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Challenging Menstrual Norms in Online Medical Advice: Deconstructing Stigma through Entangled Art Practice

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This article analyses three examples of online medical advice provided by UK based health websites on the topic of menstruation, and reflects on my artistic practice as a critical response to notions of menstrual normativity. The article considers to what extent these online platforms — now part of the cultural fabric of contemporary healthcare advice — sustain dominant Western cultural perceptions of menstruation. Through thematic and comparative analysis, the article explores how these texts reflect cultural discourses around menstruation through reinforcing cis and heteronormative standards, presenting menstruation as failed pregnancy, and as a largely problematic rather than positive experience. The article also reflects upon autobiographical and performative artworks as spaces developed alongside the analysis of the online medical advice texts, which propose and explore resistance to the social stigma still associated with menstruating.
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1 School of Humanities and Social Science, Liverpool John Moores University, UNITED KINGDOM
2 Liverpool School of Art and Design, Liverpool John Moores University, UNITED KINGDOM
*Corresponding Author: B.Hughes@ljmu.ac.uk
INTRODUCTION
This article considers three examples of online health advice available in 2018 aimed at a UK audience NHS
Choices, Patient.info and Boots WebMD from a socio-cultural perspective. The analysis is presented within the
context of my ongoing artistic practice, which is also discussed. The chosen example texts are from established
reputable sources with direct links to sources of medical authority. While operational, Boots WebMD was a
collaboration between the well-established USA health website WebMD and the UK pharmacy chain Boots,
designed to provide basic information on health and wellbeing1. Patient.info is owned by Egton Medical Information
Systems Ltd provides IT systems to UK General Practices. NHS Choices is published by the UK National Health
Service and has UK Government Information Standard accreditation, and with more than 48 million visits per
month(NHS, 2015) has become the most visited UK health website (ibid). Patient.info differs from the other
examples as it features two distinct strands of content, both authored and reviewed by medical professionals, but
aimed at distinct user groups. For the purposes of this research, the analysis will be focussed on the Conditions
page, which is explicitly aimed at a lay audience as opposed to a clinical reader, in alignment with the other examples
which are also produced with a general audience in mind. Artistic explorations have existed alongside and within
menstrual activism since the 1970s (Bobel, 2007, 2010; Fahs, 2016; Johnston-Robledo and Chrisler, 2011) in
addition to other forms of feminist art which have actively challenged the pervasive double-standards of sexism
and misogyny (for example Jones, 1998, 2005; Rees, 2013). My research interest in menstruation stems from the
development of an autobiographical artistic practice exploring my own experience of menstruating alongside
theoretical enquiry into menstruation in everyday culture. Following the analysis of the example texts, I reflect
upon my artistic practice as a method through which to deconstruct attitudes towards menstruation and to wilfully
break the conventions of what Karen Houppert has called menstrual etiquette(Houppert, 2000: 2). First, I explore
notions of menstrual normativity through performative printmaking in my visual work, Cycles (2016-17), where I
documented my menstrual cycle through body printing for six months. Second, I present an example of cut-up
1 Boots WebMD remained live through the earlier research and drafting of this article. Since the initial submission, Web MD and Boots have
ended their partnership, with little to no reporting or press information. The website can now be viewed via The Internet Archive, with the last
livesnapshot saved to the archives Way Back Machine on May 10th 2018.
Feminist Encounters: A Journal of Critical Studies in
Culture and Politics, 2(2), 15
ISSN: 2542-4920
Challenging Menstrual Norms in Online Medical Advice: Deconstructing
Stigma through Entangled Art Practice
Bee Hughes 1,2*
Published: September 27, 2018
ABSTRACT
This article analyses three examples of online medical advice provided by UK based health websites on the
topic of menstruation, and reflects on my artistic practice as a critical response to notions of menstrual
normativity. The article considers to what
extent these online platforms
now part of the cultural fabric
of contemporary healthcare advice
sustain dominant Western cultural perceptions of menstruation.
Through thematic and comparative analysis, the article explores how these texts reflect cultural discourses
around menstruation through reinforcing cis and heteronormative standards, presenting menstruation as
failed pregnancy, and as a largely problematic rather than positive experience. The article also reflects upon
autobiographical and performative artworks as spaces developed alongside the analysis of the online medical
advice texts, which propose and explore resistance to the social stigma still associated with menstruating
.
Keywords:
autobiographical art, menstrual normativity, practice-led research, menstruation,
gender
Hughes / Challenging Menstrual Norms in Online Medical Advice
2 / 15 © 2018 by Author/s
poetry, composed with and as a challenge to online texts such as those analysed in the first part of the article.
Finally, I reflect upon translating poetic responses into collaborative soundworks, a process of re-embodying my
emotional responses to the online medical advice explored. Following Rachel Allens analysis of radical
performance art in the context of critical medical humanities, the performative body explored in my visual work
and fragmented text/voice of poetic experiments moves towards an image of the body hinged between nature
and culture, the personal as political, objecthood and subjecthood, the biological and the psychical(Allen, 2016:
195).
The selected online health resources are everyday medical texts, as they are specialiseddealing with specific
areas of life, health and well-being but are not specialist in that lay readers should be able to understand their
content, they exist as part of everyday culture. The article explores how these texts reflect Western cultural
experiences of menstruation, particularly considering how they might uphold deep-rooted cultural notions
surrounding menstruation. Boots WebMD, NHS Choices and Patient.info, in their role as medical reference resources,
are situated within a medical model of menstruation. However, as internet resources they sit outside the traditional
boundaries of medical authority for example the physical spaces of the consulting room or the intellectual space
medical textbooks or research publications and are a part of the fabric of our everyday interactions with the
online world. The increasing use of online health advice (Smart and Burling, 2001) reflects the ubiquity of such
technologies in every realm of everyday life and the impact of neoliberal ideology on therapeutic culture (Rose,
1999) and personal healthcare. As part of the cultural fabric of contemporary healthcare advice, it is pertinent to
consider to what extent these platforms reflect the ongoing cultural discourses surrounding menstruation rather
than to accept them at face value as objective medical texts.
A recent systematic review of the impact of the use of seeking medical advice from the internet on the patient-
physician relationship sheds light on the positive role online medical advice can have on the patient experience.
