identity politics

Let’s Talk About Bleeding While Butch

Featured image are awesome undies from Harebrained Design. Not exactly butch, but there’s not exactly butch menstrual stock photos out there.

I have always had very heavy periods. Lots of blood, serious cramps that vary from keeping me flat on my back watching movies until I can stand up again to drugging myself heavily to throwing up from the pain. They’ve always been very regular (which is one of the things that rules out PCOS), and because any conventional doctor I have had wants to put me on supplemental hormones (like the pill form of birth control, usually containing heavy doses of estrogen), and I immediately say no, I’ve never been treated for this well. (I must not be adequately expressing how much pain I’m in when I’m actually talking to the doctor. They dismiss it so easily.)

I’ve tried all the things—from hot baths to raspberry leaf tea, from supplements to hot water bottles to yoga to orgasms. (The orgasms kind of help.) None of it really hurts, but all of them only take the edge off, they don’t actually help the pain. Menstrual pain is kind of like curing the hiccups: everybody has an opinion on how best to do that, but your body may or may not take to any of them. I have routines, my best ideas of what work (most of which involves taking lots of Aleve and watching favorite childhood movies and not talking to anybody), but I’m coming to realize that it’s not enough.

Things have changed a lot for me lately. In the past year and a half, since moving to the San Francisco Bay Area from New York City, my system feels very different. My grieving process has mostly passed, at least the most intense of it has, I’m pretty sure; and I’m no longer in a very high-stress and high-conflict relationship. I’m also no longer living in one of the most high-stress cities on the planet, trying to make it on a shoestring artist budget. Now that my day to day life is significantly less anxiety- and depression-producing, I’m noticing this other thing happening: I am significantly affected by hormonal mood swings. Depression, anxiety, and wacky all-over-the-place emotions in the few days up to when I start bleeding. (Usually, when the bleeding actually starts, things settle a bit.)

I’ve tracked my monthly cycle on and off for the whole twenty years that I’ve had it, and it’s almost always very regular and consistent. It’s also almost always been like this: heavy, with big repercussions on my mood, outlook, energy, and body. The feminist communities I ran around with when I was in my teens and early 20s were very encouraging of things like charting one’s cycle against the moon phases, which I still do and find very fascinating and comforting. It helps me see the Quiet Days coming, the days before I start bleeding when sometimes I am entirely too sensitive to be interacting with people in any significant way.


So lately, the past year that I’ve lived in this sweet little house with my boy and my cat and the boy’s dog and a little garden and a really good kitchen and a bedroom slash temple, I’ve been tracking. I started being treated by an herbalist in May of this year and that has helped, that has changed things. But even after three solid months taking herbs, my cycle hasn’t really changed, and my periods are still harsh, interruptive, heavy, and affect me deeply.

A few weeks ago, the last time I was bleeding, when I was in tears on the way to an event (and eventually ended up staying in the car crying instead of going to participate because it hurt less to lay flat), I said to rife, “I don’t think I can do this anymore.” I’ve been exploring some other options, and I keep worrying about the side effects, but really? The side effects might be worth putting up with if it helps me with the heavy bleeding and the pain and the moods. I’ve been doing a bunch of reading on the menstrual cycle since I’ve been looking into this lately, and it’s funny: I can’t quite tell what is off-balance in my cycle. Too much progesterone, too little? Too much estrogen, too little? Something other than hormonal releases? I just don’t know, and most of the primary care type of OBGYN doctors I’ve seen aren’t hormone experts enough to be able to tell me.

And then there’s the trans/genderqueer thing, too. I went to get an annual pap exam a few weeks ago (thank you, Obamacare) and as I was waiting in the Women’s Clinic, I thought: What if I didn’t have to go to the “women’s clinic” anymore. Why am I still going to the “women’s clinic”? Am I still not trans enough? What is worth it to me that I don’t go out of my way to go to the places that have good trans care? I almost always went to Callen Lorde, the gay community health center, in New York City, and honestly I got (and witnessed) some pretty shitty care there around my (and others’) gender identity, so it’s not like it’s exactly a given, but it’s a step at least. (I found out after my appointment that the San Francisco clinic, Lyon Martin, takes my insurance and has openings next week. So, yeah, I’ll be there from now on kthanksbye.)

(I could so easily slip into a rant about health care and trans-ness and my experiences and what I’m struggling with, but I’m trying to keep this on topic to bleeding while butch.)

I’m considering an IUD—an “intrauterine device” that would be inserted into the uterus and affects the menstrual cycle. It’s primarily used as birth control, as it’s very effective at getting the egg not to implant, but it’s also good for a variety of other things: like significantly reducing the blood flow during a menstrual cycle (because the uterine walls don’t get a chance to build up blood) and reducing cramps. I’ve been doing research about forms of birth control that don’t interfere with hormones like estrogen and testosterone that the body produces, and long term birth control options that are safe for trans men (or genderqueer folks like me) to use. (I’m not taking testosterone, but I don’t necessarily want to change the hormones in my system. I like my goatee and my sex drive, thanks.)

I’ve come across one in particular that seems to come highly recommended these days: Mirena. It’s progesterone-only, which doesn’t interfere with the estrogen or testosterone in the system, and it’s based in the uterus (as opposed to the implant in the arm or pills, which affect the whole body) so it’s localized. I’m seriously considering it, especially now that I have health insurance (thank you, again, Obamacare).

Aside from that, I have also found a couple of really good tools that I want to recommend if this by chance resonates for you.

Recently I bought a new menstrual cup. This is the third I’ve had in about fifteen years, having started using them when I was about twenty, when the only option was the Keeper, made from rubber. It lasted me about six years, until it started having a smell that I could not boil or tea tree out of it, which seemed to be a common problem. I upgraded to the Diva cup, the only other option on the market (that I knew of, anyway) around 2006. It was better—silicone, and absorbed less scent, but after about eight years it too got a little too stained. It is almost clear silicone, so it started getting stained, which visually started being … just not good enough to continue using. I tolerated the stain for a while, but when it started building a scent, I was done.

So I went online to possibly reorder the Diva cup, and while I was researching it, I realized that the landscape of menstrual cups had changed significantly since 2006 when I last bought a cup. I found a few other options like the Lunette and the Fleur, but the one that got me this time was the Sckoon. I LOVE it. I like that it’s marketed in significantly less feminine ways, and I like the design: They really took into account some of the other design flaws in the Diva and Keeper and Fleur, and they made bigger air holes (so it creates less suction) and fewer ridges (which are hard to clean). I like that it comes in colors, too (mine is red).

The thing about a cup, however, is that I don’t have to buy menstrual products every month. That might seem like kind of a small thing, but the process of buying them really was sometimes dysphoric for me. It’s not that I don’t acknowledge and celebrate that my body and sex is female—I do—but having to engage in realms that are marketed for the socialized feminine gender role just makes me so frustrated and angry and sad sometimes. On my best months, I roll my eyes and just do it, like paying a parking ticket or overpriced gas bill. Argh, but okay. It’s just part of it. But on the bad months … it can send me into a tailspin. Especially with all the hormone-induced mood sensitivities (see above)!

Menstrual cups generally come in two sizes: before childbirth, and after childbirth. The “after” is slightly larger, as you can imagine. But until I saw the Sckoon literature about the difference being how much liquid the cup holds (23 vs 30 ml), it didn’t occur to me that getting the larger size cup would, perhaps, enable me to sleep through the night without having to get up to empty the cup (sometimes more than once). Of course! Heavy flow = more blood! And if I have a slightly larger cup, I don’t have to change it as often!

Even the small size cups you don’t have to change as often as tampons. But this new larger size of cup has been making a big difference. I didn’t really think about it as one of the things that supports genderqueer and trans folks who have a menstrual cycle and don’t want to deal with all that “feminine hygiene products” crap, but it has been a really excellent tool for me to use.

