Flow

Flow Plot Summary

Introduction

Throughout human history, few biological processes have been as shrouded in mystery, shame, and contradiction as menstruation. While being a natural function experienced by roughly half the world's population, it has paradoxically been treated as something to hide, fear, and control. From ancient civilizations viewing menstrual blood as both magical and dangerous, to modern advertising campaigns selling "feminine hygiene" products through euphemisms and blue liquid demonstrations, the cultural treatment of menstruation reveals profound insights about gender, power, and societal values. This cultural history explores how different societies have interpreted, regulated, and commercialized the menstrual cycle across time. By examining religious texts, medical theories, advertising campaigns, feminist movements, and modern medical practices, we uncover how menstruation has been weaponized to control women's bodies while simultaneously becoming a focal point for female empowerment. The journey from "the curse" to "period positivity" reflects broader societal shifts in how we view women's bodies and autonomy, making this exploration relevant not just for those who menstruate, but for anyone interested in understanding how biological functions become powerful cultural symbols.

Chapter 1: Ancient Beliefs: Menstruation in Early Civilizations and Religions

The earliest recorded attitudes toward menstruation reveal a fascinating paradox that would define this natural process for millennia to come. In ancient Mesopotamia, Egypt, Greece, and Rome, menstrual blood was simultaneously viewed as both powerful and polluting – a substance with magical properties that could also contaminate and harm. This duality formed the foundation for menstrual taboos that would persist across cultures and time. In many ancient societies, menstruating women were separated from their communities during their periods. The Roman naturalist Pliny the Elder, writing in the first century CE, cataloged numerous supposed dangers of menstrual blood, claiming it could sour wine, rust iron, dull knives, and kill crops. These beliefs weren't merely superstitions but became codified in religious texts. Leviticus in the Hebrew Bible declared menstruating women "unclean" for seven days, with anything they touched becoming similarly tainted. Meanwhile, in ancient Greece, Hippocrates and Aristotle theorized that menstrual blood was the female contribution to reproduction – imperfect, passive material waiting to be formed by the active male seed. Yet alongside these fears existed a recognition of menstrual power. Some ancient cultures believed menstruating women could influence weather, control pests, or perform powerful magic. Archaeological evidence suggests menstrual blood was sometimes used in fertility rituals. The Greek word for menstruation, "katharsis," shared its root with the word for purification, suggesting an understanding that monthly bleeding served a cleansing function for women's bodies. These contradictory ancient perspectives – viewing menstruation as both defiling and sacred – established patterns that would echo through history. The separation of menstruating women, while often interpreted as exile, sometimes provided rare spaces for female autonomy and rest from domestic duties. In many indigenous cultures, first menstruation ceremonies celebrated a girl's transition to womanhood with elaborate rituals acknowledging her new reproductive power. By examining these early beliefs, we see how biological processes become imbued with cultural meaning. These meanings weren't neutral but rather reflected and reinforced power structures. Men, who controlled religious and political institutions, defined menstruation as something requiring regulation and containment. This pattern of external control over female bodies established during antiquity would continue to evolve through subsequent eras, though the justifications would shift from religious to medical to commercial domains.

Chapter 2: Medical Myths: From Wandering Wombs to Hysteria (500 BCE-1900)

The transition from ancient religious taboos to supposedly scientific theories about menstruation was hardly an improvement for women. From approximately 500 BCE through the 19th century, medical authorities constructed elaborate, often bizarre theories about female bodies that pathologized normal functions. The Greek physician Hippocrates popularized the "wandering womb" theory, suggesting the uterus could literally move throughout a woman's body, causing various ailments depending on where it traveled. This concept formed the basis of the diagnosis of "hysteria" (from the Greek hystera, meaning womb), a catchall condition applied to women exhibiting virtually any troublesome behavior. By medieval times, medical texts described menstruation as the body's way of expelling dangerous "excess blood" or "bad humors." Without this monthly purging, women would supposedly become irrational, dangerous, or ill. The influential 12th-century physician Trotula of Salerno prescribed treatments for menstrual difficulties ranging from herbal remedies to bloodletting. While some of these plant-based treatments showed therapeutic potential, they existed within a framework that fundamentally misunderstood female physiology. The Renaissance and Enlightenment brought little relief as new "scientific" approaches continued to pathologize menstruation. In 1727, physician John Freind published "Emmenologia," considered the first medical treatise focused entirely on menstruation, yet it still described the process as inherently pathological. The Victorian era perhaps marked the apex of menstrual mythology, with physicians diagnosing "menstrual madness" and prescribing rest cures, surgical interventions, and even asylum confinement for women with troublesome periods. Dr. Edward Clarke's influential 1873 book "Sex in Education" warned that education could damage women's reproductive systems by diverting blood from the uterus to the brain. These medical myths served specific social functions beyond mere ignorance. They provided scientific-sounding justifications for excluding women from education, voting, property ownership, and professional advancement. When women sought to enter male-dominated spaces, medical authorities conveniently produced evidence that such activities would harm their reproductive capabilities. The concept of "female invalidism" – that women were naturally frail and sickly due to their menstrual cycles – justified extensive constraints on female autonomy. By the late 19th century, the emerging field of gynecology began challenging some of these misconceptions, though often replacing them with new forms of control. The first commercial menstrual products appeared during this period, marketed through vague euphemisms about "female complaints" and "monthly difficulties." While offering practical solutions, these products continued the tradition of treating menstruation as something shameful requiring careful management – a perspective that would flourish in the coming age of mass marketing and commercialization.

