Plethora, Flowers and Rest: A History of Menstruation in Medicine

Few bodily processes have attracted as many explanations as menstruation. Physicians, natural philosophers, lawgivers and advertisers have each tried to say what it was, what it was for and how it ought to be handled. Their answers changed a great deal over two and a half thousand years. One thing changed much more slowly: most of the surviving explanations were written by men, so the history of what women themselves thought and did has to be pieced together from the edges of the record.

What follows traces a few of the main threads in European and American medicine, with a brief look at one religious tradition, from the Greek idea of a necessary monthly overflow to the commercial sanitary pad.

A body full of blood: the Hippocratic view

The Hippocratic gynecological treatises, the work of several anonymous Greek medical writers of around the fourth century BCE, start from a claim about tissue. Diseases of Women states that a woman’s flesh is “more sponge-like and softer than a man’s,” so that it draws more moisture from the belly. When that surplus blood leaves the body, the author says, no pain results; when it stays, the woman suffers. A man, with denser flesh and harder work to use up his fluids, never becomes so overfilled.¹ It is a model of fullness, or plethora, in which menstruation is the regular release of an excess.

On this view the danger lay in blood that could not get out. The same treatise warns that menses unable to find an exit cause illness and may even move to the lungs, and it describes healthy blood as flowing “like that from a sacrificial animal.”¹ The short treatise On Virgins applies the idea to girls at their first period: blood collects in the womb, finds no outlet, presses on the heart and lungs, and produces fevers, terrifying visions and thoughts of death. Its author dismisses the offerings women made to Artemis on a girl’s recovery and prescribes marriage and pregnancy instead.²

The Aphorisms treat the menses as a barometer of health. “When the menses are excessive, diseases take place, and when the menses are stopped, diseases from the uterus take place,” runs one; another holds that discolored, irregular bleeding means a woman “stands in need of purging.”³ Because the system valued an open exit so highly, Greek medicine had little interest in stopping a normal flow, a point the site’s article on the supposed ancient Greek tampon examines in detail. Helen King’s Hippocrates’ Woman (1998) is a book-length study of how these texts imagined the female body.⁴

Not every ancient physician agreed on what a menstruating woman should do. Soranus of Ephesus, a Greek who practiced in Rome, advised that each woman follow her own custom, since some rested while others carried on with moderate activity, though he judged that “it is safer to rest and not to bathe especially on the first day.”⁵

Residue and marvel: Aristotle and Pliny

Aristotle, writing in the fourth century BCE, built menstruation into a theory of heat. In Generation of Animals he argues that the female, having less natural heat than the male, cannot “concoct” her nourishment all the way into semen; the menstrual fluid is the less refined product. In Arthur Platt’s translation, “the catamenia are semen not in a pure state but in need of working up.”⁶ In his account the female contributes no seed of her own; what she supplies is “material for the semen to work upon.”⁶

The Roman encyclopedist Pliny the Elder, in the first century CE, preserved a very different kind of tradition. In Book 7 of his Natural History he lists effects attributed to a menstruating woman: new wine turns sour, seeds become sterile, mirrors dim, steel loses its edge, bees die, and dogs that taste the blood go mad. “It would indeed be a difficult matter to find anything which is productive of more marvellous effects than the menstrual discharge,” he writes in the Bostock and Riley translation. In the same passage he repeats the learned view that the infant forms from this fluid, with the male seed acting “as a sort of leaven.”⁷

Book 28 returns to the subject in a section on remedies drawn from the human body. Pliny reports claims that a menstruating woman who uncovered her body could drive off hailstorms and whirlwinds, or, walking through a field, make caterpillars and beetles fall from the crops (a practice he attributes to Cappadocia on the authority of Metrodorus of Scepsis). He also lists cures made with menstrual blood, for gout, fevers and the bite of a rabid dog. His attitude is mixed. He describes some of the lore as “ravings,” and of the contradictory recipes of two writers named Laïs and Elephantis he says “it is the best plan to refuse credit altogether,” yet he passes on much of the rest without objection.⁸ Pliny is best read as a collector of what was said, not as a witness to what most Romans believed or did. Even so, his stories were still being repeated in seventeenth-century England.⁹

