Blood and Guts: Menstrual Suppression in the Context of Objectification, Gender, and Choice

Abstract

Menstrual suppression, the reduction or elimination of occurrences of monthly bleeding, has become increasingly commonplace. As with many choices that women make about their bodies, however, the decision to suppress menstruation may be influenced at least in part by the socially constructed meanings associated with their bodies and its stigmatized functions. In this study, we investigated whether self-objectification may be associated with menstrual suppression using quantitative measures of objectified body consciousness. We found that one aspect of self-objectification in particular, body surveillance, was significantly correlated with menstrual suppression. We also explored menstruators’ self-reported motivations for pursuing suppression using open-ended responses and found that different groups of suppressors endorsed different motivations. That is, menstruators who sought short-term suppression were more likely to be motivated by specific activities for which periods are judged to be incompatible (i.e., sexual relations and important events), whereas menstruators who sought long-term suppression were more likely to be motivated by persistent unpleasant circumstances associated with menstruation (i.e., inconvenience and pain). Finally, we discuss the implications of these findings in context of health, stigma, objectification, and choice.

Keywords:

• Menstruation
• menstrual suppression
• self-objectification

A common euphemism for menstruation—the curse—exemplifies the negative attitudes held by many toward an event that occurs regularly for much of the population (Gottlieb, 2020; Houppert, 1999). Given popular connotations of mess, pain, and inconvenience (Brooks-Gunn & Ruble, 1980; Fahs, 2020; Gottlieb, 2020), it is no surprise that some people might long to do away with regular occurrences of menstruation. Since the advent of oral hormonal contraception in 1960, menstruators have had the ability to skip the placebo pills in each pack meant to initiate withdrawal bleeding; this is an informal, do-it-yourself method to eliminate menstruation in a given month, otherwise known as short-term menstrual suppression. More recently, specific types of oral contraception (e.g., Seasonale) and some long-acting reversible contraceptives (e.g., NuvaRing) have been marketed with the express goal of reducing or eliminating menstruation (in addition to preventing pregnancy). We refer to the use of such products for the purpose of suppression as long-term menstrual suppression. There are many reasons that individuals may choose to suppress menstruation. Below we explore different motivations for short- and long-term suppression. Further, we argue that both the stigmatization of menstruation and the internalization of sociocultural norms that sexualize the female body create conditions in which menstruators may wish to suppress their periods.

With regard to gender and menstruation, we are mindful that language can indicate an essentialist perspective on the body. Although our study focuses on menstruating cisgender women and gendered objectification, we acknowledge that not all women menstruate and not all who menstruate are women. Therefore, we often utilize the term “menstruators” (e.g., The Society for Menstrual Cycle Research, 2011, p. 1) in order to refer broadly to people who menstruate. For a detailed discussion of degendering menstruation within critical menstruation studies, see Rydström (2020).

Menstruation Is Socially Stigmatized

There is a long history of menstrual stigma, dating at least to biblical times. Historically, menstruating women were often (although not universally) considered contaminated, pathological, or dangerous in some way, and efforts were made to literally contain these women and separate them from society (Whelan, 1975). Though times have changed, these attitudes have not dissipated entirely in Western cultures, including the United States and the United Kingdom. In this paper, we consider menstruation as socially constructed in Western cultures; for a recent consideration of menstrual taboos cross-culturally, see Gottlieb (2020). Menstruation is still considered unclean and therefore something to be concealed; menstruating people are still considered dangerous, albeit in new forms, via stereotypes of erratic moodiness and irrationality (Johnston-Robledo & Chrisler, 2013). Thus, feminist psychologists have often discussed menstruation as a stigmatized condition (e.g., Chrisler, 2011; Fahs, 2020; Jackson, 2021; Johnston-Robledo & Chrisler, 2013; Johnston-Robledo & Stubbs, 2013; Peranovic & Bentley, 2017). In an experiment exemplifying this stigma, Roberts et al. (2002) found that participants evaluated a woman as less competent and less likable after she dropped a tampon from her handbag compared to when she dropped a hair clip. Interestingly, participants also evaluated women in general with more objectifying standards after watching the tampon fall, particularly in the case of participants who adhered more strongly to typical gender roles (Roberts et al., 2002). Thus, the mere sight of menstrual hygiene products may be enough to elicit stigma, and this stigma is tied to more general sociocultural attitudes about women, such as objectification.

As is the case for other types of stigma, menstrual stigma is perpetuated through dominant cultural attitudes that seep into advertisements, media, education, socialization, jokes, and shame-based social interactions (Johnston-Robledo & Chrisler, 2013). Indeed, in a content analysis of Twitter discourse surrounding menstruation, Thornton (2013) found that one major theme concerned deploying shame or disdain to encourage the concealment of menstruation. O’Flynn (2006) called this type of concealment mandate “menstrual etiquette” and asserted that menstruating people feel immense pressure to hide any hint or acknowledgement of menstruation. Wood (2020) expanded “the menstrual concealment imperative” as a framework for understanding how the stigmatized connotations associated with menstruation become internalized as a form of self-objectification; in this context, the menstrual product industry may frame concealment as a supposed choice, but it may function more accurately as a social imperative. Similarly, in a content analysis of media representations of menstrual suppression, Johnston-Robledo et al. found that monthly menstruation was constructed as “messy, inconvenient, bothersome, unhealthy, and unnecessary” (Johnston-Robledo et al., 2006, p. 353). When these representations are internalized, women’s own menstrual attitudes, toward themselves and others, can mimic negative sociocultural attitudes (Roberts & Waters, 2004) and may lead to engagement in either short- or long-term suppression, among other outcomes. Although we do not measure menstrual stigma directly in this study, we argue that menstrual suppression, and its connections with objectification, exist in the context of a highly stigmatized condition; understanding menstruation as stigmatized is crucial to understanding women’s menstrual attitudes and behaviors.

