(Archives 2001) Are Periods Passé? by Kathleen O'Grady
The human body is rarely viewed holistically anymore. In an increasingly technocratic world, our bodies are portrayed as objects made up of transferable bits and pieces.
Body components can be replaced like spare parts: blood transfusions, organ transplants, prosthetic devices, artificial bones and joints, false teeth, plastic surgery, breast and penile implants. We can be disassembled and reassembled like cyborgs.
True, the objectives of many scientific creations include the alleviation of pain and suffering, the ability to make bodies fully functional and to prolong life. But there are times when we see glimpses of another less healthy motivator: the desire to perfect the human body.
Toying with reproduction is a scientific fashion at the moment. Genetic engineering, sex selection, artificial insemination, in vitro fertilization or test tube babies, and sex changes demonstrate that nothing, absolutely nothing, is immutable. Successful ovarian transplants last year raised the spectre that menopause may be retractable. Another researcher claims that it may be technically possible for men to carry a fetus to term (though I can’t seem to get my boyfriend to agree to this particular arrangement).
Elsimar M. Coutinho has added to this mind-boggling list of what we can now do to alter the human reproductive system. In his controversial new book, Is Menstruation Obsolete? (Oxford University Press), Coutinho suggests that menstruation is obsolete: an old-fashioned practice that should disappear the way of the hula-hoop.
Coutinho has the qualifications to make his views heard widely in scientific circles. He is, after all, the pioneer of Depo-Provera, the injectible contraceptive method that is often prescribed to women who are ‘non-compliant,’ i.e., prone to forgetting to take birth control pills. He is a professor of gynecology, obstetrics and human reproduction in Brazil and has published articles for more than 30 years. Yet, despite these stellar qualifications, Coutinho’s book reads less like the scientific treatise one would expect, and more like a cultural history of menstruation.
Keenly interested in the subject, I found parts of Coutinho’s book interesting. For example, he writes how the (not-so) ancient medical practice of "bleeding" a patient to health was modeled on the process of menstruation. From as far back as Hippocrates it was hypothesized that menstruation functioned to "purge women of bad humors" (evidently, Hippocrates can add the discovery of PMS to his list of ‘famous for’s’). What he meant is that menstruation is a means by which a woman’s body cleanses itself of unhealthful elements. Galen of Rome, a student of Hippocrates, took this observation to its next (seemingly logical) level. If menstruation was the natural means by which a body cured itself of ills, an ailing body could be cured through a physician-initiated bloodletting. This practice was maintained for curing a wide variety of diseases up until the early 20th century.
Coutinho reminds readers that it was excessive bloodletting by physicians that led to the death of U.S. president George Washington after a riding accident. We can then say with some certainty that menstruation killed George Washington and liven up the next dinner party.
While it seems clear in hindsight that bloodletting was not such a great medical treatment, Coutinho raised the matter with another motive in mind. Galen was incorrect from the very start with his, and Hippocrates' assessment of the beneficial properties of menstruation. Coutinho claims the contrary, as the book's preface states: "from a medical point of view, menstruation has no beneficial effects for anyone, and for many women it is harmful to their health."
According to Coutinho, menstruation is nothing more than a failure on the part of women's bodies. "When menstruation occurs, it means that the [reproductive] system failed and, for the sake of reproductive efficiency, would have to be repeated the next month, the month after that, and so on, until a successfully nested fertilized egg starts to develop." This is not far from the standard explanation of menstruation provided in health education classes: menstruation takes place when pregnancy does not.
Coutinho's simplistic-dare I say sexist-definition of menstruation underpins the major claim in his new work: namely, that regular menstruation is not natural. For whom, I wonder? Let's ask Coutinho. A monthly menses would have been unusual for early women who were regularly pregnant or breastfeeding, according to Coutinho, who states that young women were either pregnant or lactating almost continuously (a generalization that overlooks the fact that women have used birth control and abortifacients for centuries). It is only the modern woman, he concludes, who experiences menstruation as a regular, monthly occurrence. While repeated menstruation made biological sense for Stone Age humans whose survival was by no means assured, Coutinho hypothesizes, regular menstruation is simply no longer necessary in the modern world where human survival is not contingent upon prolific childbirth.
