Episode 029: Period Talk, Inclusivity and Women’s Health with Tara Costello

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Tara Costello is a UK-based writer, educator and menstrual health advocate with a passion for de-stigmatizing period talk – most recently, in her debut book, Red Moon Gang: An Inclusive Guide to Periods.

In this episode, Tara sits down with us to talk about the importance of inclusivity in period talk (and what that means), the challenges in women’s healthcare from menstruation to menopause, her own reproductive health journey and so much more. We loved this deep and vulnerable conversation and we hope you will too!

Highlights:

• Tara’s personal story and what inspired her to start writing about menstruation
• Why language around menstrual health must include all people with periods (regardless of gender) and all types of menstruation experiences
• How negative, internalized perceptions of menstruation harms people with periods
• How Tara’s own journey with PCOS taught her to become her own best health advocate – something that she encourages all menstruators to do
• The challenges of women’s healthcare in the UK
• The implications of underfunded and under-researched women’s health issues at every stage of life
• What’s next for Tara as a writer and advocate

Connect:

Website: www.redmoongang.com

Social media: @redmoongang

Bio:

Tara is a UK-based writer and educator who has been talking frankly about menstruation for more than a decade. Her debut book, Red Moon Gang: An Inclusive Guide To Periods is out now!

Transcript:

Jessica Williams 0:00
This summer, Days for Girls is on a mission to reach 50,000 Facebook followers, and we need your help. If you are already part of our digital community, you know how much we love sharing inspiring content on social media. In fact, Facebook is one of our most effective platforms for raising awareness about period poverty, menstrual equity, and our life-changing work. That's why we're aiming to bring 1200 new folks into our family by August 13! To support our efforts, all you have to do is like and follow us on Facebook and invite your friends to like us as well. Together, we have the power to grow the Days for Girls family like never before. Thank you for your help.

Welcome to the Days for Girls Podcast, a show about breaking barriers for women and girls around the world. I'm your host, Jessica Williams, Chief Communications Officer at Days for Girls International. At Days for Girls, we believe in a world where periods are never a problem. We are on a mission to shatter the stigma and limitations associated with menstruation by increasing access to sustainable period products and menstrual health education for all people with periods.

Today's episode is with Tara Costello. Tara is a writer and educator living in the United Kingdom, who has been talking frankly, and writing about menstruation for more than a decade. Her debut book, red moon gang and inclusive guide to periods is out now. In this conversation, we talked about a variety of things from menstruation to menopause, and different diagnoses that women get and the challenges in the healthcare industry as it relates to women's health. So I hope you enjoyed this conversation as much as I did. I disclose a lot of personal information that I don't normally disclose, so I hope you find some comfort, and maybe even a little inspiration in our stories. Alright, let's go on to the show!

I thought we could start out by talking about what inspired you to write the book. I know your journey in this work is really personal, because I read your book and you talk a lot about your experience with menstruation and your body. And so I was wondering if you could take us into that a little bit and tell us the inspiration for the book.

Tara Costello 2:22
Yeah, so thank you for your kind words about the book. It's really appreciated. And like you said, yeah, is a real personal journey for me. I came from a home where menstruation was always spoken about, I was really lucky to have parents that you know, enabled these discussions and sat me down and taught me for it. So I was pretty prepared for my period when it did arrive. And I kind of just didn't really pay much attention to it. From like ages of 11. Till maybe like early, late teens or toward toward became sexually active, it always was pretty much just an inconvenience for me, I always knew they were going to be heavy and painful. I remember I used to have to take time off school, because they were just so bad. And it wasn't until I became sexually active, and I started using hormonal contraception, that I really started to notice a difference in my periods. And I got to a point in my life where I didn't want to use these forms of contraception anymore. So I made the decision to come off them. And I realized, oh my god, I have no idea like what my period is supposed to be like or what to expect coming off hormonal contraception, and it really just, I don't know… it just kind of inspired something in me. It was a kind of just this fascination and passion for menstruation through that. So around the time I was blogging and writing online and having these discussions and I realized that so many people go through the same thing. And there's just so little info out there. And I basically just started talking about my experiences, trying to get my periods back to some kind of normal post-pill basically. And I found that I had a real knack for facilitating these discussions. And I, as I said, I was really passionate about this and the fact that we have no idea what to expect of our bodies and it was just mind blowing to me. And I I just sort of started researching, talking about it, talking to loads of doctors and professionals and I kind of carved out a niche writing about this stuff. And then a few years later, when I decided to close my blog, I realized I didn't want to give up my advocacy work because I was making kind of a name for myself with talking about menstruation and I realized that there was a real gap in the market for period talk that is accessible, inclusive, and also just free of shame-filled language like this. Periods don't have to be this embarrassing thing that we have to go through alone. And I just I wanted to continue these discussions, basically. And I always wanted to write a book. And yeah, the time was just right. And I thought, okay, yeah.

