Citation
Menstrual Suppression in Context

Material Information

Title:
Menstrual Suppression in Context Objectification, Gender, and Choice
Creator:
Weis, Alexandra S
Place of Publication:
[Gainesville, Fla.]
Florida
Publisher:
University of Florida
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english
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1 online resource (64 p.)

Thesis/Dissertation Information

Degree:
Master's ( M.A.)
Degree Grantor:
University of Florida
Degree Disciplines:
Women's Studies
Committee Chair:
ZUCKER,ALYSSA N
Committee Co-Chair:
TRAVIS,PATRICIA A
Committee Members:
MORADI,BANAFSHEH

Subjects

Subjects / Keywords:
contraceptives -- feminist -- menstruation -- objectification
Women's Studies -- Dissertations, Academic -- UF
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bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Women's Studies thesis, M.A.

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Abstract:
Menstrual suppression, the practice of reducing or eliminating occurrences of menstrual bleeding, has been widely advertised and discussed but not extensively researched. The purpose of this project was to establish a theoretical base characterizing the possible sociocultural pressures at play in a narrative of menstrual choice, and gather data to strengthen or weaken one side of the theoretical argument. I consider the work of feminist scholars criticizing or engaging with menstrual suppression as contraceptive technology. Three hundred and nineteen women completed surveys about their experiences with contraceptives, menstrual suppression, interpersonal and internal objectification, sexual subjectivity, gender role, and neoliberal beliefs. I explore relationships between these constructs and find that body surveillance partially predict suppression decisions, whereas different types of suppression are associated with dissimilar aspects of sexual or gendered experience. The findings are significant for future work in feminist healthcare. The findings are all partial, however; I end the project by cautioning against essentialist perspectives that remove nuance from choice entirely. ( en )
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In the series University of Florida Digital Collections.
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Includes vita.
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Includes bibliographical references.
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Description based on online resource; title from PDF title page.
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This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Thesis:
Thesis (M.A.)--University of Florida, 2017.
Local:
Adviser: ZUCKER,ALYSSA N.
Local:
Co-adviser: TRAVIS,PATRICIA A.
Statement of Responsibility:
by Alexandra S Weis.

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UFRGP
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Applicable rights reserved.
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LD1780 2017 ( lcc )

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MENSTRUAL SUPPRESSION IN CONTEXT: OBJECTIFICATION GENDER, AND CHOICE By ALEXANDRA S. WEIS A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS UNIVERSITY OF FLORIDA 2017

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2017 Alexandra S. Weis

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3 ACKNOWLEDGMENTS I extend my deepest gratitude to my advisor, Alyssa Zucker, for supporting and guiding me through a very difficult year. I would also like to thank my committee, Bonnie Moradi and Trysh Travis, for their insight shaping the body of my work; Donna Tuckey, f or never failing to cheerfully untangle my mistakes ; my family, for supporting me from across the country; and Cadence Baer, for reminding me to take care of myself.

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4 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ ...... 3 LIST OF TABLES ................................ ................................ ................................ ................ 6 ABSTRACT ................................ ................................ ................................ .......................... 7 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ .......... 8 Selling Menstrual Suppression ................................ ................................ ..................... 8 Suppression: How, Who, and Why? ................................ ................................ ............ 9 How do People Suppress Periods? ................................ ................................ ....... 9 Wh o Suppresses Periods? ................................ ................................ .................. 11 Why do People Suppress Periods? ................................ ................................ ..... 13 2 FEMINIST PERSPECTIVES ON MENSTRUAL SUPPRESSION ............................ 15 Why is Menstruation an Important Issue for Feminists? ................................ ............ 16 Feminist Perspectives on the Menstrual Suppression N arrative ............................... 17 Gender and Technology ................................ ................................ ...................... 17 Choice and the Sociocultural Context ................................ ................................ 19 Next Steps ................................ ................................ ................................ ................... 22 3 PSYCHOLOGICAL FRAMEWORKS ................................ ................................ ......... 24 Psychology of Menstruation ................................ ................................ ....................... 24 Attitudes Toward Menstruation ................................ ................................ ............ 25 Diversity ................................ ................................ ................................ ................ 25 Objectification Theory ................................ ................................ ................................ 28 Self Objectification ................................ ................................ ............................... 28 Objectification and Menstruation: What do We Know? ................................ ....... 29 Research Goals ................................ ................................ ................................ .......... 31 4 METHOD ................................ ................................ ................................ ..................... 33 Participants and Procedure ................................ ................................ ........................ 33 Measures ................................ ................................ ................................ ..................... 34 5 RESULTS ................................ ................................ ................................ .................... 40 Preliminary Analys es ................................ ................................ ................................ .. 40 Hypothesis Testing ................................ ................................ ................................ ..... 41

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5 6 DISCUSSION ................................ ................................ ................................ .............. 49 Limitations ................................ ................................ ................................ ................... 49 Future Directions ................................ ................................ ................................ ......... 50 Contributi ons ................................ ................................ ................................ ............... 50 APPENDIX A INFORMED CONSENT ................................ ................................ .............................. 54 B BEHAVIOR QUESTIONNAIRE ................................ ................................ .................. 55 LIST OF REFERENCES ................................ ................................ ................................ ... 58 BIOGRAPHICAL SKETCH ................................ ................................ ................................ 64

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6 LIST OF TABLES Table page 5 1 Correlations between indicator variables and Menstrual Attitudes Questionnaire subscales. ................................ ................................ ....................... 45 5 2 Correlations between indicator variables and select scales related to objectification theory. ................................ ................................ .............................. 46 5 3 Correlations between indicator variables and select sexuality variables. ............. 47 5 4 Correlations between indicator variables and select gender variables. ............... 48

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7 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts MENSTRUAL SUPPRESSION IN CONTEXT: OBJE CTIFICATION, GENDER, AND CHOICE By Alexandra S. Weis May 2017 Chair: Alyssa Zucker Major: Menstrual suppression, the practice of reducing or eliminating occur rences of menstrual bleeding, has been widely advertised and discussed but not extensively researched. T he purpose of this project was to establish a theoretical base characterizing the possible sociocultural pressures at play in a narrative of menstrual choice and gather data to strengthen or weaken one side of the theoretical argument. I consider the work of feminist scholars criticizing or engaging with menstrual suppression as contraceptive technology. Three hundred and nineteen women completed surveys about their experiences with contraceptives, menstrual suppression, interpersonal and internal objectif ication, sexual subjectivity, gender role and neoliberal beliefs I explore relation ships be tween these constructs and find that body surveillance partially predict suppression decisions, whereas different typ es of suppression a re associated with dissimilar aspects of sexual or gendered experience. The findings are significant for future work in feminist healthcare. The findings a re all partial, however; I end the project by cautioning against essentialist perspectives that remov e nuance from choice entirely.

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8 CHAPTER 1 INTRODUCTION Selling Menstrual Suppression In 2009, two advertisements aired on television for Seasonique a contraceptive Emotional attempted to persuade Logical that she could stop having so many pe riods, while Logical protested with uncertainty about new and different things. Eventually, Logical happ ily in a new dress, period free ( The Well Timed Period, 2007 ). The second ad you have to have ( MLCip, 2009 ). Though only two examples, these commercials reflect the m arketing tactics that have permeated discourse about are often devalued: in this case, reproductive and menstrual decision making processes are portrayed as a tension between dich otomous emotion and logic Menstrual suppression, to opt out of periods. These commercials provide some insight into the way that advertisers constructed a narrative of me nstrual suppression, but questions remain about how this narrative and others may have been internalized by consumers. Who chooses to suppress menstruation, how do they do it, and why? Do the people who engage in this practice reflect the cultural values t hat dominate advertisements, or do their choices represent the culmination of health advancements in pursuit of freedom from biological

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9 constraints? As a feminist psychologist in pursuit of interdisciplinary answers, I believe that these questions speak to a complex problem of agency, and they may be best considered through multiple avenues. Thus, the current research will first explore relevant literature in Feminist and Gender Studies (Chapter 2), resulting in two potential theories about the cultural con text of menstrual suppression. I will then ground my perspective in psychological literature (Chapter 3), enabling me to conduct a study (Chapters 4 5) that will put pressure on one of these contextual theories in order to facilitate a critical analysis of its validity (Chapter 6). Suppression: How, Who, and Why ? How d o P eople S uppress P eriods? Studies of menstrual suppression are not always clear, partially because neither ble or consistent definitions across context Many of the top Internet search results are do it yourself recommendations: forums where women advise one another how to suppress their periods by skipping the placebo week on their hormonal contraceptive pills Often, these conversations are framed around occasional or frequent but not total cessation Total menstrual suppression can be achieved medically in several ways. Thus, we must be very clear what we mean when we use the term. First, it is important to note that the periods experienced while using hormonal contraceptives are different than periods experienced otherwise. The bleeding that estrogen levels change as a result of, for example, the absence of a daily pill ( Marcovitch, 2010 Doucleff,

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10 2016 para. 5 technically refers to methods that avoid monthly withdrawal bleeding. Some contraceptives are developed, marketed, a nd prescribed with this purpose in mind. Vaginal rings such as NuvaRing, intrauterine devices such as Mirena, and contraceptive shots such as Depo Provera can all lessen or eliminate periods, but none can guarantee full regulation. In fact, breakthrough bl with all methods, and most come with other potential disadvantages, including fertility issues, uterine perforation, and menstrual irregularity ( Doucleff, 2016 ). The menstrual cycle is also commonly regulated using contraceptive pills. Extended use regimens are designed and packaged in such a way that periods of withdrawal bleeding occur infrequently, and continuous use regimens eliminate withdrawal bleeding entirely. For instance, the afore mentioned drug Seasonique followed by seven days of low dose estrogen pills, resulting in a roughly three day period of withdrawal bleeding every three months ( Birth Control News, n.d. ). In either case, it can take months or even years for the body to adjust without breakthrough bleeding or full unscheduled bleeding episodes ( Association of Reproductive Health Professionals, 2008a ). People also sometimes alter their own pill regimens using 21 or 28 day packs, allowing for menstrual suppression on demand without a medical consistently the most popular method of contraception in the United States ( Jones, Mosher, & Daniels, 2012 ), but this type of do it yourself menstrual suppression remains vastly understudied.

