In Our Control (23 page)

During the egg’s journey, and even after it has either been fertilized or died, the follicle it burst out of is still working. The ruptured follicle, now called a corpus luteum (yellow body), continues to manufacture estrogen and primarily progesterone. Progesterone functions both to protect a potential pregnancy and to let the body know not to produce any more eggs. It also raises the body temperature, which remains high until menstruation, and if you’re controlling pregnancy with the fertility awareness method (which we’ll talk more about soon), it lets you know that ovulation has occurred.

If fertilization and implantation don’t happen, the arteries in the lining close off, preventing blood flow to its surface. The blood in the lining pools and gathers and eventually bursts forth, carrying the endometrial lining with it, and a woman gets her period. This generally occurs around fourteen days after a woman has ovulated.

The first thing you will notice about this description—something most women know from their own experience—is that the menstrual cycle is complex. It’s a complicated, multifarious, and repeating process that affects how women feel every day of the month, not simply the days when we are bleeding. This is important for many reasons, but chief among them is that if a woman chooses to chemically alter her hormonal cycles, she is making the decision to change the way her body works on a daily basis.

Many girls are happy to get their first period, but feelings about the process change within a year or two. The novelty wanes when women realize they are stuck with monthly bleeding for the next four-odd decades. This transition from feeling pretty good to less positive about menstruation doesn’t happen just on the basis of how our bodies change. From the very moment we learn that we will menstruate, different cultural voices are vying for our attentions, subtly shaping the way we see the experience. Without a doubt, the work of second-wave feminism has improved the social conversation around menstrual issues, but even educated women with access to good health information have a surprising
lack of knowledge about how their body functions and an unwillingness to talk openly about their cycles. This silence begins with menstruation and extends into decisions about birth control and sexuality. Let’s examine the roots of our complicated relationship with menstruation.

The Messy History of Menstrual Politics

For probably as long as women have been menstruating, people have been puzzling over why it happens and what it means. As Thomas Buckley and Alma Gottlieb explain, “This apparently ordinary biological event has been subject to extraordinary symbolic elaboration in a wide variety of cultures.”
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In Western society, the ancient Greeks applied their best minds to the task of unraveling the mysteries of the female body. They had some serious limitations: first and foremost, they didn’t have access to actual human organs, since the dissection of corpses wasn’t permitted.
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Through their observation of animal organs and also the behavior of living women, the Greeks theorized that the uterus was a multicompartmental appendage with tentacles.

Even at this early point, the question of whether menstruation was healthy or destructive, either to women themselves or to the world around them, was a point of contention. Hippocrates, the legendary doctor whose work is still acknowledged through the oath recited by modern medical practitioners, believed in a system of health based around the four “humors,” chemicals in the body that he imagined must be in balance to prevent illness. To this way of thinking, menstruation was a boon because, among other benefits, it got rid of bad humors and brought the body back to equilibrium. Aristotle, born shortly after Hippocrates’s death, didn’t believe bleeding was such a good thing. He believed that if you wanted to find the biggest difference between men and women, you needed to look to their hearts. It was from here, the great thinker reasoned, that blood fermented and bodily energy emanated.
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Aristotle (and many after him) believed that semen and menstrual blood were equivalent fluids with one key difference: semen left the body with great energy, while menstrual blood flowed more passively. This happened, they argued, because women’s souls have less energy than men’s, and therefore
menstrual blood was physical evidence of women’s intellectual and spiritual inferiority. In other words, monthly bleeding was physical proof that men should be in charge.

By the era of the Roman Empire, many things had come a long way. Perceptions about periods had not. Pliny the Elder, a first-century geographer and naturalist, included his observations about menstruation in his classic thirty-seven volume work
Natural History
, in which he “describes menstrual blood as a deadly poison, which contaminates and decomposes urine, destroys the fertility of seeds, kills insects, withers crops, kills flower, rots fruit and blunts knives.”
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The idea that bleeding women could damage food sources has a certain cross-cultural currency, occurring in other incarnations throughout history and even to the present day.

Following the teachings of Hippocrates, the second-century Roman physician Galen believed that menstruation had a therapeutic effect. He reasoned that if bleeding could alleviate discomfort for women, perhaps it could do the same thing for men. In this way of seeing the world, women had a built-in mechanism for getting rid of “bad blood,” but men needed some help from the lancet. Galen’s work became the basis for centuries of bleeding to cure everything from the flu to bad moods. This approach was both negative and positive in the way it imagined menstruation: the blood itself was unhealthy to the body, but on the other hand, it was fortunate that it found a way out.

The ideas forged by classical civilization about men and women’s bodies served as a base for medieval knowledge. The early fourteenth-century tract
The Secrets of Women (Secreta Mulierum)
perpetuated many folk beliefs, such as the likelihood that menstruating women could ruin mirrors, and built new metaphors to explain women’s supposed dirtiness at “that time of month”: “The uterus in women is like a toilet that stands in the middle of town and to which people go to defecate, just like all residues of the blood from all over the woman’s body go to the uterus and are cleaned there.”
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Other problematic images of bleeding equated it with “disease,” “cancer,” and “venomous snakes.”
⁶
Bettina Bildhauer argues that images of pollution, pathology, and uncontrollability were coupled with notions of secrecy to reinforce a certain set of gender relationships: simply put, menstruation was used as a primary means of keeping women in their place. The theme of locating gender difference, which emerged in
both classical and medieval ideas about bleeding, continued through the centuries and is still with us today. It began with ideas about blood, and eventually shifted to notions about the uterus and later ovaries. Today it is alive and well in beliefs about hormones, mood, and health.