Jessica Williams 5:32
Well, congratulations, writing a book is not easy. And your book is packed, like full of information – it's got so many fun illustrations in there as well. So I know this took you a lot of time. I'm curious, because in your book, you talk about that. And you mentioned it just now as well, that sometimes the ways that we talk about periods can be problematic, like you said, it can be full of shame and stigma. And I'm a 40 year old woman, and honestly, never really realized all the difference until I started working at Days for Girls, all the different subtle ways that we integrate shame and stigma into our conversations about periods. So I'm wondering if you could give us some examples and and take us more into that.

Tara Costello 6:23
Yeah, so I think it's something that is learned behavior, and I think a lot of us are first introduced to periods, maybe through parents or peers at school. And unfortunately, we are taught that, you know, it's the thing you have to keep secret. And it's, you know, it's kind of gross, it's dirty, it's embarrassing, and nobody should know that you're on your period. And I think that's probably the biggest reason why so many of us grow up with this warped perception of periods. I think a lot of us also inadvertently project our own embarrassment onto people. And that's why I think it's so important to have these discussions.

Jessica Williams 7:11
Absolutely. I mean, I can think of a lot of embarrassing stories that I have, from my teenage years, especially regarding my period. And they mostly involve the reactions of others. Yeah, you know, as it related to my period, like they would see my blood and freak out, and it just created so much shame around that. And a lot of people have stories like that. Yeah, right, we all do. What is your kind of vision for girls and women regarding reducing that shame? I mean, what would you like to see instead?

Tara Costello 7:47
All right, yeah, I would like to see, you know, the conversation move beyond, you know, periods are normal, they're not dirty. I feel like we have to spend so much time on normalizing this real basic concept, that it's a natural bodily function, that it kind of hinders us sometimes. It would be great to see the discussion just accepted as a normal bodily function that happens to a number of genders, and then we can focus on the real work like, you know, making period products cheaper, making diagnosis times for conditions like endometriosis and PCOS a lot shorter, you know, funding research and just making the conversation a lot more accessible and inclusive of everyone.

Jessica Williams 8:39
Absolutely. So can we talk about that a bit. So the subtitle for your book is an inclusive guide to periods? So why is that that piece that inclusivity so important to you? And how can people be more inclusive when they discuss menstruation?

Tara Costello 8:55
Menstruation, the topic of menstruation for me, it's very catered to a very specific kind of experience. It's often a young girl or woman, who has a perfect 28 day cycle, no further complications. And, you know, things are good. But the reality is, that's not a reality for so many of us. You know, there's there's been multiple studies that show that the 28 day cycle is only I think one in three people experience it. It's not just women and girls that menstruate and I also think that being inclusive also means including the different kinds of experiences people have, as well as including people of all genders. You know, no two periods are the same. We all experience menstruation differently. And I think that's really important to highlight because so many people will look at information that's like, you have a 28 day cycle, and then they're like, oh my god, I don't have that what's wrong with me? And i think that you know, we should be equipped with information before these things happen to us, you know, there's so many things that are normal with periods that we don't know about. So for example, blood clots are totally normal, and expected, as long as they're not as large as a large coin. But some people say they've been just completely freaked out because they have no idea what this is or what's happening.

