2. Suppressing Histories: On the Womaning of Bleeding

Gendered Materiality and the Womaning of Bleeding

The flattening of menstruation into an experience correlated with womanhood is not only transphobic but also an age-old sexist tactic used time and again for conflating what bodies do with who bodies are. Feminist and queer scholars of science, for example, draw attention to what Sarah S. Richardson describes as “the gendering of objects of biological study” such as the conflation of the X chromosome with “female,” the paralleling of the sperm and the egg gametes with men and women, as Emily Martin memorably writes about, or the gendering of sex hormones such as estrogen and testosterone (Richardson 2012, 909; Martin 1991; Oudshoorn 1994). Richardson discusses this gendering of biology as a “gender-ideological bias in science” that is also a “highly gendered screen upon which cultural theories of sex and gender difference have been projected” (2012, 910, 927). While chromosomes, gametes, and hormones are arguably different from menstruation itself—in that menstruation is a process relying on multiple components of the body rather than a component of the body in itself such as chromosomes, gametes, and hormones—I nonetheless see similarities in how menstruation is called upon to act as material proof of gender. As Hasson writes, “Menstruation has long served as a central aspect of essentialized, biological understandings of sex difference . . . serving as a marker of biological sex and thus a site of the production of gender on the body” (2020, 765). In turn, menstruation is called forth to gel gender, gel a gender binary, and gel womanhood, not to mention to associate gender with a host of ideas about the menstruating body. This, then, is the “womaning of bleeding.”

The first way in which I see the womaning of menstruation taking place is through a commitment to woman-centric language around bleeding, as Rowling’s tweet points to. This language appears virtually everywhere, from scientific and feminist studies on menstruation to popular culture and common parlance. The feminist need to commit menstruation to womanhood deserves its own analysis, but suffice it to say that it takes place for reasons that might include: to assert that historically people who menstruated were considered women, thus menstruators qua women is a historical category of analysis; to emphasize that so many women do indeed menstruate at some point in their lives that this correlation is logical; to uphold group solidarity of womanhood as a disaggregate community of bodies that is overwhelmingly characterized by the difficulties (and perhaps joys) of bleeding at some point in their lives; or to draw attention to the inequity and disenfranchisement around menstruation—such as through period inequity, period poverty, menstrual negativity, and so forth—and how it aligns with sexism, misogyny, and varied geopolitical discriminations against women. The last of these is the commitment we could generously say Rowling is gesturing to in her tweet, the idea that by moving toward gender-inclusive language, we are somehow moving away from being able to recognize women as an oppressed group of people with a specific set of common characteristics, such as monthly menstruating.

But is this so? Does opening up the language of menstruation beyond the language of womanhood actually do harm to cisgender women who are bleeders? Does an inclusive language around menstruation make it more difficult to account for misogyny and sexism in relation to bleeding? I would suggest that this is not necessarily the case. Menstruator-first language is trans-inclusive language, and it also reflects the biological fact that people across genders can and do menstruate; in this sense, menstruator-first language is actually richer in description and possibly more precise, more accurate than woman-bound models of menstruation. But even more so, menstruator-first language does not close the door on the other observable fact that many women do menstruate—it does not deny this fact and thus cannot be seen as hostile to cisgender women as it is imagined to be by Rowling’s paranoid reading. In this case, the womaning of menstruation through woman-affixed language must be read as a fear, anxiety, and discomfort around the trans and gender-capacious possibilities around menstruation. Rowling’s post and the refusal to use gender-inclusive language thus speaks to a certain fear: that if women have been historically oppressed through menstruation and have only recently shifted the story so that even menstrual product companies now advertise bleeding as a “positive” occurrence, then the broadening of menstruation to gender-inclusive language will rob these feminist successes in shifting the narrative. But again, I disagree with this fear echoed in Rowling’s tweet. Shifting to menstruator-first language does not erase the work of reconceiving of menstruation on positive terms; indeed, it might even amplify such projects through asserting that menstruation could be a desirable occurrence for people across genders. Further, not only is woman-centered language less precise, but it also reinstates a reductionist reading of gender. Insisting that menstruators are women revisions a bodily process on gendered terms, seeking proof of binary gender in the stuff of the body. Why must blood be called on to act as proof of womanhood?

