The doctor who taught me about human reproduction at medical school was in fact a veterinarian. More is known about a sheep’s rhythms than a woman’s, he said, setting the tone in our first tutorial, presumably because ewes drive a healthy profit. I was disappointed. I felt that menstruation and pregnancy shouldn’t be narrated to us like they would be for any other animal. These aren’t just biological events, but experiences coloured by memory and anticipation. What about days of frantic maxi pad changes in school cubicles that go unspoken between girls, some as young as eight, unpredictably timed yet reliably painful? Periods are a muddled burden: a monthly shame as well as a relief.
If millennials have been undernourished with information about their bodies, then previous generations were almost starved of it. A flush of coverage has arisen out of this embarrassed silence, such as Emma Barnett’s Period and BBC Radio 4’s series 28ish Days Later. Dr Jen Gunter’s Blood takes an unapologetically scientific approach to the menstrual cycle, written for anyone who wants to understand its often mystified ways and what medicine can do to help. Perhaps Gunter’s resolve to reduce stigma around women’s health was a reaction to her own upbringing in Canada, with a mother who thought tampons were “evil”. Now a gynaecologist in San Francisco with three decades of experience, Gunter became famous in 2018 for ridiculing the pseudoscientific offerings on Gwyneth Paltrow’s wellness platform Goop, and has since continued her battle against disinformation with her Substack newsletter the Vajenda, alongside bestselling books The Vagina Bible and The Menopause Manifesto. Without fear, favour or sponsor, Gunter is a cheerleader for professional expertise, informed consent and reproductive justice.
Brutally put, the menstrual cycle is “resource curation to ensure the healthiest pregnancy outcome, but at the expense of the person who menstruates”, Gunter writes. Primates are among the 2% of mammals who shed the lining of their uterus on a regular basis, a power of sorts we share with bats, elephant shrews and spiny mice. It’s a wasteful process occurring every 24 to 38 days in humans, probably evolved to protect against the invasiveness of the placenta and early pregnancies with genetic abnormalities. As with circular debates in the media 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 studies rather than mere anecdata to make decisions about their care.
Blood explains the big dipper of oestrogen and progesterone; common yet agonising gynaecological conditions such as endometriosis and adenomyosis; under-discussed concerns such as menstrual diarrhoea and the intense – sometimes suicidal – low mood of premenstrual dysphoric disorder; and today’s bazaar of contraceptive options. The details of primary ovarian insufficiency or IUDs may not be equally interesting to all readers, and with this in mind, sections end with helpful bullet-point summaries. Gunter is also reassuring about risks that have historically been overstated, such as toxic shock syndrome. Girls worry about this vanishingly rare (though serious) infection as if it were some kind of genital electrocution sparked by a tampon, but you’re more likely to be struck by lightning. As Blood makes clear: “It’s scary vagina stories that make copy.”
The book’s ability to make science sing and stick is impressive, but an even greater achievement of Blood is to expose the playbook of medical misinformation. Gunter helps readers sort out claims that “sound truthy” from those that are in fact true. Menstrual blood souring milk, ruining crops and wilting flowers seem like misogynistic tales from the past, but similar myths circulate online today. Gunter fears we’re at a public “inflection point”, as facts are becoming harder to recognise, while words such as “natural” and “ancient” win people’s trust. TikTok and Instagram promote vaginal steaming; menstrual blood face masks as cures for acne; boric acid as an elixir for genital odour; CBD (cannabidiol) infused tampons and even handknitted ones from “Gyno” Etsy.
Gunter regularly faces accusations of being closed-minded to alternative practice and overconfident 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 as they please, and she isn’t criticising consumer choices but rather the peddlers who prey on women’s discomfort and fears in the name of feminism while making money. Medics are wrongly demonised as puppets of big pharma, she says, while influencers flog untested and unregulated supplements with clear self-interest. Doctor is not a protected title in the US, and the cosplay in evidence – white coat and stethoscope – on naturopathic and wellness websites is a warning to the UK to uphold clarity about who and who is not medically trained. Gunter worries that alternative approaches not only do harm; they also represent an opportunity lost. Pain relief and hormonal contraception, for example, can also be “disease modifying drugs” that reduce inflammation and prevent sensitisation of local and central pain pathways. As treatment options expand, never has the case for safe, effective, affordable and timely gynaecological care been stronger.
Disinformation is particularly rife around abortion. Gunter’s justified anger at purity culture and “rightwing politicians who fancy themselves junior gynaecologists” escalates in the book’s final section. Maternal mortality and the mental and physical injuries of pregnancy and birth are appallingly high in the US (for black women particularly, which is also true in the UK), to the extent that “pregnancy should have a black box warning”. Termination in the first or second trimester is safer than 40 weeks of pregnancy followed by delivery, Gunter writes, despite fearmongering to the contrary. It’s disturbing to read her warning to her US readers to think twice about using period-tracking apps and location data, which have been used to incriminate women seeking an abortion. Gunter even has to advise not to take the abortion-inducing medicine misoprostol vaginally, as white residue may remain visible on a later speculum examination, whereas when it’s taken orally the result is indistinguishable from a miscarriage, as “there is no physical sign or complication unique to a medical abortion”.
Blood is a compelling example of how science communicated with clarity, relatability and wit can satisfy our needs of belonging and care, which have been mastered and sometimes manipulated by the wellness industry. With the transparency of science, Gunter shows that bodies become more, not less intriguing. She acknowledges that doctors have let women down grievously: by disbelieving them, dismissing their priorities, excluding them from research, co-opting them into experiments without consent, making health decisions on their behalf and, frankly, treating them no better than sheep. But rather than rejecting science, activist researchers, clinicians and patients must continue to row back this “medical disenfranchisement”, armed with books such as Blood and evidence about their bodies.
Kate Womersley is a doctor and academic specialising in psychiatry. Her work at Imperial College London focuses on sex and gender equity in biomedical research