Jessica Williams 10:24
So I want to go back to something you said, because there might be some people listening and being like, Wait, what? So I know it's a controversial topic. But I'd love for you to just unpack your beliefs around it a little bit. You said that, not just women and girls menstruate and there might be some people out there that don't understand what you mean by that. So can you unpack that a little bit?

Tara Costello 10:46
Yeah, totally. So to cut a very long explanation short. Gender and sex are two different things. There are a lot of people with vaginas that are not women, essentially. And the conversation needs to include transgender men, non-binary people and intersex people, because the reality is anyone with a vagina can menstruate.

Jessica Williams 11:11
You know, one of the things that I know is also important to you, and you mentioned in the book, is that people who menstruate internalize negative perceptions of menstruation. And can we talk about that a little bit? Like, what does that mean to you? When you say people are internalizing those negative perceptions, like how does that play out in our lives?

Tara Costello 11:30
Yeah, I think there's a lot of ways that it plays out. And many of us don't realize that we've been internalizing these things. One thing that really stuck with me is whenever I had to go see a doctor, about something related to vaginal health, my mom would always be like, all make sure you check your knickers so there's not any residue or discharge. Because it would be embarrassing if they saw that even though I'm seeing the doctor who, you know, has lots of experience of many bodily functions, I assume. And it wasn't until years later that I realized how ridiculous this was. And obviously, my mom meant nothing mean by it, it was just installed in her and she passed it down to me. And I think a lot of us grow up with similar experiences. I think my periods have been such a taboo for so long,

Jessica Williams 12:26
We go by what little we're given, we're sure. And I think this plays out in all kinds of ways. And one of the things that you talk about in your book, or is kind of like this consistent theme throughout your book, is educating menstruators to advocate for themselves. So finding, you know, tracking things that are going on in their bodies, writing it down, researching it, advocating, and even in one of your chapters you talked about, like, sometimes if you're not taken seriously, or you know, your symptoms continue to go undiagnosed, it's important to seek a specialist as an example. So is that something that you were taught growing up, to advocate for your health? And to do that extra work that is required for women to get their needs met, when it comes to their health?

Tara Costello 13:20
Kind of, so my mom was always really good at making sure we made a note of when our periods started and ended so we could try and get some sort of idea of our cycles. And anytime there was an issue related to periods or not, she'd always kind of be like, make sure you have all this info to have when you go see a doctor. But it wasn't until I sought our help for periods myself that I really started to realize, oh, okay, so I have to do all this extra work just to you know, get a minute of your time, to listen. For context, I that have Polycystic Ovary Syndrome. And it was pretty much ignored and undiagnosed for years. When I actually decided to really push for a diagnosis, it took me two years to get it and it's messed up because I consider myself one of the lucky ones, in terms of length on how how long it took me to get a diagnosis. I think a lot of people don't realize the importance of this until, unfortunately, they experience it with doctors, I think.

Jessica Williams 14:34
Absolutely. I've had that experience in my own life. In fact, I'm going through it right now because I was recently diagnosed as perimenopausal, which is very early for my age, you know, and I'm, I'm struggling to get proper support. And so I'm having to go to all of these different specialists and keep track of all of this and it's exhausting, right?

Tara Costello 14:55
Yeah, totally. It's frustrating that we have to advocate so much for ourselves, and it shouldn't be this way. But I think if we can equipped people with this knowledge while they're in school, until things get better, it can maybe help people.

Jessica Williams 15:12
But I know in the UK, that healthcare system is quite different than the United States. So I'm curious what the care is like there, when it comes to women's health versus like in the United States, a lot of it's privatized. So is the care, do you find that the care is a little better… what's your experience been like?