This relates to the second womaning that takes place around menstruation, similar and linked to the first but also distinct. This second womaning involves the situating of menstruation as part of “being a woman.” Here, rather than assuming that menstruators are women, the assumption is that to be a woman is to menstruate. Let me provide some examples to help clarify. In their essay considering whether menstrual suppression is a feminist technology, Jennifer Aengst and Linda L. Layne (2010) draw on menstruator responses from the online Museum of Menstruation and Women’s Health (MUM). On MUM, visitors were asked whether they as menstruators would like to stop menstruating if it would not affect their fertility. Many of the respondents who were anxious about menstrual suppression called on the idea of menstruation as making the stuff of a woman. For example, “A thirty-six-year-old woman says she would never give up her period. . . . ‘The power that resides deep within me, connecting me to all women who have lived before, and all to come’” (Aengst and Layne 2010, 67). Other responses included: “To suppress menstruation is to suppress being a woman”; “It’s a wonderful experience of womanhood. It makes us different from men”; “It’s what makes us special”; and “I feel like it is a bond with all women. . . . It assures me that I am healthy and similar to half of the earth’s population” (67). On the one hand, these comments emphasize the impact of a positive revaluation of menstruation as something meaningful and joyful in a context of menstrual negativity. On the other hand, it is indeed striking how menstruation is directly utilized to form imagined bonds with other menstruators under the class of global and time-immemorial sisterhood, to assert normalcy, and to uphold a gender binary. Importantly, menstruation surfaces in these narratives as something that is emblematic of being a woman and perhaps also as something that rules out those who do not menstruate from the category of shared womanhood, upholding youthful, cisgender, and nondisabled narratives of the womanly body. Indeed, the initial introduction of the week of placebos to sell oral contraceptives had in mind this goal. Offering control of reproduction to its users, contraceptives introduced monthly bleeding to mimic the period as a way of not further challenging notions of what it means to be a woman: “The idea that monthly bleeding would make oral contraceptives more acceptable depends on the medical and popular belief that regular menstrual cycles define ‘normal’ women’s bodies” (Hasson 2020, 767). While retaining reproductive control, users of the pill have been frequently called upon to bleed regularly, to maintain some semblance of their bleeding bodies, and to use hormones in ways that are potentially less devastating to ideas of what it means to be a woman.

I also want to mention that while the narratives I shared from MUM revalue menstrual womanhood on positive terms, the reduction of menstruation to something that is part and parcel of being a woman can cut the other way and be used to condemn women to menstruation. For example, discourses around period pain as something that is simply part of the bleeding experience draw on this logic that to be a woman is to menstruate and to menstruate is to suffer. Menstruation has been used throughout history to put women in their place, to exclude them from public spaces, and to reduce complex humanity to bleeding. We can recall that menstruation has been used as an outward symbol of womanhood as failure, difference, inferiority, impurity, an “outward sign of female inferiority” (Aristotle quoted in Verbrugge 2000, 70; Johnston-Robledo and Chrisler 2013; Martin 2001). While resignifying menstruation on positive terms is important and valid, doing so through the vector of womanhood is reductive and also harmful to women. Womanhood is not defined by menstruation, nor should it be.