The report proposed that patients used the information found on the Internet to help them prepare for their visit,
ask better questions, and understand what the physicians told them(Tan and Goonawardene, 2016). This suggests
that online medical advice has become a fully integrated part of contemporary healthcare, and has the potential to
partially democratise the clinical encounter, providing a baseline of information common to both patient and
physician. These sources are also particularly useful as they are clearly set apart from often sensationalist narratives
of the media or commercially driven platforms (MacCabe and Hull, 2014). However, it is important to note that
while these sources provide some information, they are quite limited and lack a recognition of the broad variety of
experience of menstruation. All three examples discussed below are authored and / or medically reviewed by
qualified medical doctors, but they tend not to provide reference to wider research or external information. Rather,
they uphold the clinician as the primary recognised source of authority rather than acting as gateways to
information that might engender potential conflict between patient and clinician in a small number of cases (Tan
and Goonawardene, 2016).
FRAMING MENSTRUATION IN ONLINE MEDICAL ADVICE
All three articles are relatively short and written in an accessible style, and the analysis includes only the main
text of the article. Additional content, such as advertisements which were present on Boots WebMD and
Patient.info and other website content were omitted from the sample. The articles varied slightly in length and
format, the NHS Choices piece being shortest at 906 words over a single web page. The Boots WebMD article was
presented over three click-through pages, with the main body of the text totalling 1477 words. The article available
on Patient.info is the longest of the three examples, with the main text of the article totalling 1767 words over a
single page. In order to identify similarities and divergences between the three example articles, a combination of
quantitative and qualitative analysis was used. This includes a thematic analysis of all results returned under the
search term menstruation from the home page of each selected platform and initially coded according to the
categories provided by each individual platform. Boots WebMD returned seventy-eight results, fifty-three of which
were categorised as medical reference articles. The largest group of results returned by the NHS Choices search was
the uncategorised group, at twenty-five of the forty-seven total search results. Patient.info returned by far the
greatest number of results 475 however the majority of these were user-generated topics from the platforms
discussion forum. This user-generated content was omitted from the analysis in this article, which concentrates
solely on the main authored editorial articles from each website on the topic of menstruation. However, user
generated content generated a significant amount of discussion by the platforms users that could be fruitfully
explored in further research. Of the remaining eighty-one results returned by the search conducted on Patient.info,
sixty-four are aimed at medical professionals and the remaining seventeen at a general lay audience. Patient.info is
the only website which has two defined streams of content one for medical professionals, the other for lay
readers.
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 3 / 15
This initial analysis illustrates the broad similarities and differences across the three platforms, for example it
reveals that Boots WebMD is the only one that presents sponsored advertorial alongside its medically reviewed
content. The majority of the content across all three websites relates to reference articles providing some form of
medical information. To gain a thematic overview, the search results were coded under the following broad themes:
neutral information on menstruation; problems relating to menstruation; hormones and contraception; menopause; pregnancy and related
conditions; puberty or growing up; other. The search results grouped under the theme other include articles on connected
but not necessarily directly related topics such as Headaches basicsfrom Boots WebMD, Do I have an anxiety
disorder?’ from NHS Choices, and Cold Soresfrom the Patient.info website. Other is the largest thematic grouping
for Boots WebMD and Patient.info, in the latter case being a greater proportion than all the other themes combined.
In two cases Boots WebMD and NHS Choices the next largest thematic category (after other) is problems,
with Patient.info presenting slightly more articles on the theme of hormones and contraceptives. Overall, fewer articles
were coded neutral, which includes articles that provide general information on anatomy and physical processes
such as the menstrual cycle, than as problems, with the lowest number and proportion of neutral articles appearing
on the Patient.info website. This is perhaps not surprising if we consider that advice is more likely to be sought to
explain anomalous or negative experiences rather than to confirm a positive one. Patient.info is the only platform
where I found no article titles that directly reference puberty and growing up, reflecting perhaps the medical focus
of this resource, as it caters to both medical professionals and lay readers, with nearly 80% of the articles returned
under the menstruation search being directed specifically towards their professional user base. The analysis of the
menstruation-related content across the search results and the detailed analysis of specific articles from the three
platforms suggested three key narratives through which menstruation is framed. These are: menstrual normativity2;
pregnancy and menstruation as failed fertilisation within a heteronormative framework; and positive versus
problematic periods. There are multiple discourses surrounding menstruation in Western culture which have
overlapped and influenced each other. For example, late eighteenth and early nineteenth century medical views on
menstruation were heavily informed by moralistic Christian ideologies (Lander, 1988: 10-25), and nineteenth-
century medical narratives often characterised menstruation as traumatic and debilitating (Martin, 2001: 35). In
contrast, third-wave feminist activists have strongly resisted the tendency of medicalised models to view
menstruation as a problem in need of a solution(Bobel, 2010: 7). This is reflected in the contemporary framing
of menstruation simultaneously as a biological and social phenomenon (Lander, 1988) which symbolizes both
reproductive and sexual potential (Lee, 1994: 360) of the menstruating body. Menstruation has only begun to
emerge from a culture of silence and shame relatively recently, not helped by the sex-segregation of topics such as
puberty in the classroom which means that boys (and therefore adult men) have rarely benefitted from menstrual
education at school. As stated by UK Member of Parliament, Paula Sherriff, menstrual education for children of
all genders is crucial as many boys will go on to be husbands, fathers, teachers or doctors’ (House of Commons,
2017: c175WH).
In order to identify themes within each article a keyword search was conducted (see Table 2). Keywords were
selected to search for established notions of menstrual norms and further keywords were added such as
childbearing and men as they emerged from an initial reading of each of the articles. A number of keywords yielded
no results in the three selected articles these were terms relating to gender-neutral language, specifically negative
terms relating to stigmatisation, and alternative menstrual products.
The analysis illustrates that while menstrual activism and contemporary feminist discourse discuss menstruation
without constraining it to any single gender identity, these everyday medical texts continue to utilise a traditional
binary gender framework. Within the selected articles, the words woman or women appeared 21 times [see Table 2],
and girls appeared four times. The more scientific word, female, referring to biological sex was utilised infrequently
appearing most in the Patient.info article demonstrating that while these texts have roots in medico-scientific
language, their language is heavily influenced by more cultural constructions of gender. No gender-neutral terms
such as menstruator appear across the material reviewed in any of the articles. This also reinforces traditional binary
2 Josefin Persdotter uses the term menstrunormativity in the forthcoming publication Introducing Menstrunormativity(forthcoming 2019).