Chapter 3: Commercial Revolution: The Birth of Femcare Industry (1920s-1960s)

The early 20th century witnessed the transformation of menstruation from a private matter managed through homemade solutions to a commercial opportunity. The First World War inadvertently sparked this change when Kimberly-Clark repurposed the highly absorbent Cellucotton they had developed for bandages into the first mass-produced disposable sanitary pads, branded as "Kotex" in 1920. This innovation coincided with significant social changes, including women's suffrage, increased female participation in the workforce, and the flapper era's challenge to Victorian modesty. Advertising these new products presented unique challenges in an era when merely mentioning menstruation in mixed company was taboo. Early marketing relied heavily on euphemisms, with ads referring to "those difficult days" or "feminine hygiene" without ever specifying what the products actually did. Kotex pioneered discreet purchasing methods, allowing women to drop money in a box and take their products without verbal interaction. Their 1921 campaign featured the tagline "Ask for them by name," though ironically, most women couldn't comfortably say the product name aloud. By the 1930s, tampons entered the market, with Tampax introducing the first applicator tampon in 1936. This innovation met with both enthusiasm and suspicion – some doctors warned against tampons potentially causing "moral corruption" in young women or compromising virginity. Nevertheless, the convenience of internal protection gradually won consumers over. The femcare industry expanded its market by creating educational materials for schools, with brands like Kotex producing films and booklets that simultaneously provided information while cultivating brand loyalty among young customers. The post-World War II economic boom and the rise of television advertising accelerated the commercialization of menstruation. However, broadcast standards prohibited showing actual products or using direct language, reinforcing the secrecy and shame around periods. Instead, commercials relied on coded visuals: women in white dresses, blue liquid demonstrations, and promises of "freshness" and "protection." By the 1960s, innovations like adhesive strips eliminated the need for belts and pins, marketing this freedom alongside other social changes of the era. This commercial revolution had profound impacts on women's experiences and perceptions of menstruation. While providing genuine convenience, the industry simultaneously profited from and reinforced menstrual taboos. Advertisements suggested that the worst aspect of menstruation wasn't discomfort but the potential for embarrassment through visible stains or detectable odors. The medicalization of periods through scientific-sounding terms and clinical packaging positioned menstruation as a hygienic crisis requiring expert management rather than a natural bodily process. By the late 1960s, the femcare industry had established near-complete control over menstrual discourse, creating both the problems and solutions in a self-perpetuating cycle of shame and consumption. This commercial paradigm would soon face its first serious challenge from an unexpected source – the emerging women's liberation movement and its radical reassessment of female bodies and experiences.

Chapter 4: Feminist Awakening: Reclaiming Bodies and Challenging Stigma (1960s-1980s)

