When I was a teen, I had terrible periods.
当我处于青春期的时候，月经让我深受折磨。
I had crippling cramps, I leaked blood onto my clothes and onto my bed sheets, and I had period diarrhea.
我痛经很严重，衣服和床单上总是不小心沾上漏出的血，我也会有经期腹泻。
And I had to miss school one to two days a month,
因此在学校，我每个月总要缺勤那么一两天，
and I remember sitting on the couch with my heating pads, thinking, "What's up with this?"
我也记得抱着热水袋坐在沙发上的日子，心想：这怎么回事？
When I ate food, I didn't leak saliva from my salivary glands.
当我吃东西的时候，口水可从不会从唾液腺漏出。
When I went for a walk, I didn't leak fluid from my knees, "joint fluid."
当我走路的时候，我的关节液也不会从膝盖处漏出。
Why was menstruation so different?
为什么月经那么不一样？
I wanted answers to these questions but there was no one for me to ask.
我想要知道这些问题的答案，但没有人回答我。
My mother knew nothing about menstruation except that it was dirty and shameful and I shouldn't talk about it.
我的母亲对月经一无所知，除了“这是一个肮脏且羞耻的话题，我不应该谈论它。”
I asked girlfriends and everybody spoke in euphemisms.
我问过我的女性朋友，然而她们每个人说得都很委婉。
And finally, when I got the courage to go to the doctor and talk about my heavy periods, I was told to eat liver.
最终，当我鼓起勇气去看医生并谈论我月经过多的问题时，我被告知要多吃动物肝脏。
And when I went to the drug store to buy my menstrual products, my 48-pack of super maxi pads,
当我去药店买经期用品，48包装的超长加大卫生巾，
back in the day when they were the size of a tissue box, each pad...
那时候每片卫生巾的大小就宛如一个纸巾盒...
You know what I'm talking about. You have no idea how far absorbent technology has come.
你们知道我在说什么。根本无法想象吸收技术至今进步了多少。
I used to have to buy my menstrual products in the feminine hygiene aisle.
我曾经需要在女性卫生区的货架上寻找我要买的经期用品。
And I remember standing there, thinking, "Well, why don't I buy toilet paper in the anal hygiene aisle?"
我也记得我站在那里，想着：为什么我不用在肛门卫生区的货架上买手纸？
Like, what's up with that? Why can't we talk about periods?
究竟是为什么呢？为什么我们不能谈论月经？
And it's not about the blood, as Freud would have you say, because if it were,
正如弗洛伊德所说的那样，这和血液无关，因为如果有关的话，
there would be an ear, nose and throat surgeon up here right now, talking about the taboos of nose bleeds, right?
现在这里就会有一群耳鼻喉外科医师谈论着流鼻血的禁忌，对吧？
And it's not even about periods,
这甚至也和月经无关，
because otherwise, when we got rid of our toxic, shameful periods
不然在我们摆脱有害且令人羞耻的月经后，
when we became menopausal, we'd be elevated to a higher social status.
也就是我们绝经后，我们的社会地位会被抬高。
It's just a patriarchal society is invested in oppressing women,
这依旧只是一个压迫女性的男权社会，
and at different points in our lives, different things are used.
在我们生活的不同阶段，会有不同的东西被用来压迫我们。
And menstruation is used during what we in medicine call the reproductive years.
月经就是其中一个，被用于我们在医学上称之为生殖年龄的阶段。
It's been around since pretty much the beginning of time,
在很早之前，其实已经就是这样了，
many cultures thought that women could spoil crops or milk, or wilt flowers.
在很多文化中普遍认为女性会破坏庄稼，或是牛奶，或是使花朵凋零。
And then when religion came along, purity myths only made that worse. And medicine wasn't any help.
后来随着宗教信仰的出现，圣洁的神话只是让情况变得更糟了。医学也没什么实际帮助。
In the 1920s and '30s there was the idea that women elaborated something called a menotoxin.
在20世纪20年代至30年代，有一种说法把女性描述为某种叫月经毒素的东西。
We could wilt flowers just by walking by.
我们就算只是路过花朵旁，也能使之凋零。
And that's what happens when there's no diversity, right.
这是在多样化缺失时会发生的事，对吧？
Because there was no woman to put her hand up and go, "Well, actually, that doesn't happen."
因为那时没有女性举起手，走上前并说“你看，实际上，这并没有发生。”
And when you can't talk about what's happening to your body, how do you break these myths?
