Menstrual article emailed to me by a friend
V.355, Issue 9207, 11 March 2000, Pages 922-924
Nuisance or natural and healthy: should monthly menstruation be optional for women?
It is simplicity itself to eliminate menstruation with safe, inexpensive, and widely available oral contraceptive tablets. Yet monthly menses continue to be the standard for women. Why? Any woman can tell you that menstruating is a pain, literally and metaphorically. At a minimum, it is a nuisance that requires planning and expensive sanitary supplies and paracetamol to avoid messy discomfort for about 1 week each month. In many cases, however, menstruation has a far greater impact on the female half of the population. It can debilitate, and it constitutes a significant and largely unacknowledged cost to society, according to a lively and provocative new book by Elsimar Coutinho and Sheldon Segal.1 Menstrual disorders are by far the leading cause of gynaecological morbidity reported in the USA, outnumbering their nearest competitor (adnexal masses) by a factor of three and affecting nearly 2.5 million American womean anually.2 The effects extend beyond individual women to society more generally, including through the workplace.3 Menstrual disorders cost US industry about 8% of its total wage bill. Expenses are particularly concentrated in sectors that employ predominantly women. For example, Texas Instruments found a 25% reduction in the productivity of female workers during the paramenstruum. Most treatments for conditions caused or exacerbated by menstruation are symptomatic, with little attention paid to the underlying cause—ie, the menstrual cycle itself and its hormonal fluctuations. Women are expected to function as usual, with minimal attention paid to managing the physical and mental pain and discomfort. This is surely an anomaly in modern medicine. There can be no other disease or condition that affects so many people on such a regular basis with consequences, at both the individual and societal level, which is not prioritised in some way by health professionals or policy makers.
Is menstruation really natural?
Monthly menstruation for decades on end is not the historical norm. Women in prehistoric times, as estimated by research among contemporary hunter-gathered populations,6 probably had far fewer periods (about 160 ovulations over their lifetime) than modern women. Our foremothers most likely experienced later menarche (around 16 years of age), earlier first births (19.5 years), frequent pregnancies (on average six livebirths), and long periods of breastfeeding between pregnancies, with births at intervals of 3 years. By contrast, the modern woman living in an industrialised country begins menstruating earlier (on average 12.5 years of age for American girls), first gives birth later (24 years), has fewer pregnancies (two or three), scarcely breastfeeds (3 months per birth, with half of American infants never breastfed at all), and undergoes menopause later. She can expect about 450 periods in her life. Current menstrual patterns are in this sense new and unproven as to their health effectss.
Furthermore, there is plenty of modern evidence that amenorrhoea is often healthier than the alternative.7 If a woman is not menstruating, she is probably also avoiding the sharp changes in hormone levels that regulate this bleeding. Measures to eliminate these fluctuations may help some women to avoid those mood and personality changes of premenstrual syndrome (PMS) that do not stem from problems with the receptors for these hormones. In addition, diseases directly caused by menstruation such as endometriosis would improve; and catamenial conditions (such as epilepsy and arthritis) would not worsen cyclically. Frequent ovulation and menses also contribute to anaemia, some reproductive cancers and heart disease, as well as other health threats. Anaemia in turn has been shown to hinder learning; similarly endometriosis causes great discomfort, contributing to painful intercourse and infertility among other conditions.
Obviously, our ancestors did not accomplish their long menstruation-free intervals by the artificial use of hormones. But by re-examining the credo that frequent and prolonged menstruation is the “natural” state, it is easier to see menstrual management using oral contraceptives as just another medical therapy, akin to daily and continuous pharmaceutical management of hypertension of benign prostatic hypertrophy for men. Modern medicine is all about the artificial control of conditions that range from the life threatening, debilitating, and uncomfortable to matters of mere taste. Eye glasses, insulin, fluoridated water, and now perhaps Viagra, are just a few examples. The use of hormone replacement thereapy (HRT) is a closely related example. HRT has been widely accepted by women and health professionals and provides undisputed protection against certain conditions. Suppression of menstruation is no different, and in some ways more beneficial. It not only gives relief from menstrual-related disorders to individual women, but it also confers additional health benefits and gains to society.
