Menstruation: The cost of being fertile

Perspective

Reema Jaiswal & Shrestha Chowdhury

Artwork by Reema Jaiswal

  The article explores ‘menstruation (aka: periods)’ from scientific and cultural perspectives. Menstruation is still considered a taboo subject to discuss. The authors shine light on the origins of misogyny due to lack of understanding of the female reproductive behaviour and also how the gain in the scientific knowledge has led to the emancipation of women.



  “The English has arrived!” [i]

  You may imagine English soldiers robed in scarlet uniforms marching on to confront Napoleon at Waterloo, but French women will always mean the “bloodshed” little differently.

  Wonder what that might be?

  “Periods have begun!” [i]

  Keeping the humour aside, “periods” alias “menstruation” has remained a taboo topic since ages. Ancient Greeks noticed a synchronisation between the menstrual cycle and the moon's waxing and waning. Hence, the term “menstruation” has a Greek word root; Menes meaning moon[ii]. The groovy Greeks[iii] certainly aced in trigonometry and democracy but they were ridiculously clueless about the female reproductive system.

  A deep seated misogyny existed in the ancient Greek societies. Aristotle, (circa 300 BC) the great philosopher thought that menstrual flow was excess blood that had not converted into a foetus. Menstrual blood was inert and useless until it encountered semen which added the form and triggered foetal growth[iv]. People further believed that women played a passive role in reproduction thereby justified the notion that women were inferior, needed to be controlled and possessed alike domesticated animals[v].

  People did not even consider the uterus as an organ. Instead, they thought the uterus was a free spirit roaming around a female's body in search of a baby. (Much like “a ghost” chasing you on Halloween night!) In order to pacify the spirit, girls were married off just at the onset of puberty. Young girls and women were kept on an intentional inadequate diet, so that their sexual impulses could be controlled and their morality upheld[vi]. It is similar to dietary restrictions imposed on Hindu widows in India, a trend widely prevalent even today. As a result, women at reproductive ages were often malnourished, anaemic, suffered miscarriages and health problems.

  Thanks to scientific knowledge, things are not the same as thought of before .Now, let's get into the actual biological basis of the topic at hand.

  A girl becomes reproductively active during puberty (a stage of incipient adulthood) when she begins to menstruate. Every month, when the level of hormone estrogen increases, one egg is released from one of the ovaries. This causes the inner lining of the uterus to thicken, in an attempt to make itself ready for receiving the egg.

  The egg from the ovary, reaches the uterus and waits there to meet a sperm and then fuses with it. If this fusion occurs, the egg gets converted into ‘zygote’ (the first cell which eventually forms into a foetus) and anchors to the uterine wall. This is, what we commonly know as, ‘pregnancy’. If the egg does not find a sperm in the uterus, and a fusion doesn’t happen, the estrogen levels decrease. Meanwhile, the egg dies. Now the levels of another hormone progesterone increases. This causes the thick inner lining of the uterus to slowly shed. The resultant discharge, which is a mix of blood, uterine tissue, and the decayed egg, is passed out through the vagina.

  Periods generally last usually for about 5 days but it can vary from 3 to 8. The entire menstrual cycle is roughly 28 days long, but it can be shorter or longer. Onset of periods for the first time is called “menarche” whereas termination of this monthly cycle is called “menopause”. The reproductively active stage of a woman extends from 12 to 45 years usually[vii a,b].

Female reproductive organs; menstrual cycle Fig 1: Structures of female reproductive organs (left); menstrual cycle (right)

  But why go through this gory mess every single month?

  The answer is simple. Menstruation is a product of biological evolution.

  Let's use a high-school level analogy; say there's an upcoming board exam. If you are smart then you would certainly finish covering up the syllabus early and undergo several mock tests to ensure that your nerves do not fail on the ultimate day. Likewise, imagine giving birth to a healthy offspring to be the board exam and menstruation as an efficient strategy to prepare your body for it.

  Elaborating further, humans are placental mammals. ‘Placenta’ is an organ temporarily formed in the uterus during pregnancy. Placenta acts as an exchange platform for nutrients, oxygen, etc., between the mother and the baby. The cells in the placenta undergo certain changes to make it suitable for providing nutrition and protection to the growing baby. As a line of defence against the aggressive growth of placental tissues the uterine wall also gets thickened. This process is called decidualization[vii c]. If the occurrence of pregnancy fails then the excess lining of the uterus is shed off. So we can think that menstruation is a byproduct of the decidualization process.

  Menstruation is also responsible for behavioural differences between males and females. Louann Brizendine, M.D, puts it beautifully- “Each hormone state—girlhood, the adolescent years, the dating years, motherhood, and menopause—acts as fertilizer for different neurological connections that are responsible for new thoughts, emotions, and interests. Because of the fluctuations that begin as early as three months old and last until after menopause, a woman's neurological reality is not as constant as a man's. His is like a mountain that is worn away imperceptibly over the millennia by glaciers, weather, and the deep tectonic movements of the earth. Hers is more like the weather itself—constantly changing and hard to predict.” [viii]

  All evolutionary processes do not always seem perfect when looked at from an individual's perspective. Menstruation is deemed unpleasant by many women. Nausea, abdominal pain, diarrhoea, general fatigue, loss of appetite - to name a few are now collectively recognised as premenstrual syndrome (PMS). Premenstrual dysphoric disorder (PMDD) is similar to PMS but more acute[ix]. Treatments are available now but the process of establishing menstrual “pain” was not at all straightforward and easy.