Law, not hygiene: the laws of niddah

Rules about menstruation in religious law form a separate history and should not be confused with medical theory. In Judaism, as Beth Wenger explains in the Encyclopedia of Jewish Women, the book of Leviticus declared a woman ritually impure for seven days during her menstrual flow, with sexual contact forbidden. Rabbinic law later extended the separation to twelve days (at least five days for the flow and seven “clean” days after), followed by immersion in a ritual bath, the mikveh. Wenger stresses that this impurity was “not a matter of hygienic cleanliness but rather a legal definition of ritual purity.”¹⁰

Observance has varied widely. Wenger notes that many Jewish immigrants to the United States largely set the practice aside, that some twentieth-century writers defended it on medical grounds, and that since the 1970s feminists have both rejected it and reinterpreted it as a meaningful ritual.¹⁰ Other faiths have their own traditions on menstruation, which deserve their own specialist treatment and are not summarized here.

Flowers and purgation in medieval medicine

In medieval Europe, too, menstruation was understood as a cleansing. The historian Monica Green describes menstruation in this period as the end of a whole bodily process of purification thought unique to women, and as a necessary precondition for conception. Her work explains why the menses were commonly called “women’s flower,” in what circumstances writers likened them to poison, and why some men were thought capable of “menstruating” too.¹¹

That link to fertility shaped treatment. Medicines meant to bring on menstruation (emmenagogues) are often read today as disguised abortifacients. Green argues that many were not necessarily seen that way and may have had a deliberately pronatal purpose: restoring a stopped purgation was a step toward pregnancy.¹¹ She also points out that outside medical writing menstruation was largely left unspoken, which is why medical texts are the main surviving evidence.¹¹

The best known of those texts is the Trotula, the most influential compendium of women’s medicine in medieval Europe. Long attributed to a woman physician of eleventh- or twelfth-century Salerno, it is, as Green has shown, an ensemble of three independent works by different authors, mixing southern Italian practice with theories and drugs arriving from the Arabic world; a standardized version circulated widely from the mid-thirteenth century.¹²

Early modern England: humours, flowers and clouts

The humoral framework still dominated English medicine in the sixteenth and seventeenth centuries. The historian Sara Read, author of Menstruation and the Female Body in Early Modern England (2013), explains that physicians following Galen thought men worked off excess humours through the sweat of hard labor, while women, assumed to lead more sedentary lives, accumulated a surplus that was discharged each month. An anonymous medical book of 1707, The Pleasures of Conjugal Love, called the flow “Those Sweet and Benign Humours that Nature Sends Monthly.”⁹

Regular evacuation mattered so much that a missed period was not a reliable sign of pregnancy: the midwife Jane Sharp, in 1671, put it sixth in a list of fourteen signs. Pliny’s stories were still known, Read finds, but writers generally held that a healthy woman’s blood was harmless and became noxious only when it carried the corrupt humours of disease; one writer, James Drake, claimed in 1707 that women laughed at the old myths. The everyday name was “the flowers,” and a common saying held that “where there are no flowers there can be no fruit.”⁹ Read’s book places monthly bleeding alongside other “transitional bleedings,” including those after first intercourse and after childbirth, that marked stages of a woman’s life, drawing on medical handbooks, letters, diaries and court records. One reviewer, Helen Fulton, acknowledged the breadth of the source material but argued that some of Read’s readings stretch the evidence.¹³

On practical management, Read concluded that most women simply bled onto their clothing, with linen rags placed between the thighs or fastened to garments also in use.¹⁴

Rest or work? A nineteenth-century argument

In the nineteenth century the old idea that menstruation drew on a woman’s limited resources acquired a new, energy-based vocabulary, and it entered the debate over women’s education. In Sex in Education; or, A Fair Chance for Girls (1873), Edward H. Clarke, a former professor at Harvard, argued that study diverted force to the brain that girls needed to build their reproductive organs. Schools that ignored “the periodical tides” of girls’ bodies, he warned, were damaging their health; “The race has not yet quite outgrown the physiology of Moses.”¹⁵ His remedy was that “during every fourth week, there should be a remission, and sometimes an intermission, of both study and exercise,” and he praised a Boston employer who gave his female workers three days off every fourth week.¹⁵

