Tthe doctor who taught me about human reproduction in medical school was actually 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 make a healthy profit. I was disappointed. I felt that menstruation and pregnancy should not be told to us as it would be to any other animal. These are not just biological events, but experiences colored by memory and anticipation. What about days of furious maxi pad changes in school cubicles going unspoken between girls, some as young as eight, unpredictable time but reliably painful? Periods are a tangled burden: a monthly shame as well as a relief.
If millennials are malnourished with information about their bodies, then previous generations were almost starved of it. A flood of coverage arose from this embarrassed silence, as e.g Emma Barnettsay Period and BBC Radio 4’s series 28 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 mysterious ways and what medicine can do to help. Perhaps Gunter’s intention 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 gynecologist in San Francisco with three decades of experience, Gunter became famous in 2018 for mocking the pseudoscientific offerings on Gwyneth Paltrow’s wellness platform Goop, and has since continued her fight against disinformation with her Substack newsletter the Vajendaalong with bestselling books The Vagina Bible and The Menopause Manifesto. Without fear, favor or sponsor, Gunter is a cheerleader for professional expertise, informed consent and reproductive justice.
Cruelly put, the menstrual cycle is “resource curation to ensure the healthiest pregnancy outcome, but at the expense of the person who is menstruating”, writes Gunter. Primates are one of the 2% of mammals that regularly shed the lining of their wombs, a power we share with bats, elephant mice and shrews. This is a wasteful process that occurs 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 bewildering variety of flow, pain and associated symptoms is why women need rigorous studies rather than mere anecdotal data to make decisions about their care.
Blood explain the big dipper of estrogen and progesterone; common yet painful gynecological conditions such as endometriosis and adenomyosis; under-discussed concerns such as menstrual diarrhea 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 of equal interest to all readers, and with that in mind, sections end with helpful bullet 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 caused by a tampon, but you’re more likely to be struck by lightning. As Blood make it clear: “These are scary vagina stories that make copycats.”
The book’s ability to make science sing and stick is impressive, but an even greater feat of Blood is to expose the playbook of medical misinformation. Gunter helps readers sort out claims that “sound true” from those that actually are. Menstrual blood sours milk, ruins crops and withers flowers seem like misogynistic tales of the past, but similar myths circulate online today. Gunter fears 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 cures for acne; boric acid as an elixir for genital odor; CBD (cannabidiol) infused tampons and even hand knitted tampons from “Gyno” Etsy.
Gunter often faces accusations that she is closed to alternative practices 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 is not criticizing 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 demonized as puppets of big pharma, she says, while influencers flog untested and unregulated supplements with obvious 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 maintain clarity about who is and who is not medically trained. Gunter worries that alternative approaches not only cause harm; they also represent a lost opportunity. For example, pain relief and hormonal contraceptives can also be “disease-modifying agents” 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.
Disinformation is especially common around abortion. Gunter’s justified anger at purity culture and “right-wing politicians who fancy themselves junior gynecologists” escalates in the book’s final section. Maternal mortality and the mental and physical injuries of pregnancy and childbirth are horrendously high in the US (especially for black women, who 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 fear-mongers to the contrary. It’s disturbing to read her warning to her American readers to think twice about using period-tracking apps and location data, which have been used to incriminate women seeking an abortion. Gunter even advises not to take the abortion-inducing medicine misoprostol vaginally, as white residue may remain visible during a later speculum examination, while when 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 for belonging and care, which have been mastered and sometimes manipulated by the wellness industry. With the transparency of science, Gunter shows that bodies are more, not less, intriguing. She admits that doctors have seriously failed women: by not believing them, dismissing their priorities, excluding them from research, co-opting them into experiments without consent, making health decisions on their behalf and being honest , treating them no better than sheep. But rather than rejecting science, activist researchers, clinicians and patients must continue to fight back against this “medical withdrawal”, armed with books such as 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
