The Radical, Expansive Future of Period Technology

When hormonal contraceptive pills were first introduced to the public in 1960, they were initially packaged in a bottle, like other drugs. A few years later, Ortho-Novum was the first to create the circular dispenser that so many of us are familiar with: 21 days on, seven days off. This dispenser gave a sense of temporality to periods, as they occurred in a regular fashion every few weeks. The “off” week was designed by pharmaceutical companies to create a menstrual period because they felt patients, pharmaceutical executives, and religious officials would find hormonal contraception more acceptable this way. Experiencing somewhat regular menstruation is also a major way people know they are not pregnant. Though menstruating people have for decades been hacking their own contraception to avoid periods around certain life events, such as vacations or athletic competitions, it wasn’t until the turn of the 21st century that pharmaceutical companies began to sell hormonal contraceptive pills that explicitly skipped placebo weeks in order to decrease the frequency of menstruation. 

Chemical menstrual suppression, like hormonal contraception, represents the next step of what the historian Sharra Vostral calls “technologies of passing.” Menstrual management products were the first “technology of passing,” in that they allow a menstruating person to move through the world as though they are not menstruating. Tampons make it possible to wear bathing suits and go swimming; all forms of menstrual management products decrease the risk of bloodying clothes, furniture, and bedsheets. Menstrual suppression technologies are a logical next step in pharmaceutical executives’ quest to gain customers, but it also seems like a good idea to those looking to survive in hustle and productivity cultures that leave less and less room for experiences like menstruation, not to mention those for whom eliminating menstruation would help affirm their gender. While the acceptance of menstrual suppression technologies was initially quite low, acceptability has increased dramatically over the past several decades, in no small part due to the advertising of pharmaceutical companies and advocacy by vocal physicians. And the increased accessibility to menstrual suppression technologies is part of what we need in our period (or for some, period-free) future. 

Most menstrual suppression technologies are varying types of hormonal contraceptives, which are not nearly as well tolerated by menstruating bodies as most of us believe. Across multiple studies, about half of people on hormonal contraceptive methods discontinue them. Even those who do stick with hormonal contraception often experience unwelcome side effects, which they endure as an acceptable cost in order to avoid getting pregnant or menstruating. Many groups are invested in menstruating people staying on hormonal contraceptives, including pharmaceutical companies, those who fear teen pregnancy, and those interested in global population control. But it’s possible menstruating people are not always as invested themselves, at least in the management and suppression technologies as they currently exist. According to a recent Cochrane review—effectively, the gold standard in health care if you are trying to assess quality of evidence—direct, in-person counseling, the most common intervention for improving the continuation of hormonal contraceptives, does not increase the rate at which people choose to stay on hormonal contraception. In the papers they sampled, anywhere from a quarter to half of those on a given hormonal contraceptive regimen discontinued their use over the study period. One recent study comparing self-reported continuation rates to actual pharmacy claims suggests people may overestimate how continuously they use hormonal contraception. People skip a month here or there because they forget to get their prescription in time, because the prescription is expensive, because they aren’t having potentially conceptive sex, or because they don’t love how the hormonal contraception makes them feel and need a break from it. 

Hormonal contraception, especially shorter-acting forms like pills, rings, patches, and injections, are a hassle, and users often report side effects, such as loss of libido, weight gain, vomiting, dizziness, and depression, as well as amenorrhea, irregular bleeding, and heavy bleeding. Two studies have reported some improvement in continuation among users with adverse side effects who received counseling, but the certainty of the finding was weak. Note that the goal of these studies was to figure out how people suffering serious effects could continue taking hormonal contraception. The fear of pregnancy—particularly the fear of the wrong person getting pregnant (for example, a teenager or a brown or Black person)—motivates the continued use of hormonal contraceptives that cause harm to about half of the people who try them.

Significant side effects and high rates of discontinuation also plague the levonorgestrel-containing intrauterine device, or hormonal IUD. One study that examined the experiences of 161 women who had the hormonal IUD inserted at one hospital in the United Kingdom found that almost half of them had their IUD removed due to side effects, including “bloating, headaches, weight gain, depression, breast tenderness, excessive hair growth, greasy skin, acne, and sexual disinterest.” This finding is particularly striking since these women were great candidates for the hormonal IUD: They had had a gynecological exam before having it inserted and, in most cases, also had hysteroscopic assessment of their uterine cavity to make sure they didn’t have fibroids or other lesions that could complicate their experience. 

