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Technologies and Practices of Menstrual Suppression by Katie 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 1 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. 2 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 i Re-forming the Natural Body ......................................................................................... 116 Conclusion ...................................................................................................................... 120 Chapter 6 | Conclusion .................................................................................................................123 Methodological Appendix ...........................................................................................................125 References ....................................................................................................................................134 ii For Ann, JoAnn, Jennifer, and Lela iii 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
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