tag:theconversation.com,2011:/au/topics/periods-30745/articlesPeriods – The Conversation2024-03-12T17:51:11Ztag:theconversation.com,2011:article/2220162024-03-12T17:51:11Z2024-03-12T17:51:11ZMenstrual health literacy is alarmingly low – what you don’t know can harm you<figure><img src="https://images.theconversation.com/files/580119/original/file-20240306-27-eeqobz.jpg?ixlib=rb-1.1.0&rect=8%2C17%2C5982%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stone-sculpture-female-genitals-covered-hands-1024757548">Len-art/Shutterstock</a></span></figcaption></figure><p>Given that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541669/#:%7E:text=In%20fact%2C%20approximately%2098%25%20of,the%20elephant%20shrew%20%5B6%5D.">98% of mammals</a> do not have periods, do you know why humans do?</p>
<p>When I ask my menstrual health workshop participants – including doctors – there’s usually a lot of shrugging and shaking of heads. If given multiple choice options, most think that periods either “clean the womb” or somehow “help prepare for pregnancy”. </p>
<p>Not only are these beliefs inaccurate, but they also reproduce damaging myths about the inherent impurity and <a href="https://www.perlego.com/knowledge/study-guides/what-is-abjection/">abject status</a> (responses of repulsion and horror to aspects of women’s bodies such as menstruation and childbirth) of the female body. Wombs are not dirty, or toxic. They do not need to be cleaned. <a href="https://www.menstrual-matters.com/top-10-period-myths/">Menstrual fluid</a> is not an excretory product like urine or faeces. </p>
<p>Yes, the blood part can stain clothing, but there is nothing pathological, contaminating, or dangerous about periods. The idea that the womb and vagina are dirty or toxic directly contributes to <a href="https://www.ncbi.nlm.nih.gov/books/NBK565611/">menstrual stigma</a> and associated discrimination, such as the exclusion of menstruating people from certain <a href="https://www.ncbi.nlm.nih.gov/books/NBK565592/">religious</a> places or practices, or the reports of intentional humiliation of <a href="https://www.ncbi.nlm.nih.gov/books/NBK565595/">female prisoners</a> on their periods.</p>
<p>As part of <a href="https://www.menstrual-matters.com/black-box/">my research</a>, <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">I reviewed</a> the menstrual cycle content of 16 of the most used biology and physiology textbooks in UK secondary schools, university level natural sciences, medicine, and specialist gynaecology education – and what I found was pretty alarming.</p>
<p>Nobody, it seems, is taught about the function of periods.</p>
<h2>So, why do we have periods?</h2>
<p>The most <a href="https://www.menstrual-matters.com/why-humans-menstruate/">robust evidence based theory</a> we have is described by evolutionary biologist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528014/">Deena Emera and colleagues</a>. Periods likely evolved as a kind of preemptive abortion, to protect women from unviable or dangerous pregnancies. </p>
<p>Humans have exceptionally high rates of genetically abnormal eggs, sperm and fertilised eggs, highly invasive placental attachments, and pregnancy and childbirth are risky – even potentially fatal – experiences for human females. As a result, we have <a href="https://academic.oup.com/humrep/article/32/2/346/2713082">low rates of conception</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/11023804/">high rates of miscarriage</a>, and extremely high rates of maternal mortality in comparison to other mammals. In fact, despite advances in modern medicine, nearly <a href="https://www.who.int/news-room/fact-sheets/detail/maternal-mortality">300,000 expectant mothers</a> still die every year, globally.</p>
<p>If there is no pregnancy, as in the case for most menstrual cycles, or an unviable fertilised egg is detected, a period is triggered. </p>
<p>Periods cannot possibly help a pregnancy. Just think about it for a minute. How can the removal of the contents of the womb – including any eggs that may be present – possibly help conception or maintain a pregnancy? My research suggests that this assumption is influenced by sexist beliefs that position the female body, and all women, as <em>for</em> having babies – rather than eligible for equal opportunities in education, paid employment, and leadership. </p>
<p>Take a look at this quote from one of the <a href="https://global.oup.com/academic/product/oxford-textbook-of-obstetrics-and-gynaecology-9780198766360?cc=gb&lang=en&">medical textbooks</a> reviewed for <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">the study</a>. It explicitly positions the entire menstrual cycle (not just ovulation) as critical for having babies, and childbearing as the sole purpose of the female reproductive body. The fact that humans evolved a means to terminate potentially dangerous unviable pregnancies is not so much omitted, as denied. </p>
<blockquote>
<p>The principal functions of this (female reproductive) system are to produce an ovum, enable its fertilisation and implantation, and allow growth and safe expulsion of the foetus into the external world. The menstrual cycle is critical for facilitation of the initial steps of this raison d’être of the female reproductive system.</p>
</blockquote>
<h2>What else don’t we know?</h2>
<p>Well, where do I begin? Perhaps with the fact that the second phase of the cycle from ovulation to menstruation is a series of <a href="https://pubmed.ncbi.nlm.nih.gov/36304016/">highly inflammatory processes</a>. This was only very briefly mentioned in three out of 16 textbooks. </p>
<p>Given that common premenstrual changes reflect the <a href="https://www.verywellhealth.com/signs-of-inflammation-4580526">“cardinal signs”</a> of inflammation – temperature increase, swelling, pain, and blood flow changes – and anti-inflammatory <a href="https://www.menstrual-matters.com/tips-and-tricks/all-changes/">interventions</a>, including diet, lifestyle and medications, <a href="https://www.cochrane.org/CD001751/MENSTR_nonsteroidal-anti-inflammatory-drugs-dysmenorrhoea">alleviate cyclical changes</a>, this is quite the omission. We really ought to be taught from puberty how to reduce period pain and blood loss – this is not difficult science.</p>
<p>In fact, only around half of the textbooks even mentioned blood loss, and only four went on to explain how regular periods typically result in iron deficiency – leading to anaemia in some cases. </p>
<p>Fewer than half of the textbooks mentioned any associated health issues, such as endometriosis, heavy menstrual bleeding, fibroids, polycystic ovarian syndrome, <a href="https://pubmed.ncbi.nlm.nih.gov/33347177/">premenstrual syndrome</a>, premenstrual dysphoric disorder, or the cyclical exacerbation of asthma, migraine, epilepsy, irritable bowel syndrome, auto-immune disorders, or anxiety and depression. So, even doctors are <a href="https://metro.co.uk/2022/07/22/why-wasnt-it-mandatory-for-doctors-to-be-taught-about-womens-issues-before-now-17052718/">not taught enough</a> about female-prevalent illnesses, which must surely have a negative impact on the health outcomes of their patients.</p>
<h2>Why aren’t we taught this stuff?</h2>
<p>In <a href="https://www.menstrual-matters.com/black-box/">my review</a>, no textbooks mentioned the purpose or embodied – typically painful – experiences of periods, and all effectively reduced the entire menstrual cycle to fluctuating sex hormones. </p>
<p>There is no scientific reason for this. My research shows that the exclusive focus on the female sex hormones in menstrual education is informed by societal influences, such as the myth of the hysterical or hormonal female. </p>
<p>For hundreds of years, women’s experiences of emotional and physical distress were <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">blamed on the womb</a> – as the essence of femininity – rather than distressing life experiences, pain, or underlying health conditions. There is a <a href="https://wellcomecollection.org/articles/ZN-ELxEAACMABO5a">familiar western</a> stereotype of the pathologically emotional <a href="https://www.medicalnewstoday.com/articles/the-controversy-of-female-hysteria#Female-hysteria-in-the-18th-century">“hysterical woman”</a>, who is biologically prone to invent, exaggerate, and imagine things, especially pain or distress. This gender myth is still alive and well, although now we tend to <a href="https://sciencebasedmedicine.org/the-hormone-myth/">blame the (female sex) hormones</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=755&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=755&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=755&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=949&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=949&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=949&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The doctor’s visit by Frans van Mieris, 1657.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:A_physician_taking_the_pulse_of_a_female_patient_who_is_touc_Wellcome_V0016033.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As soon as the female sex hormones were <a href="https://academic.oup.com/endo/article/160/3/605/5250672">first identified</a> in the late 1920s, textbooks containing information about menstrual physiology <a href="https://www.taylorfrancis.com/books/mono/10.4324/9780203421529/beyond-natural-body-nelly-oudshoorn">switched</a> from being about its inflammatory processes to hormonal models and explanations. Again, there was no scientific reason for this change in focus, although it reflected <a href="https://www.tandfonline.com/doi/pdf/10.1080/09612020000200260">existing societal beliefs</a> about the inherently <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">irrational behaviour of women</a>. </p>
<p>Unfortunately, menstrual health literacy has not yet recovered from this shift in physiological models.</p>
<h2>So what?</h2>
<p>Once the purpose and inflammatory nature of the menstrual cycle are understood, premenstrual changes are no longer mysterious or difficult to treat. It also becomes much easier to differentiate premenstrual changes from underlying health conditions, since the latter will not be substantially alleviated by anti-inflammatory interventions alone.</p>
<p>Teaching the reductive hormonal model of the menstrual cycle unintentionally provides pseudo-scientific evidence for the damaging hormonal or hysterical female gender myth. This myth contributes <a href="https://theconversation.com/womens-pain-is-often-not-believed-heres-how-to-make-your-voice-heard-when-seeking-help-207866">to disbelief</a> in women’s accounts of painful or distressing symptoms, and even reports of <a href="https://www.tandfonline.com/doi/full/10.1080/1369118X.2020.1770832">abuse and discrimination</a>.</p>
<p>It is time we taught more comprehensive menstrual health literacy to all.</p><img src="https://counter.theconversation.com/content/222016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters- the world's first evidence-based info hub on menstrual health and rights <a href="http://www.menstrual-matters.com">www.menstrual-matters.com</a>. Her doctoral research and current research fellowship were funded by the ESRC (Economic and Social Research Council). </span></em></p>No one seems to be taught about the function of periods. It’s time to take menstrual literacy seriously.Sally King, Menstrual Matters Founder & Research Associate in Menstrual Physiology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235862024-03-07T13:09:58Z2024-03-07T13:09:58ZTampon tax: Chinese women are breaking period taboos to campaign for lower prices<p>Menstrual health and sanitary towels have been <a href="https://www.jstor.org/stable/3814221">taboo</a> subjects for hundreds of years in China. However, things are starting to change as women begin to feel more comfortable talking about this subject in public. </p>
<p>In recent months campaign groups have been springing up to rally opposition against high levels of tax on period-related products, such as tampons and sanitary towels, using social media. </p>
<p>Grassroots organisations, such as <a href="https://thechinaproject.com/2023/10/11/end-tax-on-menstrual-products-chinese-women-say/">Period Pride</a>, use public accounts on WeChat (a popular instant messaging app) to rally public support against high prices for goods that are traditionally sold to women. </p>
<p>Another sign of an uptick in campaigning was that the <a href="https://www.nbcnews.com/news/world/feminist-consumers-china-push-back-pink-tax-rcna124560">hashtag</a> #PinkTax went viral on social media in the winter of 2023, making the case that items that were pink and aimed at women tended to cost more than products aimed at men. This issue will be bubbling up again on International Women’s Day (IWD), which has recently become a busy shopping day in China.</p>
<p>Period Pride has compared China with nearly <a href="https://thechinaproject.com/2023/10/11/end-tax-on-menstrual-products-chinese-women-say/">20 countries</a> which have scrapped or reduced tampon taxes. It has highlighted the discrepancy in taxing tampons compared to <a href="https://www.163.com/dy/article/IGC9JMB205563QMT.html">other products</a> on sale in China, such as tax-exempt contraceptive methods like condoms and birth control medication. A few years ago this kind of public discussion about periods and menstruation would not have happened. </p>
<p>One of the most significant issues is the price of sanitary towels. In China, the VAT rate for sanitary napkins is 13%, the highest level of taxation and is on a par with the tax rate applied to imported goods. Other goods considered necessities are taxed at 11%. </p>
<p>During the 14th session of the 13th National People’s Congress in 2021, congress deputy <a href="https://sbs.mof.gov.cn/jytafwgk_8395/2021jytafwgk_1/rddbjyfwgk/202108/t20210820_3746776.htm">Wang Zuoying</a> put forward a proposal advocating for the provision of free menstrual products to targeted groups of women. In June 2021, the ministry of finance responded saying that the existing tax rate for sanitary napkins, which is 13%, already reflects a reduction <a href="https://sbs.mof.gov.cn/jytafwgk_8395/2021jytafwgk_1/rddbjyfwgk/202108/t20210820_3746776.htm">from previous years</a>.</p>
<p>In September 2023, China released an <a href="https://www.china-briefing.com/news/china-value-added-tax-law-draft-legislation/">updated draft of its VAT law</a>, and asked for public feedback. Period Pride was one of the groups that publicly argued that the tax on sanitary towels and tampons was too high.</p>
<h2>History of taboos</h2>
<p>Period blood has long been falsely regarded as impure in China, with the potential to <a href="https://www.jstor.org/stable/3814221">contaminate</a> anyone who comes into contact with it. Menstruating women were traditionally prohibited from <a href="http://journal.julypress.com/index.php/ajsss/article/view/1263">entering temples</a>, even today women in some places <a href="https://radii.co/article/menstrual-period-poverty-shame-china">are banned from worship</a> during their periods. To avoid the social discomfort associated with uttering the word “menstruation”, women often used euphemisms such as <a href="https://www.tandfonline.com/doi/full/10.1080/14616742.2021.1927134#:%7E:text=Resisting%20two%20invented%20characters%20and,to%20middle%2Dclass%20feminist%20activism.">“the big aunt” or “that”</a>. </p>
<p>From the early 2000s, Chinese feminists began to tackle shame and taboos around <a href="https://www.tandfonline.com/doi/full/10.1080/14616742.2022.2155209">menstruation</a>, spurred on by the influence of western feminist movements. One notable example is the debut of the dance <a href="https://chinesefeminism.org/2021/04/21/%E3%80%8A%E9%98%B4%E9%81%93%E7%8B%AC%E7%99%BD%E3%80%8B%E5%9C%A8%E4%B8%AD%E5%9B%BD%E5%A4%A7%E9%99%86%E7%9A%84%E6%97%85%E8%A1%8C-%E4%B8%8A%E7%AF%87/">“Menarche”</a> (named after the first menstrual cycle), which featured in the Chinese adaptation of The Vagina Monologues, in 2003.</p>
<p>A Chinese social media campaign in February 2020, during the <a href="https://www.tandfonline.com/doi/full/10.1080/12259276.2022.2098554">COVID pandemic</a>, drew attention to the desperate need for women doctors and nurses to have access to sanitary pads and period pants. Many female medical workers were not given time to change their sanitary pads during their long working hours at hospitals, or did not have access to supplies. A public campaign for <a href="https://www.sixthtone.com/news/1005190">donations</a> of sanitary towels or period pants drew support, but critics argued they were nonessential items.</p>
<p>Another issue is that high prices of sanitary items leave many girls unable to afford them. In August 2020, a Weibo user shared a screenshot of <a href="https://www.sixthtone.com/news/1006124">bulk sanitary napkins</a> purchased online. The post prompted a wider discussion about how many girls in rural areas didn’t have access to these products, partly because of cost but also because of taboos. According to one report, <a href="https://www.sixthtone.com/news/1006124">5% of girls in poorer</a> rural areas across China did not use sanitary products, while 13% felt ashamed about asking their parents for money to buy them. Many girls in rural areas were using <a href="https://www.thepaper.cn/newsDetail_forward_10039659">rough paper, old towels, or worn-out clothing</a>.</p>
<p>In September 2022, a complaint about the unavailability of menstruation products on <a href="https://theconversation.com/in-china-a-debate-over-sanitary-pads-on-trains-reflects-long-held-beliefs-about-women-and-menstruation-192069#:%7E:text=China%20Railway%20responded%20that%20feminine,food%20is%20served%20on%20train.">high-speed trains</a> prompted a wider public discussion about making such products accessible. </p>
<p>The fact that this debate has to happen at all reveals the long-term invisibility of women’s needs and the deeply ingrained stigma associated with period products. Some of those who opposed the selling of menstrual products on trains were <a href="https://www.tandfonline.com/doi/full/10.1080/14616742.2022.2155209">concerned</a> that they were unclean and unsuitable for placement alongside food items. The <a href="https://www.tandfonline.com/doi/full/10.1080/14616742.2022.2155209">revelation</a> that some men do not even know that women cannot simply control their menstrual blood also reflects a shocking deficiency in sex education within Chinese schools, as well as a tendency among parents and educational providers to avoid discussing this topic.</p>
<h2>What next?</h2>
<p>The strategy used by Period Pride highlights the political constraints in China. Facing the risk of being labelled as <a href="https://muse.jhu.edu/pub/434/article/848001/summary">agents of foreign influence</a>, feminist movements have tactfully chosen to work with the government rather than against it. Instead of resorting to protests, Period Pride encourages people to use the government-provided channels for political participation. While viewed as ineffective by some, these offer a less risky alternative to traditional protests.</p>
<p>Discussions regarding menstrual pads on high-speed trains were relatively untouched by severe censorship, as they did not directly challenge the state’s legitimacy. These conversations predominantly revolved around business interests.</p>
<p>It remains to be seen whether people’s submission of suggestions through government websites will result in any change to the tampon tax. However, even if it does not, the act of submitting suggestions and making voices heard can help to build momentum for incremental change. Public discussions on social media platforms are creating an environment in which attitudes to periods are starting to erode historical taboos.</p><img src="https://counter.theconversation.com/content/223586/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research is conducted together with Ming Zhang of the UK-China Media and Cultural Studies Association, who made important contributions to this piece.</span></em></p>Chinese women are ignoring taboos around menstrual products to argue for fairer prices, using social media channels.Chi Zhang, Associate lecturer in international relations, University of St AndrewsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228872024-02-08T19:17:36Z2024-02-08T19:17:36Z‘It needs to be talked about earlier’: some children get periods at 8, years before menstruation is taught at school<figure><img src="https://images.theconversation.com/files/573999/original/file-20240207-22-gj9n0o.jpg?ixlib=rb-1.1.0&rect=98%2C0%2C6444%2C4240&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/pantyliners-on-pink-background-7692457/">Karolina Grabowska/ AAP</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Managing menstruation in public can be challenging at the best of times, but imagine being eight years old and having to deal with your period at school. You might need to change your pad during class and explain to your friends why you are not going to the swimming carnival. You might be scared you will bleed through your uniform because there aren’t any sanitary bins in the junior years’ bathroom.</p>
<p>In Australia, the average age of the first period is <a href="https://academic.oup.com/aje/article/185/7/554/3045901#113385236">about 13</a>. But about 12% of children get their period between the ages of eight and 11. Researchers call this “early menarche” or “early onset menstruation”. </p>
<p>But even though a significant proportion of students are getting their first period as early as Year 3 or even Year 2, primary school students are not officially taught about puberty until Years 5 and 6 (when they are aged between 10 and 12).</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2023.2275595">research</a> explores current period education and what support is available for early menstruators. It shows how schools can act as gatekeepers of knowledge about this essential and very normal part of human development. </p>
<h2>Period shame exists but is not inevitable</h2>
<p>Shame about periods has existed in many parts of the world for centuries. Researchers have noted how children <a href="https://www.ncbi.nlm.nih.gov/books/NBK565666/">are taught</a> not to talk about menstruation and if they do, it is often negatively (with a focus on pain and discomfort). </p>
