Managing menstrual health as an adolescent (written interview with Dr. Natasha Ramsey)

Tell us your story. What inspired you to become a doctor that specializes in Adolescent
Health?

Hi yall! I’m Dr. Ramsey AKA Gorjus Doc, a board certified pediatrician in training to become an adolescent medicine specialist. That means I care for young people ages 11-25 and help them with problems related to sexual health, menstrual health, mental health, and everything in between.
The crazy part is, I never wanted to be a doctor. In fact, I always thought I would be a journalist or a writer. Growing up I spent hours reading and writing stories, and even kept a diary to document all of my adventures growing up. Little did I know, my love for writing would lead me down a path towards medicine. In high school, I found out about a teen magazine called Sex Etc.Org that was looking for teen writers, so I jumped at the opportunity. Writing for the magazine also aligned with my interest in sexual health which started back in middle school. I was lucky to have an amazing health teacher who made learning sexual health fun and inspired me to teach others. Those were also my converse sneaker and flat twists wearing days, and the era when everyone gave themselves nicknames like Shortie or Cutie all spelled incorrectly and in bubble letters. I decided on the nickname Gorjus (Gorgeous) so that I could fit in with the crowd, and it stuck ever since.
But despite the cool nickname I gave myself, adolescence was still an awkward time for me. I definitely didn't feel Gorjus, trying to navigate all the weird changes that come along with puberty, navigating womanhood, and my blackness. My experience writing for the teen health magazine gave me the tools I needed to advocate for myself and others. It empowered me and set off a lifelong commitment to sexual health and addressing the needs of adolescents, always reflecting back on my own experiences in adolescence and the importance of representation and reproductive justice.
I decided to pursue a career as a doctor and a public health professional so that I could address
the needs of adolescents from an individual and population standpoint. I have been lucky to
have the opportunity to work with adolescents both locally and abroad. In the wake of the
pandemic and heightening of racial tensions in our country, I felt paralyzed, unable to reach
teens at a time I felt they needed me most. The pandemic forced all my passions and skills: my
passion for art, dedication to sexual health, and my commitment to diversity and anti-racism to
coalesce and that’s when GorjusDoc blossomed. I started creating sexual health education
content that celebrates black and brown youth and distributing information through social media
and artwork that highlights diversity. I see this as my life’s work- becoming a global adolescent
health specialist, championing for the needs of adolescents globally.

What are common menstrual conditions or symptoms that teenage girls deal with and what are some tips that can help girls manage these symptoms?
Adolescents are particularly vulnerable because adolescence is when menstruation starts.
Unfortunately, globally, including in the United States, menstruators often do not have
information about their bodies and what to expect with their menses. Because of that, many
adolescents suffer and do not realize the symptoms they are experiencing are abnormal or
could be treated. As an adolescent doctor I see many people who have dysmenorrhea or painful
periods and cramps, heavy menstrual bleeding which is when someone is bleeding too much or
too long, irregular periods, and sometimes even no periods at all. Sometimes abnormal periods
can become so bad adolescents can become anemic and require hospitalization for a blood
transfusion! The key to managing periods is knowledge! First understanding how periods work
is useful- it’s actually complicated communication between the brain, ovaries, which lead to
changes in hormone levels and shedding of the lining of the uterus. Knowing what’s normal and
normal for you is also important. Normal periods in adolescents last less than seven days and
can be 21-45 days apart. Period tracking apps can help with learning more about your
menstrual cycle and what’s normal for you.Tracking the number of period products can also
help with identifying if an adolescent is bleeding too much. Blood getting onto clothes and
sheets, missing school because of cramping or pain, large clots, nausea and vomiting are all
symptoms that are abnormal and should be discussed with a health care provider. Your health
care provider can also prescribe medications such as NSAID’s (ibuprofen) or birth control to
help with period cramps and abnormal periods. The last tip is if you are not sure what is normal
or not, talk with your health care provider!

What are the biggest areas of concern surrounding adolescent menstrual and reproductive health today?
One of the biggest issues related to menstrual and reproductive health is inadequate sexual
health education. In many places in the US and in many countries, sexual health education is
not comprehensive and does not prepare adolescents or provide them with the tools necessary
to make healthy informed decisions. And even comprehensive sexual health curricula do not
adequately address the needs of BIPOC and LGBTQ+ youth. This lack of knowledge means
adolescents pay the price. For instance, someone may have heavy menstrual bleeding and not
alert their parents or health care provider because they did not know it was abnormal and
require hospitalization because they became anemic. Or the teen who has missed their periods
and is sexually active but didn’t realize they could be pregnant. Additionally around the world,
including in the US, there are policies and cultural practices that create barriers to adolescents
accessing period products and being able to adequately manage their periods. In fact, these
policies ultimately impact youth’s ability to attend school impacting economic and career

advancement. This period product poverty creates menstrual inequities and sends the signal to
young menstruators that their health and futures are not important.

