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Read some excerpts from Is
To stop or not stop menstruating: MUM site
visitors give their reasons
A Brazilian doctor opposes stopping
Review Essay by Kathleen O'Grady of the book
Is Menstruation Obsolete? How Suppressing Menstruation
Can Help Women Who Suffer from Anemia, Endometriosis, or PMS.
By Elsimar M. Coutinho, with Sheldon J. Segal.
Oxford University Press, Winter 1999; pp. 190.
$24.00/ ISBN 0-19-513021-9
In our technocratic and scientific world view the human body is rarely
viewed holistically, but understood as an object made up of transferable
bits and pieces. Body components can be exchanged or replaced like spare
parts: blood transfusions, organ transplants, prosthetic devices, artificial
bones and joints, false teeth, plastic surgery, breast and penile implants.
We can all be disassembled and reassembled like the cyborgs from our favorite
The pragmatic goals of some scientific advancements are clear: the alleviation
of pain and suffering, the ability to make all bodies fully "functional,"
and the prolongation of life. But there are times when this pragmatism gives
way to another goal; in our drive for a pain-free and healthful existence
we are also seeking a means to perfect the human body.
Some of the most radical physiological transformations that are now
possible involve sexuality and reproductive processes: genetic engineering,
sex selection, artificial insemination, in-vitro fertilization, test-tube
babies and sex changes demonstrate that nothing, absolutely nothing, is
immutable. Successful ovarian transplants conducted last year "cured"
infertility in young women and suggested to some researchers that menopause
may be retractable for senior women. In the same year, another study determined
that it is now possible for men to carry a fetus to term in their own bodies
(though I can't seem to get my husband to agree to this particular arrangement).
A recent study by Brazilian Elsimar M. Coutinho adds to this mind-boggling
list of what we can now do to alter the human reproductive system. In a
controversial book newly published by Oxford University Press, Coutinho
suggests that menstruation is an unhealthy and unnecessary process that
causes women countless health and emotional problems. Is Menstruation Obsolete?,
the title of Coutinho's new work, suggests that the most medically advanced
"treatment" for menstruation would be its total cessation in all
women of reproductive age.
Coutinho's study has been hailed a scientific success by a variety of
intellectual broadsheets and magazines (see The Guardian, Canada's Globe
and Mail and The
New Yorker, for a good sample) who have reported his research as a breakthrough
for the improvement of women's lives. But even those that agree - and this
is a controversial assessment in itself - that menstruation constitutes
women's "curse" and not her "blessing," should not cheer
too soon. What Coutinho suggests is not the eradication of what, for some,
is a monthly nuisance, but a much more radical transformation of female
Coutinho has the qualifications to make his study heard widely in scientific
circles. He is the pioneer of Depo-Provera, the popular injectable contraceptive
method that is taken bi-annually. He is a Professor of Gynecology, Obstetrics
and Human Reproduction in Brazil and has published scholarly articles in
the field 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 an interesting cultural history of menstruation.
We learn, for example, that 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 was the
first to discover PMS); that 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 cures itself of ills,
an ailing body could be cured through a physician-initiated blood-letting.
This practice was maintained for curing a wide variety of diseases up until
the early 20th century.
Since, as Coutinho tells us, it was excessive blood-letting by physicians
that caused the death of George Washington (who was treated in this age-old
manner after a riding accident) we can say with some certainty that "menstruation
killed George Washington" and liven up the next boring dinner party.
While Coutinho denounces blood-letting as a modern medical treatment,
it is plain that he does so with another motive in mind. Galen was incorrect,
he notes, from the very start, with his, and Hippocrates' assessment of
the beneficial properties of menstruation. Coutinho claims the contrary
(as Segal's preface states): "from a medical point of view, menstruation
has no beneficial effects for anyone, and for many women it is harmful to
According to Coutinho's definition, menstruation is simply the sign
of a failed process: "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" (p. 4). This is not far from
the standard definition of menstruation provided in health education classes:
menstruation takes place when pregnancy does not.