当你无法谈论你的身体正在发生什么的时候，你如何打破这些迷思？
Because you don't even need to be a doctor to say that periods aren't toxic.
你甚至不需要成为一名医生来表明“月经不是有毒的”。
If they were, why would an embryo implant in a toxic swill?
如果月经是有毒的，为什么胚胎会扎根于这样一个有毒的环境？
And if we all had this secret menotoxin, we could be laying waste to crops and spoiling milk.
如果我们所有女性都携有这种秘密毒素，我们可能会毒害庄稼，让牛奶变质。
Why would we have not used our X-Women powers to get the vote sooner?
我们为什么还没用自己X女战警的能力更快地获得更多选票？
Even now, when I tweet about period diarrhea, as one does,
甚至直至今日，和别人一样，当我发送关于经期腹泻的推文时，
I mention that it affects 28 percent of women.
我也会提及，这影响着28%的女性。
And every single time, someone approaches me and says, "I thought I was the only one."
然而每一次，都有人跑过来和我说，“我以为我是唯一的一个。”
That's how effective that culture of shame is, that women can't even share their experiences.
我们的羞耻文化就是那么的有效，以至于女性们甚至无法分享她们的经历。
So I began to think, "Well, what if everybody knew about periods like a gynecologist? Wouldn't that be great?"
所以我开始思考，“好吧，如果每个人都能像妇科医生一样对月经有所了解不是很棒吗？”
Then you would all know what I know, you'd know that menstruation is a pretty unique phenomenon among mammals.
之后你就会知道所有我知道的东西，你会知道月经是哺乳动物中相当特别的现象。
Most mammals have estrus. Humans, some primates, some bats, the elephant shrew and the spiny mouse menstruate.
大多数哺乳动物有发情期。人，有些灵长类动物，一些蝙蝠，象鼩，还有非洲刺毛鼠都有经期。
And with menstruation what happens is the brain triggers the ovary to start producing an egg.
这意味着在月经期间，大脑会触发卵巢开始产生卵子。
Estrogen is released and it starts to build up the lining of the uterus, cell upon cell, like bricks.
雌性激素也因此被释放，开始形成子宫内膜，一层又一层地堆积卵子细胞，宛如砖块那样。
And what happens if you build a brick wall too high without mortar?
但如果你的砖墙建得太高却没有足够的水泥，会发生什么？
Well, it's unstable. So what happens when you ovulate?
它会不太稳固。那么当你排卵时会发生什么呢？
You release a hormone called progesterone, which is progestational, it gets the uterus ready.
你体内会释放一种叫黄体酮的荷尔蒙，这是一种孕激素，让你的子宫做好准备。
It acts like a mortar and it holds those bricks together.
它的作用就像水泥一样，把那些砖块牢固地黏在一起。
It also causes some changes to make the lining more hospitable for implantation.
它也会改变子宫内膜的环境，使之更适宜于受精卵的植入。
If there's no pregnancy, lining comes out, there's bleeding from the blood vessels and that's the period.
如果没有怀孕，那层膜会被排出体内，同时血管也会流血，这也就是月经的形成。
And I always find this point really interesting.
我总是觉得这个很有趣。
Because with estrus, the final signaling to get the lining of the uterus ready actually comes from the embryo.
因为在发情期，让子宫内膜做好受孕准备的最终信号实际上是来自胚胎。
But with menstruation, that choice comes from the ovary.
但对于月经，是否来月经取决于卵巢。
It's as if choice is coded in to our reproductive tracts.
这个决策过程好像是被编码在我们的生殖系统中一样。
OK, so now we know why the blood is there. And it's a pretty significant amount.
好了，所以我们现在了解了为什么会出血。而且还是相对大量的血。

It's 30 to 90 milliliters of blood, which is one to three ounces, and it can be more,
30-90毫升的血量，约为1-3盎司，还可能更多，
and I know it seems like it's more a lot of the times. I know.
我知道很多时候实际看起来更多。我知道。
So why do we have so much blood? And why doesn't it just stay there till the next cycle, right?
所以我们为什么排出那么多血？为什么这些东西不呆在原地等着下一个生理周期，对吧？
Like, you didn't get pregnant, so why can't it hang around?
如果你没有怀孕，为什么那些东西不可以在我们体内随意逗留？
Well imagine if each month it got thicker and thicker and thicker,
那么，想象每个月那层膜都变厚一点，再厚一点，
right, like, imagine what tsunami period that would be.