Yes, I have to use my fingers and touch my cunt (and the blood). Yes, I have to deal with emptying it in public restrooms, so I have to either be willing to bring the cup to the (communal) sink and empty it and rinse it, or to make do in a stall with a toilet paper wipe. Yes, it is not the most comfortable thing in the world, but whatever—my public bathroom experiences are already full enough of weird looks that I’ve just said fuck it, and gone for it. People are kind of trained to keep to themselves in bathrooms, so I’ve never had a problem, and very rarely has anybody even really looked at what I was doing. Yes, they are kind of expensive—but a $30-40 investment has lasted me 6-8 years in the past, so it’s definitely worth it.

So now you’ve got a couple of my secrets to how I have this monthly blood ritual of bleeding while butch:

  • A moon chart
  • A menstrual cup
  • Quiet Days

… And maybe Mirena, the IUD, in the near future, though I’m still weighing my options. I had some bloodwork done and will hopefully be able to talk to some folks who have more expertise about hormones and the cycle and trans stuff than I do. That stuff is fascinating to me, but come on, my main knowledge is my own body and that one Psychobiology of Women class I took in college—there must be experts I can talk to.

What about you? What are your secret tools for bleeding (while butch, or otherwise)?

Published by Sinclair Sexsmith

Sinclair Sexsmith (they/them) is "the best-known butch erotica writer whose kinky, groundbreaking stories have turned on countless queers" (AfterEllen), who "is in all the books, wins all the awards, speaks at all the panels and readings, knows all the stuff, and writes for all the places" (Autostraddle). ​Their short story collection, Sweet & Rough: Queer Kink Erotica, was a 2016 finalist for a Lambda Literary Award, and they are the current editor of the Best Lesbian Erotica series. They identify as a white non-binary butch dominant, a survivor, and an introvert, and they live outside Seattle as an uninvited settler on traditional, ancestral, & unceded Snoqualmie land.

63 thoughts on “Let’s Talk About Bleeding While Butch”

  1. M says:

    I’ve had the Mirena for 10 years and, other than a teensy bit of scattered periods twice a year, I’ve not really had a period in 10 years.

    I also to have terrifically bad mood swings, and life crippling cramps. All of the alleviated once I got the Mirena.

    One thing to note. The first time I had one place, it was painless and I didn’t even notice it. This time around, the placement was a beast, and every so often, I get light cramping (although never as bad as before I had it.) It was probably one of the best decisions I’ve ever made about my health.

    Good luck!

    1. Sinclair says:

      That sounds kind of miraculous! Here’s hoping my experience (if I decide to go this route … still debating, though all these comments are helping) will be as easy and as good of a decision. Thanks M.

  2. Kodiak says:

    For me, I deal with the odd looks of purchasing overnight pads while looking very much like a guy, in stride. A bit uncomfortable at times, truly. I too am a heavy bleeder, so overnights I go. Now that I am in my late thirties for some reason the cramps have pretty much stopped, but it used to be horrible. I waited it out, but Naproxen used to be my friend. I have noticed I have become far more emotional and irrational closed to my period. I even say some stupid things. I am trying to get a grasp on noticing when it’s going to happen, trying to pay more attention to cycle in order to not be the nutty butch queer at that time.

    1. DHK says:

      Seriously, Kodiak, consider a Mirena. It has saved my sanity. I was the nutty butch queer for a solid week before my cycle. No longer.

  3. GG says:

    I’ve been (thank GOD) in menopause for about 3 years now (last period Sept. 23, 2011, a date I will never forget). As a young woman my periods were regular, moderate and not painful. Later, as I went into perimenopause, I bled like a stuck pig, so much that I was often afraid to stand up after sitting for a while. I had to rely on overnight/hospital type pads because I have a Gardner’s cyst that I don’t think would allow correct seating of a cup. I know I had to quit using tampons because of it. They just wouldn’t fit right. The only advantage was that I had absolutely no pain. Anemia, yes, pain no. I’m also kind of a natural/herbal/stay way from doctors kind of gal with no health insurance, so I just muddled along the best I could. I am curious, and I ask only out of curiosity, because you didn’t mention this option at all, if you have considered a hysterectomy? I haven’t read your past, so don’t know if you have or want children, but that would obviously be a permanent solution, at least to the bleeding problem, if not hormonal, since you would most likely still have your ovaries. These days, they are done quite non-invasively. Anyway, it’s just something that crossed my mind, and I thought I’d ask. I didn’t have one, partly b/c of the insurance thing and partly b/c I tend to just stay away from “traditional” western medicine. No judgment meant or implied. Thanks for a very interesting post. GG

    1. Sinclair says:

      I’m not sure about a hysterectomy. Sometimes I think, fuck it, I can’t live like this, I will go to any extreme measure I need to in order to get this taken care of, and sometimes I’m not so sure. I don’t know about the pregnancy question … I’m 35, so as I’m aging it seems less and less likely that I will actually be pregnant and carry a child, but I don’t know. I’m ambivalent about that one. I am definitely limited by insurance and also because, like you, I tend to stay away from traditional western medicine, but I will put it on the list of options to consider.

      Thanks for your thoughts!

  4. DHK says:

    My grrl, who is a reproductive/sexual health nurse, advised me because my regular obgyn practice never did despite begging for help. I’m 50 but without menopause in sight because my system reset after I had a baby at age 42, and I’ve suffered since age 15 with horrendous cycles very much like your own. I had a Mirena put in place in early June and it has saved my sanity. The first three months to six months can be tricky, mainly because you may bleed at any given time, but the flow is significantly less. I bled lightly for most of the month between mid-July and mid-August, but now things have settled down. And super easy cramps, and no PMS! At least for me, anyway. My Diva hasn’t seen any use since mid-August, and even then I used it only occasionally, opting for thin liners instead because the flow was so light. And, thanks to Obamacare indeed, for without it, I would still be in agony.

    The placement of the Mirena is not the most comfortable experience, so be sure to eat and take an aspirin, Tylenol, Ibuprofin, whatever beforehand, and my grrl went with me to hold my hand and remind me to breathe through the procedure. I’m truly fortunate that I have her in my life because she places IUDs all the time as part of her job and is incredibly intelligent and compassionate. I was too crampy and lightheaded to drive home afterward, so my grrl took me to her house and cuddled me and coddled me through the next 3-4 hours when I finally felt well enough to drive.

    1. Sinclair says:

      >> my regular obgyn practice never did despite begging for help

      Ugh, so sorry to hear that. I so relate.

      And thanks for sharing your experience with Mirena … that sounds about like what I’ve been told. I will be sure to be gentle with my body that day (if I get it! It’s been helping me make a decision to hear people’s stories …). Thanks.

  5. Theresa says:

    I have endometriosis, and the periods you’re describing sound a lot like mine. Heavy, regular, pain so bad I sometimes throw up… I’ve tried birth control in the past (traditional pill form) with mixed results, but I didn’t want to keep pumping artificial hormones into my body so I gave up on that years ago. I did have surgery four years ago (specific for endo) that has helped (some), but those results won’t last forever and I probably won’t put myself through the hell that was recovery again. Everyone I know who has an IUD swears by it, but the insertion process would likely be too traumatic for me, so for now I’m on a regimen of ibuprofen, bed rest, hot water bottles, and vibrators, all of which work to some effect.

    The main thing I wanted to say is your doctors should not be dismissing your pain. If you described it the way you did above they should hear that, acknowledge it, and want to help you. My current NP (who I see at an LGBTQ health center) is wonderfully supportive about the amount of pain I’m in, even if we don’t agree on the best ways to treat it. I hope you can find someone who truly listens to you at your new health center.

    1. DHK says:

      I got tested for endo before I could get a Mirena. No endo, just wicked horrible periods. The endo testing, which was a biopsy, was worse than the Mirena placement.

      1. Sinclair says:

        Interesting, I didn’t know the endo test was so invasive. That’s something I’ll ask about too, though I have done some research on it and I didn’t seem to fit the criteria/symptoms, at least not upon first glance. (I know I’ve asked about it in the past and have had doctors dismiss it.) Thanks for the note.

