Created in Whose Image? by Katherine H. Bergman

“I love it,” Kelly Barclay explains. “My friends all know all about it because I rant and rave about it.”[1] One wonders what it is that elicits such affirmative exclamations, such rantings and ravings. What Barclay is so excitedly referring to is a state of relatively constant amenorrhea induced by an experimental regimen of the birth control pill. This drug regimen is being marketed to women who wish to suppress their menstrual cycle, and thus be rid of all of its difficult and uncomfortable side effects. Though Barclay no longer dreads the intense monthly cramps and emotional outbursts that come with her period, the constant administration of oral contraceptives– which she seems to be so ecstatically and uncritically promoting to her peers – points to much deeper issues in the underlying understanding of the human person.

Given that menstruation is part of women’s normal fertility cycle, what does the desire to suppress menses indicate about the society which promotes it and the women who subscribe to such a practice? I intend to indicate that the movement to suppress menses is an unfolding of the logic of contraception, and that both (intrinsically-connected) movements are rooted in a separatistic, or dualistic, understanding of the human person. The process of seeking convenience and control for both women and society at large in these two movements finally ends up alienating the human person from her bodily existence.

The menstrual cycle, or the cycle of fertility, is particular to women. This cycle, therefore, invites an exploration of what its processes might mean for the understanding of woman. Approximately once every month, a woman passes through the entirety of her fertility cycle. In a complex series of events orchestrated by hormonal influence, a woman’s body prepares for the possibility of bearing a child within it. The details of this momentous, monthly event are worth outlining here below.

In the first moment of this cycle, the pituitary gland releases Follicle Stimulating Hormone (FSH) into the bloodstream. This triggers the growth of several follicles containing immature ova in the ovaries. Next, the dominant follicle secretes increasing amounts of estrogen which, in turn, have the following effects: FSH production decreases so that the development of other ova is suppressed, the uterine lining thickens to prepare for implantation of a fertilized ovum, and cervical glands produce mucus favorable to sperm survival. Estrogen levels then peak, and this signals that the pituitary gland is to begin releasing Luteinizing Hormone (LH) into the bloodstream.

Ovulation occurs as the follicle ruptures and releases the ovum it contained into the fallopian tube. The empty follicle forms the corpus luteum which secretes progesterone. There is a twofold effect of progesterone: to suppress FSH and LH (thus preventing ovulation again in the same cycle) and to cause the thickening of cervical mucus which then acts as a barrier to sperm. If fertilization and implantation of the ovum occur, progesterone is secreted throughout the early phases of pregnancy. If fertilization and implantation do not occur, the endometrium is shed and passes out of the body. As progesterone levels drop off, the pituitary gland begins secretion of FSH again, thus beginning another menstrual cycle. [2]

Even with just a basic understanding of menstrual physiology, one is confronted with the intricacies of a system developed to allow a woman (a) to become pregnant or (b) to menstruate and then continue with her cycle (remaining, if unimpeded, open to the future possibility of conception) when she does not become pregnant. Each step in the cycle carefully prepares for the next. Given this introduction to intricacies of the female body-person, it is surprising to hear persons, such as Brazilian reproductive health expert Dr. Elsimar Coutinho, explain that they consider menstruation to be unnecessary: “[n]ature never expected women to menstruate. Nature expected women to get pregnant when they ovulate.” [3] In order to avoid menstruation, however, Coutinho does not recommend that women become pregnant. Rather, he advises women to suppress all but four of their periods each year by taking only the active birth control pills, skipping the seven placebo pills at the end of a packet, and starting the next packet of active pills immediately. The result is that the constant influx of synthetic hormones keeps the body from shedding excess endometrial tissue. Thus the woman’s natural cycle is altered and her menses suppressed.

