Menstruation, objectification and health-related quality of life: A questionnaire study

Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study

BACKGROUND

Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance.

OBJECTIVE

This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women.

METHODS

A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews.

RESULTS

In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level.

CONCLUSIONS

Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users' needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health.

Assessment of COVID-19 Vaccine Impact on Women's Menstrual Health within an 18-Month Follow-Up

Considering menstruation as a crucial factor in females' health and fertility, any factor that could change its cycle is important. This study was conducted from April 2021 to October 2022 on females who got 3 doses of vaccines against SARS-CoV-2 through different platforms. The participants were requested to provide the trained experts with any changes regarding menstrual cycles after each dose of the vaccine up to 6 months after the booster shots. The disturbances related to the vaccines were identified by the adverse events committee to find possible associations with the applied vaccines. Of 308 women who participated until the end of the study, 22 (7.1%) complained about at least one abnormality in their menstrual patterns. The most common disturbance was metrorrhagia as 10 (48%) incidences followed by menorrhagia as 6 events (24.2%). Notably, the identified complaints were persistent in 59% of the patients. In addition, 14 studied cases developed COVID-19 infection after menstrual disorders. In these cases, COVID-19 could also play a role in the persistence of postvaccine menstrual disturbances. COVID-19 vaccination could affect menstrual cycle in women with no remarkable previous medical history. More longitudinal studies are required regarding this issue.

"You have to stay in your house…because trouble can come": The impact of education, policy, and COVID-19 on menstruation experiences in Florence, Italy

Starting from menarche to menopause, menstruators have an overall negative view of menstruation, and there is a prevalent need for community awareness to increase regarding this topic. Menstruators in Italy and Europe arrive at menarche earlier than they have in previous decades, allowing less time for them to receive preparatory knowledge. Some European countries have started employing menstrual policies, yet current menstruation education minimally supports menstruators in terms of recognizing irregular symptoms and learning how to manage them. Additionally, the COVID-19 pandemic caused menstrual lifestyle patterns and experiences to be altered. The purpose of this study is to gain an understanding of menstruation-related education and policies accessible to menstruators and the impact COVID-19 had on menstruators. Researchers conducted 28 in-depth interviews in English with menstruators aged 18+ years who lived in or around Florence, Italy. All interviews were transcribed verbatim. Researchers used thematic analysis during coding to explore and understand participants' menstruation education at menarche, menstrual leave policy opinions, and how COVID-19 impacted their menstruation experiences and the availability of menstrual resources. Participants discussed varying timelines regarding when they were taught about menstruation. Their education sources varied between family, peers, personal experiences, and school. Most participants expressed enthusiastic feelings toward menstrual leave policies. Many participants reported having faced challenges accessing menstrual products during COVID-19. Most participants expressed having positive impacts, while few expressed negative impacts during COVID-19. Results found most menstruators learned about menstruation through their family before menarche but did not consider themselves prepared for their first cycle. The COVID-19 pandemic influenced many menstruators to adopt some lifestyle habits, shedding light on the varying opinions on the need for a menstrual leave policy. Revamped policies related to timing, education type, and personal leave should be considered.

Menstruation in the USA

Purpose of review

Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces.

Recent findings

First, menstruation plays many roles in psychology - premenstrual syndrome affects psychological wellbeing and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the Hypothalamus-Pituitary-Ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve "menstrual equity," by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and "impurity" associated with menstruation.

Summary

Overall, this review highlights the universality of menstruation in society. As a "fifth vital sign", there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.

