Menstrual Health Stigma in the United States: Communication Complexities and Implications for Theory and Practice

Abstract

Menstruation is a biological marker of health and wellness. In industrialized regions of the world, the average age of menarche is about 12 years, 1 and across the life span, people who menstruate can expect to have up to 400 menstrual cycles, or periods. Not all people who identify as women menstruate, and not all menstruating people identify as women. People who menstruate include cisgender women and girls, transgender people, and nonbinary people. A typical menstrual cycle is about 21 to 34 days, with menstrual bleeding lasting up to 7 days. 1 Menstruation can be accompanied by a myriad of benign symptoms, such as irritability, breast pain, abdominal bloating, fatigue, or general cramping as the uterus contracts to expel endometrial lining. 2 However, upward of 1 in 4 people who menstruate experience irregular menstrual cycles, abnormal menstrual bleeding, and/or other menstrual health problems such as severe pain. 3 Globally, menstrual health and hygiene is a forefront topic; it is one of the 5 interlinked priorities for empowering adolescent girls of the United Nations International Children's Emergency Fund 4 and is central to achieving several of the United Nations Sustainable Development Goals. 5 In the United States, the American College of Nurse-Midwives states that a hallmark of midwifery is characterized by "recognition, promotion, and advocacy of menarche … as normal physiologic and developmental processes," 6 promoting menstruation and menstrual care as basic principles of health. In addition, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both acknowledge the importance of understanding and discussing normal and abnormal menstruation patterns with patients, and both organizations suggest charting patient menstrual

Examining menstrual health experiences in Philadelphia, PA: A qualitative investigation

“… 4 , 27 One way of combatting this stigma is to recognize the physical, emotional, and economic barriers that menstruation pose, that impact an individual’s ability to function within society. 28 , 29 Moreover, participants grouped menstrual management tactics into ways of coping with bleeding and tending to systemic symptoms. Participants used both traditional and non-traditional menstrual products, pads, and tampons and rags, towels, and cloth, to manage their bleeding.…”

“…Community-based resources, which serve as hubs of information sharing, also often have a role in disseminating tangible menstrual management resources, such as pads and tampons. 28 Meanwhile, self-teaching has the added benefit of anonymity which could be a highly desirable quality for this population for whom menstrual stigma is high. 30 Participants stated they felt misunderstood, judged, or given incorrect information when speaking to their medical team, subsequently causing low utilization and avoidance of these services.…”

Discussing menstrual health in family medicine

“…Despite more than half of the population being people who menstruate, stigma, lack of conversation and pressing social needs around menstrual health persists throughout medicine. 1 Discussions around menstruation and menstrual management can be difficult for individuals, whether it is with friends or family, or in the healthcare setting. 1 Patients who have never discussed menstruation with a clinician may not know what is healthy, assume that an abnormal experience is normal and may endure periods that negatively affect their life, career or well-being.…”

“…1 Discussions around menstruation and menstrual management can be difficult for individuals, whether it is with friends or family, or in the healthcare setting. 1 Patients who have never discussed menstruation with a clinician may not know what is healthy, assume that an abnormal experience is normal and may endure periods that negatively affect their life, career or well-being. [2][3][4][5] Menstruation plays a vital role in overall well-being and contributes significantly to an individual's quality of life.…”

“…6 Patients can feel more in control of their bodies by understanding their menstrual cycle and its full-body impacts overall. 1…”