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Kate Clancy, "Period: The Real Story of Menstruation" (Princeton UP, 2023)
00:28:21
An interview with Kate Clancy
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- [00:01]
A
Welcome to the New Books Network. Hello, everyone, and welcome to another episode of the Princeton University Press Ideas Podcast, a joint production of Princeton University Press and the New Books Network. I'm Mark Clobus, and today I'm speaking with Kate Clancy, author of the book the Real Story of Menstruation. Kate, welcome to the New Books Network.
- [00:22]
B
Thanks so much for having me.
- [00:24]
A
Well, thanks for being on our show. I was wondering if you could start us off by telling our listeners something about yourself.
- [00:31]
B
Well, I'm a professor of anthropology at the University of Illinois. I'm a parent to two really amazing kids, and I have a little bit of a weightlifting habit.
- [00:43]
A
There are much worse habits to have, I suppose. What led you to write a book about menstruation?
- [00:50]
B
I have been really fascinated with processes of menstruation for a really long time, and sort of. I, I came to my interest in this in two different ways. One is that, you know, from the moment I started menstruating, I was really struck by the way that I was taught that that meant that there was something wrong with me or that my body was broken. I talk about in my preface, the moment that my nurse practitioner heard I started menstruating and how she instantly said, well, now you need to start taking iron supplements. And I remember being so struck by, like, why is it wrong that I have a period? It seems like this should be a good thing, like a marker of womanhood or something, or adulthood in some exciting way. The other thing is that as I got to understand menstruation better, I became really fascinated with the process itself. And it seemed like we really missed out on learning something really cool on the body when we developed such stigmatizing ideas and such desire to conceal something that's actually really cool.
- [01:46]
A
That's one of the things I found really fascinating about reading your book is how the way in which you approach the process of menstruation, which is such a. It's a. It's a very holistic approach. You talk about it biologically, you talk about what we know about it as a science, but you also talk about the, the, the cultural and, and, and, and, and social, you know, complications that we've imposed upon it and, and how this is often just, you know, contributed to our distortion of what it is and, you know, what it means.
- [02:20]
B
Certainly, you know, as an anthropologist, one of the things that I love about my discipline and its approach is that we seek to understand variation. And what that means is that we want to understand all of the really wild and interesting amounts of biological variation that exists in the world, but also context, cultural context, social context, geographic context, even to really better understand bodies, you know, with the goal, of course, in some ways towards better understanding evolution and adaptation.
- [02:52]
A
I was wondering if you could start us off by talking a little bit about what you refer to in your book as the why and how of menstruation. Could you, could you elaborate a bit upon what menstruation is and the process as it works as we understand it? And also, and this to me was, was, was one of the big revelations for me in reading the book, what we don't understand about menstruation and what we, what we think we might know, but we don't necessarily know for certain.
- [03:19]
B
Or so menstruation itself is a process of the uterine lining being, at least the way it was originally thought of, is it's this process of removing waste, this uterine lining that is not needed, that we have to get rid of in order to start over. The better we come to understand the processes of menstruation, the how, the more clear it actually becomes that the process of menstruation is not a process of just simply waste removal. It's actually a process of healing and regeneration. And so, you know, by day two of your period, which is often one of the heaviest days for people, you are not just removing effluent, but you are also rehealing that whole endometrial lining and creating an opportunity for all of that tissue to regrow. And menses itself is actually crucial for that process. And when we understand that how, better it begins to push against the why. The why used to be, oh, well, we menstruate because menses is toxic. There was this very old, you know, this idea from about a hundred years ago that certainly has elements of multiple centuries of misogyny that had this idea that menses is this toxic, toxic thing and that there's something toxic that has to be removed. And so the process of menstruation is a process of removing toxicity from the body. We now know that there's nothing toxic in menses. If anything, the opposite is true. But what also is interesting is that some of the uselessness narratives that it's just effluent or just waste are now probably also not quite accurate. And so again, that instead menses is actually healing, that it's necessary to processes of endometrial cycling, and even that it offers the uterus a chance to practice a process of tissue remodeling that will be really important for it should the person who has the uterus ever decide to try to become pregnant.