        1. DHK says:

          Typically, an ultrasound is done first before an endo biopsy. My nurse midwife went right to biopsy, and that was okay. Invasive, but conclusive. Your mileage may vary.

        2. cgeye says:

          One thing: Dismissing pain = wanting to punch a healthcare professional in the face. Just sayin’….

          Also, they have to do the endo to rule out cancer. They scrape (and the sensation within you’s called Uterine Cry….) just to make sure.

          They also do an endo during the process of elimination for fibroids, which also lend themselves to horrendous heavy periods. Those are checked by ultrasound, which ain’t cheap. However, they also have drugs to reduce period flows (like Tranexamic Acid) that don’t use hormones – as with everything, Consult Your Physician, This is Not Meant to Be Medical Advice, etc.

          1. cgeye says:

            “endo” = “endo biopsy”….

    2. Sinclair says:

      I’m pretty sure I don’t have endometriosis, but that’s something I should look into again. I know I’ve brought it up as a possibility to past doctors and they have said no, you don’t have that. I don’t think I ever had an ultrasound to test for it, though. Thanks for reminding me of that, though, I’ll see what else I find.

      I agree the docs should not be dismissing my pain. That is really frustrating, and one of the many reasons I want to scream about the health care system.

  6. Becca says:

    I have the Mirena- 5 years ago now. And I love it. I had a long cycle and traditional hormonal birth control didn’t work for me since it tried to shorten that cycle so I’d get lots of bleed through. Now on Mirena I hardly get a period any more. I still got some in the beginning, but lighter and less and less frequent. I can’t even remember the last time I had bleeding. But I was never good at keeping track. I did get it for birth control and now that my current partner has had a vasectomy, the no periods thing is just a bonus.

    Back in the day when I did bleed, I never ever ever ever used pads because they horrified me. That feeling! Ugh! So I’ve only ever used tampons and in college I started using Instead Cups which is the disposable version. I always left tampons in too long because I’m so lazy about my period. Switched to the cups mostly to avoid TSS. The instead cups are nice to deal with when out and about because you can just toss them in a public trash can.

    My Mirena is basically up (though I did have a dr say off label the Mirena is good for up to 7 years, which makes sense they would tell women a shorter time so accidental pregnancies don’t happen), and I’m debating whether or not to get another one.

    1. DHK says:

      My grrl, who is a reproductive/sexual health nurse at an LGBTQ friendly clinic, advised me that 6 years is about the average safe lifespan of a Mirena, particularly if you don’t want to get pregnant. 7 is pushing it, apparently.

    2. Sinclair says:

      I have heard other folks who were into the Instead cups—one of the things I like about the silicone cups is that they are reusable, the green activist in me is into that. I would probably go back to tampons if I was going to throw them away, because at least the tampons are mostly cotton. I guess I just have a thing about throwing away plastic!

      Thanks for telling me/us about what Mirena has been like for you, that seems to be a very common reaction and I’m hoping my body will react like that too. Thanks.

  7. yarrow says:

    for mood issues before bleeding, i use a Chinese traditional herbal formula called “free and easy wanderer.” it’s widely available at herb stores & Asian markets, and it has a beautifully levelling effect on the whole “taken over by aliens” part of the cycle, without dulling your ability to feel your own emotions. it just brings it down below the level of “i am crying because i missed my bus stop and i cannot make my self stop.” or what-have-you. :) if you’re already working with an herbalist, i’d check in with them to make sure that the formula will work in tandem with the rest of what you’re doing, but it’s definitely worth looking into.

    1. Sinclair says:

      The herbalist I’m working with is folding lots of things into my formula already, and it seems like I’ve gone about as far as I can with herbs, which is why I’m seeking out other things. I’m glad to hear there are herbs that work well for emotions though… I’ll keep that in mind, thank you.

  8. Raven says:

    I was not able to get the Mirena due to my uterus being 1/2 centimeter too short (damn it) but I know several women who have it and are absolutely thrilled with it. I currently use a progesterone based birth control pill (estrogen based pills made me violently ill) and after about a year my cycle dwindled to almost nothing. This prompted my nurse/midwife to put me on a continous dose sans the sugar pills and I haven’t had a period since. Being gender-fluid, the esteogen pills also caused a certain degree of dysphoria when I slid more into the masculine spectrum that I have not noticed with the progesterone pills.

    1. Sinclair says:

      Thanks for sharing about how the progesterone pills are working for you … interesting! Good to know that if my uterus is too short (never even thought of that!) there are other options. Thanks!

  9. Miriam says:

    I’ve found that taking 50mg of Vitamin B6 (well, I just take a B complex with 50mg of most of the B vitamins) throughout the month reaaaally helps reduce the anxiety/depression/general rage at the world that can happen in the days before my period. (There have been some scientific studies about B6, though none of them have been done very well, unfortunately. But there’s some concrete evidence that it helps.) It’s better to take B6 in the morning because it can keep you up if you take it too close to bedtime–it’s actually one of the components in those 5-hour energy drinks.

    Also, this seems a little silly, but lately I find bits of Gloria Steinem’s “If Men Could Menstruate” going through my head when I’m bleeding heavily. (Specifically, the lines from the world she’s imagining.) It makes me feel tough in the same way that my crazy leg hair makes me feel tough (now that I’ve trained myself to think about it that way.)

    The suction and pressure of menstrual cups always felt like they were making my cramps more painful, so I gave up on them and went back to tampons and (cloth) pads (which I find so much more comfortable than disposable ones, OMG. And I have one made out of plaid flannel!) I’m not sure where I get this from but I have a belief that it’s better not to use internal products constantly. Or maybe it’s just that every internal product will leak on me at night eventually and I don’t like dealing with that.

    1. Sinclair says:

      I really relate to things like If Men Could Menstruate … I often think of parts of Inga Muscio’s book Cunt too, and some of the other feminist literature about bleeding (like Steinem’s) that was incredibly influential to me as I was coming into feminism and my adult body. But I think some of that has over-emphasized the value of the “wild emotions” or the extra-sensitivity in a way that doesn’t work for me personally. I think it’s excellent theory generally, and I believe it, but I take my emotions seriously enough as it is that I actually think taking it a little less seriously at that time is better. Or, perhaps more accurately, that sequestering myself and paying attention to my own internal state is better than having emotions that are all wild and reactive to the outside world.

      I have tried B complex type of supplements in the past, but perhaps I’ll try again. It won’t hurt, regardless! I’ve heard other people say that about the suction of menstrual cups, but I don’t think that’s a problem for me. Or at least, I really love the cup, and the bleeding pain is pretty much awful regardless, so I’m into it. I haven’t had any cloth pads in years, but thanks for the mention—I should order some new ones. Especially for that part of the cycle where it’s not the heavy heavy part anymore, I often don’t want to keep using the cup then, and some flannel would be perfect then.

  10. beans says:

    my dealing with heavy bleeding and really intense cramps strategy has largely become a suck-it-up-and-get-through it one, which is not optimal, but it’s evolved to a point where the getting through it part is less awful than it’s historically been. i tried a number of kinds of hormonal birth control from when i was about 15-20, and none of them did much in the way of anything. since then, i’ve kind of just layered on a number of things: a heating pad (or those stick-on heat patches if something horrifically important manages to pull me out of bed), excessive amounts of ibuprofen, hydrocodone since i had top surgery last year and wound up with extra that i meter out very carefully on a basis of 1-2 per month that i really need to somehow get another prescription for in the next couple of months, and cramp bark and a tincture called “antispasmodic tonic” that’s valerian and some other things. it still sucks, but once i’m sufficiently drugged-up i can generally just stay in bed through the worst of it and then do a couple of days of ibuprofen/cramp bark.

    it’s significantly easier to do that as a grad student, though, than when i was working a job that was more time-sensitive or required me to be places and very specific times. i have a flexible enough schedule and the bleeding profusely/feeling like my uterus is trying to eat its way out of my body is regular enough that i can usually arrange things so that i can be totally out of commission for 24 hours.

    one thing i noticed was that you mentioned that one of your issues is not expressing how much pain you’re in when you’re seeing doctors. i think that’s honestly more of an issue of period pain really not being taken seriously. i’ve been really explicit about it to a number of doctors over a long period of time – NPs, OBGYNs, trans-friendly doctors, trans-oblivious doctors – and the response to even “no, seriously, i am puking and passing out and can’t function please do something” is “there’s nothing on your scans… have you tried naproxen?” medical professionals don’t take pain in general very seriously, and pain that they associate with women even less so.

