Menstruation is kinda cool in my opinion. It signifies a woman’s body’s readiness to provide a safe and supportive environment for a foetus. Many women celebrate its arrival, suffer elatedly through its pains and torments and relish the flow. Its failure to arrive can be a source of delight or horror, it can indicate malnutrition or a body that is incapable of carrying a child at that time. Its colour, odour and texture can indicate issues of concern within the reproductive organs. Its sudden arrival can create panic and mortification or hilarity. It is used as an excuse for bad behaviour and for staying home with the cats and a dvd and many things besides. But today, in the 21st century, is it necessary? Modern life and medicine has brought many of us, many things. Longer and healthier life, safe working conditions and choices. When and how to have children, what career to choose, where and how to live, who to marry and in many cases, when to live or die. One of the many things that modern medicine has brought to some women is whether or not to menstruate and while the opportunity to make this choice is not always related to money (many women cannot tolerate the hormonal treatments necessary to prevent menstruation) this is still very much the choice of rich “western” women. So, now that we CAN stop menstruation, do we need to bleed?
For many women this isn’t even a possibility, the concept of preventing their periods is abominable, uncomfortable and unquestionable but putting aside a personal emotive response, does the body actually need to menstruate in order to be healthy (from a western medical perspective)? Now I’m not a doctor, and I haven’t spent hours and hours researching this topic to the last article however I am a nurse, I have studied sexual and reproductive health and rights extensively from both a medical and a social perspective and this is what I’ve discovered. Evolutionarily, women really wouldn’t menstruate all that much. Modern women have a period on average 450 times over their lifecycle but evolutionary human woman would have been bearing and subsequently breastfeeding children from early in their womanhood, shortly after menarche and would on average have a child every two years or so until fertility, age or both stopped her, resulting in far, far fewer menstrual cycles. This is before even taking nutrition and physical stress into account which could result in a reduction in lifetime menstrual cycles of well over 60%. So are our bodies, evolutionarily speaking, really designed to bleed so frequently? Do we need to bleed?
Modern technology has brought us many breakthroughs from the electric refrigerator to the iPAD and much more in between, one of the most significant modern inventions for women’s sexual and reproductive health is the Combined Oral Contraceptive Pill (COCP), or The Pill. An invention which heralded a modern sexual revolution, women’s control over their fertility and increased opportunity for sex outside of marriage irreversibly changing the dynamic between men and women and representing one small step towards gender equality. What many people don’t know however is that the inventor of The Pill was a Catholic man and while he was very proud of his invention as he saw the potential benefits to women worldwide who needed to have better control of their fertility his ethics and morality couldn’t bear the thought of a woman not suffering for the sins of Eve and so he included the sugar pills to induce a false period and ensure that women continued to suffer the, if somewhat dulled, pain of menstruation. For decades since, doctors have failed to explain properly to women that there is no medical reason for needing the sugar pills, that the period you experience is entirely false and that there is not danger in not taking those pills. Keeping in mind that it is true that some women cannot tolerate taking the pills non-stop this is an issue with the hormones and a mild incarnation of a total intolerance which would preclude a woman from using hormonal contraception methods at all. Even now, it is only over the last year or so that alternatives to the 21/7 cycle of pills are starting to be introduced some with only 2 sugar pills, some with 4 (big scoop: I happened to be comforting the business manager of one of the major pharma’s that produce the COCP at Berlin airport on the imminent death of her mother when she told me about the process it took to have that change implemented, but that’s another story). So the technology to prevent modern women from having to menstruate monthly is there and again I ask the question, do we need to bleed?
As I sit here in my nice warm living room in Australia with my fancy laptop and my South Australian beer I know that if anything awful happens to me I’ll probably be rushed to a nearby, well equipped and staffed hospital and saved. If I fall off my horse tomorrow, someone will call an ambulance, they’ll come and give me the beautiful green whistle of love and my broken bones will be expertly set by a sexy intern who’ll give me her number and meet me for a drink after work… ok so the last bit might just be my fantasy, but the rest is pretty much accurate. Many women however do not have any of these guarantees. In some contexts a particularly heavy period could literally kill a woman. If she’s already malnourished, suffering from chronic anaemia and labouring for her livelihood, a really heavy bleed has the potential to knock her down so she really can’t get back up again. A friend of mine runs an amazing website and campaign for access and information about menstruation and periods called The Crimson Campaign (best name EVER!), she does amazing work and publishes really inspirational stories of menstruation, menarche, access to menstrual products and the reality of having a period in many countries including school exclusion, inability to maintain a job, fatigue and stigma. A lot of the information on her site is about the inability of some women to access basic menstrual products and how this prevents them from full participation in their communities compounding their poverty and isolation. This is a serious problem and should be brought to the forefront of people’s minds along with food security, education and peace. But what difference would it make to a whole generation of young women if they not only were able to gain access to quality menstrual products, but just plain did not get their periods? For some women this would literally mean the difference between life a death for others it would equal an uninterrupted education, or a reliable source of income. Of course the practical problem with this scenario is endemic to all these contexts, access to appropriate, accessible, affordable health care services, but it does raise my recurring question. Do we need to bleed?
I am aware that this conjecture is likely to upset many women who value their menstruation as a part of who they are as women. I also know that in some countries where contraceptive implants have been made available women have been desperate to have them removed as they have felt intensely uncomfortable not bleeding every month. Sadly technology like contraceptive implants also bring with them new challenges such as a story I heard from a ObsGynae who used to do fly in fly out work in remote indigenous communities. Women who had contraceptive implants inserted were becoming targets for sexual assault. Perpetrators knew that they couldn’t get pregnant and as the implants are sometimes visible and always palpable, men were grabbing potential victims by the upper arm to check whether she had a “slut stick”.
I don’t have an answer for any of these concerns and they do seriously concern me but I do want to raise the question that while we do the work of destigmatising menstruation and teach young girls to be proud and excited about their menarche don’t we also have a responsibility to question its necessity? We tell women they don’t have to have sex to have children, that breast cancer can be beaten, that they can have their tubes tied and then re-connected and their faces lifted and de-wrinkled. We live in a modern world with modern solutions, isn’t it time we started seriously thinking and talking about the need to bleed?
Photo by MadamPsychosis used from Flickr under Creative Commons License