- [05:14]
A
And that I actually have to add that I really enjoyed that story. You detail in the book as to how that toxicity argument or that toxicity misconception emerged. And I should add also that gets to one of the things I enjoyed about your book, which is that the way in which you do a great deal to tie it to the human in the sense you tie to where this is you're describing, what ultimately is that complicated human process. But about this gets to the ethnic logical approach that you adopt, which is you are talking about that. That intertwining, that interaction between the medical and biological on the one hand, and the social, cultural practice on the other, as it's evolved. And how sometimes we take misconceptions with regards to menstruation and we just run with them in ways that. It's like that old adage about how the lie is halfway around the world before the truth puts on its shoes, and how these end up becoming such burdensome baggage to properly understanding what menstruation is and how we as individuals in a society should be dealing with it.
- [06:29]
B
Certainly. And what's interesting is I teach an undergraduate course, we just had our last day yesterday called Humanizing Science, where a lot of what we do is push against this really old notion that science has a heroic narrative. There's a heroic man of science who by himself is solving problems. But we're also pushing against this other narrative that science is somehow above or separate from culture and that it is objective. And instead we look at historical example after historical example, looking at contemporary examples of all the ways in which human beings are scientists. Human beings are part of the practice and process of science. And therefore, we cannot detach science from the real world. And so it's not objective in the way we'd like it to be. And I think, you know, a lot of the stories around menstruation, once you start paying attention to the fact that, oh, wow, these people who believed themselves to be unbiased men of science were in fact parroting things that they had read, you know, that they'd learned from their ministers or that they'd been taught by their fathers or that they'd been led to believe about, you know, about women, those kinds of gendered things got into something, into a process that it doesn't necessarily have gender. And so when you see the way that gender creeps into biology, you start to see the problems of trying to tell the subjective narrative.
- [07:50]
A
And that gets to another aspect of Your book that I found very illuminating, which is you are elaborating upon the practical consequences of these mis. Mistaken narratives. And I was thinking this really comes across in your examination of the environmental factors and their. And their effect upon menstrual cycles. Because I was thinking as I was reading this about the degree to which there's that connection where we, because we have these misconceptions, we're overlooking or even ignoring the impact that these other factors have, which have a real practical impact upon women's health and what they can do with their bodies.
- [08:38]
B
Right? Right. To me, those three chapters on environmental stressors, so on energetics, on immune factors, and then on psychosocial factors are really central to the book. And yet, funnily enough, through most of my interviews, they're the ones that people ask me about the least. But are. They're the ones that are the ones where I actually have data coming out of my own lab about. Because this is where we actually understand variation, right. Is in how a body flexibly responds to environment. And when we start to understand menstruation as a process and menstrual cycles as processes that adaptively respond to environment, this idea that there is one way to be healthy and that everything else is diseased kind of falls away because we're no longer able to say that changes or disruptions or different experiences of menses or menstrual cycles are inherently bad or inherently pathological. That's not to take away from people who are living with endometriosis, fibroids, adenomyosis, and more. Right. People who are living with conditions that are causing real harm, real pain, disrupting quality of life. But I can't tell you over the course of my life how many times it has been a revelation for a person to learn that having a slightly variable menstrual cycle does not mean there's anything wrong with you and that there's no need to regulate what is inherently adaptive and responsive.
- [10:01]
A
Let's, given what you just said, let's go ahead and take a look at those factors that you just listed in a bit more detail, starting with what you describe in the book as the limited energy theory and that notion of energy. And I was wondering if you could perhaps explain that because energy, I must confess, is not the first word I think about when I think about the biological process of reproduction, necessarily. But as you explain, it's, you know, something that is integral to it, that is, you know, that, you know, we talk a lot about with regard to menstruation.
- [10:39]
B
Right. Energetics is where my training started as an undergraduate and beyond. And our, our understanding really of reproduction, especially in reproducing bodies where there's a uterus, is that resource allocation is one of the most important things we need to understand. So energy expenditure, how much you move around intake, how much you consume, those things have profound consequences for whether you can ovulate in a given cycle, whether, you know, you have the uterine architecture to potentially support a fused gamete, and whether you can actually carry that offspring through nine months of gestation and years of lactation. Because the thing is, is that all of that stuff is really energetically expensive. There's a. There's a reason people are really hungry a lot of times when they're pregnant and even more hungry. In fact, during lactation, lactating burns more calories than pregnancy. And so these resource allocation concerns are not just about do we have enough to make an egg or to ovulate an egg. It's about are we sort of considering the entire context, the entire milieu, and not just whether there's enough for this one moment in time, but whether this person can support a much longer period of energy deprivation.