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11 Regardless of whic h method is used, most clinical studies conclude that contraception regimens designed to reduce or eliminate periods are likely just as safe as comparable contraception regimens that include withdrawal bleeding (for reviews, see: Jacobson, Likis, & Murphy, 2012 ; Mendoza et al., 2014 ). That is, they appear to have the same short term side effects as typical regimens (e.g., blood clot risk) but there have been no long term stud ies. Some menstrual health authorities endorse the practice as a result ( Planned Parenthood, n.d. ), while others caution against sustained use until long term investigations are conducted, particularly with young wo men or teenagers ( Society for Menstrual Cycle Research, 2007 ). Who Suppresses P eriods? to guides a nd media speculation. However, it is un clear how many women actually engage in this behavior. Part of the reason for this is the murky definition of menstrual suppression, as discussed above to my knowledge, no comprehensive large scale data has been gat hered estimating rates for all of the different regulatory methods. Medical researchers are most interested in evaluating and promoting menstrual suppression through extended pill regimens, like Seasonique, or through injections/IUDs. Therefore, estimates of menstrual suppression in contraceptive journals are low (20% in a previous sample; Andrist et al., 2004 ) but typically only assess patients who seek long term or continuous use methods from their doctors, not people who occasionally skip a period on their own. In a previous sample of college students, most women who suppressed their menstruation did so using regular contraceptive pills ( Johnston Robredo et al. 2003 ). In that sa me sample, only 12% of women had suppressed their periods, but less than half of the women had ever used

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12 contraception methods that could be used to suppress periods. Women who were on the pill were also significantly more likely to have heard of menstrual suppression. Presumably, then, many women in their very young sample (17 22 years old) had never skipped a period because they did not have the opportunity or means. In all cases, many more women were interested in suppression or willing to suppress than actually had suppressed Both of the above studies are now outdated and limited, but specific data about suppression is difficult to pin down. According to recent statistics about contraceptives in general, four out of five women who have had sex with a ma n have used the pill, so it is likely that this is the most common way to skip periods. It is important to note that, in addition to the discussed measurement issues with es of infertility, hormonal imbalance, age, or disorder (such as polycystic ovarian syndrome). Transgender people of all identities may experience menstruation but are rarely included in large scale studies. Though my project is primarily concerned with cisgender women who menstruate, I will sometimes use gender neutral terms like instead of specifically referring to cisgender women. In perspective on the menstrual cycle ( 2011 ), I do this avoid linking gender inherently to menstruation, thus expressing solidarity with cisgender and t ransgender women who do not menstruate as well as transgender men who do. Feminist scholars have a duty to acknowledge and challenge normative boundaries where they exist and deconstruct

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13 them where possible; therefore, I will consider the complexities of g ender identity in the available literature, limited though the avenue may be. Why d o People Suppress P eriods? Online articles and other media representations of menstrual suppress ion construct a set of reasons for suppressing as mentioned previously they are often outweighed by the assertion that choice, regardless of justification, is most important. Few studies have been conducted to ascertain just how accurate this is to real healthcare decision making processes. In terms of s tudies specific to suppression, a survey of college students found that the most commonly cited factors were convenience/scheduling and personal preference ( Lakehomer et al. 2013 ). In a study of young adult transgend er patients, 53 of 123 trans men used oral contraceptives specifically to regulate menstruation in order to manage gender dysphoria and facilitate transition ( Kanj, Conard, & Trotman, 2016 ). In a very limited sam ple, Repta and Clarke ( 201 3 ) used qualitative data to contextualize suppression decisions, suggesting that convenience, manageability, and appearance concerns were among the most relevant factors. Looking to online articles for possible suggestions, what are some more concrete and specific reasons? First and foremost, contraceptives are often prescribed to treat menstruators who endure physical pain in the form of endometriosis or other serious dysmenorrhea; complete menstrual suppression may provide additional relief ( National Institute of Child Health and Human Development, n.d. ). Do it yourself guides cite other premenstrual symptoms, special occasions/travel plans, or athletic/military careers ( Association of Reproductive Health Professionals, 2008b ). Some guides invoke n ormative appeals to sexuality:

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14 Sheer panic ensues because this is literally the worst thing to happen to any woman. What will you do? You bikini will hold up against the waves of the crimson tide. And all of that only one solution: skip your period. ( LaFata, 2014 para. 7 ) Other guides simply claim that menstruators eschew periods becaus e they are seen as unnecessary Doucleff, 2016 ). Taken together, we can begin constructing a more complete picture of decision making factors related to menstrual suppression, but caution is warranted. It is unlikely that the reasons can all act independently of one another, particularl y given the proliferation of the choice narrative. Differences in complex decision making presumably exist across context, length of suppression, and contraceptive method. Given these gaps in the literature, the first goal of this study will be to gather enough information about my sample to paint a somewhat accurate picture how? Who? Why? In the next chapter, I will move from these basic descriptive boundaries to explorations of a contested feminist space: is the menstrual choice a successful applicatio n of technological empowerment and autonomy free from biology, or is it the micro level enactment of a disempowering and narrow cultural ideology?

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15 CHAPTER 2 FEMINIST PERSPECTIVES ON MENSTRUAL SUPPRESSION ave debated the wisdom of suppressing their periods. Crunchy feminists think it's unnatural; techno feminists think it's liberating Saletan, 2007 para. 3 ) Though perhaps too succinct, the Washington Post reporter above s till manages to capture the essence of a dichotomy in feminist perspectives on menstrual suppression. Put simply, some feminists in this case, stere otypically imagined as hippies who define womanhood through its supposed biological distance from manhood reject the rhetoric of menstrual suppression outright. Other feminists often third wave feminists, characterized by tech savvy and subversion of gender roles embrace cycle stopping technologies. These two feminist generalizations are destined to be p laced firmly at either end of a binary issue; after all, the first group emphasizes naturalness and biological essentialism, whereas the second equalize divides on sex/gende r lines. The missions, when constructed with simplified feminist stereotypes, seem diametrically opposed. However, there is certainly more to the story. No feminist issue should be constructed in dichotomy because it necessarily flattens the nuance of each perspective and precludes the establishment of a middle ground. In this chapter, I will attempt to flesh out these two perspectives in order to give them adequate consideration. As a result, I will be able to use the current study to investigate some core tenets of one perspective, hopefully shedding some light on the issue as a whole.

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16 Why is M enstruation an Important Issue for F eminists? Scholars have long discussed the role of menstrual discourse in controlling For some feminists, menstru al taboos reaching back to antiquity represent one of the most central foundations of patriarchy. Simone de Beauvoir ( 1952 ) bodies as mothers Fertility reflected nature, chaos, and disorder, rather than civilized men. To this day, rhetorics of bodily repulsion can be weaponized to reify female inferiority; as Breanne Fahs ( 2014 ) (para. 3). In the 1970s, the convergence of a feminist health consciousness and rejection of societally imposed shame narratives led to menstrual activism ( Bobel, 2008 ). Pharmaceutical companies and product manufacturers had repeatedly taken advantage of menstruator s by selling unsafe or toxic tampons and napkins, building distrust that would eventually culminate in a critical, alternative conceptualization of menstrual health needs. In order to force the Food and Drug Administration to regulate dangerous chemicals i in addition to letter writing campaigns and petitions advocating for safe standards, w omen were able to reclaim their ycles as natural and spiritual ( Bobel, 2008 ). Henley et al. 1998 ), but this type of feminism has largely fallen out of favor with t he public Though menstrual activism persists in some forms among (mostly white, privileged) third wave feminists ( Bobel, 2010 ),

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17 choice. We have increasing variety when it comes to menstrual hygiene, menstrual regulation, a nd even menstrual suppression. With modern technology, m enstruators can now choose how, when, and if they bleed. Feminist Perspectives on the Menstrual Suppression Narrative In this section, I will be discussing feminist analyses of menstrual suppression as a cultural narrative and as a practical technology. This will clarify the aforementioned divide between feminist groups, both of whom criticize the gendered construction of th e issue, but arrive at different conclusions. Radical/cultural feminists primarily reject the will enter a reciprocal process of co construction with the technology while using it to their benefit. Gender and T echnology According to Judy Wajcman ( 2007 ) a pioneer of feminist technoscience feminist approaches to science and technology begin with roughly the same critique. Because the fields of science and technology had been dominated by men, women had insufficient access to technological/scientific resources, and the advancements created by men were therefore unavoidably gendered to the detriment of women ( Wajcman, 2007 ). From this point in the 1970s, Wajcman writes, different branches of feminism rientations for instance, liberal feminists focused on equality of access, advocating for more women to enter the field and leaving it at that. Radical and cultural feminists soundly rejected man made technology, which led to an emphasis on gender differ ences and a return to feminine methods as they distanced themselves from masculine technology (specifically,

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18 reproductive technology). Beginning in the 1990s, postmodern cyberfeminism emerged; these feminists believed that the contemporary technology off ered opportunities to erase gender lines completely, particularly in a supposedly anonymous Internet age. somewhere between the gender sts and the Wajcman, 2007 ). Instead, technofeminists acknowledge the dynamic and inseparable nature of gender, technology, and science. They adopt a critical stance, but they als o negotiate technological spaces because they believe that technologies and gender relations are simultaneously and cooperatively constructed on the levels of design, production, and use. Put another way, technofeminism calls for critical reflection on tec hnological advancements, but also active engagement with gendered advancements that have the potential to equalize the socially constructed boundaries between sexes. Therefore, menstrual health is an area that lends itself well to this sort of active cons umption. As an example: technofeminists assert ed that the original design of the Because men were generating the science and designing the technology, they created a version of the pill that was gendered based on their cultural understanding of menstruators ( Oudshoorn, 1994 ). Imagining all menstruators to be basically the same, they created a rigid and universal regimen wherein the pattern of withdrawal bleeding equitable situation. In effect, male scientists standardized the cycles of countless women based on an