The women's liberation movement of the 1960s and 1970s brought unprecedented scrutiny to the cultural treatment of menstruation. Second-wave feminists identified menstrual taboos as a powerful tool of patriarchal control, arguing that the shame surrounding periods kept women disconnected from their bodies and dependent on male medical and commercial authorities. This period marked the first coordinated effort to reclaim menstruation as a natural, neutral biological process rather than something inherently problematic. The 1970 publication of "Our Bodies, Ourselves" by the Boston Women's Health Book Collective represented a watershed moment in menstrual history. This groundbreaking book provided straightforward, non-judgmental information about women's bodies, including detailed explanations of menstruation free from commercial or religious bias. Women's health collectives formed across the country, creating spaces where women could discuss their experiences and learn about their bodies outside medical or commercial contexts. These grassroots organizations challenged the medical establishment's authority over female bodies and advocated for women becoming active participants in their healthcare. Feminist critiques of the femcare industry emerged during this period, targeting both its products and marketing practices. In 1975, the National Women's Health Network raised concerns about the safety of tampons, particularly their potential link to toxic shock syndrome (TSS). This advocacy eventually forced manufacturers to provide standardized absorbency ratings and TSS warnings. Meanwhile, feminist publications critiqued advertising that exploited women's insecurities and reinforced menstrual shame. Gloria Steinem's satirical 1978 essay "If Men Could Menstruate" imagined a world where periods would be celebrated as proof of masculinity, highlighting how cultural attitudes toward biological functions reflect power dynamics rather than objective reality. The feminist health movement also revived interest in reusable menstrual products as alternatives to commercial disposables. Menstrual sponges, cloth pads, and early versions of menstrual cups gained popularity among women seeking both ecological sustainability and freedom from corporate influence. Some feminist spirituality movements reinterpreted ancient practices, creating modern menstrual rituals that celebrated rather than stigmatized monthly bleeding. Books like Penelope Shuttle and Peter Redgrove's "The Wise Wound" (1978) explored positive cultural and psychological interpretations of menstruation. Despite these progressive efforts, mainstream society remained largely resistant to open discussion of menstruation. When Judy Blume's young adult novel "Are You There God? It's Me, Margaret" (1970) addressed a girl's anticipation of her first period, it became one of the most frequently banned books in American schools. Television networks continued refusing to air advertisements showing actual menstrual products until the late 1970s, and even then, only during restricted time slots. The feminist awakening around menstruation created lasting changes in how women related to their bodies while exposing the immense cultural resistance to destigmatizing this basic biological function. The movement's accomplishments laid groundwork for future advocacy, though the commercial forces shaping menstrual experiences would soon adapt and evolve in response to these challenges.

Chapter 5: Modern Medicalization: Suppression, Syndrome, and Sales (1980s-2000s)

The late 20th century witnessed a significant shift in how menstruation was conceptualized and managed, with medical and pharmaceutical industries assuming unprecedented influence. The 1980s saw the emergence of premenstrual syndrome (PMS) as a formal diagnostic category, effectively pathologizing normal hormonal fluctuations. While acknowledging real symptoms many women experienced, the medical framing of PMS as a disorder requiring treatment rather than a natural variation reinforced notions that female bodies were inherently problematic and required external management. The pharmaceutical industry quickly capitalized on this medicalization trend. In 1987, Eli Lilly introduced Prozac, and by the 1990s was marketing a repackaged version (Sarafem) specifically for Premenstrual Dysphoric Disorder (PMDD), a more severe form of PMS. This strategy of creating specialized diagnoses and treatments for menstrual symptoms represented a lucrative business model. Similarly, when hormonal birth control pills were initially developed in the 1960s, they mimicked natural cycles with a week of placebo pills allowing for withdrawal bleeding. By the 1990s, pharmaceutical companies began marketing continuous hormonal contraception that reduced or eliminated periods entirely. The 1980s Toxic Shock Syndrome crisis marked another pivotal moment in menstrual history. After the introduction of super-absorbent tampons coincided with a spike in TSS cases, resulting in several deaths, consumer advocates forced industry-wide safety standards. This public health emergency temporarily brought menstrual products under scrutiny, though mainstream media coverage often sensationalized rather than educated. The crisis briefly united feminist health activists, consumer protection agencies, and medical authorities in demanding greater transparency from manufacturers. Alongside medicalization came intensified commercialization. The femcare industry expanded globally, with corporations like Procter & Gamble and Kimberly-Clark developing specialized marketing campaigns for different regions and age groups. Teen magazines became key advertising venues, with brands creating "educational" content that simultaneously informed girls about menstruation while cultivating brand loyalty. New product categories emerged, including scented pads, "period underwear," and menstrual pain medications specifically formulated and packaged for women. Environmental and health concerns about conventional menstrual products gained traction during this period. Research identified potential risks from the bleaching agents, plastics, and synthetic fibers in tampons and pads. These findings fueled growing interest in alternative products, with companies like The Keeper (1987) commercializing reusable menstrual cups. However, these alternatives remained niche options, representing a tiny fraction of the global menstrual product market dominated by disposables. By the early 2000s, menstruation had become a thoroughly medicalized and commercialized experience for most women in developed nations. While offering genuine benefits like pain relief and convenience, this paradigm reinforced the fundamental framing of periods as a problem requiring expert intervention and consumption of specialized products. The tension between biological reality and cultural construction set the stage for the emerging menstrual activism movements of the 21st century.

