“Offensive” feminine-hygiene-product ads put changing attitudes to periods in the spotlight.
Although the fuss says a lot about attitudes to menstruation, there are bigger problems facing makers of sanitary products. Sales of tampons are declining – in the UK they dropped by a quarter over four years and supermarkets have reduced the amount of shelf space devoted to them. In part, this may be down to the availability of other choices, such as menstrual cups, but the main reason seems to be that women are giving up altogether on the whole messy, inconvenient business of having periods.
“It is relatively easy to get rid of them and it is not a bad idea,” says Auckland gynaecologist Cindy Farquhar.
Read more: Are menstrual cups safe?
Many women taking the combined contraceptive pill – which contains the hormones oestrogen and progesterone – do so without a break, reducing the number of periods they have, perhaps scheduling in just a few each year. Since the pill prevents ovulation, more accurately these are withdrawal bleeds rather than genuine periods, and the latest advice is there is no medical need to bother with them.
Updated guidelines from the Faculty of Sexual and Reproductive Healthcare in the UK are that it is safe for women to continuously take the combined pill, and there is no health benefit in the traditional seven-day hormone-free interval.
It is likely that women today menstruate far more than previous generations did, since puberty is starting earlier in the developed world and women are having fewer pregnancies.
“My great-great-grandmother had 10 children,” says Farquhar. “If she started menstruating at 16 and stopped at 50, and breastfed for two years, she would have had something like 11 years of periods in her lifetime.”
Today, women have about 400 periods in their menstruating years and there are plenty of downsides. Unpredictable bleeding is difficult to manage. Women with heavy periods often suffer from anaemia. And sanitary products are expensive – a survey conducted by KidsCan last year found more than a quarter of New Zealand women had missed school or work because they couldn’t afford to buy pads or tampons.
Pushback is happening, with some feminist activists advocating that women should embrace their periods and work with their natural cycle, rather than trying to suppress it.
In her book Period Power, UK health practitioner Maisie Hill writes: “There are many, many benefits to experiencing the richness of the menstrual cycle.” However, even she admits that for some women it might be a little too rich at times and they may prefer to turn off their cycle.
Intrauterine contraceptive devices Mirena and Jaydess are another option to reduce the flow of blood and for about a third of users the bleeding stops altogether.
“Most women find this a happy place to be,” says Farquhar. “But some do come back and say they want to have periods. They may feel it is reassuring or a natural part of being a woman.”
Others worry that not regularly shedding the lining of the womb is unhealthy and think it pays to cleanse the body now and then, but Farquhar says this isn’t the case.
“There is not a particular amount of blood that needs to come out every month. It stays in a steady state when you’ve got both hormones, progesterone and oestrogen.”
Although taking the combined pill continuously prevents bleeding, Farquhar says it doesn’t always improve the mood disorders associated with pre-menstrual syndrome.
“This is poorly understood,” she says. “I do find that if you eliminate the regular cycle, you can improve the situation, but in clinical trials it hasn’t been proven to make a difference.”
She says the best remedy for pre-menstrual tension is a mild anti-depressant. “That’s the way I’d tend to go for many women.”
This article was first published in the October 26, 2019 issue of the New Zealand Listener.