<p>A <a href="https://www.theage.com.au/national/western-australia/period-embarrassment-sees-wa-students-skip-school-more-than-any-other-state-20210530-p57wh8.html">2021 survey</a> found 29% of 659 menstruating Australian students aged ten to 18 were concerned they would be teased at school for having their period.</p>
<p>Similar issues occur as students grow older. A 2022 <a href="https://journals.sagepub.com/doi/full/10.1177/17455065211070666">Australian survey</a> of 410 university students who menstruate found only 16.2% felt completely confident in managing their periods at university. Just over half believed society thought periods were taboo (and so, not something you talk about). </p>
<p>But the stigma is not inevitable. There are examples of education programs in other countries that celebrate periods and are accessible across ages. </p>
<p>There is a <a href="https://menskompetens.se/">Swedish program</a> that provides information for young people, stories about first periods and advice on how adults can talk to children about menstruation. In the <a href="https://periodpositive.com/wp-content/uploads/2022/07/a-period-positive-national-curriculum-chella-quint-20-july-2022.pdf">United Kingdom</a>, there are moves to introduce a “period positive” curriculum for school students.</p>
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Read more:
<a href="https://theconversation.com/dirty-red-how-periods-have-been-stigmatised-through-history-to-the-modern-day-206967">'Dirty red': how periods have been stigmatised through history to the modern day</a>
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<h2>What is taught in Australian schools?</h2>
<p>The <a href="https://www.australiancurriculum.edu.au/f-10-curriculum/health-and-physical-education/">Australian curriculum</a> does not not explicitly mention “period” or “menstruation” in any of its online health and physical education curriculum resources, for any year levels up to Year 10. </p>
<p>We can assume schools would cover it under topics such as “understand the physical […] changes that are occurring for them”. But without explicit mention to menstruation or periods, it is likely what is being taught across classrooms in Australia is variable and insufficient.</p>
<p>It was last updated in 2022, under the former Morrison government.</p>
<h2>Our research</h2>
<p>We <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2023.2275595">interviewed</a> 15 staff across government, Catholic and private primary schools in Australia. We asked staff about their awareness of students who have experienced early onset menstruation, how their students are educated about periods, and what support is available to them. </p>
<p>Staff spoke about how students who menstruated early “felt isolated” and voiced the need for earlier “matter-of-fact” menstruation education. As one teacher told us: </p>
<blockquote>
<p>I think we’ve got to take it down to Years 3 and 4 and be a lot more specific than we have been, because you are going to get more and more being younger.</p>
</blockquote>
<p>However, several participants shared apprehension around having discussions about periods with young students. As one teacher explained: </p>
<blockquote>
<p>You don’t want to scare young girls, like seven-and eight-year-olds […] if it is happening earlier, it needs to be talked about earlier. But that’s a hard one because a lot of girls […] aren’t really mature enough to understand […]</p>
</blockquote>
<p>Another teacher said that talking about periods in Year 3 was “probably a bit too much […] you don’t want to traumatise the child”.</p>
<p>Gatekeeping knowledge and awareness about periods from younger children is a problem on multiple levels. For one, it can deprive children of vital information about their bodies. For another, it frames menstruation as something inherently inappropriate, scary or crude. This in turn can reinforce stigma and taboo.</p>
<h2>Can we tell boys about this?</h2>
<p>Staff also spoke about how boys were not necessarily included in lessons about periods, and how male teachers may not have experience talking about these issues. As one teacher told us: </p>
<blockquote>
<p>It is a discussion that’s been done where they don’t really include the boys in it […].</p>
</blockquote>
<p>School staff also raised concerns that teaching boys about menstruation might present an opportunity for bullying or teasing. One school support officer suggested only girls should be taught about periods, noting:</p>
<blockquote>
<p>they [boys] might be like ‘oh, I found your pad!‘</p>
</blockquote>
<p>However, separating classrooms by gender for these lessons does not encourage the normalisation of periods. A <a href="https://link.springer.com/article/10.1007/s11199-016-0701-3">2016 study</a> explored the attitudes of 48 Australian men towards menstruation. Participants reported being told little or nothing about periods while growing up, and so they grew up believing it was taboo.</p>
<p>Other teachers in our study noted how important it was for male students to be taught about periods. </p>
<blockquote>
<p>I found it really frustrating that we’re giving young men who are eventually going to be in workplaces and potentially in positions of leadership, who are being deprived of these matter-of-fact moments of teaching [about menstruation] where they’re going to sort of pick up these things through like hearsay, through sort of uneducated conversation […]</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-periods-can-come-as-a-shock-5-ways-to-support-your-kid-when-they-get-theirs-177920">First periods can come as a shock. 5 ways to support your kid when they get theirs</a>
</strong>
</em>
</p>
<hr>
<h2>What needs to happen instead?</h2>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/14681811.2023.2275595">study emphasises</a> how a lack of timely and comprehensive education and support for early menstruators in Australian schools is underpinned by menstrual stigma and taboo. </p>
<p>But it also showed how the issue is driven by perceptions of children’s capacity to learn about periods, based on their age and gender.</p>
<p>This research highlights the need for the Australian curriculum to introduce specific menstruation education by at least Year 3 or earlier. The curriculum needs to explain what menstruation is, why it happens, the ways it can be managed and how it will begin happening to their peers and that this is normal.</p>
<p>In the meantime, we encourage all school staff to work towards building menstrual wellbeing by becoming comfortable discussing periods with all students, make period products accessible to all year levels in all bathrooms, and advertise free period product locations to students from Year 3. </p>
<p>This will enable all children who menstruate to manage their periods in school easily and without shame.</p><img src="https://counter.theconversation.com/content/222887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Shipman receives funding from Flinders Foundation. </span></em></p><p class="fine-print"><em><span>Olivia Bellas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In Australia, the average age of first period is about 13. But about 12% of children get their period between the ages of eight and eleven.Olivia Bellas, PhD Candidate, University of AdelaideJessica Shipman, Senior lecturer, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2203122024-01-23T13:57:59Z2024-01-23T13:57:59ZWhy your period symptoms might be worse in the winter<figure><img src="https://images.theconversation.com/files/570844/original/file-20240123-19-dn93f6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms such as fatigue, irritability, poor concentration and a weaker immune system may be pointing to iron deficiency.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-lying-on-sofa-looking-2249910765">Photoroyalty/ Shutterstock</a></span></figcaption></figure><p>Period symptoms are frustrating no matter the time of year. But those who menstruate might feel like certain symptoms are worse during the winter months, when the weather is gloomy, the days are short and cold and flu seem to always be lurking. This phenomenon has even been dubbed “<a href="https://www.huffingtonpost.co.uk/entry/winter-weather-period-fatigue_uk_652fae8fe4b03b213b07e33e">winter period fatigue syndrome</a>”.</p>
<p>Unfortunately, there’s no evidence that such a thing as winter period fatigue syndrome exists. There’s also no good evidence to suggest changes in the seasons can worsen period symptoms. But that doesn’t mean there isn’t a scientific explanation for why you might feel some of your period symptoms are worse during the colder months.</p>
<p>Symptoms such as fatigue, irritability, poor concentration and a weaker immune system, may in fact be pointing to the more obvious cause of <a href="https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/signs-symptoms">iron deficiency</a>.</p>
<hr>
<p><br>
<br>
<em>This piece was published by <a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+R292024&utm_content=InArticleTop">The Conversation</a> as part of Taking Care, <a href="https://www.refinery29.com/en-gb/taking-care-of-health">Refinery29</a>’s health and wellness hub.</em></p>
<hr>
<p>The body needs iron in order to function. Iron helps produce red blood cells, which carry oxygen throughout the body. But many people don’t get enough iron in their diet. In fact, iron deficiency is the <a href="https://pubmed.ncbi.nlm.nih.gov/35427520">most common nutritional deficiency</a> in the world.</p>
<p>Alongside the symptoms that iron deficiency can cause, low iron can also lead to <a href="https://www.who.int/news-room/fact-sheets/detail/anaemia">anaemia</a> – a fall in <a href="https://www.who.int/health-topics/anaemia#tab=tab_1">red blood cell count</a>. While the symptoms of anaemia can be very similar to those caused by iron deficiency (including fatigue, tiredness, and cold hands and feet), symptoms can be more severe, too – leading to heart palpitations, shortness of breath and even loss of consciousness.</p>
<p>Menstruation is a leading cause of both iron deficiency and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00127-9/fulltext">anaemia</a>. People with <a href="https://www.nhs.uk/conditions/heavy-periods/">heavy or prolonged periods</a> are particularly at risk as they regularly lose more blood each month than their body can replace. Some studies even estimate that in women who experience heavy periods, 90% are iron deficient and <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12394">60% are anaemic</a>.</p>
<figure class="align-center ">
<img alt="A woman with her period picks up a pink pad from a table." src="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heavy or prolonged periods put you at greater risk of iron deficiency and anaemia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/classic-comfort-menstrual-pads-black-woman-2300535095">Prostock-studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Those who normally have heavy periods might not realise that this could actually be the cause of their fatigue, irritability and difficulty concentrating. This is because so many who have heavy periods just <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997654/pdf/bjgpapr-2023-73-729-e294.pdf">assume their blood loss is normal</a>. But left unchecked, heavy periods can leave women and people who menstruate trapped in a vicious cycle of progressive blood loss and iron loss, leading to anaemia, which can be difficult to break.</p>
<p>And even though <a href="https://pubmed.ncbi.nlm.nih.gov/33247314/">many clinical guidelines</a> for managing heavy menstrual bleeding recognise the importance of treating iron deficiency and anaemia caused by excessive blood loss, these conditions are still <a href="https://www.figo.org/resources/figo-statements/iron-deficiency-and-anaemia-women-and-girls">often missed</a> – despite how treatable they are.</p>
<h2>Winter symptoms</h2>
<p>Many of the symptoms of iron deficiency and anaemia overlap with other health conditions. This is why it’s important to talk to your doctor as soon as symptoms start to make sure you’re getting the right treatment.</p>
<p>For example, fatigue, lethargy and changes in mood can also be symptoms of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349">seasonal affective disorder</a>. This is a type of depression that affects some people only in the autumn and winter.</p>
<p>So if you find your symptoms began when the shorter days and colder weather arrived, then exercise, self care (such as resting if you need to and getting plenty of sleep each night) and eating a balanced diet that contains plenty of fibre, complex carbs and protein <a href="https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/treatment">may help somewhat</a>. Your GP may also recommend talking therapy.</p>
<p>But if you find you have such symptoms all year round – and suffer from heavy or prolonged periods – this may be a sign you have iron deficiency. Certain symptoms of iron deficiency may also seem worse during the winter months. </p>
<p>Since iron deficiency affects how well your immune system functions, this could explain why you may feel you suffer from more seasonal illnesses during the colder weather. This will require a trip to the GP to be diagnosed, as well as taking an iron replacement if your doctor recommends it. This should significantly improve your quality of life and symptoms.</p><img src="https://counter.theconversation.com/content/220312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jahnavi Daru has worked as a consultant for the World Health Organization in the Department of Nutrition and Food Safety on projects related to maternal anaemia and has received grant funding from the National Institute for Health Research</span></em></p><p class="fine-print"><em><span>Ewelina Rogozinska receives funding from the National Institute for Health Research. </span></em></p><p class="fine-print"><em><span>Varsha Jain received funding from Wellbeing of Women. </span></em></p>Heavy periods are one of the leading causes of iron deficiency and anaemia.Jahnavi Daru, Senior lecturer in Women's Health, Queen Mary University of LondonEwelina Rogozinska, Research Fellow, MRC Clinical Trials Unit, UCLVarsha Jain, Clinical Research Fellow, MRC Centre for Reproductive Health, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183442023-12-21T23:19:57Z2023-12-21T23:19:57ZGot period pain or cramps? What to eat and avoid, according to science<figure><img src="https://images.theconversation.com/files/566750/original/file-20231219-27-7x7oaq.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938362/">Sora Shimazaki/Pexels</a></span></figcaption></figure><p>Painful periods are common. More than half of people who menstruate have some pain for up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">three days a month</a>, typically throbbing or cramping in the lower abdomen. </p>
<p>Digestive changes – such as vomiting, gas, bloating, diarrhoea and a “bubbling gut” – are also <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0538-8">common</a> around the time of menstruation. </p>
<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">treatments</a> for period pain (known medically as dysmenorrhoea). Not all these treatments are well-tolerated or work for everyone.</p>
<p>We’re learning more about food’s role in influencing <a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">inflammation</a> in our body. So, could eating or avoiding certain foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963185/">help</a> with painful periods? Here’s what we know based on high-quality research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may relieve period pain or cramps</h2>
<p><strong>Foods containing omega-3 fatty acids</strong></p>
<p>Foods rich in omega-3 fatty acids include chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters and edamame beans. Omega-3 fatty acids are naturally present in oils including fish, cod liver, algal, krill, flaxseed (linseed), soybean and canola oils.</p>
<p>Omega-3 fatty acids <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/">affect</a> how our cells function and the signalling pathways associated with inflammation and pain. </p>
<p>Earlier this year, researchers published a <a href="https://pubmed.ncbi.nlm.nih.gov/37545015/#:%7E:text=Meta%2Danalysis%20(n%20%3D%208,0.51)%20at%20reducing%20dysmenorrhoea%20pain.">meta-analysis</a> where they combined and analysed all data available on the impact of omega-3 fatty acids on period pain. They found diets high in omega-3 fatty acids (including supplements of 300-1,800 milligrams a day) over two to three months may reduce pain, and pain medication use, in people with painful periods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open sardine can, parsley, cut lemon on wooden table." src="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sardines and other oily fish are rich in omega-3 fatty acids.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/open-can-sardines-preserves-oil-on-1636046179">BearFotos/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-fish-oil-supplements-as-healthy-as-we-think-and-is-eating-fish-better-212250">Are fish oil supplements as healthy as we think? And is eating fish better?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin D</strong></p>
<p>Foods high in vitamin D include trout, salmon, tuna and mackerel, as well as fish liver oils. Small amounts are also found in beef liver, egg yolk and cheese. Mushrooms contain varying levels of vitamin D, and you can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/">boost</a> this by exposing them to direct midday sunlight for 15-120 minutes. </p>
<p>The body can make vitamin D when it gets sunlight exposure and you can also get vitamin D from supplements.</p>
<p>Vitamin D <a href="https://pubmed.ncbi.nlm.nih.gov/24262718/">may help</a> reduce the factors that cause inflammation in the uterus. This includes levels of hormone-like molecules called prostaglandins. </p>
<p>A 2023 <a href="https://www.mdpi.com/2072-6643/15/13/2830#B11-nutrients-15-02830">meta-analysis</a> showed women who received weekly doses of vitamin D greater than 50,000 IU (or international units) had relief from period pain, regardless of how long and how often women took the vitamin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin E</strong></p>
<p>Foods rich in vitamin E include seeds (particularly sunflower seeds), nuts (particularly almonds, hazelnuts and peanuts) and spinach, broccoli, kiwifruit, mango and tomato. </p>
<p>There is some evidence vitamin E supplements reduce period pain. In a well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/15777446/">trial</a> run over the course of four periods, women took vitamin E supplements (90 milligrams, twice a day) for five days, beginning two days before the expected start of the period. This significantly reduced the severity and duration of period pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman tipping out nut mix into palm of hand" src="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Seeds and nuts are rich in vitamin E.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-jar-nuts-dried-fruits-1112521214">NazarBazar/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may worsen period pain or cramps</h2>
<p><strong>Highly processed foods</strong></p>
<p>Highly processed foods include energy-dense, nutrient-poor foods such as takeaways, chips, biscuits, doughnuts, processed meats and soft drinks. </p>
<p>Research findings on the impact of a diet high in processed foods on period pain vary. A 2019 <a href="https://karger.com/goi/article/84/3/209/153726/Nutrition-as-a-Potential-Factor-of-Primary">review</a> found sugar consumption had little association with painful periods. </p>
<p>However, some observational studies (which do not involve an intervention) suggest women who eat more processed foods may have more intense period pain. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/19468949/">2009 study</a> found adolescent females who ate fast or processed foods for two days or more a week reported more period pain compared with those who did not. Therefore, eating less processed food may be something to consider. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<p><strong>Caffeine</strong></p>
<p>Foods high in caffeine include coffee, energy drinks and some processed energy bars. Caffeine intake is <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwij7LmPxfSCAxV5d_UHHRnyDyUQFnoECBIQAQ&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4222008%2F&usg=AOvVaw2mEjyMadOB1D6geQgAwckc&opi=89978449">associated with</a> menstrual pain. </p>
<p>Although we don’t know the precise underlying mechanism, researchers think caffeine may narrow blood vessels, which limits blood flow, leading to stronger cramps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired woman staring at bowl of breakfast, cereal and cup on kitchen table" src="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding coffee may help your period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-does-not-want-eat-her-151886987">Lolostock/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">Nope, coffee won't give you extra energy. It'll just borrow a bit that you'll pay for later</a>
</strong>
</em>
</p>
<hr>
<p><strong>Alcohol</strong></p>
<p>Drinking alcohol is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859868/">not</a> a recognised risk factor for painful periods. However, chronic heavy alcohol use reduces levels of <a href="https://academic.oup.com/alcalc/article/55/2/164/5734241">magnesium</a> in the blood. Magnesium is an important factor in relaxing muscles and supporting blood flow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
</strong>
</em>
</p>
<hr>
<h2>A healthy, balanced diet is your best best</h2>
<p>Having a healthy, balanced diet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">one of the best ways</a> we can support our own health and prevent future chronic conditions. This can help reduce inflammation in our bodies, thought to be the main way diet can help people with painful periods.</p>
<p>If you are looking for tailored dietary advice or a menstrual health meal plan, speak with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitian</a>.</p>
