Re-conceptualizing menstruation as a disease in need of treatment

The New York Times
http://www.nytimes.com/2007/07/17/op...pagewanted=all

July 17, 2007
Op-Ed Contributor
Final Period
By KAREN HOUPPERT

Baltimore

IN May the Food and Drug Administration approved a new birth control
pill, Lybrel. It is as effective at preventing pregnancy as the other
pills already out there (about 98 percent) but boasts one advantage:
Women who take it will never get their periods.

Lybrel is landing on pharmacy shelves this month. And now war has been
declared on menstruation.

Already the first few volleys in this battle have been exchanged. Gird
yourselves, women, for a barrage of advertising and research
highlighting the debilitating effects of periods and the joys of
menstrual suppression.

After all, periods and their mood swings are bad for family values
(who wants to have a stay-at-home mom when she's so darn cranky?), bad
for women's health (women were never meant to menstruate so much;
natural selection designed their bodies for back-to-back pregnancies
and breast-feeding), bad for the fashion industry (how can beige be
the new black if women won't wear it all month?) and bad for the
economy (everybody knows women take to their beds at the merest
whisper of "cramps," fueling the nation's employee-absentee rate).
Western civilization, it seems, hinges on our ability to wrangle our
messy cycles to the ground and stomp 'em out once and for all.

Sound absurd?

In a presentation by Lybrel's maker, Wyeth, to investors and analysts
last October, Dr. Ginger D. Constantine, the company's therapeutic
director for women's health, laid the groundwork. Citing company-
backed studies, she reported that menstruating women feel less
effective at work and take more sick days. Not only that, but they
don't exercise and they wear dark clothes more often, she said.

Suddenly, news articles are weighing the pros and cons of our monthly
cycles. And while it's great that the American news media are, for a
moment, challenging the culture of concealment that typically
surrounds the topic of menstruation, history shows that such debates
are, well, cyclical.

It seems every time women start demanding access to this or that,
there is a rash of studies "proving" that menstrual cycles render them
unsuitable. In the 1870s and 1880s, when Americans were debating the
value of higher education for women, a flurry of research asserted
that women's cycling constitutions made them unfit for sustained
mental and physical labor. Henry Maudsley, a British doctor, reflected
popular opinion - dressed up as "scientific truth" - when he observed
that menstruation doomed girls to failure in college.

Comparing boys and girls, Maudsley insisted in an article, was "not a
question of two bodies and minds that are in equal physical condition,
but of one body and mind capable of sustained and regular hard labor,
and of another body and mind which one quarter of each month, during
the best years of life, is more or less sick and unfit for hard work."
Maudsley's definition of "hard work" was unclear: no one worried that
the fragile cook, servant girl or farmer's wife was being overtaxed
during any time of the month.

After women pressed ahead, attended college and excelled in the halls
of learning, the debate about menstrual cycles shifted from their
suitability for higher education to their suitability for public life
in general. When the suffragists asked to participate in the political
process, experts retaliated with more research proving that women
belonged in the domestic sphere; menstruation figured prominently
among the reasons.

Once women won the right to vote in 1920, the menstruation-equals-
inadequacy debate ebbed for a while. In fact, two decades later, new
proof arrived that women were perfectly fit and capable - even when
bleeding - and therefore should step right up and join the war effort.
When Rosie the Riveter was needed in American factories and recruits
in the Women's Army Corps, the War Department produced films telling
women of the abundance of scientific evidence proving periods are no
big deal.

A 1942 American propaganda film, "Strictly Personal," for example,
coached novice Wacs on nutrition, rest and exercise. In one scene, a
soldier lies listlessly on her cot - "I can't drill today, I feel
unwell," she whines - but a fellow Wac tells her to buck up. And a
voiceover "doctor" explains: "That's Victorian stuff. And so is that
trash about nerves and sensibility during this period." Menstruation,
he says, "is no excuse for absenteeism and self-coddling."

But then the war ended, and Rosie and the Wacs were retired - and
shown a fresh batch of studies proving that children need their moms
at home, that the workplace is potentially hazardous to women's unborn
children and that women's cycles make them less efficient workers than
men. By 1953, the affliction premenstrual syndrome turned up in the
medical literature.

Someone cynical might suggest that research highlighting
menstruation's distressing consequences bubbles to the surface every
time the public feels anxious over women's expanding roles. (Say, the
possibility that there might be a menopausal woman in the White House
- and yes, you can't win for losing here, given that our periods
allegedly drive us to distraction and their cessation does the same.)
So take today's hoopla over menstrual suppression with a grain of
ibuprofen.

While it may be good news for the 8 percent of women who have
debilitating periods (a constellation of symptoms known as
premenstrual dysphoric disorder), the rest of us may be puzzled by the
fuss. Sure, getting our periods can be a bother sometimes, but after
the traumatic moment of menarche - "How can this be happening to me
when the sixth-grade pool party is tomorrow and I have no idea where
that tampon goes?" - most of us get used to it.

It just is.

This is not a particularly profitable attitude for Wyeth, angling for
its share of the $1.7 billion annual American market for birth control
pills. It's also not terribly useful for Barr, which makes Seasonale,
an oral contraceptive that reduces women's periods to once every three
months. Nor for Watson, which sells a generic equivalent.

So what's a poor company to do? Re-conceptualize menstruation as a
disease in need of treatment.

And what's a poor menstruating woman to do? Get cranky with the
prophets who offer to cure us of menstruation; who minimize the
complex interplay of hormones and their many roles in our bodies; who
gloss over the still unknown long-term effects of menstrual
suppression; who promise that cycle-free women are better lovers,
mothers, workers.

Or just don't buy it.

Karen Houppert is the author of "The Curse: Confronting the Last
Unmentionable Taboo, Menstruation."


Copyright 2007 The New York Times Company