想象一下那种血崩会是什么感觉。
We can't reabsorb it, because it's too much.
我们无法重新吸收那些东西，因为量太大了。
And it's too much because we need a thick uterine lining for a very specific reason.
量大是因为我们对厚子宫内膜的需求是出于一个非常特定的原因。
Pregnancy exerts a significant biological toll on our bodies.
怀孕对我们的身体会造成一个巨大的生物伤害。
There is maternal mortality, there is the toll of breastfeeding and there is the toll of raising a child until it is independent.
这包括产妇死亡，母乳喂养的伤亡，抚养孩子直至他们成年其中获得的伤害。
And evolution... That goes on longer for some of us than others.
还有进化...对于我们有的人持续时间还更长。
But evolution knows about risk-benefit ratio. And so evolution wants to maximize the chance of a beneficial outcome.
但进化是基于风险效益比率的。进化的目的是最大化有益结果出现的可能性。
And how do you maximize the chance of a beneficial outcome?
那你怎么最大化这一可能性呢？
You try to get the highest quality embryos.
你尝试保留最高质量的那个胚胎。
And how do you get the highest quality embryos?
那你如何尝试保留最高质量的胚胎呢？
You make them work for it. You give them an obstacle course.
你让它们为此奋斗。你给它们一个需要通过的障碍。
So over the millennia that we have evolved, it's been a little bit like an arms race in the uterus,
所以经过上千年的进化，子宫内的竞争宛如一场军备竞赛，
the lining getting thicker and thicker and thicker,
内膜变得越来越厚，
and the embryo getting more invasive until we reach this détente with the lining of the uterus that we have.
胚胎也更具侵入性，直至与子宫内膜的关系达到一个缓和状态。
So we have this thick uterine lining and now it's got to come out, and how do you stop bleeding?
所以我们有了这层厚厚的子宫内膜，它现在需要被排出体外，但是你是如何停止流血的？
Well, you stop a nose bleed by pinching it, if you cut your leg, you put pressure on it.
通常流鼻血的话，你会捏住鼻子止血，如果你划到腿了，你会加压止血。
We stop bleeding with pressure.
压力能够帮助止血。
When we menstruate, the lining of the uterus releases substances
当我们来月经的时候，子宫内膜会释放一种物质，
that are made into chemicals called prostaglandins and other inflammatory mediators.
它能够生成一种名为前列腺素的化学物质以及其它炎症介质。
And they make the uterus cramp down, they make it squeeze on those blood vessels to stop the bleeding.
它们会造成子宫向下筋挛，使子宫对血管造成压力从而起到止血作用。
They might also change blood flow to the uterus and also cause inflammation and that makes pain worse.
它们也可能会让血流向子宫，同时引发炎症，并加剧疼痛感。
And so you say, "OK, how much pressure is generated?"
你会说：“好吧，这里产生的压力有多大？”
And from studies where some incredible women have volunteered to have pressure catheters
在一些研究中，一些了不起的女性自愿使用压力导管，
put in their uterus that they wear their whole menstrual cycle
植入她们的子宫中，她们在整个月经周期都带着那个导管。
God bless them, because we wouldn't have this knowledge without, and it's very important knowledge,
感谢她们，因为没有她们，我们不会了解这个知识，而这是一个很重要的知识，
because the pressure that's generated in the uterus during menstruation is 120 millimeters of mercury.
因为在月经期间子宫内产生的压力为120毫米汞柱。
"Well what's that," you say.
你会问：“这代表什么？”
Well, it's the amount of pressure that's generated during the second stage of labor when you're pushing.
这相当于你分娩第二阶段用力时所产生的压力。
Right. Which, for those of you who haven't had an unmedicated delivery,
没错。对于在座没有进行过非药物分娩的人，
that's what it's like when the blood pressure cuff is not quite as tight as it was at the beginning,
这就好比你戴着的血压袖套不像一开始那样紧，
but it's still pretty tight, and you wish it would stop.
但依旧蛮紧，而且你希望它会停止的那种感觉。
So that kind of makes it different, right?
这情况就变得很不一样了，对吧？
If you start thinking about the pain of menstruation, we wouldn't say if someone needed to miss school
如果你开始回想经期疼痛，我们不会说，倘若一个人在学校旷课，
because they were in the second stage of labor and pushing, we wouldn't call them weak.
是因为她们处于分娩第二阶段，并且用力在生孩子，我们不会说她们是弱者。
We'd be like, "Oh my God, you made it that far," right?