Table 1. Frequency and percentage of coded categories found in search results for menstruation on Boots WebMD,
NHS Choices and Patient.info
. Percentages are rounded to two decimal places, and therefore do not equal 100
THEME
Boots WebMD
NHS Choices
Patient.info
neutral
13 (16.67%)
4 (8.51%)
2 (2.47%)
problems
19 (24.36%)
12 (25.53%)
10 (12.35%)
hormones & contraceptives
4 (5.13%)
5 (10.63%)
11 (13.58%)
menopause
5 (6.41%)
5 (10.63%)
4 (4.94%)
pregnancy
8 (10.26%)
9 (19.15%)
4 (4.94%)
puberty
8 (10.26%)
4 (8.51%)
0
other
21 (26.92%)
7 (14.9%)
50 (61.73%)
Hughes / Challenging Menstrual Norms in Online Medical Advice
4 / 15 © 2018 by Author/s
understandings of gender that codifies menstruation as a strictly biological phenomenon that happens to cis
women, and leaving non-binary and/or trans menstruators out of discussion. It is interesting to note that while
none of the articles contain words that explicitly reference stigma, no explicitly positive words are used to describe
menstruation either. The articles reinforce a narrative of menstruation that is personal and private, referring only
to medical professionals or a man who might provide sperm to fertilise an egg other than the reader, assumed
to be a woman or girl.
MENSTRUAL NORMATIVITY
Emily Martin (2001) contrasts prevailing medical metaphors used to describe menstruation, pregnancy and
menopause in terms of mechanical production with the oral testimonies of the lived experience of these
phenomena of women from different class and racial backgrounds. She states that in the current medical model,
regular periodicity between well-defined limits is considered normal(Martin, 2001: xi), and that while regularity
is normal, good, and valued; irregularity is abnormal and negatively valued (ibid). She goes on to draw on
scholarship from heart health and epidemiological research which suggests that increased flexibility and variance
might actually suggest a greater ability to adapt to the various stresses of life such as changing environments or life
circumstances (Martin, 2001: xii). The influence of medicine on broader understandings of menstruation is
underscored in Landers analysis of menstruation as simultaneously a biological event and a cultural event(Lander,
1988: 9) which has often been presented to women through the lens of medical ideology, reflecting social ideology
(ibid). The cultural representation of menstruation has been explored in different forms, with researchers exploring
areas from menstrual activism (Bobel, 2010), to art and literature (Bobel and Kissling, 2011), to print culture and
advertising (Houppert, 2000; Røstvik, 2018). What emerges from this body of literature on the subject of
menstruation and the many other recorded accounts of the phenomenological experience of menstruation from
people who menstruate, that menstruation is a highly individual and varied experience. From the physical
experience of menstruating through to attitudes informed by the differing intersections of class, gender, culture,
racial and socio-economic identity, for all the physiological things menstruators might have in common, there are
many other aspects physical and social that might differ considerably.
Of the three selected main articles on menstruation, Boots WebMD uses the term normal most frequently (11
times in total), while the NHS Choices article does not use it at all. The Boots WebMD article is titled Normal
menstrual cycle and periods(Boots WebMD, 2016: 1), with the term repeated in the first subtitle: what happened
during a normal menstrual cycle?(ibid). The doubling of the term normal at the opening of the article reinforces
Table 2. Keyword frequency within the Boots WebMD, NHS Choices, and Patient.info articles on menstruation
BOOTS WEBMD
NHS CHOICES
PATIENT. INFO
TOTAL
21
34
64
140
3
53
78
134
26
2
11
39
14
7
9
30
6
1
14
21
3
10
8
21
8
7
5
20
11
0
7
18
3
3
9
15
3
6
5
14
2
7
2
11
3
2
3
8
1
0
7
8
1
3
3
7
0
1
4
5
0
4
1
5
3
0
2
5
3
1
0
4
0
4
0
4
3
0
0
3
2
1
0
3
1
0
0
1
0
0
1
1
1
0
0
1
0
1
0
1
1
0
0
1
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 5 / 15
the notion of a normative menstrual experience, which in this particular text is presented almost exclusively in
relation to pregnancy:
During a womans childbearing years, her body will usually experience a menstrual cycle: a complicated
cycle controlled by hormones to prepare her body for pregnancy. (Boots WebMD, 2016: 1)
The first sentence of the article firmly situates menstruation in a context of childbearing and pregnancy,
alienating those menstruators who do not associate their menstrual cycle and flow with a desire or are unable
to become pregnant. The sentence also constructs a dichotomy between the menstruating person and their
body. The subject in this instance the woman and her body are alienated by a process that is described as
controlled and experienced outside the menstruator. The rest of the article echoes this oddly detached language
referring to a womanor a girland her body, or to the reproductive organs and gametes as though they are
independent entities instead of parts of one whole. This reinforces the notion that the process of menstruating is
something unpleasant and unnatural that should be kept at arm’s length. The framing here contrasts starkly with
both the NHS Choices and Patient.info articles which both use the terms you/yours frequently, and develop a more
individualised, and perhaps patient-conscious tone and description of menstrual experience.
Instead of describing or qualifying menstruation itself as something with a normal standard, Patient.info refers
to the common variations which are normal(Patient.info, 2017), as well as some common problems(ibid). This
is a small but significant difference in the conceptualisation of menstruation presented across the three examples:
instead of establishing a description of menstruation that is itself normative, variation is framed as the norm. It is
especially important that sources of information with some perceived form of medical authority are careful to
establish variation as a key feature of menstruation, and to clearly define ranges of expected experience that are
not considered to be pathological. In contrast, Boots WebMD cites a vague cycle length of around 28 days(Boots
WebMD, 2016: 1) which varies from woman to woman(ibid). None of the advice provided across the three
articles establishes clearly how much variation outside twenty-eight days a menstruator might experience before
needing to seek further advice from a primary care provider, other than to suggest they should take a pregnancy
test. As Rees notes, in socio-cultural terms, the tyranny of the notion of a bodily norm means that, in the act of
being human, our very humanity our age, weight, ability sets us up to fail(Rees, 2017: 7). In my experience
this is no less true for menstruation: it is an event that varies greatly between and for individuals, but has
often been framed as an unchanging, regularly cyclical and predictable event.
PREGNANCY AND MENSTRUATION AS FAILED FERTILISATION
Fertility and reproduction are central to contemporary Western debates on gender, and as Cordelia Fine
observes, we are spellbound(Fine, 2017: 14) by debates surrounding hormones and the contested ground of
reproductive evolutionary divergences between the two traditionally recognised biological sexes (ibid).