What advice do you have for girls that are suffering from severe cramps,but are told it is
“normal” by other adults and experts?
Painful cramps are not normal. Period. Painful cramps are caused by the release of a hormone in the body called prostaglandins. During menstruation, the lining that has built up in the uterus sheds and comes out of the vagina. In order to help with getting the lining out of the uterus, the body releases prostaglandins that cause the uterus to contract and push the blood out. This contracting and cramping can be painful, but it doesn’t have to be! There are many ways to treat them and many ways to prevent them. Medications like NSAIDS work by blocking prostaglandins and therefore blocking cramping. Taking these medications BEFORE your periods starts can help to beat the cramps before they start. Another medication that helps with decreasing painful cramps is birth control. A lot of people think birth control is only for preventing pregnancy, but they are also excellent at regulating the menstrual cycle. Birth control contains hormones your body already makes and helps to regulate that communication between the brain, ovaries, and uterus. Some birth control methods decrease how much of a lining your uterus builds up and thus decrease the amount of cramping you may have. Some birth control methods can stop your periods all together! Not having a period is safe, as long as it is due to a birth control method. Not having a period and not being on a birth control method is abnormal and should be discussed with your HCP. There are also many non medicinal options including heat packs, stretches, and exercise that can help with period cramps. Severe abdominal pain can also be a sign of other serious health conditions such as endometriosis, ovarian torsion, and ectopic pregnancy and should be discussed with a HCP.

Why is it important to make sure that young girls are educated about their menstrual and
sexual health?
Lack of knowledge regarding sexual health and menstrual health has huge implications for adolescents. Without comprehensive sexual health knowledge, adolescents are at risk for unplanned pregnancy, STI’s, HIV, domestic violence, and much more. It’s not only important that young girls are educated about menstruation, but everyone.This ensures that gender diverse individuals get the information they need as well. This also ensures that young men can advocate for their peers who are menstruators and their needs. Part of the reason period poverty exists is because of stigma and lack of knowledge around periods. Discussing periods should be normalized. Having a period should be normalized. Period products should be made free and available to students in schools and other safe spaces.

How can early diagnosis of conditions such as PMS, endometriosis, PCOS, and more help
women treat their symptoms better?
I know I sound like a broken record, but knowledge is power. The more people know about their bodies, the more agency they have, the better they are able to communicate with their parents, partners, and providers. With more knowledge , people can talk with their health care providers about their symptoms, track them, identify relieving and triggering factors and even start treatments or interventions to prevent complications. For instance, many menstruators with PMS or endometriosis may miss school, interfering with their school engagement and grades. Having PCOS can increase the risk of endometrial cancer and cardiovascular disease in the long term and can cause issues with fertility. But in the short term, it can cause stigma and shame related to growing hair in unwanted places, acne, and weight gain and can even cause heavy menstrual bleeding requiring hospitalization. Understanding what is happening with their bodies gives youth the tools to identify these health issues early on and treat these symptoms and prevent long term consequences.

In your experience ,what topics about reproductive health are many adolescents uneducated about, and how do you think it could impact their overall lifestyle and health?
Our sexual health education system focuses a lot on the negative impacts of sex, and all the things that can go wrong. It rarely embraces or highlights the beauty of diversity or discusses the tough conversations or information adolescents need to advocate for themselves. How do you talk to your partner, consent, pleasure, celibacy, and things outside the spectrum of STIs and pregnancy are often left out of the discussion. In addition, many sexual health programs are not inclusive and leave out marginalized populations such as BIPOC and LGBTQ individuals. There are many gaps in what youth are learning in school, which is why many turn to social media and other outlets to get the information they need. That is why I started GorjusDoc to provide youth with sexual health education content that celebrates marginalized youth.

In the future,what advances do you hope to see being made adolescent menstrual health?
In the future, I hope to see free access to menstrual products for all in the US that are environmentally friendly and sustainable. I hope to see more discussions about equity, the overlap or race and gender and how that impacts menstrual health and access. And that those discussions lead to the development of policies that address inequities and address those gaps. I hope to see comprehensive sex ed in every school as it is the basis of achieving menstrual equity. And when I say comprehensive, I mean EVERYTHING. Communication, consent, dealing with breakups, sexting, all that! And I hope these practices become the norm across the world! That young people have access to education, clean water, toileting, menstrual products, and policies are put in place to protect and empower youth. The most vulnerable should not be deprived of access to education or opportunities because of normal and magical bodily functions. Periods should be celebrated, and not be taboo. This why I do the work I do with GorjusDoc, to spread knowledge about sexual health across the world and advocate for the
empowerment of young people everywhere.

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