Such a practice, advocates claim, could be beneficial for several reasons. The first reason given, perhaps due to its direct appeal to women, is that the woman might avoid the suffering, discomfort, and inconvenience associated with her unaltered cycle. One journalist touted “[n]o cramping, no tampons, no bloating, no backaches: For many women, the concept has been nothing more than an impossible dream.” [4] This ‘impossible dream’ has ‘come true’ through menses manipulation, which purports to “drastically reduce menstrual pain and PMS symptoms, which include mood swings, food cravings, and breast tenderness.” [5] Seasonale, the brand name for the new regimen of birth control pills about which Barclay raved, will offer “not merely convenience but health benefits – a safe way to avoid cramps, migraines, bloating, crying jags, anxiety and other problems that affect them about every four weeks.” [6] The promotion of this drug regimen is also financially convenient: suppression of menstruation allows women “to forgo costly feminine hygiene products.”[7]

A second set of reasons used by promoters revolves around the longer-term health benefits of menstruation suppression. They claim that “[a]nemia, which plagues a significant portion of menstruating women, could be prevented, as could some reproductive cancers and quite possibly heart disease, which have been linked to frequent ovulation and menses.” [8]

The third of motivating rationales for ‘menses management’ is mentioned discreetly amidst the rest: it is that menstruation has a significant impact on the operating costs and efficiency of industries and big businesses. “Menstruation and its accompanying pain and suffering are estimated to cost U.S. industry about 8 percent of its total annual wage bill. One large employer – Texas Instruments – determined there was a 25 percent reduction in the productivity of its female workers during their monthly periods.” [9] The solution proposed to counter decreased productivity is to prescribe “hormones to women who want to skip monthly bleeding.” [10] This is considered to be “an easy and cost-effective way to reduce on-the-job absenteeism and individual suffering.” [11]

“Menses management”– the euphemistic reference to altering woman’s normal body processes – seems to work for everyone. Women do not suffer discomfort, are more emotionally stable, and have to deal with fewer inconveniences. ‘Big Business’ can increase efficiency and bolster profit. But the implications of this practice of menstrual suppression go much deeper than these surface indicators reveal at first glance. The implications can be better understood by looking to the movement, and the technology, that gave rise to menses management: that associated with the birth control pill.

Birth control pills or oral contraceptive pills (sometimes simply referred to as “the Pill”) are most commonly composed of a combination of synthetic estrogen and progestin which augment the natural endogenous forms of these hormones already present in the body. The mechanism of these pills alters the way a woman’s body functions by deceiving it:

The estrogen contained in the contraceptive pill contributes to the thickening of the endometrium, which breaks down when use of the pill is discontinued for several days. This results in ‘menstrual’ bleeding, though a woman on the Pill does not have a true menstrual cycle. [13] The bleeding that occurs during the placebo week is not the same as a woman’s normal cycle: “These artificial menstrual periods are most accurately called ‘hormone withdrawal bleeds’ or ‘letdown bleeds,’ to avoid confusion with true menses.” [14]

The inclusion of this 4^th week of let-down bleeding in the cycle of oral contraceptive use had its origins in the perceived preferences of women. In the late 1950's, the developers of the Pill decided to administer it in a cycle of 21 synthetic hormone pills followed by seven placebo pills so that the artificial cycle would mimic the normal four-week cycle. The motivation behind this decision was “not because it would make the Pill safer or more effective, but because researchers thought more women would be more likely to use it if they still had their menstrual period each month.” [15] As the inclusion of a period every four weeks in the birth control regimen is – as William Gibbons, chairman of obstetrics and gynecology at the Eastern Virginia Medical School has concurred [16] – arbitrary, then the further alteration of suppressing menstruation (accomplished by such drug regimens as Seasonale) accords with the initial logic behind the birth control pill.

In fact, the continuous use of oral contraceptive pills is considered to be only a slight modification to women’s typical practice of taking the Pill with its seven placebos. Linda Potter cites the regulation of the menstrual cycle as a use of the birth control pill secondary to pregnancy prevention: “Consistent use of oral contraceptive pills also regularizes menstrual cycles in frequency, timing, and amount of flow, so the Pill is sometimes prescribed specifically for that purpose.” [17] Potter thus underscores the connection between birth control pill use for contraception and for menstrual regulation. The two are not entirely separate issues: first, fertility is suppressed; eventually it becomes desirable to, on one hand, suppress all reminders of that lost fertility (menses suppression), or on the other hand, retain some vestige of that fertile state (let-down, or withdrawal bleeding).