Cultural biases against “medicalising” menstruation
There is still, however, some way to go before widespread acceptance of the idea that menses should be optional and convenient. Women and health professionals are conditioned to think of monthly menstruation as the holy grail of womahood. Birth control pills themselves, for contraceptive purposes, have now been accepted for many years, but there was a sensitivity among their earliest marketing executives to the psychological importance to women of the monthly bleed. The classic “21/7” schedule of oral contraceptive use was designed to mimic the normal menstrual cycle, even though it was unnecessary (other than perhaps to reassure women poineering this new technology each month that they were not pregnant—something easily handled today with home pregnancy urine dipsticks which can be used as needed). Users of oral contraceptives experience a “withdrawal” bleeding or “pseudo period” for 1 week out of each 28 days, substituting in the minds of many women for menses. This schedule is supposedly easier for doctors to explain and for women to understand.
Actually, the bleeding that oral-contraceptive users experience each month bears little biological resemblance to a menstrual period. Indeed, there is scarcely any builtup uterine lining to be shed for these women. Rather, the bleeding results from a drop in the hormone levels after the 21st day when the woman stops taking active tablets and switches to placebo. Women who use oral contraceptives and feel that they are maintaining a “normal” or “natural” cycle are being duped. There is no evidence of any health benefit to taking the placebo tablets for 1 week each cycle. Women taking oral contraceptives might as well be told that with the exact same health risk-benefit ratio, they could eliminate bleeding completely by discarding the placebo tablets in each pack and using the other tablets continuously. In this vein, even if convincing health-based arguments touting the benefits of true menstruation could be marshalled, the millions of women currently using oral contraceptives to control their fertility are already not menstruating in any medical sense. These women at least should be offered the option of eliminating the useless bleeding and related iron-deficiency anaemia and other drawbacks they experience each month, courtesy of the drug company marketing departments. Such women should not feel alarmed that they are not really menstruating—the few health-based theories supporting true menstruation do not convince; far more evidence points to the protective properties of oral contraceptive use and the advantages of being amenorrhoaeic. As to the most significant populerties of oral contraceptive use and the advantages of being amenorrhoaeic. As to the most significant popular fear—that of monthly shedding as protection against cancer—even true menstrual bleeding involves shedding only the top layer of the endometrim, and not the basal layer where cancer can start.
Criticisms of this view
There are of course some problems with this approach. First, viewing menstruation as “unnecessary” and medically controllable in some way pathologises it for all women, even those for whom it is simply a practical nuisance rather than the cause or correlate of serious health problems. Rather than a natural event with unpredictable and varying consequences, menstruation might be viewed as a “sickness” and women who opted not to suppress their cycles, and therefore to menstruate “naturally”, might face censure. In fact, suppression should be just one option for women.
Second, some may argue that synthetic hormones can never approximate the fine balance created by the body. Indeed, for certain women, particular synthetic hormonal regimens may end up exacerbating the symptoms of PMS or inducing other unwanted side-effects. Being wary of “technological” approaches to achieve a desired “natural” state, however, does not explain why the hormone fluctuations associated with “natural” menstruation are healthful or even benign for most women.
Despite these counterarguments, menstrual control with oral contraceptives could substantially improve women's health and concurrently constitute a gain for society. It may not be for all, but at the very least, health professionals and women should know about the option and its potential benefits. When such a safe, simple, and inexpensive treatment is already so widely available, women should not have to be driven loony by their lunar cycles if they prefer not to bleed each month.
bloody discharge may not be normal.
I am not a women but I happen to stumbled apon this topic. Here is an article that seems to address what you are talking about.
They do not mean the "sloughing off of the menses" which is what menstruation is, but "bloody discharge" which is not menstruation even though it accompanies menstruation almost universally in women of childbearing "age" in the modern world.
The article is primarily devoted to "reasons" and hypotheses as to why delayed menarche or menstrual abnormalities are characteristic of ballerinas. If the researchers had been looking on a broader scale they would have researched the subject more and discovered this same syndrome among the following: female tennis players, runners, swimmers, gymnasts, and in fact, all female athletes who exercise regularly and consistently. Further they would have found this syndrome among primitive females in certain areas of the world, most notably among Hunza women and among women who live thoroughly in accord with our biological adaptations per the health system advocated by Life Science!
If the Harvard School researchers had looked even farther, they might have noted that female domesticated dogs and cats often have bloody menstruation whereas their wild relatives do not.