Is Menstruation Obsolete?
Kathleen O'Grady

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 sci-fi flicks.

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 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 (UK), the Globe and Mail (Canada) and The New Yorker (US), 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 physicality.

Coutinho has the qualifications to make his study heard widely in scientific circles. He is the pioneer of Depo-Provera, the popular injectible 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, 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 their health" (xiii).

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" (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 breast-feeding (and therefore without periods), "young women were either pregnant or lactating almost continuously" (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 aged 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 renowned 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" (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 (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 sexually active, heterosexual 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 (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) 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 that the "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 (Strassmann, 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 (O'Grady, 2000). 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 ([1] 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 labor to cure. Science may be working rapidly to perfect the human body, but it is certainly not shaping it 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 it 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.


1Museum of Menstruation: See online bibliographies for the science and social history of menstruation, and extensive primary source materials on the accoutrements of menstruation. back

Works Cited

Coutinho, Elsimar.Is Menstruation Obsolete? How Suppressing Menstruation Can Help Women Who Suffer from Anemia, Endometriosis, or PMS. New York: Oxford University Press, 1999.

Houppert, Karen.The Curse: Confronting the Last Unmentionable Taboo: Menstruation. New York: Farrar, Straus and Giroux, 1999.

Hrdy, Sarah Blaffer. Mother Nature: A History of Mothers, Infants, and Natural Selection. New York: Pantheon, 1999.

Martin, Emily. The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon, 1987.

O'Grady, Kathleen. "Contraception/Birth Control." [2000]. An Encyclopedia of Women and Religion. Eds. Serinity Young, et al. New York: Simon and Schuster (forthcoming).

Profet, Margie. "Menstruation as a Defense Against Pathogens Transported By Sperm." Quarterly Review of Biology 68/3 (September 1993): 335-381.

Strassmann, Beverly I. "The Evolution of Endometrial Cycles and Menstruation." Quarterly Review of Biology 71/2 (June 1996): 181-221.

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