    1. Sinclair says:

      >> that’s honestly more of an issue of period pain really not being taken seriously.

      You are SO RIGHT about that beans! Damn. I really shouldn’t blame myself, though I still do (as evidenced by this write-up); I tend to think that if I was just expressing it a little more, saying the right keyword, they would listen/hear me. But your line, “there’s nothing on your scans … have you tried naproxen?” ARGH that has exactly happened to me. Or they say, “have you tried a hot water bottle?”

      Thanks for sharing some of your story beans … I am curious about the cramp bark, I’ve taken something like that in the past but didn’t notice it helping, but maybe combined with other things it’d be more effective now. I too hated the hormonal/pill birth control I tried from like 15-20 … I relate a lot to what you’re sharing. Thanks.

      1. Beans says:

        my experience with cramp bark has been that it doesn’t do anything particularly miraculous, but seems to make things slightly less awful (or as my last therapist would say, better, not good)? at the very least i’ve got some decent placebo effect something or other going on. i’ve found that it does the most when i take it 3-5 times a day for a couple of days before i start bleeding, and then through the first two or three days depending on how i’m feeling.

    2. Stabbity says:

      i think that’s honestly more of an issue of period pain really not being taken seriously.

      That’s exactly what I came here to say! I have occasional intense abdominal pain that I don’t have an explanation for yet, and I have literally said the exact words “severe, tearing abdominal pain” to more than one doctor, and to date zero of them have given a shit. It’s not you! You are not doing anything wrong! Doctors just suck.

      medical professionals don’t take pain in general very seriously, and pain that they associate with women even less so

      That’s been my experience too.

      Aside from doctors being asshats, I absolutely love my Mirena. I’m on my second, and the last insertion was awful but even then the pain was manageable (by keeping naproxen in my system continuously) by the next morning. I do plan to hound my doctor until he gives me the good drugs for my next insertion, though. I spot a little now and then but I basically don’t get my period anymore.

  11. Erica says:

    Thank you for this post! As weird as it sounds, I’m always interested in hearing about other people’s experiences with menstruation, probably because I, like a lot of other people, grew up with menstruation being a taboo topic you only talked about when absolutely necessary. My menarche was at age 11. I had been questioning my gender since age 5, but by age 9 or 10, I had become really good at repressing my gender. Nonetheless, I still was ashamed of getting my first period, since I saw it as an embarrassment and also the end of my childhood (developing large breasts at 11 didn’t help, either). I didn’t tell anyone I had my period until a year after my menarche. I got very sick at age 13. I was later diagnosed with a severe case of fibromyalgia (a chronic illness), but one of the first things my various doctors did was diagnose me with PCOS. I had very heavy, irregular periods and bad cramps. The bleeding caused me to get anemia. I was put on birth control pills when I was 14 or 15. I’m glad that I’m on birth control pills because I now have light, regular periods. When I’ve tried to go off birth control pills, I’ve ended up in the hospital because of hemorrhaging. I love taking the pill, though, so I’m happy to stay on it until menopause! The pill, along with the other medications I’m on, causes my already low libido to be almost nonexistent. As in, I only masturbate (and therefore orgasm) 6-8 times a year. This isn’t too much of a problem for me, as I’m asexual, anyway. I like to masturbate because it’s fun and relaxing, but I’m not too hung up about not having a “normal” libido. I use LunaPads (cloth pads) on the rare occasion that I need to use a pad. Usually, I just wear dark underwear during menstruation, just in case. I prefer not to use a cup because I’m not into putting things into my front hole. Some people think cloth pads are “gross” but oh well… haters are going to hate.

    1. Sinclair says:

      Thanks for sharing your story Erica. I really like hearing about other people’s menstruation experiences too, it really is such a taboo topic, and one that so many of us have really epic experiences with. Thanks for sharing.

  12. J says:

    I don’t have anything to add about the intersection of menstrual management and the trans experience, but I do have two things to say…

    1. I wanted Mirena to change my life, and it did — it made me profoundly depressed, and despite removing it after less than a year, more than 2 years later things still haven’t evened out much. I know many people who love their Mirenas, and several others who had the same experience I did. So despite it being a lower and topically-applied hormone, do keep a watch out for creeping depression symptoms, and be willing to consider that it may be implicated.

    2. For management of incredibly heavy bleeding, Lysteda ( can be a miracle. It’s non-hormonal, taken only when you’re bleeding, and just decreases the bloodflow (and also cramping, in my experience) tremendously. I don’t know why more people haven’t heard of it (probably because it doesn’t make the drug company that much money) but I’m very grateful my doctor recommended it to me.

  13. alice says:

    My period experience was exactly like what you went through Sinclair! Heavy bleeding for at least @ weeks, pain so bad I would lay in bed & cry, lots of missed work. I tried 4 diff pills & the patch before my gyno figured out that I’m sensitive to estrogen. I have the mirena right now, have had it for 2 years or so & its been a lifesaver! The healing was a bitch honestly, I had pain for awhile. Insertion was terrible, but I had a guy doing it, so that could have been he wasn’t very gentle. Or I’m just super sensitive! But other people I know had no pain on insertion or healing so it’s different for everyone I guess! Other than some regular bleeding now & then, but nothing compared to what it was, my periods are pretty much non-existent now. I have found out that being sick or extreme changes in my stress level will bring on regular bleeding, but luckily it’s only for a day or 2 still. I do get mild cramps, & some spotting most months but it usually lasts about a day/2 at the most. That & tylenol do wonders now. Before, no amount of pain meds could even touch the pain I was experiencing. My gyno said I also don’t have endometriosis but if there was a possibility of that, then the progesterone in the mirena will take care of that. I highly recommend the mirena, for anyone who had the experiences I had. It was a lifesaver & made me functioning again without the mood swings, hours of endless crying & extreme pain. Also, I now take chelated iron at the start of all my periods, no matter how light, it helps with tiredness & general ickyness feeling! Don’t take on an empty stomach though! Hope this helps!

  14. Wendi says:

    Thank you for this post. I am finding that the older I get the more my monthly visits from “Aunt Flow” affect me. I get really bad headaches, almost migraine like, a couple days before I start bleeding. After talking to my biological mother, I discovered that it seems to be hereditary. Unfortunately. There are parts of me that now look forward to menopause. Although, I’m sure I’ll hate the hot flashes.

    I’ve been using the Diva cup for the past couple of years and am happy to hear there is another alternative. I’m due for a new one soon and am thinking I’ll try the Sckoon cup this time. I like the idea of less ridges and easier to keep clean. The few times I’ve been on the road and forced to buy tampons in the store (because I don’t track my cycles and was caught without my cup) were emotionally difficult for me to deal with. But, I dealt with it like you described. Rolled my eyes and just dealt with it. It seems to take way more energy during those hormonal times, though.

  15. Zoe says:

    I’m another devoted Mirena user. I had heavy periods since menarche, and used to stay home from school vomiting, but that’s no longer an option as a grown up with a real job. Before I had the IUD I had super regular periods and I miss the predictability sometimes (and ruin more underwear than when I could set my clock by my menses), but it’s totally worth it for the decrease in flow and decrease in cramping and hormonal swings.
    As a queer person, you definitely have to bring it up as no one will offer you an IUD since they see it primarily as birth control. When I was in grad school, several of my straight friends were offered IUDs by student health for similar menstrual complaints – no one brought it up with me until I went in and asked for it.
    Lyon Martin is a great place, especially if you want your gender to be honored – even if the bay area there’s an amazing number of medical folks not at all savvy about gender. It is a safety net clinic, so the wait times are long, and I would recommend always getting the first appointment of the day and bringing a book.
    And please, for your own sake, don’t minimize the pain you’re in. People bring things up to their doctors for two reasons 1) to make sure it’s not something bad and 2) to get it fixed. If you mention pain as a “by the way” at a “well woman exam” your provider may think you are asking for reassurance. It helps to say “this is what brought me in”. Yeah, maybe you shouldn’t have to do that and they should be able to hear it in the other things you say, but medicare reimburses 12 minutes for primary care visits, so help your doctor help you.

