Menstrual extraction

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Menstrual extraction
Abortion type Surgical
First use 1971
Gestation First trimester
Developed and often used in lay setting.
Infobox references

Menstrual extraction is a form of vacuum aspiration, used to empty the uterus. In contrast to other forms of vacuum aspiration, it has been used as a way to pass the entire menses at once, and has had a social role as a way to have access to early abortion without needing medical assistance or legal approval.[1][2][3][4][5] In some countries where abortion is illegal, such as Bangladesh, “menstrual regulation” or “menstrual extraction” are used as euphemisms for early pregnancy terminations.

Early development[edit]

The Del Em

In 1971, a member of a feminist reproductive health self-help group, Lorraine Rothman, modified equipment found in an underground abortion clinic that was developed for a new non-traumatic, manually-operated-suction abortion technique. Rothman took the thin, flexible plastic Karman cannula (about the size of a soda straw), and the syringe (50 or 60ml), and added a one-way bypass valve, to fix two main problems.[1] The contraption could prevent air from being pumped into the uterus, and also suctioned uterine contents directly into the syringe, thus limiting the amount that could be removed. Rothman's and Downer's group dubbed the new invention the "Del Em." Rothman added two lengths of clear plastic tubing, one from the cannula to the collection jar and another to go from the collection jar to the syringe. With this new set-up, the contents of the uterus went directly into the jar, allowing for the extraction of more material, and the two-way bypass valve diverted any air that may have been inadvertently pushed back toward the body to exit harmlessly into the air; this would prevent air from entering the uterus.[1] By making it possible for more than one person to operate the device, the skill level of the operators was greatly reduced. One person could concentrate on guiding the sterile cannula through the vaginal cavity into the cervical os while another could pump the syringe to develop the vacuum. The Del Em made the procedure more comfortable, with personal control of the suction.[6]

Downer's and Rothman's group, the Feminist Women's Health Center, called their new technique "menstrual extraction" or "ME", downplaying its potential use as a safe way to perform abortions (which were then illegal in most states), and emphasizing its innocuous use in suctioning out menstrual blood and tissue. It made its debut at the National Organization for Women conference in Santa Monica, California in August 1971. However, to their dismay they were not allowed to have a booth due to the "concept being too shocking."[1] Instead, they hung flyers around the conference, announcing a demonstration in their hotel room. The attendees were given a plastic speculum to begin their education. From the extensive mailing list collected during these demonstrations, Downer and Rothman began a national tour, going all over the country (to 23 cities on a Greyhound bus) teaching the new technique.[1][7][8] According to the National Women's Health Network, "the early self-helpers advocated that women join self-help groups and practice extracting each others' menses around the time of their expected periods."

After legalization of abortion[edit]

The Roe v. Wade Supreme Court decision made abortion legal in 1973. After that, menstrual extraction was practiced much less, though it did not disappear. It did begin to regain in popularity in the late 1980s and early 1990s, when the U.S. Supreme Court ruled on Webster v. Reproductive Health Services, which limited access to abortion by state of residence and type of medical insurance. Self-helpers even reprised the 1971 tour, travelling around the U.S. sharing self-examination and menstrual extraction techniques; however it never reached the heights of the early 1970s.[9]


Since 1971, groups performing menstrual extractions have had an excellent safety record, obviating any opportunity for legal action culminating in the prosecution of any individual. However, the possibility of legal troubles continues to exist, and because of that many of these 'self-help' groups have sought legal advice and researched the laws in the states in which they perform ME. Additionally, many of these 'self-help' groups do not publicize themselves or offer menstrual extraction to those outside of their tight-knit groups, in order to protect themselves and their techniques from legal investigations.[10]

There is one instance in which Carol Downer, one of the co-developers of ME, had legal entanglements. It is well known as the "Yogurt Defense" case, in which Downer was arrested while at her self-help group and charged with practicing medicine without a license because she inserted yogurt into the vagina of another member of the group as treatment for a yeast condition. Downer went to trial and was acquitted, as the jury did not see inserting yogurt as practicing medicine.[10][11]

Outside the United States[edit]

Around the same time that menstrual extraction was first used in the United States, a method utilizing nearly identical technology was beginning to be used internationally. This method, another type of Manual Vacuum Aspiration, is most often called Menstrual Regulation. As with ME, menstrual regulation, when desired as a method of controlling fertility, is performed very early in the menstrual cycle, earlier than a pregnancy test can be performed. One main difference between these two methods is the equipment used. While the Del Em was created such that one is able to put it together from individual pieces and it consists of three parts: the cannula with a one-way valve, a collection jar and the syringe, which are connected by plastic tubing; Menstrual Regulation is performed with a commercially produced kit which consists of two parts, the cannula with a one-way valve and a directly connected syringe. With this kit, the contents of the uterus are sucked directly into the syringe. ME is performed by a group; Menstrual Regulation is performed by an individual practitioner.[10][12]