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19 abstract ideal of womanhood, proving that the social realities of mens truators and menstrual technology are indeed co constructed ( Oudshoorn, 1994 ). Given this example, it is clear how technofeminists might endorse total or partial menstrual suppression. With only 21 or 28 day cycles at on immediately viable way to effect change in the design is to reschedule the monthly withdrawal bleeding through pill manipulation. Similarly, complete suppression may represent even greater freedom from the disproportionately gendered original regimen. Though technofeminists would likely still critically analyze the social construction of the technological rhetoric, they would also occupy a relatively optimistic position in which their choices result in shifting technoscience. Choice a nd the Sociocultural C ontext The radical feminists who largely rejected masculine skewed technology focused much more acutely on bodies and choice. This is not necessarily surprising; the notion of choice and, in particular, informed choice in a bioethical context has always been Gunson, 2012 ). However, this is significant in that it represents an ontological shift in the choice paradigm as compared to technoscien ce; whereas technofeminists attempt to critically engage choice on a one on one level, this perspective maintains that menstruators as a whole are being misled by a co ( 2013 ) asserts that rhetorical paradox. It holds the promise of individual agency but can also be co opted to promote controversial choices that reinforce sexist ste reotypes As Woods ( 2013 ) observes, choice in the realm of healthcare has the potential to empower patients, but it is also inevitably commercialized. It is no coincidence that, for instance,

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20 greater concern for prem enstrual symptoms (in the form of PMS and PMDD) shortly preceded greater demand for medications regulating moods and periods. In an effort to popularize Yaz, a contraceptive pill that simultaneously regulated the menstrual cycle and premenstrual moods, Bay er Healthcare Pharmaceuticals launched a marketing bodies. Creating a self reliant, confident, individualistic ideal juxtaposed with the specter of a debilitating condition like PMDD allowed the co mpany to manipulate the choice narrative. After all, would an empowered girl let menstruation get in her way when instead she could choose to better herself physically, mentally, and emotionally? Similarly: by constructin individual, binary choice, marketing campaigns have camouflaged their own complicity in the perpetuation of harmful narratives by setting the responsibility solely on the shoulders of the consum er. One such harmful narrative perpetuated is in fact the very idea on which menstrual suppression is built. The controversial book Is Menstruation Obsolete? ( Coutinho & Segal 1999 ) first brought this narrative to th e forefront by framing menstruators keep menstruating only because we are holding onto tradition and unwilling to advance into a new age where the supposedly unbiased march f orward of biomedical progress has left us with p eriods that are not even real. According to Katie Ann Hasson, this redefinition of menstruation reflects a rhetorical shift designed to preclude the necessity for healthcare decision making defined by the presence or lack of ovulation rather than the experience of bleeding, then

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21 all hormonal contraceptives already suppress the menstrual cycle ( 2016 ). In this case, if the patient has already mad e the choice to suppress their cycle, then the social meanings of their withdrawal bleeding periods are diminished whether or not they feel choice from concerns about natural ness or safety by implicating the consumer in a choice they had already made and taken responsibility for; at this point, hanging onto a fake period can seem silly and counterproductive, particularly when accompanied by advertising tactics that insinuate t hat menstruators are inhibited competitively by biological difference, the decision to suppress menstruation may seem like an 2013 p. 268 ). When the choice narrative enters such rigidly defined territory, it becomes necessary to discuss the neoliberal context that facilitates framing healthcare decisions as consumerism. A neoliberal healthcare narrative is not a n uncommon one. Neoliberalism, a political ideology emphasizing free market, limited government regulation, meritocracy, and an ethic of personal responsibility ( Bockman, 2013 ; Steger & Roy 2010 ) neoliberal healthcare narrative, individual choice is important healthiest self is a moral mandate of sorts. Patients are faced with these choices even if they are not equipped or inclined to make them ( Glasdam, Oeye, & Thrysoee, 2015 ). Phrased another way, we have the healthcare choices available to us, and so it is a matter of personal responsibility to take ad vantage of the choices that better enable us to succeed. In a supposed meritocracy, successful may mean more self regulated and

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22 cycle as per the image put forth by ph armaceutical companies can become a mandate as well. This is particularly true if one has negative connotations about periods ( Gunson, 2016 ). Several feminist criticisms of menstrual suppression specifically link the rhetoric of choice to neoliberal values (see Gunson, 2010 & 2012 ; Hasson, 2012 ; and Kissling, 2013 ). Though neoliberal values may not be d eployed consciously by the medical surveillance come to be axioms through their continual reiteration such that their value is no longer Gunson, 2010 p. 1331 ). Similarly, menstruators are likely unaware of the ideologies whose values they are accepting if they make uncritical menstrual suppression decisions. The neoliberal context serves to obscure the gendered issues at play framing the issue as one of narratives that may be reified. I will discuss this at greater length in the next chapter, but for now suffice it to say that feminist critiques that are skeptic al of menstrual suppression may also call into question the objectifying narratives present in the social distance oneself ( Johnston Robledo et al., 2003 ; Roberts & Waters, 2004 ). Next Steps Given the two feminist perspectives that I have described, I want to move on to build the psychological framework which will contextualize the discussion with actual perspective that implicates internalized gendered and neoliberal values, I will create a research paradigm to test whether the theory can be substantiated. I also think it is the

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23 theory more likely to reflect suppression motivations as a result of my own feminist jour ney unpacking the internalized oppressive narratives that once led me to decreased well being and poor healthcare decision making. However, it is likely if not d efinite, that the final conceptualization of menstrual suppression will not fit exactly into either theory. As explored by Gunson ( 2012 ) experiences of decision making and menstrual suppression are multi faceted: The narrat ives of the women who were particip ants in this study demonstrated accommodation as well as uncertai nty and sk epticism. In so doing, they constructed a range of health identities that both appro priated and contested dominant u nderstandings of choice, ref lecting the complex inters ections of social, cultural and embodied constraints when taking up medical technologies (p. 8) Thus, though I expect to see the aforementioned themes figure prominently in my data, I also want to be careful not to overstate the degree to which participants will present with specifically technofeminist or neoliberal/gender normative reasoning. The data that I gather will serve to contextualize and, hopefully, lend validity to some of the discussed themes.

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24 CHAPTER 3 PSYC HOLOGICAL FRAMEWORKS Psychology of Menstruation Feminist psychologists have posited that menstruation is a source of social stigma with negative consequences for well being and mental health ( e.g., Chrisler, 2011 ; J ohnston Robledo & Chrisler, 2013 ). In an experiment exemplifying this stigma, Roberts et al. ( 2002 ) found that participants evaluated a woman as less competent and less likable aft er she dropped a tampon from her handbag; interestingly, participants also evaluated women in general with more objectifying standards after watching the tampon fall, particularly in the case of participants who adhered more strongly to typical gender role s. Thus, the mere sight of menstrual hygiene products may be enough to elicit stigma. Relevant to the previous chapter, advertisement is an important vehicle through which this stigma travels, but it is also internalized via dominant cultural attitudes tha t seep into media, education, socialization, jokes, and shame based social interactions ( Johnston Robledo & Chrisler, 2013 ) Menstruators who internalize the stigma of menstruation may have lower self esteem and enga ge in more frequent self monitoring, which is likely related to objectification theory (explored below). Negative attitudes toward menstruation are prevalent, but they are especially negative for menstruators who have high levels of shame and self objectif ication ( Johnston Robledo et al. 2007 ). Some feminist researchers have suggested that this affects menstrual health decision making, including menstrual suppression (e.g., Joh nston Robledo & Chrisler, 2013 ); however, insufficient research exists to test that claim

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25 Attitudes Toward M enstruation Several studies have found evidence that menstrual attitudes are related to body image and related constructs. In a recent small sampl e, for example, Chrisler and colleagues ( 2015 ) found that greater body appreciation predicted positive menstrual attitudes, although they did not extend this link to interest in menstrual suppression. Schooler and colleagues ( 2005 ) found that menstrual shame was indirectly related to making and risks through body comfort levels. Premenstrual syndrome, commonly understood as the experience of emotional an d physical symptoms preceding the onset of menstruation, has also been studied by feminist researchers. Cosgrove and Riddle ( 2003 ) found that traditional femininity was correlated with certain premenstrual symptoms, inclu ding negative affect and impaired concentration The authors suggest through qualitative analyses that women cope with failures to live up to idealized images by distancing themselves from menstrual or premenstrual versions of themselves ( Cosgrove & Riddle, 2003 ). Diversity As with many areas of psychological research, much of our knowledge about menstrual attitudes is based in convenience samples : mostly White, young, heterosexual, cisgender, middle or upper class women enrolled in college. As a result, we have limited knowledge about the menstrual attitudes of people of color and queer people among others Though I do not select for specific identity groups in my study, it was my hope that using an online participant pool instead of the typical college sample would give me some diversity in race/ethnicity, age, and sexuality. On the topic of race, it is pos sible that menstruators differ, but little research is available In a small qualitative study, Fahs ( 2011 ) observed that White women more

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26 often expressed positive emotions ab out menstrual sex than did women of color. However, Deuster and colleagues ( 2011 ) collected data from a sample of deployed military women and found that African American women reported lower menstrual concerns than did White women, Asian women, or Latinas. In a compariso n of a predominantly Black sample in Georgia and a predominantly White sample in Oregon, Edelman et al. ( 2007 ) found no racial differences in period enjoyment, but significantly fewer Black women expressed willingness t o engage in period suppression. Overall, the literature about menstrual attitudes is lacking in sufficient racial diversity and thus few comparisons between racial groups can be made. Some transgender people menstruate, and their unique social positions indicate that their relationships with menstruation are likely very different from that of cisgender women. Nuanced issues like d ysphoria, gender presentation, and safety in public restrooms could complicate the matter Unfortunately, transgender people ar e almost never considered in menstrual cycle research Some feminist academics are trying to rectify this erasure, but progress is slow. T ransgender issues are rapidly evolving, and feminists sometimes lag behind, breeding distrust ( Vasquez, 2016 ) It is certainly not helpful that there is a history of radical feminist scholars characterizing menstruation as an issue of gender essentialism as an example, consider recent if thirteen Morris, 2015 p ara 5 ). As a result, rectifying the dearth of research about the menstrual cycl es of transmasculine individuals requires careful and purposeful work on the part of feminist psychologists, who must navigate relatively uncharted waters while mending existing feuds among