Menstrual Suppression

Menstrual suppression is poorly understood as a phenomenon. This is, in part, due to an inconsistent definition across contexts: While medical researchers may focus primarily on menstrual suppression planned and prescribed by a physician (e.g., Kantartzis & Sucato, 2013), popular online sources accessible to the average woman may focus more on the colloquial understanding of skipping your period (e.g., LaFata, 2014). We define menstrual suppression here as the practice of reducing or eliminating occurrences of menstrual bleeding through the use of contraceptives, whether in a short- or long-term fashion. Potential differences between short-term and long-term suppressors remain largely unexplored. Generally, however, long-term and short-term suppression are characterized by different contraceptive methods: Long-term menstrual suppression requires commitment and often extra expenses or medical visits depending on the contraceptive method that is chosen; on the other hand, short-term suppression may be achieved with relatively little planning and may be done on short notice without committing to future suppressed menstruation. These differences in method may imply differences of motivation, rate, or deliberation.

To our knowledge, there are no population-based estimates of menstrual suppression rates. In convenience samples, however, researchers have reported menstrual suppression rates of 12% (Johnston-Robledo et al., 2003), 17% (Lakehomer et al., 2013), and more recently 32% (Jackson, 2021). There is mixed empirical evidence regarding the most common reasons that people choose to suppress their periods. Medical journals often report on “special cases” for which people are specifically prescribed long-term menstrual suppression. For example, women with relevant medical conditions, such as endometriosis or hematologic abnormalities, may manage their conditions through contraceptive use (Kantartzis & Sucato, 2013). Members of the military may desire menstrual suppression during deployment to overcome situational barriers to menstrual hygiene (Trego & Jordan, 2010). Transgender men and other gender minority individuals with uteruses may seek out menstrual suppression in order to alleviate gender dysphoria (Kanj et al., 2016; Snedecor et al., 2019). However, these data do not speak to reasons that the vast majority of cisgender women may choose menstrual suppression, nor do they indicate the prevalence or method of suppression among women at large.

Lakehomer et al. (2013) investigated short-term suppression methods in one survey of 1,719 college students. Approximately 17% of the women surveyed had altered their pill regimen to suppress menstruation, and their stated motivations included convenience or social scheduling (51.3% of those who engaged in suppression), personal preference (28.9% of those who engaged in suppression), reduction of menstrual symptoms (16.7% of those who engaged in suppression), and sport or athletic reasons (3.1% of those who engaged in suppression). Questions remain regarding the decision to suppress: What are potential motivations involved in personal preference? What psychological factors may be at play?

Some studies (i.e., Gunson, 2010; Repta & Clarke, 2013) have used open-ended, in-depth interviews to explore experiences of menstrual suppression. These researchers were able to use their data to speak to their participants’ motivations. For example, Repta and Clarke (2013) compared the decision-making processes of suppressors and non-suppressors; women who engaged in suppression considered convenience, pain, and body image, whereas women who had not engaged in suppression voiced concerns about staying healthy and “natural.” On the other hand, women in Gunson’s (2010) sample eschewed consideration of menstruation as “natural.” Instead, they weighed personal and practical concerns in their suppression decisions, discussing predictability, stability, menstrual symptoms, and concerns about fertility.

Though they did not examine specific motivations to suppress, McMillan and Jenkins (2016) explored meanings associated with online commercials for menstrual suppression. Ads they reviewed implied that having a monthly period is not a healthy or effective lifestyle and choosing fewer periods would lead to a fuller life (McMillan & Jenkins, 2016). Indeed, given that advertisements for menstrual conditions (e.g., Chrisler & Levy, 1990; Parlee, 1987), products (e.g., Erchull, 2013), and contraceptives (e.g., Johnston-Robledo et al., 2006; Kissling, 2013; Medley-Rath & Simonds, 2010; Woods, 2013) have long been a subject of feminist analyses, it stands to reason that analysis of internet representations of menstrual suppression may similarly provide insight into sociocultural constructions of menstruation. Many of the online DIY guides cite premenstrual symptoms, special occasions, travel plans, and athletic careers as motivations to suppress (Association of Reproductive Health Professionals, 2008). Some guides invoke normative appeals to sexuality:

Sheer panic ensues because this is literally the worst thing to happen to any woman. What will you do? You haven’t seen your boyfriend in weeks and you’re accumulating cobwebs down there. There’s no way your white bikini will hold up against the waves of the crimson tide. And all of that bloating will make you look like a balloon in your bandage dress. There’s only one solution: skip your period. (LaFata, 2014, para. 7)

Other guides simply claim that menstruators eschew periods because they are seen as unnecessary in today’s society (e.g., Doucleff, 2016). Given this brief window into online discourse, it seems possible that “personal preference” may in fact be reflective in some way of normative sociocultural ideas and attitudes about menstruation.

