Illustrations by Mary Kirkpatrick
Jen Gunter is an obstetrician and gynecologist. Her latest book is Blood: The Science, Medicine, and Mythology of Menstruation, from which this essay has been adapted.
The menstrual cycle is the wheel that drives humanity.
To make human reproduction work, half the population needs to have a highly specialized biology that can be repeatedly hormonally rewired for a potential pregnancy, as well as bleed hundreds of times and each time repair itself without scar tissue. And while biologically this is an evolutionary marvel, it’s also a source of aggravation, pain and suffering for many, because retrofitting a body for a potential pregnancy and then bleeding for several days 400 or so times over a lifetime can have medical consequences. At times, it can be a faulty system, but individual discomfort or injury isn’t evolution’s concern, and in fact, evolution’s motto might be best summed up as “good enough.”
Unfortunately, instead of a world where those who bear the physical burdens of reproduction, whether they reproduce or not, have equal footing, we have the opposite. The ancient Greeks, the originators of Western medicine, labelled the female body as inferior, and the act of menstruation has been viewed as proof that women have troublesome physiology and are by nature dirty and toxic. Many religions and cultures have long carried that same torch based on the erroneous belief of impurity and the idea that menstrual blood is filthy and contains actual toxins that poison the body (and especially men, if they were to touch it). Women have been banned from places of worship, from preparing food, from having sex and even from their own homes based on the supposed polluting powers of menstrual blood. And lest we think that was the medicine of yore, there was more than one letter published in 1974 in The Lancet, a leading medical journal, hypothesizing that there might be sound medical beliefs to support the notion that menstrual blood was toxic and that menstruating women could wilt flowers. I know, 1974!
I just can’t get my head around the concept of believing that menstruating women could wilt plants. If this were true, it wouldn’t be a curse; it would be a weapon. After all, if they could, wouldn’t they have used that power to lay waste to entire crops, bringing kings, emperors and governments to their knees? Yet the fact that no woman has ever done this, or even used magical plant-wilting abilities to own a little land of her own, was not proof enough of its absurdity. But that is the patriarchy: Facts are irrelevant; it’s the world order that matters.
Because of this historical, pervasive shaming of menstruating bodies, we’ve found innovative ways to refer to the menstrual cycle. That time of the month, Aunt Flo, surfing the crimson tide, moon time, the curse, the visitor, my girl, Carrie, the English have landed and shark week – these are all euphemisms I’ve heard, and I marvel at the creativity and wryness and even slyness behind many of them. My personal favourites are “checking into the Red Roof Inn” (likely regional to the United States) and “there are communists in the funhouse,” which, according to Urban Dictionary, is Danish in origin. According to a 2016 survey by Clue, the period-tracking app, more than 5,000 euphemisms are used around the world for menstruation.
It’s important to acknowledge that the creativity behind these phrases was often a result of the inability to discuss menstruation openly. Much of the silencing is patriarchal – as if the very biology that drives humanity is dirty. Euphemisms are “polite” ways to get around the unseemly act of bleeding, or “women’s things,” although I love the subversiveness of a euphemism like shark week – it’s far more graphic than “menstruation” or simply saying “I’m bleeding.”
There are real consequences to not being able to speak freely about menstruation. When you can’t speak about something, it implies shame, which can be devastating. How do you ask for help when the very subject is taboo? Many people have no idea what constitutes typical bleeding and, consequently, suffer from symptoms. When the basics of the menstrual cycle aren’t taught, it is easier to be dismissed in a provider’s office and to fall victim to disinformation online and from so-called alternative medicine providers.
The taboo of menstrual bleeding is even deeply evident in how menstrual products are often labelled in public under the grating and incorrect term “feminine hygiene products.” They are not “feminine hygiene” products because needing them is not a sign of being feminine – it’s a sign that you need something to catch blood – and they’re not hygiene products because menstruating is not unhygienic.
They are menstrual products. And they’re essential. And please, to any store that sells menstrual products: If you are still labelling them “feminine hygiene,” spend the money for a new sign. Really. It will be a small cost for you, and people who menstruate will almost certainly look more favourably upon your store, which I imagine might be good for business – never mind that it’s the right thing to do.
The enduring stigma surrounding menstrual products is something to behold, and not a good something! I’m amazed that even now, in the time of COVID-19, people will keep a box of tissues on their desk and think nothing of someone walking by, grabbing one and blowing their nose. Snot is coming out onto the tissue in public. Sure, we can’t usually see it, but we know it’s there, and snot and the respiratory droplets that come with it can spread illness. Ick! Yet somehow, this behaviour is socially acceptable, while at the same time, people often feel the need to perform magic tricks to hide a pad or tampon while walking to the restroom to take care of “business.”
Without menstrual products, children, teens and adults who menstruate are forced to socially isolate during menstruation or risk going out and soaking their clothes. Period-related social isolation can affect schooling, the ability to support oneself financially, and even health. Access to menstrual products is, unfortunately, not universal, and period poverty – not being able to afford the needed menstrual products – is a real concern worldwide. In one survey, 60 per cent of respondents said they needed to budget to afford menstrual products.