COVID-19 vaccination and menstrual cycle characteristics: A prospective cohort study

We prospectively examined the association between COVID-19 vaccination and menstrual cycle characteristics in an internet-based prospective cohort study. We included a sample of 1,137 participants who enrolled in Pregnancy Study Online (PRESTO), a preconception cohort study of couples trying to conceive, during January 2021-August 2022. Eligible participants were aged 21-45 years, United States or Canadian residents, and trying to conceive without fertility treatment. At baseline and every 8 weeks for up to 12 months, participants completed questionnaires on which they provided information on COVID-19 vaccination and menstrual cycle characteristics, including cycle regularity, cycle length, bleed length, heaviness of bleed, and menstrual pain. We fit generalized estimating equation (GEE) models with a log link function and Poisson distribution to estimate the adjusted risk ratio (RR) for irregular cycles associated with COVID-19 vaccination. We used linear regression with GEE to estimate adjusted mean differences in menstrual cycle length associated with COVID-19 vaccination. We adjusted for sociodemographic, lifestyle, medical and reproductive factors. Participants had 1.1 day longer menstrual cycles after receiving the first dose of COVID-19 vaccine (95 % CI: 0.4, 1.9) and 1.3 day longer cycles after receiving the second dose (95 % CI: 0.2, 2.5). Associations were attenuated at the second cycle post-vaccination. We did not observe strong associations between COVID-19 vaccination and cycle regularity, bleed length, heaviness of bleed, or menstrual pain. In conclusion, COVID-19 vaccination was associated with a ∼1 day temporary increase in menstrual cycle length, but was not appreciably associated with other menstrual cycle characteristics.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUND

Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.

AIM

To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.

METHODS

All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30^th of April 1980 and the 30^th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.

RESULTS

A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.

CONCLUSION

There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Menstruation and social inequities in Spain: a cross-sectional online survey-based study

BACKGROUND

Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain.

METHODS

A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed.

RESULTS

A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13-1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36-0.93). Lifetime self-reported menstrual poverty was between 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). Completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06-0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52-2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively.

CONCLUSIONS

Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies.

“It’s Just Another Unfortunate Part of Being Female”: A Qualitative Study on Dysmenorrhea Severity and Quality of Life

The present study sought to understand similarities and differences in the experiences of women with mild, moderate and severe menstrual pain. Women aged 18-50 years were recruited from the community between May and July 2019 (n = 624). Participants were asked to rate their menstrual pain severity using a Numerical Rating Scale categorised into mild (scores 1-4), moderate (scores 5-7), and severe dysmenorrhea (scores 8-10) and respond to three open-ended questions about the impact of menstrual pain. Inductive template thematic analysis was used to understand patterns of meaning and compare and contrast the experience of menstrual pain across severity. Three themes were derived, including 'Dysmenorrhea is more than menstrual pain;' 'It puts a hold on lives;' and 'Lack of health-related information.' Women across all pain severities reported disabling symptoms, disrupted physical activity and the need for education and treatment. Those experiencing mild pain reported relatively brief symptoms and minor impacts, whilst those with moderate, and especially severe pain reported debilitating symptoms and extensive impacts. Supportive care including education is needed for all menstruating people.

Association between menstrual cycle length and covid-19 vaccination: global, retrospective cohort study of prospectively collected data

OBJECTIVES

To identify whether covid-19 vaccines are associated with menstrual changes in order to address concerns about menstrual cycle disruptions after covid-19 vaccination.

DESIGN

Global, retrospective cohort study of prospectively collected data.

SETTING

International users of the menstrual cycle tracking application, Natural Cycles.

PARTICIPANTS

19 622 individuals aged 18-45 years with cycle lengths of 24-38 days and consecutive data for at least three cycles before and one cycle after covid (vaccinated group; n=14 936), and those with at least four consecutive cycles over a similar time period (unvaccinated group; n=4686).

MAIN OUTCOME MEASURES

The mean change within individuals was assessed by vaccination group for cycle and menses length (mean of three cycles before vaccination to the cycles after first and second dose of vaccine and the subsequent cycle). Mixed effects models were used to estimate the adjusted difference in change in cycle and menses length between the vaccinated and unvaccinated.

