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“If Your Cycle is Normal, Why Play with It?”

Women in India Grapple with Religious Pressures to Suppress Menstruation

Sravya, from Mumbai, India, confesses that the hormone treatment she received changed her life.

Suffering from adenomyosis, a condition where the inner endometrial layer grows into the muscle layer of the uterus, Sravya would experience debilitating period pain accompanied by a bloated stomach. She would also suffer from heavy bleeding, which made her life very difficult during the four days of her period.

Upon her doctor’s advice, she got a hormonal IUD and realized that it helped control her symptoms — her periods are now 90% lighter with barely any cramping, and they last for only a couple of days at most.

“This enabled me to continue pursuing my degree,” says Sravya, who is doing a Ph.D. in Neurobiology and asked to be identified by her first name to protect her privacy.

The hormone progesterone maintains the inner endometrial lining of the uterus, waxing and waning in a cycle. When the natural levels of progesterone decrease, the endometrial lining is shed, what we commonly describe as a “period”.

“We give a surplus amount [of progesterone] to maintain the endometrium and not shed till we want,” explains Dr. Ananya Petkar, an independent gynecologist from Mumbai. She often prescribes hormone therapy to her patients, mostly for correcting hormonal imbalances.

For people like Sravya, whose periods can be a debilitating nightmare, hormone therapies can help manage or suppress menstruation. The American College of Obstetricians and Gynecologists has reached a clinical consensus that menstrual suppression can help transgender or gender-diverse individuals decrease gender dysphoria associated with menstruation, and benefit menstruators who might experience debilitating symptoms.

Just this July, the U.S. Food and Drug Administration approved the first daily oral contraceptive containing progesterone to be used without a prescription. This came after the Dobbs decision in 2022 that made abortions inaccessible for millions of Americans across the country.

For others, hormone pills are simply convenient – they can manipulate their period to avoid discomfort during vacations, sports events, or other special events. Pills containing a progesterone analog are similarly available easily over-the-counter in India. In the United States, these are available in the form of norethisterone tablets. Unlike birth control pills, period delay tablets such as norethisterone tablets are not contraceptives and do not prevent pregnancy.

However, the easy accessibility of such medicines in India’s context means that instead of just being a tool for reproductive freedom, women could also be coerced to hormonally manipulate their periods for religious purposes outside the purviews of health professionals.

 

S., from Bengaluru recalls the time she took hormone pills for a special occasion — it was a religious function after her wedding.

“I was very okay with taking it because, for me, these pills were as equal to Dolo or anything, ” she says. (Dolo is the common name of paracetamol, a common medicine to treat mild pain or fever.) “But this is not associated with pain — it doesn’t have anything to do with your body.”

India is a diverse country with several cultures which have various meanings associated with menstruation. However, most of them share one common perception — that menstrual blood is dirty, and a menstruating woman is impure. (This article uses the word “women” to describe people who menstruate while recognizing that not all people who identify as women menstruate, and not all people who menstruate identify as women.)

These stigmas and myths largely shape the restrictions that menstruating women are subjected to. They are often isolated, made to sleep on separate beds, sit on separate sofas, and eat from separate utensils. Family members may prohibit them from entering the kitchen, the storeroom, or even their houses entirely — some women have to stay in huts outside their villages without electricity for the duration of their period.

This ingrained notion of impurity associated with menstruation means if a woman has to participate in a religious function, others could expect or demand her to “purify herself” by detaching herself from her natural period.

Dr. Supriya Kamath, a gynecologist from Mumbai, has most commonly seen women seek such medications for that purpose, in both rural and urban areas. She has often witnessed family members compelling women to consume pills to manipulate their periods.

“These pills are supposed to be taken a week or five days prior to the expected date of menstruation and to be taken until you want to avoid your period,” says Dr. Kamath. She adds that since women frequently suffer from hormonal imbalances due to environmental and stress factors, she discourages women from taking pills frequently or in the long term since these can further disrupt the hormone balance.

“If your cycle is normal, why play with it?” Dr. Kamath ponders.

Indeed, S.’s period has always been very comfortable and normal, with only some mood swings. Yet, she admits that men in her family, even distant relatives, have encouraged her to pop pills to delay her period so she could participate in religious functions.

“They don't force you, but subtly they will say, ‘Why don’t you take a tablet?’ or ‘Oh, it’s okay, you can take a tablet?’ she describes. “In our community, if you have periods, you’re not supposed to come and participate.”

K., also from Bengaluru, has taken hormone pills to delay her period three times — the first for her cousin’s wedding, the second for her wedding, and the third to perform death rituals when her father-in-law passed away. However, unlike S., she experiences painful periods and admits she wouldn’t have taken hormone pills if not for her comfort. “I don’t mind missing the ritual also due to whatever religious beliefs,” she adds.

Both K. and S., who asked to be identified by their initials so they could speak candidly, have seen women in their family — their cousins, mothers, mothers-in-law — manipulate their period to be able to participate in important functions. S.’s mother recommended the tablets to her, inaccurately claiming that there were no side effects. (In fact, side effects of progesterone tablets could include nausea, headaches, and mood swings.) K.’s cousin had taken some pills on the advice of a gynecologist, and experienced lesser side effects, so she recommended those to K.

“It costs Rs.58 ($0.7) for a strip of 10,” K. says. Neither consulted a doctor before taking these pills themselves.

Dr. Petkar believes that these medicines should not be available over-the-counter, and women should not take these medicines without consulting a doctor. Dr. Kamath concurs. “Any kind of such pills if not taken in a proper way might have some future complications,” she explains, while urging women to consider consulting gynecologists before self-medicating with hormones.

This argument carries particular currency given that women often may not know when to start taking the course of medicines. The first time S. used hormone tablets to be comfortable during her high school farewell, she got her period anyway.

While hormone therapy is a scientific tool that can empower women to make decisions about their pregnancies or their menstrual cycles, the deeply rooted beliefs of impurity against menstruation have led to this tool being exploited by others to control women’s bodies.

As society evolves, combining sexual health education and access to healthcare can create a community free of stigma where members accept menstruation as a natural aspect of women’s lives. This will facilitate a future where women are free to make decisions about their bodies and menstrual cycles and people respect and support these choices.

Now, S. has a changed view of whether to manipulate her period to satisfy others’ religious expectations.

“I tell people that I’ve already taken it but I don’t want to take them anymore, because I would like to let the natural process take place.”


 



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Sneha Khedkar

From Mumbai, India, Sneha obtained a B.S. in Microbiology and Biochemistry from St. Xavier’s College (Autonomous) in Mumbai, and an M.S. in Biochemistry from the Maharaja Sayajirao University of Baroda, in Vadodara. She was a Research Fellow at the Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem) in Bengaluru and has written for Slate, Undark, and The Hindu.

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