Additionally, the use of the Pill is presupposed in the proposal of continuous use: “The practice involves nothing more than standard packs of birth control pills, which women take as they normally would except for one caveat...” [18] In this simple statement, the connection between the suppression of the menstrual cycle and the inhibition of a woman’s fertility is made explicit. It has become culturally acceptable for a woman to alter her cycle in order to achieve a practical sterility. Given this presupposed acceptance, what problem could there be with decreasing visible reminders of the fertility they have evaded? The “withdrawal bleeding” allowed by the placebo pills to prevent the stagnation of the endometrial lining (which could possibly lead to further complications such as endometrial cancer), need not necessarily correspond with a woman’s natural cycle. This withdrawal bleeding is not an indication of the healthy fertility of a non-contracepting woman, rather it is a remnant which was included for the sake of easing women’s fears about oral contraception. Not surprisingly, monthly menstruation has come to be considered merely a cultural vestige of a previous age which one may or may not cling to out of some kind of schizophrenic nostalgia for fertility.

The practices of “menses management” and oral contraceptive use (for the intended end of contraception) are not only explicitly connected in their mode of application, but are also based on some common presuppositions about the human person. These presuppositions reveal the worldview of those who subscribe to the practices. It is the argument of this paper that these presuppositions reveal a dualistic, or separatistic, understanding of the human person.

Some have called the use of contraception “an unnatural separation of powers.” [19]This estimation is rooted in the non-dualistic understanding that “the natural law concerning man derives from an essential unity in the human person. Because one reveals himself in his or her actions, this essential unity of the person carries forward into a unity of his actions, at least his conscious ones.” [20]When one acts contrary to this essential unity, it is contrary to the very unity of his nature as a human being. Natural law teaches the manner in which men and women ought to act in order to harmonize with the core of their being and with the design of the Creator. [21]

In their book, John and Sheila Kippley give the example of human communication in which there is a basic unity between what is in the mind and its outward expression. The unity of his human nature (and the order of creation) is thus respected when a person communicates, whether in written or oral form, that which he has judged to be true. Lying fractures this essential unity: “Lying is an internal separation of a communication from its power to express and generate judgments truthfully.” [22] The Kippley’s identify coital intercourse as a special form of human communication which contains specific powers: “Just as one of the powers of intellectual communication is the ability to create a new idea in the listener, so also one of the powers inherent in the human action of coitus is the power to create a new person in the womb of the mother.” [23] Contraception breaks the unity of sexual intercourse by introducing “an internal separation of an interpersonal action of coital union from the fully human generative power that is internally structured in this action by the unity of the person’s being.” [24]

In contrast to the organic unity of the individual described by the Kippley’s, the “separatist” understanding of human sexuality severs “the bonds between the unitive/amative/affectionate dimension of human sexuality and its procreative dimension, deeming the former alone as personal and human and the latter as merely a biological function, of itself subpersonal in character and of human and personal significance only when consciously willed and chosen.” [25]

Ashley Montagu holds to such a split between ‘sexual’ and ‘reproductive’ behavior. He wants to be unequivocally clear about the distinction he makes between the two: “Sexual behavior may have no purpose other than pleasure, pure hedonism or impure hedonism, without the slightest intention of reproducing, or it may be indulged in for both pleasure and reproduction.” [26] That sexual behavior may be used for multiple purposes indicates that, for Montagu, the nature and purpose of sexual intercourse is determined by subjective intention– that is, by the intention of those subjects involved in the act. The consciousness of the human person applies a meaning to the physical act, whose purpose is not assumed to be intrinsically related to its objectivity. To hold that meaning is given by the person from outside the act itself is to place the person outside the act. The person – expunged from a truly integrated bodily involvement – interacts with the body as if it were an instrument. This separation between the body and the person is characteristic of separatism or dualism.

The separatist understanding is compatible with belief that male/female differences occur only at the anatomical or biological levels. [27]“For the separatist, then, a person is a conscious subject of experiences that possesses a body.” [28] The idea of possession conveyed here indicates the separation of the person from his body: the person has the experience of being within either a male or a female body structure. Thus, the separatist understanding “not only separates the relational, interpersonal meaning of sexuality from its biological, reproductive meaning but it also separates the person from his or her body.” [29] Thus, consonant with separatist thought, Montagu believes that in sexual intercourse, the acting body (in his reduced understanding of body as instrument) may equally be made use of for orgasmic pleasure, for the communication of affection, or for conceiving a child according to the will of the person.