Third and finally, the womaning of menstruation takes place through the allotment of menstruation not only through woman-centric language and the assessment that to be a woman is to menstruate but also through the assignment of bleeding as “woman’s duty,” her particular challenge and lot in life. While similar to the second and implied in the first way menstruation undertakes a gendering, the duty argument is frequently all the more frustrating because it prescribes to menstruators, as well as to women, specific reproductive functions. Menstruation is understood as perhaps painful, uncomfortable, and disgusting but also as necessary and grounded in very outdated but persistently present ideas of women’s lot in life as one of suffering. As surgeon and professor of midwifery Harold Beckwith Whitehouse framed it in the early twentieth century, “Periodic uterine haemorrhage is one of the sacrifices which women must offer at the altar of evolution and civilization” (quoted in Sanabria 2016, 71). The idea that the body must menstruate and must reproduce as some sort of obligation to patriarchy or the nation-state is grounded in antichoice rhetoric rooted in ideas of binary essentialism. Because, while it is not a value judgment that some people menstruate, to suggest that it is an assignment, a task, a calling, in a context of profound menstrual inequity, a lack of access to menstrual gear, the high costs of menstrual products, an inattentiveness to pain, and the efforts to silence even talk of menstruation (as with recent efforts in Florida to prevent talk of bleeding up to grade six) is to assign to menstruators a lot of suffering (Friedman 2023). This ties into Gloria Steinem’s famed 1978 mens-ifesto where she outlines how “characteristics of the powerful, whatever they may be, are thought to be better than the characteristics of the powerless” (1978, 110). With the menstrual duty perspective, menstruation is not only a characteristic, however; it is an expectation, an assignment. Also, and ironically, we will see how the “women’s duty” argument of the womaning of menstruation is present in some discourses around reducing bleeding and menstrual suppression. The duty perspective directly feeds into right-wing and populist control over bodies, especially the bodies of trans people and those who can become pregnant. This womaning suggests that cisgender women must reproduce and remain ready for reproduction and that in order to reproduce they must menstruate. Drawing on a material understanding of the reason menstruation takes place—that is, to eliminate endometrial tissue in the uterus if no pregnancy has taken root—a woman’s duty lens is deeply misogynist in its utilization of cisgender women’s bodies for reproductive purposes.

Kate Manne argues that “misogyny upholds the social norms of patriarchies by policing and patrolling them; whereas sexism serves to justify these norms—largely via an ideology of supposedly ‘natural’ differences between men and women” (2018, 88). In this sense, while woman-affixed language around menstruation and the assessment that to be a woman is to menstruate might be instances of what Manne classifies as sexism, frameworks that bind menstruation to duty instrumentalize women for purposes beyond their own bodies and agencies, corresponding with her definition of misogyny. In practice, I think the three ways in which the womaning of menstruation takes place are overlapping, misogynist, and sexist, as well as transphobic, ascribing a gendered materiality to a bodily event that, in truth, has no gender. Yet the duty-to-menstruate argument, wrapped up in narrowing reproductive rights, does speak to one of the key features of misogyny Manne discusses—namely, the expectation that women exist to provide services to others, be it emotional labor or reproduction.

While it may be hard to imagine what a break from womaning would look like for menstruation, it is valuable to understand that biological processes are gendered to support particular systems. In this case, the biological occurrence of menstruation is gendered of and only of women in dialogue with sexist, transphobic, and misogynist worldviews. Menstruation is called upon as material proof of gender, as evidence of so-called natural bodily difference to gel gender into being. The idea that menstruation is not in itself of any one gender is deeply frightening to both a gender binary system and expectations of who women are and what they should be expected to do for others.

Menstrual Suppression According to Coutinho’s Thesis of Menstrual Obsoletion

What I hope to show in the subsequent sections is that while menstrual suppression is a necessary and potentially life- and trans-affirming technology, arguments for suppression can still be rooted in misogynist and transphobic discourse, as well as in an anxiety around gender and the unmaking of gender. In other words, menstrual suppression can still be grounded in some of the same ideas, or approximations of the same ideas, I raised around the womaning of menstruation, including the attachment of bleeding to women, the idea that womanhood is defined by bleeding, and the duty argument around bleeding and reproduction.

