No Need to Bleed: Technologies and Practices of Menstrual Suppression by Katie Ann Hasson A ...

152 Pages·2012·0.84 MB·English

No Need to Bleed:
Technologies and Practices of Menstrual Suppression

by
Katie Ann Hasson

A dissertation submitted in partial satisfaction of the
requirements for the degree of
Doctor of Philosophy
in
Sociology
and the Designated Emphasis
in
Women, Gender, and Sexuality
in the
Graduate Division
of the
University of California, Berkeley

Committee in Charge:
Professor Raka Ray, Co-Chair
Professor Charis Thompson, Co-Chair
Professor Kristin Luker
Professor Leslie Salzinger
Professor Barrie Thorne

Fall 2012

Abstract

No Need to Bleed: Technologies and Practices of Menstrual Suppression

by

Katie Ann Hasson

Doctor of Philosophy in Sociology

University of California, Berkeley

Professor Raka Ray, Co-Chair
Professor Charis Thompson, Co-Chair

In 2003, the FDA approved Seasonale, the first of a new generation of birth control pills
designed to reduce the number of menstrual periods a woman has in a year, or to eliminate them
entirely. These “new” pills are actually made from the same synthetic hormones as previously-
available birth control pills, but are designed and packaged to be taken in an extended regimen.
Neither the pills, nor the practice of using extended regimens of birth control pills to suppress
menstruation, were new. How, then, did Seasonale (and other menstrual suppression pills)
emerge as a “new” medical technology? In this dissertation, I examine the social shifts that
shaped the emergence and acceptance of menstrual suppression pills and practices at this
particular time, as well as the work that was required to produce menstrual suppression as a
“new” technology.
Taking menstrual suppression birth control pills as a case, my dissertation examines how this
reproductive technology is co-constituted with gendered bodies and selves in line with shifting
configurations of medicine, markets, and the state. I follow technologies of menstrual
suppression across multiple arenas: scientific knowledge production, medical practice, markets,
state regulation, and everyday life. Drawing on medical literature, product websites and FDA
documents, as well as interviews with women and medical professionals, I ask three questions:
1) What shifting understandings of menstruation, the body, and medicine underlie the emergence
of menstrual suppression? 2) How do medical, advertising and regulatory discourses produce
expectations for women to use technology to manage menstruation? 3) How do women enact
gendered selves through their engagement with discourses, practices, and technologies of
menstrual suppression?
I argue that menstrual suppression reconfigures menstruation to produce gendered bodies and
selves that dovetail with prevailing biomedical and neoliberal ideals. I make this argument in
three parts, knitting together textual, institutional, and experiential perspectives on menstrual
suppression. First, menstrual suppression technologies emerge amid shifting medical conceptions
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of disease and health. These technologies reflect the history of medicalization of women’s health
and pathologization of menstruation, while simultaneously participating in a project of
biomedicalization, which emphasizes transformation and optimization of the body. Second,
medical research, marketing, and regulatory discourses alike address women as neoliberal
subjects: consumers of health products and services who are free to transform their bodies but
individually responsible for acquiring the knowledge necessary to navigate the medical
marketplace. They construct this neoliberal subject as the ideal user of menstrual suppression
technology, in turn constructing menstrual suppression as a new biomedical technology. Third,
these discourses and institutions shape – but do not determine – the varied ways women engage
with these medical technologies. Physicians divide their understandings of extended regimen
birth control pills into, on the one hand, a treatment they prescribe to assist patients experiencing
menstrual symptoms and, on the other, a convenience for savvy patients who are eager to
exercise control over their periods. Race and class shape these constructions of patients and
ultimately structure women’s access to menstrual suppression technologies. Women, especially
those who have experienced problematic periods, renegotiate notions of what a normal, natural,
or acceptable period is through their engagements with menstrual suppression pills and practices.
Throughout, I argue that menstrual suppression technologies show how neoliberalism as a raced
and gendered project plays out on women’s bodies, shaping subjects (differently) according to
norms of gender, race, and class through technologies that reconfigure bodies and selves from
the inside out.