Menstruation and its absence are powerful signs and sources of anxiety for people who are trying to conceive,
or are worried they may be facing an unwanted pregnancy. Despite my own experience of severe dysmenorrhoea3,
there have been times when the arrival of my period has been a huge relief. I can only begin to imagine the depth
of grief that might accompany starting your period if you are hoping to become pregnant. While the absence of
menstruation due to pregnancy may be good news for some, and it is entirely reasonable to discuss fertility in the
context of the menstrual cycle, it is also important to consider that not all people who menstruate want to become
pregnant at all. For example, a report by NHS Digital states that 79% of women attending Sexual and Reproductive
Health Services (SRH) in England in 2016-17 were visiting to start or maintain contraception methods (NHS
Digital, 2017: 10). Additionally, use of Long Acting Reversible Contraceptives increased from 18% in 2002-3 to
31% of women accessing SRHs in England (Health and Social Care Information Centre, 2014: 6). Martins (2001)
examination of the language of medical textbooks revealed that many described menstruation negatively as the
result of a failed fertilisation process. It is striking that over thirty years later this narrative is still evident in the way
Boots WebMD frames its discussion of menstruation overwhelmingly through the lens of childbearing(Boots
WebMD, 2016: 1).
To frame menstruation entirely through a reproductive lens assumes that the menstruator desires pregnancy,
and reduces the potential of their bodies to be and be seen only as vessels for carrying babies. As Janet Lee notes,
the onset of menstruation signifies both emerging sexual availability and reproductive potential(Lee 1994: 344)
which in a Western patriarchal society is often understood through heteronormative desires. This perspective
designates the post-menarche body as reaching adulthood, and therefore ready to fulfil the dual roles of object of
sexual desire and mother (e.g. Lee, 1994; Haug et al., 1987; Young, 1990).
3 Dysmenorrhoea is the medical term for period pain.
Hughes / Challenging Menstrual Norms in Online Medical Advice
6 / 15 © 2018 by Author/s
Of the three articles analysed, Boots WebMD presents a model of menstruation that emphasises pregnancy.
Words relating to pregnancy are used more frequently in the Boots WebMD article (see Table 2) than either of the
other texts, reinforcing the sexualisation of menstruators within a heteronormative narrative of sex for
reproduction. Patient.info and NHS Choices briefly discuss pregnancy within the broader context of the menstrual
cycle, foregrounding individual experience and cyclicity rather than fertility, going some way towards decentring
traditional gendered childbearing roles and heteronormative expectations from the cultural construction and
understanding of menstruation.
Patient.info frames menstruation as a cycle of hormonally mediated bodily changes. It makes very little mention
of pregnancy at all until its explanation of the phases of the menstrual cycle, noting that it is possible to become
pregnant if you have recently had sex and there are sperm in your womb(Patient.info, 2017) during the first half
of the menstrual cycle. NHS Choices takes a similar approach and tone, restricting the discussion of pregnancy to a
discrete section within the article, and places fertility within the broader context of the menstrual cycle and
contraception through providing links to these topics. Both of these platforms describe menstruation as an
internally regulated process that is affected by fluctuating hormones within the individual menstruator.
In contrast, Boots WebMD presents menstruation in terms of not becoming pregnant. The article presents an
unnecessary tautology of a mans sperm(Boots WebMD, 2016: 2) fertilising the passive egg, noting that if that
does not happen then menstruation begins. Instead of emphasising menstruation as a cyclic process, it presents
the interaction of an external factor as the core agent of influence in the process. Patient.info and NHS Choices
discuss pregnancy in a comparatively clinical and neutral tone, and while both mention sperm, neither of these
articles mention men. While their discussion of sexual intercourse and pregnancy draws on scientific definitions of
biological sex in the context of reproduction, they do not explicitly frame this within a heteronormative narrative
of sex to the same extent that Boots WebMD does.
Furthermore, the topic of pregnancy is threaded throughout the Boots WebMD article, bookending the advice
from the first paragraph to the final section sensitively titled How many eggs does a woman have?(Boots
WebMD, 2016: 3). While all three examples contain sections that address related conditions and problems which
might impact the menstrual cycle, Boots WebMD names pregnancy first and foremost (ibid). This may be true in
the sense that being pregnant stops periods, but there are many other factors that impact the menstrual cycle. The
article does list other factors, but only after a short paragraph detailing pregnancy as a separate and overriding
condition. Even in the list of other conditions that might affect menstruation, emotional stress is linked directly to
pregnancy even though it seems reasonable to assume that any number of different areas in the life of anyone
that menstruates could induce stress. It demonstrates the depth of the investment in the model of menstruation as
failed pregnancy, and the overarching outdated and sexist model which emphasises the woman-as-mother role,
defined by heterosexual relationships and a pre-supposed normative desire to produce babies.
This approach seems out-of-step with changing contemporary cultural attitudes towards childbearing. For
example, recent data from the UKs Office for National Statistics (ONS) reveals three significant trends: in England
and Wales, fewer children are being born than in previous generations; more women are delaying their pregnancies
until later than they did in previous generations; and the number of women remaining childless is also rising (ONS,
2017). By foregrounding pregnancy as the most central issue relating to menstruation consistently through the
advice, the proprietors of Boots WebMD seem clearly invested in a traditional ideological view of women in society,
with the female body bounded by a rigid definition as a reproductive vessel.
The framing of menstruation as failed pregnancy is alienating to cis women who do not want to have children.
It is also an insensitive and unnecessary reminder to those who would like to become pregnant but cannot,
especially as it draws on fertility anxieties, detailing in the closing of the article that the vast majority of eggs within
the ovaries steadily die(Boots WebMD, 2016: 3). It is also alienating to cis and trans and/or non-binary
menstruators who experience physical and/or psychological difficulties relating to menstruation and further
reinforces traditional binary gender roles. For example, a poem by menstrual activist Cass Bliss Clemmer illustrates
this poignantly. The piece, posted to their recently launched website, Bleeding While Trans, describes menstrual
bleeding as experiencing another day I shed my gender(Clemmer, 2018).
Highly gendered and binary representations of menstruation are exclusionary, forcing the definition of women
as menstruators, and menstruators as women in a rigid and damaging way. To continue to frame menstruation in
the terms of failed reproduction is both a failure to recognise that cultural norms have started to shift away from
the patriarchal binaries of gender, and is a stubborn continuation of traditional roles that represent a diminishing
section of culture. That two of the three cases studied are able to discuss menstruation without emphasising
pregnancy suggests that there may be an ideological agenda at play in the Boots WebMD resource. This might be
fruitfully explored further in light of the recent and ongoing campaign from the British Pregnancy Advisory Service
(BPAS), which has lobbied the senior management of Boots to reduce the price of emergency contraception in
line with other retailers (BPAS, 2017).
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 7 / 15
POSITIVE VERSUS PROBLEMATIC PERIODS
As well as constructing and reflecting notions of menstrual normativity to different degrees, the articles present
menstruation as positive or problematic in varying ways. The overall framing of menstruation across all three
articles is overwhelmingly as problematic, with only one of the articles making any positive statement about
menstruation. Menstruation is discussed in each of the texts as an experience that has to be coped with in two key
areas: dealing with unwanted physical and emotional side-effects and the management of menstrual flow.