<p>It’s important to stress, however, that diet alone cannot treat all forms of menstrual pain. So if you are concerned about your painful periods, check in with your GP who can discuss your options.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
</strong>
</em>
</p>
<hr>
<p><em>This article has been updated to reflect the correct date of a review that found sugar consumption had little association with painful periods.</em></p><img src="https://counter.theconversation.com/content/218344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch is an Accredited Practising Dietitian and member of Dietitians Australia. She works for Southern Cross University. </span></em></p><p class="fine-print"><em><span>Pui Ting Wong is a PhD Candidate at The University Queensland (UQ) Centre for Community Health and Wellbeing, and receives the UQ Tuition Fee Offset and Stipend Scholarship. She is also an Accredited Practising Dietitian and a member of Dietitians Australia.</span></em></p>A cup of coffee might help you kick-start your day, but it may actually make painful periods worse. Here’s what else to avoid (and eat) if you have period pain.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Lecturer, Southern Cross UniversityPui Ting Wong, PhD Candidate, culinary education and adolescent mental health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114182023-09-05T20:06:11Z2023-09-05T20:06:11ZHow much period blood is ‘normal’? And which sanitary product holds the most blood?<figure><img src="https://images.theconversation.com/files/544687/original/file-20230825-19-mnnz4r.jpg?ixlib=rb-1.1.0&rect=26%2C17%2C5881%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-hand-reusable-menstrual-disc-on-2331704445">Shutterstock</a></span></figcaption></figure><p>Heavy menstrual bleeding or heavy periods affect up to a <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Heavy-Menstrual-Bleeding-Clinical-Care-Standard.pdf">quarter of women</a> and people who menstruate, and <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">can impact quality of life</a>. Women who have had heavy periods for a long time often consider this normal, or <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">something to be simply put up with</a>. </p>
<p>Diagnosing heavy periods has traditionally been based on the nature of bleeding. Women might describe bleeding through clothing, having to change pads and tampons every two hours or sooner, or passing clots larger than a 50 cent coin. Doctors consider a woman to have heavy periods if she <a href="https://www.ncbi.nlm.nih.gov/books/NBK279294/#:%7E:text=Doctors%20consider%20a%20woman%20to,fitness%20and%20other%20individual%20factors.">regularly loses more than 80 millilitres of blood</a> during one menstrual period. That’s four Australian tablespoons’ worth. Women diagnosed with heavy bleeding should follow up with their doctor to establish the cause of their bleeding and guide treatment. </p>
<p>But estimating blood loss and getting a sense of when it’s outside the normal range can be difficult. Recent research on how best to manage menstrual blood could help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">Heavy periods are common. What can you do, and when should you seek help?</a>
</strong>
</em>
</p>
<hr>
<h2>More period options than ever</h2>
<p>There are now a variety of menstrual products for women to choose from.</p>
<p>These include disposable pads and tampons, as well as reusable products such as menstrual cups and discs, washable pads and period underwear. There are multiple factors which influence choice of menstrual product, including comfort, cost, capacity, environmental benefits and <a href="https://www.healthdirect.gov.au/toxic-shock-syndrome">potential health risks</a>. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2468784721001987?via%3Dihub">2022 French survey</a> of over 1,100 women showed traditional sanitary protection was still the most widely used there (81% used disposable pads and 46% used tampons) but 16% of respondents were using alternative products. A <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02197-3">recent study in Victoria</a> indicated many young people are choosing reusable products, with environmental impacts an important motivator. </p>
<p>Another benefit of reusable <a href="https://www.healthline.com/health/menstrual-cup-dangers#cups-vs-pads-and-tampons">menstrual cups</a> and <a href="https://www.healthline.com/health/menstrual-disc">menstrual discs</a> is they can remain in the vagina for up to 12 hours. A menstrual cup sits in the vagina below the cervix and extends into the canal. A menstrual disc, on the other hand, fits back into the vaginal fornix, which is where your vaginal canal meets your cervix. Discs are usually wider and shallower than cups and <a href="https://pubmed.ncbi.nlm.nih.gov/36791417/">can be worn during sex</a>. There are now reusable and disposable options for menstrual discs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line diagrams of various menstrual products: pads, tampons, cups, discs" src="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=137&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=137&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=137&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=172&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=172&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=172&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/simple-minimalist-lineart-period-products-including-2193917377">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-anyone-have-a-pad-tv-is-finally-dismantling-the-period-taboo-122258">Does anyone have a pad? TV is finally dismantling the period taboo</a>
</strong>
</em>
</p>
<hr>
<h2>What holds the most blood?</h2>
<p>There has been very limited research into the maximum capacity of different menstrual products. Manufacturers can report collection capacity of their products using liquids such as water. </p>
<p>A <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">recent research study from the United States</a> aimed to more accurately measure the capacity of menstrual products in the laboratory using expired donated human blood, which is more similar to menstrual blood. </p>
<p>Some 21 different menstrual products were tested in the study. Menstrual discs showed the greatest capacity (61ml on average) and period underwear held the least (2ml on average). </p>
<p>Tampons, pads, and menstrual cups held similar amounts of blood (approximately 20–50mL). The authors noted it is difficult to accurately approximate capacity for patients with heavy menstrual bleeding due to “flooding” (high-velocity flow) and passing clots. </p>
<p>The comparison shows period underwear, despite its advertised capacity, may actually only absorb a small amount of blood and very slowly. Women with heavy periods tend to use period underwear as “back up” for another method. </p>
<h2>We need a standardised scale for menstrual bleeding</h2>
<p>Currently, the ways to determine whether someone is having heavy menstrual bleeding is through asking detailed questions and using the <a href="https://www.rch.org.au/uploadedFiles/Main/Content/rch_gynaecology/PBAC.pdf">Pictorial Blood Loss Assessment Chart</a>, which relates to the saturation of menstrual pads and tampons. </p>
<p>The overall impact of the heaviness of menstrual bleeding on a woman’s quality of life is also important. </p>
<p>Even with pads and tampons, there is significant variability in terms of capacity. The introduction of newer products potentially introduces more confusion, with both users and clinicians uncertain about the storage capacity of each category of product, and specific brands within these categories. </p>
<p>With heavy menstrual bleeding often <a href="https://pubmed.ncbi.nlm.nih.gov/33840528/">underdiagnosed and undertreated</a>, clinicians need to ask specifically about the menstrual products used and how they are used to better understand a person’s bleeding patterns. The fresh US research could help women and their doctors better assess the heaviness of their periods. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
</strong>
</em>
</p>
<hr>
<h2>3 tips for managing heavy flow</h2>
<ul>
<li><p><strong>1. Experiment with period products.</strong> It may be good to try out different types of products (and even different products in the same category) to find the ones that suit you best. The advertised capacity of each product may not ring true with your own experience, due to the nature of your flow (particularly if it is heavy or “gushes”). </p></li>
<li><p><strong>2. Monitor the heaviness of your period.</strong> The capacity of different menstrual products varies widely. Menstrual discs have very high storage capacity in comparison to other products. That can actually lead to an underestimation of menstrual loss. Looking up the storage capacity of each product can help you work out whether you are having heavy periods or not, even though we know this may be based on liquids like water. This information can be found on the product website or the <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">new study</a>. </p></li>
<li><p><strong>3. When to seek medical advice.</strong> If you think you might be having heavy periods, feel tired or dizzy during your period, or you feel your periods are interfering with your life, talk to your GP or other healthcare professional. It can help to track the heaviness of your periods and how often you are changing your period product and to bring this record to your appointment. Your GP can <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">talk to you about treatment</a> with medications (both hormonal and non-hormonal) and other management options.</p></li>
</ul><img src="https://counter.theconversation.com/content/211418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Working out how much blood you’re losing and getting a sense of when it’s outside the normal range can be difficult. Recent research on the capacity of different period products could help.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyBianca Cannon, GP and Lecturer at Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085022023-09-05T12:56:59Z2023-09-05T12:56:59ZFive ways to take control of your menstrual cycle and improve your sports performance<figure><img src="https://images.theconversation.com/files/542580/original/file-20230814-25-aydj9i.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taking a proactive approach to your menstrual cycle can help promote your sports performance every day.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-young-woman-lifting-barbells-looking-417189208">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Menstruation is often seen as a negative experience, with symptoms that can be disruptive to daily life. Participation in sport and physical activity is particularly affected, with <a href="https://womeninsport.org/press-release/more-than-1-million-teenage-girls-fall-out-of-love-with-sport/#:%7E:text=Women%20in%20Sport's%20research%20found,them%20take%20part%20in%20activity.">78%</a> of teenage girls reporting they avoid exercise while on their period. </p>
<p>Elite athletes have also <a href="https://www.bbc.co.uk/sport/53705777">reported</a> their performance is negatively affected by their period. So, how do we reduce or manage period-related symptoms? The first step is understanding our menstrual cycle.</p>
<p>There are <a href="https://optimalperiod.com/menstrual-cycle-101/">phases of the menstrual cycle</a>, based upon hormonal fluctuations, where certain symptoms are more frequently experienced. The two main phases are the follicular phase and the luteal phase and they are divided by ovulation. A menstrual cycle should last between 21 and 35 days, with menstruation indicating day one of the cycle and the number of days until the next bleed. Ovulation is approximately half way through the cycle.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
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</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>This is different for those taking hormonal contraceptives, as their natural hormone levels are suppressed by the synthetic hormones and any bleed is known as a “withdrawal bleed”, which is not equivalent to a period.</p>
<p>During the follicular phase, hormone levels are low to begin with. The first three to five days are the time of menstruation and an increase in oestrogen occurs prior to ovulation. For some, this phase provides many positive symptoms of increased confidence, energy and motivation. </p>
<p>After ovulation, hormone levels are higher, with a peak in progesterone and a secondary peak in oestrogen. It is during this time that the menstrual cycle is frequently associated with negative symptoms such as bloating, fatigue and changes in mood.</p>
<p>But we know that menstrual-related symptoms can be improved through diet, sleep, reducing stress and exercising. So taking a proactive approach can help to promote sports performance on every day of the menstrual cycle.</p>
<figure class="align-center ">
<img alt="A hand holds a smartphone which is displaying a menstrual calendar app." src="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are apps which can help you track your menstrual symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tracking-periods-by-using-menstrual-1940658049">Kaspars Grinvalds/Shutterstock</a></span>
</figcaption>
</figure>
<h2>1. Track your cycle</h2>
<p>Tracking your menstrual cycle and related symptoms is crucial to taking a proactive approach. Note the first day of your period to check you are having a regular cycle. This is an <a href="https://pubmed.ncbi.nlm.nih.gov/32707266/">important marker</a> for both reproductive and holistic health. </p>
<p>Record any <a href="https://optimalperiod.com/menstrual-cycle-101/">symptoms</a> such as stomach cramps, fatigue and tiredness, changes in mood, anxiety and breast tenderness, along with life events. This helps to determine what’s caused by the menstrual cycle as opposed to other factors. </p>
<p>Complete this for at least three cycles to identify your own pattern. Everyone has a unique experience of the menstrual cycle and related symptoms. </p>
<p>See a doctor if your cycle consistently lasts less than 21 days, is longer than 35 days or absent for three months or more, after the first two years of having periods. If any symptoms are debilitating and affect your daily activities, this is not normal and you need to seek medical advice.</p>
<h2>2. Improve your diet and hydration</h2>
<p>Eat a <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/">well-balanced diet</a>, because this will help give you the energy for training and sport, while also reducing bloating and managing <a href="https://optimalperiod.com/exploring-symptoms-3-what-causes-food-cravings-with-top-tips-on-management/">cravings</a>. </p>
<p>If you train hard, ensure you are <a href="https://optimalperiod.com/wp-content/uploads/2023/02/FAH-carbohydate.pdf">fuelling your training</a> appropriately to support your menstrual cycle. This changes according to what activity you’re participating in. For example, for high intensity workouts, you will need some quick releasing carbohydrate such as a banana or an energy drink during your session, as well as before and after.</p>
<p>If you can, don’t eat too many processed foods such as takeaways, sugary drinks and crisps. Try to eat at least five portions of fruit and vegetables every day. Batch cooking meals can help achieve this – have food prepared in the freezer ready for when you are tired, lacking motivation or short on time. </p>
<p>Drinking plenty of water is also important, as it will help to reduce bloating. </p>
<h2>3. Get better sleep</h2>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079200901382">Sleep</a> is vital because a lack of sleep or poor sleep quality can make many menstrual cycle-related symptoms <a href="https://www.semanticscholar.org/paper/The-Relationship-of-Premenstrual-Syndrome-Symptoms-A%C5%9Fc%C4%B1-G%C3%B6kdemir/cb2222a23d05cf64f804bbcab9a2d730437b6176">worse</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988893/">Sleep hygiene</a> strategies can help prevent symptoms. These include going to bed and getting up at a similar time each day, starting the day with sunlight and limiting your caffeine intake (especially in the afternoon).</p>
<h2>4. Reduce your stress</h2>
<p><a href="https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/">Stress</a> increases the severity and duration of symptoms related to the menstrual cycle and is therefore an important factor to manage. </p>
<p>This is individual and finding a strategy that works for you will differ from person to person. Some ways to reduce stress could include socialising with friends, or meditating. Plan these in advance to prevent stress rather than reacting once you are already stressed.</p>
<h2>5. Stay active</h2>
<p>Sometimes getting to training is the hardest part when experiencing menstrual-related symptoms. Consider other activities such as walking or yoga to manage symptoms like stomach cramps while you are implementing the above strategies. And if there are days when you have more energy and motivation, maximise them while you are getting to understand your menstrual cycle.</p>
<p>You can use heat and pain relief for symptoms such as stomach cramps. Have these to hand if stomach cramps are affecting your ability to train around the time of menstruation. You could also speak to your trainer to adapt a session if required.</p>
<p>The menstrual cycle has long been seen as a negative thing. And there has not been enough information on how to manage symptoms. But we must change that narrative. Symptoms can be managed or reduced so you can continue to participate in sports and other activities. Don’t feel ashamed of your period – take control and be proactive in managing it.</p><img src="https://counter.theconversation.com/content/208502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Brown is affiliated with Arc'Teryx. </span></em></p>Understanding our menstrual cycle and taking a proactive approach to our periods is vital to improving sports performance.Natalie Brown, Research officer for the Welsh Institute of Performance Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2069672023-08-22T11:37:31Z2023-08-22T11:37:31Z‘Dirty red’: how periods have been stigmatised through history to the modern day<figure><img src="https://images.theconversation.com/files/534079/original/file-20230626-18276-xgl2o6.jpg?ixlib=rb-1.1.0&rect=32%2C0%2C3648%2C2424&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/feminine-hygiene-tampons-on-red-background-2101295386">IKagadiy/Shutterstock</a></span></figcaption></figure><p>About a year ago, at a friend’s wedding, a fellow guest asked whether I knew that modern sanitary towels owe their origins to resourceful World War I field nurses who discovered the efficacy of <a href="https://graphics.wsj.com/100-legacies-from-world-war-1/sanitary-products">repurposing military bandages</a> as period pads. I did not.</p>
<p>As a historian interested in the relationship between technology and the body – and someone who menstruates – the conversation had me wondering why I’d never considered the evolution of menstrual products. The answer, I believe, lies in the pervasive <a href="https://www.ncbi.nlm.nih.gov/books/NBK565666/">culture of shame</a> that has long surrounded menstruation, stifling open dialogue around the subject.</p>
<p>That, I thought, must change. So, I embarked on a <a href="https://universityofleeds.medium.com/challenging-taboo-why-its-time-to-put-periods-in-plain-sight-1a34f5622219">research project</a> with a team of colleagues at the University of Leeds into the history of menstrual stigma.</p>
<p>What we’ve discovered so far are examples of stigma and shame surrounding periods from many thousands of years ago through to the modern day.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>Not a new problem</h2>
<p>A frequently cited example of menstrual stigma is the Bible’s <a href="https://www.christianity.com/bible/kjv/leviticus/15-19-33">Leviticus chapter 15, verses 19-33</a>. This passage asserts that women (along with anything they lie or sit on) become “unclean” during menstruation. If a non-menstruating person touches either the menstrual blood, or anything the woman has touched, they too will become unclean. </p>
<p>This association between menstruation and corruption (not just of the menstruating person, but also of people and objects around them) has been persistent among male scholars through history. </p>
<p>For example, writing around AD70, <a href="https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.02.0137%3Abook%3D28%3Achapter%3D23">Pliny the Elder</a> says menstruation “is productive of the most monstrous effects”. He writes that crops “will wither and die”, and bees “will forsake their hives if touched by a menstruous woman”. </p>
<p>In the seventh century AD, <a href="https://sfponline.org/Uploads/2002/st%20isidore%20in%20english.pdf">Isidore of Seville</a> expanded on Pliny’s accusations, claiming: </p>
<blockquote>
<p>If they are touched by the blood of the menses, crops cease to sprout, unfermented wine turns sour, plants wither, [and] trees lose their fruit. </p>
</blockquote>
<p>Even as late as 1694, we find <a href="https://quod.lib.umich.edu/e/eebo2/B26427.0001.001?view=toc">books on midwifery</a> that liken menstruating women to the cockatrice (a mythical beast with venomous breath) on account of their allegedly shared ability to disperse poison through the air. </p>
<h2>From history to today</h2>
<p>Unfortunately, discussions of menstruation have continued to reinforce shame around the issue through the 20th and 21st centuries, <a href="https://www.tandfonline.com/doi/full/10.1080/23293691.2022.2124041">portraying periods</a> as something to be embarrassed about and to be kept hidden.</p>
<p>In 1950, Good Housekeeping, the popular women’s magazine, <a href="https://repository.duke.edu/dc/adaccess/BH0132">published an advert</a> for Modess’ newly packaged sanitary towels, which read: “So skilfully shaped not to look like a napkin box, that the sharpest eyes couldn’t guess what’s inside the wrapping.”</p>
