Physiology

• When I ask my menstrual health workshop participants – including clinicians – there’s usually a lot of shrugging and shaking of heads.
• If given multiple choice options, most think that periods either “clean the womb” or somehow “help prepare for pregnancy”.
• Yes, the blood part can stain clothing, but there is nothing pathological, contaminating, or dangerous about periods.

So, why do we have periods?

• Periods likely evolved as a kind of preemptive abortion, to protect women from unviable or dangerous pregnancies.
• As a result, we have low rates of conception, high rates of miscarriage, and extremely high rates of maternal mortality in comparison to other mammals.
• The menstrual cycle is critical for facilitation of the initial steps of this raison d’être of the female reproductive system.
• The menstrual cycle is critical for facilitation of the initial steps of this raison d’être of the female reproductive system.

What else don’t we know?

• Perhaps with the fact that the second phase of the cycle from ovulation to menstruation is a series of highly inflammatory processes.
• This was only very briefly mentioned in three out of 16 textbooks.
• We really ought to be taught from puberty how to reduce period pain and blood loss – this is not difficult science.

Why aren’t we taught this stuff?

• My research shows that the exclusive focus on the female sex hormones in menstrual education is informed by societal influences, such as the myth of the hysterical or hormonal female.
• This gender myth is still alive and well, although now we tend to blame the (female sex) hormones.

• Again, there was no scientific reason for this change in focus, although it reflected existing societal beliefs about the inherently irrational behaviour of women.
• Unfortunately, menstrual health literacy has not yet recovered from this shift in physiological models.

So what?

• It also becomes much easier to differentiate premenstrual changes from underlying health conditions, since the latter will not be substantially alleviated by anti-inflammatory interventions alone.
• Teaching the reductive hormonal model of the menstrual cycle unintentionally provides pseudo-scientific evidence for the damaging hormonal or hysterical female gender myth.

Sally King is the founder of Menstrual Matters- the world's first evidence-based info hub on menstrual health and rights www.menstrual-matters.com. Her doctoral research and current research fellowship were funded by the ESRC (Economic and Social Research Council).

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