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27 trans people, feminists, and academic researchers. In fact, as sug gested in an opinion piece by transgender neuroscientist Kale Edmiston the best way to move forward is perhaps to make room for trans people in academia so that they can be treated seriously as experts in their own experience ( Edmiston, 2016 ). Based on the scant amount of research available, the trans community appears to have a complex relationship with menstruation. In one of the very few studies of masculine of center people, Chrisler et al. ( 2016 ) found that participants had mixed attitudes about menstruation but anticipate d negative opinions from others ; perhaps as a result, most hid their menstruation by avoiding public restrooms or products that require f requent changing in public. In terms of menstrual suppression, the participants exhibited more positive attitudes toward menstrual suppression than did cisgender women in previous studies, and 40% had suppressed their periods in some way ( Chrisler et al., 2016 ). The researchers note, however, that participants were often hesitant to discuss menstruation with medical professionals ( Chrisler et al., 2016 ). Given the variability in tra ns experience, it is likely that further study would reveal even greater complexity; perhaps the inclusion of masculine people who did not identify as trans men resulted in less negativity toward menstruation as a result of decreased concerns about dysphoria and passing as male. Similarly, it is possible that sexual orientation complicates menstrual attitudes, but there is too little research on the specific experiences of lesbians and bisexual or queer women to say for sure. Fahs ( 2011 ) sp oke to this issue in a small qualitative study wherein thematic analyses revealed that lesbians and bisexual women expressed more positive emotions related to menstrual sex However, contrary to predictions,

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28 another study found no sign ificant difference in menstrual attitudes by sexual orientation ( Morrison et al., 2010 ). Objectification Theory Objectification Theory, proposed by Fredrickson and Roberts ( 1997 ), attends to the ways that women adopt the perspective of an outside observer when t hey evaluate their own bodies. The widespread sexualization of women and girls forcibly reduces their va lue to physical attractiveness. Through objectification, their bodies may be separated into parts inscribed with sexual meaning; in this way, their bodies can be detached from their personhood, minimizing all other characteristics in favor of a physicality that exists only to please heterosexual men. Thus, the male g aze functions as a way of policing women, whether women are literally gazed at in interpersonal interactions or are more abstractly the object of male gaze in media representations ( Fredrickson & Roberts, 1997 ). Since sexualization seems unavoidable to most women, objectification happens without the consent of the objectified. From birth, their internalization ( Smolak & Murnen, 2011 ). Seeing that her value is dictated by her appearance, an individual is likely to build her self concept around it, and so she may evaluate herself as an object in much the same way that an outside observer w ould ( Fredrickson & Roberts, 1997 ). Self O bjectification Self objectification is associated with body surveillance and feelings of shame, and, as explained by Roberts and Waters ( 2004 women in the cultural flight away from the corporeal body, engaging in a great variety of body altering practices designed to transform the physica l body into the idealized body (p.

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29 10). When self objectificat ion distances women from their bodies, they have lower awareness of internal bodily states ( Fredrickson & Roberts, 1997 ). This cycle of shame and detachment may be related to how the individual evaluates and prio ritizes their menstrual cycle. Andrist ( 2008 ) proposed a similar function: objectification, as a way of devaluing women, causes women to frame their bodies as cultural symbols, and menstrual suppression allows one to distanc e oneself from animalistic embodiment. Self objectification has been operationalized in a variety of ways and, as a result, measured differently by psychologists. In this study, I take my cue from Moradi ( 2010 ) by noting that self objectification may be conceptualized as a process that dynamically links several constructs within Objectification Theory. As a result, I decided to seek answers using three constructs to speak to the complex process of self objectification: exp erienced sexual objectification, an external component working in tandem with internalization; internalization of bodily standards; Objectified Body Consciousness ( McKinley & Hyde, 1996 ) which incorporates body survei llance and body shame Each component I have chosen draws on Objectification Theory, but due to a lack of relevant research I do not know which pieces of the puzzle will fit in with menstrual suppression. Objectification and Menstruation: What do We Know? Previous samples have shown a relationship between self objectification and negative attitudes and emotions about menstruation ( Roberts & Waters 2004 ; Schooler et al. 2005 ). Gro se and Grabe ( 2014 ) found that self objectification predicted negative menstrual attitudes which in turn predicted attitudes about alternative menstrual products. Though one previous study has attempted to link self obje ctification to aspects of menstrual suppression and failed to do so ( Johnston Robredo et al., 2003 ), tha t study is outdated and limited in its scope and sensitivity. As discussed above, the

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30 researchers failed to access a large population of menstrual suppressors in a young sample of women with little variability in contraceptive methods. In the aforementioned experiment by Roberts and collea gues, participants with high levels of gender conformity who saw the woman drop a tampon from her bag exhibited a generalizable increase in objectification attitudes That is, gender normative people evaluated women as a whole with more objectifying standa rds after watching the tampon drop ( Roberts et al., 2002 ). I will be employing the ideas of gender conformity and objectification in my own study, albeit in a different context. Relatedly, Erchull ( 2013 ) linked objectification and menstruation using a terror management framework. Terror Management Theory originally proposed by Greenberg, Pyszczynski, and Solomon ( 1986 ), is a psychological context for unde rstanding the existential crisis of mortality While this seems complicated and death. As Erchull ( 2013 ) elaborates, reminders of our natural or animal nature can trigger mortality salience, and as a result we often distance ourselves from aspects of ourselves that seem animalistic. If menstruation is a reminder of corpore ality, then people will generally want to distance themselves from menstrual signifiers, and objectification is an efficient way to do so ( Erchull, 2013 ). In a content analysis of menstrual product advertisements, Erchull ( 2013 ) found that only roughly half of the images depicted women at all, and of those, most depicted idealized but largely nonsexual bodies herent in an Erchull, 2013 p. 37). The author

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31 suggests that this objectification strategy could extend to menstrual suppression, although no suppression advertisements we re analyzed. Research Goals Taken together, the existing research suggests that menstruation is stigmatized and that women may respond through objectification theory, but the body of work is still limited and often mixed. As a result, asking questions abou t menstrual suppression is complicated, but I specifically targeted a sample of women who ha d used hormonal contraceptives in order to gather data related to the themes outlined in Chapter 2: is the degree to which someone internalizes a neoliberal, self o bjectifying narrative related to their engagement in menstrual suppression? Conceptually, I am interested in the power of this internalization to affect the subjectivity of women. Specifically, I expect ed that the degree to which someone experiences self o bjectification may be related to disregarding bodily needs in favor of minimizing shame, controlling the body, and using the body as an object. This is my primary interest. However, because I think that previous menstrual suppression studies have fallen sh ort in part because they did not differentiate between varying levels of menstrual suppression, I expect ed a secondary model to emerge. Menstruators who suppress occasionally will likely have different specific motivations that menstruators who suppress co ntinuously. My hypotheses are as follows: 1. Among people who engage in menstrual suppression, the most common method will be personal manipulation of 28 day oral contraceptive regimens. 2. Greater levels of self objectification will be related to higher menstr ual s uppression 3. Greater internalization of neoliberal beliefs will be related to higher menstrual suppressio n. 4. Different methods of suppression will reflect different motivations for suppression: Suppressing occasionally (i.e., using do it yourself cycle manipulation) will be associated with sexuality (specifically, sexual subjectivity and sexual motivation)

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32 and suppress ing continuously (i.e., using prescribed methods like continuous oral contraceptives or IUDs) will be associated with normative gendered values and low collective self esteem.

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33 CHAPTER 4 METHOD Participants and Procedure This study was approved by the University of Florida Institutional Review Board. I recruited participants through Prolific Academic (prolific.ac) a crowdsourcing website dedicated specifically to academic research I used the prescreening tools on the Prolific Academic website in order to verify t hat the women in the sample had at least some experience using hormonal contraceptives so as to maximize the likelihood of recruiting participants who had faced a menstrual suppression choice. Volunteers who met the criteria were directed to an online survey hosted on Qualtrics software and were compensated approximately $2.50 upon completion. At the time of analyse s, data were collected from 336 adult women. A s part of the data cleaning process, I eliminated responses from participants in nations other than the U.S., Canada, and the United Kingdom because of language barriers and possibly confounding differences in cultural influence (though there were not enough participants from any one of these English speaking nations to select from a single location). I also eliminated responses from agender. Tho ugh these participants met the contraceptive use prescreening criteria, I did not have the means to accommodate the complex motivations that may influence their suppression behaviors, including but not limited to dysphoria and gender presentation. The final sample (n=319) ranged in age between 18 and 49, and the mean age of the sample was about 31 years old (SD=6.7). Participants were primarily White (93.4 %), followed by Latina (3.8 %), Native American (2.2 %), Black (2.5 %), Asian/Pacific Islander ( 1. 9 %), and other (2.2 %). Participants lived primarily in the United Kingdom (66.1%),

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34 followed by the United States (29.5%), and then Canada (3.1%). Most participants identified as heterosexual (78 .7 %), followed by bisexual (15.4 %), lesbian/gay (2.5 %), queer, (1.3%), or other (2.2 %). Most participants were also highly educated, with the vast majority (72.7%) holding a college degree or greater Measures Suppression behavior After providing informed consent (Appendix A), p articipants completed a questionnaire (Appendix B) developed for this study, about their contraception use and menstruation experiences. This first section of the survey assessed the outcome variables: menstrual suppression overall, long term menstrual suppression, short term menstrual suppression, and likelihood of future suppression. Participants also provided open ended responses about their reasons for suppressing and rated the pai n, symptomology, and inconvenience of their menstrual cycles. Menstrual attitudes. Participants c ompleted the Menstrual Attitude Questionnaire ( Brooks Gunn & Ruble, 1980 ). The scale is designed to measure several d ifferent attitudes about menstruation, and is therefore divided into five subscales. The debilitation subscale ( study reliability throughout, consists of 12 items, including The 0.63) consists The natural subscale ( =0.82) consists of four items, ion of general good The predictable subscale ( =0.73) consists The denial subscale ( = 0.82 ) consists of seven n who attributes Response options

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35 ranged from 1 ( strongly agree ) to 7 ( strongly disagree ). I averaged the items in each dimension but did not create a single score for total menstrual attitudes because of the disparate nature of some of the subscale predic items may not. Sexual subjectivity. I used the Female Sexual Subjectivity Inventory ( Horne & Zimmer Gembeck, 2006 concepts. The instrument contains 20 items divided in to five subscales. The sexual body esteem subscale ( =0.87 ) consists of ( =0.83) which measures al pleasure from the self, consists of three ( =0.77) entitlement to sexual pleasure from partners, consist The fourth subscale ( =0.82) efficacy in achieving sexual le to ask a partner to provide the The sexual self reflection subscale ( =0.89) contains five Response options ranged from 1 ( n ot at all true for me ) to 5 ( very true for me ). I averaged the items in each subscale and also in the inventory overall to create a total sexual subjectivity score ( =0.87).