<p>Although the tone of this advertisement is upbeat and chatty, it reinforces the idea that menstrual products should be kept hidden. Some 70 years later, in 2020, Tampax was <a href="https://www.dailymail.co.uk/femail/article-8986283/Tamax-blasted-stigmatising-silent-wrappers-promise-discretion-opening-tampons.html">criticised</a> for <a href="https://tampax.co.uk/en-gb/our-tampons/pearl-compak-with-applicator/regular/">advertising tampons</a> that “open silently for full discretion”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/solving-period-poverty-is-about-more-than-just-making-products-free-195245">Solving period poverty is about more than just making products free</a>
</strong>
</em>
</p>
<hr>
<p>Another example of the stigmatisation of menstruation can be seen in the long history of euphemisms. A <a href="https://www.tandfonline.com/doi/pdf/10.1080/00437956.1948.11659341">study published in 1948</a> identified a range of harmful menstrual euphemisms including “the curse”, “dirty red” and describing a woman as “in season”. </p>
<p>A <a href="https://link.springer.com/article/10.1007/BF00287209">similar study</a> from 1975 discussed 128 menstrual euphemisms, many of which are still used today (such as “Aunt Flo” and “on the rag”). While some of these euphemisms might provoke a giggle (my personal favourite being “riding the cotton pony”), they’re designed to obscure discussions of menstruation and, in doing so, they reinforce the shame that surrounds it.</p>
<h2>The harms of stigma</h2>
<p>This long history of menstrual stigma continues to inform contemporary culture, having a negative effect on people who menstruate today. In 2021, a group of researchers <a href="https://www.webofscience.com/wos/woscc/full-record/WOS:000678124300032?SID=EUW1ED0CDDKqxdvp1VlfLU9D6rBGE">concluded</a> that feelings of stigma and shame perpetuate the expectation that people should hide their menstruation.</p>
<p>This may take the form of hiding sanitary supplies at school and at work, or concealing symptoms of menstruation, for example.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Periods remain stigmatised today.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-sad-africanamerican-teen-student-sitting-2196946065">nimito/Shutterstock</a></span>
</figcaption>
</figure>
<p>We know this secrecy prevents people from identifying when their experiences of menstruation are unusual and from subsequently seeking healthcare. For example, a <a href="https://plan-uk.org/media-centre/girls-too-embarrassed-to-see-their-gp-about-period-related-symptoms-survey-reveals">2018 survey</a> found that 79% of girls and young women had faced symptoms linked to their period that concerned them, but they hadn’t seen a doctor or health professional. </p>
<p>Similarly, <a href="https://www.endometriosis-uk.org/press-release-time-end-stigma">statistics from charity Endometriosis UK</a> reveal that 62% of women aged 16-54 would put off going to a doctor with symptoms of endometriosis because they don’t think it’s serious enough to bother a doctor with, or they’d be embarrassed, or don’t think they’d be taken seriously, or think symptoms including painful periods are normal.</p>
<h2>What can we do?</h2>
<p>Stigma around menstruation is deeply entrenched in society. But there are numerous small actions each of us can take, which collectively can make a significant difference. First of all, we can all (irrespective of age, gender or sexuality) embrace open conversations about menstruation. </p>
<p>We can discard the use of menstrual euphemisms, as continually relying on these perpetuates the notion that this natural bodily function should remain concealed and shrouded in shame.</p>
<p>We can also use our collective voices, for example by engaging with companies on social media, to demand a more truthful portrayal of menstruation in the media (such as, as Kotex has done, banishing the absurdity of using blue liquid to <a href="https://www.wsj.com/articles/kotex-decides-womens-blood-is-red-not-blue-11579800492">demonstrate their products</a>).</p>
<p>Of course, we also need to do work on a larger scale. We need to tackle period poverty, ensure access to clean water and private toilets, and encourage employers to develop positive menstrual policies. </p>
<p>But we can start by talking. If we can end the secrecy and silence that has long surrounded menstruation, we can begin to create a future that empowers all who menstruate.</p><img src="https://counter.theconversation.com/content/206967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Gillibrand receives funding from the Leeds Arts and Humanities Research Institute, University of Leeds. With thanks to Katie Carpenter, Sophie Turbutt, and Claire Turner for their work on the ‘Stigma and Shame? Challenging Menstrual Taboo Through Time’ project.</span></em></p>Stigma and shame around menstruation can be found as far back as the Bible.Rachael Gillibrand, Lecturer in Premodern History, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2090042023-08-18T10:06:20Z2023-08-18T10:06:20ZHow tracking menopause symptoms can give women more control over their health<figure><img src="https://images.theconversation.com/files/540127/original/file-20230731-234595-td2ntl.jpg?ixlib=rb-1.1.0&rect=32%2C5%2C3566%2C2343&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can track your menopause symptoms by using an app, a dedicated website or a diary. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ny-usa-2-may2022young-fitness-woman-2157077103">Krotnakro/Shutterstock</a></span></figcaption></figure><p>Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them.</p>
<p>People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. </p>
<p>The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important.</p>
<figure class="align-center ">
<img alt="A word cloud displaying the symptoms of menopause." src="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/menopause-symptoms-tags-cloud-estrogen-level-1017507085">Double Brain/Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry.</p>
<p>There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. </p>
<p>The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. </p>
<p>As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. </p>
<p>One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” </p>
<h2>Why does monitoring symptoms help?</h2>
<p>One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. </p>
<p>Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms.</p>
<p>Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. </p>
<p>Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. </p>
<p>Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.</p><img src="https://counter.theconversation.com/content/209004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lancastle consults to Gedeon Richter, Theramex, Merck Serono and Health and Her. The links with Theramex and Merck Serono are prior to 2020.
She has received honoraria and expenses from Gedeon Richter, Theramex, and Merck Serono for presentations and CPD events. The menopausal symptom monitoring research was funded by a KESS studentship for my PhD student (Robin Andrews), which included company partner funding from Health and Her, and I have provided web-support articles for Health and Her. The studies discussed in this article did not involve Health and Her clients and was not administered via the Health and Her organisation. Health and Her were not involved in the analysis or write up of the studies discussed in this article. </span></em></p>Tracking the many physical and emotional symptoms of menopause with a website, app or diary can help women better monitor their health.Deborah Lancastle, Associate Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067002023-07-23T19:58:45Z2023-07-23T19:58:45ZDoes a woman’s menstrual cycle affect her athletic performance? Here’s what the science says<p>During the Women’s FIFA World Cup, it has been wonderful to see the spotlight turn to female athletes. </p>
<p>There’s always been <a href="https://pubmed.ncbi.nlm.nih.gov/24766579/">more research on male athletes</a> compared to female athletes, but the gap is narrowing. </p>
<p>One thing we still don’t know enough about is the effect of the menstrual cycle on athletic performance. </p>
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Read more:
<a href="https://theconversation.com/explainer-why-do-women-menstruate-13744">Explainer: why do women menstruate?</a>
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</em>
</p>
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<h2>What does the menstrual cycle do to a woman’s body?</h2>
<p>The menstrual cycle is a complex cascade of events typically lasting 28 days. The primary female sex hormones oestrogen and progesterone rise and fall as the body cycles through four phases, beginning at menstruation, maturation and releasing of an egg (ovulation), preparation for pregnancy, and restarting the cycle if the egg is not fertilised.</p>
<p>Fluctuations in female sex hormones have been associated with changes in inflammation, metabolism, muscle activation and body composition, which <a href="https://pubmed.ncbi.nlm.nih.gov/33572406/">can influence athletic performance</a>. </p>
<p>For instance, <a href="https://pubmed.ncbi.nlm.nih.gov/22306563/">inflammation decreases</a> when the body is preparing to ovulate, reaching its lowest point around ovulation. It then increases following ovulation and peaks during menstruation. </p>
<p>This peak coincides with lower perceived performance among many female athletes.</p>
<p>The menstrual cycle can also give rise to symptoms including pain, cramps, weakness, and poor sleep and focus, <a href="https://pubmed.ncbi.nlm.nih.gov/35911030/">challenging performance</a> during training and competition. </p>
<p>For example, <a href="https://doi.org/10.1080/24733938.2021.2020330">research</a> conducted in elite female soccer players found over 87% of players perceived reduced power and increased fatigue during menstruation, while over 66% perceived their reaction time and recovery to be affected.</p>
<p>Considering the approximate maximum career length of soccer players (21 years) and a woman’s fertile life, that adds up to about 250 times throughout a woman’s soccer career that performance may be compromised. </p>
<p>Trends observed among female soccer players closely mirror the experiences of other female athletes, with over <a href="https://pubmed.ncbi.nlm.nih.gov/37389782/#:%7E:text=Results%3A%20Sixty%20studies%20involving%206380,the%20most%20prevalent%20MC%20disorder">74% reporting</a> negative effects mainly during the first days of menstruation. </p>
<p>For some, this may lead to reduced training participation, potentially compromising skill development, fitness levels, and even their chances of being selected for competition. </p>
<p>But the menstrual cycle is complex, and its effects can vary between athletes and sports. Consequently there is disagreement regarding whether the menstrual cycle universally affects athletic performance, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076834/#:%7E:text=Findings%20suggest%20that%20strength%2Drelated,cause%20variations%20in%20strength%20performance">some research</a> <a href="https://pubmed.ncbi.nlm.nih.gov/32661839/">indicating</a> no influence of the menstrual cycle on certain performance measures. But these studies are few and had various logistical limitations, including a small number of participants.</p>
<p>Also important to note is that most studies to-date have excluded women using hormonal contraceptives, which is about <a href="https://pubmed.ncbi.nlm.nih.gov/29283683/">50% of female athletes</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35475746/#:%7E:text=Conclusion%3A%20Most%20WSL%20players%20do,minimise%20discomfort%20and%20maximise%20performance.">28% of female soccer players</a>. The use of hormonal contraceptives suppresses natural hormonal fluctuations and replaces them with external synthetic versions of female sex hormones, affecting the athlete differently. </p>
<p>Clearly the extent and severity to which the menstrual cycle impacts athletic performance is highly variable and complex, with more research needed. So for now it’s sensible to consider the effects of the menstrual cycle on an individual basis.</p>
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<strong>
Read more:
<a href="https://theconversation.com/supporting-menstrual-health-in-australia-means-more-than-just-throwing-pads-at-the-problem-161194">Supporting menstrual health in Australia means more than just throwing pads at the problem</a>
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<h2>How to support athletic performance at all cycle stages</h2>
<p>It’s essential for players to familiarise themselves with their own cycles to understand how they’re affected throughout, as well as communicate any menstrual cycle-related issues to support staff (physicians and coaches). This awareness can guide adjustments in training and nutrition when required.</p>
<p>For example, oestrogen has an important influence on iron levels in females, such as chronic oestrogen deficiency is <a href="https://pubmed.ncbi.nlm.nih.gov/23041085/">linked to iron deficiency</a>. Iron status can also be compromised by blood loss during menstruation, depending on the heaviness and duration of bleeding.</p>
<p>Iron is essential for human function, facilitating energy production and the transportation of oxygen around the body. In soccer, about <a href="https://pubmed.ncbi.nlm.nih.gov/16521852/#:%7E:text=Of%20the%20investigated%20female%20soccer,at%20the%20top%20international%20level">60% of elite female players</a> present as iron deficient, compared to <a href="https://pubmed.ncbi.nlm.nih.gov/18384395/">less than 12% of their male counterparts</a>. For an iron deficient midfielder, this might translate into covering less distance at lower speeds. </p>
<p>It’s therefore important female athletes have their iron levels regularly checked by qualified practitioners. Addressing deficiencies through diet, supplementation, or iron transfusions, will ensure athletic performance during training and competition is not compromised.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1631298254078894082"}"></div></p>
<p>Individual athletes’ training loads can also be strategically managed to accommodate severe menstrual symptoms. </p>
<p>Football clubs around the world have been <a href="https://www.tandfonline.com/doi/full/10.1080/24733938.2020.1828615">experimenting with this strategy</a> since it gained popularity during the 2019 Women’s FIFA World Cup. But how does it look in practice? </p>
<p>For team sport athletes, such as soccer players, this can be a demanding logistical task. It’s not easy to track the menstrual cycles of more than 25 players concurrently, and hold training sessions at convenient times for all of them. The complexities are heightened when training and game days cannot be avoided. </p>
<p>But performance coaches must consider athletes’ needs and ensure they’re prepared for competition, while minimising the risk of injury and menstrual discomfort. Coaches should also ensure athletes maintain adequate nutrition for both competition and to support their menstrual cycle. </p>
<p>For an athlete who reports severe menstrual symptoms during the first days of menstruation (such as increased pain and weakness), this might translate into reduced training intensity, additional recovery days, and an anti-inflammatory diet that also supports the restoration of iron levels (increased intake of nuts, seeds, berries, lean red meats, and fibre and Omega-3 rich foods). </p>
<p>And it’s important to keep in mind some athletes might experience menstrual cycle issues in phases other than menstruation. So, training and nutrition should be flexible and individualised across the cycle. </p>
<p>Using this approach, athletes can mitigate the influence of the menstrual cycle on their performance, giving them the best opportunity to achieve their athletic potential and success during competition.</p>
<img src="https://counter.theconversation.com/content/206700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara Chica-Latorre receives funding from the Australian Department of Education</span></em></p><p class="fine-print"><em><span>Michael Pengelly and Michelle Minehan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fluctuations in sex hormones are associated with inflammation peaks and troughs. These could potentially influence athletic performance.Sara Chica-Latorre, Phd Candidate and Research Assistant, Research Institute for Sport and Exercise, University of CanberraMichael Pengelly, PhD Candidate, Research Institute for Sport and Exercise, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055702023-07-12T05:25:17Z2023-07-12T05:25:17ZPeriod shame stops countless girls from continuing sport. The Women’s World Cup can help break this stigma<p>In the lead up to the first FIFA Women’s World Cup hosted in the Southern Hemisphere, host nations Australia and Aotearoa New Zealand are forging other firsts, including efforts to break the shame, stigma and taboo that <a href="https://www.westernsydney.edu.au/__data/assets/pdf_file/0003/1932321/Final_White_Paper_Menstrual_Equity_in_Educational_Institutions_and_Workplaces_V.2.pdf">continue to shroud periods</a>.</p>
<p>In April, both teams unveiled new kits that <a href="https://www.theguardian.com/football/2023/apr/04/matildas-unveil-first-period-conscious-kit-design-for-womens-world-cup">included period leak protections</a>, together with materials and tailoring that specifically respond to the needs of high performance women footballers.</p>
<p>New Zealand has also swapped out its <a href="https://www.nzfootball.co.nz/newsarticle/126803?newsfeedId=1253670">traditional white shorts</a> for teal blue to help combat period anxiety.</p>
<p>Similar changes are occurring across the global sporting landscape, albeit more slowly in some quarters.</p>
<p>Despite initial reluctance, last year the All England Club <a href="https://www.skysports.com/tennis/news/32498/12749640/wimbledon-relaxes-all-white-kit-rule-for-female-players-after-fresh-criticism-from-billie-jean-king-and-judy-murray">relaxed</a> the long-held tradition that Wimbledon players wear all white, so women can now wear <a href="https://www.abc.net.au/news/2023-07-03/wimbledon-whites-rule-change-women-period-female-athletes/102554006">dark undershorts</a>.</p>
<p>In rugby, the <a href="https://www.rugbypass.com/news/ireland-statement-womens-team-to-stop-wearing-white-shorts/">Irish national women’s team</a> have permanently switched white shorts for navy, while <a href="https://www.nzherald.co.nz/sport/nz-rugby-invests-in-new-shorts-for-referees-due-to-menstrual-concerns/BDDOZ3TYN5CBROYS5M2KEMUJMA/">New Zealand</a> referees are no longer required to wear white shorts.</p>
<p>The impact of these changes should not be underestimated. The shame and taboo associated with periods stops <a href="https://www.theaustralian.com.au/sport/nrl/nrlw-star-tiana-penitani-working-to-break-sport-taboo-of-female-athletes-and-periods/news-story/5324dde42e6b77dc7e25d5bd8ce6bc54">many young girls from continuing sport</a>, and misinformation about menstruation affects the performance and health of countless elite athletes. The 2023 FIFA Women’s World Cup is an opportunity to dispel period myths and put a focus on the specific needs of athletes who menstruate.</p>
<h2>Women athletes aren’t small men</h2>
<p>Women’s elite sport continues to be professionalised, yet their training protocols have often been based on <a href="https://www.fasttalklabs.com/fast-talk/why-women-are-not-small-men-with-dr-stacy-sims/">research evidence derived from male cohorts</a>.</p>
<p>This research doesn’t consider the physical and psychological changes that women athletes may experience at <a href="https://journals.sagepub.com/doi/pdf/10.1177/1747954120916073?casa_token=zYiabLH-iMIAAAAA:r5Ul9YjFvOhrZEufH6pyIZmB3sxBYtlV9v_diTl76LjAZFgLn0-QBRcbgW-PTHMtJZFWbb8W5XZT">each phase of the menstrual cycle</a>, nor how that may affect peak performance.</p>
<p>Research into how the menstrual cycle affects the performance of women athletes is growing. Teams are employing methods to <a href="https://www.theguardian.com/lifeandstyle/shortcuts/2019/jul/10/how-period-tracking-can-give-all-female-athletes-an-edge">work with the period cycle</a>, rather than against it.</p>
<p>Reigning FIFA Women’s World Cup champions the United States say that menstrual tracking is one of their <a href="https://www.fitrwoman.com/post/fitrwoman-in-the-news-ending-the-period-taboo">performance weapons</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/new-study-much-of-what-were-told-about-gym-exercises-and-resistance-training-is-from-studies-of-males-by-men-205753">New study: much of what we're told about gym exercises and resistance training is from studies of males, by men</a>
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<h2>No longer a mark of honour</h2>
<p>Ignoring and generalising the needs of women athletes not only hurts performance, but can damage health. </p>
<p>Overly intense training can cause some athletes to stop having periods. This has often been considered normal by coaches and a <a href="https://www.abc.net.au/news/2023-03-19/carla-papac-periods-menstrual-health-women-athletes/102074230">mark of honour</a> among athletes themselves. Indeed there’s a dangerous notion in many high performance sporting cultures that the absence of menstruation equates to an ideal elite athlete.</p>
<p>But this can lead to serious health consequences, including a condition called RED-S – relative energy deficiency in sport. <a href="https://www.perthsportsmedicine.com.au/relative-energy-deficiency-in-sport-perth-claremont-cockburn-wa.html">Symptoms</a> include periods stopping or becoming irregular, reduced performance, mood changes, and recurrent illnesses and injuries including stress fractures.</p>
<p>Australian research involving 112 women elite and pre-elite athletes found almost 80% of participants demonstrated <a href="https://bjsm.bmj.com/content/55/1/38">at least one symptom consistent with RED-S</a>. Nearly 40% experienced at least two symptoms.</p>
<p>Like women in other workplaces, elite athletes are often reluctant to discuss the impact of their periods fearing assumptions they are a liability in team environments, less capable, and not deserving of development opportunities.</p>
