Introduction: The Inherent Dis/Empowering Nature of Femininity
There is no question that in today’s Westernized and industrialised society that women’s menstrual cycles and concepts of femininity have changed since pre-industrial times. Through biological, social, and cultural changes over the past hundreds of years, the average woman has gone from spending approximately 50 percent of her reproductive lifetime menstruating, to 90 percent (Derr 1982:644). Modern medical advancements such as the development and availability of the birth control pill have allowed women more freedom in terms of their sexuality and distanced them from an historic, pronatalist reproductive life. In turn, this has decreased the risk of pregnancy from unprotected intercourse. The majority of Western women have shifted away from spending most of their lives in a pregnant or amenorrheic state (Harrell 1981:803) to having one or two pregnancies amongst some 520 monthly menstrual cycles (Sapolsky 2004:134). This has come to define the modern Western cycle we see today. Yet this new, more “liberated” modern cycle is also having profound implications on sociocultural conceptions of women’s femininity and fertility in Western society, as well as significant health risks that are only just starting to be understood.
In this article I wish to explore and describe the changes in biological, social, and cultural experiences of menstruation that have occurred between the pre-industrial era and present day. Throughout time, women have sought to establish and maintain a sense of empowerment through their feminine nature and processes. Unfortunately, especially in the case of Western society, patriarchal sociocultural structures seem to perpetually iterate that the nature of femininity is inherently disempowering and inferior. It is my hope that through an awareness and understanding of these processes and changes that women will gain a sense of strength and control over their bodies and places in society from the information presented here.
Shifts in Experiences of the Female Reproductive Cycle from the Pre-Industrial to the Modern Era
Historically, up to the end of the pre-industrial era, women were having far fewer menstrual cycles in their lifetimes. This was due to a number of factors. First of all, humans in general had a shorter life expectancy, as many of the modern advancements and conveniences of modern medicine had not yet been discovered. Secondly, sexually active individuals were using less consistent and reliable forms of birth control like the rhythm method (planning intercourse around a woman’s ovulatory/fertile part of her cycle), birth spacing, plugs, or herbal concoctions (Harrell 1981:804). Moreover, girls were having later menarches, due to more physically demanding lifestyles, traditional (less varied) diets and more challenging access to food. Additionally, women were having earlier and more frequent pregnancies. Marriage typically occurred around a girl’s menarche, with pregnancy soon following. Conjointly, mothers spent more time breastfeeding their children than Western women today, typically into the first two or three years of their children’s lives (Harrell 1981:803; Sapolsky 2004:134).
As noted by Robert Sapolsky, an example of where this pre-industrial cycle can still be examined presently is among the !Kung people of the Kalahari Desert in Southern Africa. As they have throughout history, these women still experience approximately 24 menstrual cycles in their reproductive lifetimes (2004:134). This is due primarily to the frequency and length of time these women spend breast feeding their children (typically into the child’s third year). Before the woman’s child learns to walk, the child will nurse every 15 minutes, even into the night. The child is usually carried in a sling at the mother’s hip with liberal access to the breast. At night the mother and child co-sleep, allowing the child to nurse in the night often without waking the mother. As the child gets older, she or he will come nurse every hour or so. The length of time and frequency of nursing together result in a steady level of prolactin being maintained in the mother’s body. Prolactin is a peptide hormone that suppresses ovulation and menstruation through a process called lactational amenorrhea, which can last even after cessation of breastfeeding for up to 16 months (Sapolsky 2004:134; Konner & Worthman 1980:788-791; Harrell 1981:803). This, along with pregnancy, means a !Kung woman will go for approximately 5 years without a menstrual cycle for every child she bears. Combine this with later menarche and a lack of consistent contraceptive methods, and these women experience approximately 5% of the number of menstrual cycles that Western industrial women do today in North America.