  16. Debra T. says:

    My wife is on Mirena. She had her second one placed last year. She has it for pain control. She has severe spinal stenosis and the menstrual pain.would cause intractable pain.
    She no longer bleeds nor does she have pain. It was a change her life kinda drug.
    I had an outpatient surgery called uterine ablation. Easiest surgery I ever had. I never bled again.
    Good luck on your path.

  17. C says:

    After 15 years of cramps and pain like you’re describing, I tried acupuncture at a community clinic with a sliding scale for services. I didn’t go every week, but for about 6 months I went as close to weekly as possible and for the first time I had a cycle like many of my friends would describe: Five days of light to moderate bleeding, no heavy bleeding or passing clots, very mild cramping the first day, and best of all no trouble sleeping through the night. It’s been a wonderful experience.

  18. Debra T. says:

    Your website didn’t think my old aol address was valid so I used the wife’s.
    I typed this one handed as I’m recovering from a not as easy wrist surgery.
    Its so exhausting dealing with health care workers even if you are one.
    I hope things get better for you soon.

  19. Kimberly says:

    Thanks for sharing your experience! I’ve recently switched from a copper IUD (no hormones) to a Mirena. I started the copper because my reaction to birth control pills has been largely morning sickness every day. It was great not having the added hormones in my system, but the copper IUD actually tends to make periods heavier and cramps worse. It was okay for a while but after about 5 years, I started having cramps about three weeks out of the month and a heavy period for about seven days. In addition, the hormones fluctuations were really triggering a lot of depression and anxiety so I did a bunch of research and decided on the Mirena (Only an option because of Obamacare! It’s an expensive device and procedure.). I’m going into month 5 and so far, my period has been super irregular. I think one month I actually bleed heavily enough to use my cup. The rest of the time, it’s sort of days of light spotting and very mild cramps. My cloth pads have been sufficient coverage though. The procedure was more painful than my first IUD and my doc insisted on an ultrasound to verify placement was correct. So, if an ultrasound is triggering for someone, I’d recommend making that clear up front. I don’t know how common that is.

    I wish you luck in this endeavor. Again, I appreciate your sharing, and all the other comments here. It’s always nice to see how other people are dealing with these issues.

  20. L says:

    I have a generic insulin resistance, diagnosed by my OBGYN last year. I’ve put up with increasingly heavy and painful periods for years. Nothing helped. Since being treated for the insulin resistance, my hormone levels are better, meaning my periods are less likely to result in hysterical sobbing and/or a bloody axe-wielding rampage. I am on a second cycle hormone based birth control to help regulate, but the biggest difference has been the Metformin. I highly recommend having your insulin levels checked.

    I read your comment about a hysterectomy, and understand your point of view. Have you considered an endometrial ablation? It’s a non-surgical option, although it’s not as effective if you have fibrous cysts. My state denies sterilization to women under a specific age without children (welcome to the South!), except in cases of dire medical need, but I have a friend who had the ablation and it worked wonders!

  21. Kaleb says:

    I am a former pro athlete with a myriad of parts of my body that don’t work well anymore because of my years on the field or court. Including blowing out discs in my back that can be debilitating enough to land me in bed on ice to try to alleviate them. However, my monthly bleeding and cramps were getting so bad that they would bring me to my knees and I was throwing up, despite taking naproxen and norco in heavy doses). Internist insisted on a transvaginal ultrasound (not pleasant, but not the end of the world except having to drink 40oz of water and hold it for more than an hour—then let them run the ultrasound wand around in your hoo-haa), which found I have a really healthy uterus that is rather large and only one minor spot that “probably isn’t causing a problem” (I beg to differ). After discussion with the OB/GYN (who said “by law, I can’t give you an IUD for heavy bleeding, ONLY for birth control, so let’s not talk about your marriage” though he knew damn good and well I had a wife). He had 2 options. Mirena (5 year)or a Skyla (3 year). Skyla is used for women who have never had children or who are younger. He decided on a Skyla because he didn’t think I needed the larger amount of hormones in the Mirena. I’ve had it almost a year. It was rocky at first, bleeding 4 days, off 4 days, on 8, off 6, on 12, off 12. But I’ve been more my old regular self the last few months in terms of regularity and hormone levels. I have about 3 days of sort of bleeding (I used to go thru a SuperMongo tampon in an hour and have a pad for backup and laugh at the idea I could use a cup–I would have spent my time cleaning and replacing the cup and starting over). I now use mostly “teenager” sized tampons with the occasional “Regular” size. I have a little spotting a few days later, then poof, I’m done. I still have some cramps. Occasionally it feels like the IUD is trying to stick out of one side of my uterus, but maybe 1 or 2 times has it ever been anywhere near as bad as my cramps used to be. Insertion wasn’t pleasant, but not much worse than a bad PAP smear that day. A few days of uncomfortableness and then no worse than a light period. My hotflashes are cranked down to a handful per month, instead of many, many of them, frequently. Also—in CA, birth control is supposed to be covered by insurance. It is a bit odd to have to explain I have an IUD, despite being rather butch—to any and all medical folks and techs. One even told me “Oh, this must be a mistake, it says you have an IUD, I’ll just remove that”, to which I had to tell her, no, it is no mistake, I tried to bleed to death and we’re trying to help that. There may be a small copay for the IUD, but mine was fully covered ($865 for the Skyla, I think $460 for the insertion, I think the Mirena would have been $1100). Good luck and hope that all our stories help. Feel free to email me if you want. K

  22. Claire says:

    Just wanted to say that I enjoyed the post :) I brought a diva cup with me when I was living abroad and will never look back (though I found mine didn’t last even HALF as long as you were describing, but maybe that was lack of access to clean water?)

    Wishing you luck and love on figuring out the pain situation and with the Mirena. Its unfortunate that the copper, non-hormonal, IUD’s don’t do anything for a period (other than make it worse from what I hear.) I explored a few non-hormonal birth control options after having a DVT (blood clot), but ultimately decided to ditch the whole thing. My mood swings and cramps are worse, but I do tend to feel like I’m matching up with a more natural cycle.

  23. JR says:


    I got an ablation nearly 3 years ago, & I wouldn’t trade it for anything. I got the NovaSure procedure to zap my uterine lining, & the Essure procedure as permanent birth control at the same time. Both procedures lasted about 15 minutes total, & though they were uncomfortable, I never experienced the type of pain I’ve heard other folks go through with the IUD. Both are nonsurgical procedures; everything happens through the cervix, no incisions. I was riding my bike the next day.

    I was told that after getting NovaSure, a small percentage of people experience no periods afterwards. I was one of them, for a time. For two years I experienced zero bleeding, & I felt so much more comfortable in my skin. Exactly two years later, though, I started bleeding regularly on a monthly cycle again–that first time, I was betrayed & devastated by seeing that blood, but even though I still have to deal with a monthly cycle, it’s significantly lighter. I only use menstrual products to manage my period for one day each month. Because of my age (I was 25 at the time), I was told that it was likely my body would repair the tissue damaged in the ablation, so it was something I expected–I had just hoped I would’ve had more than two years.

    Still, I’m so pleased that I went through with it. Honestly, the only downside was finding a doctor in the first place who was willing to consider me as a candidate for NovaSure/Essure–I had to go to three clinics before I found a doctor willing to trust my word that my periods were an indignity for my genderqueer identity & that yes, I was 25, but I know no cell in my body ever wants me to be pregnant. It’s bullshit I ever had to prove that to anyone, but that’s another story. I’d hope your age grants you more ease finding a doctor if you ever decide to go ahead with an ablation.