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36 Locus of causality for sex. motivations for engaging in sexual activity, I used seven statements from the Perceived Locus of Causality for Sex scale ( Jenkins, 200 3 ). Parti cipants responded to the prompt by checking any number of Gender c onformity. I measured gender conformity using the Conformity to Feminine Norms Inventory 45 ( Parent & Moradi, 2010 ). The measure consists of 45 items divided into nine subscales of five items each. The thinness subscal e ( =0.89) ( =0.83) investment in appearance subscale ( =0.84) contains items such as: attractive The modesty subscale ( =0.85) The relational subscale ( =0.77) contains items The involvement with children subscale ( =0.95) ( =0.88) The romantic relationships subscale ( =0.82) The sweet and nice subscale ( =0.74) Responses range fro m 1 ( strongly disagree ) to 4

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37 ( strongly agree ). I averaged the items in each subscale and separately averaged all 45 items to create a total conformity score ( =0.84). Neoliberal beliefs. Participants completed the Neoliberal Beliefs Inventory ( Bay Cheng et al., 2015 ). The measure consists of 25 items divided into four subscales. The system inequality subscale ( =0.89) contains does not exist today to such a degree that affirmative The competition subscale ( =0.82) contains five items, including letting people have equal opportunity, not guaranteeing equal outcome Th e personal wherewithal subscale ( =0.91) c ontains eight items, includ The government interference subscale ( =0.88) contains five items, including Response options range from 1 ( strongly disagree ) to 5 ( strongly agree ). I averaged all 25 items to create a total neoliberal beliefs score ( =0.94) in addition to the subscales. Collective self esteem. Participants completed the Collective Self Esteem Scale ( Luhtanen & Crocker, 1992 ), which I altered slightly to specifically target esteem related to collective womanhood The measure consists of 16 items divided into four subscales of four items each. The membership self este em subscale ( =0.81) includes items such collective self esteem subscale ( =0.84) belong to the social group (womanhood) I do esteem subscale ( =0.83) includes items such as: The importance to identity subscale ( =0.88) includes

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38 items such as: d) has very little to do with Response options range from 1 ( strongly disagree ) to 7 ( strongly agree ). I averaged all 16 items to create a total collective self esteem scale ( =0.87) in addition to subscales. Sexual objectification. objectification, I administered the Interpersonal Sexual Objectification Scale ( Kozee et al., 2007 ). The scale consists of 15 items in two dimensio ns The body evaluation dimension ( =0.93) someone was not listening to what you were saying, but instead gazing at your body or ( =0.84) measures unwanted explicit sexual ersonal objectification score ( =0.93) in addition to averaging within the two dimensions. Objectified body consciousness. In order to assess components of objectification, I used the Objectified Body Consciousness Scale ( McKinley & Hyde, 1996 ). The scale consists of 24 items divided into three subscales with eight items each The surveillance subscale ( =0.89) includes items such as: (reve rsed). The body shame subscale ( =0.87) contains items such as: I feel ashamed of myself when I The control subscale ( =0.82) includes items Response

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39 options ranged from 1 (strongly agree) to 7 (strongly disagree). In addition to these subscales, I averaged all 24 items to create a total score ( =0.85). Sociocultural attitudes toward appearance. Participants completed the Sociocul tural Attitudes Towards Appearance Questionnaire 3 ( Thompson et al., 2004 ). The measure consists of 30 items divided into four subscales. The general internalization subscale ( =0.94) not care if my body (reversed). The athlete internalization subscale ( =0.81) ( =0.95) consists of se ven items, such as ( =0.91) Response options range from 1 ( definitely disagree) to 5 (definitely agree). I averaged all 30 items to create a total internalization score ( =0.95) in addition to the four subscales.

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40 CHAPTER 5 RESULTS Preliminary Analyses Though I only collected responses from 336 women (319 after data cleaning) over 1000 people responded to the prescreening item on the Prolific Academic website. O ver 70% of those respondents reported that they had in fact used hormonal contraceptives at some point. However, since Prolific Academic does not require its participants to respond to every demographic screening question, I cannot say for sure how accurate this representation is of the participant pool as a whole. Additionally, American, there are no restrictions on nationality or country of origin. I restricted my study to participants from the U.S., the United Kingdom, and Canada, but the prescreened pool may draw from any country. The vast majority of participants had experien ce using contraceptive pills (88.7 %). Some participants reported having used hormone injections (12 .9 %), intrauterine devices (11.9 %), and implants (14 .4 %). On the whole, participants reported moderate menstrual discomfort; on scales from one to ten, parti cipants rate d their menstrual pain (M = 4.96, SD = 2.4 ), m enstrual inconvenience (M = 5.67 SD = 2. 48 ), and premenst rual syndrome symptoms (M = 5.44, SD = 2.45 ). A bout a third of the total sample had ever consulted with a doctor a bout menstrual suppression (36.7 %), but over half (61.5 %) safe. More than half of the sample reported having ever suppres sed their menstrual cycles (58 %). As predicted the majority (75.1 % or 43.6% of the to tal sample ) of

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41 suppressors had done so using short term methods (i.e., skipping a period manually by manipulating pill regimens) whereas only 31.4 % (18.2 % of the total sample) had used long term methods. A bout half (51.1 but the responses were somewhat polarized, (21.6%) (21.9%) being the two most c ommon responses. As a preliminary step, I first ran correlations between the indicator variables and the outcomes of interest The resu lts of select correlations are reported in Table 5 1 (Menstrual Attitudes Questionnaire subscales) Table 5 2 (ob jectific ation theory related scales), Table 5 3 (sexuality subscales), and Table 5 4 (gender subscales). I removed several subscales that did not yield any significant correlations (i.e., Female Sexual Subjectivity Inventory: pleasure from self, efficacy, and tota l scales; Collective Self Esteem: public and identity scales; Objectified body Consciousness: control scale; Sociocultural Attitudes Toward Appearance Questionnaire: athlete and pressure scales; Conformity to Feminine Norms Inventory 45: domesticity, modes ty, relational, romance, and niceness scales; the Neoliberal Beliefs Inventory; and the Interpersonal Sexual Objectification Scale). Hypothesis Testing Hypothesis 1. I predicted that, of those participants who engaged in menstrual suppression, the majority would do so short term by manipulating their own contraceptive regimens. As stated in the previous section, this hypothesis was supported: 75.1% of suppressors used s hort term methods as compared to 31.4% of suppressors who used long term methods.

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42 Hypothesis 2. I hypothesized that greater levels of self objectification would be related to higher levels of menstrual suppression. In order to test this relationship I ran a logistic regression with the outcome variable menstrual suppression (of any kind), predicted by the Objectified Body Consciousness Scale (total score) the Interpersonal Sexual Objectification Scale (total score), and the Sociocultural Attitudes Toward Appearance Questionnaire (total score) The model tested against a constant onl y model was statistically significant 2 = 9.749, p = .021, df = 3), but I rejected the model because the results were driven only by the Objectified Body Consciousness Scale, while the other scales were nonsignificant. Instead, a model using the Objectif ied Body Consciousness Scale as the only predictor was significant ( 2 = 6.732 p = .002 df = 8) The odds ratio of the statistic was e xp(B) = 1.592, indicating that for every unit increase in the Objectified Body Consciousness Scale, the odds of the outc ome occurring increase d by roughly one and a half times, or 159%. However, as indicated by the R statistic (.04) the model explained very little of the variance (4%). This was not entirely surprising, given that I was only testing using a single predictor. It is noteworthy that, upon further examination, the subscale driving this effect s eemed to be the surveillance scale. When the model was run with the subscales sep arated, the surveillance score was the only one to reach significance ( p = .001 ). Thus, a regression with this subscale as the only predictor ( 2 = 10.119, p = .001, df = 1) explains about 4.2% of the variance according to the R statistic (.04 2). For every unit increase in surveillance, the odds of suppression increased by 137% (exp(B) = 1.374).