As previously mentioned, Western females are experiencing earlier menarche than their traditional/pre-industrial counterparts (Morris et al 2011:394-399). Menarche is defined as the age at first menses, or first menstrual cycle. Over the past few hundred years, there has been a steady trend showing a decline of the age at menarche (Morris et al 2011:394-399). The reasoning behind this decline varies in the literature, but the primary reasons identified are more balanced nutrition, better health, and decreased physical activity. Modern North Americans enjoy the convenience of a mass array of local and imported foods available at refrigerated and conveniently located grocery stores/markets. This allows for the possibility of a more rich, varied and indulgent diet and lower risk of disease. The high physical demand of traditional cultures to obtain basic dietary sustenance (by persistence hunting, growing/hunting seasonally dependent food, etc) is diminished from people being able to drive wherever they need to. With boundless dietary choices, more controlled rates of disease, and an increasingly sedentary way of life, women’s percentages of body fat have steadily increased over time.
Adipose tissue produces and stores estrogens that affect a woman’s reproductive system. Consequently, higher levels of body fat have been linked to earlier menarches and higher rates of fertility. When a pre-menarcheal girl reaches a critical body fat ratio, the necessary levels of estrogen then triggers the onset of menses. This ratio of body fat needs to be maintained at or above that critical threshold throughout her lifetime to maintain necessary hormone levels, or else menstruation and/or ovulation will cease (Frisch 1988:81-95).
Research suggests this kind of decrease in essential estrogen-producing body fat is the reason behind the phenomenon presently being documented in the UK: the levelling-off and gradual increase of the age of menarche (Karapanou & Papadimitriou 2010:1-8). Girls are becoming increasingly involved in sports and physically demanding activities like gymnastics and ballet at a very young age. A positive correlation exists between the amount of physical training a girl engages in before first menstruation, and her age of menarche (Frisch 1988:81-95). This increased level of activity in a way mimics the strenuous daily activity experienced by traditional peoples, and prevents the development of that critical ratio of body fat from developing until later on into a girl’s teenage years. Compounded by the ideal figure propagated in the media of a slim/lean woman, I think one could hypothesize that infertility in general is on the rise as more media-affected women are becoming increasingly active (often to a detrimental extent) and underweight.
Now, what does the average modern, Westernized menstrual cycle look like? The “textbook” cycle occurs every 28 days, though in reality there is high variability from woman to woman, and with futher variability in an individual’s life as she ages (e.g. as hormone and physical activity levels fluctuate throughout her lifetime) (Mihms et al. 2011:229-236). In the first few years after menarche at age 8.5-12, many menstrual cycles are anovulatory (i.e. no egg is released by the ovaries), as are the last few cycles before menopause (90 percent of women reached menopause by age 55 (Weismiller 2009)). As such, the modern woman’s “reproductive life” can be potentially up to 50 years (or ~550 menstrual cycles) in length.
In comparison to a century ago, for example, or even thirty years ago, North American women are experiencing more freedom than ever before when it comes to their bodies, their social lives and their careers. Along with the widespread availability and use of contraceptives like birth control pills and condoms, women are generally making a choice to have fewer children and to wait later in life to have their first child. Marriage in the West is typically now for love rather than for access to stable resources or a pre-arranged tying together of families. Women may be waiting to find “the one” before settling down and starting a family, if they indeed decide to marry at all (vs commonlaw partnerships). As women leave their traditional “domestic work” in the home to join the public workforce, they are commonly putting their career in front of starting a family in terms of priorities. For example, my grandmother, born in the 1920s of Italian immigrants to Canada, made a point of marrying my grandfather (who had an excellent job with the railway) in her late teenage years in order to secure a home and reliable financial future. She never used contraception, and she was pregnant within a year of their marriage. She did not consider (nor feel the need to) get a job until after her children were grown and out of the home. This is in great contrast to my own experience, where I have used birth control pills since age 15, and placed a high priority on establishing myself in a stable and enjoyable vocation over finding a husband and/or having children. If I were to consider my grandmother and myself as representative examples of our respective generations, I would guess that most women of my generation are having more menstrual cycles than women of my grandmother’s generation because of the shifts in social/cultural influences.