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Table of Contents
Acknowledgments.......................................................................................................................... iv
Chapter 1 | Introduction: Making Sense of Menstrual Suppression ................................................1
Making Sense of Menstrual Suppression ............................................................................ 5
Technologies of Gendered Bodies and Selves .................................................................. 10
Research Methods ............................................................................................................. 14
Chapter 2 | From Bodies to Lives, Complainers to Consumers: Measuring Menstrual Excess ....18
The Problem of Measuring Menstrual Excess .................................................................. 19
Measurement and Diagnosis ............................................................................................. 19
Methods............................................................................................................................. 22
From Bodies to Lives, Complainers to Consumers .......................................................... 23
Conclusion ........................................................................................................................ 30
Chapter 3 | Emergence of Menstrual Suppression Birth Control...................................................33
Literature ........................................................................................................................... 34
Hormonal Contraceptives as Treatment for Bleeding Problems ...................................... 35
Establishing Menstrual Suppression: Shifting Constructions of Hormonal Contraception
and Users ........................................................................................................................... 46
Conclusion ........................................................................................................................ 53
Chapter 4 | Flexible Bodies of Knowledge: Marketing, Regulation, and Configuring Neoliberal
Subjects ..........................................................................................................................................54
Configuring Users of Menstrual Technologies ................................................................. 54
Marketing by Giving the Information: Menstrual Suppression and Configuring Neoliberal
Subjects ............................................................................................................................. 55
“They Just Need to Give the Information”: Regulating for the Ideal Neoliberal Subject 69
The Neoliberal Subject of Menstrual Suppression?.......................................................... 85
Chapter 5 | Prescribing and Practicing Menstrual Suppression: Achieving a Normal Period and
Re-forming the Natural ..................................................................................................................87
Prescribers’ Perceptions of Menstrual Suppression and Construction of Users ............... 88
Using and Practicing Menstrual Suppression ................................................................. 100
“Regular Periods like Girls Are Supposed to Have”: Getting Started with Hormonal
Contraceptives and Menstrual Suppression .................................................................... 101
Scripting Bleeding: Pills and Practices ........................................................................... 108
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Re-forming the Natural Body ......................................................................................... 116
Conclusion ...................................................................................................................... 120
Chapter 6 | Conclusion .................................................................................................................123
Methodological Appendix ...........................................................................................................125
References ....................................................................................................................................134

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For Ann, JoAnn, Jennifer, and Lela
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Acknowledgments

Writing a dissertation can seem a lonely process, and so I am delighted to begin here by
acknowledging and thanking the many people who accompanied me and made this work
possible.
In my first year as an undergraduate at the University of Chicago, I took a feminist theory
course with Leslie Salzinger that changed the way I looked at the world and sparked many of the
questions that I’ve returned to over and over, including in this dissertation. I’ve been incredibly
fortunate to have her appear at UC Berkeley at crucial junctures in my progress. I am so grateful
for her support and guidance over the years, and especially fortunate to have had her as a
dissertation committee member over the past year.
Raka Ray, Charis Thompson, Barrie Thorne, Leslie Salzinger, and Kristin Luker made up
the dream team of feminist scholars advising this dissertation. They have generously shared their
time, attention, and insights, and my scholarship is much stronger for it. Raka Ray took me on as
her student rather late in my graduate career, and I have benefitted immensely from her unfailing
support, encouragement, and mentorship. Charis Thompson has deftly guided me through the
joys and perils of interdisciplinary work and provided me with provocative questions in equal
measure with unfailing encouragement and good cheer. Barrie Thorne has been a model of
feminist community building and, as my personal advisor, helped me find my way through
academic life. Although they were not directly involved in the dissertation, Dawne Moon, Jodi
Halpern, Michael Burawoy, and Liz Watkins influenced my thinking and provided support and
guidance at earlier stages. Induction into Raka’s gender dissertation working group has been an
exceptional perk, and I was very lucky to have the opportunity to work with this amazing cohort
of co-dissertators: Abigail Andrews, Kemi Balogun, Jenny Carlson, Dawn Dow, Kimberly
Hoang, Kate Maich, Kate Mason, Jordanna Matlon, Sarah Anne Minkin, and Nazanin Shahrokni.
I am also thankful for financial support from the Sociology Department, the Center for the Study
of Sexual Cultures, and the Graduate Division at UC Berkeley.
I have made many dear friends over the course of my time in Berkeley and I am so very
grateful for the ways they have enriched my life and work. Many friends helped me talk through
ideas, shared meals, went for a run or out dancing, read drafts, encouraged my writing, listened
to practice presentations, kept me company, and generally made my life better, including Kate
Darling, Kristen Gray, Jennifer Jones, Sarah MacDonald, Selby Mashakova, Jennifer Randles,
and Wes Terray. In addition to being an exceptionally kind, generous friend and an amazing
listener, Sarah Anne Minkin read nearly every word I wrote in the first several years of graduate
school (and allowed me the privilege of reading hers). Her insightful critiques improved my
writing, built my confidence, and still serve as my model for how to give constructive feedback.
Dawn Dow and I have shared countless cafe tables, many early mornings (and a few very late
nights) of writing, and many more hours talking through our lives and work. Despite the new
distance, I fully expect and look forward to many years of the same! Dawn, along with Gretchen
Purser, Silvia Pasquetti, Sarah Gilman, and Siri Colom made up the writing group that saw me
through, beginning with the first tenuous steps of the dissertation. I am so grateful to them for
their feedback and encouragement, especially the support they provided in getting this project off
the ground. I am also sincerely grateful to Pamela Reaves for her care and encouragement.
Likewise, the “Accountability Club” in its various iterations has sustained me through the
long process of dissertation writing. My heartfelt thanks go to Emily Smith Beitiks, Jenny
Denbow, Hedda Høgåsen-Hallesby, Anastasia Kayiatos, Martine Lappe, and Preetha Mani for
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the weekly (daily, hourly) doses of in-person and virtual support. Martine and Emily provided
the pep talks and inspiration that buoyed me through the final stages of research and writing.
Anastasia Kayiatos, in addition to getting the group going, offered a lifeline through a very tough
time and has been my near-constant companion in these final, manic weeks of writing. I can’t
imagine having done this without her support and encouragement!
Finally, I would like to thank my family. I am so grateful for your love and the many
forms of emotional and material support that have truly made it possible for me to pursue this
work. Robb Mazzoli and Bett Hansen have supported every step along the way and cheered
every milestone. Three (now four) generations of strong women set me on this path and make
sure that I keep going. Ann Egan, JoAnn Egan, and Jennifer Hasson have provided inspiration,
examples of perseverance and grace, and every form of encouragement. This dissertation is
dedicated to you.
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Chapter 1 | Introduction: Making Sense of Menstrual Suppression