- [11:55]
A
And that, of course, is then complicated by a lot of our sociocultural factors that you described, where we have concepts of body type and attractiveness that essentially are saying to women that they must be a certain way, even though what is being demanded of them is actually pushes back against this stuff. It basically you're it, it causes it. We're asking women to reduce their energy availability for, you know, for their bodies.
- [12:31]
B
Right? So much of the advice for people who menstruate is in some way around reducing energy intake, limiting our movement, telling us we should eat less. And all of it is bad science. You know, we now there are so many, there are so many avenues by which we've come to understand that being in a larger body does not automatically make a person less healthy. And that in fact, a lot of the harms of living in a larger body are not, in fact about, like, excess weight, but actually about the harms of fat stigma and fat phobia. And when it comes to studying menstruation, that continues to be true. We actually see that there is more disruption of the menstrual cycle, far more in being underweight than being overweight. We've seen that all of these hand wringing, you know, BMI requirements in order to be allowed to access infertility treatments don't actually improve outcomes for parents or offspring. And in every conceivable way it's bad science to say that obesity or living in a heavier body is the thing we should really be caring about here when it comes to energetics.
- [13:40]
A
I'd like to talk now about the second part of the environmental factors which are the immunological challenges. Wonder if you could elaborate a bit upon those factors there and how they contribute to variations in menstrual cycles.
- [13:55]
B
Sure. So there's a couple of things to think about with immunological factors. One is that the uterus is this organ that has to avoid pathogens from getting in and has all sorts of things in place to keep that from happening. But it also has to suppress its immune evasion or its immune desires if there's potentially an embryo around that wants to implant. And so the uterus is this really cool uterine or, sorry, this really cool immune organ that is constantly negotiating changes to immune functions and the immune system and is constantly in conversation with the broader immune system. Most of my own research has focused on how it is that changes to inflammatory factors or like changes to systemic inflammation might have an effect on uterine function or on menstrual cycles. So that's where I spend a lot of time in the book. But the other big place we pay attention is this thing that a lot of patients noticed as they were first getting the COVID vaccines, which I'm so glad we have a vaccine that reduces severity of disease. I wish we had one that actually reduced transmission, but, you know, we have one that reduces severity of disease and. But patients were noticing that their periods were affected. Well, the uterus is an immune organ. It's a bleeding organ. Guess what? Immune function and bleeding are very tied like bleeding and clotting is part of the immune process. It should not have been surprising to us that this is a potential link. And yet people, gaslit patients who came to them with concerns, mocked them, told them that they were. That it wasn't real, told them, well, you must just be perimenopausal or maybe you have cancer. We need to go through these in. In, you know, these invasive treatments. Whereas, you know, the people I were, I was talking to, anyone who had any basic understanding of the uterus was like, of course, this makes sense. This is worth exploring. Because the uterus is an immune organ. Of course it's going to be affected by a massive inflammatory event from a really immunogenic vaccine. And I think for me, what that chapter also does is really shows that we should be listening to people when they express to us that they're experiencing changes to Their bodies, especially if those changes are uncomfortable or concerning to them, whether or not they have some kind of link to fertility. I'd like to stop seeing so much hand wringing around fertility and more attention paid to the lived experience of menstruation.
- [16:24]
A
And that, of course, gets to that final factor that oftentimes complicates matters, which is the psychosocial. And this gets. And I bring this up oftentimes we see how when people raise these concerns, when individuals talk about these things, they oftentimes face a lot of criticism, commentary, snark, which can be. Which can you really. Which contributes to a lot of the baggage that surrounds menstruation, as you describe and as you point out, can actually have a physical impact upon women going through the menstrual cycle. About how the stress of dealing with this, the. The. The, you know, you know, unwanted insertion of people's judgments and how this can, you know, is one of the many things that can affect how a person. How a person's body, you know, undergoes the cycle, right?
