"My mama told me it would happen": menarche and menstruation experiences across generations

"It shouldn't be just hush-hush": A qualitative community-based study of menstrual health communication among women in Philadelphia

INTRODUCTION

Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

METHODOLOGY

In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory-driven approached based on the social-ecological model was used to analyze the data.

RESULTS

Varying emotional responses arose across social-ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma.

DISCUSSION

Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community-based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non-binary individuals who menstruate.

Menarcheal experience, beliefs about and attitudes toward menstruation in Mexico: Changes in the last 20 years

We explored how menarcheal experiences and attitudes toward menstruation of Mexican adolescents have changed in the last 20 years. Two questionnaires were applied to female adolescent students, and the results were compared with those obtained in 2002-3 when adolescents of the same ages were surveyed using the same questionnaires. Although some aspects of menstrual education have not changed, the secrecy surrounding menstruation has diminished. In contrast, the belief that menstruation is disabling and keeps women from their normal activities has increased. It is important that adolescents receive adequate preparation about psychosocial and physical aspects of the menstrual cycle.

"In our community, we normalize pain": discussions around menstruation and uterine fibroids with Black women and Latinas

BACKGROUND

Uterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment.

METHODS

Community engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis.

RESULTS

Participants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids.

CONCLUSION

Despite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.

"Make Sure You Wash Your Monkey": Multigenerational Vaginal Hygiene Messages from Black Women

In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women (n = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.

The Experience of Menarche for Young People With Sensory and Motor Impairments: A Systematic Review

Young people with disabilities may face barriers to optimal management of menstrual health, including the management of menarche, a unique stage of development. This systematic review examined the barriers to and facilitators of a positive experience of menarche for young people with visual, hearing, or mobility impairments. The MEDLINE, Embase, PsychINFO bibliographic databases, and grey literature were systematically searched in February 2022 to identify relevant research. Thematic synthesis of the extracted study findings was undertaken, using a team-based approach. A total of seven primary qualitative, and 1 mixed method studies were eligible for inclusion. The themes identified through metasynthesis were: timeliness of pre-menarcheal access, with many being unaware of menarche before it occurred, leading to fear and shock at their first period; resonance, with individuals reporting positive impacts of guidance from those with similar disabilities; and frame, the impact of surrounding societal narratives on the experience of menarche. Families, and those involved in the care of children with visual, hearing, and mobility impairments should be made aware of the importance of timely and resonant menarcheal support and guidance for these individuals and of broadcasting positive surrounding narratives of menarche. This should enable a positive experience of menarche for these vulnerable young people, supporting a good trajectory for later-life menstrual health.

A cross-sectional study of knowledge, taboos, and attitudes towards menstruation

BACKGROUND

The level of knowledge and comprehension surrounding puberty and menstruation. It can substantially impact women's overall health. This cross-sectional study is conducted to get insights about menstrual knowledge, attitudes and taboos among college and university female students in Haryana.

METHODS

A survey was conducted to investigate the experiences of menstruation among female students from government universities and colleges. Respondents were categorized on the basis of age, education qualification, and background setting. Random sampling was used to ensure participation from six administrative zones. The chi-square test was used to determine statistical significance, and the analysis was built around the p-value.

RESULTS

The data reveals that there is no significant association between the age of the participants and their awareness of menstruation, scientific knowledge related to menstruation, or their personal relationships with mother, father, or family members. Similarly, there is no significant association between the participants' scientific knowledge and their level of education. However, there is a significant association between participants' personal relationships and level of education (p = .025). Additionally, a significant association was observed between taboos and level of education (p = .025).

CONCLUSION

Age, residential area, and educational levels do not seem to significantly impact participants' awareness and knowledge. This study highlights the influence of personal equations and education on attitudes and beliefs surrounding menstruation. The significant association between personal relationships and education underscores the importance of a supportive family. The persistence of menstrual taboos among undergraduates suggests that there is still a need for comprehensive and inclusive menstrual health education. This study also addressed the sustainable developmental goals for good health and well-being. Future studies should focus on exploring cultural factors such as religious beliefs and cultural norms in more detail to develop interventions that may help improve menstrual health outcomes among college and university students.