The most widely known discourse around the medical value of menstrual suppression stems from Brazilian scientist and gynecologist Elsimar Coutinho, who played a role in the development of Depo-Provera and wrote the book titled, in its English translation, Is Menstruation Obsolete? (1999). Coutinho’s work has been central to spreading awareness around menstrual suppression as a possibility and has also helped craft a culture in Brazil that is more amenable to prescribing extended-regimen contraceptive pills (Sanabria 2016, 72). The first of Coutinho’s axioms is that menstruation is a modern invention. Coutinho begins his book with this very axiom, writing that “contrary to common belief, regular monthly menstruation became part of a woman’s life relatively recently in the historical presence of humans on earth. . . . It is reasonable to assume that at the dawn of the human epoch women menstruated rarely or not at all—it would have been extraordinary for a woman to menstruate regularly” (1999, 1–2). Coutinho claims the reasons why, in the past, women (his language) did not menstruate as frequently as they do now include that they were more often pregnant, lactated for longer, and died younger during pregnancy and childbirth, reducing their total number of cycles and bleeding days. As he writes, “Many would be successfully inseminated at their first ovulation. They would never experience regular menstruation but would continue to be amenorrheic (free of menstruation) during pregnancy and breast-feeding, just as they were in infancy and adolescence” (65). Hence, supposedly over time as “women reproduced less, they menstruated more often” (5). Stemming from the faux-evolutionary ideas around bleeding’s shy presence in humanity’s history, Coutinho develops the thesis that menstruation is unnatural and new and that “recurrent menstruation is unnecessary . . . a needless loss of blood” (159). Further, Coutinho sees monthly bleeding as a cause for concern and even a health risk, since it fuels endometriosis, dysmenorrhea, and fibroids, as well as asthma, insomnia, arthritis, and epilepsy (81, 159). Coutinho in turn reads oral contraceptives one-dimensionally as offering impressive health benefits in addition to supposedly curing menstruation.

Importantly, as Sanabria discusses in her ethnography of menstruation and menstrual suppression in Bahia, Brazil, Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil (2016), “the historical and anthropological records on the frequency of menstruation are anything but clear” (74). For example, the evidence Coutinho provides for why people menstruated less include “the supposition that paleolithic woman would have spent most of her life pregnant or breast-feeding [which] is reinforced by anthropologic evidence indicating that the number of males exceeded females by the proportion of three to one” (1999, 65), hardly compelling evidence. Ideas around ancient menstruators, such as those that form the base of Coutinho’s thesis, partake in “paleofantasies” that involve ungrounded notions about the past filtered through narrow conceptions of gender and heterosexuality (Leslie Aiello quoted in Zuk 2013, 5; Sanabria 2016, 101). Laura Jones, writing on what she terms “paleo-rhetoric,” argues that it assumes bodies are unchanging and unaffected by culture throughout history (2011, 136). As Jones argues, “The idea underlying these paleofantasies is that via a return to an idealized, prehistoric past, balanced health, both mental and physical, can be attained” (142). While paleofantasies are often applied to diets, they are surprisingly also found in Coutinho’s and similar work pertaining to menstruators (Jones also discusses the work of Patricia Sulak and Leslie Miller). Menstrual suppression is leveraged for Coutinho as, at its heart, a method of the womaning of menstruation, seeking to return “modern women” who experience upward of 450 cycles in a lifetime to the operations of the “ancestral women,” in vague and ill-defined terms (Coutinho 1999, 2). The womaning of bleeding takes place not only through a fantasy of bleeders as necessarily women but also through an even deeper fantasy of the origin woman, of Eve, who “did not menstruate” because she was too busy reproducing, lactating, and dying in childbirth (Coutinho quoted in Sanabria 2016, 2). The nonmenstruating Eve paleofantasy speaks loudly to an anxiety around both gender and menstruation—namely, the anxiety that women are reproducing less.

Coutinho’s discourse of menstrual suppression supports and breeds a culture of menstrual negativity, informing negative ideas around bleeding—such as that it is dirty, unhealthy, linked to failure, and unnatural—and that these ideas, in turn, stigmatize bleeders themselves. Coutinho certainly makes menstruation out to be a pathology in ways that are curiously linked to misogyny and retrench the idea of bleeders as necessarily being women (1999, 127). What is especially striking for me is that, while on the surface Coutinho’s thesis stems from a concern with menstruators’ pain and a desire to reduce such pain, more internally it hones a fantasy of a primordial origin woman who might not be a menstruator but who is certainly a body mired in the realities of ceaseless reproduction. In this sense, while womanhood is not defined for Coutinho in terms of menstruation, it nevertheless remains defined in terms of the capacity to reproduce and thus falls into the third category of the womaning of menstruation as a woman’s duty, necessary to serve nature, the species, community, nation-states, and heterosexuality. In this sense, reproduction replaces menstruation as the defining element of being a woman; woman as reproducer replaces woman as menstruator.