The cost of menstruation is not limited to the impact of shame or the price of menstrual products. For many, the menstrual cycle causes pain and suffering and significantly affects quality of life, for example, with severe menstrual cramps, menstrual migraines or premenstrual syndrome. In addition to the suffering, there are appointments, scans, medications and surgery, as well as the ramifications of missed work and school. And then there is the impact of having symptoms repeatedly dismissed, or, for those with a caring and attentive provider, limited therapies because of the systemic underfunding of conditions that affect women. In the United States, the research budget of the National Institutes of Health (NIH) was US$41.7-billion in 2022, with US$16-million allocated for endometriosis, a condition that affects 10 per cent of women, or 5 per cent of the population. In contrast, Crohn’s disease, a painful inflammatory bowel disorder that, like endometriosis, can be devastating, affects about 0.3 per cent of people and receives US$90-million in funding. From when I entered medical school in 1986 to now, treatment options for Crohn’s have improved significantly. We have not seen similar progress with endometriosis. This isn’t about disease favourites, but it’s damning testimony about the lack of investment in many medical conditions that affect those who menstruate.
Some things have changed in my medical lifetime. For example, when I attended medical school, the idea that the human papillomavirus (HPV) caused cervical cancer was just a hypothesis, and now we can prevent cervical cancer with a vaccine against HPV. We now know so much more about so many conditions. But some things that should have changed remain sadly stagnant. Research is slower than it should be, many people still struggle to access quality care, politicians in many parts of the world are still weaponizing reproductive health for political gain, and social media provides a playground for disinformation.
For me, the answer to advocating in the doctor’s office, insisting our political leaders do better, or sifting through the misinformation is to provide a source of quality information. I think back to my own experiences. I suffered from terrible menstrual diarrhea (yes, there is no good menstrual diarrhea, but while the qualifier might seem unnecessary, if you’ve had menstrual diarrhea, you get it). I thought I was uniquely broken because no one ever discussed this, not even Judy Blume. It wasn’t until I was a medical student when we had a lecture about prostaglandins, and I learned they could cause diarrhea and were released during menstruation, that I had my light-bulb moment. I wanted to stand up and scream, “SAY WHAT NOW?” Of course period diarrhea was a thing! I raced down after the lecture to ask the professor if the two might be connected, and his answer made it clear that he hadn’t really thought about it, but yes.
I promptly negotiated my way into the OB/GYN clinic, scooped up some sample packs of oral contraceptive pills and, by the next cycle, was as close to menstrual nirvana as possible – minimal cramping and diarrhea. The next year in medical school, I learned you could take the pill every day and not have a period, and, like magic, my periods were gone – except it was courtesy of medical research and some ingenuity on my own part. Before starting the pill, I had to plan my life around my menstruation because when the diarrhea was bad, I might need a bathroom 15 times a day. Now, I could just live my life.
There are several important take-home messages here. The first is that knowledge about my body and the available medications allowed me to make an informed decision and act on it. The second is that having quality knowledge about the menstrual cycle since the age of 20, when I started medical school, meant I was essentially immune to the disinformation found everywhere, so I had nothing to unlearn. And the final one is the tenacious nature of menstrual shame. When I later found out that menstrual diarrhea affects 12 per cent of people who menstruate, I was stunned. This phenomenon has, at times, ruined my life. Once, before my hormonal-contraception era, I was lucky enough to go to New York and visit the Metropolitan Museum of Art, but I spent the entire time in the bathroom. Why did I have to wait until I was in medical school to find out that I suffered from something that was common and could be treated? Why did I have to wait so long to find out that I was not in this alone?
Even now, when I mention menstrual diarrhea in a lecture (and you bet I do: letting everyone know about this phenomenon has become one of my missions), there’s always someone who approaches me afterward to tell me they thought they were the only one. Same thing when I post on social media: I get direct messages from people who thought they were alone in this. How’s that for gaslighting? Six per cent of the world’s population will, at some point in their lives, experience menstrual diarrhea (when everyone is counted, those who menstruate and those who don’t), but it’s still something few people know about. And yet, 10 per cent of Canadians have asthma, and I’m sure every person reading this piece has heard of asthma.
One of my favourite experiences is when people who have read either of my previous books – The Vagina Bible or The Menopause Manifesto – tell me they found the information enlightening and empowering. I hear stories of how people advocated for an IUD, got physical therapy to treat pain with sex, or weren’t afraid to start vaginal estrogen because of words I wrote.
That’s why I wrote my new book, Blood – not just for diarrhea education, of course, but for all of it. Because if you have or have had a menstrual cycle, or you know someone who menstruates, or you have benefited from menstruation, you should know about it.
And let’s be real: Everyone has benefited from menstruation. Otherwise, you wouldn’t be alive to read this.