TThe doctor who taught me about human reproduction in medical school was, in fact, a veterinarian. More is known about the rhythms of sheep than about those of women, he said, setting the tone for our first lesson, presumably because ewes make a healthy profit. I was disappointed. I felt that menstruation and pregnancy should not be told to us like they would be for any other animal. These are not just biological events, but experiences colored by memory and anticipation. What about days of frantic changes of maxi pads in school cubicles that go unspoken between girls, some as young as eight years old, unpredictably timed yet reliably painful? Menstruation is a messy burden: both a monthly shame and a relief.
If millennials are malnourished with information about their bodies, then previous generations are nearly starved of it. This embarrassed silence has given rise to reporting, such as that of Emma Barnett Period and the BBC Radio 4 series 28 days Later. Doctor Jen Gunter’s Blood takes an unapologetically scientific approach to the menstrual cycle, written for anyone who wants to understand its often baffling ways and what medicine can do to help. Perhaps Gunter’s decision to reduce the stigma surrounding women’s health was a response to her own upbringing in Canada, with a mother who thought tampons were “bad.” Now one Gunter, a San Francisco gynecologist with three decades of experience, rose to fame in 2018 for mocking the pseudoscientific offerings on Gwyneth Paltrow’s wellness platform Goop, and has since continued her fight against misinformation with her Substack newsletter the Vajendain addition to best-selling books The Vagina Bible And The Menopause Manifesto. Without fear, favor or sponsorship, Gunter is a cheerleader for professional expertise, informed consent and reproductive justice.
Crudely put, the menstrual cycle is “the management of resources to ensure the healthiest pregnancy outcome, but at the expense of the person menstruating,” Gunter writes. Primates are among the 2% of mammals that regularly shed the lining of their uterus, a kind of power we share with bats, elephant shrews and spiny mice. It is a wasting process that occurs every 24 to 38 days in humans and likely evolved to protect against placental invasiveness and early pregnancies with genetic abnormalities. As with circular media debates about whether menopause is a blessing, a neutral event or the worst phase of a woman’s life, menstruation is not a single experience that unites half the population. The staggering variety of flow, pain, and associated symptoms is why women need rigorous research rather than mere anecdata to make decisions about their care.
Blood explains the large amount of estrogen and progesterone; common but painful gynecological conditions such as endometriosis and adenomyosis; underexposed problems such as menstrual diarrhea and the intense – sometimes suicidal – depressed mood of premenstrual dysphoric disorder; and today’s bazaar of contraceptive options. The details of primary ovarian insufficiency or IUDs may not be of interest to all readers, and with this in mind the sections end with useful brief summaries. Gunter is also reassuring about risks that have historically been exaggerated, such as toxic shock syndrome. Girls worry about this extremely rare (though serious) infection as if it were some kind of genital electrocution caused by a tampon, but you’re more likely to be struck by lightning. If Blood makes it clear: “They are scary vagina stories that copy.”
The book’s ability to make science sing and stick is impressive, but an even greater achievement Blood is to expose the playbook of medical misinformation. Gunter helps readers distinguish statements that “sound true” from statements that are actually true. Menstrual blood soured milk, destroyed crops and withering flowers seem like misogynistic stories from the past, but similar myths circulate online today. Gunter fears that we are at a public “tipping point” as facts become increasingly difficult to recognize, while words like “natural” and “old” gain people’s trust. TikTok and Instagram promote vaginal steaming; menstrual blood face masks as a remedy for acne; boric acid as an elixir for genital odor; Tampons with CBD (cannabidiol) and even hand-knit tampons from “Gyno” Etsy.
Gunter is regularly accused of a closed attitude towards alternative practices and of overconfidence in her opinions. To which she would say that evidence-based medicine is not an opinion, even if you don’t like it. Consenting adults can do whatever they want, and she is not criticizing consumer choices, but rather the hucksters who prey on women’s discomfort and fears in the name of feminism while making money. Medical professionals are being unfairly demonized as puppets of the big pharmaceutical industry, she says, while influencers with clear self-interest are pushing untested and unregulated supplements. Doctor is not a protected title in the US, and the cosplay seen – white coat and stethoscope – on naturopathic and wellness websites is a warning to the UK to maintain clarity about who is and who is not medically trained. Gunter worries that alternative approaches don’t just cause harm; they also represent a missed opportunity. For example, pain relief and hormonal contraception can also be ‘disease modifying drugs’ that reduce inflammation and prevent sensitization of local and central pain pathways. As treatment options expand, the case for safe, effective, affordable and timely gynecological care has never been stronger.
There is particular misinformation around abortion. Gunter’s righteous anger about purity culture and “right-wing politicians who consider themselves junior gynecologists” escalates in the last part of the book. Maternal mortality and the mental and physical harm from pregnancy and birth are alarmingly high in the US (especially for black women, which is also the case in Britain), to the extent that “pregnancy should be a black box warning to have”. Termination in the first or second trimester is safer than forty weeks of pregnancy followed by childbirth, Gunter writes, despite fear mongering to the contrary. It is disturbing to read her warning to her American readers to think twice about using menstrual tracking apps and location data, which have been used to target women seeking abortions. Gunter must even advise against taking the abortion-inducing drug misoprostol vaginally, because white residue may remain visible during a later speculum examination, while when taken orally the result is indistinguishable from a miscarriage, because “there are no physical signs or complications . unique for a medical abortion”.
Blood is a compelling example of how science communicated clearly, relatably, and humorously can meet our needs for belonging and care, which are controlled and sometimes manipulated by the wellness industry. With the transparency of science, Gunter shows that bodies are becoming more intriguing, not less. She recognizes that doctors have failed women in serious ways: by not believing them, overriding their priorities, excluding them from research, including them in experiments without consent, making health decisions on their behalf, and treating them, fairly said, no better to treat than sheep. But instead of rejecting the science, activist researchers, doctors and patients must continue to resist this “medical denial,” armed with books like Blood and evidence about their bodies.
Kate Womersley is a doctor and academic specializing in psychiatry. Her work at Imperial College London focuses on sex and gender equality in biomedical research