by Isabella Newton
Menstruation has long been burdened with social taboos. In consequence, menstrual bleeding is enshrouded in a culturally endorsed sense of shame, preventing open discussion about the difficulties many menstruating people encounter when riding the crimson wave. In the UK, period poverty has recently become a focal point of feminist activism and state policy-making. We are recognising the discriminatory nature of taxing menstrual hygiene products, and how these issues are compounded by menstrual stigma and period shame. However, further recognition needs to be given to all aspects of menstrual experience, and progress here continues to be limited by our subscription to what I call the medicalised construction of ‘clockwork periods’. This term refers to the conceptualisation of menstruation in Western medical discourses as a mechanically regular biological phenomenon. Today, menstruation continues to be defined by its regularity, with any deviation from the clockwork model being deemed ‘abnormal’. This perception of abnormality is reinforced by inadequate sexual health education and an enduring culture of menstrual secrecy. The great extent to which we, as a society, have internalised this myth is evident in the fact that only a minority of menstruating people experience 28-day menstrual cycles and regular ovulation, and yet we continue to hold the model of regularity up as a standard of normality. Recent studies have shown that the perpetuation of this myth can have an incredibly adverse impact on the self-image of menstruating people who don’t conform to the model of regularity.
'PCOS remains mostly absent from feminist discourse on menstruation...'
Polycystic Ovary Syndrome (PCOS) is just one example of non-conformity. PCOS is a very common endocrine condition, affecting around 1 in 10 women in the UK. Despite this, Professor Celia Kitzinger and Jo Willmott, a professor and student duo based at Loughborough University at the time, highlighted that there has been incredibly little public discussion about PCOS outside of medical texts. Moreover, the rare mentions it gets usually reinforce the shame of the condition as a ‘deviation’ from proper femininity. PCOS also remains mostly absent from feminist discourse on menstruation, and has been relegated to the sidelines of period poverty activism. My fundamental aim in writing this piece is to raise awareness of the anxieties that menstruating people can face if they deviate from the mythical medical narrative of clockwork periods. I hope to highlight the need to find an equilibrium between solidarity in shared experience, and appreciating the benefits of a more individualised approach to articulating menstrual experience.
At the age of 10, I was told in my first Sexual Education class that I would start menstruating when I was 12-14 years old, and have a period every 28 days that would last for 3-4 days each and would cause me some minor discomfort. In reality, I started my period when I was 11 years old, and it lasted for 11 days. I then had incredibly painful periods, which would often cause me to miss school and/or work. When I was around 15, my periods started to get more irregular, and by the time I was 18 I was only menstruating every 3-5 months. Now aged 24, I was recently diagnosed with PCOS. Essentially, PCOS causes your ovaries to become inflamed and develop small fluid-filled sacs that surround your eggs and prevent you from ovulating. Classic symptoms of PCOS include irregular menstruation or no periods at all, infertility, hirsutism, and acne. It has also been linked to an increased risk of developing serious chronic diseases such as type 2 diabetes and certain cancers, as well as emotional/psychological disorders such as depression and anxiety. However, despite all we know about the physiological symptoms of PCOS, how it affects people’s daily lives remains severely under-researched. My immediate thoughts when I was diagnosed were largely negative and self-deprecating. I felt a sense of inadequacy and loss, as if I had failed at the task my body was designed to do, and was cheated out of the certainty of regular monthly bleeding. After some reflection and conversations with friends, I started to question why these feelings prevailed even in the knowledge that PCOS is so common. I then set to work researching. While conducting my research, I discovered that the NHS website has an entire page dedicated to ‘Period Problems’, which deals with heavy periods, irregular periods, painful periods, and other conditions. Paradoxically, the page repeatedly reassures menstruating people that many of these ‘problems’ are common, and yet sets them against the standard of the unproblematic clockwork period. For those of us who experience these ‘problems’, and therefore deviate from the prescribed framework, this can cause a number of anxieties.
'womxn with PCOS are often most concerned about their feminine and reproductive identities'
The mythical model of the clockwork period creates a medical ideal of ‘femininity’ and reproductive ‘health’, which can be especially detrimental to the emotional states of womxn with PCOS. For instance, irregular periods are often accompanied by symptoms such as excessive hair-growth (hirsutism), which in itself is culturally shamed and deemed unfeminine. This is compounded by the increased levels of testosterone commonly found in people with PCOS, and the culturally constructed male-female hormone dichotomy (another largely mythical formulation which warrants a separate discussion of its own). The increased presence of a ‘male’ hormone in womxn with PCOS, together with an ‘abnormal’ menstrual cycle, reinforces feelings of inadequacy. Studies indicate that womxn with PCOS are often most concerned about their feminine and reproductive identities, and may even consider themselves as ‘freaks’ (evidenced in a 2017 study by Tomlinson et al, whose findings echoed those of Kitzinger and Willmott).