Objectification Theory and Menstruation

As is evident from the LaFata (2014) quotation above, some of the critique of menstruation in popular discourse is based on sexualized conceptions of how women’s bodies should look and act. Objectification theory (Fredrickson & Roberts, 1997) guided our understanding of internalized sociocultural pressures as they relate to menstrual suppression. Objectification theory broadly contextualizes women’s lived experiences through the sociocultural meanings attached to their bodies. Specifically, objectification involves valuing women as bodies at the expense of their personhood, agency, and individuality. Self-objectification, then, is the process by which an outsider’s objectifying perspective on one’s body is turned inward, and it is associated with body surveillance and feelings of shame.

A small body of literature connects objectification to menstruation in general. Self-objectification involves viewing oneself as a sex object, and menstruation is often conceptualized as incompatible with sexuality (Erchull, 2013; Johnston-Robledo & Chrisler, 2013). Previous studies have found a relationship between self-objectification and negative attitudes and emotions about menstruation in general (Roberts & Waters, 2004; Schooler et al., 2005). Roberts and Waters (2004) argued that women engage in a “variety of body-altering practices designed to transform the physical body into the idealized body” (p. 10); such cultural flights away from the devalued corporeal body can include menstrual suppression, which may allow distancing from stigmatized embodiment (Andrist, 2008). Similarly, Wood (2020) framed menstrual concealment (including menstrual suppression) as a form of self-surveillance, linking such obligatory body practices to self-objectification. Indeed, women who endorse higher self-objectification attitudes have reported that they would not miss their cycle if it were suppressed (Johnston-Robledo et al., 2003) and have been more likely to report menstrual shame and positive attitudes toward menstrual suppression (Johnston-Robledo et al., 2007). Most recently, Jackson (2021) found that the body surveillance component of self-objectification was related to suppression attitudes indirectly, through menstrual shame; that is, women higher in surveillance experienced more menstrual shame, which in turn related to their positive attitudes toward menstrual suppression. Although Jackson’s sample included a subset of women who engaged in actual suppression behavior, only attitudes toward suppression were explored in her analyses.

The Current Study

• We aim to add to the limited knowledge base on motivations to suppress menstruation. Prior studies that focused on menstruators’ motivations to pursue menstrual suppression (Gunson, 2010; Repta & Clarke, 2013) used small samples, as is appropriate for qualitative work. In the current study, we used mixed methods (quantitative survey and open-ended response data) from a larger sample to explore rates of and motivations for both short- and long-term menstrual suppression among cisgender women with a history of hormonal contraceptive usage. We hypothesized the following: (1) Short-term and long-term suppressors will express different motivations for suppression. Broadly, we expected that short-term suppressors will more frequently be motivated by individual events or one-time circumstances, whereas long-term suppressors will more frequently be motivated by persistent circumstances or global preferences. However, this hypothesis is primarily exploratory; we did not make specific a priori predictions about what themes may emerge when coding motivation responses.

Additionally, we investigated potential links between self-objectification and menstrual suppression. Prior scholars have drawn a theoretical link between objectification and menstruation (Andrist, 2008; Erchull, 2013; Roberts & Waters, 2004; Woods, 2013). Empirical work to date has connected objectification to menstrual attitudes (Johnston-Robledo et al., 2003, 2007; Roberts, 2004; Ryan et al., 2020) including willingness to try menstrual suppression in the future (Jackson, 2021; Sveinsdóttir, 2017). However, our study is the first to our knowledge to examine whether self-objectification is related to actually engaging in menstrual suppression. Thus, we further hypothesized:

• (2) Having higher levels of self-objectification would increase the odds of engaging in menstrual suppression.

Because the extant literature has not assessed connections between objectification and types of suppression, we could not make a specific prediction, but we wanted to take advantage of our unique dataset to explore whether:

• (3) Short-term suppressors and long-term suppressors may differ in their mean levels of self-objectification.

Method

Participants and Procedure

This study was approved by the University of Florida Institutional Review Board. We recruited participants through Prolific (prolific.co), a crowdsourcing website dedicated specifically to academic research. We chose this tool for several reasons: Prolific offers custom prescreening to determine participant eligibility among their entire active participant pool; Prolific uses a standard “minimum wage” consistent with our ethical principles, offering higher payment to participants than other popular crowdsourcing websites; and Prolific employs quality checks that prevent repeat submissions and improve participant naivety. Indeed, Peer and colleagues (Peer et al., 2017) found that Prolific participants appeared to report higher levels of naivety and lower levels of dishonest behavior compared to participants recruited through Amazon Mechanical Turk. We used the prescreening tools on the Prolific website in order to recruit participants who indicated some experience using hormonal contraceptives so as to maximize the likelihood of recruiting participants who had faced a menstrual suppression choice. Volunteers who met the criteria (aged 18–50 years; female; resident of the United States, United Kingdom, or Canada; current or past history of hormonal contraceptive use) and provided informed consent electronically were directed to an online survey hosted on Qualtrics and were compensated ∼ US$2.50 upon completion.

We initially collected data from 336 adults. As part of the data cleaning process, we eliminated responses from participants in nations other than the United States, Canada, and the United Kingdom (n = 5) because of language barriers and possibly confounding differences in cultural influence. We also eliminated responses from participants whose stated gender identity was listed as “genderqueer” or “agender” (n = 6); although these participants met the contraceptive use prescreening criteria, our survey did not have the means to accommodate the complex motivations that may influence the suppression behaviors and motivations of non-cisgender participants, including but not limited to gender dysphoria and gender presentation. In addition, because we were most interested in menstruators who choose to suppress because of personal preference rather than medical necessity, we removed menstruators whose motivation to suppress was the elimination of extreme pain or who suppressed by accident. Therefore, we also filtered out participants with very high reported menstrual pain (endorsed as 9 or 10 on a 10-point scale, n = 28) and participants who engaged in menstrual suppression without choosing to do so (i.e., suppression that occurred as an incidental side effect of contraception, n = 20). We believe that this has eliminated participants who pursued long-term contraception without specifically seeking menstrual suppression. However, we made this designation based on their open-ended motivation responses and it is possible that some participants did not offer comprehensive descriptions of their motivations. Finally, we eliminated participants with inconsistent responses (n = 21).

