Sabia Wade, 31, has been using the Mirena intrauterine device (IUD) for the past three years, and, as a result, has rarely had a period or any breakthrough bleeding. But in the last couple of months, as she has navigated the stressors of the COVID-19 pandemic that has put more than 25 million Americans out of work and caused the death of over 100,000 people nationwide, she has noticed an increase in bleeding.
“This month in particular has been a mix of breakthrough bleeding—off and on,” Wade says. “Definitely more frequent than before.”
Studies have shown that an increase in stress can impact a person’s period. And now that a reported 45 percent of Americans say the current public health crisis has negatively impacted their mental health, according to a recent Kaiser Family Foundation poll, people who have periods are noticing a change in the frequency, intensity and duration of their menstrual cycles.
“The current stress of the pandemic and the shifts in my body has definitely made things rougher,” Wade, from Atlanta, Georgia, explains. “Due to my reproductive history, when I bleed I am in extreme pain. And since bleeding is happening more often now, there have been a lot of ups and downs.
“I’m trying to control my pain, my mood and the grief I’m experiencing from losing many loved ones during this pandemic,” she continues.
But for those in the LGBTQ2 community, like Wade, there are additional barriers to reproductive healthcare and period products that can make any change in menstruation even more difficult to navigate.
“I’m a cis woman partnered with a cis woman, so when she ovulates or her period begins, my hormones fluctuate and my pain inevitably increases,” Wade says. “I have the ability to know what stage my partner is in in her cycle by my cramping and bleeding, but it definitely causes some hard feelings between us—especially during this pandemic when emotions are running high already.
“It’s especially hard when we can’t separate because we’re in quarantine. There are no breaks!” she explains.
The financial ramifications of the virus and the necessary precautions states have put in place to help mitigate the spread will also disproportionately impact LGBTQ2 people’s ability to access period products—both now and in the future.
A recent study by the United Nations predicts that as many as 580 million additional people will live below the poverty line as a result of the coronavirus. When one in five LGBTQ2 Americans lived in poverty prior to the pandemic, when trans folks are more likely to live in poverty than cisgender people and when a recent study published in the journal Obstetrics & Gynecology found that 64 percent of women who live below the poverty line are unable to afford period products, it is gay, trans, non-binary and gender nonconforming people who are more likely to have difficulty accessing menstrual hygiene products. All this as the country inches closer to a recession that experts believe will be worse than the Great Depression.
But it isn’t just an inability to procure period products that people in the LGBTQ2 community may have to deal with when seeking reproductive health and period care. From being misgendered and having healthcare professionals downplay their pain, to doctors assuming patients’ sexuality and deadnaming them during virtual appointments, it’s the larger failing of the medical community to adequately treat LGBTQ2 individuals with respect (and to comprehensively address and eradicate doctors’ and other healthcare professionals’ implicit and explicit biases towards the LGBTQ2 community) that can make discussing period pain—or any other menstruation issue—tiring, triggering and a burden.
“I’ve had physicians assume my sexuality when I mention the Mirena I have, especially because I present as a cisgendered feminine woman,” Wade says. “I’ve found myself emphasizing my sexuality and reminding medical staff that Mirenas can be used for reasons outside of birth control.”
Queer women faced disproportionate barriers to adequate healthcare prior to the pandemic; barriers that are likely to be exacerbated as LGBTQ2 patients are pushed to the back of the line so other “high-risk” patients can be prioritized. Studies have shown that doctors often wrongly conclude that queer women do not need cervical cancer screenings, for example, based on the assumption that they haven’t had sex with cisgender men. LGBTQ2 individuals also have greater difficulty accessing health insurance, face discrimination and bias among healthcare providers and are at greater risk of experiencing mental health issues as the result of isolation, prejudice, stigmatization, a lack of support from family and a lack of access to healthcare and mental health care services.
For Jenna Brown, 28, living in Austin, Texas, their period has been accompanied with a level of dysphoria—a level they say hasn’t subsided during the pandemic. “Everyone who menstruates should be able to opt-out during a pandemic, I think,” they explain. “I’m joking, but [I wish this was possible].”
Along with the dysphoria, Brown says they’re experiencing an increase in cramping and are having difficulty managing their emotions, in no small part due to the increase in stress that this current moment in global history has caused. “During my luteal phase, I feel completely out of control of my emotions,” they say.
Studies have shown that a lack of exercise, a changed diet and an altered sleep routine or disturbance of a person’s circadian rhythm—our internal natural sleep/wake cycle—can all affect hormones and how we feel about our bodies. And now that one in four Americans are sheltering-in-place as a result of COVID-19, more Americans are ordering food delivery to avoid a trip to the grocery store and more are experiencing insomnia during the pandemic. It stands to reason, then, that hormonal changes are becoming increasingly more common—changes that could prove devastating for LGBTQ2 folks who are already at higher risk of body image and body dysmorphia issues.
Of course, it’s not all bad. For A. Hollingworth, 34, who resides in Tacoma, Washington, her period has remained more or less the same during the pandemic. And since she uses a menstrual cup, she hasn’t had an issue accessing period products during this time.
Sheltering-in-place has also given Hollingworth a chance to take a breath and look inward. “I have been more in touch with myself,” she says, “so it’s allowed me to slow down and tend to myself.”
But the fact remains that as the country continues to weather this storm, it will be LGBTQ2 people—along with Black and brown people—who will disproportionately bear the burden. And with an administration at the helm that has targeted trans military members, rescinded bathroom rules for trans students and wants to allow healthcare professionals to discriminate against LGBTQ2 people under the guise of “religious freedom,” the difficulties queer and trans people face in accessing period products and other reproductive healthcare are likely to not only remain, but increase.
Still, the resilience of the LGBTQ2 community is palpable in this and every other difficult moment in global history. When it comes to reproductive and period healthcare, Wade has put that resilience into practise more than once. And she’s ready to do it again.
“I’ve had two prior reproductive health surgeries: The first was to remove a large fibroid, and the second was to detach my uterus from my bowel,” Wade says. “Since then, I’ve been diagnosed with pelvic floor dysfunction, vulvodynia, chronic pelvic pain, interstitial cystitis, possible endometriosis and a few other things.
“Right now, I’d like to continue pelvic floor therapy and that’s not possible. I don’t know when it will be possible, so until then I’m trying to manage what I can on my own.”