Coutinho's definition of menstruation is important since it underpins
his major claim in this new work - that regular menstruation is not "natural."
According to Coutinho, a monthly menses would have been unusual for early
women who were regularly pregnant or breastfeeding (and therefore without
periods), "young women were either pregnant or lactating almost continuously"
(p. 2). It is only the modern woman, he argues, 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 no longer necessary in the modern
world where human survival is not contingent upon prolific childbirth.
Coutinho concludes with a syllogistic logic: since menstruation exists
for the purpose of prolific childbearing, and repeated childbirth is no
longer necessary, then menstruation is now "obsolete." Without
the promise of 10 or 12 children to bear, menstruation, according to Coutinho,
is a waste of a woman's resources. It takes away her energy, lowers her
iron levels and induces an array of minor health troubles - headaches, nausea,
cramps, moodiness - and major health symptoms for those with chronic menstrual
ailments, such as endometriosis. Regular menstruation, Coutinho concludes,
is an outmoded function of our evolutionary ancestors and should now be
suppressed in all reproductive-age women.
Not all scientists, however, are so quick to dismiss the import of women's
monthly bleeding. Margie Profet - a young, maverick evolutionary biologist
from the University of California, Berkeley - made her entry into the scientific
forum in 1993 by asking a question no scientist had thought to ask since
Hippocrates and Galen: "Why do women menstruate?" Profet's findings,
painstakingly detailed in an article for the renown Quarterly Review of
Biology, come remarkably close to her scientific forbears. Profet argues
from an evolutionary standpoint that there must necessarily exist a functional
purpose for regular menstruation or it would not have endured the mutations
of our evolution; menstruation must offer some advantage for human survival
or it would not have survived itself. 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 noted at the outset that menstrual blood differs in composition
from that of regular blood, most notably by containing 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" (p. 335). 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? From men, of course: "Sperm are vectors of disease," states
Profet unhesitatingly (p. 335). Sexually active women require a method by
which to protect themselves from potential infection caused through intercourse.
Menstruation is nothing less than a sign of the ongoing war of the sexes
- the natural means through which women protect themselves from men.
The enforced cessation of menses then, from Profet's perspective, would
be harmful to a woman's health rather than beneficial - "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 her body's natural capacity
to defend itself against pathogens (Profet, p. 355).
Critics of Profet, of which there are many, argue to the contrary that
menstrual blood acts as the perfect nesting ground for a host of sexually
transmitted microorganisms, and moreover, a woman is more susceptible to
a wide variety of vaginal infections during menstruation than at any other
time in her cycle. 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 never over.
A recent book by Village Voice reporter Karen Houppert (The Curse: The
Last Unmentionable Taboo [read the MUM review])
adds another dimension to the menstruation debate. Houppert collates health
studies conducted on toxic shock syndrome and other reproductive health
problems (including infertility and endometriosis) and finds that much of
these ailments may be directly caused by even trace levels of dioxins found
in most tampons and pads - the chlorine compounds that make our "sanitary
protection" whiter than white. Given Houppert's findings, it may be
less that menstruation "causes" the onset of infectious diseases,
as critics of Profet claim, than that our "treatment" of menstruation
interferes with a natural immune process.
Beverly Strassmann, an anthropologist from the University of Michigan,
challenged Profet's hypothesis in a subsequent (1996) article from the same
journal (Quarterly Review of Biology) arguing that Profet has more in common
with her critics than one would first suppose. Profet, like Coutinho, and
most researchers of menstruation focus their attentions on the physical
act of expelling blood from the vagina. Strassmann to the contrary argues
that the primary purpose of menstruation is 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, she too finds her
answer in evolutionary biology. The cyclical reconstitution of the endometrium
is more cost-efficient than maintaining the health and vigor of a single
entity. She argues, "edometrial 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 (Strassmann, p. 181).