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

BACKGROUND

While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators.

OBJECTIVES

The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia.

DESIGN

This project was a qualitative research study.

METHODS

We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach.

RESULTS

Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies.

CONCLUSION

Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.

"Sometimes I just forget them": capturing experiences of women about free menstrual products in a U.S. based public university campus

BACKGROUND

Studies have proven that lack of access to menstruation products negatively affects school attendance, academic performance, and individual health. Implementing "period policies," or programs offering free menstruation products, are becoming popular in schools, businesses, and communities in high-income countries. U.S.-based Purdue University announced in February 2020 that free pads and tampons would be stocked in all women's and gender-neutral restrooms in campus buildings. This study aimed to capture the experiences of menstruators about free menstrual products and the impact of a university-wide free menstruation management product policy and program. A second purpose was to understand how access to menstrual management products is intertwined with broader socio-cultural experiences of a menstruator.

METHODS

As part of a larger study, virtual focus group discussions (n = 32 across 5 focus groups) were conducted in February 2021. Eligible participants were student-menstruators attending Purdue University. We used thematic analysis techniques for data analysis, allowing for a constant comparative approach to data contextualization and theme identification.

RESULTS

Focus group discussions revealed vivid menarche and menstruation experiences, shifting period culture, recollections of shame and stigma, and use of various technologies to manage menstruation. Recommendations for community-based programs offering free products included maintaining stock, making informed product choices, and broadly distributing program information to increase awareness of free product placements.

CONCLUSIONS

Findings offer practical recommendations that will contribute to menstruation management and period poverty solutions for university communities.

Spanish menstrual literacy and experiences of menstruation

There is growing recognition of the important role menstrual health plays in achieving health, education, and gender equity. Yet, stigmatisation and taboo remain present and negative emotions like fear and shame dominate the narrative when speaking about periods. This paper analyses how formal and informal menstrual education is received in Spain, to understand the role of menstrual health literacy in the way menstruation is experienced, and to identify what information would be useful to integrate into formal menstrual education. An online survey with more than 4000 participants (aged between 14 and 80, both people who will/do/have previously menstruate/d and those who do not menstruate) was conducted. Data was gathered using the digital platform Typeform, descriptive and inferential statistical analyses were performed with SPSS software and qualitative data was thematically analysed using Nvivo. Many participants declared not having received sufficient information on menstruation prior to menarche, particularly about how to physically manage it. Furthermore, negative emotions like shame, worry, and fear were recurrently reported to describe menarche; this has not changed between generations. Interestingly, we saw an increase in stress and sadness with an increase in perceived knowledge of the reproductive role of menstruation. We did observe a reduction in negative emotions when people who menstruate perceived they had sufficient information on how to manage their first bleeding. It is recommended that menstrual education beyond reproductive biology, particularly including how to physically manage periods, is integrated into school curricula. Menstrual education of everyone - including those who do not menstruate-can improve how periods are experienced in Spain.

Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey

Objectives:

There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university.

Methods:

An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant.

Results:

A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors.

Conclusion:

Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.

Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries

BACKGROUND

There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research.

METHODS AND FINDINGS

Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts.

CONCLUSIONS

We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest.

REVIEW PROTOCOL REGISTRATION

The review protocol registration is PROSPERO: CRD42019157618.

From "period poverty" to "period parity" to meet menstrual health needs

Menstruation is a natural experience for most girls and women, yet it is often associated with socially imposed taboos and shame. "Period poverty" is a new term that has garnered the attention of media and politicians. It has articulated a public discussion of the menstrual health challenges that remain in many cultures.

