Bleeding from your internal organs is never a fun time. Whether haemorrhaging from your uterus drives body image changes amongst females is certainly worth exploring further.

The Menstrual Cycle: Overview

The menstrual cycle is chaotic, and exploring this further can help us understand the challenges and barriers that menstrual cycle research poses.

The “typical” menstrual cycle (LOL what who has one of those) typically ranges from 26-35 days (Mihm, Gangooly and Muttukrishna, 2011). Menstruation is governed by oestrogen and progesterone.

The cycle begins with menstruation. The first appearance of the Red Sea signals day 1. Menstruation lasts on average between 4-6 days (Farage, Neill and MacLean, 2009). Menstruation ends, and thus signals the follicular phase from day 7-14. Ovulation occurs around mid-cycle here (Richards et al., 1998). The luteal phase follows from days 15-28 (Farage et al., 2009).

Again, there’s huge variability here, so you can imagine how difficult it is for researchers to standardise something that is impossible to standardise! So, when we examine the research, it is easy to be critical and say that things weren’t standardised. Let’s not do science a disservice by devaluing all studies that don’t have the perfect menstrual cycle for each subject. Find me a large sample size of women who menstruate in the exact same way, I bloody dare you. Anyway, I digress, but keep that in mind as we delve more into the research.

Body Image: Overview

Body image is largely an umbrella term. It typically encompasses body perception and body satisfaction (Carr-Nangle et al., 1994). Body image refers to emotional, thoughts and feelings toward our body image and size. This is of course difficult to narrow down, and open to interpretation from different researchers. There are a litany of physiological, psychological and attitudinal factors that influence body image (Grogan, 2006).

So, let’s get into just how much your uterus trying to strangle you from the inside out affects it.

Pre-Menstrual Symptoms & Body Dissatisfaction

Some studies have shown that body dissatisfaction to be highest during the peri/pre-menstrual phase. Carr-Nangle et al. (1994) in an early study found that negative thoughts and anxiety over physical appearance was highest peri-menstrual. This finding is echoed in Jappe and Gardner’s 2009 study of 30 women. Conversely, Morotti et al. (2013) found no change in body satisfaction across the menstrual cycle. This isn’t really supported by wider research (Kaczmarek and Tambacz-Oleszak, 2016)

Most interestingly is the findings from Teixeira et al. (2013). Again, body dissatisfaction was highest during the menstrual period, but no significant difference in anthropomorphic measurements were found. Translation: we feel like we are swollen she-hags once we start bleeding, but we actually don’t change significantly at all! Highly interesting.

For women who suffer from pre-menstrual syndrome (PMS), this body dissatisfaction is particularly heightened. This is potentially exacerbated by stress, anxiety and mood swings, which are common features of PMS (Kleinstäuber et al., 2016). PMS sufferers reported feeling more self-conscious and less attractive (Lee, 2002).

Reasons for this decrease in body dissatisfaction can be potentially due to bloating that occurs naturally during menstruation. Fluid retention/bloating tends to be highest around day 1 of menstruation for females and decrease as the cycle progresses (White et al., 2011). From my n=1 experience, nothing will shoot down your self-esteem like feeling like you’re with child, only you’re bleeding internally.

Not every female will bloat (if you don’t I am highly jealous), so this may not hold true for everyone. We’ve covered the role of PMS and eating behaviour here, so I won’t get too far into it. However, it’s worth keeping in mind that stress, fatigue and altered emotional regulation can drive body dissatisfaction too!

It’s not all self-hatred and bleeding for everyone. Women with higher regard for their body are less swayed by the effects of menstruation on body image (Chrisler et al., 2015).

So, we can’t just say that everyone will suffer from impaired body image during menstruation, because that just doesn’t hold true in research.

The Oral Contraceptive

Again, this can and will be an article in itself. However, we cannot overlook the influence of the female oral contraceptive pill on female body image. The oral contraceptive affects users differently. For some it can exacerbate poor body image and body dissatisfaction (Bird and Oinonen, 2011), even when Body Mass Index (BMI) and depression were controlled for. This was also exemplified in Bird’s 2006 study of 127 women, showing body dissatisfaction may be negatively impacted by certain OCP users.