In the seventeenth and eighteenth centuries, ideas about bleeding were changing. Michael Stolberg explains that by 1600, the “ ‘pathological’ view of menstruation was a minority position amongst learned physicians.”
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Doctors and women continued to believe that the female body was full of toxins and poisons best eliminated by periods, but a competing approach, the “plethora” model, was gaining popularity. According to this viewpoint, it wasn’t that women had too many bad substances in their bodies—it was that they had too many good ones. An excess of healthy blood had no less need for evacuation than a glut of toxic blood. The “iatrochemical” model rerationalized and essentially repackaged older ideas about bodily impurities and bleeding, again likening female genitals to “a gutter.”
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If earlier centuries had identified the problem of female bodies as residing in their fluids—poisonous blood—by the eighteenth century, doctors were beginning to believe that the real root of the trouble lay in female organs, namely, the uterus.

This cultural relocation of female weakness to the uterus famously continued through the nineteenth century and Victorian era. During this time, many trends emerged that continue to impact dialogue about women’s health today. As Julie-Marie Strange explains, the shift in focus to the body coincided with “increasing professionalisation” of a medical community that “used its empirical claims to assert that science had proven, and could even improve, the laws of nature.”
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This represented a change from earlier practitioners who based their opinions about women’s bodies on philosophical and even metaphysical considerations and served, among other things, to obfuscate the ways in which doctors were using the language of science to transmit social ideas (in this case, the mental inferiority of women and their lack of fitness for public life). One popular stream of logic went like this: the primary biological task of a female body is to carry and bear children. This requires that extra energy be directed to the reproductive system, energy that men can use for other purposes. Because of this, if a woman chooses to direct her energies to mental pursuits, she compromises her ability to perpetuate humanity and
fulfill her “duties” as a female-bodied person. Doctors saw what they perceived as “mental instability” around menstruation as evidence for this: “Menstruation exposed the vulnerability of female mental health” with characteristics such as “exalted nerve tension” and bad temper.
¹⁰
(Significantly, this moment is the genesis of modern arguments about menstrual suppression. Strange writes that medical journals into the twentieth century argued “that if women behaved as nature intended, continual pregnancy and lactation would render menstruation almost obsolete.”
¹¹
) Underlying this interpretation is a belief that women’s actions are based in their bodies and men’s in their mental capacities.

Already this was complicated formulation: doctors argued that menstruation was a sign of failed pregnancy, but also that the lack of menses (amenorrhea) was a cause (or at least a by-product) of ill health that led to insanity.
¹²
British asylums in the late nineteenth century documented patients’ menstrual irregularity and tied its normal resumption to mental recovery. Psychologist Anne E. Walker explains, “The normal functions of the uterus and ovaries were seen as the basis of ‘normal’ femininity, with abnormalities or dysfunction resulting in madness, hysteria, or physical illness.”
¹³

Change was again in the air as the century drew to a close. The idea that the uterus, as one physician wrote in 1870, was the base on which God built the rest of the female body,
¹⁴
was losing currency. By the beginning of the twentieth century many doctors had shifted their concern about female difference to the ovaries, a transition that would progress to hormones by the middle of the century. In an 1881
Lancet
article Dr. James Totherick wrote, “One might heartily wish that the word hysteria were banished from our medical language, and indeed, so far as its etymological signification is concerned, from our thoughts.”
¹⁵
(The ancient idea of hysteria has, of course, never completely gone away; for a modern example, one need look no further than a 2006
New York Times
article proclaiming “Is Hysteria Real? Brain Imaging Says Yes.”
¹⁶
) The important thing to notice here is that no matter what part of the female body is under scrutiny (menstruation, the uterus, the ovaries, or the hormones), there is always a part of women’s natural functioning that some people will point to as the place where difference—and supposed female inferiority—comes from.

As the nineteenth century melted into the twentieth, feminist activists and an increasingly educated female population created their own response to paradigms that portrayed menstruation as mentally and physically debilitating. They rejected long-held notions such as the necessity of rest during periods. Groups such as the Medical Women’s Federation rewrote menstrual language, aiming to normalize the experience, stressing activity, cleanliness, and self-control—an insistence designed to counter the idea that periods indicated women were “out of control” and needed a man to manage them. They argued that for many women, period-associated illness and disability were self-fulfilling prophecies. If young women were taught to participate in normal activities and not to see themselves as ill, they would develop good patterns that would lead to more educational and vocational opportunities. Programs of youth education were promoted, and mothers were encouraged to give their daughters “the facts” about menstruation.

As Strange points out, while this movement represented progress in many ways, it also discouraged women from telling their daughters about menstrual difficulties.
¹⁷
If they had terrible cramps, they should keep it to themselves so as not to distort their daughters’ opinions about the normalcy of bleeding. This sort of selective silence and denial of menstrual realities became a distinguishing feature of how the new woman dealt with periods. As Sharra L. Vostral notes, if you could “pass” as your non-menstruating self, then no one could tell you when you were and weren’t able to fully function.
¹⁸
If you could foster the fantasy that you didn’t bleed, then the fact that you did couldn’t be used to mark you as different or disabled. It relied on notions about hygiene, self-control, and femininity that reinforced rather than dismantled gender roles. Like nineteenth-century feminists who opposed contraception and invested in widely held beliefs about female “moral superiority” to gain political power, women insisted that ladylike silence about periods was the only way to avoid having female power limited by them.