Coutinho also shows a secondary interest in making sure that periods do not affect worker productivity or the lives of those around menstruators. While discussing the pain that menstruators might experience, as well as changes in mood, he expresses concern at how mood changes “can affect not only the woman herself, but also those around her . . . [causing] marital conflicts, mistreatment of children, aggressiveness at work directed indiscriminately toward subordinates and superiors alike, excessive food intake, and alcohol abuse. Paranoia toward friends and relatives, loss of a job or promotion, separation from a husband, divorce, suicide attempts, and other acts of violence” and “inattention to cooking recipes, failed examinations, tardiness at classes or meetings, low marks at school, involvement in car accidents, mishaps at home or work, even committing crimes or felonies” (1999, 70–71). While he is also citing other literature in this litany of alleged failures menstruators bring forth on the world, I want to emphasize that in this chapter Coutinho clearly discloses that rather than only being concerned with the difficulties menstruators experience, he is equally if not more concerned with the difficulties they impart on others, writing, “Clearly, PMS can be an extremely serious problem for the patient and for those around her” (71). Notably, while little has been written on pain and menstruation, a small cottage industry exists on the topic of premenstrual syndrome (PMS) and PMS looms large in the cultural imaginary as the reason for why menstruators are unreliable, undependable, mercurial, and incapable of occupying positions of authority or leadership. Many feminists argue that because “PMS has such a wide range of symptoms . . . its coherence as an actual syndrome falls apart” (Przybyło and Fahs 2018, 212; Chrisler et al. 2006; Chrisler and Caplan 2002; Markens 1996). PMS-related language, including that exhibited by Coutinho, tends to distract from the pain and difficulties related to bleeding because it often focuses more on how bleeding affects others and also fails to name the embodied experiences of pain, dysphoria, and discomfort menstruators experience (Przybyło and Fahs 2018). PMS language, often trafficking in stereotypes against both women and menstruators, thus can distance the reality of pain from the menstrual experience and conceive of menstruation as a problem for others.

Coutinho also expresses some interest in reducing menstruation as a way to increase women’s (his language) contributions to society—that is, their productivity. He targets menstruator “absenteeism” from work and expresses concern with how menstruation and PMS “can diminish the quality of her work” (1999, 73). Apparently, “the forty-eight hours preceding menstruation are the most dangerous because this is the time when most accidents occur. The reduction in mental alertness and difficulty in concentration explain computer glitches, typing errors, filing mistakes, and coffee spills—problems that plague many office workers” (74). Notice again how the concern is invested not in the embodied difficulties associated with being a menstruating body, such as with pain, or in being asked to work despite and with pain but rather in the greater losses to society, be they workplace or family related. As I reflect with Fahs, a focus on PMS often has the effect of “obfuscating the pain element of periods,” of “minimiz[ing] the impact of menstrual negativity on women’s and other menstruators’ lived experiences,” and of failing to explore “the connection between menstrual pain and psychological menstrual distress” (2018, 207, 212). Coutinho’s focus on PMS, as well as his sheer interest in how it affects both the workplace and others, might thus be another giveaway that his vision of menstrual suppression is not invested in either the experiences of menstruators or in questioning gender in relation to bleeding.

Hence, Coutinho’s thesis of menstrual obsoletion and support of menstrual suppression do not in any way actually ungender menstruation; they only migrate it to a state unnecessary if not used in service of reproduction, retrenching gendered materiality. Menstruation is inconvenient, he holds, on many fronts, as well as evolutionarily unnecessary, and he advocates for suppression on these grounds. Suppression is intended not to question how gender is made, or even women’s roles in society, but rather to return gender to its natural, material, ancient origin of reproduction. Sanabria argues that technology is called upon for Coutinho to return to menstruators’ “natural” state of reduced bleeding (2016, 76). Thus, menstrual suppression or “hormonal intervention is mobilized as a means to mold the body back to a purportedly original state” (102). While menstruation is rendered unnecessary and, indeed, pathological, it is only so due to the greater purpose of the uterus as a vessel of reproduction. Reproduction and lactation, it turns out, over and above menstruation, constitute the true cult of being a woman. Menstruation, in this sense, is an example of how humans got lost on the path of modernity, forsaking their true material genders, with women forgetting their origin function as reproductive and lactating—rather than menstruating—bodies. Rather than ungendering bleeding, Coutinho’s promulgation of menstrual suppression, his thesis of menstrual obsoletion, shows how menstruation can act as a conduit for anxiety around both the questioning of gender and women’s roles in society.

