The ‘nonmenstrual woman’ in the new millennium? Discourses on menstrual suppression in the first decade of Extended Cycle Oral Contraception use in Canada

Abstract

In the early-twenty-first century, extended cycle oral contraception (ECOC) became available by physician prescription in North America. Researchers speculate that this drug, with its capacity to reduce or eliminate menstrual bleeding, may shift not only women's biological processes but also their experiences of menstruation. In this paper, I discuss women's experiences of menstrual suppression drawing on findings from a qualitative study conducted before ECOC was available, and examine these findings against recently published research on menstrual suppression in an ECOC era. Findings suggest that the body as a natural entity figures strongly in women's discourses on suppression. They further suggest that suppression is a contingent, paradoxical and practical achievement, not a securely or fully realised embodied state. This paper reads women's accounts of menstrual suppression prior to ECOC as a challenge to the modern artifice of a mind/body split, and questions whether this challenge is perhaps made less discernible in an ECOC era, where attention may no longer be paid to the daily practices of menstrual suppression. Hence, a case is made for the varied political effects of ongoing non-menstruation versus event-specific practices of non-menstruation.

En este nuevo milenio, el anticonceptivo oral de ciclo extendido (aoce) puede obtenerse en Norteamérica por medio de una receta médica. Los investigadores han especulado con que este medicamento, capaz de reducir o de eliminar el sangrado menstrual, podría alterar no solo la biología de la mujer sino también sus períodos menstruales. En el presente artículo, la autora se centra en los resultados surgidos de un estudio cualitativo (realizado antes de que estuviera disponible el aoce) que analizó las vivencias experimentadas por varias mujeres en torno a la supresión menstrual. Asimismo, compara dichos resultados con los hallazgos obtenidos por un estudio reciente (2013) sobre el mismo tema, realizado después de que apareció el aoce. Las conclusiones de ambos estudios dan cuenta de que el cuerpo, visto como una entidad «natural», aparece prominentemente en los discursos sobre la supresión menstrual articulados por las mujeres. En 2001, las mujeres asignaron al cuerpo un rol activo y no pasivo en la supresión de la menstruación. Asimismo, las conclusiones indican que la supresión menstrual constituye un logro dependiente, paradójico y práctico, y no un estado encarnado, firme y totalmente materializado. Si bien tanto en 2001 como en 2013 algunas mujeres suprimieron su menstruación, a partir de la aparición del aoce tales prácticas podrían haberse vuelto menos estresantes. Para fines de este artículo, la autora interpretó las vivencias de las mujeres en torno a su supresión menstrual, antes de la existencia del aoce, como un cuestionamiento del artificio moderno que establece una disyuntiva mente/cuerpo; dicho cuestionamiento es menos perceptible después de la aparición del aoce, ya que es más probable que el cuerpo responda. En este sentido, se vuelve menos necesario prestar atención a cuándo, cómo y por cuánto tiempo se suprimirá la menstruación. Por lo tanto, se sostiene que el no menstruar continuamente tiene varios efectos políticos versus la práctica de no menstruar en momentos específicos.

Aujourd'hui, le contraceptif oral à cycle prolongé peut être obtenu en Amérique du Nord sur présentation d'une prescription médicale. Les chercheurs se sont demandés si ce produit, avec sa capacité de réduire ou d'éliminer les saignements menstruels, pourrait modifier non seulement la biologie des femmes mais aussi leur expérience de la menstruation. Dans cet article, je me concentre sur les résultats d'une étude qualitative, conduite avant que le contraceptif oral à cycle prolongé soit disponible, sur l'expérience de la suppression des règles chez les femmes; et j'examine ces résultats au regard d'une étude récente (2013) sur le même thème, à l'ère où le produit est disponible. Les résultats des deux études suggèrent que le corps, en tant que entité « naturelle », est très présent dans le discours des femmes sur la suppression des règles. En 2001, les femmes identifiaient le corps comme étant actif (non passif) dans le processus de suppression de la menstruation. En outre, les résultats suggèrent que la suppression menstruelle est un accomplissement conditionnel, paradoxal et pratique, et non un état solidement incarné ou complètement réalisé. Alors que la suppression de la menstruation existait chez les femmes en 2001 et en 2013, avec le contraceptif oral à cycle prolongé, cette pratique pourrait être moins risquée. Dans cet article, je reviens sur les récits des femmes concernant leurs pratiques de suppression menstruelle, avant l'arrivée du médicament, en considérant celles-ci comme un défi à l'artifice moderne d'une rupture esprit/corps, moins discernable à l'ère du contraceptif oral à cycle prolongé, dans laquelle 1) le corps est plus susceptible de se soumettre 2) il n'est plus nécessaire d'accorder autant d'attention à « quand-comment-et pour-combien-de-temps » la suppression menstruelle doit être pratiquée. À partir de là, je développe une justification des divers effets politiques de la non-menstruation continue, en opposition aux pratiques de non-menstruation liées à des événements spécifiques.