The final sample (n = 256) ranged in age between 18 and 49 years, and the mean age was 30.7 years (SD = 6.7). Most participants were White (92.2%), followed by Latina (3.5%), Black (3.1%), Native (2.3%), Asian/Pacific Islander (2.3%), and other (2%). The majority of participants lived in the United Kingdom (63.7%), followed by the United States (31.6%) and then Canada (3.1%). Most participants identified as heterosexual (80.1%), followed by bisexual (14.5%), lesbian/gay (2.3%), queer (1.2%), or other (2%). Most participants were also highly educated, with the majority (73%) holding a college degree or greater.

Measures

Suppression Behavior

After providing informed consent, participants completed a questionnaire, developed for this study, about their contraceptive use and menstruation experiences. This section of the survey assessed the outcome variables: long-term menstrual suppression and short-term menstrual suppression. We defined menstrual suppression in the survey in order to clarify any confusion about terminology (“Menstrual suppression, sometimes called ‘skipping your period,’ is a way of using certain types of birth control to avoid having monthly bleeding”). Short- and long-term suppression behaviors were assessed with separate questions and examples in order to clarify differences between the two practices. For long-term suppression, we asked participants “Have you ever suppressed your menstruation long-term (for example, by eliminating monthly periods with injections, such as Depo-Provera or reducing monthly periods to 4 per year with hormonal pill cycles, such as Seasonale)?” To assess short-term suppression, we asked participants “Have you ever ‘skipped a period’ on your own (for example, by skipping the placebo week on your birth control pills in order to plan when your next period would be)?” These suppression questions were dichotomous (with only “yes” or “no” as response options) and independent (such that participants could separately report both long- and short-term suppression). We believe the instructions were clear and, given the detailed examples, these items have face validity.

Suppression Motivation

Participants who answered “yes” to either of the suppression behavior items also provided brief open-ended responses about their reasons for suppression via free-response to the question: “Why did you make the decision to suppress your periods? (Feel free to type as much as you need.).” Notably, because we assessed short- and long-term suppression separately, participants who had engaged in both types could report their motivations for both behaviors separately. Participant responses ranged from one word to a few sentences long. The first author of the paper derived coding categories by reading through all responses three times and taking notes on themes. Most responses were very brief and clear, leading directly to simple categories; for example, responses, such as “holiday or important occasion” and “avoid inconvenience” reflect the coding categories holiday/event and general convenience (see Table 1). A minority of responses exceeded one sentence; in these cases, responses were divided into meaning fragments where appropriate and assessed thematically. Often, these longer responses involved the participant reporting or explaining more than one motivation: for example, “Inconvenience, wanted to keep having sex, holidays (wearing swimwear).” After themes were established, each response was coded by the first author. A graduate student who was otherwise unaffiliated with the project coded a selection of responses and reliability was high (97.69%). We dropped from analysis themes that were mentioned by fewer than 10% of suppressing participants: premenstrual syndrome symptoms, doctor recommendation, control, pointless, and occupation. This left five coding categories: pain, holiday/event, sex, general convenience, and dislike/disgust. Examples of responses within each category are reported in Table 1.

Table 1. Examples of responses within each motivator coding category.

Category	Examples
Pain	“They were horrible painful”
	“I occasionally get terrible cramps.”
	“Wanting to avoid pain”
Holiday/event	“Holiday or event around period”
	“Holidays, Christmas, New Year, birthdays”
	“Was going on holiday and didn’t want it to be ruined”
Sex	“More sexual encounters”
	“LDR [long distance relationship] and wanted to have sex while not on period”
	“Planning/hoping to have sex”
Convenience	“Periods on the whole are just the most inconvenient thing that has ever existed”
	“Too inconvenient to have them”
	“They’re inconvenient and something I can live without.”
Dislike/disgust	“I just hate having periods and I can’t bear the thought of having 12 per year. It makes me feel like an animal”
	“Not wanting to see my period”
	“Because I hate being on my period. By taking 4 packs in a row I have more painful periods but it’s worth it to not have them as often.”

Objectified Body Consciousness

In order to assess participants’ levels of self-objectification, we used the Objectified Body Consciousness Scale (OBCS; McKinley & Hyde, 1996). The scale consists of 24 items divided into three subscales with eight items each. The surveillance subscale (α = 0.90) includes items such as “I think more about how my body feels than how my body looks” (reverse-scored). The body shame subscale (α = 0.87) contains items such as “I feel ashamed of myself when I haven’t made the effort to look my best.” The control subscale (α = 0.84) includes items such as “I really don’t think I have much control over how my body looks.” Response options ranged from 1 (strongly agree) to 7 (strongly disagree). In this sample, the surveillance and body shame subscales were positively correlated (r = .59, p < .001) and the control and body shame subscales were negatively correlated (r = −.13, p = .04), but the surveillance and control subscales were not correlated (r = .06, p = .36). The OBCS development paper demonstrated acceptable reliability and validity for the subscales (McKinley & Hyde, 1996); a more recent review and analysis suggested that surveillance and shame have good validity, but control does not (Moradi & Varnes, 2017).