While scientists continue to engage in the debate over the functional
attributes of menstruation and their value in the modern world, feminist
critics can assess Coutinho's proposal from other angles. Firstly, there
are questions concerning the accuracy of Coutinho's perpetually pregnant
ancient woman. We have little evidence to pronounce conclusively that women
rarely menstruated in the past. Rather, we have ample evidence to suppose
that women were regularly practicing birth control methods (and hence, menstruating)
in countless cultures. Menstrual rituals and ceremonies, as well as menstrual
accoutrements (early versions of pads and tampons) are also detailed by
multiple historical documents from cultures across the globe (http://www.mum.org
www.mum.org). Even if Coutinho could prove conclusively that repeated pregnancy
existed for the ancient woman, he neglects to note that this would not describe
a woman's "natural state" (a condition imposed by nature) but
rather a social and environmental condition (as modern woman's decision
to have one or two children is socially and environmentally dictated).
For scholars like Emily Martin (author of Woman in the Body) what Coutinho's
text presents is an example of the normative paradigms that continue to
function in scientific discourse, particularly in relation to women's bodies
which are seen as aberrations from a male "norm." "Menstruation,"
in Coutinho's understanding, is "unnatural," that is, "pathological,"
a "sickness" that the medical establishment must work to cure.
Science may be working rapidly to perfect the human body, but it is certainly
not in the image of woman.
In the end it may not be so surprising to find that the means through
which Coutinho suggests that menstrual suppression can be achieved is via
regular Depo-Provera injections, the birth control method that he, himself,
pioneered. So while the media continues to herald Coutinho's discovery that
menstruation is not "natural" and is an ailment that has a ready
cure, good feminist studies of menstruation and menstrual history, of which
there are many, indicate that such a pronouncement is suspect at best. What
is required are independent assessments of Coutinho's work (from those not
likely to benefit directly from the wide-spread usage of Depo-Provera).
Ideally these studies would begin from a premise contrary to Coutinho -
that menstruation is "natural," that is has a purpose, and that
its function may not be limited to potential pregnancy. Only when we can
first assess the value of the regular processes of women's bodies can we
fully understand their role and function in the physical and emotional health
of all women.
Kathleen O'Grady is the co-author of Sweet Secrets:
Stories of Menstruation (Second Story Press, 1997). She is a Visiting
Scholar at the Institute for Women's Studies and Gender Studies at the University
of Toronto. You can reach her at email@example.com
Coutinho, Elismar (1999) Is Menstruation Obsolete? How Suppressing Menstruation
Can Help Women Who Suffer from Anemia, Endometriosis, or PMS. New York:
Oxford University Press, 1999.
Houppert, Karen (1999) The Curse: Confronting the Last Unmentionable
Taboo: Menstruation. New York: Farrar, Straus and Giroux.
Hrdy, Sarah Blaffer (1999) Mother Nature: A History of Mothers, Infants,
and Natural Selection. New York: Pantheon.
Martin, Emily (1987) The Woman in the Body: A Cultural Analysis of Reproduction.
Museum of Menstruation: http://www.mum.org www.mum.org (See online bibliographies
for the science and social history of menstruation, and extensive primary
source materials on the accoutrements of menstruation).
O'Grady, Kathleen (2000) "Contraception/Birth Control" in
Serinity Young, et al. (eds), An Encyclopedia of Women and Religion. New
York: Simon and Schuster (forthcoming).
Profet, Margie (1993) "Menstruation as a Defense Against Pathogens
Transported By Sperm," Quarterly Review of Biology 68, 3(September):
Strassman, Beverly I. (1996) "The Evolution of Endometrial Cycles
and Menstruation," Quarterly Review of Biology 71, 2(June): 181-221.
This essay originally appeared in Herizons (a Canadian feminist
magazine) in Winter 2000.
Kathleen O'Grady contributed the great bulk of the bibliography
on this site, as well as the article "Contraception
and Religion" and a large part of the discussion on religion
©2001 Harry Finley. It is illegal
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without written permission of the author. Please report suspected violations