Keywords::

• menstrual suppression
• ECOC
• feminism
• gender
• the pill
• discourse

Notes

^1. Menstrual suppression refers to the elimination or reduction of monthly bleeding through extended or continuous use of hormonal contraceptives. Bleeding during OC use is called withdrawal bleeding, however, I refer to all bleeding as menstruation, given the two are socially understood in very similar ways.

^2.Seasonale™ and Seasonique™ advertise four periods annually. Lybrel™ advertises the possibility of none.

^3. See Andrist et al. (2004a, 2004b), Gunson (2007, 2010), Repta and Clarke (2013) and Johnston-Robledo et al. (2003) for analyses of various aspects of menstrual suppression.

^4. The SOGC report states: ‘Pre-marketing studies testing medication for a young, generally healthy population can only look for indicators of short-term benefits or harms’ (Black, Leboeuf, and Reid 2007, 19).

^5. The ACOG website states: ‘Dysmenorrhea [severe menstrual pain] affects up to 90% of young women and is a leading cause of women missing school and work’ (n.p.). Such characterisations suggest that menstruation is itself a pathological event.

^6. See Ussher (2003).

^7. Mamo and Fosket (2009) use ‘truth effect’ from Balsamo (1996): ‘ideologies in progress that produce cultural ideas about bodies and identities’ (Mamo and Fosket 2009, 925).

^8. Menstrual bleeding has not always been uniquely the property of ‘women’ (see Duden 1991).

^9. Butler's (2004) notion of performativity includes the specificities of its reception: ‘Gender performativity is not just drawing on the norms that constitute, limit and condition me; it's also delivering a performance within a context of reception, and I cannot fully anticipate what will happen’ (345).

^10. See Halliday and Boughton (2009).

^11. Sherman (2005) defines ‘induced menopause’ as ‘the cessation of menstruation that follows either surgical removal of both ovaries (with or without hysterectomy) or iatrogenic ablation of ovarian function (e.g., by chemotherapy or radiation)’ (4S).

^12. Other studies that indicate fewer women are familiar with menstrual suppression through OC (Andrist et al. 2004a; Johnston-Robledo et al. 2003). Andrist et al. (2004a) found 20% had suppressed menstruation and ‘73% had never heard of menstrual suppression with birth control pills’ (361).

^13. Women utilised different strategies at different times, depending on perceived needs, risk and time. Sometimes women had a few months to adjust their cycles to accommodate an upcoming event. In other cases immediate change was required and OC use was continuous until menstruation was deemed appropriate. Some engaged in one of these practices, some in multiple.

^14. Menstrual suppression is not complete or certain with off-label OC or ECOC use. Suppression did not always work and on occasion produced uncertain and complicated situations or side-effects. In this study and in that of Repta and Clarke (2013), women were hesitant to suppress after having had limited success with suppression. The few and limited trials show ECOC offer partial non-menstruation. In the ‘long-term’ (i.e., two years or eight cycles) study of Seasonale™ available upon the writing of this paper, women experienced a median number bleeding or spotting days of a minimum of two per 91-day cycle (Anderson, Gibbons, and Portman 2006, 94).

^15. ‘Gender is a project that has cultural survival as its end’ (Butler 1990, 139). ‘I have to become gendered in order to survive (in most domains); in becoming gendered, I become complicit in supporting those arrangements’ (Bell 2008, 396).

^16. This alternation is not of some apriori natural type of body, but of a body already thought of as a cyborg of sorts (Balsamo 1996).