Patient.info provides the closest thing to a positive statement regarding menstruation in all three examples,
answering its heading that questions whether there is a need to change your behaviour while bleeding:
No. Carry on as normal. If you find the periods painful, regular exercise sometimes helps. Periods are
not dirty; they are a normal part of a womans life. You can go swimming, have a bath, etc. You may
prefer to use tampons if you enjoy swimming. (Patient.info, 2017)
To state that menstruating is not unclean falls quite far short of positive affirmation, but to go even go this far
is more than we see in the other selected texts. The enduring influence of conservative Christian values on UK
menstrual culture is reflected in the continued encouragement of modesty and silence to ensure that menstruation
remains hidden. While menstruators have been segregated from their communities (or have possibly chosen to be
sequestered away during menstruation) across many religions and societies, Victoria Newton observes that in a
contemporary UK context we have witnessed a historical shift from the invisible menstruating woman to invisible
menstruation(Newton, 2016: 183). The hesitant positivity presented by Patient.info is barely a cause for celebration,
the rest of the paragraph is far from innocuous. Directing menstruators to exercise their pain away and to carry
on as normalis paternalistic and dismissive of both the deeply ingrained shame that accompanies menstruating,
as well as the reality that according to the National Institute for Health and Care Excellence (NICE) anywhere
between 50 and 90 per cent of menstruators in the UK are affected by dysmenorrhoea (NICE, 2014). Beyond the
prevalence of dysmenorrhoea among menstruators, this instruction towards stoicism falls within the gender biases
that are well documented across different areas of medicine (Holdcroft, 2007; Hamberg, 2008; Samulowitz et al.,
2018). The research in this area points towards a culture of disbelief of womens pain and their ability to report
their own experiences accurately (for example see Fassler, 2015; Fillingim et al., 2009; Hoffmann and Tarzian,
2008).
Simple changes to the framing of menstruation at points in the text such as this could be made to acknowledge
the broad variety of menstrual experience and menstruating individuals. For example, stating that exercise and
painkillers can provide relief or instead of ring-fencing menstruation as being a normal part of womens lives, it
would be far more inclusive to state they are a normal part of life. This would include trans and/or non-binary
menstruators, as well as acknowledging that menstruation is part of life for everybody to some degree even
people who do not menstruate might have family members, partners, or friends that do menstruate and it should
be framed and promoted as a normal part of their lives too.
Menstrual management is discussed in all three texts. On the one hand these sections provide (limited) practical
information on what to do while bleeding. On the other hand, other than the single example noted above the
articles frame menstruation as something unclean that needs to be cleaned up and disposed of, particularly through
the use of the term sanitary rather than menstrual products in the Patient.info and NHS Choices articles. Feminist
scholars and activists have criticised the term feminine hygiene product (e.g. Fahs, 2016; Quint, 2017), though sanitary
product seems to have elicited less robust critique. As Breanne Fahs states:
The phrase feminine hygiene [original emphasis] implies products to keep the unkempt, unruly, unhygienic,
dirty, unsanitary, bloody vagina in checkrather than simply stating the actual terms for what women
use. (Fahs, 2016: 48)
While sanitary product avoids needlessly gender[ing](ibid) products as the term feminine hygiene product does, it still
maintains the notion that menstruation and therefore people who are menstruating are fundamentally
unclean. The term sanitary product also continues to shroud menstruation in euphemism, reinforcing the private,
personal nature of bleeding(Houppert, 2000: 81). While Patient.info and NHS Choices do at least provide sub-
sections specifically addressing menstrual products even if the terminology used is problematic the Boots
WebMD article provides no general practical advice for what to do while bleeding.
Perhaps most perplexing and worrying is that menstrual management is only mentioned by the Boots
WebMD article in the context of problems relating to menstruation. Instead of providing practical advice or
menstrual product suggestions, the article only refers to tampons in relation to Toxic Shock Syndrome (TSS).
Furthermore, while alerting readers to the danger of contracting TSS additional information, explanation or context
is subtly signposted by an embedded text hyperlink. This reflects the lasting cultural association between tampon
Hughes / Challenging Menstrual Norms in Online Medical Advice
8 / 15 © 2018 by Author/s
use and TSS following the emergence of menstrual toxic shock syndrome as a public health threat to women of
reproductive age(Hajjeh, Reingold et al., 1999: 807) following the full commercial launch of the super-absorbent
Rely tampon developed (and later discontinued) by Procter and Gamble (Bobel, 2010: 53; Houppert, 2000: 26).
However following the introduction of guidance for proper use of tampons and changes to the manufacturing of
tampons, cases of TSS have greatly reduced and now most UK cases of TSS are not related to menstruation
(Sharma et al., 2018). Boots WebMD only otherwise mentions menstrual pads and tampons in relation to using a
large number of pads for a heavy flow. Both of these instances provide very little practical everyday advice, and
without further research from the reader could potentially cause considerable alarm. It is particularly irksome to
find that an article supposedly about menstruation provides much more information and advice on pregnancy and
fertility than it does how to manage periods on a day-to-day basis.
The types of menstrual products mentioned in each article are largely restricted to disposable, commercial
products. This reflects the significant influence including promoting and upholding menstrual taboo major
brands have had over menstrual management (Røstvik, 2018) and menstrual education (Houppert, 2000: 60-74).
All three articles mention pads and tampons. The only alternative, reusable method suggested menstrual cups
is noted by Patient.info and NHS Choices. None of the articles mention products such as period underwear or
reusable cloth pads and none enter into any discussion of the positive and negative aspects such as personal
comfort, initial or long-term cost, or environmental considerations of the methods mentioned other than how
they collect or absorb the blood or that tampons might be more convenient(Patient.info, 2017). This is another
area where cis-normativity might be productively countered through basic information, as menstrual products have
emerged in recent years such as absorbent boxer shorts that break gender binaries and the gendered
expectations that are deeply ingrained in the use of and marketing of traditional menstrual products. Non-
conventional products such as menstrual cups or absorbent period underwear in a variety of styles other than
traditionally feminine styles are crucial for trans and/or non-binary menstruators who might be at risk of
violence if found to be menstruating, as Fahs describes the experience of one of her psychotherapy clients:
Nash spent his entire menstrual cycle hoping not to bleed through, and he constantly feared that other
men would hurt or even kill him if they discovered him as FTM [female-to-male]. Menstruation felt like
a lethal form of outinghim as a trans man. (Fahs, 2016: 82)
Providing a greater range of information is crucial to enable all menstruators to find methods that are most
suitable to their individual situation from environmental or health concerns, to serious issues surrounding
personal safety and alternatives to disposable menstrual products should be more comprehensively
incorporated into medical advice and information resources.