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43 Hypothesis 3 I hypothesized that greater internalization of neoliberal beliefs would be related to higher levels of menstrual suppression. I again ra n a logistic regression with the outcome variable menstrual suppression (of any kind), but this time using the total Neoliberal Beliefs Inventory as a predictor. The model was not statistically significant ( 2 = 2 .034, p = .154, df = 1), indicating that neoliberal beliefs were not are not a good predictor for menstrual suppression. I investigated further by running a model using the four subscales of the Neoliberal Beliefs Inventory; however, none of the scales reached significance. Hypothesis 4. I hypothesized that different types of suppression (short term or long term) would reflect different motivations for suppression. Specifically, I suspected that long term suppression would be related to gendered predictors and short term sup pression would be related to sexual predictors. In order to test this hypothesis, I ran several logistic regression models. I first attempted to predict long term suppression with gendered predictors (collective self esteem and gender conformity); this mo del did not reach significance ( 2 = 4.125 p = .127 df = 2). However, a model of long term suppression predicted by collective self esteem alone was statistically significant ( 2 = 4.118 p = .042 df = 1). The odds ratio of the model was exp(B) = .665, indicating that for every unit increase in collective self esteem the odds of the outcome occurring decreased by 33.5%. However, as indicated by the R statistic (.031 ), the model explaine d very little of the variance (3 %). Thus, I decided to run a third model for long term suppression using the subscales of the Collective Self Esteem Scale that appeared most relevant according to the correlation matrix. This model, using the private self esteem and

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44 importance to identity sub scales, was statistically significant at the .039 level ( 2 = 6.464, df = 2). The odds ratios (exp(b) = .789 and exp(b) = .845, respectively) indicated relatively small changes per unit, but the R statistic (.048) was slightly improved, expla ining about 5%. I then moved to short term suppression. In this model, I used the five subscales of the Female Sexual Subjectivity Inventory as predictors. The model was statistically significant ( 2 = 12.921 p = .024 df = 5). Looking at the variables in dividually, the only subscale that reached statistical significance was the partner subscale (p = .006). In a model containing only this subscale ( 2 = 7.631 p = .006 df = 1) we see that for one unit increase in the predictor, the odds of short term men strual suppression increase by about two and a half times (exp(B) = 2.515). Again, as indicated by the R statistic (.06), the model explained little of the variance (6%).

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45 Table 5 1. Correlations between indicator variables and Menstrual Attitudes Questionnaire subscales. Variable Suppression (any) Suppression (long term) Suppression (short term) Future likelihood MAQ : debilitation .08 .02 .18* .10 MAQ : bothersome .05 .03 .02 .33** MAQ : natural .09 .01 .09 .33** MAQ : predictable .06 .10 .04 .04 MAQ : denial of symptoms .00 .09 .16* .06 p .01. ** p .001.

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46 Table 5 2. Correlations between indicator variables and select scales related to objectification theory. Variable Suppression (any) Suppression (long term) Suppression (short term) Future likelihood OBCS: surveillance .18** .05 .11 .18** OBCS: shame .08 .13 .14 .18** OBCS: total .17** .06 .11 .19** SATAQ 3: internalization .12* .01 .17* .13* SATAQ 3:information .12* .02 .06 .05 SATAQ 3: total .12* .04 .14 .09 p .01. ** p .001. Note: Sociocultural Attitudes Toward Appearance Questionnaire 3 is denoted here as

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47 Table 5 3 Correlations between indicator variables and select sexuality variables. Variable Suppression (any) Suppression (long term) Suppression (short term) Future likelihood FSSI: body esteem .00 .03 .16* .10 FSSI: entitlement to pleasure from partner .07 .05 .21** .07 FSSI: sexual self reflection .10 .07 .02 .13* Motivation: sensation .08 .04 .07 .15** Motivation: partner happiness .03 .18* .10 .03 Motivation: feeling attractive .03 .26** .00 .14* p .01. ** p .001. Note:

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48 Table 5 4. Correlations between indicator variables and select gender variables. Variable Suppression (any) Suppression (long term) Suppression (short term) Future likelihood CFNI: thinness .0 5 .00 .07 .1 2* CFNI: appearance .11* .06 .08 .1.7** CFNI: children .16** .02 .22** .21** CFNI: fidelity .0 8 .12 .0 1 .14** CSE: membership .11 .07 .00 .14* CSE: private self esteem .03 .16* .07 .02 CSE: total .07 .15* .05 .11* p .01. ** p .001. Note: The Conformity to Feminine Norms Inventory Collective Self

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49 CHAPTER 6 DISCUSSION Three out of four of my hypotheses were at least partially supported. I found that : more women engaged in short term, manual suppression rather than long term suppression ; objectification (specifically, body surveillance) partially predicted suppression; a nd different suppression types were associated with different factors (namely, long term suppression was partially predicted by private collective self esteem tied to womanhood and short term suppression was partially predicted by the dimension of sexual s their partners). Unfortunately, I found no support for my hypothesis that neoliberal beliefs would be associated with suppression. Limitations My study has several limitations the first and foremost of which is a lack of diversity. Though I had hoped that an online sample would provide more diversity than a convenience sample of college students, and though I did have a wide range of ages, most participants were White. This no generalizability; it also inadvertently contributes to a trend of feminist menstruation research as an area dominated by Whiteness. In terms of sexuality and gender identity I was unable to assess nuance in any meaningful way; in fact, as pointed out by one asexual participant, many of the measures assumed sexual activity or desire, heterosexual or otherwise. Transgender participants were similarly excluded from the study, because the measures often assessed feminine norms or iden tity. I specifically sought out a sample with experience using hormonal contraceptives, and despite the benefits of doing so, this may also be a limitation.

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50 Again, m y results are not generalizable; I cannot say what percentage of menstruators suppress, on ly what percentage of hormonal contraceptive using menstruators suppress. Additionally, although the nationality of participants did not appear t o complicate the results, it is certainly possible that a U.S. specific study would have yielded different find ings. Future Directions Now that I have shown that menstrual suppression is a widespread issue warranting study, I am hopeful that future researchers will expand on my methods. Efforts to bridge my limitations particularly in terms of racial sexual, and gender diversity would provide a fuller picture of the nuance at pla y in menstrual decision making. Future research should also work towards characterizing the middle ground that I h ave begun to explore here In a way, the low explanatory power of my re sults supports a model of menstrual suppression that is far more complex and multifaceted than those suggested by previous theoretical and empirical work. Thus, researchers can combine aspects of the two seemingly disparate theories described in Chapter 2 in order to explore agentic yet culturally situated motivations for menstrual suppression. As a beginning step, a mixed methods study co ntrasting with their qualitative descriptions of decision making processes may prov ide some enlightenment as to the breadth of a possible model. Contributions Although these r esults do not fully contextualize menstrual suppression, they represent several steps forward for the literature. First and foremost, the clear majority of women in my sample who favored short term suppression are relevant to future research about menstruation, contraceptives, and reproductive healthcare decisions.

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51 Limited research has assessed short term manipulation in the past (for example, see Lakehomer et al., 2013 ), but none have found high proportions of suppressors and most do not delineate between different types of suppression. Because I was able to access a targeted sample of women who had used hormona l contraceptives, I obtained a more accurate portrayal of menstrual suppression tendencies for t hose women who had access to the means, knowledge, and potential pressure to make the choice. Additionally, by clearly defining suppression and asking separatel y about suppression methods I allowed for more women to admit to skipping periods occasionally and casually. Thus, my study assessed the issue with a novel, multi pronged strategy while adding to the scant literature pointing to growing prevalence. Secondly, my findings indicate a link between self objectification and menstrual suppression. In 2003, psychologists failed to find any correlation between Objectif ied Body Consciousness or other self objectification mea s ures int erest in menstrual suppression ( Johnston Robledo et al., 2003 ) and in the inte rvening years this remained largely unchallenged My results reveal a potential for this link to be meaningful especially grows bu t more work must be done to establish a solid knowledge base. Though I attempted to measure the process of self objectification usi ng three separate measures, the I nterpersonal Sexual Objectification Scale was uncorrelated with any of my indicators and the Sociocultural Attitudes Toward s Appearance Questionnaire 3 did not contribute significantly to regression models. Only the Objectified Body Consciousness Scale predicted suppression, and within that scale only the body surveillance portion was particularly important. While I originally hypothesized that self objectification as a

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52 larger process would be more relevant, it makes sense that body surveillance would stand out as a predictor. Surveillance em phasizes the importance of appearance to the point of ignoring or disregarding its function; presumably, if one is vigilant about presentation but distanced from internal experiences, then menstruation could represent a nagging reminder of the messier, ugl ier side of gendered embodiment. Interestingly, Johnston Robledo and colleagues ( 2003 ) found correlations between surveillance and Though not strong evid ence for an objectification link (certainly many people would not miss their periods without having internalized objectifying menstrual rhetoric) it does speak to some kind of a consistent correlation across the years. Lastly, the associations between lo ng and short term suppression and individual subscales is intriguing. Because of the small effects and the lack of cross construct scale significance, the topic needs refinement before I can claim confident explanations. However, the findings imply that m y original hypotheses are based in some truth. If long term menstrual suppression is related to lower levels of collective self esteem, it stands to reason that the choice to suppress in a semi permanent way can function as an avenue for distancing oneself from womanhood. On the other hand, if short te rm/ manual suppression is related to the degree to which one feels entitled to sexual pleasure from a partner, it could be that occasional suppression is practiced in order to What remains is the question of feminist theory. Which scholars are correct? Are reproductive technologies a malleable feminist tool, or are they laden with cultural meanings and pressures that undermine consumer choice? Although my hypotheses

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53 leaned on the side of the latter, my find ings were so partial that I only feel it is correct to land somewhere in the middle. The measure of neoliberalism was not correlated with anything, and I found evidence for the importance of components of Objectification Theory and gender roles but not for constructs in their entirety. Additionally, because so little variance could be implicated, I do not have strong explanatory power. It seems likely that these societal forces matter, but they do not overwhelmingly dictate choice. I believe it is important to continue studying these themes so that feminist researchers and healthcare providers can make room for as much agency as possible in healthcare decision making. Still, simplistically define d as static and singular, as having only one authentic truth, there is 2016 p 322 ). Though feminists should make room for menstruators to make an informed c hoi ce about their nature, nature can be individual, constructed, and contested.