而会说，“我的天，你竟然做到了！”对吧？
And we wouldn't deny pain control to women who have typical pain of labor, right?
我们不会否认那些承受典型分娩阵痛女性的忍痛能力，对吧？
So it's important for us to call this pain "typical" instead of "normal,"
用“典型”，而非“正常”来形容这种疼痛很重要，
because when we say it's normal, it's easier to dismiss.
因为当我们说这很正常，这说明疼痛很容易消失。
As opposed to saying it's typical, and we should address it.
然而说这很典型，代表我们需要解决它。
And we do have some ways to address menstrual pain.
我们确实有一些解决痛经的办法。
One way is with something called a TENS unit, which you can wear under your clothes
一个方法就是使用经皮神经电刺激（TENS）止痛仪，你可以把它贴在衣服里，
and it sends an electrical impulse to the nerves and muscles and no one really knows how it works,
它能将电流送往神经和肌肉，并且没人真正知道其中的原理，
but we think it might be the gate theory of pain, which is counterirritation.
但我们认为这个技术可能是基于闸门理论，即反刺激。
It's the same reason why, if you hurt yourself, you rub it.
同样这也是为什么如果你伤到了自己，你会搓揉疼痛处。
Vibration travels faster to your brain than pain does.
振动，相比疼痛，能够更快地被神经传导至大脑。
We also have medications called nonsteroidal anti-inflammatory medications.
我们也有药物方法，实用非甾体抗炎药物（NSAID）。
And what they do is they block the release of prostaglandins.
它们的主要作用是抑制前列腺素的合成。
They can reduce menstrual pain for 80 percent of women.
该药物可为80%的女性缓解痛经。
They also reduce the volume of blood by 30 to 40 percent and they can help with period diarrhea.
也可以减少30%-40%的出血量，同时缓解经期腹泻情况。
And we also have hormonal contraception, which gives us a thinner lining of the uterus,
我们也有荷尔蒙避孕药，让我们的子宫内膜变薄，
so there's less prostaglandins produced and with less blood, there's less need for cramping.
从而减少前列腺素的生成，并缓解出血情况，同时对痉挛的需求也变小。
Now, if those treatments fail you -- and it's important to use that word choice,
如果这些治疗方法对你都没用--这里的措辞很重要，
because we never fail the treatment, the treatment fails us.
因为我们从不会让治疗失败，而是治疗对我们没用。
If that treatment fails you, you could be amongst the people who have a resistance to nonsteroidal anti-inflammatories.
如果那些治疗方法“辜负”了你，你可能属于对NSAID具有抗药性的一批人。
We don't quite understand, but there are some complex mechanisms why those medications just don't work for some women.
我们尚未完全理解，为什么这些药物就是对某些女性无效用，这其中包含着一些很复杂的机制。
It's also possible that you could have another reason for painful periods.
也可能是因为，导致你经期疼痛的原因与上述情况都不同。
You could have a condition called endometriosis,
也可能是因为你患有子宫内膜异位症，
where the lining of the uterus is growing in the pelvic cavity, causing inflammation and scar tissue and adhesions.
即子宫内膜生成于盆腔中进而引起炎症，疤痕组织以及黏附现象。
And there may be other mechanisms we don't quite understand yet,
或许其中还有我们尚未了解的机制存在，
because it's a possibility that pain thresholds could be different due to very complex biological mechanisms.
因为这会牵涉到非常复杂的生物学机制，疼痛阈值也可能会随之不同。
But we're only going to find that out by talking about it.
但我们只有通过不断谈论它，才能发现更多。
It shouldn't be an act of feminism to know how your body works.
了解你的身体如何运作不应该是一种女权主义的行为。
It shouldn't... It shouldn't be an act of feminism to ask for help when you're suffering.
这不应该...在你身受月经折磨时寻求帮助，这不应该是一种女权主义的行为。
The era of menstrual taboos is over.
月经作为一种话题禁忌的时代已经结束了。
The only curse here is the ability to convince half the population
这里唯一的魔咒就是说服一半的人口，
that the very biological machinery that perpetuates the species, that gives everything that we have, is somehow dirty or toxic.
那个让各个物种得以在历史长河延续生命，给予我们所拥有的一切的生物系统，是肮脏的、有毒的。
And I'm not going to stand for it.
我不会去支持这个观点。
And the way we break that curse? It's knowledge. Thank you.
如何打破这一魔咒？用知识。谢谢。