- [17:24]
B
You know, the amount of gaslighting that. That people with uteruses experience in medical contexts, in interpersonal contexts, in broader, you know, ways that they move through public. The public world, have really profound consequences for their bodies. So it's not just. And, you know, one of the things I try to talk about in that chapter is it's not just about the original insult, right? It's not about that. That particular moment of someone's bad behavior. It's also about what access do they have to respond to it safely, right? If someone cat calls me on the street, what access do I have to respond safely to that in a way that makes it clear that that behavior is not okay? Or when I'm afraid for my life in that moment, because what if that person escalates? If I'm in a workplace, a really bro y workplace, what access do I have to respond safely to that that doesn't escalate? And so we're constantly having to deal with these moments of being constrained in our environment in terms of how we respond. Which means it's kind of two insults, right? There's two ways in which it gets into our body. First, the original harm, and then the ways in which our stress system is upregulated even more when we don't have access to handling that insult in some kind of reasonable way.
- [18:36]
A
You describe it, it's. You're in a situation where it's not just fight or flight, but it's also. It's fight, flight or Freeze. And each one of those brings with it its own sets of stressors, which could have a negative biological impact.
- [18:51]
B
Yes, absolutely. And so, you know, we have. Because so much of early work on stress responses focused primarily on. On males or on whichever sex in the moment when we're looking at animals, we think to be more gregarious. And usually, of course, if it's men doing the research and doing the observations, they might find certain types of male behavior more interesting. So it took a while for us to move from recognizing that fight and flight were not the only possible responses, but freeze. And also tend and befriend. So repairing processes, talking them out, you know, having a sort of a huddle with somebody, venting to another person. Those types of things are also responses that are available to a person in a moment of stress, but again, in certain environments are impossible to access.
- [19:43]
A
Now, you. In your book, you're elaborating upon the, you know, circumstances in which women find themselves you know, practically every day throughout their lives. And you're describing it, how we've reached this. In your final chapter, you talk a bit, and I love the title, the future of the period in which you talk about the better environment that you envision for this one that takes this information that you studied, that you've learned, that you've processed, and that you talk about what sort of world we could have, and you're not talking about something that is. That is, you know, you know, insanely out of reach, talking about something that is very practical. How could we be as a society, as a community, you know, as individuals, be better approaching the process of menstruation in ways that are more accommodating of its reality.
- [20:47]
B
Right. To me, the answer is that we should just be caring more about the material body, period, pun intended, I suppose, because by thinking about the kind of future I wanted for people who menstruate, it really forced me to reckon with disability justice and disability studies more broadly. Not because periods are necessarily a disability, though some people who experience them absolutely experience them that way, but that all of us move through different moments in our lives where we are able to exist in public life more or less readily because of the way public life closes out so many types of bodies. And so for me, like my period future is one was where we actually care about each other, where we care about material bodies, where we commit to making sure everybody has access to, you know, clean food. I mean, clean water, food, healthy air to breathe, housing, you know, a dignified life. And periods are a part of that. Because of the way that all of the. Or like a great entry point into thinking about this. Because the solution we keep trying to create for periods are to make them go away. And like, there's a lot of things in bodies that we can't just make go away through an IUD or through a really absorbent pad, neither of which are solutions that are accessible for everybody. For some people, those are wonderful solutions, but for not, not, not everybody actually has a positive experience with an iud. Um, and so, you know, it's an entry point into starting to ask, why do we make a world that's so hard for most of us to exist in? Why is it that, you know, most sidewalks are not accessible by wheelchair? Why is it that we don't actually have more flex room around being ill from time to time? Why has everyone taken off their masks and decided we don't care if pregnant people get Covid. Why have we, why, why have we all accepted this world? All of us who think we're so justice minded and so progressive and we don't make room for bodies, we don't make room for people. So my hope is that this starts a conversation around periods, but honestly, in the middle of a pandemic that people are pretending doesn't exist. I also hope this forces us to reckon with the fact that we are claiming, so many of us are claiming a certain politics that doesn't actually show up in how we treat people every day.
