The women’s health conversation we’re not having with Elizabeth Micks, Chen X. Chen, and Alison Edelman

0:00This episode is sponsored by Nature Raised Farms. Think about your last trip to the grocery store. For many of us, the freezer aisle has become a maze of choices, ingredients, and trade-offs. After a day spent making decisions, it's a relief when one can just feel easy. That's what I appreciate about Nature Raised Farms. It's built on a simple belief. Food shouldn't be complicated. Their chicken is made with simple ingredients offering poultry and great taste in one. Chicken that's really just chicken. Free from gluten, dairy, and soy. Made with no seed oils or artificial ingredients. When food is made simple, there's more room in your day for everything else.

0:43Look for Nature Raised Farms Chicken next time you're shopping and make your choice a little easier. Today's episode is sponsored by Kashi. Say hi to new Kashi Gut Health Granola, a straightforward, delicious way to fuel your gut, made with prebiotics, fiber, and cultures. My favorite flavor, blueberry almond, has perfectly crispy clusters, delicious almonds, and bursts of whole blueberries. It's an easy fit for a daily routine, whether that's for breakfast or a snack. In a world of overwhelm, it's a straightforward, delicious choice. Try new Kashi Gut Health Granola. This episode is sponsored by Kohler Smart Toilets.

1:23The objects we interact with most are often the ones we notice least. Kohler Smart Toilet challenges that assumption. What if the most overlooked space in your home could become the most considered? Their Veil Smart Toilet is a sculptural silhouette that isn't just intentional, it's a philosophy. That design changes everything. The Kohler Veil Smart Toilet is sleek, with a rounded shape that's more like architecture than just plumbing. And it goes beyond looks. The touchscreen controls and customizable cleansing features offer a level of comfort and cleanliness that exceed expectations. It's all about elevating those ordinary daily rituals into something extraordinary through thoughtful design.

2:03Kohler has been pushing these boundaries for over 150 years, mastering that balance of stunning form and high performance function. That's a long time to get it right, and it shows in every detail. Experience the difference of Kohler Smart Toilets. Find out more at Kohler.com. This is TED Health, a podcast from TED, and I'm your host, Dr. Shoshana Ungerleiter. I'm a board-certified and practicing internal medicine physician. A few years ago, I found myself in a place that I never expected to be. After learning, I carry a BRCA2 mutation and then making the decision to have my ovaries removed. I was suddenly thrown into surgical menopause at age 42, and it happened almost overnight.

2:51And what surprised me wasn't that my body was changing. I expected that. What actually surprised me was how hard it was to find good medical guidance about what I was experiencing. It actually took months, a lot of reading, a lot of conversations, and more appointments than I can even count. Menopause isn't something that I specialize in as a physician. But I quickly realized that there were very few people who really understood the nuances of the situation. And the whole time, I just kept thinking, if navigating this was difficult for me, somebody with medical training and access to specialists, what's it like for everybody else?

3:34Menopause and women's health in general remains one of the biggest blind spots in medicine. Women's health is often treated as really a niche topic. which is absurd considering that women make up about half the population. But historically, medicine has centered male physiology as the default. That has shaped everything from research studies to drug development to even the way that symptoms are recognized and diagnosed. Then there's the knowledge gap that exists outside the healthcare system. Many women move through major life transitions without getting clear information about what's happening in their own bodies.

4:14Menopause is one example, periods or another, fertility, pelvic pain, contraception, even vaginal health. These are things that affect millions of people every day, but they're still surprisingly difficult to talk about openly. Thanks to really dedicated researchers, clinicians, and patients taking ownership of these questions, that's slowly changing. And it starts with a dialogue, asking better questions and demanding better answers. To keep that dialogue going, we're sharing a little bundle of three TED-Ed lessons today, all about women's health. Our first TED-Ed lesson takes on a topic that almost everyone with a vagina experiences, but very few people talk about comfortably.

4:57Vaginal discharge. I can't tell you how many patients I've met over the years who worried that something was wrong simply because no one had ever explained what a normal vagina looks and feels like. When a topic is wrapped in silence, it's hard to know what's expected and what's worth paying attention to. And many times, the things we don't talk about often end up being the things that we understand the least. So let's get this conversation started.