RESULTS

Most people (n=15 713; 80.08%) were younger than 35 years, from the UK (n=6222; 31.71%), US and Canada (28.59%), or Europe (33.55%). Two thirds (9929 (66.48%) of 14 936) of the vaccinated cohort received the Pfizer-BioNTech (BNT162b2) covid-19 vaccine, 17.46% (n=2608) received Moderna (mRNA-1273), 9.06% (n=1353) received Oxford-AstraZeneca (ChAdOx1 nCoV-19), and 1.89% (n=283) received Johnson & Johnson (Ad26.COV2.S). Individuals who were vaccinated had a less than one day adjusted increase in the length of their first and second vaccine cycles, compared with individuals who were not vaccinated (0.71 day increase (99.3% confidence interval 0.47 to 0.96) for first dose; 0.56 day increase (0.28 to 0.84) for second dose). The adjusted difference was larger in people who received two doses in a cycle (3.70 days increase (2.98 to 4.42)). One cycle after vaccination, cycle length was similar to before the vaccine in individuals who received one dose per cycle (0.02 day change (99.3% confidence interval -0.10 to 0.14), but not yet for individuals who received two doses per cycle (0.85 day change (99.3% confidence interval 0.24 to 1.46)) compared with unvaccinated individuals. Changes in cycle length did not differ by the vaccine's mechanism of action (mRNA, adenovirus vector, or inactivated virus). Menses length was unaffected by vaccination.

CONCLUSIONS

Covid-19 vaccination is associated with a small and likely to be temporary change in menstrual cycle length but no change in menses length.

Association between menstrual cycle length and covid-19 vaccination: global, retrospective cohort study of prospectively collected data

OBJECTIVES

To identify whether covid-19 vaccines are associated with menstrual changes in order to address concerns about menstrual cycle disruptions after covid-19 vaccination.

DESIGN

Global, retrospective cohort study of prospectively collected data.

SETTING

International users of the menstrual cycle tracking application, Natural Cycles.

PARTICIPANTS

19 622 individuals aged 18-45 years with cycle lengths of 24-38 days and consecutive data for at least three cycles before and one cycle after covid (vaccinated group; n=14 936), and those with at least four consecutive cycles over a similar time period (unvaccinated group; n=4686).

MAIN OUTCOME MEASURES

The mean change within individuals was assessed by vaccination group for cycle and menses length (mean of three cycles before vaccination to the cycles after first and second dose of vaccine and the subsequent cycle). Mixed effects models were used to estimate the adjusted difference in change in cycle and menses length between the vaccinated and unvaccinated.

RESULTS

Most people (n=15 713; 80.08%) were younger than 35 years, from the UK (n=6222; 31.71%), US and Canada (28.59%), or Europe (33.55%). Two thirds (9929 (66.48%) of 14 936) of the vaccinated cohort received the Pfizer-BioNTech (BNT162b2) covid-19 vaccine, 17.46% (n=2608) received Moderna (mRNA-1273), 9.06% (n=1353) received Oxford-AstraZeneca (ChAdOx1 nCoV-19), and 1.89% (n=283) received Johnson & Johnson (Ad26.COV2.S). Individuals who were vaccinated had a less than one day adjusted increase in the length of their first and second vaccine cycles, compared with individuals who were not vaccinated (0.71 day increase (99.3% confidence interval 0.47 to 0.96) for first dose; 0.56 day increase (0.28 to 0.84) for second dose). The adjusted difference was larger in people who received two doses in a cycle (3.70 days increase (2.98 to 4.42)). One cycle after vaccination, cycle length was similar to before the vaccine in individuals who received one dose per cycle (0.02 day change (99.3% confidence interval -0.10 to 0.14), but not yet for individuals who received two doses per cycle (0.85 day change (99.3% confidence interval 0.24 to 1.46)) compared with unvaccinated individuals. Changes in cycle length did not differ by the vaccine's mechanism of action (mRNA, adenovirus vector, or inactivated virus). Menses length was unaffected by vaccination.

