No Need to Bleed: Technologies and Practices of Menstrual Suppression

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 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