According to William E. May, proponents of a separatist understanding agree that “the reproductive dimension of human sexuality is, of itself, biological and therefore of functional and not personal value, although it can, of course, become personally and humanly significant when it is ‘assumed into consciousness’ and freely and responsibly chosen.” [30] The separatist approach denies the body an objective meaning by placing absolute determination of meaning within the subject. Separatism promotes the idea that the human person is to control his body in an instrumental way. Oral contraceptive use has encouraged this improper dominion in the realm of fertility. The very same pharmaceutical developments which have allowed for the suppression of fertility have given women the option of suppressing the menstrual bleeding which is a sign of that fertility. This approach fosters a very particular view of humanity. If the body is merely an instrument which is to serve the person, then modification or development of that instrument to better serve the desires of that person (whatever those desires might be) is acceptable and encouraged. Man may re-make his body in whatever image he so chooses.

Hester M. Songer, a clinical instructor of obstetrics and gynecology at Temple University School of Medicine in Philadelphia, elucidates the anthropology which underlies the movement for increased suppression of menstruation: “We’re talking about giving a woman the ability to exert even greater control than she ever has before, freeing her up from the nuisance, uncomfortable, messy business of menstruating.” [31] In other words, a woman can exert even greater control over her body. She becomes even more free the more she distances herself from normal body processes. Herein lies a split between the woman as active rational agent and woman as embodied-person. Woman controls her body by treating it as an object to be manipulated at will. Indeed, there ought to be a proper sense of self-mastery in human action, but this proper sense must integrate the body with the person from the very beginning.

In a dualistic approach, inconveniences associated with our bodily mode of being are to be eliminated insofar as is possible. The implication is that humanity ought to rise above bodily existence. A woman’s fertility has become a ‘problem,’ and so she must be rendered sterile by oral contraceptives. The mess, the suffering, and the rest sometimes required by a woman during her period are an inconvenience to the woman and society at large, so menstruation must be eliminated. A reflection on the marketing techniques for menstrual management discussed above is apropos at this point. The benefits proposed for the suppression of menstruation included “no cramping, no tampons, no bloating, no backaches,” [32] not to mention that the elimination of that added nuisance for employers – absenteeism and decreased on-the-job productivity. Woman’s body, as given, is problematic. Menstruation is a hindrance that prevents woman from functioning without interruption in her productivity. In order to “fully participate” in what has become normative for post-industrialized culture, she must make her body like a man’s. The natural rhythms of her body are considered an inconvenience and an obstruction to her full participation in a career, or in any of her other societal roles. When the practically sterile, menstrually suppressed woman becomes normative, it can no longer be denied that society refuses to accept woman precisely as woman. It will only accept her insofar as she is willing to modify her person (including her body) to fit with societal expectations.

The refusal to accept woman as woman is evident in the treatment of menstruation as a disorder. Researchers Sarah Thomas and Charlotte Ellertson criticize the belief that menstruation is natural: “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.” [33] Hypertension is a condition in which blood pressure is abnormally high— it is a disorder. Menstruation is not a disorder. Unless some intervention – in the form of synthetic hormones, abnormally low body weight, or illness – disrupts her cycle, a healthy, non-gestating woman will shed the excess tissue of the endometrial lining of her uterus at regular intervals. Continuous use of oral contraceptives treats the woman’s healthy body as deviant. To call such a practice “just another medical therapy,” or to liken it to continuous, daily management of hypertension, is to make a judgment about woman in her body-person. The way that our body functions without deliberate interference is no longer considered to be natural. Woman, as she was created, ovulates and menstruates: the presupposition that this process need be artificially altered – the woman’s body tricked to suppress her normal cycle – ought to be exposed and evaluated carefully.

Continuous use of oral contraceptive pills, with the intention of suppressing menstrual bleeding, presupposes that humanity is to control bodily existence and may manipulate the human body by chemical and mechanical means even if this manipulation is not in response to a bodily disorder or illness. We ought to medicate bodies, not to alter them, but to return them to the fullness of health. To do otherwise indicates a false sense of human development based on the instrumentalization of the body — the idea that the human body is somehow a separate entity from the human person over which that person has absolute dominion. The instrumentalization of the human body follows from initial step of separation between the body and person.