Tara Costello 15:32
I mean, it's not as bad as it is in the U.S. in terms of, you know, you'd have to pay for everything. Like the NHS is really great, even though it's underfunded. But I think my problem with period care, in particular, is that there's no way to become a specialist in some of these conditions. So you know, how some doctors, they want to specialize in something, like they seek out a fellowship, and they have all this experience and study that specific thing they want to specialize in. There isn't really an equivalent to that for things like endometriosis, and PCOS, and fibroids. And because of that, unfortunately, we have doctors that can say they're specialists just because they've spoken to patients about these conditions, when the reality is they don't have the knowledge or the experience to treat them. In terms of my experiences, again, I think it's very tame in comparison to some of the other people I've spoken to. But I've pretty much suffered with heavy periods all my life. And I've been to see different doctors on and off about it when I've been pushed to try and find things out from either my family or my peers. And I've always kind of been told, I'll just lose some weight, and then things will work itself out, which is unfortunately, a very common experience here in the UK with people seeking help for periods. And it wasn't till later, I found a new doctor who actually did specialize in gynocological health, and had like the experience and credentials to back it up, she basically explained to me that the previous doctors did the wrong tests, and they didn't do tests at certain times. So when someone's – I finally found a doctor who knew what she was doing, the care was very good. And I was impressed. And you know, she got me in for an ultrasound pretty promptly. But I wonder if I didn't have the knowledge I had, I probably would have just accepted what previous doctors have told me and then continued to struggle all my life.

Jessica Williams 17:39
I think a lot of women do that. Unfortunately, I think you're right. And it's a really sad state of affairs. Because I think, you know, like you said, there needs to be more money devoted to research and the study of women's health and a lot of these conditions that are idiopathic, which is like, we don't really know what causes them.

Tara Costello 18:03
Yeah, especially for conditions where there's no cure. And we have doctors out here saying that, you know, just have a baby or just have a hysterectomy. And then it will get rid of your endometriosis. And it's like one, those are huge life changing decisions and two, it's not accurate. You know, many people have had endometriosis come back after hysterectomy. And so it is kind of dire, the level of care we've got for those chronic conditions that really impact your daily life. But in terms of general period health, I think it's slowly getting better. But again, I think it's really hard to find a doctor and stay with them. So the doctor that diagnosed me as PCOS, she's the best doctor I've seen in my entire life. And she's unfortunately moved away and I have no way of like, talking to her anymore.

Jessica Williams 19:00
That's heartbreaking.

Tara Costello 19:01
I know. I was like, legit really upset. I had like a grieving period because she was just such a fantastic doctor. And really, I've just felt so indebted to her for helping me get diagnosed. And also, it sucks that the onus is on the patient to seek specialist care when really we should be having these referrals, if doctors aren't comfortable enough or confident enough, or if they don't have what it takes to diagnose, we shouldn't just be sending people away. We should be giving them the referrals. And I don't think that happens enough.

Jessica Williams 19:35
I used to work in an OB/GYN clinic. Many years ago, I worked there for as a receptionist for like, three years while I was in graduate school. And I remember this woman coming in and she said I feel like I'm in labor. And the doctor said, you're not in labor. Like you're on birth control. You're on the IUD, go home, take some Advil, you'll be fine. You're just having period cramps, and she was on her way out the door and she passed out in the hallway. And I called 911. And she had an ectopic pregnancy that had, like, was bleeding internally and had to have emergency surgery. You know, but the doctor did not take her seriously when she was like, I feel like I'm in labor. Like this, I've had children before, this feels like labor, something's wrong. And just go home and take a couple Advil and I hear that all the time. You know. It's incredibly frustrating.

Tara Costello 20:36
That is, a lot of people have to go to A&E over here for a really bad period plan. And still, even they're not taken seriously enough.

Jessica Williams 20:48
What's A&E?

Tara Costello 20:49
Oh, sorry. It's like, I guess the emergency room? Is what people call it in the States, I think?

Jessica Williams 20:55
Oh, okay. And you know, the diagnosis that you got? You said it was PCOS. Is that right?

Tara Costello 21:01
Yeah, yeah.

Jessica Williams 21:02
What is that? I've never heard of that.

