Deconstructing the Luteal Phase
After summer comes autumn, and after ovulation comes the luteal phase. This is the phase that got me interested in deconstructing my cycle to begin with. And to make this make sense, I’m going to start with a story.
Ever since my transplant, we’ve watched my labs rise and dip. My numbers shoot up, sending everyone into a panic, only a week later to return to normal. Around the same time as my numbers would increase, I would get violently ill. Fevers, uncontrollable shivering, nausea and vomitting, extreme muscle pain. The first time it happened it lasted 24 hours, and I assumed I’d caught some kind of bug. And then it happened again, and again. Sometimes I would get extremely itchy (something associated with the accumilation of bile salts under the skin) and would scratch myself until I broke blood vessels, causing rashes and marks to appear. I would bruise, my eyes would be bloodshot, and it looked like I had just been in a fight. Every single month. I had scans and biopsies, scopes and surgeries, since my symptoms appeared the same way they would have had I been in liver rejection. But since they would always correct themselves, we all kind of just watched and waited.
During this time of intense sickness and waiting, it became a joke in my house when I got sick that my period was coming soon. One month last year, around the same time as this sick period had landed me in the hospital, I decided to track it to see if there was any rythm or reason to when I would get sick. I documented what I ate, where i went, trying to see if there were any similarities. There was only one. Every time this happened, I was in the luteal phase of my cycle.
So I did what all underbelieved, underrepresented women in healthcare do, I started reading medical journals. I talked to other patients, I read articles, I focused on western medicine and eastern traditions and drug interactions and lab values. And then I brought it to my coordinator. “I have a theory,” I said. I told him I thought my sick episodes, and the fluctuation in my numbers, directly related to where I was at in my cycle. I’d done enough research to know my theory was right, but this was the daunting moment of bringing it to my medical team. My coordinator shrugged it off, saying the commonly used medical line of when you hear hoofbeats, think horses before zebras. Since I was a liver transplant patient with known graft complications, it was most likely my graft function. A few hours later my transplant doctor called me back and the first words out of his mouth were, “Holy shit, you were right.”
Only recently have studies been done involving transplant immunosuppression medication and the female body. Why, you may ask, were these drugs not tested on females prior to being used for the general public? The answer is their hormones provided too big a variable to be properly studied. Let that sink in for a minute. In these recent studies that came out, it showed that in otherwise healthy female transplant recipients (the study my doctor sent me was kidney and liver transplant patients) can experience major enzyme fluctuation depending on the horomones at certain times of the menstrual cycle. During the luteal phase, progesterone in the body is at its peak. Tacrolimus, a commonly used immunosuppressant, increases progesterone. High levels of progesterone in the body can result in high ALP levels, the very level being monitored that rose without reason eery month before correcting itself. High ALP levels have been linked to every side effect and symptom I was experiencing.
There is a big gender bias in healthcare, and in the transplant field. Recipients of solid organ transplants are more likely cis males. While there is no rule on gender mismatching in donor transplants, it has been linked to higher success rates if a female recipient has a female deceased donor (living donor transplants are an entirely different ball game. And reminder, we are talking mainly about liver. Things cross over, of course, but my research has been done specifically in liver transplantation). Female recipients are (typically) smaller, with the added variable of the menstrual cycle and hormonal fluctuations, and there is the added socio-economic variable, in which females typically have different societal expectations than men, and if these factors aren’t addressed they can be a hinderance in recieving adequate transplant care. There are some factors that prove better outcomes in women than men, such as adherance to a treatment plan and ability to seek supports and trauma healing work post surgery, but again it comes down to a there is no one size fits all across the board. And yet we treat it like it is. Women are vastly underrepresented in transplant healthcare as a whole.
So linking it back to the menstrual cycle, we’ve already established hormonal factors create a lack of testing of immunosuppression in females, and prove to be one factor in post transplant complications. The luteal phase is also, typically, a time for completion, focus, winding down. If we experience PMS, it’s also during this time pre-bleed, as our hormones undergo a major shift if conception and pregnancy does not take place. It’s creative energy lends itself to the archetype of the sorceress, the medicine woman or the queen. There is need to go inward, to recieve rather than give, to tap into that sensual energy. I used to think this phase was go go go until bleeding actually starts, and then its supposed to be a hard stop and to rest, or a forced rest due to PMS symptoms. Which is actually a very patriarchal, capitalistic, male way of looking at it (see where I’m going here?) The way of the womb isn’t masculine, it’s feminine. Our menstrual cycles mimic the moon cycles mimic the earth cycles, and it’s all cyclical rather than the male, more linear way of being. And yet we try to fit the female design into male domination, and are surprised when it doesn’t work. It’s because we were never meant to be that way!
It’s like a transplant protocol created for the male body being used on the female body. Of course they can make it work, but it’s going to take some squeezing and forcing and manipulating to get to the desired result. It’s pathologizing something that isn’t a pathology at all. Your menstrual cycle isn’t a pathology. You are not a pathology, and you are not broken. The problem is and always has been the broken system.