How Shifts in Modern Conceptualizations of Biological Health and “Femininity” are Affecting Menstruation Patterns
As Westernized/industrialized culture becomes the norm around the globe, we see an increasing eroticisation of the female breast. For example, many municipalities ban breast and/or nipple exposure in public, even for breastfeeding. The function of the breast as providing subsistence for children has become secondary to its conceptualization as a sexual entity (Harrell 1981:806-807). I suggest that this shift in conceptualization has discouraged many North American mothers from becoming familiar and comfortable with breastfeeding their children, especially as the child ages, thereby decreasing the amount of time they experience lactational amernorrhea. Moreover, Westernized activities have become increasingly based on date or time of day instead of necessity. An example of how this impedes lactational amenorrhea is that a mother typically will not feed her baby based on its crying, but instead bases her decision to nurse on the time of day (Harrell 1981:807). If the baby is crying and this coincides with “dinner time,” then it is time to nurse. If not, the baby might be judged to be crying for some reason other than hunger. This spacing of nursing sessions prevents the mother from breastfeeding often enough to maintain the necessary levels of prolactin needed to fully sustain lactational amenorrhea. In turn this further lessens the amount of time before her menses resume. These are examples of social and cultural factors that, combined with the biological instances of earlier menarche and longer life expectancies, result in modern women having such a high number of menstrual cycles.
In fact, pregnancy is no longer the primary symbol of reproductive health and femaleness as it was in the pre-industrial cycle. Rather, a recurring, monthly menstrual cycle has become the indicator of healthful womanhood, effectively reversing the order of reproductive states a women experiences most to primarily menses, pregnancy, and briefly, lactational amenorrhea.
Harrell describes the similarities and differences between the pre-industrial and industrial cycles that have come to affect our perceptions of womanhood, fertility, and femaleness that we hold today (1981:796-823). The pre-industrial reproductive cycle is characterized by three components: pregnancy, lactational amenorrhea, and menses. Out of the three, a woman with this cycle spends most of her reproductive lifetime experiencing lactational amenorrhea, (some 12-16 months per child), followed by pregnancy (approximately 9 months per child), and finally menses (around 3-4 cycles between children). Menses will return after lactational amenorrhea stops with the cessation of breastfeeding and consequently a decline in prolactin levels. However, the onset of a woman’s menstrual cycle after lactational amenorrhea could, in theory, be further delayed because of the potential environmental stresses experienced in pre-industrial societies. My examples of such stresses include: 1. vigorous and sustained physical activity required for daily subsistence activities (e.g. hunting/gathering) that would decrease a woman’s critical fat ratio needed for the resumption of her cyclic activity, 2. general stress involved with day-to-day living like fear of wild animals or disease harming one’s children, 3. malnutrition/a decrease in fat stores because of climatic conditions, like drought, that would harm agricultural harvest and food supply. These factors contribute to the idea that menstrual activity was more of an aberration in a woman’s reproductive lifetime than the norm it has become today.
Menstruation in pre-industrial culture was a symbol of power but also tended to be anxiety-ridden as it symbolized a sort of danger to the group (Derr 1982:644-645). To be in that stable state of pregnancy or lactation for the majority of one’s life ensured others that a woman was fostering the continuation of their group by being clearly fertile. Contrarily, menstruation was an indicator that a woman had failed to conceive, perhaps even infertile, and was thus not actively continuing her group’s lineage. A menstruating woman was a threat, and symbolized the death of her group’s continuance.
Harrell describes the powerful significance given to the liminal menstrual state in the following quote:
For women in preindustrial ages and societies, the less common menstrual cycle may signal a ‘coming into heat,’ an emotional and genital ripeness for copulation, interjected between the stable. . .parasitized state of lactational amennorrhea and the transforming, [swollen], parasitized state of pregnancy (1981:816-817).