5:33Our bodies are fluid factories, constantly producing, purging, and recycling secretions to fulfill all sorts of functions. Our reproductive organs are no exception. Vaginas are engaged in ongoing cycles of fluid discharge, But it can be hard to know what kind of discharge is normal when there's taboo in talking about it. And absorbency tests for menstrual products tend to show anonymous blue fluids. So, what's healthy discharge? And when is there cause for concern? Anyone who has a uterus might not experience much discharge early in life. But that changes with puberty as the ovaries start producing estrogen.

6:19This causes the vagina's inner lining, or epithelium, to thicken and cycle faster. These vaginal epithelial cells in turn start producing more glycogen, which fuels the growth of lactic acid and hydrogen peroxide-producing lactobacillus bacteria, which make the vagina more acidic. Specialized goblet cells in the cervix also begin releasing more mucus, which is enriched with immunity-boosting proteins called immunoglobulins. The acidic environment, regenerating vaginal epithelium, and cervical mucus all help protect against infections. Vaginal discharge mainly consists of cervical mucus, sloughed epithelial cells, and bacteria, which all exit the vagina with the help of gravity.

7:12Because of its acidity, discharge can sometimes bleach or leave holes in fabric. But, of course, discharge varies considerably with the monthly menstrual cycle, in sync with shifting levels of hormones like estrogen and progesterone. During the first half of the menstrual cycle, known as the follicular phase, estrogen levels gradually increase as a new egg or follicle develops. The uterus's inner lining, the endometrium, thickens, preparing for an embryo to embed should an egg get fertilized. Early in the follicular phase, cervical goblet cells produce mucus that initially may be whitish, thick, or sticky.

7:57In the days prior to ovulation, as estrogen levels further increase and the ovary prepares to release an egg, these cervical goblet cells secrete a thinner, clearer mucus, which is easier for sperm to travel through. And in the days following ovulation, progesterone levels increase, stabilizing the endometrium in preparation for pregnancy. The cervix produces thicker, cloudier, and sometimes yellowy colored mucus that now helps form a physical barrier against sperm and pathogens. If no embryo implants, estrogen and progesterone levels start falling, leading to menstruation. And over the course of around 2-7 days, the endometrium clears its excess tissues, and approximately 20-90 milliliters worth of menstrual fluid leaves the vagina.

8:51If a pregnancy does occur, it induces a surge in cervical mucus, which forms a thick, jelly-like plug that helps seal off the womb. Oftentimes, this mucus plug is discharged before labor, as the cervix softens and opens. Meanwhile, factors beyond pregnancy and the usual ebb and flow of the menstrual cycle also influence vaginal discharge. Sexual arousal can trigger fluid to make its way out of tiny blood vessels and across the wall of the vagina. This clear vaginal transidate, comprised mostly of water and proteins, helps provide lubrication along with secretions from glands at the opening of the vagina.

9:36Hormonal contraceptives can also cause differences in discharge because they tend to cause thicker cervical mucus, similar to the kind otherwise associated with the two-week phase following ovulation. Menopause also alters things. As estrogen levels decrease, the vaginal epithelium thins and proliferates at a slower rate. The cervix secretes less mucus, and the reproductive microbiome changes, resulting in less discharge overall. In addition to these shifting factors, everyone's baseline production of discharge varies greatly. What's important to note is if the baseline changes. For example, clumpy white discharge can occur when more yeast and epithelial cells are being shed than usual, and may indicate an active yeast infection.

10:29Thin, gray or white odorous discharge, on the other hand, might be a sign that certain bacteria are flourishing and making the vagina less acidic, consistent with an infection called bacterial vaginosis. Sexually transmitted infections, polyps, hormonal disorders, and other conditions can also cause differences in discharge. Because changes may be caused by a number of things, instead of self-diagnosing, it's a good idea to have a doctor weigh in in the case of any unusual bleeding, itching, pain, color, or odor. The usual variation in vaginal discharge, though, is simply a sign that the fluid factory of the body is at work and operating in good order.

11:36This TED-Ed lesson was created by Elizabeth Mix. It was directed by Juliana Arazo and narrated by Susan Zimmerman with music by Anna Roman. Next, we're talking about period pain. Menstrual cramps are so, so common, and so often minimized. For generations, period pain has been written off as just part of being a woman. And sometimes that's true, but sometimes it isn't. The challenge is knowing the difference. And that's where this next TED-Ed lesson comes in. In 1920, Hungarian physician Béla Schick ran a highly questionable experiment. He asked several women, some on their periods, to briefly hold flowers.