Both studies also note the need for further investigation in this area, so we need to be careful about generalising these results to the wider population.

Conclusions

Being a woman is hard. You have to fight the patriarchy and watch as your basic human rights become currency for politicians to barter with. Love that for us. Anyway, all that is terrible enough without bleeding from your internal organs once a month.

Whether the menstrual cycle leads to impaired body image for women is certainly worth considering. Difficulties standardising cycles across the female population and the sheer volume of influences on body image (in addition to perceptions on what constitutes body image) make it difficult to say for sure. However, it sure is worth looking further into #notallmenstrualcycles.

References

• Bird, J.L. (2006) ‘Involvement of oral contraceptive side effects and genes in body dissatisfaction and eating dysfunction’, Knowledge Commons.
• Bird, J.L., Oinonen, K.A. (2011) ‘Elevated eating disorder symptoms in women with a history of oral contraceptive side effects’, Archives of Women’s Mental Health, 14(345).
• Carr-Nangle, R.E., Johnson, W.G., Bergeron, K.C., Nangle, D.W. (1994) ‘Body image changes over the menstrual cycle in normal women’, Journal of Eating Disorders, 16(3), pp. 267-273.
• Chrisler, J.C., Marván, M.L., Gorman, J.A., Rossini, M. (2015) ‘Body appreciation and attitudes towards menstruation’, Body Image, 1(1), pp. 78-81.
• Farage, M.A., Neill, S., MacLean, A.B. (2009) ‘Physiological Changes Associated with the Menstrual Cycle’, Obestetrical & Gynecological Survey, 64(1), pp. 58-71.
• Grogan, S. (2006) ‘Body image and health: contemporary perspectives’, Journal of Health Psychology, 11(4), pp. 525-530.
• Jappe, L.M., Gardner, R.M. (2009) ‘Bosy-Image Perception and Dissatisfaction Throughout Phases of the Female Menstrual Cycle’, Perceptual and Motor Skills, 108, pp. 74-80.
• Kaczmarek, M., Trambacz-Oleszak, S. (2016) ‘The association between menstrual cycle characteristics and perceived body image: a cross-sectional survey of Polish female adolescents’, Journal of Biosocial Sciences, 48(3), pp. 374-390.
• Kleinstäuber, M., Schmelzer, K., Ditzen, B., Andersson, G., Hiller, W., Weise, C. (2016) ‘Psychosocial Profile of Women with Premenstrual Syndrome and Healthy Controls: A Comparitive Study’, International Journal of Behavioral Medicine, 23, pp. 752-763.
• Lee, S. (2002) ‘Health and Sickness: The Meaning of Menstruation and Premestrual Syndrome in Women’s Lives’, Sex Lives, 46(1), pp. 25-35.
• Mihm, M., Gangooly, S., Muttukrishna, S. (2011) ‘The normal menstrual cycle in women’, Animal Reproduction Science, 124(4), pp. 229-236.
• Morotti, E., Battaglia, B., Persico, N., Zampieri, M., Busacchi, P., Venturoli, S., Battaglia, C. (2013) ‘Clitoral Changes, Sexuality, and Body Image During the Menstrual Cycle: A Pilot Study’, The Journal of Sexual Medicine, 10(5), pp. 1320-1327.
• Richards, J.S., Russell, D.L., Robker, R.L., Dajee, M., Alliston, T.N. (1998) ‘Molecular mechanisms of ovulation and luteinization’, Molecular and Cellular Endocrinology, 145(2), pp. 47-54.
• Teixeira, A.L., Damasceno, V.O., Dias, M.R., Lamounier, J.A. (2013) ‘Association between Different Phases of Menstrual Cycle and Body Image Measures of Perceived Size, Ideal Size and Body Dissatisfaction’, Perceptual and Motor Skills, 117(3), pp. 892-902.
• White, C.P., Hitchcock, C.L., Vigna, Y.M., Prior, J.C. (2011) ‘Fluid retention over the Menstrual Cycle: 1-Year Data from the Prospective Ovulation Cohort’, Obestetrics and Gynecology International, 1(1).