Following Harrell’s line of thought, with a monthly recurring menstrual cycle as we are seeing now in modern Western industrial society, women are perpetually living their lives in a highly sexualized state (no wonder the breast has become so eroticized), with pregnancy being uncommon and divergent from this state (1981:806). Perhaps this explains the increasing significance surrounding the circumstances of a woman’s pregnancy and childbirth in North America. With menstruation now being the norm, its significance has become reduced and is almost redundant. The more sporadic events of pregnancy and childbirth, on the other hand, have become highly ritualized and medicalized in the West (Derr 1982:644) when historically they may not have been heralded with such ceremony. Some examples of these medicalizations and rituals include “custom babies/pregnancies” where women can select the appearance and sex of, and how and when they have, their babies; baby showers, a popular North American ritual; and the significantly hospitalized/medicated/isolating experience of giving birth (Derr 1982:644). There is also increasing pressure for the woman to revert as quickly as possible to her pre-pregnancy state/life after her significant yet relatively short pregnancy and childbirth experiences. In this example we see, again, the once primary state of lactational amernorrhea being shortened by Western customs in favour of the modern primary menstrual state (Derr 1982:644-645).
Physical and Social Health Consequences of the Modern Cycle
Unfortunately for women, the idealized pre-pregnancy state/life, characterized by hundreds of menstrual cycles, is relatively unnatural as we have now come to understand from the pre-industrial cycle. The shift from pre-industrial to industrial patterns has occurred over just a matter of a few hundred years, and, as such, the female reproductive system has not yet caught up to these modernized patterns. Essentially, the female reproductive system has come to be regularly activated hundreds more times than evolution intended (Sapolsky 2004:132-134). We are seeing telling consequences of this. Women are now incurring a prevalence in cancers unseen in those with a pre-industrial cycle. Strong positive correlations have been found between the number of ovulatory menstrual cycles a woman has and her risk for developing breast cancer, with the correlation being especially strong if she waits until later in life to have her first child (Clavel-Chapelon 2002:831-838; Vecchia et el. 1985:417-422). These women are also at high risk for endometriosis, ectopic pregnancies, as well as uterine and ovarian cancers (Sapolsky 2004:134; Treloar et al. 2010:534–540).
The use of birth control pills to reduce the number of cumulative cycles in a woman’s reproductive life could potentially reduce these risks. However, there are significant risks inherent in using birth control pills themselves, which are further compounded by having their dosage regimens based on a monthly cycle (NIH 2012). Birth control pills are in fact classified as carcinogenic to the cervix by the World Health Organization, and have been shown to also increase a woman’s risk of developing breast cancer, liver cancer, uterine corpus cancer, and colon and rectal cancers (Beral & Franceschi 2007:1609-1621; Kahlenborn et al. 2006:1290-1302; Rosenblatt et al. 2009:27-24; NIH 2012). The Pill is strongly correlated with rare but serious cardiovascular conditions like ischemic strokes, venous thromboembolisms, and myocardial infarctions (Sabatini et al. 2011:130).
However, there are benefits of hormonal contraceptive use that might be worth their risks. Women who take birth control pills have been shown to have diminished risk of developing ovarian and endometrial cancers (NIH 2012; Hicks & Rome 2010:445). Using birth control pills to reduce a woman’s risk for other cancers associated with a high cumulative number of lifetime menstrual cycles could be more beneficial than allowing hundreds of cycles to occur without intervention. Recent studies have shown that extended use of the Pill to reduce the number of periods to 4 a year, or through continuous use to induce amenorrhea, poses no significant health risks (Hicks & Rome 2010:445-451). Benefits of this kind of usage even reach beyond the physical to include social and psychological improvements, such as greater feelings of control and life satisfaction, and better Pill regimen adherence (2010:449).