  24. LB says:

    Without getting into the details of the horrifying truth of what my periods used to be like, I’ll say that I am ultra sensitive to hormonal changes. Even the localized progesterone of Mirena eventually seeped into my blood system and turned me into a neurotic freak. The removal was 10x worse than the implantation and I ended up gushing blood after the removal with severe cramping for about 24-hours.

    Shortly after that, I was going in for a thermal ablation. I went from changing my Size B Diva Cup every 4-6 hours (which was twice as long as a pad or tampon) to changing it every 12 hours because that’s the recommendation. However, I can go a full 24 if there were some kind of situation that required that. And that knowledge makes those long days away from home much easier… no more TP wipes in the stall!

    And for some people, the ablation will completely end the menstruation. You’ll still go through PMS (emotional changes from your naturally-occurring hormones), but your periods (if you still have them) will not be as terrible for you.

    And thank you for the Sckoon recommendation! The design, compared to the Diva, looks like it will be more tapered on the bottom, which will allow for a more comfortable fit.

  25. BT says:

    I used to have debilitating cramps ever since I started menstruating at 14. Within a few months, I went on the pill which helped some but not completely. When I was in my early 20s, I started having a chronic yeast infection that couldn’t be cured by traditional Western methods, so I started going to a community acupuncture clinic in LA. While they didn’t cure the yeast infection, an unexpected and incredible side effect of treatment was that my cramps were completely eradicated. I mean COMPLETELY. I remember the doctor asking me if my cycle was normal, and I said “yeah… I mean, I have cramps, but that’s normal, right?” And he said, “NO, that’s not normal, and it’s actually very easy to solve with acupuncture.” After treatment, my cramps were totally gone for a few years, and probably would’ve stayed gone except that I made other changes to my body.

    After a few years I finally solved the yeast problem by eliminating all sugar/honey/syrup/juice and most fruit from my diet and stopping the hormonal birth control. So then I got a copper IUD (non-hormonal), and that brought back the cramps with a vengeance plus a cycle so heavy that I could overflow a size 2 menstrual cup in 1-2 hours. So I went back to acupuncture, which again eliminated cramps with a few treatments, but couldn’t really help with the heavy flow. With time, flow has lessened somewhat but it’s still dramatic compared to my former cycle and others I know. But at least no cramps!!

    For eliminating cramps, I really recommend Village Health Foundation in LA. $20 suggested donation for each visit, no insurance necessary. They also do other aspects of traditional Chinese medicine like herbs.

  26. ELA says:

    YMMV, but unless it’s been ruled out already, PCOS could potentially still be a factor. Not everyone has missing or irregular periods, it’s a syndrome sometimes people can have it despite having very different symptoms to other people with it. I have it and have only minimal variation in the timing of my cycle.

    You may have already looked at diet if you’ve considered herbs, but I have had amazing results by cutting certain foods out of my diet. Particularly soy and sugar, as well as dairy and gluten. I particularly hit on the soy because of a friend who developed PCOS (including the heavy painful periods) after a year of being vegetarian and eating a lot of tofu and other soy foods, and then reversed her symptoms after cutting out all soy. I’m very strict, to the point of avoiding foods with even very small quantities of soy lecithin, and it’s made my periods not even a third of how heavy they were before. Where before I also could barely walk during my period I can now pop a low dose painkiller or two just the first day and then forget that I’m bleeding at all. It only takes very minor exposure to soy in my diet to swing me back to heavy, long, and agonizing, but it’s so worth it to be strict.

    Anecdotal accounts I found when I was researching showed some people with PCOS having good experiences cutting out soy and others the opposite, but it might be worth a try just to see how you react if you’d like to avoid the more invasive or expensive options. It took a few months being off soy for me to get to the level of relief that I enjoy now, but much of the lessening of symptoms happened within my first cycle.

    Having also been to the point of tears calling my partner and wailing that I couldn’t hack this a minute longer, hang in there and keep trying for better treatment. It’s some damn bullshit when serious period related pain isn’t taken seriously. Hope you can find a good solution soon.

    1. Sinclair says:

      Thanks for that, ELA. I’ve had doctors say it’s not PCOS, but I don’t think I’ve officially been tested, either. I’m definitely looking in to more testing to try to get everything (like PCOS, and endometriosis) ruled out.

      Interesting how diet has really helped you—soy and diary and sugar and gluten, huh? As resistant as I am to cutting those things (I like them!) it might be time to try. I’ve done a lot of experimenting with my diet over the years, and have been vegan, vegetarian, soy free, and gluten free for periods of time to try it out, and honestly I haven’t noticed anything that different. But maybe I need to be taking better notes, or maybe it’ll be different this time.

      Regardless, thanks for sharing your story and thanks for that idea. It’s definitely something I have and will keep considering.

      1. ELA says:

        You might not have to cut them all out to get relief, I cut the other three out for multiple reasons with PCOS relief only a minor factor, but I’ve found soy is far and away the biggest contributor to my period problems. My friend only needed to cut out soy and sugar, but she also only uses raw diary and fermented whole grains for other reasons, everyone is so different! If you’ve eliminated gluten without noticing a change, you’re probably fine there. I never pinned down any obvious reactions to soy till I’d been off it for a few months, almost like everything was so under siege that my body was just kind of reacting all over the place wherever it could rally long enough to do so.

        Now I have a new ‘normal’ the changes to my cycle are really obvious where they weren’t before. I suspect like some people find with various intolerances (particularly gluten when cut out for digestive reasons) that my body needed the break to heal and reset, and now it’s stronger it reacts more immediately to the reintroduction of things I can’t tolerate.

  27. AN says:

    Just chiming in, another person who had her life completely changed forever by Merina. That this is a wonder and I am so grateful. Pre-Merina, I had unpredictable schedule, knock me on my ass cramps for days, nausea, diarrhea, bleeding for 10 days a month, super mood crazies, my whole life. One memory that sticks out – 18 years old, my first semester in college, unable to stand up from the pain, and in that half delirious mental state you get to when you’ve been in pain too many hrs in a row without relief? you know what I mean? I literally crawled on the floor from the dorm bathroom to my bedroom, and wondering if I would wake up the next day, or if this could actually kill me. Moving in with 12 random women was about the worst thing that ever happened to my cycle.

    Merina insertion was very painful, uncomfortable, and emotionally difficult BUT it was over pretty quick and the painkiller prescription I took afterwards worked completely. I took the prescription that night, and the next morning, and then I was all better.

    First few months Post-Merina had lots of erratic bleeding but little-no cramps. It was so strange to bleed without cramps, I had never experienced it, and I was kind of giddy!!! By the end of the fourth month I had no bleeding, nothing. I still had some cycle-symptoms, mood changes, sensitive breasts, etc. but it was truly heaven.

    10-ish months post-Merina my period came crashing back, all at once, very heavy bleeding, and some unhappy cramps, but the cramps were still nothing like before. I was devastated, and very concerned. I went to a great free women’s clinic in SF (I am cis-gender Femme, uninsured at that time, this was pre-Obamacare) and they did a bunch of tests, and they agreed this was rare but couldn’t find anything wrong.

    Between 10-13 months Post-Merina, my period settled in a regular-ish schedule again. I get my period every month now for the last two years, but the bleeding is TINY, only the barest of spotting. I still get cramps, pain, aches, diarrhea, and mood intensity, but other symptoms are gone, and these ones are quite mild compared to before.

    No regrets, still best thing I ever did. I LOVE not using tampons or cups or anything. I LOVE that my period is short and manageable. And those 6 months with NO PERIOD OR SYMPTOMS at all?? It was fun while it lasted :)

    1. Sinclair says:

      Thanks for sharing your experiences, AN! I appreciate it. It’s really good to know many of the ways bodies respond to Mirena.