Tara Costello 21:04
Oh, so it's a condition where the, basically, the ovaries aren't doing their job properly. And the three main symptoms that people most talk about is irregular period, acne or an increase of hair, due to androgens – an excess of androgens. And basically, I never thought I would have it even though I've considered myself someone somewhat knowledgeable of this condition. Because it turns out basically, I do have it because the ultrasound showed that my ovaries were triple the size they should be. And basically, because we focus so heavily on these three main symptoms, I think loads of people don't know they have it, because I only had – they say they diagnose you if you have at least two or three, and I had one of three. So that's why I it took me so long to get diagnosis. But basically, it is a hormone disorder, your ovaries aren't able to – basically it's like a buildup of follicles and they don't release so you don't ovulate. Your periods are low. It can impact lots of other things like insulin resistance, your energy levels. It's hard. I feel like it's not as intense as endometriosis. So maybe that's why it doesn't get as much coverage. But it is a very hard condition to live with. It's something that impacts me every day of my life, not just my period. And I think a lot of people are left to kind of figure things out on their own with it.

Jessica Williams 22:51
Mm hmm. I feel the same way with this perimenopausal diagnosis. I feel like it's okay, you're perimenopausal, that's why you're tired all the time. Here's some birth control. Bye bye!

Tara Costello 23:03
Yeah, when it comes to perimenopause, or menopause, there's just like…if we think the lack of support for periods is bad. It's like, next to none for those two later stages of life. I think we're only really starting to have a conversation about both those.

Jessica Williams 23:19
Yeah, I was like you, I went through a grieving period of several days where I was like waiting. It was like, I wasn't expecting to hear that at this age.

Tara Costello 23:31
Yeah, it kinda just blows your mind when you get a diagnosis on it. And you kind of sit with it for a bit and you're like, wow, okay, so my life is just gonna look different now. And then it's taken me… how I got my diagnosis, like, I think in 2019, and I guess I'm like, over two years, and I'm still figuring out how to manage things. Because there's just not that support there. And pretty much have to just try and manage yourself.

It's like, you have to become an expert in it, and constantly study and research and journal about your body. Ugh. There's just a lot.

And that's not always, you know, an accessible option to people. I feel very fortunate that I'm able to do this, and I have a lot of knowledge and passion for the topic, but it shouldn't be that way for everyone. I'm happy to do that, because this is where my interests lie. But, you know, not everyone has the time or resources or even interest to to study all this. And, you know, we should be equipping people with the information they need and the help they need.

Jessica Williams 24:36
Absolutely. Well, I love that you've done that with your book. It's a real inspiration for women to take control of their health in general, I think not just menstrual health, because you've talked about so much related to women's health. So well done on that book. And I'm curious what's next for you? You know, with the Red Moon Gang, like, is there a gang?

Tara Costello 25:00
Yeah, so alongside the book, I want an educational website. And you know, I have like a very engaged audience on Instagram too, just everyone I talk to, I just consider them part of the gang basically. Yeah, I'm just continuing with my advocacy work. I've been focusing on talking about menstrual capitalism and the current state of the market. And in terms of future things that are coming, I'm hoping that there will be a second book, I have a few ideas in the works. But yeah, I just want to continue the advocacy work, continue these really important conversations. And yeah, just continue to try and help people basically.

Jessica Williams 25:49
So if people want to connect with you learn more about you buy your book, where should they go?

Tara Costello 25:55
You can go to redmoongang.com. And you can also find me on Instagram at @redmoongang. I have a link in the bio for all these other places you can find me.

Jessica Williams 26:06
And we'll put those links in the show notes. Tara, this has just been wonderful. Thank you for your time.

Tara Costello 26:12
Thanks so much for having me.

Jessica Williams 26:16
The Days for Girls Podcast is produced by Days for Girls International. For show notes and resources mentioned in this episode, visit daysforgirls.org/podcast. If you'd like to support the work we do on the show, leave a rating or a review wherever you listen, subscribe to the show, and share our episodes on social media or with your friends. To learn more about Days for Girls and to join our global movement, please visit daysforgirls.org. Thank you for listening. See you next time.