The final aspect of the three articles to compare is the information presented on the physical and emotional
symptoms associated with premenstrual syndrome (PMS) and other problems such as painful, irregular, heavy or
absent periods. The quantitative analysis suggests that Patient.info places most emphasis on physical symptoms of
PMS; it has by far the most instances of the word pain (see Table 2). However, a close comparative reading of the
three articles provides a more nuanced picture of their presentation of negative premenstrual symptoms.
Patient.info and NHS Choices provide links to further information on PMS whereas Boots WebMD does not,
linking only to general pages relating to some premenstrual symptoms such as bloating, depression and
headaches rather than providing further information in the specific context of the menstrual cycle. Boots WebMD
lists the most premenstrual symptoms of all three articles ten in total including a broader range of emotional
and physical complaints, such as trouble sleeping or concentrating and feeling upset or depressed. The broader list
of potential negative premenstrual symptoms presented is one of the most positive aspects of the Boots WebMD
article. Listing a range of symptoms, rather than hiding most behind a click-through link, gives a more detailed and
accessible understanding for the reader and normalises a broader range of symptoms overall. It is also worth noting
that Boots WebMD is the only of the three articles to refer to premenstrual symptoms, rather than using the medical
terms PMS, PMT (premenstrual tension) and PMD (premenstrual disorder). This perhaps reflects a more
individualised and emotive approach also expressed in the framing of menstruation around pregnancy by
this resource, in contrast to the more straightforwardly medical tone and content presented by Patient.info and NHS
Choices which are both directly associated with the medical profession in the UK.
Amongst the description of negative aspects of menstruation the Patient.info article notes that you may feel
irritable before a period(Patient.info, 2017), that such symptoms are normal(ibid) and that if you experience
more severe(ibid) symptoms then you may be experiencing PMS. There is no indication of what constitutes a
normal or severe level of discomfort, which on the one hand may encourage menstruators to consider what is
normal for them, but on the other provides no frame of reference to suggest what sort of pain should warrant
further investigation. Moreover, the only emotional impact mentioned is that you might feel irritable(ibid). This
is a vague and reductive description which plays into the stereotypical and stigmatising view of premenstrual people
as potentially violent, irrational, emotionally labile, out-of-control, and physically or mentally ill (Johnston-
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 9 / 15
Robledo and Chrisler, 2011). Adverse physical symptoms such as period pain and heavy periods are afforded more
detailed and reassuring advice, reiterating that experiences vary: some women have more pain that others
(Patient.info, 2017). The weighting of the advice towards physical symptoms reflects ongoing public, political
e.g. the equality4mentalhealth.uk campaign launched in 2015 (Wax, 2016) and clinical debates (Millard and
Wessely, 2014) surrounding the lack of parity between physical and mental health care in the UK.
NHS Choices places very little emphasis on menstrual problems such as pain and excessive bleeding, instead
providing links to these related conditions at the end of the first section of the article. Unlike the other examples,
which frame periods in terms of related problems or through establishing normal menstruation in their titles, the
NHS Choices article is neutrally titled as Periods. This neutral framing is carried through the article, which though
quite generalised and brief provides ample links to related pages and notes that menstruation is a varied experience.
The article neither dwells on nor dismisses unwelcome physical conditions such as dysmenorrhea, and along with
the neutral title this potentially creates a more neutral space for readers to construct their own meanings around
menstruation. While possible related physical conditions are given little attention, PMS is afforded its own sub-
headed section. This provides a link to a more detailed page, and while it adds mood swings(NHS Choices, 2016)
to the list of possible symptoms, the only other emotional affect named is feeling irritable and loss of interest in
sex(ibid). While a much broader range of symptoms appears on the linked page on PMS, it would it would be
useful to include a broader range of possible emotional symptoms within the main article in order to reassure those
affected and promote a more nuanced understanding of PMS overall.
In the first part of the article, I have explored the largely problematic ways in which menstruation is framed in
a selection of everyday medical texts published online and how this might inform and / or reflect contemporary
understandings of menstruation. I will now discuss the practice-led research that was the main catalyst for the
above analysis, and my use of performative artistic techniques to develop alternative personal understandings of
my own experience of menstruation.
DECONSTRUCTING MENSTRUAL STIGMA THROUGH ENTANGLED
AUTOBIOGRAPHICAL ART PRACTICE
My artmaking is an exploration of the continued rippling effect of encountering menstruation both my own
and the representation of menstruation generally stuck between medicalisation and the languages of advertising
built upon maintaining the secrecy of the event of menstruation. As Jennifer Weiss-Wolf observes, to sell menstrual
products for much of their history the message was always the same. No leaks, no stains. No pain. No problem
(Weiss-Wolf, 2017: 14). Against a backdrop of pervasive cultural messaging, the experience of menstruating has
become aestheticised, commodified, and open to comparison with the normative experiences portrayed, however
caricatured they may be. My work joins others who present menstruation on their own terms, as a form of
menstrual activism which Bobel and Kissling describe as revealing:
how women internalize destructive messages about womanhood including notions of our bodies as
messy, unruly things (yes, things) that need to be tidied up, medicated, plucked, smoothed, and trimmed.
(Bobel and Kissling, 2011: 123).
It is perhaps not stated often enough that these messages are not only internalised by cis women they are
available to and internalised by everyone, giving rise to anxiety for those who menstruate and reinforcing harmful,
misogynistic expectations of female bodies in others. Chris Bobel (2007: 87) describes menstrual activism as
growing from the 1970s womens health, environmental and punk movements with a scathing critique of the
dominant Western cultural narrative of menstruation, resisting the framing of menstruation as dirty, shameful, and
something best hidden (ibid), and to challenge the binary view of gender that equates menstruation with
womanhood(Bobel, 2006: 89). Bobel has also noted that the broad range of activities undertaken over decades
reveal[s] the diverse ways menstrual activism has responded to shifting temporal, political, and social contexts
(Bobel, 2008: 739). Fahs (2016: 96-97) outlines in detail the important work menstrual activists have undertaken
to challenge the proliferation of commercial menstrual products, resist the pathologisation of menstruation, and
encourage more positive relationships to bleeding for menstruators and non-menstruators alike. She also points to
different strategies that could be adopted by menstrual activists that go beyond the traditional focus on commercial
menstrual products (Fahs, 2016: 104). These strategies include rebelling against the culture of secrecy and shame
around menstruation(ibid) and adopting radical postures of outingoneself as menstruating women(ibid).