Contraceptive Use and Menstrual Symptoms

Participants provided information about their contraceptive use and menstrual symptoms. We provided a list of contraceptive methods (including “birth control pills,” “hormone shots,” “IUDs,” “arm implants,” “condoms,” and a free text option) and instructed participants to select the methods they had used presently or in the past. Participants also rated the pain and symptomology of their menstrual cycles. For example, regarding pain, we asked participants: “On a scale of 1–10 (1 being no pain and 10 being extreme pain), how much pain do you typically experience during menstruation?” Regarding premenstrual syndrome symptoms, we asked participants: “On a scale of 1–10 (1 being no symptoms and 10 being extreme symptoms), how much are you typically affected by PMS (for example, moodiness)?” Finally, we asked participants: “On a scale of 1–10 (1 being no inconvenience and 10 being extreme inconvenience), how much are you typically affected by the ‘inconvenience’ of having your period?” These items are face valid.

Suppression-Related Attitudes and Knowledge

We asked participants three questions about their suppression-related attitudes and knowledge. Participants responded “yes” or “no” to the question “Have you ever consulted with a doctor about suppressing your menstrual cycle?” We also asked participants to rate, using 6-point Likert scales, how safe they believed menstrual suppression to be and how likely they were to consider menstrual suppression in the future, regardless of whether they had previously suppressed. These items are face valid.

Results

Preliminary Analyses

The vast majority of participants had experience using contraceptive pills (89.1%). Some participants reported having used hormone injections (10.5%), intrauterine devices (12.1%), and implants (11.7%); these numbers add to more than 100% because participants were encouraged to list all types of contraception they had used in the past or presently. On the whole, participants reported moderate menstrual discomfort; on scales from 1 to 10, participants rated their menstrual pain (after elimination of participants with pain levels of 9 or above, M = 4.64, SD = 2.11), menstrual inconvenience (M = 5.46, SD = 2.43), and premenstrual syndrome symptoms (M = 5.31, SD = 2.40). Almost a third of the total sample had ever consulted with a doctor about menstrual suppression (30.1%), but over half (61.7%) thought that menstrual suppression was “a little” (15.2%), “somewhat” (28.1%), or “very” (18.4%) safe. Perceived safety was moderately positively correlated with menstrual suppression (r = .430, p < .001) and with likelihood to engage in menstrual suppression in the future (entire sample: r = .52 p < .001; among non-suppressors: r = .43, p < .001).

About half of the sample reported having ever suppressed their menstrual cycles (50.4%; n = 129). There was substantial overlap in suppressors: that is, of the 32 long-term suppressors left after data cleaning, 25 (78%) reported having also engaged in short-term suppression at some point. The majority (94.6%, or 47.7% of the total sample) of suppressors had suppressed using short-term methods (i.e., skipping a period manually by manipulating pill regimens), whereas only 24.8% (12.5% of the total sample) had used long-term methods. Just under half (47.7%) of the entire sample stated that they were “a little” (14.8%), “somewhat” (12.5%), or “very” (20.3%) likely to consider menstrual suppression in the future, but the responses were somewhat polarized, with “very likely” (20.3%) and “very unlikely” (25%) being the two most common responses. Likelihood to engage in menstrual suppression in the future was moderately positively correlated with current or past menstrual suppression (r = .44, p < .001). Future likelihood was also weakly positively correlated with two subscales of the OBCS: body surveillance (r = .18, p = .004) and body shame (r = .15, p = .020).

We report frequencies for each suppression motivation category in Table 2 separately for short-term and long-term motivations. Among long-term suppressors, the most common motivation category was general convenience, endorsed by 56.2% of long-term suppressors (14% of all suppressors and 7% of the overall sample). This was followed by the pain category, endorsed by 31.3% of long-term suppressors (7.8% of all suppressors and 3.9% of the overall sample). The categories of premenstrual symptoms and dislike/disgust tied for third most commonly reported motivator among long-term suppressors at 15.6% (3.9% of all suppressors and 2% of the overall sample) each. Among short-term suppressors, on the other hand, the most common motivator was the holiday/event category, endorsed by 68.9% of short-term suppressors (65.1% of all suppressors and 32.8% of the overall sample). This was followed by the general convenience category, endorsed by 29.5% of short-term suppressors (27.9% of all suppressors and 14.1% of the overall sample). The sex category was the third most commonly reported motivator among short-term suppressors at 18.9% (17.8% of all suppressors and 9% of the overall sample).

Table 2. Frequency of suppression motivator categories among participants.

	Type of suppression
	Long-term			Short-term
	% Within long-term	% Within suppressors	% Within sample	% Within short-term	% Within suppressors	% Within sample
Pain	32.3%	7.8%	3.6%	4.9%	4.7%	2.2%
Holiday/event	6.5%	1.6%	0.7%	68.9%	65.1%	30.3%
Sex	3.2%	0.8%	0.4%	18.9%	17.8%	8.3%
Convenience	58.1%	14%	6.5%	29.5%	27.9%	13%
Dislike/disgust	16.1%	3.9%	1.8%	7.4%	7%	3.2%

Note. For each category, prevalence is reported separately by long-term and short-term motivation. Thus, percentages reflect how common each thematic category was within each suppressor group (long-term only n = 32; short-term n = 122), within the suppressor group as a whole (n = 129), and within the entire sample (n = 256).

