Is Menstruation Obsolete? by Elsimar M Coutinho, Sheldon J Segal. Oxford University Press, £15.95, pp 190. ISBN 0 19 5113021 9. Rating: ★★★
Menstruation is one of the most prominent anthropological taboos to have left its mark on present day society. Women who are menstruating have been branded as impure and, in a not too distant past, were accused of turning cow's milk sour or causing iron to rust. Elsimar Coutinho claims that “Recurrent menstruation is unnecessary and can be harmful to the health of women. It is a needless loss of blood.” This statement represents the key message of the book. Coutinho advocates an almost lifelong medical suppression of menstruation. This position is obviously controversial but undeniably fascinating.
Coutinho is a widely published Brazilian fertility expert who has gained merits through her contributions to the development of the hormonal contraceptive medroxyprogesterone acetate. Her new book contains a lucid description of gynaecological problems, such as dysmenorrhoea and endometriosis, that will be well appreciated by patients and their partners. Sound medical knowledge is amply supplemented by a historical overview of reproductive biology. Coutinho devotes special attention to the ancient practice of bloodletting. This technique was commonly used to “detoxify” the body, a belief that helps us understand society's view of menstruation. Coutinho adds entertaining anecdotes, linking, for example, the tragic life of Marilyn Monroe to her menstrual problems.
However, Is Menstruation Obsolete? somehow made me feel uneasy as it is persistently overshadowed by postcolonialist assumptions. For example, Coutinho interprets menstruation mainly as a control mechanism enforced by a male and Christian dominated society. I cannot shake off the impression that historical events that have little to do with this are moulded to suit the author's position. Findings and interpretations that do not support Coutinho's hypothesis are mostly ridiculed, rejected, or omitted.
Modern knowledge can easily make a joke of old fashioned practices common among those who were pioneers in medicine and who often had religious, political, or economic prejudices. However, rather than representing a premeditated stigmatisation of menstruating women, the early pioneers' theories were often a consequence of a lack of anatomical and physiological knowledge amplified by the absence of modern technology.
Coutinho anticipates criticisms and therefore spends a great deal of her time pre-empting any eventual argument offered by naturalists believing that life should follow the natural course of things. In some instances Coutinho's view is easy to support. The use of hormone replacement therapy to prevent postmenopausal osteoporosis is a good example. On other occasions it is much harder to be sympathetic to her suggestions.
Despite the teleological flaws, Coutinho's alternative view of menstruation deserves careful consideration. To some extent her book may offer a modern replacement for R F Vollman's classic work The Menstrual Cycle. Coutinho and Sheldon conclude: “We envisage a campaign involving both the public and private sectors, engaging the medical profession to educate the public about the uselessness of menstruation for women not actively seeking pregnancy.” This message also resembles a postcolonial political pamphlet rather than a scientific account, prompting further independent verification of the author's hypothesis.