These studies suggest that we need further feminist comment on the findings of PCOS research, to combat anxieties about failing to conform the norms of ‘proper’ womanhood or femininity. For instance, Kitzinger and Willmott noted that women in their study saw the regularity of the menstrual cycle as fundamental to natural femininity, and the relative irregularity they experienced was one of the most distressing symptoms of PCOS. These women also experienced an added burden of menstrual secrecy, caused by an anxiety that open discussion of their symptoms would put their identities as women under scrutiny. These are not trivial worries. Rather, they are the manifestations of an internalised cultural conceptualisation of woman as mother, and female body as mechanical life-giving vessel. Further, they are often accompanied by more pervasive psychological issues, as shown by studies which have identified a higher risk and prevalence of depression in PCOS groups. I just so happen to be a case in point, having been diagnosed with depressive disorder a few weeks before my PCOS diagnosis (way to kick a woman when she’s down). Given these findings, the lack of research into the emotional impact of PCOS seems even more like a glaring blindspot on the part of medical authorities.
'PCOS was definitely not mentioned on the token period-education pamphlet we were given at school...'
The anxieties faced by womxn with PCOS are also the product of reductive sexual education programmes, and often a lack of information provided by health professionals. PCOS was definitely not mentioned on the token period-education pamphlet we were given at school that contained little more than a diagram of a vagina. Nor was it mentioned later in our Sex Ed tutorials, which almost entirely consisted of fear-mongering images of STIs and putting a condom on a banana. After my PCOS diagnosis, I asked my GP if there was anything I could do to stop the condition worsening, or to keep more serious linked conditions like diabetes at bay. I was met with: “just maintain a healthy lifestyle and go back on the pill.” He actually seemed a bit thrown by the question, and redirected me to the NHS website (which, of course, I had already read). This is why opening up public discussion about our menstrual experiences is so important: I have learnt so much more from my own experience, and listening to or reading about the experiences of others, than from established medical authorities.
Encouraging steps have been taken in recent years to increase our recognition of the particular burdens menstruating people face in their daily lives. We do, however, have further to go in ensuring that our activism encompasses all aspects of menstrual experience. This is why I advocate for a more individualised approach, in which we can appreciate the benefits of solidarity in shared experiences while also recognising the necessity of dismantling the model of menstrual ‘normality’. Liberating ourselves from the medical myth of the clockwork period is crucial in helping menstruating people with PCOS and other conditions overcome feelings of inadequacy and abnormality. This all starts with simply talking about periods and our menstrual experiences, so shout loud and proud about your bleeding or lack of bleeding, your aches and pains, your regular or irregular flow, and listen to the experiences of others. Most importantly, confront and interrogate your own feelings of menstrual secrecy and shame, and challenge the institutions that perpetuate them.
Celia Kitzinger and Jo Willmott, ‘’The thief of womanhood’: women’s experience of polycystic ovarian syndrome’, Social Science & Medicine, vol 54(3) (2002), pp 349-361
Dagmar Makalová, ‘Current methods of managing menstrual bleeding’, Gynaecology Forum, vol 16(3) (2011), pp 23-27
Elizabeth Hollinrake et al, ‘Increased risk of depressive disorders in women with polycystic ovary syndrome’, Fertility and Sterility, vol 87(6) (2007), pp 1369-1376
Lucinda Farmer, ‘Myths surrounding menstruation’, Gynaecology Forum, vol 16(3) (2011), pp 8-12
Julie Tomlinson et al, ‘The diagnosis and lived experience of polycystic ovary syndrome: A qualitative study’, JAN Leading Global Nursing Research, vol 73(10) (2017), pp 2318-2326
Melissa J. Himelein and Samuel S. Thatcher, ‘Depression and Body Image amongst Women with Polycystic Ovary Syndrome’, Journal of Health Psychology, vol 11(4) (2006), pp 613-625
Isabella is a postgraduate law student, with a special interest in human rights and women’s health. Alongside her studies, she is an avid period poverty and menstrual stigma activist. Her passion for periods began a few years ago when she started advocating for a menstrual health charity, Irise International. She has since organised and spoken at panel talk events and sexual education workshops, facilitating discussion about menstrual experience. Periods have also featured strongly in her academic work, such as her undergraduate dissertation entitled ’Talking About Periods’, and a legal research project on the gender inequality perpetuated by the Tampon Tax.