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Doody's Review ServiceReviewer: Raymond W. Ke, MD (University of Tennessee at Memphis College of Medicine)
Description: This book, which is essentially an essay, argues that regular monthly menses is not a natural state in women and that it actually places them at risk for disease. The authors construct their arguments by first reviewing a historical frame of reference for menstruation, then providing evidence linking menstruation to disease. The suppression of menstruation, both naturally and medically is discussed next, followed by possible criticisms of the arguments.
Purpose: The authors are vigorous in their arguments supporting suppression of menstruation as a means of lowering medical risk. It is clear that they believe strongly in the notion that regular menstruation is outdated and harmful. They admit that their position may invite a feminist and political outcry, but also use the same means to further their argument, suggesting that incessant ovulation is a conspiracy by the medical and pharmaceutical industry to preserve the status quo.
Audience: This book is written squarely for the lay public. It is primarily directed at women of reproductive age to take a critical look at their own menstrual patterns. Dr. Coutinho is a gynecologist who pioneered the use of an injectable contraceptive in his home country of Brazil. Dr. Sheldon Segal assisted Dr. Coutinho in the translation of the original Portuguese manuscript.
Features: This book takes readers through complex medical issues in an easily readable and organized style. Language appropriate for the audience is used, and tantalizing anecdotes such as one regarding Marilyn Monroe, in order to maintain the reader's interest, is inserted. However, much of the book is repetitive and tiresome in how it uses the same few facts to buttress the authors' arguments. It is not altogether balanced and makes liberal assumptions regarding certain studies to support the authors' argument. For instance, the citation that gymnasts have higher bone density than non-athletes who menstruate regularly fails to address the fact that most gymnasts do menstruate regularly. However, of the ones who stop menstruating, bone density does decline. The book is interspersed with facts that are, in certain instances, highly circumstantial and, in others, plainly wrong. To his credit, the authors do provide useful and understandable information regarding menstruation and its associated diseases. They also address some possible arguments with their position, although he will often use ridicule rather than debate when discussing positions counter to theirs. They are careful to remind all patients to discuss their individual cases with their physicians before initiating any therapy.
Assessment: If one reviews this book from a lay perspective, then it does serve a useful purpose in providing meaningful information about a subject that is extremely common and highly ignored. However, the authors' assertion that incessant menstruation is harmful and, furthermore, the medical suppression of such menstruation will be beneficial, requires a huge leap in faith. Although many physicians have used the techniques proposed for many pathologic conditions, long-term use in normally menstruating women as a means of lowering future disease risk is clearly unproven. In that light, a book that argues for these techniques directly to the public without any supporting evidence is irresponsible.