12:21Then, without proper controls and relying solely on his own observations, he claimed that the blooms held by the menstruating women wilted more quickly. Schick's explanation for this was not only unscientific, but also played into age-old myths about periods. He concluded that menstruating women's bodies released toxins, excreted in sweat and blood that can kill plants. While it unfortunately took decades to debunk Schick's so-called menstrual toxin hypothesis, some good did come from this work. The idea prompted investigations into the composition of menstrual fluid, eventually leading to a discovery that helped explain a very real problem, period cramps.

13:09Anywhere from 50 to 90 % of people who menstruate deal with painful abdominal or pelvic cramps during their period. A condition known as dysmenorrhea. Individual experiences can vary from mild discomfort to throbbing aches to contraction-like cramps that rival the pain of labor. Cramping can extend into the back and thighs and be accompanied by bloating, nausea, and even vomiting. And for at least 10 % of people who menstruate, these symptoms are so severe that they disrupt their day-to-day activities. Healthcare experts classify dysmenorrhea into two main types, primary and secondary dysmenorrhea.

13:52For some, menstrual cramps can be traced back to underlying conditions, including endometriosis, where tissue similar to the uterine lining grows outside the uterus. or uterine fibroids, which are non-cancerous growths. This type of pain is called secondary dysmenorrhea. While these cases can be linked to specific conditions, the origins of pain are often not well understood. For example, endometriosis can lead to scarring and inflammation, and uterine fibroids can push against other organs, both of which can cause discomfort. Yet the intensity of cramp pain doesn't always match the severity of these factors.

14:34And because the conditions are so variable, so is the treatment. Primary dysmenorrhea, on the other hand, is much more common. And it refers to painful menstrual cramps that can't be linked to an underlying condition. Despite how misguided Schick's experiments were, they set a path toward better understanding this pain. While early researchers obviously never found a menstrual toxin in the 1960s and 70s, scientists studying menstrual fluid did discover the presence of compounds called prostaglandins. And further research showed that many people with painful period cramps often had higher levels of prostaglandins in their menstrual fluid.

15:16One important role of prostaglandins is to stimulate the muscles of the uterus to contract, an essential step in shedding the uterine lining during a period. So it's thought that an excess of prostaglandins may intensify these contractions, causing pain. This process can also cause blood vessels to constrict, reducing the flow of oxygen, and releasing chemicals that activate pain receptors. Since many over-the-counter pain medications, like naproxen and ibuprofen, work by targeting prostaglandins, they can provide relief for some people with period pain. Others find hormone-based contraceptives that thin the uterine lining and in turn reduce prostaglandin production to be helpful.

16:01But while prostaglandin research was foundational and shaped the way we understand menstrual pain, in recent years, it's become evident that prostaglandins are just part of the story. Many other factors likely contribute to painful cramping. including hormones, inflammation, brain pathways, and perhaps even the microbiome. And because period pain is not fully understood, existing treatments don't always work for everyone. On top of that, talking about menstrual cramps can feel awkward or even taboo, leading many people to feel that they have to simply put up with the pain. But regularly suffering from severe cramping is far from benign.

16:44Some experts believe that repeated exposure to pain can cause the nervous system to become more sensitive, leaving a person vulnerable to developing chronic pain conditions. That's why more research is needed to untangle the complex drivers of this surprisingly common experience and to develop better treatments. That work can start with recognizing that period pain is real, and it affects hundreds of millions of people.

17:20That TED-Ed lesson was created by Chen X Chen. It was directed by Caitlin McCarthy, narrated by Alexandra Panzer, and featured music by Jem Musurluolu. Today's final TED-Ed lesson focuses on emergency contraception, a topic that has accumulated an astonishing amount of confusion over the years. The morning after pill has become one of the most debated medications in reproductive health. But despite all the attention it receives, so many people still don't know exactly how it works. And this lesson takes us into the science behind a medication that has generated far more conversation than understanding.

18:05In a 2021 study, researchers asked over 500 participants a simple question. How does the morning-after pill work? Despite these pills' widespread use, 60 % answered incorrectly. Emergency contraceptives are often misunderstood. In fact, even the phrase, the morning-after pill, is a misnomer. So how do they work? Each month, the brain and the ovaries prepare an egg to be released. First, a group of immature eggs start to grow protective, fluid-filled sacs called follicles. Around the eighth day, one of these follicles becomes mature, or dominant, and the others are reabsorbed. At this point, the brain signals the pituitary gland to produce luteinising hormone, often just called LH.