'Making of a Strong Woman': a constructivist grounded theory of the experiences of young women around menarche in Papua New Guinea

BACKGROUND

Menarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This study explored post-menarcheal women's understanding about body changes and menarche, preparation for menarche, and related cultural beliefs and practices at menarche.

METHODS

A constructivist grounded theory study was conducted with 98 female participants who originated from four PNG provinces: Eastern Highlands Province; East Sepik Province; Milne Bay Province; and National Capital District. The participants were purposively and theoretically sampled, with 10 focus group discussions and six individual interviews conducted using a semi-structured interview guide for data collection. Focus group discussions and interviews were voice recorded and transcribed. Data were inductively analyzed using initial, intermediate and advanced coding, memos and constant comparative methods to develop a theoretical model that explains women's experiences at menarche. Interview participants also identified actions required to improve future experiences of girls at menarche in PNG.

RESULTS

A grounded theory comprising the core category of 'Making of a Strong Woman' and four interconnecting categories ('Having Baby Sense'; 'Beginning of Learning'; 'Intensifying Learning'; and 'Achieving Womanhood') was constructed. 'Urban' and 'Rural' represented both geographical and socio-cultural intervening conditions that influence the experiences of girls at menarche. Experiences of young women at menarche were rooted in socio-cultural beliefs and practices. Women reported being physically and emotionally distressed and unprepared at onset of menarche. Mothers were considered important support, however, their ability to adequately prepare their daughters is limited by shame and secrecy. Despite these limitations, cultural practices at menarche provided an opportunity for intensive preparation of girls for womanhood.

CONCLUSION

Limited pre-menarcheal awareness of the meaning of body changes and menarche of girls was linked to culture of shame and secrecy about open discussion on sexuality. However, traditional cultural practices provide an opportunity for collective support and focused learning for girls. Findings from this study have implications for broader sexual and reproductive health education programs in addressing menstrual health and hygiene in PNG, and the Pacific.

Results from a literature review of menstruation-related restrictions in the United States and Canada

Initiation of menstruation is often associated with secrecy and silence, leading to menstruation-related restrictions enforced by various structural and social factors. Most of the research investigating menstruation-related restrictions has been conducted in low- and middle-income countries. It is unknown 1) which populations in the United States and Canada may face menstruation-related restrictions, and 2) what type of restrictions are practiced by these populations. A literature review found 21 articles published between 2000 and 2019 covering menstruation-related social and structural restrictions in the United States and Canada. In addition to more research, we encourage clinical providers to have culturally competent conversations with patients to understand potential menstruation-related restrictions.

The myth of menstruation: how menstrual regulation and suppression impact contraceptive choice

BACKGROUND

Women in the US have access to various hormonal contraceptive methods that can regulate menstruation. This study examined the attitudes and perceptions of reproductive-aged women toward contraceptive methods, including how menstrual regulation and suppression preferences influenced contraceptive choice.

METHODS

Data collection used a mixed-methods approach, including 6 focus groups (n = 61), individual interviews (n = 18), and a web-based survey (n = 547).

RESULTS

Participants described contraceptive method preferences that allowed monthly bleeding and daily control, expressing concerns about long-acting reversible contraception (LARC) because of decreased user involvement. Some participants noted LARC improved their menstrual control. Many participants felt menstruation was healthy, whereas suppression was abnormal and resulted in negative health outcomes. Though participants indicated LARC as beneficial (M = 4.99 ± 1.66), convenient (M = 5.43 ± 1.68), and healthy (M = 4.62 ± 1.69), they chose combined oral contraceptives due to convenience.

CONCLUSIONS

Findings suggest women need more information about menstrual regulation and suppression before selecting a contraceptive method, specifically in relation to LARC versus combined oral contraception. Framing menstrual suppression as healthy and natural may improve perceptions of long-term health consequences related to LARC. Providers should discuss menstrual suppression safety to ensure selection of contraceptive options aligning with women's preferences and needs.