According to the National Abortion Federation, "in the developing world, menstrual regulation is still a crucial strategy to circumvent anti-abortion laws." Although abortion is illegal in Bangladesh, the government has long supported a network of Menstrual Regulation clinics.[13][14] It is estimated that 468,000 menstrual regulations are performed each year in Bangladesh.[15] NAF also reports "some other countries allow menstrual regulation because it presumably takes place without a technical verification of pregnancy".[16] Said countries are claimed to include Korea, Singapore, Hong Kong, Thailand, and Vietnam.[17] In Cuba, where abortion is legal, menstrual regulation is widely practiced— menstrual extraction is offered to everyone whose period is two weeks late, without a pregnancy test.[18]


  • Rebecca Chalker and Carol Downer (1996). A Woman's Book of Choices: Abortion, Menstrual Extraction, RU-486. Seven Stories Press. ISBN 1-888363-28-2. 
  • "Unofficial Abortion". Time Magazine. September 11, 1972. 
  • Emin-Tunc, Tanfer (Summer 2004). "Into Our Own Hands: The Women's Health Movement in the United States, 1969-1990". NWSA Journal, Indiana University Press. 16 (2): 237–239. doi:10.1353/nwsa.2004.0052. 
  • "No Going Back" (1988) Federation of Feminist Women's Health Centers - Video which presents menstrual extraction as an abortion method that can be used by women in self-help health groups.
  • Ninia Baehr (1990). Abortion without Apology: A Radical History for the 1990s. Boston: South End Press. p. 21. 


  1. ^ a b c d e Chalker, Rebecca, and Carol Downer. A Woman's Book of Choices, Abortion, Menstrual Extraction, RU-486. 1st ed. New York: Four Walls Eight Windows, 1992.
  2. ^ Boston Women's Health Book Collective.(1992)."The New Our Bodies, Ourselves,"New York:Simon and Schuster Inc.p.406
  3. ^ Federation of Feminist Women's Health Centers.(1981)."A New View of a Woman's Body,"New York:Simon and Schuster.p.121-127
  4. ^ Federation of Feminist Women's Health Centers.(1981)."How to Stay Out of the Gynecologist's Office,"Hollywood:Women to Women Publications.p.3,43
  5. ^ Sage-Femme Collective.(2008)."Natural Liberty Discovering Self-Induced Abortion Methods,"Las Vegas, Nevada:Sage Femme!p.30,63-77
  6. ^ Rebecca Chalker (1993). "The Whats, Whys, and Hows of Menstrual Extraction" (PDF). On the Issues. 
  7. ^ Davis, Flora.(1991)."Moving the Mountain The Women's Movement in America since 1960, "New York: Simon Schuster. p. 233
  8. ^ Morgen, Sandra.(2002)."Into Our Hands The Women's Health Movement in the United States, 1969-1990,"New Brunswick, New Jersey, and London:Rutgers University Press.p.8
  9. ^ Pearson, Cindy. "Self Help Clinic Celebrates 25 Years." Network News March/April 1996
  10. ^ a b c Chalker, Rebecca, and Carol Downer. A Woman's Book of Choices, Abortion, Menstrual Extraction, RU-486. 1st ed. New York: Four Walls Eight Windows, 1992.
  11. ^ Ruzek, Sheryl Burt.(1978)."The Women's Health Movement Feminist Alternatives to Medical Control,"New York:Praeger Publishers.p.57
  12. ^ Ruzek, Sheryl Burt.(1978)."The Women's Health Movement Feminist Alternatives to Medical Control,"New York:Praeger Publishers.p.169
  13. ^ Bergum, SE (1993). "Saving lives with menstrual regulation". Plan Parent Chall, International Planned Parenthood Newsletter (1): 30–1. PMID 12345324. 
  14. ^ Amin, R; et al. (1988). "Menstrual regulation in Bangladesh: an evaluation of training and service programs". International Journal of Gynecology & Obstetrics. 27 (2): 265–71. doi:10.1016/0020-7292(88)90018-5. PMID 2903095. 
  15. ^ "Incidence of Abortion Worldwide". International Family Planning Perspectives, Guttmacher Institute. 1999. Retrieved 2006-09-17. 
  16. ^ C Joffe (1999). "Abortion in Historical Perspective". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG. A Clinician's Guide to Medical and Surgical Abortion (Reprint by National Abortion Federation). Philadelphia: Churchill Livingstone. 
  17. ^ "Abortion for All: How the International Planned Parenthood Federation promotes abortion around the world - IPPF's Illegal Activities". 2000. 
  18. ^ Hans Veeken (1995). "Cuba: plenty of care, few condoms, no corruption". BMJ. 311 (7010): 935–7. doi:10.1136/bmj.311.7010.935. PMC 2550926Freely accessible. PMID 7580557. Retrieved 2006-09-17.