. And that’s just wrong.

  2. This is such an interesting post and you have given me a lot to think about. There is so much truth in what you say about people normalizing their symptoms and I would definitely fall into that group. Great food for thought. Thank you. ?

  3. Thank you for writing this. I have to hold up my hands and say I’ve been one of the discouraged and have always just found ways of coping. I’ve called in sick with flu, stomach bugs and migraines because I can’t explain to a manager what’s really happening.

    I’ve made some changes recently and will monitor the impact, if this doesn’t work then I’ll find some courage and speak to a GP.

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  5. Great post! I also found a way of “dealing with it,” because most of the doctor’s I saw couldn’t be bothered. The world needs more doctors like you and your colleague.

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