periods

“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.