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<h2>Change is happening, albeit slowly</h2>
<p>Across some high performance pathways, road maps are being developed to specifically support women athletes. For example, the Australian Institute of Sport launched an <a href="https://www.ais.gov.au/fphi">initiative</a> in late 2019 to “improve female athlete specific knowledge and systems of support”. And in March, the South Australian government started its “I’m an athlete. Period” <a href="https://www.orsr.sa.gov.au/news/elite-athletes-help-remove-the-stigma-around-periods-and-sport">campaign</a> which aims to promote positive menstrual health in sport.</p>
<p>Many women athletes themselves have started to <a href="https://www.abc.net.au/news/2023-03-19/carla-papac-periods-menstrual-health-women-athletes/102074230">speak up</a> about the taboo associated with menstruation and are lobbying for change.</p>
<p>Earlier this year, decorated Australian Olympic swimmer Cate Campbell shared the performance struggles she has experienced managing her periods.</p>
<p>While her training and nutrition regimens were monitored with precision, the absence of information and access to a network of women’s health professionals saw her suffer a <a href="https://www.abc.net.au/news/2023-02-01/cate-campbell-katja-dedekind-swimming-womens-health-periods/101848960">near career-ending injury</a>.</p>
<p>To try and manage her periods, she had a contraceptive bar inserted into her arm, which is meant to be inserted into the fat layer above the muscle. But because she’s an elite athlete, she has a very low body fat percentage, so the bar was inserted next to her muscle. A botched attempt to retrieve the bar caused her permanent nerve damage. </p>
<p>She’s now using her profile to raise awareness of <a href="https://www.abc.net.au/news/2023-02-01/cate-campbell-katja-dedekind-swimming-womens-health-periods/101848960">women’s health issues</a> and to try and reduce the taboo around periods.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Clmm_2lBpxM/?hl=en","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Girls’ barriers to sport</h2>
<p>Puberty, and the start of periods, is a time when girls’ participation in grassroots sport <a href="https://www.independent.co.uk/voices/girls-periods-sport-body-image-b1936093.html">falls off sharply</a>.</p>
<p>A UK survey of more than 4,000 teenagers published last year found there are <a href="https://www.theguardian.com/education/2022/mar/07/uk-girls-lose-interest-in-sport-as-teenagers-women-in-sport-survey">complex barriers</a> and deep-rooted negative attitudes affecting girls’ enjoyment of sport, including period shame and body image issues. </p>
<p>It found, of girls in the survey who used to be sporty, 78% said they avoided sport when they had their period, and 73% of this cohort said they didn’t like others watching them take part in physical activity.</p>
<p>Of girls who avoided exercise on their periods, 73% said it was due to pain and 62% did so out of fear of leakage.</p>
<p>Various state governments are investing in grassroots sport facilities that <a href="https://footballfacilities.com.au/2022/08/25/female-facilities-set-to-flourish/">better attend to the needs of women</a>. But many facilities continue to lack basic amenities <a href="https://www.newsofthearea.com.au/public-amenities-in-port-stephens-to-be-more-inclusive">including menstrual bins</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/celtic-fc-leads-way-in-tackling-period-poverty-now-other-clubs-need-to-follow-96748">Celtic FC leads way in tackling period poverty, now other clubs need to follow</a>
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<p>An important way to address these issues is for sporting clubs to develop “period positive” <a href="https://www.ccyp.com.au/wp-content/uploads/2023/05/Period-Positive-Sports-Clubs.pdf">cultures</a>. </p>
<p>Clubs should undertake measures such as:</p>
<ul>
<li><p>providing comfortable and period-friendly uniforms</p></li>
<li><p>supplying sanitary bins and ample period products for free </p></li>
<li><p>and having open discussions about periods and how they may impact athletes. </p></li>
</ul>
<p>These can help girls and women be empowered to manage their periods in ways that will enable them to continue their participation and not feel ashamed or embarrassed.</p>
<p>With the world cup media spotlight, we have an unprecedented opportunity to break menstrual shame, silence and taboo.</p><img src="https://counter.theconversation.com/content/205570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The tournament is an opportunity to dispel period myths and put a focus on the specific needs of athletes who menstruate.Michelle O'Shea, Senior Lecturer, School of Business, Western Sydney UniversityHazel Maxwell, Senior Lecturer, Western Sydney UniversityKylie A Steel, Senior Lecturer in Motor Learning and Skill Acquisition, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2018712023-06-27T02:14:36Z2023-06-27T02:14:36ZHow do I insert a tampon?<figure><img src="https://images.theconversation.com/files/532313/original/file-20230616-19-ay9uyd.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C3320%2C1705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">pexels sora shimazaki</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>If you’ve just decided to start using tampons and you’re finding it tricky, you’re not alone! Lots of young teens and first-time tampon users have told me they experience “tampon trauma” – meaning it hurts, won’t go in or gets stuck coming out. But with a little bit of practice, it’s super easy.</p>
<p>Tampons are safe and convenient, especially if you’re going to the beach, swimming or doing something physically active. You can’t feel a tampon once it’s inserted properly, which is why some people prefer tampons to pads or period undies. Tampons are used by <a href="https://www.nationalgeographic.com/environment/article/how-tampons-pads-became-unsustainable-story-of-plastic#:%7E:text=Did%20You%20Know%3F,-Usage&text=Recycling-,5.8%20billion%20tampons%20were%20sold%20in%20the%20U.S.%20in%202018,ocean%20when%20sewer%20systems%20fail.">millions of people</a> around the world. They’re made from natural cotton, rayon fibre or both, and absorb fluid, including menstrual blood. </p>
<p>In Australia, tampons are classified as “medical devices” which means they have to meet certain safety standards. So even though there’s a confusing array of brands available in Australia it’s good to know they all pass the safety test.</p>
<p>Just like pads and period undies, tampons come with different absorbencies, such as “mini” or “light”, “regular” and “super”. As you get to know your own periods and cycle, you’ll also get to know which tampons suit you best over the course of your period. It’s common for the first couple of days of a period to be heavier, meaning you might need a tampon with higher absorbency.</p>
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Read more:
<a href="https://theconversation.com/menstrual-cups-vs-tampons-heres-how-they-compare-120499">Menstrual cups vs tampons – here's how they compare</a>
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<h2>How to insert</h2>
<p>A tampon is designed to sit inside the vagina, right up high against the cervix. The vagina is a stretchy muscular tube and has plenty of room to accommodate a tampon. </p>
<p>The vagina slopes upward and backward, towards the spine. A common difficulty first-time tampon users encounter is pushing the tampon straight up rather than slightly backwards, so it hits the front wall of the vagina and feels like it can’t go up any further. The same can happen in reverse when pulling a tampon out – it needs to be pulled slightly forward, not straight down, or it could hit the back wall of the vagina and feel stuck.</p>
<p>If you want to, you can practise using a tampon between your periods, or when your flow is light. Wash your hands first, then get a mini-sized tampon and make it slippery by putting some water-based lubricant on it. Some people might dab a tiny bit of Vaseline on the tip of the tampon instead. Vaseline shouldn’t be put on tampons during a period, as it reduces absorbency. </p>
<p>Pull the string so it reaches its full length before you insert it. Stand in front of a mirror and have a look at where the opening of your vagina is by pulling the vaginal lips apart. Then either squat, or put one leg up on a stool, shelf, or side of the bath, which gets you in a comfortable position to practise. </p>
<p>Gently put the tip of the tampon into the opening and then push it up and back with your finger. You can put your fingers inside your vagina first, to get a feel of the way your vagina slopes. (If you have long nails, take care not to scratch yourself!)</p>
<p><iframe id="tc-infographic-879" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/879/daa47e958c4391e8fa586f1fc90bb0554872c2d7/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Some tampons come with an “applicator”. This is made of two cardboard or plastic tubes, one inside the other. The larger tube has the tampon inside it, and the smaller one sits just below the tampon. When inserting, you hold the smaller part and push the applicator inside your vagina rather than putting your fingers inside. When the applicator has gone all the way in, you push the tampon out by “plunging” the smaller tube up, pushing the tampon out. </p>
<p>It’s virtually impossible to put a tampon into the wrong hole! There are three holes in that part of the body – the vagina, the urethra (where wee comes out) and the anus, or bum hole, where poo comes out. Most people are familiar with where the bum hole is, because (hopefully) they wipe their bums a lot! </p>
<p>The urethra is very small, and you wouldn’t be able to fit a tampon into it. It sits high up towards the top of the vulva – where your inner vaginal lips meet in the middle, and just below the tip of the clitoris.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram showing a vulva" src="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=561&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=561&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=561&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=704&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=704&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=704&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vulva diagram.</span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Tampons can be left in for up to six hours. If your period is heavier than anticipated and the tampon has become “soaked”, you might have to change it earlier. You’ll know when that happens because some menstrual fluid will leak onto your undies. </p>
<p>Don’t panic though – it’s something you’ll be able to feel and deal with before anyone else notices! If you know you have heavy flow days and want to take extra precautions, you can wear a light pad on your undies (or period undies) as well as using a tampon. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">Heavy periods are common. What can you do, and when should you seek help?</a>
</strong>
</em>
</p>
<hr>
<h2>Toxic shock syndrome</h2>
<p>You might have heard about something called Toxic Shock Syndrome. This is caused by a bacterial infection that releases toxins into the blood and is a serious condition. </p>
<p>It can happen anywhere in the body but is known to be associated with the use of ultra super absorbency tampons. There are now guidelines and regulations worldwide for tampon manufacturing to reduce the risk of infections. </p>
<p>These days toxic shock syndrome is extremely rare (about <a href="https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome#:%7E:text=Toxic%20shock%20syndrome%20affects%201,absorbent%20tampons%20during%20their%20period.">0.001%</a> of people), and still only occurs if tampons are left in for several hours, allowing the bacteria to multiply. </p>
<p>Symptoms are high fever, vomiting, diarrhoea, muscle aches, headaches and a rash.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Environmentally friendly options</h2>
<p>It’s important to NEVER flush a tampon down the toilet. If you’re in a public toilet, there should be bins inside toilet cubicles for all disposable period products. At home, you could wrap it in tissue and put it in a rubbish bin. You might also be aware people are now looking at environmentally friendly alternatives to disposable pads and tampons. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman throwing a used tampon into a bin" src="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Never flush a tampon down the toilet, put it in a bin.</span>
<span class="attribution"><span class="source">Pexels/Karolina Grabowska</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Reusable pads and period undies were designed to help reduce waste from disposable pads. There’s now also an alternative to tampons, which is the modern “menstrual cup”. These are made of medical grade silicone that you fold over, push up inside your vagina using two fingers, and then pop! It springs open inside the vagina and catches any menstrual fluid. </p>
<p>Unlike a tampon, they sit a little lower down in the vagina, and just like tampons, they can take practice getting used to. These can be used for up to 12 hours which makes them super convenient. You can try a menstrual cup anytime – and some people might switch between tampons and a cup or pads or period undies, depending on what feels right on the day.</p>
<p>Managing periods is something almost half the population deals with. It can feel scary, but it might help to know that just about everyone who has periods goes through the same process of figuring it out! The more you arm yourself with information and know how much choice is out there, the more confident you’ll feel. And don’t forget there are always adults out there who are willing and able to give you advice and help. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-queues-for-womens-toilets-are-longer-than-mens-99763">Why queues for women's toilets are longer than men's</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/201871/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Kang has received funding from the National Health and Medical Research Councill, Australian Research Council and Medical Research Futures Fund. She is affiliated with the Australian Association for Adolescent Health and the International Association for Adolescent Health. She has co-authored Welcome to Your Period, Welcome to Consent, Welcome to Your Boobs and Welcome to Sex.</span></em></p>Lots of young teens and first-time tampon users are intimidated by tampons. But they’re easy once you get the hang of it.Melissa Kang, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995682023-04-27T15:01:40Z2023-04-27T15:01:40ZWhy menstrual leave could be bad for women<figure><img src="https://images.theconversation.com/files/519854/original/file-20230406-18-29woex.jpg?ixlib=rb-1.1.0&rect=0%2C98%2C6000%2C3898&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bad-period-full-length-view-caucasian-2064704318">NFstock/Shutterstock</a></span></figcaption></figure><p>Spain recently <a href="https://www.euronews.com/next/2023/02/16/spain-set-to-become-the-first-european-country-to-introduce-a-3-day-menstrual-leave-for-wo">adopted a menstrual leave policy</a>, which makes additional (paid or unpaid) days off work available to “<a href="https://doi.org/10.1007/978-3-030-53269-7_9">only and all cisgender women</a>”.</p>
<p>It’s so great that we’re having more public conversations about menstrual and menopausal health, but I’m getting very tired of being told that menstrual leave is the solution.</p>
<p>As someone with a background in policy evaluation and the founder of the world’s first evidence-based <a href="https://www.menstrual-matters.com/">menstrual health website</a>, I am well placed to comment on this topic. When I evaluated existing menstrual leave policies around the world, I found that they were not progressive or beneficial for <a href="https://doi.org/10.1007/978-3-030-53269-7_9">female reproductive health or gender equality</a>. </p>
<p>The thing is, it is really hard to argue against something that sounds good, even if the available evidence suggests otherwise. Humans seem to be bad at going beyond surface thoughts and we may even prefer stories that align with <a href="https://www.tandfonline.com/doi/abs/10.1080/1350178X.2014.939691">rather than challenge gender stereotypes</a>. </p>
<p>So, here is a quick outline of what I think you should know about this policy.</p>
<h2>What is the problem?</h2>
<p>There are <a href="https://doi.org/10.1007/978-3-030-53269-7_9">four main arguments</a> used by those promoting menstrual leave policy:</p>
<ol>
<li><p>It will make the workplace fit for the menstruating female body.</p></li>
<li><p>It will improve menstrual health.</p></li>
<li><p>It will reduce menstrual shame and stigma, and associated discrimination.</p></li>
<li><p>It will improve gender equality in the workplace and beyond. </p></li>
</ol>
<p>However, it has never been made clear exactly how the policy will deliver these outcomes. In fact, based on what we know about existing menstrual leave policies, it might not contribute to any of them.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life._</p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-important-things-you-should-have-learned-in-sex-ed-but-probably-didnt-202177?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five important things you should have learned in sex ed – but probably didn’t</a></em></p>
<p><em><a href="https://theconversation.com/postpartum-exercise-can-have-many-benefits-heres-how-to-do-it-safely-200388?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Postpartum exercise can have many benefits – here’s how to do it safely</a></em></p>
<p><em><a href="https://theconversation.com/joy-can-help-us-be-better-at-work-heres-how-to-find-it-198260?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Joy can help us be better at work – here’s how to find it</a></em></p>
<hr>
<p>For instance, the policy does not make it easier to manage your period at work because your employer doesn’t have to change a thing. Instead, you are encouraged to stay away from the workplace. </p>
<p>The policy also does nothing to improve menstrual health. The 90% of people who menstruate and <a href="https://abdn.alma.exlibrisgroup.com/discovery/delivery/44ABE_INST:44ABE_VU1/12152380480005941">do not regularly experience severe symptoms</a> do not need to take a whole day off work during their periods. </p>
<p>Meanwhile, the minority who do regularly experience severe symptoms almost always have <a href="https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/">an underlying health issue</a>, such as endometriosis, heavy menstrual bleeding, polycystic ovary syndrome, fibroids, auto-immune disorders, depression or premenstrual dysphoric disorder. Encouraging people to cope with severe symptoms alone at home every month, is not an effective or humane solution.</p>
<p>These health conditions deserve effective and timely medical diagnosis and treatment, sick leave and reasonable workplace adjustments. The same things that apply to all chronic health conditions and are already covered by <a href="https://www.legislation.gov.uk/ukpga/2010/15/contents">EU and UK labour policies</a>. </p>
<p>Menstrual leave also does not help to reduce menstrual shame, stigma or discrimination. It actually encourages the removal of menstruation – and by extension women – from the public realm by hiding it at home.</p>
<p>This sex-based policy conflates healthy periods with debilitating menstrual health conditions, which both pathologises the normal female body and undermines health conditions that mainly affect women. This is partly why women and conditions that mainly affect women are <a href="https://doi.org/10.1155/2018/6358624">more likely to be dismissed by doctors</a>, sometimes taking <a href="https://www.medicalnewstoday.com/articles/gender-bias-in-medical-diagnosis#how-does-it-affect-diagnosis">years to get a formal diagnosis</a>.</p>
<p>Finally, by medicalising the menstrual cycle (that is, positioning it as an illness rather than a healthy process) these policies reinforce sexist beliefs that make it seem like all women are <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">biologically inferior (mentally and physically)</a>. This is a major contributing factor in gender discrimination, especially in the workplace, since these ideas are <a href="http://www.beacon.org/Inferior-P1278.aspx">used to undermine</a> the value, contribution and leadership potential of women.</p>
<figure class="align-center ">
<img alt="A woman clutches a hot water bottle to her body." src="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Period leave policies keep menstruation at home where employers don’t have to deal with it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-cropped-view-unhealthy-30s-woman-2113290665">Fizkes/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Menstrual leave might even make things worse</h2>
<p>Not only have existing menstrual leave policies failed to address the problems they set out to solve, they have also directly resulted in <a href="https://www.menstrual-matters.com/ml-gender-4/">discrimination against female workers</a>. This is largely due to the gender myths reinforced by the policy. It makes all women seem like more expensive and less consistent and productive employees. It can also lead to a backlash from colleagues and employers <a href="https://books.google.co.uk/books/about/Periodic_Struggles.html?id=F5YvQwAACAAJ&redir_esc=y">against a sex-based benefit</a>.</p>
<p>We already know that shared parental leave (for parents regardless of gender) is a <a href="https://doi.org/10.2307/j.ctvfrxngh">more effective policy than maternity leave</a> (which is female sex-based). It improves the gender pay gap, women’s hiring, promotion and leadership opportunities, child health outcomes, fatherhood experiences and gender equality in wider society.</p>