In my visual artwork, I deploy my menstruating body in a performative gesture that both outs me as a
menstruator and illustrates a menstrual cycle that does not fit the normal descriptors provided by medical texts,
such as those analysed above. Cycles (2016-2017) (see Figure 1) is a series of 3 metre long hand stitched scrolls,
each divided into 28 sections sometimes a few more or less by a knotted red stitch. I began the work as a
Hughes / Challenging Menstrual Norms in Online Medical Advice
10 / 15 © 2018 by Author/s
way to confront my painful, inconsistent menstrual cycle, making a single print each evening over a six month
period by applying paint to my vulva with a small brush or my fingers. Once inked, I carefully press the linen
against my vulva, transferring the paint and any body fluids present to the cloth. I refer to my practice as performative
printmaking, as it goes beyond traditional printmaking techniques that utilise mechanical apparatus to create images.
Instead, I utilise my body as printing plate and press, with the resulting serialised images forming a material
document of the gesture. The artworks form a documented performance of my irregular and changing menstrual
cycle, a direct and public challenge to the stigma of menstruation(Johnston-Robledo and Chrisler, 2011: 9).
The white scrolls with carefully divided sections are intended to evoke notions of the sanitary, suggesting both
the clinical setting and the private sphere: white sheets; white pads and tampons; white cotton knickers; the dread
of staining any of them. In her analysis of menstrual stains in relation to Kristevas (1982) exploration on the abject,
Fahs notes that if a menstruator has bled through their clothing, they have bled through [original emphasis] not only
their literal underwear and pants but also transformed the boundary between public/private, self/other, and
animal/human(Fahs, 2016: 38). The ink and blood left on the scrolls are a direct retort to a persistent emphasis
on the private, personal nature of bleeding (Houppert, 2000: 81) and a standardised rather than individualised idea
of the menstrual cycle. Furthermore, in exposing the variations in my own cycle through the Cycles prints, alongside
my other works in poetry and in talking openly about my periods in relation to these works, I aim to counter this
normalised period and present a personalised account of a menstruating body. The reiterative process of making
the prints, and the repetition in my other works, are my attempt to paraphrase Sara Ahmed of not
reproducing the grammar of patriarchy (2017: 4) which underpins the narrative of menstrual taboo. Judith Butler
refers to a recurrent moment […] when we grasp that we are in the midst of reiterating a norm, even that a norm
has entered into a basic sense of who we are, and start to deviate […] from that more obedient sense of repetition.
(Butler in Ahmed 2016: 484). My artistic practice begins with and stays with a realisation that for most of my
adolescent and adult life I too had been reiterating the norm of period taboos.
To make these works is to fall out of alignment to borrow Ahmeds term (2017: 55) with what is expected:
silence, shame and deference to taboo and to recalibrate the way in which I act out my period, both at a personal
level and as an artist facing an outside audience.
At the core of the Cycles project is a desire to de-mystify menstruation and bodies that menstruate as distinct
from the norm, as a phenomenon that affects most of the population in some way directly as menstruators, or
indirectly as the partners, friends or relatives of menstruators. That vulvas and vaginas and images of them
exist outside the erotic, the sensational, the medical and the abject. I aim to present the everyday-ness of
Figure
1. Bee Hughes, Cycles, 2016-
2017. Acrylic and menstrual fluid on hand stitched linen scrolls, installation
size variable
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 11 / 15
menstruation, and suggest the ever-changing and fluctuating nature of the human body as no two vulva prints are
the same. These works are at once intensely personal and present a fragmented and incomplete picture of myself
as the artist, which can only be understood within my biography with access to further discussion, gallery
presentation, additional writings such as this article, or oral presentations. Though my work presents an alternative
image of menstruation, when read alongside the online medical advice, it becomes apparent that neither art nor
medicine can provide a complete picture alone. Both medical and vernacular knowledge and belief (Newton,
2016: 1) which inform the overarching cultural constructions of menstruation outlined above are incomplete.
Reading cultural, medical and artistic articulations through each other offers the potential to entangle everyday
folk(Newton, 2016) meanings, medical knowledge and personal experience towards surfacing empowered,
nuanced understandings of menstruating bodies made accessible through the dissemination of artworks and
autobiographical context in multiple forms.
Alongside and intertwined with the visual work are poetic experiments which began as written and visual
poems, later developed into soundworks. My poems are composed by cutting-up or redacting and permuting
phrases from online advice pages such as those analysed above and stem from a desire to explore my
experience of not feeling accounted for and listened to in my ongoing encounters with medical professionals
regarding my own menstruation. In the tradition of cut-up writing, the source text is re-appropriated into a radically
different context. Miles writes of William Burroughs (one of the earliest and most well-known cut-up writers) and
his analogy of language as a virus that the only way neutralise the power of those in control is to destroy their
means of control: their language(Miles, 2010: 126). While the poems are collaged from found words that are
themselves divorced from any single subjective experience, they hold an emotional resonance. Through permuting
and repeating phrases and words, I attempt to recreate the feeling of searching for medical advice online, skimming
texts and finding little reassurance. The poem a period is… (2016) appropriates text from the NHS Choices website,
intertwining words of medical authority with personal experience and emotion. This intervention aims to
deconstruct and complicate the language of menstruation I found while consulting everyday medical resources
online. I enmesh my embodied experience with these texts as a personal means of questioning and reconfiguring
the way menstruation and menstruating bodies are understood by moving the text from its assumed original
context as medical to a more explicitly cultural space. Through these experiments there is a potential to highlight
the complex entanglement of culture and medicine in the understanding of menstruation that has been so well-
articulated by many of the scholars cited here. Through exposing and entangling the medical with the cultural in
this way, this research aims to underscore the extra-clinical space of online medical advice as part of everyday
experience, as a cultural medical hybrid text rather than a strictly specialist part medical authority that is traditionally
inaccessible to lay audiences.
Figure 2. Bee Hughes, a period is..., 2016, visual poem
Hughes / Challenging Menstrual Norms in Online Medical Advice
12 / 15 © 2018 by Author/s
In the poem I aim to mirror the feeling of frustration that arose while reading online advice which presents
little space for variation, outliers or non-conforming bodies and cycles. For example, in a period is… (2016), the
repetition of a woman and bleeds reflects irritation that the original text described bleeding categorically as something
women do. The exasperation was twofold: first, there was the implication that womanhood should be defined by
the ability to menstruate; second was the idea that only cis women menstruated. In the reiteration and
fragmentation of these phrases, I am opening this orthodoxy up to question rather than reinforcing it as hard fact
by repeating the words until they lose their meaning and their power to define menstrual experience.