Womaning through Suppression: Seasonale and Menstrual-Suppression Birth Control

I move now to consider the popular brand of menstrual-suppression birth control Seasonale and how it is embroiled in the womaning of bleeding. I do so with an interest in how it is possible that a technology that can be life- and trans-affirmative, as well as reduce severe pain for millions of menstruators, continues to be caught up in narrow gender fantasies around menstruation. Seasonale, developed by Duramed Pharmaceuticals, is a hormonal contraceptive containing both progestin (in the form of levonorgestrel) and estrogen (in the form of ethinyl estradiol). Approved in 2003 by the FDA, in addition to being a contraceptive, it is commonly advertised as a form of menstrual reduction, decreasing periods from twelve to four a year, corresponding to the four seasons. Users take Seasonale in three-month cycles of twelve weeks, with withdrawal bleeding in the thirteenth week. In addition to Seasonale, many similar extended-regimen pills have been in circulation for the last two decades, including Seasonique, Introvale, Jolessa, Lybrel, Quasense, and Amethyst, though Seasonale was the first of its kind. Rather than being advertised as a form of menstrual suppression, Seasonale is advertised as menstrual management and presented as a way for menstruators to have more control over their menstruating bodies, including decisions over when they will schedule their withdrawal bleeding. As the branding slogan suggests, “Fewer Periods. More Possibilities.” It is important to add that at its inception, Seasonale did not really present users with any new technology, as menstrual suppression was already at the very heart of oral contraceptives, when taken month-round; with the first hormone-based oral contraception advertised and suggested as a form of menstrual management, to treat menstrual disorders, rather than for birth control per se, “menstrual suppression was thus always a possible use for the pill” (Hasson 2020, 764). That menstrual suppression has not always been advertised as part and parcel of hormonal contraception and that this off-label use is not always known to users speaks to the degree to which menstrual suppression is culturally feared, especially in the United States and Canada, both because of how it might desuture womanhood from menstruation and for how it might transform what it means to be a menstruator.

Thus, in order to make menstrual suppression in the form of Seasonale sellable, rather than threatening, to both consumers and doctors, strategic branding positioned it as a tool of managing rather than eliminating periods. Like Coutinho’s thesis, Seasonale traffics in the idea that having fewer periods is healthier and more liberatory. Touted health benefits include that bleeding less is healthy in itself (echoing Coutinho), that it reduces breast and endometrial cancer, and, importantly, that it reduces pain. Very rarely are potential side effects of the drug mentioned, as I will discuss shortly. Some feminist scholars argue it can be considered a “lifestyle drug” “that promise[s] a refashioning of the material body with transformative, life-enhancing results” (Mamo and Fosket 2009, 925). This is true in relation to how it is advertised and branded, pivoted less as a form of pain reduction or an essential option for menstruators and more as a drug that can enhance one’s life and eliminate the supposed inconvenience of monthly bleeding. In the positioning of health goals as a branding method, Seasonale also enacts what scholars of recent decades articulate as an increased interest in optimizing health through “healthicization” or “healthism” (Conrad 1992; Crawford 1980; Metzl and Kirkland 2010). Robert Crawford describes healthism as a “preoccupation with personal health as a primary—often the primary—focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles . . . [and] seen to lie within the realm of individual choice” (1980, 368). Healthism positions the achievement and pursuit of “health” as a moral good in itself (Conrad 1992, 223). While, as I have made clear throughout, I indisputably support access to menstrual suppression as a form of trans-affirmative and pain-relieving care, Seasonale’s branding of less—but still some—bleeding as in itself “healthy” is caught up in harmful ideas around menstrual management as a necessary obligation of menstruators. Laura Mamo and Jennifer Ruth Fosket argue that Seasonale “co-opts the language of empowerment, taps into the desire for freedom, and repackages it into a pharmaceutical” (2009, 940). Seasonale draws on discourses of menstrual negativity as well as on menstruators’ legitimate concerns about the burden of menstrual management and pain in order to suggest the reduction of periods as salutary. In addition to this, Seasonale, similarly to the menstrual product ads I discussed in the previous chapter, co-opts discourses of liberation to sell menstrual management to bleeders.

