# The medicalisation of menstruation: a double-edged sword

## TL;DR

This paper examines how efforts to improve women's health through medicalizing menstruation can unintentionally reinforce gender inequality.

## Contribution

The paper introduces a critical analysis of historical and contemporary examples where menstruation-related initiatives had unintended negative consequences.

## Key findings

- 19th-century psychiatry linked menstruation to mental disorder, which was used to justify limiting women's education.
- Hormone replacement therapy, while beneficial, has been marketed in ways that reinforce gender stereotypes about aging.
- Menstrual leave policies may unintentionally stigmatize menstruating individuals by singling them out for special treatment.

## Abstract

The intersection of menstrual and mental health is an under-researched area which is gaining attention from the public, researchers and clinicians. However, there may be unintended risks associated with this increased attention. Here we review some historical and cultural aspects of the well-intentioned medicalisation of menstruation and discuss their impact on gender (in)equality.

To critically integrate lessons from the past into current momentum around improving women’s healthcare.

Narrative review with interdisciplinary authorship including psychiatry, medical anthropology, and history.

We explore three exemplars. 19
th century psychiatry identified menstruation as a time of risk for mental disorder, which recognised relevant aspects of female experience but used this to argue against female education. The 20
th century discovery that hormone replacement therapy can ease menopausal symptoms has helped many, but aggressive marketing may increase gender-based stigma regarding female identity, the experience of menopause and aging. Lastly, the introduction of menstrual leave and menstrual product policies aims to ease the burden on those who menstruate, but may have the paradoxical effect of portraying those who menstruate as a burden themselves.

Menstruation research occurs in the context of historical and ongoing sexism and the process of menstruation is currently highly stigmatised in many cultures. This makes the process of change complex and rife with ‘double edged swords’ whereby well-intentioned initiatives can have unintended effects. Researchers and clinicians in this area should be aware of how attention to menstruation and gendered difference can be misconstrued and used to inadvertently further gender-based disparities.

Sometimes well-intentioned ideas can have unexpected negative consequences. In this review, we discuss three examples of such ‘double edged swords’ when medicine and policy pay attention to women’s bodies. First, we explore how 19th century psychiatry identified the onset of menstruation as a time of risk for mental disorder, leading to suggestions that women should not be educated or engage in mental activity. Second, we revisit the advent of hormone replacement therapy (HRT) in 20th century menopause care, which has improved the wellbeing of many. Yet, HRT has been aggressively marketed to correct the perceived unstable behaviour of menopausal women, tying into broader prejudices about aging. Third, we consider 21st century policies for menstrual leave and the provision of free period products, which take steps towards reducing great stress for many menstruating people. Yet, they do so by singling out menstruators as in need of special help, instead of addressing poverty and health-related leave in more general terms that recognise how people of all sorts have different energy levels, discomforts, and hygiene needs. We conclude with suggestions for moving forward thoughtfully with these double-edged swords in mind.