In a study interviewing physicians who administer hormonal contraception, respondents were less than understanding when patients requested early removal of the IUD. Physicians in this sample were often frustrated when patients were dissatisfied with their IUDs for any reason. Intent on getting as many people as possible to use them, a physician from the study confessed: “I don’t try to influence women’s decisions, but I do try. Like I don’t want me to be the person making the decision, but I do want to guide them to make a good decision for them. But I usually say it’s my favorite method. … And I usually say that it’s our most effective method, and it’s very easy to put in.” When patients asked to have their IUD removed, physicians often discouraged them by requesting that they keep it in for a few more months to see if symptoms change. While many physicians emphasized the importance of patient decision-making, others only grudgingly ceded to patient autonomy. Others expressed disappointment or disagreement with their patients. These coercive stances run counter to the broader goals of reproductive justice. 

Gynecologists often see their family-planning role as one in which they stop as many unplanned pregnancies as possible and in particular get as many people on long-acting methods (like the IUD, Depo Provera, or implant) as possible. Psychologists Patrick Grzanka and Elena Schuch point out that this is part and parcel of the original goals of fertility control, which was directed first and primarily at white women and pitched as an opportunity for personal agency. However, dif­ferent people are going to experience and be pressured differently in long-acting contraception usage, leading to a kind of “conditional agency” depending on their race and gender. The overfocus on how successful a product is in preventing birth, over side effects or one’s ability to stop and start the product at will, is how physicians are taught to recommend contraceptive options. This limits patients’ abilities to generate their own priorities to inform their choices. 

Beyond discouraging patients from removing IUDs, and beyond even how hard it can be to find a physician who will remove one, physicians also discount the pain caused by IUD placement. For instance, the science fiction author Monica Byrne recently shared on Twitter the story of a friend’s unanesthetized IUD insertion. The replies that followed demonstrated how frequently menstruating people are discouraged from using local or systemic anesthetic during multiple procedures—not just IUD insertion but IUD removal, hysteroscopy, and endometrial biopsy. Research on pain management during these procedures is hard to come by; the most recent meta-analysis I could find on local anesthetic for IUD insertion was from 2018 and included only 11 studies. In the Twitter thread, people shared stories of health insurance companies that had refused to cover better methods of IUD insertion, such as insertions guided by ultrasound rather than by feel. Many of the Twitter posts describing insertions where the respondent was not offered or was denied pain medication described the pain as worse than childbirth. Many of these respondents were also horrified by their doctors’ dismissive responses. As Byrne responded to one tweet, “It’s like they build gaslighting into the pre-op.” Many respondents, including the original sharer, expressed gratitude toward and/or approval of the IUD, even though it had also caused them significant pain and even trauma. Many people need both contraceptive and menstrual suppression technologies, yet these technologies can come with a steep personal cost. 

Safe and effective contraception and menstrual suppression are necessary medical technologies for many people, especially as access to abortion continues to erode. Yet the main method of reversible menstrual suppression seems to be tolerable, at best, about half the time for those who try it. As far as I know, there are no methods being tested right now that do not require hormonal manipulation in order to reversibly suppress the period. I cannot imagine such a low level of research and development were these products that primarily affected cisgender men. And we need to be able to critique the systems that have led to inadequate contraceptive solutions for so many while continuing to improve access to what we have. This is not about discarding hormonal contraception. It’s about working toward something that works better for a greater number of people. 

So part of my period future involves pushing structural solutions for the development of feminist technologies to improve menstrual suppression for those who want it. We need better legislation and regulatory oversight on the development of new methods to stop menstruation reversibly. We need tax dollars and other incentives for biotech and pharmaceutical companies to work on novel therapies. And we need to improve the gender ratio in these industries so that more menstruating people are involved in the decisions regarding how money is allocated for research and development departments. 

I’d love to consider a broader period future: one that also creates more room for menstruating bodies. Given the attacks on reproductive justice, mass shootings, forced detransitions, and our ongoing climate crisis, I often struggle to imagine a just future, let alone to let my children out of my sight. Yet we need these dreams if we want to have any hope of getting a better present and a better future. We need to imagine a future where we acknowledge that we are humans with bodies that need attention and love, that the needs of bodies are all dif­ferent, that our minds are housed in these bodies and are better off when we don’t ignore the house. More than self-care or body positivity, I am advocating for the radical (but not new or original) idea that humans deserve dignity and that dignity means not only accommodating but celebrating and noticing all people.

