Reframing the significance of menstruation: evolutionary insights from an organismal-relational perspective.

Cultural stigma and medical pathologization have long shaped scientific and social perceptions of menstruation, limiting both research and clinical attention. This paper outlines three major sources of negative perceptions and examines their influence on scientific discourse and cultural attitudes. To counter these biases and misconceptions, evolutionary accounts of menstruation are explored, which emphasize its crucial role in human physiology and reproduction. Two evolutionary approaches to adaptation are compared: one adopts a functionalist stance that assigns specific functions to traits. While this perspective offers a naturalized and positive understanding of menstruation, it remains insufficient to capture the phenomenon's full complexity. In response, the paper draws on a second approach, organismal and relational, which emphasizes whole-organism adaptation within developmental and ecological contexts. This contrast is also reflected in evolutionary medicine, where organismal approaches support integrative views of disease patterns. Revisiting late 20th-century debates on whether menstruation is adaptive or a byproduct, the paper presents key elements of the alternative organismal-relational perspective. This framework makes it possible to distinguish three broad categories of menstrual pathologies and supports the claim that organismal evolutionary perspectives offer a richer understanding of menstrual health.