This sentiment carried through into my poems as they are translated into soundworks. This process of returning
the words to the body through my voice reflects the performative form of the visual works. Un-voiced (Hughes and
Petersen, 2017a) combines a spoken word poem composed by redacting the same advice used for a period
is…(2016) with non-vocal breathing sounds composed and performed by Eva Petersen. The piece plays on the
expectations of a performance, and the expectation of silence that surrounds the social stigmatisation of
menstruation. Petersen is a vocal artist whose entire performance for the piece is comprised of pre-vocal breathing
exercises. In contrast, a clear voice dispassionately reads words pulled from the medical text: the pronouns used in
the text you, woman, girl and the words period and vagina emerge from the breathing. The tension between the
intimate breathing sounds and the disjointed, context-free words alludes to the various ways contemporary culture
tends to silence or homogenise individual experiences. When played on a loop as in the collaborative exhibition
Comfort Zones (Hughes and Petersen, 2017b), alongside close-up self-portraits of Petersens mouth taken whilst
singing and the Cycles prints the repetitive, fragmented phrases echo (sonically as well as metaphorically) the
growing sense of frustration associated with my ongoing exploration of everyday medical texts and traditional
ideologies and attitudes surrounding menstruation.
CONCLUSIONS
My artistic practice is a work-in-progress which will continue to develop and respond as this research evolves.
Preliminary findings of this practice-led research have enabled me to situate my practice as alongside menstrual
activism, as it continues to evolve as a method through which to question and challenge socio-cultural stigma and
normative assumptions constructed through sources of medical and cultural authority. My practice has become a
space of personal resistance to normative constructions of menstruation, and through its dissemination I hope to
contribute to ongoing discussions that erode the norm of menstrual taboo. In the re-appropriation of medical texts
and re-embodiment of my work through sound as in Un-Voiced (2017) I aim to continue to develop my own
voice and understanding of menstruation, particularly investigating sites of tension where my own work might
further deconstruct or become complicit in normative ideas and practices of menstruation in wider culture.
Figure
3. Installation image of Comfort Zones
exhibition at Liverpool School of Art & Design, 2017. Photograph:
Bee Hughes
. Pictured: Eva Petersen, Yes, I am Looking Straight at You, 2017, photographic prints
. Bee Hughes,
Infinite Cycles, 2017, multimedia installation.
Feminist Encounters: A Journal of Critical Studies in Culture and Politics, 2(2), 15
© 2018 by Author/s 13 / 15
Depicting menstruation that conforms to neither contemporary ideals the regular or the regulated as an
everyday rather than pathologised occurrence, complicates the traditionally assumed binaries of health/disease,
whole/broken, normal/abnormal(Price and Shildrick, 1998: 4) often attached to biomedicine. Though these
binaries have been eroded through the turn towards a reinstatement of the materiality of the body(ibid: 7) in
feminist critical theory, this turn has also been criticised for remaining highly abstract(ibid). The practice of art-
making, particularly autobiographically entangled, visceral and phenomenologically produced through the body
has the potential to foreground literally and figuratively the material body in the very acts of academic
production(ibid) and anchor theoretical explorations in tangible, relatable situations.
This developing body of work began as a highly personal method of claiming control over my irregular
menstrual cycle. It has shifted towards what may be described as an artistic practice not developed in service or
opposition to the clinical and life sciences, but as productively entangled with a biomedical culture’’ (Viney et al.,
2005: 2). It is produced in the context of a broadened notion of the medical beyond the primal scene of the clinical
encounter(ibid) through engagement with online medical texts utilised outside (as well as within, in some cases)
the clinic. Cycles presents an embodied experience that falls between and outside the intertwined medical and
vernacular ideals of menstruation. Modified by hormonal contraceptives, my body presents neither a normative
ideal 28-day cycle reinforced by now widespread use of the contraceptive pill (Oudshoorn, 1994) nor fulfils the
further promise of a cycle fully under control and rendered invisible through the cessation of menstrual flow
achieved through a form of technological manipulation(Balsamo, 1996) provided by hormonal contraceptive
developments.
My analysis of the examples websites reflect that these examples of health advice remain grounded in traditional
binary conceptions of gender and focus specifically on menstruation as a phenomenon that happens to cis women.
Boots WebMD, NHS Choices and Patient.info present menstruation in relation to problems, yet offer limited practical
advice on managing or coping with the experience of bleeding and any other related symptoms. I found limited
positive framing of menstruation in the suggestion across all three studied sources that variation between individual
experiences is normal. However, there remains an emphasis on defining and reinforcing normative notions of
menstruation, and a limited potential for democratising medical knowledge between patients and physicians.
Instead of providing a clear measure by which to understand whether your experience is medically normal, the
construction of menstrual normativity has obscured, ignored or minimised difficulties experienced by non-
normative menstruators.
Framing menstruation around pregnancy is particularly problematic in terms of younger readers seeking
practical advice via this familiar and seemingly authoritative platform, and receiving only messages about their
bodies in relation to pregnancy, presented as a cis-heteronormative and passive account of the body. The example
texts form a bridge between medical practitioners and everyday life, presenting an outward impression of
objectivity, trustworthiness and medical authority. They lack room for nuance, present limited practical advice and
reinforce a highly binary and essentialist view of womanhood, constructed as dependent on the ability to
menstruate and bear children.
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Copyright © 2018 by Author/s and Licensed by Lectito BV, Netherlands. This is an open access article distributed under the Creative Commons
Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
... This societal conceptualisation of PMS is extremely narrow because it "indexes just one symptom: the supposed tendency for a menstruating woman to lose control of her emotions" (Gottlieb 2020, 144). Indeed, television series and films have a tendency to portray menstruators as ill, moody and unstable, for comedic effect (Hughes 2018). These discourses that frame menstruators as emotional are harmful because they subject menstruators to "ridicule, dismissal and trivialization" (Fahs 2016, 4). ...
... Emotion is the main theme of 62 memes in the dataset, thereby indicating that social media users view mood as a central aspect of menstrual experience. By characterising menstruators as emotionally unstable, 41 of these memes perpetuate the "myth of the irrational female" (Hughes 2018), thereby perpetuating problematic societal assumptions. One text-based meme states, "menstruation, mental breakdown, and menopause all contain the word men." ...
... The other meme refers to "people who menstruate" rather than to women. This meme therefore echoes a push towards inclusivity within recent menstrual activism (Hughes 2018). Across the entire dataset, only five memes use either "menstruator" or "people with periods." ...
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