On September 5, 2003, the US FDA approved Seasonale, a new oral contraceptive
designed to reduce the number of periods a woman has in a year to four by having women take
active pills for 84 days, followed by a “hormone-free” week. Barr Laboratories, Inc., the
pharmaceutical company that produced Seasonale, heralded its development as “the single most
significant advance in oral contraception in the past 40 years” (Barr Laboratories 2003: 4). Four
months prior, in a Washington Post article reporting Seasonale’s impending approval, one
physician was quoted as saying:
We’re talking about giving a woman the ability to exert even greater control than
she ever has before, freeing her up from the nuisance, uncomfortable, messy
business of menstruating… We’re talking about a major quality of life
improvement if we can suppress her menstrual cycles. (Stein 2003)
Media interest renewed four years later, when the FDA approved Lybrel, an oral contraceptive
that is taken continuously – 365 days per year – in order to completely suppress menstruation.
Headlines announced the “end” of periods, and authors speculated about the impact of making
menstruation optional, as in this article in US News and World Report:

With the Food and Drug Administration's approval today of the first birth control
pill to stop menstruation, women may soon come to view their period as just
another lifestyle choice. Drug manufacturers have already tinkered with the
monthly flow… But Lybrel, made by Wyeth, would stop [periods] altogether.
(Kotz 2007)

At the end of 2007, TIME Magazine even included Lybrel as #6 on its list of the top 10 medical
breakthroughs of the year, alongside the development of a bird flu vaccine and the discovery of
new sources of stem cells (Guthrie 2007). News coverage, whether supportive or critical,
presented menstrual suppression birth control pills as a controversial new technology,
highlighting the potential of menstrual suppression to radically change women’s lives.
Yet for many women who were already taking their birth control pills in a way that
allowed them to experience no monthly bleeding, Seasonale, Seasonique,1 and Lybrel were not
news at all. Reyna2, a 27-year-old, white woman from San Francisco, was already using her birth
control pills to manipulate her cycle, deciding for herself when and how often she would have a
period. She told me when I interviewed her, “When I saw those commercials, I was like, ‘Duh.’
And I thought, ‘You know that all they did is advertise it, right? It’s just marketing, because you
can do that with the other pills.’ Obviously, I had been doing it.”
Reyna was right. There was nothing new about the chemical formula of Seasonale. It
contained the same hormones, ethinyl estradiol and levonorgestrel, in the same dose, as one of
Barr Laboratories’ already existing birth control pills, Nordette. Further, as even the news
articles admitted, using hormonal birth control to suppress menstruation was not new. It had been
possible to use oral contraceptives to skip periods since their invention, and for decades many

1 Seasonique is a sister product to Seasonale. FDA approved and launched in 2006, it maintains the same 84/7 pill
regimen, but includes 7 pills with a small amount of estrogen (ethinyl estradiol) rather than 7 placebo pills.
2 All interviewees’ names are pseudonyms.
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