“When did you have your last period?”

Kate Forbes over at A Cunt of One’s Own recently wrote a really good post on cis privilege with respect to receiving health care. In what seems to be becoming a pattern with me, some of the points in her post got me thinking about something completely tengential to the topic of that post.

Anyway, one particular part of one of her anecdotes really stood out to me, and reminded me of one of my pet peeves when visiting emergency rooms and walk-in clinics (i.e. receiving health care from anyone other than my primary care provider – and I do acknowledge that having a primary care provider is its own privilege. I’m very grateful to be living in Canada.) I get UTIs on a semi-frequent basis (at about a rate of 1-2 per year these days, which is pretty manageable). When I see a doctor to get antibiotics to deal with these, one of the questions that will commonly be asked when I had my last period.

This seems like a totally innocuous question, that may simply be relevant to the situation, right? Well, yes and no. The thing is that when a doctor asks someone when their last period was, they’re really trying to ascertain the answer to other, related, and more relevant questions. In the particular case of my UTIs, they’re sometimes trying to establish whether the blood that’s present in my urine (sorry, guys) is actually coming from my vagina rather than my urethra. In other words, they want to know if I’m a complete idiot who just didn’t realize that they were on their period.

Most of the time, though, the “when did you have your last period?” question is a smoke-screen for establishing the likelihood that you might be pregnant, which may affect the decision-making process for choosing your treatment. Now, there’s a plethora of problems with this approach.

  • First of all, the most straight-forward way of finding out if a person might be pregnant is to ask them directly whether they might be pregnant. But this is often not what doctors do. They ask a related question, about one’s last period, because they do not trust the people they are treating to know anything about their own bodies or the risk factors for pregnancy in their lives. It is simply assumed that we will not correctly of honestly answer a question about whether we are pregnant. This problem, then, has a couple of corollary problems:
      1. By not even making it explicitly clear that the question they are asking is actually about the patient’s likelihood of pregnancy, the doctor does the patient a huge disservice, by assuming that they know what the implications of potential pregnancy should be. That is, if a doctor is trying to establish the likelihood of pregnancy as a part of the process of choosing a patient’s treatment using the question about their last period, that doctor is assuming that patient would be willing to accept non-standard or less effective treatment for the sake of that potential foetus. What if the answer to the real question of “is there any chance you might be pregnant?” is “well, I’m not sure, but it really doesn’t matter, because if I am I’m going to get an abortion”? Then the patient does not get the opportunity to voice their actual position if all they are asked is when their period was.

     

    1. The actual question, “when did you have your last period?” This question tells you almost nothing about a person’s pregnancy status, or really anything else about their health, either. Particularly since this question is often being asked by doctors in walk-in clinics and emergency rooms, who have no idea what their patient’s ‘normal’ cycle looks like, this question may put many people on the spot for how much detail they want to go into about their menstruation when they are asking the doctor to look after a broken bone, or whatever else. Maybe the patient you’ve assumed to have a uterus is trans* (which itself raises questions about whether you show due diligence and asks these questions of your transmasculine patients, for whom they may be more relevant), or maybe they have a medical condition that prevents them from menstruating, or from menstruating regularly, or there is some other personal reason why they don’t want to fucking well get into this with you because it has nothing to do with the care you are supposed to be giving them. I personally take active hormonal birth control for 11-12 week periods without break, so my uterus only sheds its lining a few times a year. But if I say “well, I don’t know, two and a half months?” which is a normal answer for me, I am guaranteed to get a look of concern from the doctor. And furthermore, some people continue to get mostly regular-seeming light periods-like bleeding through the first few months of pregnancy. Yes, there are certain averages, but very few people are actually average, and the answer to this fucking period question tells exactly nothing about the person you are supposed to be caring for. Honestly, if you really, really don’t trust people to know what their risk factors for pregnancy are, aren’t there better questions you could be asking, about their recent sexual activity and birth control methods? This is just stupid.

 

Rant end.

8 comments

  1. I have reservations about aspects of this post, but I don’t think the technical details of why I will sometimes continue to use that question as part (the key word being part) of a thorough medical history are important right now. I do, however, agree that we medical professionals really could and should be better trained to be aware of the assumptions that many of our questions are based on. During my four years of medical school, I never once had any lectures about trans patients, and I’m also in a fairly conservative region of the US, so we do not come across trans patients in the hospital very often either.

    I have some thinking to do about which parts of my standard general history I might need to change.

    1. That’s pretty fair. I quite probably shouldn’t have been so against the question itself as I was, since I don’t necessarily know all of the reasons for asking it. I just know that I’ve been frustrated with answering and then having to explain what that answer means well enough for the doctor to actually understand the answer to what turns out to have been an underlying question that they could just have easily asked me directly (whether that be about my chances of pregnancy, or about whether my body has generally been functioning normally – which again, different answers are normal for different people). I get that it’s actually relevant when I’m getting a PAP smear, for instance, but then I get those from my primary care physician, and she knows what’s up with me.