In order to assess possible differences between participants living in different areas of the world, we ran comparisons for consistency in the two largest nation groups, the United Kingdom (n = 163) and the United States (n = 81). Though we also received some responses from Canadian participants (n = 8), there were not enough to reliably compare means. There was no significant difference in the overall or subscale scores of the OBCS between the U.K. and U.S. participants. There was, however, a difference in suppression frequency between the two groups. According to a Chi-square test of independence [χ² (2, N = 244) = 25.3, p < .01], a higher proportion of participants from the United Kingdom had ever suppressed their menstruation compared to participants from the United States. More specifically, there was no significant difference in long-term suppression [χ² (2, N = 244) = 0.88, p = .35.], but there was a significantly higher proportion of short-term suppressors in the United Kingdom [χ² (2, N = 244) = 24.5, p < .01] compared to the United States. We are unsure what accounts for this difference in rates of short-term suppression, as both menstrual attitudes and objectified body consciousness appeared to be similar across countries.

Hypothesis Testing

Hypothesis 1

We predicted that short-term and long-term suppressors would endorse different motivations for suppression, but because this hypothesis was exploratory and the motivation data was open-response, we did not make specific a priori predictions about the nature of potential differences. Frequencies for the motivation categories, reported in Table 2, show that the most common motivators among long-term suppressors (general convenience, pain, and dislike/disgust) do differ from those reported by short-term suppressors (holiday/event, general convenience, and sex). In order to test these differences statistically, we conducted a series of Chi-square tests of independence for these five categories. When expected values were <5, Fisher’s exact tests were used. Because there was substantial overlap in long-term and short-term suppression and relatively few participants who had engaged in long-term suppression only, we coded the overlapped suppressors as long-term suppressors only and removed their responses from the short-term group for the purpose of the analyses. Because participants reported motivation separately for short- and long-term suppression, we were able to analyze these suppressors using their long-term motivations only. The results of these analyses are reported in Table 3. Long-term suppressors were statistically more likely to endorse pain and convenience as motivators, whereas short-term suppressors were more likely to endorse holidays or events and sex as motivators. As expected, short-term suppressors were more likely to suppress for individual events and circumstances. Thus, this hypothesis was supported: Short-term and long-term suppressors do indeed report different motivation.

Table 3. Prevalence of suppression motivation categories in chi-square analyses.

	Long-term		Short-term
	N	% Within long-term	n	% Within short-term	χ^2(1)	p
Pain^a	10	32.3%	5	4.9%		<.01
Holiday/event	2	6.5%	72	68.9%	45.46	<.01
Sex^a	1	3.2%	19	18.9%		.025
Convenience	18	58.1%	28	29.5%	7.86	.005
Dislike/disgust^a	5	16.1%	6	7.4%		.14

Note. For these analyses, participants who reported both long- and short-term suppression were filtered into the long-term suppressor category, using only their motivation responses from the long-term section of the survey. The frequencies reported in this table are therefore different from the overall frequencies reported in Table 2.

^aBecause there was at least one cell with expected value <5 in this analysis, we report the Fisher’s exact test rather than the Pearson’s Chi-square statistic.

Hypothesis 2

We hypothesized that greater levels of self-objectification would be related to engaging in menstrual suppression of any kind. In order to test this relationship, we ran a logistic regression with the outcome variable menstrual suppression (short- or long-term combined, n = 129, vs. none, n = 127) predicted by the subscales of the OBCS. The model tested against a constant only model was statistically significant (χ² = 13.28, p = .004, df = 3). Examining the variables in the model, the effect was driven primarily by one subscale. The body surveillance subscale was significant within the model (p ≤ .01), whereas the body shame (p = .55) and body control beliefs (p = .18) subscales were not. The odds ratio statistic [exp(B) = 1.49] indicates that for every unit increase in the body surveillance subscale, the odds of the menstrual suppression outcome increased by roughly 1.5 times, or 149%. However, as indicated by the Nagelkerke’s R² statistic (.067), the model explained only a small amount of the variance (6.7%). Thus, the body surveillance component of self-objectification seems to be significantly associated with menstrual suppression of any type, partially supporting hypothesis 2.

Hypothesis 3

We wondered whether short-term suppressors and long-term suppressors might differ in their mean levels of self-objectification. To test this relationship, we ran t tests comparing the group means for the subscales of the OBCS. As was the case in our analyses for hypothesis 1, there was substantial overlap between short-term and long-term suppressors; to mitigate this overlap, we again coded the overlapped suppressors as long-term suppressors only (long-term n = 32, short-term only n = 97). There was a significant difference in the scores for the body shame subscale of the OBCS only, such that long-term suppressors (M = 4.20, SD = 1.33) reported greater levels of body shame than did short-term suppressors (M = 3.59, SD = 1.15); t(127) = 2.49, p = 0.014. The other OBCS subscales did not differ significantly between groups. Thus, the body shame component of self-objectification seems to be more prevalent in long-term suppressors than in short-term suppressors.

