Is Regular Menstruation Natural or Necessary?

Preagricultural women had about 160 lifetime menstrual cycles, attributable to late menarche, high parity, extended periods of breastfeeding, and early menopause.¹ That number has almost tripled to about 450 cycles for contemporary women who live in industrialized Western nations (see Figure 1).

FIGURE 1. Frequent Menstruation Is a Relatively New Biological State1

Menstruation can mean many things to different women. For some women, menstruation symbolizes being a woman; they welcome it as a reassuring sign of health and fertility. Others view it with resignation and find bleeding every month to be inconvenient, awkward, messy, and expensive. On the other hand, monthly periods serve important psychological and cultural purposes to some women, who may feel reassured by their periods that they aren’t pregnant, find satisfaction in the ritualistic aspects of their monthly cycle, or simply find the concept of transitioning to a period-free life too jarring.

At a minimum, menstruation can be an inconvenience. For many women, monthly menstruation causes substantial distress. Of the 2.5 million women in the United States aged 18–50 years who have menstrual disorders, about 65 percent contact their clinician for menstrual symptoms and 31 percent report spending a mean of 9.6 days in bed each year, resulting in costs to American industry of an estimated 8 percent of the total wage bill.^2,3 Based on data from a 1999 survey of US women, investigators estimated that women with heavy menstrual flow worked 6.9 percent less, or 3.6 fewer weeks, each year. This translates into estimated lost wages of about $1,692 per woman annually.⁴ Menstruation can cause anemia from excessive menstrual volume and can exacerbate preexisting conditions such as iron deficiency anemia and hereditary anemia. It can also cause or increase the severity of pelvic pain, endometriosis, and migraine headaches. Dysfunctional uterine bleeding and menorrhagia represent additional menstrual-related burdens for women. Even though many women and clinicians believe that menstruation is necessary to women’s health, no evidence exists that it prevents uterine infections or cancers, or that it improves other parameters of women’s health.

In light of these facts, should women’s menstrual cycles be suppressed? In the absence of evidence supporting that regular menstruation enhances women’s health, the Association of Reproductive Health Professionals and the National Association of Nurse Practitioners in Women’s Health believe that medically induced amenorrhea represents an appropriate option for women and an important focus for future research.

References

1. Eaton SB, Pike MC, Short RV, et al. Women’s reproductive cancers in evolutionary context. Q Rev Biol 1994;69:353-367.

2. Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecologic conditions reported by US women: findings from the National Health Interview Survey, 1984-1992. Am J Public Health 1996;86:195-199.

3. Dalton K, Holton W. Once a Month: Understanding and Treating PMS, 6th ed. Alameda, CA: Hunter House, 1990.

4. Côté I, Jacobs P, Cummings D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol 2002;100:683-687.