  The word “hysterical” meaning “frenzied or maniac” stems from “hysteria” which means uterus in Greek. Women weeping in menstrual cramps were thought to be possessed by an evil spirit. Even in Victorian times women went great lengths to prove that they were in pain. Diseases like endometriosis were taken seriously much later[x]. Ironically many books still report menstruation to be a painless process. Jen Gunter in her TED talk “Why can't we talk about our periods” says “It shouldn't be an act of feminism to ask for help when you're suffering. The era of menstrual taboos is over.” [xi]

  Myths related to menstruation are countless. It is necessary to reflect upon how their inception and prolonged persistence has affected human culture. For example in India, menstruating women are not allowed in religious premises. Durga puja is pompously celebrated to worship the power of fertility and femininity but menstruating women, quite often, voluntarily avoid the rituals. Young women are taught to identify themselves as “unholy” during periods. This superstition probably stemmed from the stench owing to poor hygiene practices. In today's world, with the availability of sanitary pads, menstrual cups etc, hygiene maintenance during menstruation is simplified for the women in the city, while the village population continues to suffer to some extent. Social awareness is lacking as much as resources.

  People have lawfully claimed the right to enter temples like Sabarimala which restricted entry of women irrespective of reproductive active ages all together for centuries[xii]. But century old practises have deeply percolated into the collective subconscious. The fight against such prejudices is difficult, especially when female family members teach young women not to openly “discuss women issues” with the “male members” in the family.

  Dr. Jyoti Sanghera, Office of the High Commissioner for Human Rights, in her opening speech at “Celebrating Womanhood”, Geneva, 2013, said “Stigma around menstruation and Menstrual Hygiene is a violation of several human rights, most importantly of the right to human dignity, but also the right to non-discrimination, equality, bodily integrity, health, privacy and the right to freedom from inhumane and degrading treatment from abuse and violence.” [xiii]

  Gladly the gap between the truth and ignorance is narrowing. The understanding of the menstrual cycle led to the birth of contraceptive pills[xiv]. It has left a tremendous impact on the feminist movement. Women have better reproductive control and enjoy sexual freedom to an extent never thought before. World Menstruation day is celebrated on May 28th every year to create awareness and to normalise the discussion about periods. Japan is one of the pioneering countries to allow menstrual leave[xv]. Museums dedicated to menstrual cultural history are already established in Western countries like the USA[xvi].

  The topic of menstruation is too vast and important to ignore. Bodily functions are a product of biological evolution but our culture is a product of our collective and conscious effort towards betterment. Menstruation isn't dirty. It is not to be ashamed of. Little acts of empathy and attentive support can empower women earnestly. Let us venture to build a world where bodies don't act as barriers to achieving dreams.

Editor's Note:

Arpita Pal, a graduate student at IISER Kolkata, from the Department of Biological Sciences, is conducting an experimental survey to estimate the level of awareness regarding menstruation among the general public. Kindly spare 5 minutes to fill this out and share it with others as well - https://forms.gle/gEc6Da1jQajKcfWu6. As a small effort to spread awareness regarding this basic biological process, she will share the results of this survey with everyone, in an analytical article.



Bibliography

  1. Flow: The Cultural Story of Menstruation by Elissa Stein and Susan Kim
  2. Flow: The Cultural Story of Menstruation by Elissa Stein and Susan Kim
  3. “The Groovy Greeks” by Terry Deary
  4. Dean-Jones, Lesley. (2007). Menstrual Bleeding According to the Hippocratics and Aristotle. Transactions of the American Philological Association (1974- ). 119. 10.2307/284268.
  5. Keuls, Eva (1985). The Reign of the Phallus: Sexual Politics in Ancient Athens. Harper & Row; First Edition.
  6. Journey of Greek food — Documentary Series

    1. Garg, S., & Anand, T. (2015). Menstruation related myths in India: strategies for combating it. Journal of family medicine and primary care, 4(2), 184—186.
      https://doi.org/10.4103/2249-4863.154627
    2. UCFS Health — The Menstrual Cycle
    3. Emera, D., Romero, R., & Wagner, G. (2012). The evolution of menstruation: A new model for genetic assimilation. BioEssays, 34(1), 26—35. https://doi.org/10.1002/bies.201100099
  7. The Female Brain by Louann Brizendine
  8. Office on Women's Health — Premenstrual dysphoric disorder (PMDD)
  9. Ask Me About My Uterus: A Quest to Make Doctors believe in Women’s Pain by Abby Norman
  10. Jen Gunter: Why can't we talk about periods?
  11. The Hindu — Sabarimala women entry
  12. Celebrating Womanhood
  13. The Atlantic — The Team That Invented the Birth-Control Pill
  14. Alice J. Dan PhD (1986) The law and women's bodies: The case of menstruation leave in Japan, Health Care for Women International, 7:1-2, 1-14, DOI: 10.1080/07399338609515719
  15. Smithsonian — Feminine Hygiene Products

Shrestha Chowdhury is a fifth year Integrated PhD student from the Department of Chemical Sciences at IISER KOLKATA.She is also a member of the editorial board at Cogito137.She enjoys reading books along with watching documentaries in her leisure time.

Reema Jaiswal started her scicomm journey with a masters in Science Communication from National Council of Science Museums Kolkata. She has been working in the field of museums and science centres in our country for the past 7 years. She designs hands-on science exhibits and conducts outreach programs for school students.. Also being an artist, she uses cartoons, illustrations etc for science communication and storytelling. The cover image for this article is one of her artworks inspired from the idea that bloodshed which is related to birth is sacred.

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