Discussion

In this study, we investigated factors related to the use of hormonal contraceptives to suppress menstruation. While there are many such potential factors, we chose to focus on the internalization of sociocultural attitudes about women in the form of self-objectification. Additionally, we explored themes in self-reported motivations to suppress. Our first prediction, that short-term and long-term suppressors would report different motivations for suppression, was supported: Short-term suppressors were more likely to endorse holidays or events and sex as motivators, and long-term suppressors were more likely to endorse pain and convenience. These themes fit into our broad predictions as well. That is, short-term suppressors were indeed more likely to be motivated by specific, individual events for which periods are deemed incompatible (having sex and important occasions), whereas long-term suppressors were more likely to be motivated by persistent circumstances associated with menstruation (pain and inconvenience). Our second prediction, that greater levels of self-objectification would be related to engaging in menstrual suppression, was partially supported. Specifically, higher scores on the body surveillance subscale of the OBCS (McKinley & Hyde, 1996) were significantly positively associated with menstrual suppression of any kind. Finally, our third prediction, that long-term suppressors and short-term suppressors may differ in their levels of self-objectification, was supported partially. Specifically, scores on the body shame subscale of the OBCS were significantly higher for long-term suppressors than for short-term suppressors.

We believe that these results speak to the complexity of choice and personal preference in menstrual behaviors. There are many motivations to suppress one’s period. To borrow a few motivations voiced by our participants, one might want to avoid pain and discomfort, make one’s life more convenient, or facilitate sexual experiences; these motivations are consistent with Jackson’s (2021) qualitative data showing that menstruators who had engaged in short-term suppression endorsed convenience (avoiding menstruation during special events or for planned sexual activity) and quality of life (minimizing pain) as motivations. These themes offer us important insight into the decision-making process involved in menstrual suppression. However, such choices may be influenced by the sociocultural context. Because menstruation is socially stigmatized (Fahs, 2020; Johnston-Robledo & Chrisler, 2013), an individual may find it difficult or impossible to disentangle the influence of dominant cultural notions when making menstrual decisions.

This is obvious in some cases; as one participant wrote, “I just hate having periods and I can’t bear the thought of having 12 per year. It makes me feel like an animal.” We can see clear lines drawn between this narrative and the stigmatization of menstruation as something gross and uncivilized. It stands to reason that, in order to evoke such disgust and disdain, menstruation must be imbued with sociocultural negativity and stigma. In turn, these strong internalized attitudes may drive the decision-making process for menstrual suppression.

Delving deeper into the literature on menstrual suppression, we can also see a link between our participant responses and terror management theory. Erchull (2013) linked objectification and menstruation using a terror management framework, which suggests that humans are motivated to distance themselves from animalistic traits in order to cope with mortality. In a content analysis of menstrual product advertisements, Erchull (2013) found that only roughly half of the images depicted women at all and, of those, most depicted idealized but largely non-sexual bodies, which “provide needed distance from realities of women’s corporeal nature that are inherent in an advertisement for a product to manage menstruation” (Erchull, 2013, p. 37). Erchull suggested that this objectification strategy could extend to menstrual suppression, although no suppression advertisements were analyzed. Interestingly, some of the open-ended responses we collected in this study seemed to invoke key aspects of the terror management literature. Particularly in the “disgust/dislike” category, some suppressing participants expressed avoidance of having to personally face the reality of menstruation; for example, one participant wrote about “not wanting to see my period” and another said “I hate being on my period. By taking 4 packs in a row I have more painful periods but it’s worth it to not have them as often.” Indeed, as mentioned above, one participant even directly mentioned perceptions of animalistic bodily realities. Although this was not a widely disclosed motivation in our sample, it is interesting to note that this theoretical framework may be acknowledged indirectly by some menstrual suppressors. More in-depth qualitative analysis may shed further light on the potential link between terror management theory and menstrual management.

We also reflect on the potential power of sociocultural context within another popular response category: sexual activity. The sex taboo associated with menstruation is so prevalent that men often believe it is a nonnegotiable rule (e.g., Peranovic & Bentley, 2017). Schooler et al. (2005) explored a model of women’s sexual decision-making wherein shame about menstruation was linked to sexual decision-making factors (passivity and risk) through body shame. They cautioned that the ability to engage in menstrual suppression does not necessarily increase sexual agency; body shame is partially caused by menstruation’s stigmatization, which is often inherent in sociocultural norms promoting the elimination of periods (Schooler et al., 2005). Certainly, the issue of sexuality and menstruation is complicated. In a qualitative exploration of sexuality and menstruation, Fahs (2011) found that negative responses to sex during menstruation were thematically tied to many factors, both physical (bodily discomfort) and shame-based (partner judgment and negative self-perception). Across these research studies, there are common trends: Where menstruation and sex intersect, there are taboo and shame. Outside of sexual activity, the influence of sociocultural context on menstrual suppression decision making may be more obscured. Most of our participants wrote brief responses, often only one or two words. In these cases, our data do not allow us to explore beneath the surface for hints about dominant values, beliefs, and stigmas.

On the other hand, we looked for—and found—a statistical link between sociocultural norms and menstrual behaviors. We believe that the association between self-objectification (specifically, body surveillance) and menstrual suppression lends evidence to the assertion that such dominant attitudes about women do indeed factor in to the decision-making process, whether consciously or unconsciously, for women who choose to suppress their periods. Objectification prompts us to view the body from the eyes of an other; the body becomes an object, which should be sexually attractive and sexually available as its main function. In fact, McMillan and Jenkins (2016) analyzed extensive interviews with women about the representation of menstrual suppression in media and found that, when discussing whether to embrace the practice, the women invoked narratives about “pleasing or conforming to the image established by one’s male partner when it came to menstruation” (McMillan & Jenkins, 2016, p. 6). The promise of menstrual suppression is the promise of a “sanitized, deodorized, and fresh bodily presentation” (Roberts, 2004, p. 22)—a body closer to an ideal object. Notably, our statistical findings were driven by the body surveillance subscale of the OBCS. This subscale focuses on the ways that one might monitor one’s body. Someone who scores high on body surveillance values the way a body appears to an outside viewer over and above its comfort, physical sensations, and bodily capabilities. A link between body surveillance and menstrual suppression may speak to how the hypothetical outsider’s vision of an idealized body influences women’s behaviors.