18:53A big surge in LH tells the dominant follicle to rupture, releasing the egg. This is ovulation. The egg travels to the fallopian tube where it stays for about 24 hours and it's only in this very short window that it can be fertilized by sperm. The rise of LH also stimulates the production of a hormone called progesterone. When progesterone binds at specific receptors, this also helps to signal ovulation. And high levels of progesterone are vital for preparing the uterine lining to support the possible implantation of a fertilised egg. So, where do emergency contraceptive pills come into play? Emergency contraceptives are not abortion pills.

19:37Instead, they work much earlier in the process, before pregnancy, by disrupting or delaying ovulation. There are two main types of pills. The first type, sometimes called Plan B, contains a molecule called levonorgestrel, which is structurally very similar to the body's hormone, progesterone. When taken, levonorgestrel interferes with the production of LH. Because LH doesn't surge, there's no ovulation. That said, Plan B needs to be taken before an LH surge. It can't prevent ovulation once LH starts rising. The second type of pill contains a molecule called ulipristal acetate It works by blocking progesterone from binding at receptors thereby delaying ovulation Ulipristal acetate works even if LH has already begun to rise which means it's effective in a wider window of time than Plan B Since both pills work by blocking or delaying ovulation the name, the morning after pill, can be misleading Emergency contraceptives are most effective when taken as soon as possible after sex to better the chance of disrupting ovulation before it occurs.

20:50There is no need to wait until morning. For this reason, many healthcare providers suggest having them on hand. Yet, emergency contraceptives may still prevent pregnancy even if they're taken three to five days after sex, depending on the pill. That's because sperm can live in the reproductive tract for about five days. So, for example, if a person ovulates three days after having unprotected sex, there's still a chance of pregnancy. Since it's difficult to know exactly where someone is in their cycle, it's best to take emergency contraceptives as soon as possible. But perhaps the most widely held misconception about these pills is that they can harm a person's future fertility.

21:32Decades of research have shown that this isn't the case, even if emergency contraceptives are taken multiple times. In fact, the effects of both pills are short-lived, and they don't provide continued protection. It's recommended that a person uses condoms for the remainder of their cycle, and if they have unprotected sex again, then repeat use. Of course, emergency contraceptive pills aren't fail-proof, as they neither prevent fertilisation nor the implantation of a fertilised egg. These pills are ineffective if someone has already ovulated or the LH surge has already peaked. However, there is a third option that can protect against pregnancy, even if a person has already ovulated.

22:14Many people know copper intrauterine devices, or IUDs, as a form of long-term birth control, but they also work to prevent pregnancy if inserted soon after unprotected sex. Unlike emergency contraceptive pills, a copper IUD can prevent pregnancy before and after fertilization. Copper is toxic to sperm and creates a uterine environment that makes implantation unlikely. Of course, copper IUDs might be less accessible in an emergency situation. They must be inserted by a trained healthcare provider. But on the upside, they continue to prevent pregnancy for at least 10 years while in place. Most healthcare providers agree that it's more effective, as well as less expensive, to use a regular form of birth control when trying to avoid pregnancy.

23:01But if or when you need it, emergency contraceptives are a safe option to use.

23:16This TEDx lesson was created by Alison Edelman, directed by Magali Garcia, and narrated by Bethany Cutmore-Scott, with music by Salil Bayani, Camp Studio. Before we wrap up, I keep coming back to a simple thought. every person deserves to understand their own body and that sounds obvious but history suggests otherwise for a long time women's experiences have been understudied underfunded and sometimes dismissed altogether we're beginning to correct that but there's still a long way to go and my hope is that the next generation grows up in a world where talking about periods menopause fertility pelvic pain, contraception, or vaginal health, feels as normal as talking about cholesterol or blood pressure.

24:04Because understanding your body is about more than information. It's about feeling equipped to make decisions. And it's about recognizing when something isn't right. It's about having language for experiences that can otherwise feel confusing or isolating. And maybe, most importantly, it's about trusting yourself. I've learned that when people understand what's happening in their bodies, they tend to carry a little less fear, a little less shame, a little more confidence in asking questions and seeking care. And the more we talk openly and learn openly and teach openly, the less alone people have to feel.

24:44And that's it for today's episode. Thank you so much for listening. TED Health is a podcast from TED. and I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah DeGrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne high lash.

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