      Edited to add: Do you mind letting me know what it is the question does tell you about a patient? Or is that a much bigger question than I might think it is?

      1. It tells you if the patient is currently menstruating, which is good to be prepared for if you’d like to do a speculum exam. It could lead to you finding out that the patient has not yet hit puberty and started menstruating, or that they have hit puberty and by the normal sequence of things should have started, so maybe they have Androgen Insensitivity syndrome, or their vagina doesn’t open. Or maybe they haven’t menstruated in several months and could be underweight, pregnant, or starting menopause. Or maybe they’ve been heavily menstruating for weeks, and this is normal to them, but it’s something we would want to explore further because they could have cancer, or they could be anemic from the blood loss.

        It’s not meant to be the only question you ask a presumed cis woman to find out whether or not she’s pregnant. It’s supposed to be one of many questions that could lead to more information about her current status so that we can learn more about if there’s something going on that she didn’t realize was wrong, or maybe there’s something she didn’t know we could help with (birth control pills to lessen the severity of her menstrual cycle, for example).

        The problem with direct questions in medicine is that if you only ask direct questions, you only get the answers to questions you thought about, and it’s easier to miss things.

      2. Cool. Thank you for taking the time to respond. Knowing what’s going on in doctor’s heads helps me to be less frustrated sometimes :)

        And yeah, I do get the theoretical value of asking more open-ended questions in many cases (it’s actually a major tenet of library reference services, for instance) to allow you to get a better big picture or to encourage people to tell you what they think is important rather than assuming you know precisely what you should be asking about. And I can see how this particular question can save time, rather than asking a series of related questions. But it still seems embedded with all kids of assumptions about what’s a normal answer to the question. And I guess I’m still confused about why I get asked this question when all I’ve done is pee in a cup to prove that I have an infection and that I need a scrip for antibiotics (I’ve already acknowledged that the presence of blood in the sample may have come from my period if I’m having it, but I’m pretty sure the bacteria would be a problem regardless of the source, and my UTIs don’t always present with blood, but I do always get asked this question). Why is “when did you have your last period?” more useful than, say, “has your menstruation been normal lately?” with a corollary question of what constitutes ‘normal’ for the person in question?

      3. Sorry, busy weekend! One of my boyfriends was visiting. Anyway, Daisy Deadhead gave you some more reasons why it’s a useful question, and like I said, it’s supposed to be one of many questions. You can’t just ask that one question and expect to have a full history of a woman’s reproductive health; you’re supposed to ask many other questions, and lots of follow up questions. So it’s not necessarily more useful than other questions, it’s just part of the standard set we’re taught. Not everyone does the set thoroughly every time, so sometimes you’ll just get asked a few things that don’t really seem all that helpful without much detail, because someone just needs to fill out certain boxes on a checklist.

        And the reason we go into more detail than expected for a simple visit is because it’s our job to try to pick up other things that could be going wrong every time you make contact with the healthcare system, because not everyone is doing all the routine maintenance care they should be doing. So there’s a lot of random questions that you’ll be asked just as a basic screening tool, by nurses, doctors, and even techs.

  2. Speaking of intersectionality…. hello! Old folks exist!

    I can’t quite believe you got through a whole post about this question and ignored a major reason it is asked.

    One thing they are also asking is whether you might be in menopause, which can influence many body-processes, such as body temperature, blood pressure… and the immune system (the UTI). It is possible that younger women can be in perimenopause or premature menopause. (Since many people these days look much younger than their chronological age, due to botox, etc… it isn’t a totally off-the-wall question.) Lots of women are in menopause and do not realize it; it usually takes a test of hormone levels to be sure. There are often many “false alarms” in which periods cease for a few months and then start up again. The official end of menopause is measured as not having menstruated for a whole year. Some women are so busy they don’t realize a whole year has passed until they are asked the question… my co-worker had this experience.

    1. Not to mention, as a (cis)woman prone to UTIs herself, a bunch of things that cause UTIs are related to menstruation. Case in point: Menstrual cups, while awesome for many of my friends, are a very bad idea for me — they press up against the urethra and can cause UTIs, particularly, it seems, in women who are prone to them. (I found this out during a lovely conversation with an ob-gyn at my student health center, who pointed out that, while menstrual cups may be great for some women, they clearly may not be the best option for me.) The same goes for sex during menstruation, it seems.

      Basically, while asking about the timing of one’s last period may not always be relevant, when it comes to identifying the potential cause of a UTI, it *definitely* is.

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