Though we do not know for certain why only the body surveillance subscale of the OBCS was related to suppression, we believe that this could indicate that self-surveillance may be more closely linked to menstrual management than other aspects of self-objectification. The surveillance subscale represents a woman’s tendency to view herself as an outside observer might, and monitoring herself for menstrual signifiers may be one aspect of that surveillance. Although they had no significant menstrual suppression findings in their sample of college women, Johnston-Robledo et al. (2003) found that participants who scored highly on the body surveillance subscale were more likely to view menstruation as a bothersome event and more likely to report that they “would not miss menstruating” (p. 69) if it were eliminated. From a theoretical standpoint, Wood (2020) argued that the menstrual concealment imperative is framed in media and the social sphere as an empowering choice, which prompts women to willingly engage in vigilant self-surveillance, whether that is hiding, denying, avoiding, or eliminating menstruation. Finally, Jackson (2021) found that body surveillance predicted menstrual shame, which in turn predicted support for the idea of menstrual suppression; her study did not examine the relation of the other OBCS subscales to suppression attitudes. Thus, we believe that self-surveillance may be uniquely tied to menstrual suppression, beyond the other aspects of objectified body consciousness. However, we also acknowledge that there have been no previous findings directly linking objectified body consciousness to menstrual suppression behaviors, and it is possible that our self-surveillance finding is spurious.

It is also difficult to say why long-term suppressors reported significantly more body shame than did short-term suppressors. It is possible that individuals who choose to make a long-term decision to suppress their menstruation for years into the future may experience more body shame than those who choose to suppress contextually or occasionally. Future research may clarify these potential links.

Limitations

Though our data provide important evidence for the link between self-objectification and menstrual suppression, they are limited by several factors. First, our sample showed a distinct lack of racial diversity. Though sometimes considered more representative of the general population than college convenience samples, online crowdsourced samples are typically less racially diverse than the general U.S. population (e.g., Paolacci & Chandler, 2014; Pew Research Center, 2016). In a comparison of multiple crowdsourcing websites, Peer et al. (2017) described Prolific’s ethnic diversity as “low” but found that it was generally comparable to MTurk. Prolific now offers a new feature that facilitates nationally representative samples, which could be useful in future survey studies. For more information on the benefits and drawbacks of the Prolific website, see Kothe and Ling (2019), Palan and Schitter (2018), and Peer et al. (2017). Our sample, perhaps due to sampling criteria or the crowdsourcing website used, had a greater overrepresentation of White participants than expected; this warrants caution in generalizing our research findings. Furthermore, our sample combined data from the United Kingdom, United States, and Canada. While this was a practical choice in order to collect data through the U.K.-based Prolific website, it may limit the applicability of our study.

Beyond this, our sample is limited by a shortage of long-term suppressors. There were far more short-term suppressors than long-term suppressors, and the substantial overlap between the two groups means that it is difficult to make claims about the characteristics of individuals who choose solely long-term suppression. While we took steps to work with this aspect of the dataset (i.e., collecting motivation responses separately by suppression type in order to explore motivation themes specific to each behavior), it could be useful to specifically seek long-term suppressors in future studies.

Our statistical analyses also present an important limitation. The hypothesis 2 model incorporating the OBCS scales accounted for a small amount of variance (6.7%). Future research should explore more complex models with greater explanatory power in order to clarify the nuances of choice and preference in menstrual behaviors.

Despite these limitations, this project contributes to the knowledge base about motivations for and correlates of menstrual suppression. To our knowledge, ours is the first study of its kind that shows a statistical link between objectification and menstrual suppression behaviors. The extant literature has examined menstruation and menstrual management in the context of objectification conceptually (e.g., Andrist, 2008; Erchull, 2013; Roberts & Waters, 2004; Woods, 2013), and empirical research has examined links between objectification and menstrual attitudes (e.g., Johnston-Robledo et al., 2003, 2007; Roberts, 2004; Ryan et al., 2020; Sveinsdóttir, 2017), between objectification and alternative menstrual products (e.g., Grose & Grabe, 2014; Lamont et al., 2019), and between objectification and support or willingness to try menstrual suppression in the future (e.g., Jackson, 2021; Sveinsdóttir, 2017). This body of literature speaks to objectification’s role in menstruation, and our data allow us to look at the relationship in a different light—that is, with regard to experienced behavior and motivation.

As with so many aspects of women’s embodied experiences, self-objectification is implicated here, in that higher levels of surveillance of one’s own body is related to the likelihood of engaging in menstrual suppression. Further, it appears that women engage in short- and long-term suppression for different reasons. We believe that our study raises important issues for future research and practice related to menstrual health, medical agency, and the socioculturally situated nature of choice. Decisions to engage in menstrual suppression are varied and nuanced, and personal preference in this case may involve shades of dominant discourses on blood and guts.

Acknowledgments

We are grateful to Sky Alexandra Martin for assistance with coding data and to Staci Ouch, Hannah Brown, Lucy Xie, and Bonnie Moradi for feedback on the manuscript.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported financially by the Vada Allen Yeomans endowment at the University of Florida Foundation.