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54 APPENDIX A INFORMED CONSENT Informed Consent This study is being conducted by Alexandra Weis, a graduate student at the University of Florida, working with the research lab of Dr. Alyssa Zucker (Center for Gender, In this research study, we are interested in your behavior, beliefs, and attitudes related to contraceptives, menstruation, and menstrual regulation. We will also as k you to fill out questionnaires about your experience of gender and the social environment. This study will take about 20 minutes of your time and it will be conducted entirely online. You will be compensated about £2.00 (~$2.50) for your time. Your p articipation in this study will be confidential to the fullest extent provided by the law. No identifying information such as your name will be collected. Your Prolific ID will be used for only to compensate you for your work. It will not be shared with an yone outside the research team and will be deleted from the data after collection is complete. There is a minimal risk that security of any online data may be breached, but since (1) no identifying information will be collected, (2) both the crowdsourcin g website (Prolific Academic) and the survey host (Qualtrics) use several layers of encryption, and (3) your data will be removed from the server soon after you complete the study, it is highly unlikely that a security breach of the online data will result in any adverse consequence for you. Only the researchers will have access to your information on the Qualtrics server. Researchers will not have access to identifying information (such as your name and email address) that you have provided to Prolific Ac There are no anticipated risks or benefits associated with participation in this study. Participating in this study is volun tary and there is no penalty for not participating. You do not have to answer any question that you do not want to answer. You have the right to withdraw from the study at any time by closing the window. If you have questions about the study, you may con tact Alexandra Weis (a.weis@ufl.edu), Graduate Research Assistant in the Center for Gender, Who to contact about your rights as a research participant in the study IRB02 office, Box 112250, University of Florida, Gainesville, FL 32611 2250; phone 352 392 0433. By clicking the button below you are indicating that you have read the informed consent statements above and agree to participate.

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55 APPENDIX B BEHAVIOR QUESTIONNAIRE We a re interested in how you use birth control in your everyday life and whether it affects your menstrual cycle. As a result, we will ask you some questions in this section about your sexual behavior and your experiences using different kinds of contraceptive s. Choose the answer that applies to you best. BQ1 Do you currently use any of the following contraceptives? (Check all that apply) Birth control pills (1) Hormone shot (2) IUD (3) Arm Implant (4) Condoms (5) Other (6) ____________________ BQ2 Have you e ver used any of the following contraceptives? (Check all that apply) Birth control pills (1) Hormone shot (2) IUD (3) Arm implant (4) Condoms (5) Other (6) ____________________ BQ3 In an average month, about how many times do you have sexual contact with a partner? BQ4 On a scale of 1 to 10 (1 being no pain and 10 being extreme pain), how much pain do you typically experience during menstruation? ______ (1) BQ5 On a scale of 1 to 10 (1 being no symptoms and 10 being extreme symptoms), how much are you typically affected by PMS (for example, moodiness)? ______ (1) BQ6 On a scale of 1 to 10 (1 being no inconvenience and 10 being extreme your period? ______ (1) BQT2 using certain types of birth control to avoid having monthly bleeding.

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56 BQ7 Have you ever consulted with a doctor about suppressing your menstrual cycle? Yes (1) No (2) BQ7 Have y ou ever suppressed your menstrual cycle? Yes (1) No (2) Condition: No Is Selected. Skip To: If you have never suppressed your men.... BQ8 If you have suppressed your menstrual cycle, what method or methods did you use to do so? BQ9 Have you ever suppressed your menstruation long term (for example, by eliminating monthly periods with injections such as Depo Provera or reducing monthly periods to 4 per year with hormonal pill cycles such as Seasonale)? Yes (1) No (2) Display This Question: If Have you ever suppressed your menstruation long term (for example, by eliminating monthly periods with injections such as Depo Provera or reducing monthly periods to 4 per year with hormonal pill c... Yes Is Selected BQ10 How long did you supp ress your menstruation in this way? Less than six months (1) Six months to a year (2) One year to two years (3) Two years to three years (4) Longer than three years (5) ____________________ Did not suppress my cycle long term (6) Display This Question: If Have you ever suppressed your menstruation long term (for example, by eliminating monthly periods with injections such as Depo Provera or reducing monthly periods to 4 per year with hormonal pill c... Yes Is Selected BQ10 Why did you make the decision to suppress your periods? (Feel free to type as much as you need.) placebo week on your birth control pills in order to plan when your next period would be)? Yes (1) No (2)

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57 Display This Question: your b... Yes Is Selected Q251 How many times would you say you skipped your period in this way? One time (1) Two to four times (2) Five to seven times (3) Eight to ten times (4) More than ten times (5) ____________________ Did not skip my period on my own (6) Display This Question: your b... Yes Is Selected BQ12 What caused you to skip your period? (Feel free to type as much as you need.) future? Very unlikely (1) Somewhat unlikely (2) A little unlikely (3) A li ttle likely (4) Somewhat likely (5) Very likely (6) BQ14 BQ15 How safe do you think menstrual suppression is? Very unsafe (1) Somewhat unsafe (2) A little unsafe (3) A little safe (4) Somewhat safe (5) Very safe (6)

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58 LIST OF REFERENCES Andrist, L. C. (2008). The i mplications of o bjectification t heory for w h ealth: Menstrual s m aternal re c esarean d elivery. Health Care for Women International 29 (5), 551 565. doi: 10.1080/07399330801949616 Andrist, L. C., Arias, R. D., Nucatola, D., Kaunitz, A. M., Musselamn, B. L., Reiter, S., ward menstrual suppression with extended use of oral contraceptives. Contraception 70 (5), 359 363. doi: 10.1016/j.contraception.2004.06.008 Association of Reproductive Health Professionals. (2008a). Menstrual s uppression Retrieved from http://www.arhp.org/publications and resources/clinical fact sheets/menstrual suppression Association of Reproductive Health Professionals. (2008b). Understanding m enst rual s uppression Retrieved from http://www.arhp.org/uploadDocs/understandingmenstrualsuppression.pdf Bay Cheng, L. Y., Fitz, C., Alizaga, N. M., & Zucker, A. N. (2015). Tracking h omo o economicus: Development of the n eoliberal b eliefs i nventory. Journal of Social and Political Psychology, 3 (1), 71 88 doi: 10.5964/jspp.v3i1.366 Birth Control News. (n.d.). Seasonique Retrieved from http://birthcontrolnews.org/the pill/extended cycle pills/seasonique/ Bobel, C. (2008). From Convenience to Hazard: A Short History of the Emergence of the Menstrual Activ ism Movement, 1971 1992. Health Care for Women International 29 (7), 738 754. doi: 10.1080/07399330802188909 Bobel, C. (2010). New blood: Third wave feminism and the politics of menstruation New Brunswick, NJ: Rutgers University Press. Bockman, J. (2013). Neoliberalism. Understanding People in Their Social Worlds, 12 (3), 14 15. doi: 1 0.1177/1536504213499873 Brooks Gunn, J & Ruble, D. N. (1980). The menstrual attitude questionnaire. Psychosomatic Medicine 42 (5), 503 512. Chrisler, J. C. (2011). Leaks, l umps, and l ines: Stigma and w b odies. Psychology of Wo men Quarterly 35 (2), 202 214. d oi: 10.1177/0361684310397698 Chrisler, J. C., Gorman, J. A., Manion, J., Murgo, M., Barney, A., Adams Clark, A., McGrath, M. (2016). Queer periods: A ttitudes toward and experiences with menstruation in the masculine of centre and transgender community. Culture, Health, and Sexuality, 18 (11), 1238 1250. doi: 10.1080/13691058.2016.1182645

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59 Chrisler, J. C., Marvn M. L., Gorman, J. A., & Rossini, M. (2015). Body appreciation and attitudes toward menstruation. Body Image 12, 78 81. doi: 10.1016/j.bodyim.2014.10.003 Cosgrove, L. & Riddle, B. (2003). Constructions of Femininity and Experiences of Menstrual Distress. Women and Health, 38(3), 37 58. doi: 10.1300/J013v38n03_04 Coutinho, E. M. & Segal, S. J. (1999). Is menstruation obsolete? New York, NY: Oxford University Press. de Beauvoir, S. (1952). The second sex New York: Random House. Deuster, P. A., Powell Dunfo rd, N., Crago, M. S., & Cuda, A. S. (2011). Menstrual and o ral co ntraceptive u se p atterns a mong d eployed m ilitary w omen by r ace and e thnicity. Women and Health 51 (1), 41 54. doi: 10.1080/03630242.2011.540742 Doucleff, M. (2016, May 23). Do w omen n eed p eriods? Retrieved from http://www.npr.org/sections/health shots/2016/05/23/478562615/do women need periods Edelman, A., Lew, R., Cwiak, C., Nichols, M., & Jensen, J. (2007). Acceptability of contraceptive induced amenorrhea in a racially diverse group of US women. Contraception, 75 (6), 450 453. doi: 10.1016/j.contraception.2007.02.005 Edmiston, K. (2016) Transgender l abor and t ransgender k nowledge in a cade mic r esearch Retrieved from http://feministing.com/2016/08/02/transgender labor transgender knowledge in academic research/ Erchull M. J. (2013). Distancing t hrough o bjectification? Depictions of w b odies in m enstrual p roduct a dvertisements Sex Rol es 68 (1), 32 40. d oi: 10.1007/s11199 011 0004 7 Fahs, B. (2014, August 19). Two or three things I know for sure (about menstruati on) Retrieved from http://www.menstruationresearch.org/2014/08/19/two or three things i know for sure about menstruation/ Fahs, B. (201 of pleasure and disgust. Feminism and Psychology 21 (2), 155 178. d oi: 10.1177/0959353510396674 Fredrickson, B. L. & Roberts, T. A. (1997). Objectification t heory: Toward u nderstanding w l ived e xperiences and m ental h ealth r isks. Psychology of Women Quarterly 21 173 206. making in the medical field iberal framed healthcare system. Nursing Philosophy 16 (4), 226 238. doi: 10.1111/nup.12092