  28. Cubby says:

    If you’re uncomfortable with the hormones in Mirena, there’s also the copper IUD. I’ve had a Mirena, and let me just warn you: stock up on Aleve and watch out for severe cramping in the first 24 hours. But I have a note here that no one else has brought up yet: fisting, and how little doctors assume it as a common sexual practice, or want to talk about it.

    I’m a trans guy. I like to be fisted. A lot. Because I have a male partner and we bareback and there’s a theoretical possibility that testosterone wouldn’t prevent implantation, I spoke to my doctor about Mirena. This was a GLBT health center in the city I live in during the summers, so I asked about IUDs and “rough sex.” I was told that because of the design (insert anatomical model demonstration here), that wasn’t really an issue, that if an IUD was going to perforate anything and go wandering about my abdominal cavity, the biggest risk for that was at the time of placement. So, I thought, okay, I can’t be the only person with a vagina who’s asked them about this.

    Insert long story here about my Mirena mysteriously going missing after a week, with subsequent pelvic ultrasound, x-ray, and pelvic CAT scan to make sure my body had ejected it and that it wasn’t wandering aimlessly around inside. (Most of the year, I live in a city without easy to find trans-competent healthcare, so I wasn’t going to take any chances about having to be the only guy in the OB/GYN waiting room when something went wrong.) I was just glad to have insurance that would cover this healthcare odyssey. Still no word on when my body ejected it, whether the vigorous fisting had anything to do with it, etc.

    (Dear reader: the incredibly smoking hot sex was worth losing an IUD for.)

    You’d be doing the kinky queer world a great service to ask a doctor about the interactions of IUDs and fisting and report back what you find. I have a theory that trimming the filaments at the end might make it somewhat less likely to get knocked loose by fisting, but I wasn’t able to have that degree of nuts-and-bolts conversation with my medical personnel.

    In the end, I ended up getting one of the various forms of subdermal-implant hormonal birth control options. Once it healed up, it seems to be okay.

  29. late to the party, but oh man, i got a lunette cup a year or 3 back, and it has seriously changed my life. yes, femme and all, but i have always been seriously body dysphoric about my period, and sometimes i *forget about it* now, which is…pretty solidly the best thing ever. that, and what you said about not having to buy tampons.

    also, thank you for this – my honey has very bad experiences with all this, and birth control options had never occurred to us…i will have to look into that.

  30. Ashley says:

    The cup has been a godsend for me. I also bleed HEAVILY and once I figured out how to line it up correctly over my cervix (duh! not sure why this was so hard for someone who gave birth twice at home to understand, but it’s something I somehow missed and couldn’t figure out for the longest time why I was having so much trouble with the cup…), it’s been the absolute best thing I’ve bought for myself in a long time.

    A word of caution on the IUD – I am allergic to latex and had an absolutely incredible allergic reaction to the Mirena. It was so severe, think swelling and itching that got progressively worse over the course of the first 24 hours that I removed it myself, in the bathroom because I was afraid I was going to stop breathing. They swear it wasn’t because of my latex allergy, that it’s completely unrelated, but it wasn’t a fun experience (the hives, itching and swelling lasted for WEEKS!)

    Have you thought about endometrial ablation? I’ve heard both good and bad things about it, but it is supposed to help with the excessive bleeding.

  31. seeley says:

    hey, i’m glad there’s some forum here on these topics. my notes: i’m 38, trans, so far mostly no-ho, have used a Keeper cup almost exclusively since ’99, and disposable liners or tampons only a few times since then when in a pinch. my chest was never that endowed and my amount of bleeding since 14 has been neither the lightest nor heaviest. it has been a somewhat irregular cycle, w/greater or lesser cramps and some pms effects varying. i have hidden disabilities and enough early experience w/medical mistreatment that i’m reluctant to learn about or pursue western med system options, neither did i know insurance info or options for years. but if you can find a good chinese medicine practitioner, i’d second that recommendation.
    3x in the last 12 yrs, my body/emotions have gotten so stressed from major loss (suicide, etc.) that i started bleeding and continued for over 3 weeks. the last time was worse than before; after 2wks it became heavier, enough that i began to worry if i’d need a transfusion. i finally went to the highland e.r., they only offered pain meds and maybe extra iron. i went to the herbal apothecary, was recommended the strongest western herb tincture they had to deal w/’hemorrhaging post-childbirth’–didn’t do anything for me, and i have a high pain tolerance, rarely take drugs and am pretty sensitive to them, and have been helped by western herbalism for other issues. when desperate and close to broke, a friend offered to pay for me to see her acupuncturist. so i saw a guy who worked part time at the school on shattuck in berkeley–he took time to do a more thorough health assessment, then the needles calmed my system a fair bit just in that one session. also sent me off w/prescription for a chinese herb, which i could only get at a local chinese pharmacy powdered in capsules–and it tasted intense even like that–but that put an end to my bleeding within a few days.

    re: menstrual cups, i’m a big advocate, and glad to know of options like sckoon. ‘diva’ is just too dysphoric for me. but i actually had my first keeper last 13 yrs, ’99-’12–just want folks to know it’s possible. yes, it did acquire a smell; i didn’t love that, but didn’t have to carry it w/me except for a bit of time monthly. i eventually was told that boiling it, while sterilizing, will break down the rubber faster and isn’t good for the integrity. i just got into washing well w/soap after a week’s use and making sure it was well dry before storage. i also haven’t found it necessary to wash regularly during the week of use, mainly just use toilet paper for some cleaning, and will leave inserted for up to 24 hrs if i’m bleeding just lightly. have done this for years, occasionally may be susceptible to some yeast infection but knock it off w/dropping carbs and sugar, adding garlic…having the inert latex rubber inserted for a while is Not risky like tampons w/synthetics which led to TSS.
    however, a friend thinks she may have developed latex allergy partly from her use of one, so, that may be worth researching. after 9+ yrs of using my keeper, it developed a permanent divot from how i’d fold it and the rubber getting softer; after 13 yrs got a new one b/c the material had degraded enough that it felt like it wasn’t holding blood as well anymore. but considering they’re supposed to last 10 yrs, i’ve found it a very solid option. only challenges: while backcountry camping/hiking, not having lots of extra clean water to carry w/me to keep washing my hands while bleeding off the hook, nor extra tp so experienced feeling a bit extra sweaty and dirty (an issue when cycle started unexpectedly), and while using men’s rooms which i do nowadays maybe 40% of the time when facing public bathrooms, feeling a bit anxious re: sound or sometimes smell when i’m dumping cup out in the stall. however, i’ve decided most cis guys don’t want to attend to other bathroom users’ bodily functions unless someone specifically draws their attention. i do find breaking the suction when i’m pulling the cup out sometimes makes a funny, audible sucking/pop sound, feels conspicuous. my cis guy gay sex-pos therapist said when i told him, that i could pass it off with, ‘oh, just taking out my buttplug!’ :)
    lastly, i’ve had a couple housemates get iud’s in ’06, and they cramped intensely, hurt like hell following and also for one when she did start menstruating in the next couple months. was told the body was trying to reject a foreign presence. hope options are better now….
    i also started seeing an osteopath dr. a yr ago who prescribed me a topical low dose of progesterone, then an oral one, to take post-ovulating for 10 days till bleeding. this was supposed to gradually balance my cycle toward more regularity, and less blood/cramp/pms. i feel meh about it, have enough other health concerns which take priority and since somewhat consistent topical cream application didn’t seem to make a clear change, i’ve given up. however, supplementing supposedly has been quite helpful for some folks, and doesn’t increase your estrogen. the idea is that gradually your body corrects its own hormone level production and you don’t need to continue indefinitely. may be worth learning more. good luck!

  32. Chelsea says:

    Just stumbled across you from Oh Joy Sex Toy, maybe a little late to the party on this but here goes anyway.

    I was in the exact same position where I had terribly heavy, terribly painful, but very regular periods, which a standard gyn will say isn’t PCOS. Tricky thing is, sex hormones aren’t the only factor. Thyroid levels play a very critical roll (both ovarian and testicular cells have high numbers of thyroid receptors), and if you have the rather unpleasant combination of hypothyroidism and PCOS, truly awful but regular periods are exactly what you get. Took me over 8 years to get the proper diagnosis (at one point was even told by a psychologist that I had hysteria, in the literal “your womb is inflaming your mind” sense…).