<p>These improvements occur because the policy avoids the gender-based backlash associated with maternity leave. This backlash is driven by the conscious or unconscious resentment of, and associated discrimination against, working women due to a perceived unfair advantage (paid time off work) and/or biological liability (the female reproductive body). The <a href="https://www.menstrual-matters.com/ml-gender-4/">same issues</a> apply to menstrual and menopausal health workplace policies.</p>
<p>We need to improve workplace (and school, and medical) knowledge of reproductive health and wellbeing. We should all know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">what’s normal</a> or the sign of an underlying health condition. Likewise, it’s shocking that some people do not know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">why we menstruate</a> or how to reduce cyclical changes.</p>
<p>We also need to make <a href="https://www.bloodygoodemployers.com/">workplaces (including schools) fit for those who have periods</a> and to promote more <a href="https://www.menstrual-matters.com/ml-alternatives-5/">flexible and equitable work cultures and practices</a> that benefit all employees. For instance, challenging “presenteeism” if employees feel obliged to work even when feeling unwell, and ditching <a href="https://www.ndtv.com/feature/amazon-staff-in-uk-claims-their-toilet-breaks-were-timed-3727431">“timed” toilet breaks</a>. </p>
<p>While these <a href="https://www.menstrual-matters.com/ml-alternatives-5/">actions</a> are not quite as simple or catchy as “menstrual leave”, they would at least make a positive difference in the lives of millions of workers – without unintentionally worsening gender inequalities.</p><img src="https://counter.theconversation.com/content/199568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters. Her doctoral research was funded by the ESRC (Economic and Social Research Council). She is affiliated with the Women's Equality Party and a board member of the Society for Menstrual Cycle Research. </span></em></p>Sex-based policies can lead to backlash and further discrimination in the workplace.Sally King, PhD Candidate, Department of Global Health & Social Medicine, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034512023-04-25T17:32:33Z2023-04-25T17:32:33ZFrom rags and pads to the sanitary apron: a brief history of period products<figure><img src="https://images.theconversation.com/files/522746/original/file-20230425-26-nzw4m7.jpg?ixlib=rb-1.1.0&rect=260%2C35%2C5721%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tampons-feminine-sanitary-pads-pattern-on-2185561705">Skrypnykov Dmytro/Shutterstock</a></span></figcaption></figure><p>Period blood: it’s not something many people want to talk about. Taboos around menstruation and menstrual blood have been around for centuries. Even today, despite menstrual blood being <a href="https://www.ncbi.nlm.nih.gov/books/NBK565646/">featured in contemporary art</a>, this basic part of many women’s identities still isn’t something that can be easily mentioned in public. </p>
<p>Menstruation is generally seen as something to be managed and contained – with period leaks considered <a href="https://www.womenshealthmag.com/health/a19938692/period-leaks-in-public/">a source of embarrassment</a>. This is despite <a href="https://periodpositive.com/">campaigns</a> aimed to help younger people feel more able to talk about menstruation. </p>
<p>For many women, the time of the month means relying on tampons, pads or a menstrual cup to collect the <a href="https://www.ncbi.nlm.nih.gov/books/NBK279294/">two to three tablespoons of blood</a> that are lost over the four to five days of their period.</p>
<p>But a <a href="https://www.theguardian.com/global-development/2019/apr/13/cloth-cow-dung-cups-how-the-worlds-women-manage-their-periods">2019 study</a> of how women around the world manage menstruation showed that many still use leaves, sheep’s wool, newspaper, grass or even cow dung, as an absorbent substance. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5y1_pgqTow8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>A <a href="https://blogs.worldbank.org/education/globally-periods-are-causing-girls-be-absent-school">2016 report from Unesco</a> found that 10% of young women in Africa did not attend school during their periods. Indeed, one way of avoiding leaks is simply not to go outside the home when menstruating, which is why menstruation still has important consequences for women’s education. </p>
<h2>Periods of the past</h2>
<p>It’s likely that <a href="https://www.getty.edu/news/education-periods-facts-women-medieval-history-past-before-pads-tampons/">women in the past</a> had fewer periods, with <a href="https://helloclue.com/articles/culture/what-was-it-like-to-get-your-period-in-ancient-greece">lighter bleeding</a>, not only because they spent more of their lives pregnant but also because their <a href="https://www.theguardian.com/society/2022/jan/06/women-losing-their-periods-because-of-restrictive-diets-and-excessive-exercise">diet was poor</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Early period pad." src="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=221&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=221&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=221&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=277&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=277&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=277&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sanitary napkin from around 1942 – from military stocks for nurses.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene#/media/File:Camelia_Popul%C3%A4r_sanitary_napkins_from_stocks_of_the_Wehrmacht_Third_Reich_with_acceptance_stamping_-_Intim_hygiene_supply_nurses_around_1942_-_content_10_pieces_per_pack_-_D.R._WZ_No._378543_and_386768_-_Image_002.jpg">Wikipedia</a></span>
</figcaption>
</figure>
<p>Yet medical texts going back to <a href="https://www.diva-portal.org/smash/get/diva2:937408/FULLTEXT01.pdf">ancient Greece</a> seem to propose that the ideal bleed should be heavy. This was due to the belief that menstruation happened because women’s bodies had a more spongy texture compared to men’s bodies, so their flesh absorbed more fluid from what they ate and drank. Blood that did not come out was even thought to <a href="https://diotima-doctafemina.org/translations/links-to-translations/the-illness-of-maidens/">cause mental illness</a>. </p>
<p>Medical texts up to the 19th century still reflected these ideas from ancient Greece, but there is evidence from early modern Europe that men were comfortable discussing menstruation. The 17th-century man of letters Samuel Pepys even mentioned his wife’s menstrual cycle <a href="http://earlymodernmedicine.com/review-menstruation-and-the-female-body/">in his diary</a>. </p>
<p>As for dealing with the bleeding, historian <a href="http://earlymodernmedicine.com/review-menstruation-and-the-female-body/">Sara Read</a> has concluded that at this time most women just bled on their clothes. Rags placed between the thighs or attached to clothing were also used. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sanitary belt shown in black and white." src="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An early commercial menstrual product in the form of a menstrual belt. Illustration from 1911.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene">Wikipedia</a></span>
</figcaption>
</figure>
<p>It was in the 19th century that the market for special menstrual clothing was developed: from belts and pads to the <a href="http://www.mum.org/sanapron.htm">“sanitary apron”</a> which was worn over the buttocks to stop leakage onto clothing when sitting down. Until disposable cotton pads were developed in the late 1890s, pads still needed to be washed out and dried (though reusable pads have recently made a comeback). </p>
<p>From the late 1960s, the use of a sticky strip meant that pads could be secured in the underwear rather than needing to be fixed to a special belt. </p>
<h2>Return to reuse</h2>
<p>Historian <a href="https://muse.jhu.edu/article/399411/pdf">Lara Freidenfelds</a> has shown that in the US by the 20th century, menstruation was increasingly seen as a normal part of life – no longer requiring a few days of rest as was previously the case. And commercially produced products came to be valued as a status symbol.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram showing folded fabric." src="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1731&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1731&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1731&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=2176&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=2176&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=2176&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Instructions on how to fold a piece of fabric for a menstrual pad. At the bottom, how to fasten the pad with a cord to the waistband is demonstrated – from the German book The Woman as a family doctor, 1911.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene">Wikipedia</a></span>
</figcaption>
</figure>
<p>In the 1930s the <a href="http://www.mum.org/faxAd.htm">first tampons</a> came onto the market. They were described as “internal sanitary napkins”. Menstrual cups made from rubber also date back to the 1930s – although they have largely been replaced these days by silicone cups which come in a <a href="https://www.nytimes.com/wirecutter/reviews/best-menstrual-cup/">wide range of sizes</a>. The risk of leakage with a cup of the correct dimensions appears to <a href="https://www.nytimes.com/wirecutter/reviews/best-menstrual-cup/">be lower</a> than with a pad or tampon. </p>
<p>Modern menstrual products damage the environment. Tampon applicators and wrappers are made of plastic and pads contain it too. There is also an increased awareness of the <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.122-A70">risks of chemicals</a>, such as dioxins, used in both tampons and pads. This has boosted the market for products containing natural materials. </p>
<p>Disposable or reusable menstrual discs are also available – basically, a round silicone disc that collects blood. And period pants, invented in 2017, are sold as <a href="https://www.modibodi.co.uk/pages/howitworks">“better for the planet”</a>. </p>
<p>Rather than marketing commercial products in the world’s poorest countries, charities such as <a href="https://www.actionaid.org.uk/our-work/period-poverty/reusable-sanitary-pads-and-sustainability">ActionAid</a> run training sessions on making your own pads. Women in wealthier countries have been <a href="https://www.actionaid.org.uk/blog/2019/06/05/would-you-make-and-wear-your-own-reusable-sanitary-pads?gclid=Cj0KCQjwuLShBhC_ARIsAFod4fJvB_9i5cFjtYAvqacKtiWwfevD7n4TRyl4XGdWfgAIeE9fzkpK7e0aAqWBEALw_wcB">surprised</a> at how comfortable these are to wear. </p>
<p>Today’s promotion of reusable pads or period pants is a return to a past way of dealing with menstruation – though it’s clearly now much easier for most women to wash and dry these items. </p>
<p>Their use suggests our attitude to menstrual blood may be shifting. Indeed, seeing menstrual products as “waste” that needs to be hidden and disposed of “hygienically” doesn’t go with the idea of washing out your pads and hanging them up to dry on the line.</p><img src="https://counter.theconversation.com/content/203451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Breaking the taboo: the fascinating history of menstrual products.Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955782022-12-27T19:20:14Z2022-12-27T19:20:14Z6 non-fiction reads for kids this summer, recommended by kids aged 9 to 11<figure><img src="https://images.theconversation.com/files/499962/original/file-20221209-25000-8w73ee.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5607%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Drew Perales/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Kids are often gifted books for Christmas, but the trick is to get them to read them! </p>
<p>No one likes nagging their kids to read, though we know <a href="https://www.smh.com.au/education/read-the-room-it-s-time-to-act-on-our-children-s-literacy-20220904-p5bf7w.html">reading is crucial</a> to their <a href="https://www.cambridge.org/au/academic/subjects/education/teacher-training-and-professional-develop/english-and-literacies-learning-how-make-meaning-primary-classrooms">critical and literacy development</a>. </p>
<p>But what do <em>they</em> think about books and reading over the summer? Kids’ voices are often overlooked when it comes to cultural criticism. </p>
<p>For the past two years, I have been facilitating a children’s book club. In our most recent session, I asked the participants – aged 9 to 11 – to share their summer reading recommendations. </p>
<p><a href="https://www.bloomsbury.com/au/children-and-biography-9781350236370/">My research</a> has found that kids respond positively to non-fiction books in social reading environments. Reading non-fiction impacts positively on their civic and critical literacy. So, we focused on non-fiction recommendations.</p>
<p>These tips – straight from the kids themselves – might help adult readers to know what books to buy this Christmas, or to hunt out at the library over summer.</p>
<hr>
<h2>1. You Don’t Know What War Is: The Diary of a Young Girl from Ukraine by Yeva Skalietska</h2>
<p>This is <a href="https://www.bloomsbury.com/au/you-dont-know-what-war-is-9781526660138/">an eye-opening and heart-breaking story</a> about a 12-year-old girl called Yeva Skalierska, living through the Ukraine war of 2022. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=908&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=908&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=908&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1142&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1142&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1142&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>A normal girl who loves school and spending time with friends, she suddenly goes through shelling and bombing right out the front of her own house. She travelled around Ukraine with her grandmother, and many other Ukrainians, trying to escape the war and danger. This book is Yeva’s personal diary account of the experiences of the war through her eyes. </p>
<p>I found it fascinating that a girl so similar to me can be going through something so drastically different. This is happening at this very moment, not in the history books, which makes me wonder why we have to have more war like this. This is a good book for anyone wanting to understand the impact of war on children and families and to put into perspective the things we might complain about that don’t really matter. </p>
<p><strong>– Chloe, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-must-read-books-about-russia-and-ukraine-our-expert-picks-179832">5 must-read books about Russia and Ukraine: our expert picks</a>
</strong>
</em>
</p>
<hr>
<h2>2. Goodnight Stories for Rebel Girls: 100 Inspiring Young Changemakers by Jess Harriton and Maithy Vu</h2>
<p>This is <a href="https://www.rebelgirls.com/products/100-inspiring-young-changemakers">the latest book</a> in the amazing <a href="https://www.rebelgirls.com/products/good-night-stories-for-rebel-girls">Goodnight Stories for Rebel Girls</a> series. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=804&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=804&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=804&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1011&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1011&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1011&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>The book contains 100 short stories about young changemakers. A changemaker is someone who has achieved something in the world to make it a little bit better. These changemakers are from all parts of the world with different abilities. </p>
<p>The book is introduced by conservationist Bindi Irwin. The subjects in this book include Greta Thunberg (activist), <a href="https://en.wikipedia.org/wiki/Isabella_Springmuhl_Tejada">Isabella Springmuhl</a> (fashion designer) and Zendaya (actor and singer). </p>
<p>I think this book is wonderful because this Rebel Girls book focuses on young people only. Young girls aren’t usually recognised as having an impact in the world, so that’s what makes this book special. People who read this will see how great young people are at making the world a better place.</p>
<p><strong>– Darcy, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/empathy-starts-early-5-australian-picture-books-that-celebrate-diversity-153629">Empathy starts early: 5 Australian picture books that celebrate diversity</a>
</strong>
</em>
</p>
<hr>
<h2>3. Welcome to Your Period by Melissa Kang and Yumi Stynes</h2>
<p>This is <a href="https://www.hardiegrant.com/au/publishing/bookfinder/book/welcome-to-your-period-by-yumi-stynes/9781760503512">a very informative book</a> about welcoming you to your period and what is going on with your body as you grow up and start changing into a young woman. The authors are two women that have experienced everything you’re starting to go through and know all the tricks to managing your period. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=769&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=769&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=769&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=967&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=967&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=967&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>They understand what you’re going through and how you may feel about the situation. The book makes you feel as if it’s nothing to worry or be scared about. The authors act like your big sisters; they’ll guide you and teach you everything you need to know about your body. They make you feel comforted, with different alternatives to manage your period to suit your body type, and help you talk to somebody you can trust and help you through that process. </p>
<p>I think that this book is a really great preparation for when you don’t have your period but when you feel like you need to start managing it or talking to a helpful adult who can help you through this tough time.</p>
<p><strong>– Arly, age 10</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-periods-can-come-as-a-shock-5-ways-to-support-your-kid-when-they-get-theirs-177920">First periods can come as a shock. 5 ways to support your kid when they get theirs</a>
</strong>
</em>
</p>
<hr>
<h2>4. Barefoot Kids by Scott Pape (2022)</h2>
<p><a href="https://www.harpercollins.com.au/9781460763650/barefoot-kids/">This book</a> is all about money and how to invest properly. It teaches you about money and how to use it a “smart” way. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>Usually, when I think of a book about money, I think “oh no I’m not reading that!”. But this book was super fun, exciting and interesting. I loved it. It included short interviews of children who started a business and got heaps of money. It was really inspiring and amazing for giving ideas. It had good instructions of what to do to earn money, and I found it interesting that children five and up can have their own business. </p>
<p>I definitely recommend this book to other kids aged nine and up, because I gave it to my cousin who is nine years old, and she loved it. It definitely helps children to be “smarter” with money than most adults. I think it would be very intriguing for kids with a short attention span. </p>
<p>It tells kids that they are the boss, while also telling them to get parents’ permission and help. It tells you how to separate money into four buckets and has apparently changed lives. I give this book a five-star rating.</p>
<p><strong>– Sienna, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teaching-kids-about-maths-using-money-can-set-them-up-for-financial-security-85327">Teaching kids about maths using money can set them up for financial security</a>
</strong>
</em>
</p>
<hr>
<h2>5. How to Speak Dog: a Guide to Decoding Dog Language by Aline Alexander Newman</h2>
<p><a href="https://www.harpercollins.com.au/9780008257910/how-to-speak-dog/">How to Speak Dog</a> is a fantastic book about how to communicate with dogs. This book tells you when your dog is sick, sad, happy or scared. It has many interesting facts about dogs. It even tells you how to deal with an aggressive dog and what to do if a dog attacks you. How to Speak Dog even has some pages on how to train your dog.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1126&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1126&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1126&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
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<p>I think people will like this book because it has lots of information about dogs and dogs are a common pet. They could have a new puppy with some bad habits, and they might need help training their pup. </p>
<p>I have a dog and this book was very helpful to me because I learnt from it that my dog is scared when he shows the whites of his eyes. My favourite thing about this book is that they have funny facts on every page. Facts like: “A dog can smell half a teaspoon of sugar dissolved in an Olympic sized swimming pool.”</p>
<p><strong>– Avery, age 9</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-pat-or-not-to-pat-how-to-keep-interactions-between-kids-and-dogs-safe-182419">To pat or not to pat? How to keep interactions between kids and dogs safe</a>
</strong>
</em>
</p>
<hr>
<h2>6. Against all Odds: Young Readers’ Edition by Richard Harris and Craig Challen</h2>
<p>This is <a href="https://www.phoenixdistribution.com.au/against-all-odds-young-readers-edition">an interesting, educational, and suspenseful</a> book, with exhilarating and thrilling twists all through it. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=923&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=923&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=923&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1160&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1160&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1160&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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</figure>