Where Do We Go From Here?
With such a powerful and convenient menstrual regulation tool, will monthly bleeding slowly retrogress back to the more liminal state seen in the pre-industrial cycle? I suggest that this very well may the case, as menstruation has almost developed into an (unhealthful) inconvenience that women could do without and even abolish if desired (Hoskins 2001:121-122). However, I also feel there are conflicting perceptions of menstruation in relation to femininity and health in North American culture. On the one hand, menstruation exemplifies the inferiority, weakness and vulnerability of the female, a view held amongst patriarchal cultures pervasively throughout history as well as today. A woman’s menses symbolize contamination, something “icky,” and thus something a woman must conceal. This view is further permeated in the media, with tampon companies making advertisements to show the many ways to conceal their menstrual products. Some (e.g. Tampax, Kotex) disguise their products in bright, colourful and shiny packaging, making their tampons look like small candies. In the event that the woman accidentally shows she is carrying one, it is hoped an onlooker might mistake it for something else. In this way women are influenced by the media to feel that their period is something to be embarrassed about – an awkward state that should not be advertised to others.
In another sense, the ability to manage one’s menstruation (and manage one’s body) is a display of social status and health. Tampons are generally thought of as the best way to discreetly manage and conceal one’s period (Martin 2009:335), but they are also the most expensive, compared to menstrual pads. A woman of higher social class would presumably not have to work so many hours in an environment that would interfere with the secret management of her period. With more and more women in the public work force, especially as the current North American economy continues to tank, a lower class woman may find herself in an employment situation where “the organization of time and space make[s] secret management of menstruation” challenging (Martin 2009:336). This may in turn increase her risk for contracting Toxic Shock Syndrome (TSS) from not having the opportunity to change her tampon often enough. To have the means to manage menstruation so discreetly that others are unable to tell if/when a woman is having her period implies the woman would have the time and money to maintain her physical and social health.
This idea leads us to the opposing view that a woman’s monthly menses has become a symbol of health, femininity and fertility in modern society. A menstruating woman is “in heat,” (following Harrell’s logic) and is thus capable of conceiving a child and contributing to society as a mother. Therefore, experiencing menses might still be seen as desirable by females and the rest of society, meaning women might not choose to induce complete amenorrhea through extended continuous pill regimens unless this positive symbolism changes.
Conclusion
Through the medical advancements, social liberation movements and cultural shifts that have occurred since the pre-industrial era, North American women today are living more socially and sexually liberated lives than preceding generations. But is this newfound liberation a source of empowerment, or is it putting women in a more vulnerable position than ever before? Western sociocultural evolution is occurring at such a fast pace that women’s bodies are struggling to keep up: their reproductive systems have essentially gone into overdrive, and we are starting to see significant health consequences of this. Women are no longer living in a society of hunter-gatherers, nor spending most of their lives pregnant or breastfeeding – I am not suggesting that we make an attempt to return to this pre-industrial lifestyle. However, I do suggest we examine the modern tools we have, like the Pill, in the case that these might be useful to make the transition from pre-industrial to modern menstrual patterns less strenuous on the female body (i.e. by lessening the number of annual menstrual cycles to one more similar to that seen in a pre-industrial pattern). As for the modern transition of social and cultural perceptions, I would like to see further research conducted in this area. In particular, it would be useful to examine women’s self-perceptions of femininity, health and empowerment relative to their reproductive processes. Are women finding more empowerment through their menstrual cycles (compared to pregnancy, breastfeeding), now that a monthly menstrual cycle is the norm? Furthermore, I suggest conducting research on men’s perceptions of menstruation and its taboos, and how these relate to men’s ideas of female health and sexuality. There seems to be very little literature that includes this male perspective, and it might provide some insight into the direction of the modern sociocultural perceptions of women’s reproductive health.