CONCLUSIONS

Covid-19 vaccination is associated with a small and likely to be temporary change in menstrual cycle length but no change in menses length.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study

INTRODUCTION

Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18-55 in Barcelona and surrounding areas (Spain).

METHODS

A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis.

RESULTS

Three themes were identified: "Systemic neglect of menstruation and the menstrual cycle", "When "the private" becomes public: menstrual management" and "Navigating menstrual health: between medicalization and agency". Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants' day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health.

CONCLUSIONS

The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals' training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations.

Managing the premenstrual body: a body mapping study of women's negotiation of premenstrual food cravings and exercise

BACKGROUND

Women's eating behaviours and exercise patterns have been found to fluctuate across the menstrual cycle, manifested by premenstrual food cravings and reduced exercise. However, the meaning and consequences of premenstrual changes in eating and exercise behaviours remains underexplored. The aim of this qualitative study was to explore how women who feel negatively about their premenstrual bodies construct and experience premenstrual changes to eating and exercise practices, which disrupt their usual patterns of body management.

METHODS

Four hundred and sixty women aged 18-45 completed an online survey in response to a Facebook advertisement targeted at women who feel negatively about their bodies during the premenstrual phase of the cycle. Participants reported moderate premenstrual distress, high body shame and high risk of disordered eating attitudes using standardised measures. Sixteen women reporting rich accounts of premenstrual body dissatisfaction were invited to participate in body-mapping, involving visually illustrating experiences on a life-sized outline of the body, followed by a telephone interview. Thematic analysis was used to explore qualitative survey, interview, and body-mapping data.

RESULTS AND DISCUSSION

Results found that outside of the premenstrual phase these women engaged in restrictive eating and intensive exercise behaviours, which were disrupted by premenstrual cravings, hunger, fatigue, pain and feeling physically uncomfortable. For a minority of the women, this facilitated self-care in reducing the strict management of their bodies during the premenstrual phase. Others experienced feelings of guilt, shame, self-disgust and pushed their bodies physically through increased exercise.

CONCLUSIONS

These findings emphasise the need to acknowledge changes in body management across the menstrual cycle, with implications for women's mental health and feelings about the self. Internalisation of pressures placed on women to manage their bodies through restrictive eating behaviours and rigorous exercise plays a role in women's premenstrual body dissatisfaction and distress. The current study aimed to explore how women who feel negatively about their premenstrual bodies construct and experience premenstrual changes to eating and exercise practices. Outside of the premenstrual phase these women engaged in restrictive eating and intensive exercise behaviours which were disrupted by premenstrual cravings, hunger, fatigue, pain and feeling physically uncomfortable. Some women allowed themselves to take a premenstrual break from their usual strict eating and exercise behaviours, whereas others felt guilt, shame, self-disgust and physically pushed their bodies through increased exercise. These findings emphasise that changes to eating and exercise behaviours across the menstrual cycle and pressures placed on women to manage their eating and exercise behaviours have implications for women's premenstrual distress and body dissatisfaction.

Examining the association between menstrual symptoms and health-related quality of life among working women in Japan using the EQ-5D

Background

Menstrual symptoms have been identified as a substantial burden among women of reproductive age, affecting their health status and quality of life globally. A range of menstrual symptoms have been studied as they affect the health-related quality of life (HRQoL), showing variations across specific menstrual symptoms and study settings. A major concern is demonstrated due to menstrual symptoms in women’s professional and social life, and consequently societal and economic loss for women and the society at large. Yet evidence is scarce that estimates the index form HRQoL score related to menstrual symptoms that is needed for health economic evaluations.

Methods

This study aims to investigate the association between menstrual symptoms and the HRQoL among working women in Japan in an index form, using a self-reporting questionnaire (n = 6048). The EQ-5D-3L (EuroQoL 5-dimension 3-level) is used that is a widely used tool to measure health outcomes for health economic evaluations globally. Multivariate regression analysis is conducted to assess the association between the HRQoL score and specific nineteen physical and mental conditions related to menstruation (e.g., pain, heavy bleeding, concentration, negative affect).