<p>(Editor’s note: the book tells the inside story of the cave rescue of a boys’ soccer team in Thailand, back in 2018. It’s written by the two Australian cave divers involved in the rescue.)</p>
<p>This book explained everything in great detail, giving the reader a real idea of what’s happening. I liked how they made the book extremely fascinating, and the authors went far to explain everything to an understandable degree. </p>
<p>I disliked how such a large chunk of the book was an autobiography about Craig and Richard. I would recommend this for 10-15 year olds, since younger children may not understand the complex vocabulary used in the book. I would rate it 7.5/10.</p>
<p><strong>– Molly, age 11</strong></p><img src="https://counter.theconversation.com/content/195578/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Douglas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How can you get your kids to read this summer? Research has found they respond well to reading non-fiction – so we’ve gathered 6 top non-fiction books, recommended by the kids themselves.Kate Douglas, Professor of English, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915112022-12-20T23:29:15Z2022-12-20T23:29:15ZHeavy periods are common. What can you do, and when should you seek help?<figure><img src="https://images.theconversation.com/files/501199/original/file-20221215-15837-s4jucz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Heavy-Menstrual-Bleeding-Clinical-Care-Standard.pdf">one in four women</a> of reproductive age experience heavy periods, also known as heavy menstrual bleeding. Periods are a very personal experience and women (and people with uteruses) who have had heavy periods for a long time will often consider this normal, or something to be simply put up with. </p>
<p>A woman with normal periods loses between six to eight teaspoons of blood with each period. On average, bleeding lasts for five days, but a normal period can last for up to eight days. Trying to work out the amount of blood loss can be tricky, but if you have <a href="https://wearwhiteagain.com.au/is-my-period-heavy/">any of these symptoms</a> you probably have heavy periods: </p>
<ul>
<li><p>bleeding through clothing </p></li>
<li><p>having to change pads and tampons every one to two hours </p></li>
<li><p>passing clots larger than a 50 cent coin </p></li>
<li><p>avoiding leaving the house on the heaviest days </p></li>
<li><p>periods that interfere with your physical, emotional, or social life. </p></li>
</ul>
<p>Many women with heavy periods also experience severe period pain. If you are having heavy periods, talking with your doctor can help you choose the right treatment option for you. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Causes</h2>
<p>Heavy periods are most often caused by: </p>
<ul>
<li><p>hormone-related problems. Causes include <a href="https://www.jeanhailes.org.au/resources/perimenopause-fact-sheet">perimenopause</a>, <a href="https://www.jeanhailes.org.au/resources/pcos-fact-sheet">polycystic ovarian syndrome</a>, or thyroid conditions</p></li>
<li><p>changes within the uterus (womb), such as <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Heavy-menstrual-bleeding.pdf">fibroids</a> or polyps (benign tissue growths from the wall of the uterus). Less commonly, cancer or precancerous changes may be the cause of heavy bleeding. Some of the red flags doctors look for are sudden changes in bleeding patterns or vaginal bleeding after menopause</p></li>
<li><p><a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Heavy-menstrual-bleeding.pdf">blood disorders</a>.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two images of wombs - one showing dangly growths, and one showing mounded growths." src="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Uterine polyps and fibroids.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Some women can have more than one contributing cause. However, around <a href="https://www.racgp.org.au/getattachment/b1da25d9-03e0-44b1-9622-bd75d2ef6fef/20041031farrell.pdf">half of women</a> with heavy bleeding will not have any recognisable cause, even after testing. Nevertheless, the symptoms will still need treating. </p>
<h2>Tests</h2>
<p>All women with heavy periods need to have some tests performed to establish the potential cause of their bleeding, and to guide the treatment options. This may include a: </p>
<ul>
<li><p>physical exam </p></li>
<li><p>cervical screening test, if not up-to-date </p></li>
<li><p>blood test to check for low iron levels, and possibly thyroid and clotting function </p></li>
<li><p><a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">pelvic ultrasound</a>.</p></li>
</ul>
<p>The doctor may suggest further tests, such as a test for chlamydia, pregnancy or a biopsy of the uterus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pad with blood and bloodclot" src="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Passing clots larger than a 50 cent coin is a marker of heavy menstrual bleeding.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Treatments</h2>
<p>Don’t just put up with heavy periods, there are now many good treatment options. </p>
<p>You can consider starting initial treatment for heavy bleeding before your first visit to the GP. Oral non-steroidal anti-inflammatories such as ibuprofen or naproxen can be taken regularly from the first day of the period for up to five days. Many women are aware anti-inflammatories treat period pain, but they can also <a href="https://assets.jeanhailes.org.au/Tools/Heavy_menstrual_bleeding_tool.pdf">decrease the volume of bleeding by up to 50%</a>.</p>
<p>Another oral treatment for heavy bleeding which may be prescribed by your GP is <a href="https://www.nhs.uk/medicines/tranexamic-acid/">tranexamic acid</a>. This is taken for the first four days of the period. Anti-inflammatories and tranexamic acid can also be taken together. </p>
<p>Another effective medical treatment is the <a href="https://www.fpnsw.org.au/sites/default/files/assets/HORMONE%20RELEASING%20IUD.pdf">hormone-releasing IUD</a> (brand names Mirena and Kyleena). These provide reliable contraception and reduce bleeding. These can be inserted by a GP who has experience in IUD insertion, by a family planning clinic, or by a gynaecologist. </p>
<p>Oral hormonal options for treatment include the <a href="https://www.fpnsw.org.au/factsheets/individuals/contraception/combined-hormonal-contraceptive-pill">combined oral contraceptive pill</a> or <a href="https://www.healthnavigator.org.nz/medicines/n/norethisterone/">progesterone tablets</a>. </p>
<p>Another important part of treating heavy bleeding is replacement of iron stores if you’re deficient. You can try to increase your <a href="https://www.healthdirect.gov.au/how-to-meet-your-iron-needs-infographic">dietary iron intake</a>, but your GP may also recommend oral iron supplements. These can cause side effects such as constipation or nausea, so your GP may recommend an iron infusion instead. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in underwear holding her lower abdomen" src="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many options for treating heavy menstrual bleeding. Talk to your GP.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Do I need to see a specialist?</h2>
<p>Your GP may <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">refer you to a specialist</a> if there are red flags, an abnormality on the pelvic ultrasound or if the bleeding doesn’t improve after six months of trialling treatment. </p>
<p>The gynaecologist may offer a <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Hysteroscopy-pamphlet.pdf">hysteroscopy</a>, where a camera is inserted into the uterus. This can be used to treat abnormalities such as fibroids or polyps. </p>
<p><a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Endometrial-Ablation.pdf">Endometrial ablation</a>, where the lining of the uterus is purposefully damaged, can be used to reduce or completely cease monthly bleeding. But it’s not suitable for women who are planning a future pregnancy. </p>
<p>The final option for treating heavy bleeding is surgical removal of the uterus via <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Hysterectomy-pamphlet.pdf">hysterectomy</a>. Historically, this was often used due to a lack of other treatments. While it does permanently resolve heavy bleeding, it has more risks than the other treatments, and is obviously not suitable for women who still wish to bear children. Hysterectomy is considered when other treatments are ineffective or inappropriate, or <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">at the patient’s request</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imagine-having-your-period-and-no-money-for-pads-or-tampons-would-you-still-go-to-school-156570">Imagine having your period and no money for pads or tampons. Would you still go to school?</a>
</strong>
</em>
</p>
<hr>
<h2>5 tips for getting help for heavy periods</h2>
<ol>
<li><p><strong>Don’t delay.</strong> See your GP if you think your periods are heavy or if they’re interfering with your work or personal life </p></li>
<li><p><strong>keep a diary</strong> of symptoms and track your cycle to help your GP understand your periods. Jot down some notes, fill out a period tracking chart or use a free app to keep track</p></li>
<li><p><strong>allow enough time.</strong> Make an appointment specifically to discuss your heavy periods and get answers to any questions you have. Consider making a double appointment</p></li>
<li><p><strong>don’t be embarrassed</strong> to discuss your symptoms or ask your GP questions. This is a common and important problem</p></li>
<li><p><strong>go back for review</strong> if your bleeding isn’t improving after starting treatment. It might be time to discuss other options.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191511/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around a quarter of women experience heavy periods. It probably seems normal to them, but it’s not something you just have to put up with.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyBianca Cannon, GP and Lecturer at Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1913522022-11-24T19:06:08Z2022-11-24T19:06:08ZFrom sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms<figure><img src="https://images.theconversation.com/files/488439/original/file-20221006-20-jjy784.jpg?ixlib=rb-1.1.0&rect=8%2C51%2C5742%2C3776&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Period pain is a common symptom of the menstrual cycle, affecting about <a href="https://www.liebertpub.com/doi/10.1089/jwh.2018.7615">70% of young women</a> – but it’s far from the <a href="https://www.dovepress.com/the-comorbidities-of-dysmenorrhea-a-clinical-survey-comparing-symptom--peer-reviewed-fulltext-article-JPR">only symptom</a>.</p>
<p>Here are five lesser-known symptoms associated with the menstrual cycle – and what’s going on in your body to cause them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>1. Bowel disturbances (period poos)</h2>
<p>Some people experience disturbances in their bowel habits leading up to their period and this commonly manifests as <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a>.</p>
<p>This happens because when you menstruate, your body releases a special chemical called prostaglandins. Prostaglandins help the uterus to cramp, which helps push menstrual blood out of the uterus and into the vagina so it can leave the body.</p>
<p>When you get period pain (especially if a person has endometriosis) a nerve in the back called the <a href="https://youtu.be/O172DUJ-_BY">dorsal root ganglion</a> is activated. </p>
<p>This can cause a range of symptoms, including back pain. This same process can make the bowel sensitive, which can lead to bowel pain or irritable bowel syndrome and contributes to changes in bowel habits like <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a> or constipation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman sits on the toilet." src="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people experience disturbances in their bowel habits leading up to their period.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-using-her-cellphone-while-in-the-toilet-7623575/">Photo by Miriam Alonso/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>2. Stabbing pains</h2>
<p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. </p>
<p>For some, this pain can shoot up the vagina or back passage.</p>
<p>This is related to the cramping that occurs when prostaglandins are released in the body and the nerve in the back (the dorsal root ganglion) is activated. </p>
<p>This can trigger spasms of the pelvic floor muscles (a group of muscles in the bottom of the pelvis that supports the bladder, bowel and uterus).</p>
<p>Seeing a <a href="https://www.endozone.com.au/treatment/53">pelvic health physiotherapist</a> and learning to relax these <a href="https://www.endozone.com.au/treatment/pelvic-floor-muscle-relaxation">muscles</a> can help manage this type of pain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman clasps her thigh as if in pain." src="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>3. Fatigue</h2>
<p>It’s common to feel a bit run down around the time of your period. But for some people this can go beyond just regular tiredness.</p>
<p>A recent <a href="https://www.ajog.org/article/S0002-9378(19)30427-2/fulltext">survey</a> of 42,879 women showed about 70% experience this symptom. It is often <a href="https://doi.org/10.1186/s41687-020-00200-1">described</a> as feeling “exhausted”, “drained”, “tired”, “lethargic”, “worn out”, and/or “weak”.</p>
<p>Fatigue can be due to the brain’s experience of pain. We can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698023/">measure</a> changes in the brain when people experience pelvic pain. Ongoing <a href="https://youtu.be/O172DUJ-_BY">pain signalling</a> to the brain causes these changes, which results in extreme tiredness and sometimes headaches and nausea.</p>
<p>Having a <a href="https://www.endozone.com.au/endometriosis-related-fatigue">good sleep schedule</a>, exercising and eating well can help with fatigue.</p>
<h2>4. Ovulation pain</h2>
<p>Ovulation occurs when a mature egg is released from the ovary. </p>
<p>During this time, estrogen levels are high, and a lot of clear watery mucus is produced by cells in the cervix (which is why seeing extra clear watery mucus at this time is a sign ovulation is approaching). </p>
<p>Most people feel pretty good when their estrogen levels are high. But when the follicle the egg is in gets bigger near ovulation, the pressure of the follicle and its release can cause pain. This ovulation pain is sometimes called <a href="https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122#:%7E:text=Mittelschmerz%20is%20one%2Dsided%2C%20lower,doesn't%20require%20medical%20attention.">mittelschmerz</a>, which is German for “middle pain”.</p>
<p>This can feel like a sharp, relatively short-lived stabbing pain in the lower abdomen on one side.</p>
<h2>5. Mood changes</h2>
<p>Between <a href="https://doi.org/10.2147/JPR.S179409">50%</a> and <a href="https://doi.org/10.1016/j.ajog.2019.02.048">70%</a> of people who have periods experience changes to their mood leading up to or during their period.</p>
<p>But for between <a href="https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x04_Depressive_Disorders">1-5%</a> of people, the impacts on mood can be more severe and may be associated with a condition called premenstrual dysphoric disorder (PMDD).</p>
<p>This occurs when people experience severe mood changes, anxiety or depression in the week before their period, which usually improves within a few days of their period starting.</p>
<h2>When should you see a doctor?</h2>
<p>Symptoms vary so much between people, there is a huge range of “normal” and it can be tricky to decide when to follow up with your doctor. But it is worth chatting to a GP if:</p>
<ul>
<li><p>your period pain interrupts daily activities such as work, school or caring responsibilities</p></li>
<li><p>the pain associated with your cycle is severe or changes</p></li>
<li><p>you have difficulty going to the bathroom, pain with urination or bowel movements or your bowel habits change</p></li>
<li><p>you feel emotionally or mentally overwhelmed</p></li>
<li><p>you experience pelvic pain at other times (outside of your period).</p></li>
</ul>
<p>When these symptoms are severe, they can be due to conditions such as endometriosis.</p>
<p><a href="https://www.endozone.com.au">EndoZone</a> – an evidence-based website co-created with people affected by endometriosis – has a <a href="https://www.endozone.com.au/health-report-form#no-back">self-test</a> for people trying to decide if their period symptoms require further medical care, and tips on how to describe them to a doctor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-10-girls-skip-class-because-of-painful-periods-and-most-wont-talk-to-their-teacher-about-it-150286">3 out of 10 girls skip class because of painful periods. And most won't talk to their teacher about it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca O’Hara received funding from the Department of Health (Commonwealth) and Jean Hailes for Women’s Health for the development of EndoZone. </span></em></p><p class="fine-print"><em><span>Louise Hull received funding from the Department of Health (Commonwealth) and Jean Hailes for Women's Health for the development of EndoZone. She is affiliated with Endometriosis Australia (Medical Advisory Board). </span></em></p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. For some, this pain can shoot up the vagina or back passage.Rebecca O'Hara, Grant Funded Researcher: Endometriosis, Robinson Research Institute, University of AdelaideLouise Hull, Professor and Endometriosis Group Leader, The Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1932352022-11-01T16:41:28Z2022-11-01T16:41:28ZPremenstrual dysphoric disorder: the frightening psychological condition suffered by Dixie D'Amelio<figure><img src="https://images.theconversation.com/files/492533/original/file-20221031-14-afjifv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5559%2C3700&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dixie D'Amelio has recently been diagnosed with PMDD.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-york-september-09-dixie-attends-2202865137">Ron Adar/ Shutterstock</a></span></figcaption></figure><p>Singer and social media star Dixie D'Amelio revealed on Instagram recently that she has been diagnosed with premenstrual dysphoric disorder (PMDD). In her post, she shared how the condition left her feeling that she didn’t “want to be here anymore” and that she had never felt “so low”.</p>
<p>But although PMDD affects <a href="https://iapmd.org/about-pmdd">one in 20 women</a>, very few people know about it. This means that many – just like D'Amelio – may suffer for years without knowing why they feel the way they do, and may not get the help they need. On average it takes <a href="https://iapmd.org/press-releases/2022/6/13/global-study-reveals-alarming-34-of-people-with-menstrual-related-disorder-have-attempted-suicide">12 years</a> before people receive a correct diagnosis. </p>
<h2>What is PMDD?</h2>
<p>Premenstrual dysphoric disorder is a <a href="https://iapmd.org/about-pmdd">severe mood disorder</a>, where people experience distressing and frightening psychological symptoms in the week or two before their period.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/should-i-post-photos-of-my-children-online-heres-what-new-parents-need-to-know-about-sharenting-190507?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Should I post photos of my children online? Here’s what new parents need to know about sharenting</a></em></p>
<p><em><a href="https://theconversation.com/four-ways-to-support-a-friend-or-loved-one-with-long-covid-190824?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Four ways to support a friend or loved one with long COVID</a></em></p>
<p><em><a href="https://theconversation.com/sunscreen-heres-why-its-an-anti-ageing-skincare-essential-187322?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Sunscreen: here’s why it’s an anti-ageing skincare essential</a></em></p>
<hr>
<p>PMDD is not the same as PMS. They differ significantly in severity. Up to 80% of women experience <a href="https://www.nhs.uk/conditions/pre-menstrual-syndrome/">PMS symptoms</a>, which may cause both emotional and physical symptoms such as breast tenderness, bloating, weepiness or irritability. PMS symptoms are typically manageable and don’t impact severely on everyday life.</p>
<p>In contrast, PMDD has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594422/pdf/12905_2020_Article_1100.pdf">debilitating impact</a> on everyday life, and may even affect relationships, education and employment. While many of the physical symptoms are the same as PMS, people with PMDD will experience far more severe psychological symptoms. These include mood swings, a feeling of hopelessness, anxiety, irritability, feeling overwhelmed and difficulty concentrating.</p>
<p>Some people will first experience PMDD around the time their periods begin. But others may develop the condition later on, such as after pregnancy, or after they <a href="https://lunahub.net/pmdd-and-work-one-patients-story/">stop breastfeeding</a> their child. </p>
<p>Although the causes of PMDD are not fully understood, ongoing research is exploring <a href="https://womensmentalhealth.org/posts/etiology-premenstrual-dysphoric-disorder">several possible mechanisms</a>. These include genetic factors, long-term exposure to the hormone progesterone and one of the chemicals it breaks down into (allopregnanolone), an irregular relationship between the hormones oestrogen and serotonin, differences in brain structure and even past history of trauma. </p>
<h2>How is it treated?</h2>
<p>Most people with PMDD experience thoughts of <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03851-0">self-harm and suicide</a>. One in three people with PMDD will attempt to end their life. This is why it’s so important to increase awareness about the condition, so more people can get the help they need. </p>