The most thorough reply came from the physician Mary Putnam Jacobi, professor at the Woman’s Medical College in New York. Her essay The Question of Rest for Women during Menstruation won Harvard’s Boylston Prize for 1876 and was published in 1877. Jacobi gathered data: of 268 women who returned her questionnaire, 94, or 35 percent, reported no pain, discomfort or weakness at all during menstruation. Her conclusion was direct: “There is nothing in the nature of menstruation to imply the necessity, or even the desirability, of rest, for women whose nutrition is really normal.” She did not dismiss suffering. For women in pain, especially those working under an employer, she held that rest should be allowed “whenever practicable.”¹⁶

From washable cloth to the boxed pad

Alongside these debates, a commercial market for menstrual products was taking shape. The historian Helen King notes that the nineteenth century brought a market in specialized menstrual wear, from belts and pads to a “sanitary apron” worn to protect skirts when sitting, and that disposable cotton pads appeared in the late 1890s. Tampons followed in the 1930s, and adhesive strips that attached pads to underwear in the late 1960s. Historian Lara Freidenfelds has argued that by the twentieth century Americans increasingly treated menstruation as a normal part of life that no longer called for days of rest.¹⁴

The best-known early disposable pad in the United States came out of the First World War. According to Kimberly-Clark’s own history, the company had supplied a creped cellulose wadding called Cellucotton for surgical dressings, and Red Cross nurses used it as menstrual pads. After the war the company developed a pad from the material, and Kotex (for “cotton texture”) went on sale in October 1920. Many publications refused its advertising until the Ladies’ Home Journal accepted an ad, and many stores at first declined to stock it.¹⁷ The company’s account is a corporate history and should be read as such, but its story of reluctant advertisers and shopkeepers fits the long reluctance, visible in every period above, to speak about menstruation in public.

Seen across these centuries, the explanations changed at least as much as the experience, which itself shifted as women had fewer pregnancies and more periods, and as washable cloths gave way to commercial products.¹⁴ A monthly purge, an unrefined seed, a dangerous emanation, a flower before fruit and a drain on limited energy were each confidently presented as the truth in their time. What each one tells us most clearly is how a society understood bodies, and women’s place in it.

Footnotes

1. Hippocrates, Diseases of Women 1.1, 2, 6, trans. Hanson, in Lefkowitz and Fant no. 343. ↩ ↩²

2. Hippocrates, On Virgins, in Lefkowitz and Fant no. 349. ↩

3. Hippocrates, Aphorisms 5.36, 5.57, trans. Adams. ↩

4. King 1998, Hippocrates’ Woman. ↩

5. Soranus, Gynecology 1.26, trans. Temkin, in Lefkowitz and Fant no. 355. ↩

6. Aristotle, Generation of Animals 1.19-20, 727a-729a, trans. Platt. ↩ ↩²

7. Pliny, Natural History 7.13 (Bostock and Riley). ↩

8. Pliny, Natural History 28.23 (Bostock and Riley). ↩

9. Read 2013, FSA Blog. ↩ ↩² ↩³

10. Wenger, “Mikveh,” Jewish Women’s Archive. ↩ ↩²

11. Green 2005, “Flowers, Poisons, and Men” (abstract). ↩ ↩² ↩³

12. Green 2002, The Trotula, publisher’s summary. ↩

13. Fulton 2013, Times Higher Education review of Read 2013. ↩

14. King 2023, “From rags and pads to the sanitary apron,” The Conversation. ↩ ↩² ↩³

15. Clarke 1873, Sex in Education, Parts II and IV. ↩ ↩²

16. Jacobi 1877, The Question of Rest for Women during Menstruation, title page, pp. 27-28, 223-232. ↩

17. Kimberly-Clark, “Cotton substitute improves women’s lives.” ↩