Western culture is becoming more fast-paced and technology-based, and more disconnected from its formerly simple, naturalistic existence. Long-held perceptions of femininity, health, motherhood, and sexuality are being uprooted from their evolutionary underpinnings. It is important to take note of this, and to use our past as an evolutionary and biological reference point. As women are left trying to consolidate their evolutionary past with an unknown future, I hope that instead of feeling overwhelmed and vulnerable during this accelerated, uncertain time in history, they will look inward and find strength, empowerment through their femininity, and a sense of control over their social and biological futures.
References
Beral, V., and S. Franceschi
2007 “Cervical cancer and hormonal contraceptive: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies,” The Lancet, 370:1609–1621.
Clavel-Chapelon, F. & E3N Group.
2002 “Cumulative Number of Menstrual Cycles and Breast Cancer Risk: Results from the E3N Cohort Study of French Women,” Cancer Causes & Control, 13:831–838.
Derr, Bruce W.
1982 Implications of Menstruation as a Liminal State, 84:644–645.
Frisch, Rose E.
1988 “Fatness and Fertility,” Scientific American, 258:99–95.
Harrell, Barbara B.
1981 “Lactation and Menstruation in Cultural Perspective,” American Anthropologist, 83:796–823.
Hicks, Caitlin W., and Ellen S. Rome
2010 “Menstrual manipulation: Options for suppressing the cycle,” Cleveland Clinic Journal of Medicine, 77:445–453.
Hopkins, Janet
2003 Review of Regulating Menstruation: Beliefs, Practices, Interpretations. Medical Anthropology Quarterly 17:121–122.
Kahlenborn, Chris, with Francesmary Modugno, Douglas M. Potter and Walter B. Severs
2006 “Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer,” Mayo Clinic Proceedings, 81:1290–1302.
Karapanou, Olga, and Anastasios Papdimitriou
2010 “Determinants of menarche,” Reproductive Biology and Endocrinology, 8:115.
La Vecchia, Carlo, with Adriano Decarli, Sergio di Pietro, Silvia Franceschi, Eva Negro and Fazio Parazzaini.
1985 “Menstrual Cycle Patterns and the Risk of Breast Disease,” European Journal of Cancer and Clinical Oncology, 21:813–822.
Martin, Emily
1987 Review of Culture, Society and Menstruation. Medical Anthropology Quarterly 1:335–337
Mihm, M., with S. Gangooly and S. Muttukrisna.
2011 “The normal reproductive cycle,” Animal Reproduction Science, 124:229–236.
Morris, Danielle H., Michael E. Jones, Minouk J. Shoemaker, Alan Ashworth and Anthony J. Swerdlow.
2011 “Secular trends in age at menarche in women in the UK born 1908–93: results from the Breakthrough Generations Study,” Paediatric and Perinatal Epidemiology, 25:394–400.
National Cancer Institute
2012 Oral Contraceptives and Cancer Risk. National Institute of Health.
Rosenblatt, Karin A., with Dao L. Gao, Roberta M. Ray, Zamia C. Nelson, Karen J. Wernli, Wenjin Li and David B. Thomas
2009 “Oral contraceptive and the risk of all cancers combined and sit-specific cancers in Shanghai,” Cancer Causes & Control, 20:27–34.
Sabatini, Rosa, with R. Cagiano and T. Rabe
2011 “Adverse Effects of Hormonal Contraception,” J Reproduktionsmed Endokrinol, 8:130–156.
Sapolsky, Robert M.
2004 Why Zebras Don’t Get Ulcers. New York: Henry Holt and Company, LLC
Treloar, Susan A., with Tanya A. Bell, Christina M. Nagle, David M. Purdie and Adele C. Green
2010 “Early menstrual characteristics associated with subsequent diagnosis of endometriosis,” General Gynecology, 202:534–540.
Weismiller, David G.
2008 “Menopause,” Primary Care: Clinics in Office Practice, 36:199–226.
No comments:
Post a Comment