Seasonale is also entwined with ideas of the womaning of bleeding. Its early ads, discussed by feminist scholars such as Mamo and Fosket, portray white, thin, youthful, nondisabled femininity, clad in white airy garments (2009). These materials are suggestive of the target vision for what a menstruator should look like, demonstrating that semantic blurring of woman and menstruator I discussed. While it is not unusual for contraceptives to uphold a woman-affixed language when it comes to menstruation, or for discourses around menstruation more broadly to use such language, this approach continues to traffic in an investment in both menstruators as necessarily women and women as necessarily menstruators. Indeed, the rhetoric of managing rather than eliminating one’s period speaks to this commitment to womaning menstruation, suggesting that women need to bleed (at least sometimes) as both a duty and a defining feature of their womanhood.

Menstrual suppressants such as Seasonale—while routinely advertised to white, youthful, cisgender, and apparently nondisabled menstruators—are in fact also recommended in ableist ways to people with disabilities. Linda Steele and Beth Goldblatt (2020) examine the ways in which nonconsensual sterilization and menstrual suppression are recommended to people with disabilities as a way to eliminate their periods, reduce care work for caregivers, and avoid the discomfort menstrual blood causes in public spaces. Menstruators with disabilities are ableistically assumed to need suppression because of assumptions that they are unable to maintain proper menstrual hygiene, to avoid distress, and to regulate emotions. Notably, in many countries, nonconsensual sterilization and menstrual suppression of menstruators with disabilities is legal, upheld by law under the guise of being necessary and therapeutic. Hence, the “disabled person’s wishes are irrelevant and overridden if therapeutic intervention is considered medically beneficial” (2020, 79). So, even as menstrual suppression is recommended to a certain type of woman who is nondisabled, menstrual suppressants are also coercively used against menstruators with disabilities.

One other element of menstrual suppressants, or partial menstrual suppressants branded as menstrual management, such as Seasonale, that I want to emphasize is the downplaying of side effects. Menstrual suppressants, while providing a potentially life- and trans-affirmative medical technology for menstruators, nonetheless may also contribute to menstrual trauma, including through the risk of side effects and the obfuscating of these risks by pharmaceutical companies. Sanabria raises the issue that many of the studies measuring health risks and side effects of menstrual suppressants report conflicts of interest in the favor of pharmaceuticals (Sanabria 2016, 17). While oral contraceptives can always cause bodily changes—such as weight gain, depression, nausea, blood clots, stroke, heart attacks, and cancer—fewer studies have been done on the effects that increasing the number of days one takes estrogen and progesterone can have, as with extended-regimen pills that increase hormone intake by nine weeks a year (Mamo and Fosket 2009, 943). Potential harms with extended-regimen contraception include increased risk of stroke and heart attack and an increased chance of breast and liver tumors (Drugs.com 2024). Decisions around whether to suppress are thus themselves embedded in the load of menstrual trauma menstruators must navigate, even if they opt out of menstruation. In my own case, while menstrual suppression has been integral to dramatic pain reduction and decreased bleeding dysphoria, it has also led to migraines and weight fluctuation, intensified depression and other mental health concerns, as well as the knowledge of an increased risk of blood clots, stroke, heart attack, and cancer. Thus, even as I learned—deep into my life as a menstruating body—how to reduce pain in my daily life, this itself has come at a risk and alongside the navigation of new forms of pain. But even more vitally, menstrual-suppression technologies such as Seasonale continue to demonstrate an investment in the gendering of bleeding and in narrow understandings of menstruation as woman’s embodied domain, as something women as bleeders must contend with.