I would argue that menstrual liberation is about becoming more visible as menstruating people while working to ensure that our needs are considered alongside our community’s and planet’s needs. One important step in pursuing this path is to shift how we frame the questions we ask about menstruation. As the botanist Mary O’Brien has powerfully argued, when a scientist seeks to offer a risk assessment on a given problem, it involves adopting a particular cultural frame: how much harm a given individual, community, or ecosystem can handle. So when it comes to menstrual concealment and management, risk assessment asks: What concentration of volatile organic compounds in menstrual pads is too much? How long can someone wear a tampon before developing an infection? How many disposable menstrual products can a landfill take before phthalates leach into the groundwater? Or with menstrual suppression: What causes the fewest side effects alongside the highest efficacy for the most people? 

O’Brien points out that asking these kinds of questions, rather than alternatives assessment questions, “is to contribute to the currently dominant, but suicidal, assimilative capacity approach and practices of our society.” Alternatives assessment questions take a dif­ferent perspective. Pursuing menstrual liberation, one could ask, what alternatives do we have to the creation of menstrual products that contain harmful endocrine-disrupting chemicals? What alternatives do we have to a life so tightly scheduled or privacy so hard to come by that menstruating people need to wear these products for 12 or more hours at a time? What alternatives do we have to suppression technologies that are not universally effective or tolerable? In Pollution Is Colonialism, Max Liboiron reminds readers that there is no “away” where we can put plastics where we are not ultimately shoving harm on someone else. Plastics aren’t going anywhere. Likewise, there is no away where menstruating people can put our messy, leaky bodies—and, frankly, people in power will continue to notice and deride their existence whether or not those bodies conform to their version of professionalism and civility. A risk assessment perspective would ask what menstrual concealment and suppression technologies could support our autonomy with the least amount of harm. An alternatives assessment perspective would ask whether concealment and suppression are the only options on the table. 

My own alternatives assessment, my period future, imagines a world where we have ready access to single-stall bathrooms with plenty of menstrual management supplies that are safe and easy to use; where we don’t have that feeling of a completely saturated pad and realize “Oh shit, I have to be somewhere in two minutes”; where we know that the products we can readily access and that are effective for us do not harm us nor hasten climate change. I even imagine rooms where people could hang out from time to time with a heating pad or some ibuprofen. Bio-breaks would be built into the day, and care work would be the basic expectation people have for each other at home, at school, at work, and out in public. What I am imagining is a world where it is as unremarkable for someone to openly carry a tampon as it is to carry a hair clip and where discussing the care of our bodies does not label us weak. 

If this sounds like disability justice, that’s because it is. In her book Care Work: Dreaming Disability Justice, Leah Lakshmi Piepzna-Samarasinha writes about the “crip skills” those with disabilities have developed to make their way through the world and how those skills are what make it possible to problem-solve, support each other, and change environments. These are skills all of us with bodies need, for two reasons. First, disability is a liminal category people can move in and out of over the course of their lives; we can break an ankle, develop chronic illness, need recovery time after surgery. Second, our present and future get better when we consider accessibility as a foundation for justice. As Piepzna Samarasinha declares, “When I think about access, I think about love.” 

If my environment were more accessible, more accommodating of menstruating bodies, would I still want to excise periods from my life? I don’t know. I know that I am exhausted by the ways I have to manage my body to fit in this world. As I’ve grown older, I’ve found myself less interested in changing myself to fit the world and more interested in making the world accept and make room for me and my friends, colleagues, and loved ones. 

Menstruating people need safe ways to manage periods, including stopping them; they need treatment and care for their chronic illnesses; they need a complete reenvisioning of how they fit into the world, especially in public. Perhaps period futures can be messy: incommensurable at times, changing, flexible. Perhaps we need to consider the possibility that there will never be a menstrual alternatives assessment or technology that is perfect. Yet there is so much to be gained—autonomy, community, connectedness, and work toward a just and safe world—in the trying.

Excerpted from PERIOD: THE REAL STORY OF MENSTRUATION © 2023 by Kathryn Clancy. Reprinted by permission of Princeton University Press.