- [23:05]
A
That for me was something else I was thinking about as well when I was reading your entire book, which is how much of this conversation, how much of this understanding, and I use understanding in this respect in quotes, is based upon people who frankly don't have those interests. There you talk about we. But so much of it is about people who is being driven by people whose, even if their intentions are good, who frankly don't have that, that direct knowledge and frankly at some point don't really care to gain it.
- [23:34]
B
Right, right, exactly. And you know, I think that there are ways that sometimes we turn up our noses at people who once they have a personal experience, it changes how they think about things. But I actually do think that's a really powerful way for people to learn. And you know, like, it's only once I have had to reckon with my, my. One of my oldest kid right now has a really bad sprained ankle, was in crutches for weeks and we had to all completely change our lives and our schedules to get them to and from school, which means leaving work early, hours early, you know, to go wait in line with my car to pick up my teenager and bring them home. And, you know, or just thinking about like all. Or like all of the extra things we had to get so that they could get access to an elevator, because otherwise children are not allowed to use elevators at the school. You know, just in so many ways. We've. It's not often until you come up against these things that you notice they're there. If you've been living in a, let's say a straight body, a CIS body, an able, you know, a largely abled body, it's only once you have those experiences or a loved one does that sometimes you realize, like, actually, maybe I should be caring more about this.
- [24:39]
A
And that's something that makes me think back to why it is that we have not really had that conversation about menstruation because you have half the population which will never have those experiences. And then we have a culture which effectively has long limited or shut down any sort of open exchange about these concerns.
- [25:00]
B
Exactly. I'll give you a semi hilarious example which is that all of the facilities guys and maintenance guys in my building at work are men and several years ago. So that means they're the ones cleaning the bathrooms. They're the ones managing products and stuff that are in various bathrooms. And the women's bathroom, we don't have any, all gender bathrooms in my building, which is a whole other enraging thing. But the women's bathroom has never had trash cans in the stalls, which often means that somebody with a tampon, out of desperation, just flushes the tampon even though they know that they're not supposed to, or they accidentally leave some of their menstrual product detritus, you know, in the room because they don't want to carry with bloody hands out into the main trash can. That's a big open trash can. And there's no way to, there's no baggies or anything, like any way to manage it. So one day the facilities guys got mad and wrote notes on all of the stalls saying, please stop flushing your tampons. And then the people who use the bathroom started writing back saying, how about you put some, some, some actual trash cans in these stalls? And then the facilities guys responded and said, don't be lazy. It's seven steps. So, you know, there was just this, like, there are so many. There are, there are some little, little things you can do to make a restroom a little easier, a little more hygienic, a little safer for a menstruating person. To do. And this person who'd never had an experience with blood and clots just kind of oozing out of your body, and you have two seconds between classes to actually manage everything, and you have nowhere to put stuff like, can you blame them for occasionally flushing the tampon? And, you know, it never got resolved. That was maybe four years ago. And despite multiple requests, we still have not had trash cans put in those stalls.
- [26:47]
A
I think that right there just illustrates how far we are from and how much work we have to do to get to that future you described at the end of your book.
- [26:55]
B
Exactly. Because if it's the people who are creating spaces, the people who are maintaining spaces, if these are folks who've not had certain types of lived experiences, they're not going to understand their importance or incorporate them into how they produce these publics.
- [27:09]
A
We appreciate the time you've taken to speak with us, but before we go, could you tell us what you're working on now?
- [27:13]
B
Sure. I am already starting to work on another book with Princeton, so I'm really excited to be under contract for a second book with Princeton University Press. The tentative title is Pregnancy the New Science of Miscarriage. And I'm really excited to continue to sort of think about the science, push against some of the cultural norms that have produced a really inaccurate understanding of stillbirth, miscarriage, abortion, contraception, a lot of interrelated ways that pregnancies end. And so I actually, I was lucky enough to get a fellowship from my university this year, so I'm going to be on teaching leave, and that'll actually give me the time to do the writing this next year.
- [27:56]
A
Well, congratulations on the fellowship, and I hope we can have you back on the podcast when your book's published.
- [28:02]
B
Absolutely.
- [28:03]
A
Thank you so much, Kate Clancy, thank you very much for taking some time out of your schedule to speak with us. I hope you have a wonderful day.
- [28:09]
B
You, too, Sam.