Trans Futures of Ungendering Menstruation: Suppressants for Biohacking

As I have discussed in this chapter, many forms of menstrual-suppression discourse circulate a womaning of menstruation that continues to be seeped in menstrual negativity, misogyny, and transphobia. In particular, I looked to Coutinho’s thesis of menstrual obsoletion for how it relies on retrograde ideas of women as reproductive entities and to extended-regimen contraceptive pills as a form of managing bleeding. In both cases, the menstruator emerges not only as a woman but also as a particular type of woman whose burden it is to contend with menstrual management, even if undertaking some degree of menstrual suppression. As I also mentioned with the J. K. Rowling tweet, menstruator-forward language makes people very upset about the potential for questioning menstruation’s tight bind to womanhood. In finishing this chapter, I want to suggest that while menstrual suppressants are commonly framed in ways that retrench the anxiety around menstruation’s role in gelling gender, both trans and nontrans menstruators have long been wielding suppression along different lines, hacking gender, biology, and discourses around the womaning of bleeding.

Hil Malatino frames the biohacking of gender as “one method for altering biological composition in the gendered directions one desires,” including the “practice of manipulating biology through engaging biomolecular, medical, and technological innovations” (2017, 180, 179). Biohacking gender includes off-label, illegal, and DIY forms of fashioning the drugs one needs, as well as the support of care networks and knowledge sharing; it “is democratizing because it bypasses systems of bureaucratic gatekeeping and institutional regulation and thus expands accessibility” (181). I would argue that menstruation has long been hacked by those wanting to question both the presumed innateness of the body and the confines of menstruation’s bond with gender. For example, in the 1970s, women’s health activists undertook menstrual extraction as a “feminist empowerment tool for manipulating the menstrual body” (Mamo and Fosket 2009, 938). Menstrual extraction involves the removal of endometrial tissue from the uterus through a manual vacuum made from plastic tubes, a syringe, and a mason jar and was developed as the Del-Em menstrual extraction kit by Lorraine Rothman and Carol Downer in 1971. While it was used for abortions before Roe v. Wade, it could also hasten the menstrual period, so the bleeding occurred all at once, in the span of under thirty minutes. I would argue that menstrual extraction functioned as well to unbind womanhood from monthly bleeding, presenting a hacked DIY approach to the form and length a period needed to take. While perhaps not quite as invested in opening menstruation up to bleeders of all genders as it was about challenging what bleeding meant for women bleeders, menstrual extraction certainly did provide a hacking of the gendered body and its ties to bleeding.

Hormonal contraceptives have likewise been used off-label for menstrual suppression before menstrual management became more common with the appearance of Seasonale in 2003. I discovered the possibility of menstrual suppression after having TSS as a child, before the widespread availability of suppressants such as Seasonale, yet was prevented from accessing it by my guardian, who feared both health risks and sexual promiscuity for me. When I finally turned to suppressants, it was through a DIY ethos of doing my own research and using low-dosage contraceptive pills not marketed for extended suppression. The use of contraceptives off-label in this way by nonbinary and trans menstruators—as well as, I would argue, by cis menstruators—is infused with the gender biohacking ethos Malatino discusses, hacking the parameters of gender, the body, and menstruation. Nonbinary survival necessitates a hacking-based approach to navigating medical systems alongside acquiring affirmative medication. Yet Malatino also warns that too often the queering and transing of technology and biomedicine undertakes the active forgetting of the violence behind these technologies, such as its development on the bodies of people of color. Hormonal contraception is necessarily infused with the histories of being tested on Puerto Rican, Indigenous, Black, and other people of color, resulting in the nonconsensual sterilization of many (Malatino 2017, 185; Nelson 2003; D. E. Roberts 1997; Torpy 2000). In this sense “gendered self-determination through biomolecular procedures is intimately tied to forms of knowledge production built on and through neo-colonial violence” (Malatino 2017, 186). Further, hormone use, whether practiced to hack gender or not, leads to accretive amounts of hormones entering the environment through discharged urine, which can then be “traced across the organisms that make up the ecological webs of relatedness in which humans are embedded” and is developed through violent testing on nonhuman animals (Sanabria 2016, 188). In the next chapter, I explore how forms of menstrual toxicity, as a form of menstrual trauma, become entangled in both bodies of individuals and the environment, focusing specifically on toxic shock syndrome and the use of harmful chemicals in menstrual products.