Results

The index form HRQoL score for menstrual symptoms is estimated as 0.682 in the study population (where a score one suggests perfect health). The association of the HRQoL score varies substantially across the menstrual symptoms. Several of the physical conditions and disorders show a substantial negative association with the HRQoL score. Also, most of the mental and psychological issues are significantly and negatively related to the HRQoL score.

Conclusions

This study suggests that HRQoL is substantially and negatively affected by menstruation among working women in Japan. Distinct variations of negative influences across menstrual symptoms underscore the multi-dimensional nature of menstruation and consequently the need of collective interventions to address these difficulties. The evidence of HRQoL continues to be an important area for future research on women’s health and health economic evaluations to inform effective and efficient resource allocations for relevant health policies and financing strategies.

Unmet Menstrual Hygiene Needs Among Low-Income Women

OBJECTIVE

To assess the menstrual hygiene needs of low-income women in St. Louis, Missouri.

METHODS

Using an exploratory, cross-sectional design, women 18 years of age and older were recruited from a purposive sample of 10 not-for-profit community organizations that serve low-income women in St. Louis. From July 2017 to March 2018, 183 interviewer-administered surveys and three focus group discussions were conducted. Surveys and focus groups identified where and how women access menstrual hygiene products and what they do when they cannot afford to buy them. Using a snowball sampling strategy, 18 community organizations were also surveyed electronically to assess what services and supplies they provide for menstrual hygiene.

RESULTS

All women invited to participate in the interviews and the focus groups agreed to do so. Nearly two thirds (64%) of women were unable to afford needed menstrual hygiene supplies during the previous year. Approximately one fifth of women (21%) experienced this monthly. Many women make do with cloth, rags, tissues, or toilet paper; some even use children's diapers or paper towels taken from public bathrooms. Nearly half of women (46%) could not afford to buy both food and menstrual hygiene products during the past year. There was no difference in menstrual hygiene needs by age. Two thirds of organizations indicated that menstrual hygiene was a need of their clients. Thirteen provide menstrual hygiene supplies to their clients; two provide menstrual hygiene education.

CONCLUSION

Menstrual hygiene supplies are a basic necessity that many low-income women lack. We document the extent to which low-income women in a major metropolitan area in the United States are unable to afford these basic necessities and what they do to cope. Women's health care providers should advocate for improved access to menstrual hygiene supplies for low-income females across the United States.

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.

Self- and Other-Dehumanization Processes in Health-Related Contexts: A Critical Review of the Literature

Dehumanization is an everyday, pervasive phenomenon in health contexts. Given its detrimental consequences to health care, much research has been dedicated to understanding and promoting the humanization of health services. However, health care service research has neglected the sociopsychological processes involved in the dehumanization of self and others, in formal but also informal health-related contexts. Drawing upon sociopsychological models of dehumanization, this article will bridge this gap by presenting a critical review of studies on everyday meaning-making and person perception processes of dehumanization in health-related contexts. A database search was conducted in PsycINFO, Web of Science, Scopus, and PubMed, using a combination of keywords on dehumanization and health/illness/body; 3,229 references were screened; 95 full texts were assessed for eligibility; 59 studies were included. Most studies focused on informal contexts, reflecting a decontextualized and one-sided view of dehumanization (i.e., not integrating actors’ and victims’ perspectives). Despite the dominant focus on self-dehumanization, emerging perspectives uncover the role of processes that deny human uniqueness to others, and their individual determinants and consequences for mental health. A few studies bring to light the functions of a variety of dehumanizing body metaphors on self- and other-dehumanization. These trends in the literature leave several gaps, which are here critically analyzed to inform future research.

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

The purpose of this study was to understand women's menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older (Mean = 49.13 ± 14.76 years; Range = 19-78 years) living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.