As I have observed in my article "Psychosomatic and Symbolic Aspects of Menstruation", the way women experience the menstrual bleeding is one of the many parameters by which we can evaluate their pattern of relationship with the female nature. Considering the powerful archetypal symbolism of blood, we can easily deduce that, for women, the constant experience of this cyclical uterine bleeding which is menstruation greatly increases their capacity of deeply experiencing the organic and visceral processes typical of the female nature, especially those related to their sexual organs and the intimacy of their pelvis.

Given the enormous emotional and archetypal importance of the genitals, bleedings originating from these organs, even physiological, as menstruation, finish by acquiring a very special symbolism. Several fantasies associating blood and sexuality may arise. In this way, through the symbolism of menstruation women can somatically express many of their psycho-sexual and emotional problems. Through the psychosomatic pathways, innumerable conflicts related to women's nature can be directly or indirectly projected on the body, originating the more varied menstrual alterations. On the other hand, through the somatopsychic pathways, menstrual dysfunctions can give rise to several psychological conflicts regarding this aspect of female nature. Therefore, the menstrual bleeding is always endowed with a very powerful symbolic force.

In some cases, excessive and/or prolonged menstrual bleedings ( hypermenorrhea or menorrhagia ) caused by functional disorders in the intricate mechanisms of the hypothalamus-pituitary-ovaries axis, may also be a way of expressing a "wounded" femininity, which metaphorically "vanishes and fades away in blood" through the genitals. From the psychosomatic point of view, intense menstrual cramps ( dysmenorrhea ), often physically caused by an increased production of prostaglandins in the premenstrual and menstrual endometrium, are regarded by some authors as a possible rejection of menstruation and/or even to the female nature itself. In cases of serious conflicts concerning femininity, the menstrual bleeding itself can be experienced as a "hardship", a "trial" inherent to woman's nature.

Possibly the recent proposal of artificially supressing the menses through the uninterrupted use of hormones became highly widespread just due to this old feelings of rejection caused by menstruation, now regrettably reinforced by those who defend the hormonal menstrual suppression even by reasons of minor medical importance.

On the other hand - though this will bother many feminists -, H.-J. Prill has mentioned that, according to Helene Deutsch, a supposed ( and always arguable ) "fundamentally masochist" psychological structure of women also would contribute to the development of pathological ways of experiencing menstruation. Thus, many times the unhealthy symbolism of the menstrual bleeding would be reinforced by stimulating masochist fantasies ( H.-J. Prill - "Ginecologia Psicosomatica" -, Editorial Alhambra, Madrid, 1966 ).

Regardless of all of this, we know quite well that the establishment of such pathological ways of experiencing this cyclical uterine bleeding which is menstruation also happens as a consequence of the old prejudices and misconceptions regarding this event of female physiology and nature - many of which, unfortunately, have not been entirely eradicated yet. Nevertheless, I want to emphasize that innumerable psychological mechanisms can be and are involved in menstrual disorders as well as in any other gynecologic problem. Moreover, in the area of Psychosomatic Medicine everything happens according to highly individual patterns, and we must never forget that each person is one person - and, obviously, in Gynecology each woman is one woman.

As I have observed in my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology"), the very specific aspects of all psychosomatic projections depend on individual predispositions for determined disturbances and on the meaning of the somatizations within the whole personality and life of each woman. In this way, I want to make it clear that the psychosomatic "mechanisms" mentioned here are nothing more than generalizations regarding only some of the many possible situations.

Menstruation has always been surrounded by a rich mythology, characterized not only by aspects regarded as positive, but also as negative. As I always emphasize, this periodic uterine bleeding is an important archetypal symbol of women's nature, and its regular occurrence is the more evident external sign of the cyclical feature that characterizes female physiology. The coming of menstruation indicates both the end of a cycle that terminates and the beginning of a new one. Menarche, which occurs in the middle of the puberal changes through which the girl's body acquires the features of the adult woman, is usually endowed with a very special symbolic meaning. Conversely, in a way menopause symbolizes the decline of femininity at the somatic level ( though many women will disagree about that ).

Unfortunately, there are also the old prejudices and misconceptions about the menstrual flow, often associating it with something "impure" or "dangerous" that, for this reason, should be eliminated and expelled from the body. At a conscious level, for the modern and educated women these misconceptions are already mostly outmoded. Even so, some "remnants" of them can still remain acting unconsciously, aggravating and even originating several cases of premenstrual syndrome and dysmenorrhea. Probably even the old idea of an "impurity" or "toxicity" intrinsic to the menstrual blood and content was reinforced by the physical discomforts that often precede and accompany the menses.

The often intricate and problematic group of signs and symptoms that characterize the premenstrual syndrome and dysmenorrhea results, in turn, from physiological alterations in women's bodies that, through the somatopsychic pathways, can stimulate the emergence of negative archetypal contents regarding this cyclical uterine bleeding. It is also possible that, in ancient times, the predominantly "obscure" view of menstruation had originated exactly from these physiological premenstrual and menstrual symptoms allied to the powerful symbolic psychological meaning of this genital bleeding.

In mythologic and esoteric literature many references can be found to "powerful magic forces" attributed to menstruating women, characterized both by positive and negative aspects. Nevertheless, it is fundamental to remark that whenever we analyze this sort of material, we must be fully aware that, in this field, concepts and ideas are presented through an essentially symbolic language, and that, according to Jungian psychology, it is mostly through symbolism that the archetypal contents of the collective psyche become evident.

From the standpoint of Archetypal Psychology, in the positive aspects of the old menstrual myths we can verify an association between the magical meaning of women as sources of life, symbols of Eros and fertility, and the magical meaning of blood as vital fluid. In the specific case of menstruation, blood flows exactly from the female genitals, situated in the depth of the woman's belly. The innumerable fantasies that were always created about the female sexual organs reinforce this symbolism of the menstrual bleeding.

As to the negative aspects of the old menstrual myths, I have already observed that they possibly had originated from the widely known signs and symptoms that often precede and go along with the menses, and that include emotional alterations and even changes in the behaviour ( the psychical manifestations of the premenstrual syndrome ). We also must observe that, in the past, the association of the usually "traumatic" symbolism of blood losses in general with the physical discomforts that often accompany menstruation must also have contributed considerably to making this event of female physiology acquire unfavourable connotations.

The possible cause for the development of all menstrual mythology - not only in its positive but also negative aspects - was the result of the association between the mystery and the fascination of women, the fantasies about the female genitals, the symbolism of blood and blood losses, and the signs and symptoms of the premenstrual syndrome and dysmenorrhea.

Note.: See also my aforementioned "Psychosomatic and Symbolic Aspects of Menstruation".

Nelson Soucasaux is a gynecologist dedicated to Clinical, Preventive and Psychosomatic Gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993.

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Email: nelsons@nelsonginecologia.med.br