Chapter 6: Beyond Taboo: Alternative Approaches and Cultural Shifts (2000s-Present)

The 21st century has witnessed unprecedented openness around menstruation, challenging centuries of silence and shame. Digital platforms have democratized menstrual discourse, allowing individuals to share experiences and information outside traditional channels controlled by medical or commercial interests. Social media campaigns like #PeriodsAreNotAnInsult and #BloodNormal have directly confronted taboos, while period-tracking apps have made millions of women more aware of their own cycles, creating new forms of embodied knowledge. Menstrual activism has expanded beyond Western feminist circles to address global inequities. Organizations like WASH United established Menstrual Hygiene Day in 2014, highlighting how period poverty and inadequate facilities prevent girls worldwide from attending school. The 2018 documentary "Period. End of Sentence." won an Academy Award for depicting Indian women manufacturing low-cost pads, bringing menstrual equity into mainstream conversation. Countries including Kenya, India, and Scotland have implemented policies providing free menstrual products in schools, recognizing period supplies as necessities rather than luxuries. The alternative menstrual product market has flourished, challenging corporate dominance of the femcare industry. Reusable options like menstrual cups, period underwear, and cloth pads have gained significant market share, appealing to environmental concerns about the estimated 200,000 tons of menstrual waste generated annually. Subscription services offering organic cotton tampons and pads have disrupted traditional retail models, often incorporating social responsibility through donation programs. These developments represent a partial reclaiming of menstrual management from large corporations that historically controlled both products and messaging. Cultural representations of menstruation have dramatically expanded, with periods appearing in advertising, television, literature, and art. Companies like Thinx and Bodyform have created groundbreaking campaigns showing actual red liquid instead of the traditional blue demonstration fluid. The 2015 viral photo of artist Rupi Kaur lying in bed with a visible menstrual stain, initially removed by Instagram but later reinstated after public outcry, marked a turning point in visual representations of menstruation. These normalized depictions help destigmatize a universal biological process long rendered invisible. Scientific understanding of menstruation has also evolved, with researchers identifying potential benefits beyond reproduction. Studies suggest that menstrual blood contains stem cells with regenerative properties, while cyclical hormonal fluctuations may enhance creativity, intuition, and specific cognitive functions during different phases. These findings challenge the historical framing of menstruation as merely a reproductive function or uncomfortable side effect, suggesting it may serve multiple biological purposes. Despite these positive shifts, challenges remain. Period product manufacturers continue marketing to insecurities, pharmaceutical companies promote menstrual suppression as liberation, and many cultures maintain restrictive practices around menstruation. Trans and non-binary individuals who menstruate face particular challenges navigating female-centered menstrual discourse and products. Nevertheless, the current era represents the most significant disruption to menstrual taboos in human history, with increasing recognition that how we treat this biological process reflects broader commitments to gender equality, environmental sustainability, and bodily autonomy.

Summary

Throughout this cultural history of menstruation, we've witnessed how a natural biological function became a powerful mechanism for controlling women's bodies, experiences, and social participation. The remarkable consistency of menstrual taboos across diverse cultures and historical periods reveals that these attitudes were never simply about hygiene or health but rather about maintaining gender hierarchies. Religious prohibitions, medical pathologizing, commercial exploitation, and environmental impacts all stem from the same fundamental impulse to treat female bodies as problematic and requiring external management and control. The journey toward menstrual liberation offers valuable insights for other social justice movements. First, bodily autonomy requires access to both accurate information and material resources—knowledge alone cannot overcome structural barriers like period poverty. Second, commercial interests often co-opt progressive language while maintaining problematic frameworks, as seen in how "empowering" marketing campaigns still fundamentally frame menstruation as a problem requiring purchased solutions. Finally, true cultural change requires addressing taboos directly rather than working around them, as evidenced by how open conversation has more effectively reduced stigma than decades of euphemistic advertising. As menstruation continues emerging from secrecy into open discourse, it demonstrates how even the most entrenched cultural attitudes can transform when people reclaim authority over their own bodies and experiences.

About Author

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Elissa Stein

ELISSA STEIN’S most current book is FLOW: the Cultural Story of Menstruation. She lived her publishing dream-come-true night with a launch party at Rizzoli's on 57th Street that The New Yorker wrote about the next day. Previous projects include NYC adventures with kids, interactive thank you notes, and labor support for parents-to-be, along with visual histories of iconic pop culture—two of which were featured in Entertainment Weekly’s Must Have list. In addition to writing, she runs her own graphic design business. To balance the above, she practices yoga, knits with enthusiasm, and shops for vintage coats on ebay. She lives in New York City with her husband Jon and their two children.

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