In conclusion, it is interesting to note that even given the possibility of suppression of menses, most women choose not to suppress them. In noting this, Potter notes a kind of schizophrenia. This schizophrenia, this dis-integration in the self, is a sign that we do not make ourselves. There is something about the desire to retain some fragment of the menstrual cycle that indicates that, even though it is possible to modify our bodily selves, our bodies were created with a particular design. The longing for menses perhaps points in the direction of that original design. In a way, Potter is right. The cycle created by the Pill is a false cycle. These women are not really menstruating, yet they wish to hold onto some vestige of their true cycle. They seem to have some implicit understanding that their fertility and all of its cycles and signs has something important to do with what it means to be a woman:

This hesitance to be rid of the normal ways their bodies function indicates that, on some level, women still understand that they are not persons using their bodies, but are themselves body-persons.

The unity of the body and the person is what indicates to us that we ought to be treated as a unity.

Richard Hogan, in his commentary on the audiences of Pope John Paul II concerning the body and Christian marriage, underscores the unity within the human person. The body with the soul forms the human person. Due to the deep intrinsic unity in which a human person is formed, the body is able to reveal, to express, the person. Dualistic or separatistic approaches to the human person obscure this foundational truth. “Contrary to some current beliefs and practices,” writes Hogan,

The body of a woman has much to say about who she is. When the language which the body speaks is stifled by contraceptive or ‘menses management’ movements, we all lose a crucial understanding of who woman was created and destined to be.

Billings, Evelyn and Ann Westmore. The Billings Method: Controlling Fertility without Drugs or Devices. New York: Ballantine Books, 1980.

Flynn, Anna M. and Melissa Brooks. A Manual of Natural Family Planning. London: Unwin Paperbacks, 1988.

Hogan, Richard. “A Theology of the Body.” Fidelity 1.1 (December, 1981) 15-19, 24-27.

Joyce, Mary. The Meaning of Contraception. Staten Island, New York: Alba House, 1970.

Kippley, John and Sheila. The Art of Natural Family Planning. Cincinnati, OH: The Couple to Couple League International, Inc., 1979.

May, William E. Sex and the Sanctity of Human Life: The Truth of Catholic Teaching. Front Royal, Va.: Christendom College Press, 1984.

May, William E. Sex, Marriage, and Chastity: Reflections of a Catholic Layman, Spouse, and Parent. Chicago: Franciscan Herald Press, 1981.

Montagu, Ashley. “The Pill, the Sexual Revolution, and the Schools.” Sex, Man, and Society. New York: G. P. Putnam’s, 1969.

Potter, Linda S. “Menstrual Regulation and the Pill.” Regulating Menstruation: Beliefs, Practices, Interpretations. Van de Walle, Etienne and Elisha P. Renne, eds. Chicago: University of Chicago Press, 2001.

Sevrens, Julie. “Menstruation obsolete, doctor says.” Pensacola News Journal. 10 September 2000. P. 3B.

Stein, Robert. “Experimental Pill Puts Menstruation on Hold; Seasonal Expects FDA Approval Soon.” The Washington Post. 3 March 2003. Sec. A, p. 1.

8. Ibid. Though it is not within the scope of this paper, it is worth noting that the long-term health benefits claimed above for the Pill must be weighed against the harmful effects of prolonged use of the Pill. As Evelyn Billings and Ann Westmore point out: “The Pill indisputably does what it claims to do – it prevents pregnancy. But as well as fulfilling its professed function, the Pill can do many other things – some of them very unpleasant – to your body.” (Evelyn Billings and Ann Westmore, The Billings Method: Controlling Fertility without Drugs or Devices (New York: Ballantine Books, 1980), p. 162.) They also explain that no organ in the body is immune from the effects of the Pill. There are in excess of thirty known side effects which range from an increase in formation of blood clots (thrombosis), liver tumors, birth defects, and high blood pressure to menstrual irregularities and post-pill infertility. These are documented by such leading medical organizations as World Health Organization and the US Food and Drug Administration (Billings, p. 162-172). The Pill is also implicated in an increased possibility of infections, migraines, diabetes, weight gain, depression, irritability, and a loss of interest in sex (Billings, p. 171).

12. Linda S. Potter, “Menstrual Regulation and the Pill,” Regulating Menstruation: Beliefs, Practices, Interpretations, eds. Van de Walle, Etienne and Elisha P. Renne (Chicago: University of Chicago Press, 2001), p. 141. Emphasis added.