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60 Greenberg, J., Pyszczy nski, T. & Solomon, S. (1986). The causes and consequences of a need for self est eem: A terror management theory. In R.F. Baumeister (E d.), Pu blic Self and Private Self (p 189 212). New York, NY: Springer Verlag Grose, R. & Grabe, S. (2014). Sociocultural attitudes surrounding menstruation and alternative menstrual products: The explanatory role of self objectification. Health Care for Women International, 35, 677 694. doi: 10.1080/07399332.2014.888721 Gunson, J. S. (2016). Nature, menstrual suppression, and the value of material feminism. Health Sociology Review 25 (3), 312 325. doi: 10.1080/14461242.2016.1198982 Gunson, J. S. (2012). Menstru al suppression: The rhetoric and realities of choice. Outskirts: Feminisms Along the Edge, 27. Social Science & Medicine 71, 1324 1331. doi:10.1016/j.socscimed.2010.06.041 menstruation. Gender and Society, 30 (6), 958 983. doi: 10.1177/0891243216672662 Hasson, K. A. (2012). From bodie s to lives, complainers to consumers: Measuring menstrual excess. Social Science and Medicine, 75 (10), 1729 1736. doi: 10.1016/j.socscimed.2012.07.005 R. J. (1998). Developing a scale to measure the diversity of feminist attitudes. Psychology of Women Quarterly 22 317 348. doi: 10.1111/j.1471 6402.1998.tb00158.x Horne, S. & Zimmer Gembeck, M. J. (2006). The f emale s exual s ubjectivity i nventory: Devel opment and v alidation of a m ultidimensional i nventory for l ate a dolescents and e merging a dults. Psychology of Women Quarterly, 30 (2), 125 138. d oi: 10.1111/j.1471 6402.2006.00276.x Jacobson, J. C., Likis, F. E., & Murphy, P. A. (2012). Extended and contin uous combined contraceptive regimens for menstrual suppression. Journal of Health 57 (6), 585 592. doi : 10.1111/j.1542 2011.2012.00250.x Jenkins, S. S. (2003). Gender and Self Dete rmination in Sexual Motivation (Doctoral dissertation ). Retrieved from ProQuest Dissertations and Theses database (UMI No. 311492 8 ). Jones, J., Mosher, W., & Daniels, K. (2012). Current c ontraceptive u se in the U nited States, 2006 2010, and c hanges in p atterns of u se s ince 1995. National Health Statistics R eports 60 1 26.

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61 Johnston Robledo, I., Ball, M., Lauta, K., & Zekoll, A. (2003). To b leed or n ot to b leed: Young w a ttitudes t oward m enstrual s uppression. Women & Health 38 ( 3), 59 75. doi : 10.1300/J013v38n03_05 Johnston Rob ledo, I. & Chrisler, J. C. (2013 ). The m enstrual m ark: Menstruation as s ocial s tigma. Sex Roles 68 (1), 9 18. d oi: 10.1007/s11199 011 0052 z Johnston Robledo, I., Sheffield, K., Voigt, J.,& W ilcox Costantine, J. (2007). Repro ductive shame: Self objectification and young attitudes toward their bodies. Women and Health, 46 25 39 doi: 10.1300/J013v46n01_03 Kanj, R. V., Conard, L. A. E., & Trotman, G. E. (2016). Menstrual s uppression and c ontraceptive c hoices in a t ransgender a dolescent and y oung a dult p opulation. Journal of Pediatric and Adolescent Gynecology 29 (2), 201 202. doi: 10.1016/j.jpag.2016.01.100 Kissling, E. A. (2013). Pills, periods, and postfeminism. Feminist Media Studies, 13 (3), 490 504. doi: 10.1080/14680777.2012.712373 Kozee, H. B., Tylka, T. L., Augustus Horvath, C. L., & Denchik, A. (2007). Development and p sychometric e valuation of the i nterpersonal s exual o bjectification s cale. Psychology of Women Quarterly 31 (2), 176 189. doi: 1 0.1111/j.1471 6402.2007.00351.x LaFata, A. (2014, September 30). Ladies, h w hat r eally h appens w hen y ou u se b irth c ontrol to s kip y our p eriod Retrieved from http://elitedaily.com/women/what really happens with you purposely skip your period on birth control/777489/ Lakehomer, H., Kaplan, P. F., Wozniak, D. G., & Minson, C. T. (2013). Characteristics of scheduled bleeding manipulation with combined hormonal co ntraception in university students. Contraception 88 (3), 426 430. doi: 10.1016/j.contraception.2012.12.012 Luhtanen, R. & Crocker, J. (1992). Collective s elf e steem s cale: Self e valuation of o s ocial i dentity. Personality and Social Psychology Bulleti n 18 (3), 302 318. doi: 10.1177/0146167292183006 Marcovitch, H. (2010). Withdrawal bleeding. In (42nd ed.) London, England: A & C Black. Mc Kinley, N. M. & Hyde, J. S. (1996). The objectified body consciousness scale development and validation. Psychology of Women Quarterly 20 (2), 181 215. doi: 10.1111/j.1471 6402.1996.tb00467.x MLCip. (2009, May 1). ercial [Video file]. Retrieved from https://www.youtube.com/watch?v=6xsnKcNgZW8

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62 Mendoza, N., Lobo, P., Lertxundi, R., Correa, M., Gonzalez, E., Salamanca, A., & Snche Borrego, R. (2014). Extende d regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone free interval: A systematic review of randomised and observational studies. The European Society of Contraception and Reproductive Health Care 19 321 339. doi: 10.3109/13625187.2014.927423 Moradi, B. (2010). Addressing gender and cultural diversity in body image: Objectification theory as a framework for integrating theories and grounding research. Sex Roles, 63 138 148. doi: 10.1007/s11199 010 9824 0 Morris, S. (2015, November 18). Germaine Greer gives university lecture despite campaign to silence her Retrieved from https://www.theguardian.com/books/2015/nov/18/transgender activists protest germaine greer lecture cardiff university?CMP=share_btn_tw Morrison, L. A., Larkspur, L., Calibuso, M. J., & Brown, S. (2010). a tt itudes a bout m enstruation and a ssociated h ealth and b ehavioral c haracteristics. American Journal of Health Behavior, 34 (1), 90 100. National Institute of Child Health and Human Development. (n.d.). What are the treatments for endometriosis? Retrieved from https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/Pages/treatment. aspx Oudshoorn, N. (1994). Beyond the n atural b ody: An a rchaeology of s ex h ormones. London, England: Routledge. Parent, M. C. & Moradi, B. (2010). Confirmatory f actor a nalysis of the c onformity to f eminine n orms i nventory and d evelopment of an a bbreviated v ersion: The CFNI 45. Psychology of Women Quarterly 34 (1), 97 109. doi: 10.1111/j.1471 6402.2009.01545.x Planned Parenthood. (n.d.). How d o I u se t he b irth c ontrol p ill? Retrieved from https://www.plannedparenthood.org/learn/birth control/birth control pill/how do i use the birth control pill?_ga=1.178665126.34387870.1486275918 perceptions and experiences of menstrual suppression. Sex Roles, 68 91 106. doi: 10.1007/s11199 011 0038 x Roberts, T. A., Goldenberg, J. L., Power, C., & Pyszczynski, T. (2002). p e ffects of m enstruation on a ttitudes t owards w omen. Psychology of Women Quarterly 26 131 139. Roberts, T. A. & Waters, P. L. (200 4 ). S elf o bjectification and t n ot s o f resh f Women & Therapy 27 (3 4), 5 21. doi: 10.1300/J015v27n03_02

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63 Saletan, W. (2007, May 27). Period. The e nd? Retrieved from http://www.washingtonpost.com/wp dyn/content/article/2007/05/25/AR2007052502020.html Schooler, D., Ward, L. M., Merriwether, A., Caruthers A. S. (2005). Cycles of s hame: Menstrual s hame, b ody s hame, and s exual d ecision m aking. The Journal of Sex Research 42 (4), 324 334. doi: 10.1080/00224490509552288 Smolak, L. & Murnen, S. K. (2011). The sexualization of girls and women as a primary antec edent of self objectification. In R. M. Calogero, S. Tantleff Dunn, & K. J.Thompson (Eds.), Self objectification in women: Causes, consequences, and counteractions (p. 53 75). Washington, DC: American Psychological Association. Steger, M. B. & Roy, R. K. ( 2010 ). Neoliberalism: A v ery s hort i ntroduction Oxford, New York: Oxford University Press. The Society for Menstrual Cycle Research. (2011 ). The m enstrual c ycle: A f eminist l ifespan p erspective. Retrieved from https://www.socwomen.org/wp content/uploads/2010/05/fact_4 2011 menstruation.pdf The Society for Menstrual Cycle Research. (2007). Society for Menstrual Cycle R esearch c alls for m ore r esearch on l ong t erm e ffects of c ycle s topping c ontraceptives: Menstruation is n ot a d isease Retrieved from http://menstruationrese arch.org/wp content/uploads/2009/07/SMCRposition06082007.pdf Thompson, J. K., van den Berg, P., Roehrig, M., Guarda, A. S., & Heinberg, L. J. (2004). The s ociocultural a ttitudes t owards a ppearance s cale 3 (SATAQ 3): Development and v alidation. Internation al Journal of Eating Disorders 35 (3), 293 304. doi : 10.1002/eat.10257 Vasquez, T. (2016, May 20). transgender women. Retrieved from https://bitchmedia.org/article/its time end long history feminism failing transgender women Wajcman, J. (2007). From w omen and t echnology to g endered t echnoscience. Information, Communication and Society, 10 (3), 287 298. doi: 10.1080/13691180701409770 The Well Timed Period. ( 2007, July 28). Seasonique TV ad Retrieved from http://thewelltimedperiod.blogspot.com/2007/07/seasonique tv ad.html Woods, C. S. (2013). Repunctuated f eminism: Marketing m enstrual s uppression t hrough the r hetoric of c hoice. Communication 36 267 287. doi : 10.1080/07491409.2013.829791

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64 BIOGRAPHICAL SKETCH Alexandra Weis will receive her Master of Arts in Center for at the University of Florida in 2017. She will move on to pursue a Ph D in the field of psychology, where she hopes to continue integrating feminist thought with social science practice.