    Sadly it can be a bit tricky to get a proper thyroid diagnosis because most doctors just want to do only the most basic lab work and only go by the lab’s “normal” range, which has been proven to be wildly inaccurate. If you have or can find a doctor willing to take your problems seriously, make sure they run a full thyroid panel not just a TSH. Everyone thinks of hormones as just the sex hormones, but they’re only a tiny part of a very complicated and very interwoven system.

    Obviously there are other potential causes of your symptoms as well, but I felt I should bring this one up as hypothyroidism causes no end of terrible health problems, a number of which can be very much deadly. If it hasn’t come up as a possibility and checked out in the past, it’s worth ruling out just to be safe. Best of luck.

  33. Sinclair,

    I very much agree with the likelihood of PCOS. I strongly urge you to consult a reproductive endocrinologist. A plain old endocrinologist *might* be helpful, but I am a firm believer in going to the right MD from the get go.

    After three years of 3-4 visits/week, I jokingly consider myself a professional RE patient. I don’t speak lightly or uninformed on this subject.

    I hope this is something you can easily access. I have complete faith that a few blood draws will give you all the answers you’re searching for!

    All the best,

  34. zen says:

    I am a bit late here but I have experience with PCOS endometriosis and fibroids….sounds like fibroids to me.. Possibly intrauterine. But you know your body best. good luck Sinclair x

  35. SL says:


    I too have found a menstrual cup to be the best kind of protection. I have adenomyosis, which a type of endometriosis, in which the uterine lining grows back into the uterine muscle layer, causing pain and heavy bleeding. I had miserable PMS for many years and found relief in the ayurvedic herb Ashwaghanda. I take it morning and night every single day and it has changed despondency to just an “out of sorts” feeling. The adenomyosis was in remission for several years after my child was born, and then started to build up again. For the last four years I’ve been miserable with “flooding” periods that have resulted in hard-to-control anemia. The best thing about the cup for me – and I use a Diva cup – wasn’t the ease, protection, or savings, it was the ability to tell my doctor how much I was bleeding in a way that was accurate. Our conversations went from her asking me, “How many tampons are you soaking?” to me being able to say (on my worst day), “I’ve bled more than 8 ounces in the past 10 hours.” I was scheduled for a hysterectomy last winter, but decided against it for a multitude of reasons, but mostly because I finally seem to be moving toward menopause (I’m 53)… so I’m hoping to “out run” my need for the surgery in a race to the cessation finish line.

  36. Taylor says:

    hey Sinclair, thanks for your posts as always. I know this is a bit late, but I was visiting Boulder, Colorado this weekend and spent some time with a hippie friend of mine who swears by vaginal steams….I am a bit of a skeptic and more attuned to western medicine, but talking to her was really interesting and it made me think of this post and your issues with cramps and heavy bleeding. Anyway, I thought I would share the link to her website–maybe worth trying out!

  37. gbb says:

    I’ve had the Mirena for about a year and a half and heartily recommend it. the first couple of months involved a lot of spotting and some cramping, but since then I’ve been period-free and happier for it.

  38. Tamara says:

    This post is amazing and really hit home for me. While I’m not butch by any means, I definitely struggle with my period. For the past eight months, I’ve had the worst periods of my life. I get terrible mood swings and I can’t stop cry. When you wrote, “I can’t do this anymore” I almost started crying. I had this moment every month for the past 8 months. I finally went to the doctor for a Pap smear and to talk about my period, and he wasn’t that much help! This post was way more helpful than any info he gave me. Thank you!

  39. seeley says:

    two years later…first coming across this post in ’14 introduced me to some new info, incl. about ablations. at start of ’15 i moved from bay area up to oly, wa, and also got ‘scrip before i left town for higher dose of T than i’d tried before–had done a couple rounds of minimal dosage topically after getting connected to the fremont transvision clinic in ’11, which masculinized me just slightly but not enough to stop bleeding. getting enrolled in medicaid/obamacare in washington state was much easier; i found another clinic and provider who saw me through enough hormonal transition last year to stop bleeding and pass regularly. last late summer/fall i had some surprise bleeding recur; wasn’t as consistent in t dosing for a while but then got very consistent, and still had mystery blood returning sometimes–got tested as having high enough t levels that this was a concern, then got ultrasound last winter; a tiny benign cyst found on ovary may prompt the bleeding…anyway, my provider suggested considering ablation. after jumping more hoops over months, i got the procedure two days ago, and would recommend w/caveats.
    it felt like a good decision for me b/c: i now pass enough that it’s safer for me to use men’s bathrooms, am planning to go nomad east, won’t have access to t ‘scrip refills for a while after leaving wa and would start menstruating regularly again–will need to use highway truck stops, many public restrooms in unfamiliar locales…dealing w/full blood cup dump and cleaning in them seems riskier for transphobic reaction.
    i’m not planning to try pregnancy–this procedure is more often approved for ppl who’ve already borne children; it scars and reduces the endometrial lining enough that it’s possible an egg could fertilize but likely not stay viable in that uterine environment.
    i’d rather avoid full hysterectomy surgery (ablation is an outpatient operation, one step below, but w/faster recovery), and avoid more varying of hormonal inputs like w/an iud.

    since federal expansion of medicaid coverage of trans health care was approved summer ’15, i’ve been able to get ‘scrips of Fortesta gel pump (i prefer hormone topically absorbed vs. injected) covered by my health insurance (paid out of pocket before), and also last month got insurance co. to approve covering this ablation too (think it costs about $2-3000?).
    insurance first denied as “not medically necessary”–the ob/gyn clinic i was referred to that offers ablations appealed the denial on my behalf, and when insurance actually approved it they said i had a 3 month window to schedule it in. i passed statement to nurse, who maybe submitted this in info appealing the denial, of my concerns re: bleeding as a future safety issue, as well as noting my irregular/sometimes heavy history–so think advocating this should be considered part of appropriate trans health care could be useful.

    in brief, novasure/radio frequency burn of the tissue would be preferable to the ‘thermal’ (scalding water sealed in past cervix) ablation–you generally need a uterine biopsy first (ow, not pleasant, uses forceps to secure cervix and goes past pap smear to take tissue sample at back wall of uterus) so doc can gauge condition of uterus also depth-wise: need at least 5″ (i think??) for novasure device to fit in, so that pre-op assessment helps determine which variation of procedure someone could receive. doc will also want record of an ultrasound, evaluating for any issues (gnarly cysts, etc) calling for other ops.

    ppl have a whole range of responses; i believe a majority experience positive results–i.e. up to 44% never menstruate again and the other 56% continue w/much lighter bleeding than before. some have hella pain/cramps in short term recovery, some can jog a mile per their usual routine 3 days later. i feel lucky to have been treated fairly respectfully in clinic and hospital so far (first referral was transphobically rejected by a clinic in oly that basically said ‘we serve women and aren’t prepared to do this’), and to most discomfort so far from reaction to narcotic med first night post-procedure…no significant continuation of cramps or op pain yesterday/today, though hot water bottle and heating pad were key and i still feel some meh today–have chronic pain and high pain tolerance, so guess my body’s just going ‘ok, adjusting’…
    no immersing in water, or inserting anything in canal for generally at least 7 days post-op: doc will want to schedule follow up 7-10+ days later to evaluate if cervix has properly retracted from its dilation for the procedure…if cervix still isn’t closed, anything intro.d internally could risk infection passing into uterus. when it’s ok to have an orgasm post-op, apart from any penetration, is up to the recipient’s judgment…there’s discharge from the scarred lining for at least a month, more light/watery than of fresh blood, so that requires prep w/absorbent padding.

    wanted to share notes on my experience as being basically positive, and hopefully w/long term result of reducing bleeding and its related stress. and thanks to this forum for initially informing me of ablation and other options!

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