His logic is syllogistic: since menstruation exists for the purpose of prolific childbearing, and repeated childbirth is no longer necessary, then menstruation is now "obsolete." In other words, without 10 or 12 children to bear, menstruation is a waste of a woman's precious resources. It takes away her energy, lowers her iron levels and induces an array of minor health troubles-headaches, nausea, cramps, moodiness (and, I would add, mad chocolate cravings) and major health symptoms for those with chronic menstrual ailments. Regular menstruation, Coutinho concludes, should now be suppressed in reproductive-aged women.
Not surprisingly, his conclusion is unpopular among feminists in the scientific community. Margie Profet, an evolutionary biologist from the University of California made her entry into the scientific forum in 1993 by attempting to answer the same question as Coutinho, namely: "Why do women menstruate?" Profet argues from an evolutionary standpoint that there is a functional purpose for regular menstruation or it would not have endured evolution. It is not likely, Profet maintains, that our bodies are so inefficient as to permit a monthly expenditure of energy without a concurrent gain.
Profet notes that menstrual blood differs in composition from regular blood, notably because it contains immune cells called macrophages. These cells are able to combat the presence of pathogens present in the uterine cavity. It is from this observation that Profet establishes her hypotheses: "Menstruation functions to protect the uterus and oviducts from colonization by pathogens." Regular bleeding is a regular cleansing, in Profet’s estimation, keeping women’s reproductive organs free of contaminants. And from where do these pathogens come? "Sperm are vectors of disease," she says.
Naturally then, women who have sex with men require a method by which to protect themselves from potential infection. Menstruation is nothing less than a natural means through which women protect themselves from diseases carried by male sexual partners.
The enforced cessation of menses, from Profet’s perspective, would be harmful to a woman’s health. "The uterus appears to be designed to increase its bleeding if it detects infection... .Thus, artificially curtailing infection-induced uterine bleeding may be contraindicated," since it interferes with the body’s natural capacity to defend itself against pathogens.
Profet is not without her critics. Some of them are researchers who hold that menstrual blood acts as the perfect nesting ground for a host of sexually transmitted microorganisms, and more-over, that a woman is more susceptible to a wide variety of vaginal infections during menstruation. Profet accepts the fact that some microorganisms flourish during menstruation, but notes that while humans have evolved to maximize survival, so have pathogens.
The continued threat of sexually transmitted disease only highlights the fact that our evolutionary battle with bacteria is ongoing. Village Voice reporter Karen Houppert adds another dimension to the debate in her book, The Curse: The Last Unmentionable Taboo. Houppert collated health studies on toxic shock syndrome and other reproductive health problems (including infertility and endometriosis) and found that they may be directly caused by trace levels of dioxins found in most tampons and pads–the chlorine compounds that make our ‘sanitary protection’ whiter than white. It may be less that menstruation causes infectious diseases, as critics of Profet claim, than that our treatment of menstruation interferes with the natural immune process.
Beverly Strassmann, an anthropologist at the University of Michigan, challenged Profet’s hypothesis in The Quarterly Review of Biology, criticizing Profet for focusing on the physical act of expelling the endometrial lining. She asserts that the primary purpose of menstruation is actually the regrowth of the endometrium, of which menstrual blood is only a side effect. Why, she asks, do women periodically regenerate the endometrium?
Like Profet, Strassmann finds her answer in evolutionary biology. The cyclical reconstitution of the endometrium, she says, is more efficient than maintaining the health and vigor of a single entity. She argues that endometrial economy preserves the metabolic equivalent of six days worth of food for women–an important evolutionary survival advantage for those times in human history when the food supply has been scarce, and where six days can mean the difference between life and death.
While scientists continue to engage in the debate over the functional relevance of menstruation in the modern world, feminists can assess Coutinho’s proposal from another angle. For scholars like Emily Martin, author of Woman in the Body, Coutinho’s ideas simply reinforce the sexist notion that women’s bodies are aberrations from a male norm. Menstruation, in Coutinho’s understanding, is therefore a sickness that the medical establishment must work to cure. Perhaps it is not surprising that the means through which Coutinho would like menstrual suppression to be achieved is regular Depo-Provera injections, the birth control method that he himself pioneered.
I think I’ll hold on to my ‘glad rags,’ as my grandmother used to call them, and my Midol. Besides, I wouldn’t want to miss my monthly chocolate binges.
Kathleen O’Grady is the co-author of Sweet Secrets: Stories of Menstruation (Second Story Press). She is currently Visiting Scholar at the Women’s Studies Institute at the University of Ottawa.