<p>If you suspect you have PMDD it’s important to visit a GP to get a diagnosis. But before you do, you will want to track your menstrual cycle for at least two months. This is essential, as you will be able to show your doctor monthly patterns in your mood, and how this affects different aspects of your life. There are <a href="https://iapmd.org/steps-to-diagnosis">many apps</a> you can use to help you do this, or you can record it in a journal. </p>
<figure class="align-center ">
<img alt="Young woman uses a period tracking app on her phone." src="https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492534/original/file-20221031-25-o45gzs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Use a journal or app to track monthly patterns in your symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/high-angle-obese-latin-woman-using-2164626231">antoniodiaz/ Shutterstock</a></span>
</figcaption>
</figure>
<p>PMDD is <a href="https://drive.google.com/file/d/1k5sRLensvbRuHkI3AG8M333pXwgeUUMK/view">typically managed</a> in a few different ways. The treatment plan you’re given may not be the same as the next person. </p>
<p>Many people will be given anti-depressants known as serotonin-selective reuptake inhibitors (SSRIs). These can <a href="https://pubmed.ncbi.nlm.nih.gov/35686687/">work within hours</a> to improve symptoms for people with PMDD. Although SSRIs can be taken everyday, they can also be taken only when symptoms return each month. </p>
<p>Another common treatment is prescribing hormonal contraceptives which prevent ovulation, such as the pill. This helps prevent the sharp changes in hormone levels which trigger PMDD episodes. </p>
<p>People who fail to respond to SSRIs or oral contraceptives may be given alternative treatments, such as <a href="https://mft.nhs.uk/app/uploads/sites/4/2019/11/19-71-GnRH-analogue-injections-Nov-19.pdf">GnRH analogues</a>, which put women into a temporary artificial chemical menopause. The last-resort treatment for women who have not had success with other treatment options is <a href="https://iapmd.org/surgery">oophrectomy</a>, which surgically removes the ovaries. </p>
<h2>What can you do?</h2>
<p>It can be scary to learn you might have PMDD. But fortunately, there’s support out there. The <a href="https://www.iapmd.org">International Association of Premenstrual Disorders</a>, for example, has many excellent resources not only for you, but also your loved ones and health professionals. They provide information about PMDD and how you can manage it.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312261/?report=reader">Peer support</a> can also be a lifesaver. Knowing you have people to talk to about your experiences or who are going through the same thing can empower you and give you hope. Even if you don’t have friends who are going through something similar, there are <a href="https://iapmd.org/group-support/#ourgroups">moderated support forums</a>, <a href="https://iapmd.org/video-support-groups">video</a> support groups and social media platforms where you can <a href="https://www.instagram.com/explore/tags/pmdd/?hl=en">find an online community</a> of other people living with PMDD. </p>
<p>PMDD was only recognised as a medical condition <a href="https://www.psychiatrist.com/blog/pmdd-in-the-dsm-5/">in 2013</a>, which is pretty recent in medical terms. This means there’s still a lot of work to be done in terms of improving diagnosis and treatment of the condition. This is something <a href="https://www.lynsaymatthews.com">my own research</a> aims to do. </p>
<p>Increasing awareness of PMDD is crucial in helping people access the right support, but also for educating health professionals on the symptoms and management options. But thanks to people like D'Amelio, PMDD is finally being talked about – which will hopefully lead to more people finally getting the help they need.</p><img src="https://counter.theconversation.com/content/193235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynsay Matthews receives funding from Research England and the Economic and Social Research Council to undertake PMDD research. Lynsay is affiliated with the Scottish Government as a member of their Cross Party Group on Women's Health. </span></em></p>One in 20 women have PMDD – though very few may realise they have it.Lynsay Matthews, Lecturer in Public Health, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1897172022-10-10T08:58:31Z2022-10-10T08:58:31ZHeavy periods can lead to big health problems for young women — but many don’t get the help they need<figure><img src="https://images.theconversation.com/files/488304/original/file-20221005-18-94b9f4.jpg?ixlib=rb-1.1.0&rect=31%2C0%2C4236%2C2841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with heavy menstrual bleeding may loose close to a pint of liquid during their period.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/buys-woman-hygiene-protection-723967453">Tony Thiethoaly/ Shutterstock</a></span></figcaption></figure><p>Many of us have no idea whether or not our period is “normal”. It’s no wonder, since not only is everyone different, but the stigma still keeps many of us from asking questions or discussing what we go through every month with friends and family. </p>
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<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/heavy-periods-can-lead-to-big-health-problems-for-young-women-but-many-dont-get-the-help-they-need-189717&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/us/topics/audio-narrated-99682">here</a>.</em></p>
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<p>But there is such as thing as bleeding too much. In fact, <a href="https://pubmed.ncbi.nlm.nih.gov/25627706/">around a quarter</a> of women experience a clinical condition known as menorrhagia – also called heavy menstrual bleeding. This is when your period is abnormally heavy or prolonged. Here’s what you need to know about the condition.</p>
<h2>What counts as a heavy period?</h2>
<p>Typically, during a “normal” period, you lose between <a href="https://pubmed.ncbi.nlm.nih.gov/5922481/">70ml and 80ml of fluid</a> (the equivalent of around two double espressos). Around <a href="https://www.karger.com/Article/Abstract/496608">50% of the fluid lost is blood</a>. But people with heavy menstrual bleeding may lose around <a href="https://pubmed.ncbi.nlm.nih.gov/5922481/">160ml-400ml of fluid</a> (a little less than a pint of liquid).</p>
<p>The most common symptoms of heavy menstrual bleeding are:</p>
<ul>
<li>Bleeding through pads or tampons every one to two hours,</li>
<li>A period that lasts more than seven days,</li>
<li>Passing blood clots larger than 1 inch (around the size of a 10p coin).</li>
</ul>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/period-delay-tablets-can-help-you-temporarily-skip-your-period-heres-how-they-work-184991?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Period delay tablets can help you temporarily skip your period – here’s how they work</a></em></p>
<p><em><a href="https://theconversation.com/why-the-body-positivity-movement-risks-turning-toxic-189913?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Why the body positivity movement risks turning toxic</a></em></p>
<p><em><a href="https://theconversation.com/taking-a-mental-health-day-can-be-good-for-you-heres-how-to-make-the-most-of-one-186493?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Taking a mental health day can be good for you – here’s how to make the most of one</a></em></p>
<hr>
<h2>Are heavy periods bad for you?</h2>
<p>Despite how common it is, most women with the condition aren’t even aware they have it. Many even assume their period is “normal”. But this way of thinking can be a problem, as heavy menstrual bleeding can sometimes be a sign of an <a href="https://www.medicalnewstoday.com/articles/295202">underlying issue</a> – such as fibroids, endometriosis, or a pelvic infection or bleeding illnesses. A recently fitted intrauterine device (IUD) may also temporarily cause heavy menstrual bleeding. </p>
<p>Around <a href="https://pubmed.ncbi.nlm.nih.gov/25627706/">two-thirds</a> of women with heavy menstrual bleeding also go on to have long-term iron deficiency anaemia as a result. </p>
<p>When we menstruate, we <a href="https://my.clevelandclinic.org/health/diseases/3929-anemia">lose red blood cells</a> which are integral for carrying oxygen (a source of energy) throughout the body. If you bleed heavily every month, you lose more red blood cells than normal.</p>
<p>Anaemia can take a while to develop, but can cause a range of symptoms that can have a major effect on your daily life.</p>
<p>While pale skin or lips are tell-tale physical signs, a <a href="https://my.clevelandclinic.org/health/diseases/3929-anemia">person with anaemia</a> may also feel more tired than usual, irritable, dizzy, confused and even depressed. Anaemia can also cause headaches, brain fog, increased heart rate and even <a href="https://my.clevelandclinic.org/health/diseases/3929-anemia">weight loss</a>.</p>
<h2>What can you do about heavy periods?</h2>
<p>If you suspect you may have heavy menstrual bleeding, it’s important to speak to your doctor as soon as you can. Diagnosis can take <a href="https://www.tandfonline.com/doi/full/10.1185/03007995.2012.759096?scroll=top&needAccess=true">up to several months</a> after you first visit your GP, so it’s important not to put it off.</p>
<p>Going to your appointment armed with information is always useful. For example, it’s good to have an idea of your usual blood loss either by using menstrual cups to measure volume or tracking how many sanitary items you use every cycle. </p>
<p>Keeping a menstrual diary or using a tracker app can also help, as well as knowing if the condition runs in the family. If you haven’t done this, it’s likely <a href="https://www.ncbi.nlm.nih.gov/books/NBK56538">your doctor</a> will ask you to track these things for a few months before diagnosing you. </p>
<figure class="align-center ">
<img alt="A woman uses a period tracking app on her phone." src="https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488287/original/file-20221005-12-o0sqkd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keeping track of your period can be useful when speaking to your GP.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tracking-periods-by-using-menstrual-1940658049">Kaspars Grinvalds/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Your doctor will be able to <a href="https://www.ncbi.nlm.nih.gov/books/NBK56545/">prescribe you certain medications</a> that may lessen the effect of heavy menstrual bleeding – including the contraceptive pill or <a href="https://www.nhs.uk/medicines/tranexamic-acid/">tranexamic acid</a> (which controls bleeding and helps blood clots). Surgical options may also be needed should the condition be caused by another issue, <a href="https://111.wales.nhs.uk/Heavyperiods,Menorrhagia/#Diagnosis">such as fibroids</a>. </p>
<p>If you suspect you may have anaemia, it’s similarly important to track your symptoms carefully, especially how you feel both before and after your period. Many <a href="https://www.stlukes-stl.com/health-content/medicine/33/000373.htm">common conditions</a>, such as anxiety, cough, flu, and food allergies, have overlapping symptoms with iron-deficiency anaemia, so asking your doctor for a blood test is important as it will tell you whether or not you’re anaemic. </p>
<p>If you’re diagnosed with anaemia, iron supplements may be prescribed to help your body generate new red blood cells. A healthy, balanced diet containing foods high in iron – such as <a href="https://www.nationwidechildrens.org/conditions/iron-deficiency-anemia">dark meats</a>, <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/iron/">chickpeas, beans, leafy greens and nuts</a> – may also help.</p>
<h2>Why it’s important to receive help</h2>
<p>But as many women with heavy menstrual bleeding know, it often takes far too long before they get the help they need. This can mean <a href="https://www.researchgate.net/figure/Effect-of-menorrhagia-on-daily-activities-Percentage-of-women-with-light-normal-or-heavy_fig5_23318428">years of unnecessary suffering</a>, with the condition affecting everything from their personal life, <a href="https://www.nationwidechildrens.org/family-resources-education/700childrens/2016/10/heavy-menstrual-bleeding-what-girls-and-parents-need-to-know">school attendance, participation in sports</a> and even their work. Those who develop anaemia, as a result, will experience even more effects on their <a href="https://anemiacentral.com/wp-content/uploads/2017/03/Iron-deficiency_anaemia_and_physical_performance_i.pdf">physical</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680022/">mental</a> health.</p>
<p>This is why there needs to be far more openness and education about women’s health. Not only does this mean talking more about what is and isn’t normal when it comes to periods, it also means making sure healthcare providers are properly educated about the signs and symptoms of this condition – and the harms that can come from it. Having a more open discussion and raising awareness may help more women get the help and treatment they need sooner.</p><img src="https://counter.theconversation.com/content/189717/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around a quarter of women have clinically heavy periods.Suzannah Williams, Associate Professor in Ovarian Physiology, Lead for Ovarian Cryopreservation and Fertility Preservation Research, Lead of Rhino Fertility Project, University of OxfordTomi Adeniran, DPhil in Women's and Reproductive Health, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869622022-07-18T12:20:20Z2022-07-18T12:20:20ZCOVID vaccines are linked to heavier periods for many – new findings from large study<figure><img src="https://images.theconversation.com/files/474577/original/file-20220718-4540-axzkoq.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/menstrual-hygiene-products-including-cup-pads-2083953145">FabrikaSimf/Shutterstock</a></span></figcaption></figure><p>COVID has affected countless aspects of our lives. For many people who menstruate, one of the pandemic’s effects has been on periods. People have reported <a href="https://academic.oup.com/ije/article/51/3/691/6447179?login=false">changes to their menstrual cycles</a> after having COVID, from the timing of their period, to its duration, to bleeding (a heavier or lighter flow).</p>
<p>Meanwhile, many people have reported changes to their menstrual cycles after COVID vaccination. The <a href="https://www.science.org/doi/10.1126/sciadv.abm7201">largest study yet</a> on this topic has just been published, finding that 42% of people who regularly menstruate reported a heavier period after COVID vaccination.</p>
<p>The researchers, based in the US, launched an online survey in April 2021, which was advertised through multiple channels, including TV news, Twitter, blogs and radio. The survey asked for demographic information and included questions about people’s periods, from symptoms to timing and bleeding duration. </p>
<p>It also asked about COVID vaccination status. For this analysis, all participants had been fully vaccinated, meaning they had received two doses at least 14 days before completing the survey (boosters were not yet available at the time). Most participants had received either the Pfizer or Moderna vaccines.</p>
<p>The results are based on responses from 39,000 people who regularly menstruate or who have done so in the past. The latter group could include people who have been through menopause, people receiving gender-affirming treatment, or people using hormonal contraceptives that suppress menstruation.</p>
<p>The study excluded anyone who had had COVID.</p>
<p>In the group who regularly menstruate, 42% reported a heavier period after their vaccine, 44% reported no change, and 14% reported a lighter period.</p>
<p>In the second group, two-thirds of post-menopausal participants and people on long-acting reversible contraceptives (such as <a href="https://www.acog.org/womens-health/faqs/long-acting-reversible-contraception-iud-and-implant">IUDs and implants</a>) reported breakthrough bleeding after COVID vaccination. Over one-third of those on gender-affirming treatment (which eliminates menstruation) experienced breakthrough bleeding.</p>
<h2>What has other research found?</h2>
<p>Other studies have also found changes in periods following vaccination. </p>
<p>For example, a study of almost 4,000 participants in the US found that after a second vaccine people started their period on average just over <a href="https://journals.lww.com/greenjournal/Fulltext/9900/Association_Between_Menstrual_Cycle_Length_and.357.aspx">half a day later</a> than expected.</p>
<p>A <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3998180">Norwegian study</a> of more than 5,500 people found that over 7% of participants experienced heavier and longer periods after receiving their first COVID vaccine dose.</p>
<p>Similarly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976114/">a study</a> of 2,269 women in the Middle East and north Africa found that women reported menstrual irregularities such as longer periods and longer cycles (more time between periods) after vaccination.</p>
<figure class="align-center ">
<img alt="A smiling young woman with a bandaid on her arm." src="https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474610/original/file-20220718-68563-vt4z8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people have reported changes to their period after COVID vaccination.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/successful-covid19-vaccination-happy-young-lady-2052071627">Prostock-studio/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why might these changes happen?</h2>
<p>Reports of cycle changes after vaccination is not a new phenomenon. A <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/653642">1913 study</a> showed heavier bleeding after typhoid vaccination. Similarly, <a href="https://www.jstage.jst.go.jp/article/kurumemedj1954/29/3/29_3_123/_article/-char/en">a 1982 study</a> on hepatitis B and a more recent one <a href="https://pubmed.ncbi.nlm.nih.gov/29481964/">on HPV</a> found changes to menstrual cycles following vaccination. </p>
<p>We don’t yet fully understand the biological mechanism behind cycle changes linked to COVID vaccines. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690231/">changes to menstrual cycles</a> usually stem from one of two routes: hormones or inflammation. A vaccine works by provoking the immune system to react to exposure to a disease, which can influence inflammation.</p>
<p>As the study didn’t find any differences between users of hormonal contraceptives (such as the pill) and non-users, the authors suggest the mechanism is likely to relate to inflammation rather than hormones. </p>
<p>The authors also suggest that menstrual changes could be due to the effect of the immune system on the uterus. In particular, the inflammation sparked by the vaccine could affect the uterine lining, leading to breakthrough bleeding. But this requires <a href="https://www.bmj.com/content/374/bmj.n2211">more research</a>.</p>
<p>Whatever the case, changes to menstrual cycles after vaccination are short-lived. For most, cycles should return to normal within a few months.</p>
<h2>Some things to keep in mind</h2>
<p>While the effect of vaccines on periods is not an area that has traditionally attracted a lot of research, the issue has been brought into the spotlight by the scale and speed of the COVID vaccination campaign. Because more people are having similar symptoms at the same time, this leads to more attention and more research.</p>
<p>It’s important to note that this study cannot conclude that the vaccine <em>causes</em> menstrual changes. While it shows associations, to establish a causal link, we would need a clinical trial (so, to follow people who did and didn’t receive a COVID vaccine over a longer period of time). Indeed, the authors stress the importance of including questions about menstrual cycles in future vaccine research. </p>
<p>Further, the way participants were recruited in this study means the results should be interpreted with caution. People who saw changes in their period after vaccination might have been more inclined to respond to the survey, which could have skewed the results. Most of the participants were also white, so the results may not apply to racially diverse groups.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-pandemic-has-affected-periods-175672">How the pandemic has affected periods</a>
</strong>
</em>
</p>
<hr>
<p>This research should provide an impetus for further study and raise awareness of menstrual changes as a possible side-effect of COVID vaccination. The public should be made aware of possible side-effects, not because they’re dangerous, but because people need to know what to expect. </p>
<p>Just as you might have a painkiller on hand to take if you develop a headache after vaccination, some people may want to be prepared with extra menstrual products. Knowing what to expect could be especially useful for people who are no longer menstruating but may experience breakthrough bleeding following vaccination.</p><img src="https://counter.theconversation.com/content/186962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriella Kountourides does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This is not cause for concern, but it’s important information to have.Gabriella Kountourides, PhD Candidate in Biological Anthropology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1862572022-07-07T12:25:00Z2022-07-07T12:25:00ZNo, submitting junk data to period tracking apps won’t protect reproductive privacy<figure><img src="https://images.theconversation.com/files/472894/original/file-20220706-21-sv4o06.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media is flush with advice urging non-menstruating people to use period tracking apps in order to trip up the apps' algorithms.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/florida-miami-beach-young-couple-using-cell-phone-royalty-free-image/1125575075">Westend61 via Getty Images</a></span></figcaption></figure><p>Social media users posted ideas about how to protect people’s reproductive privacy when the <a href="https://www.npr.org/2022/06/24/1102305878/supreme-court-abortion-roe-v-wade-decision-overturn">Supreme Court overturned Roe v. Wade</a>, including entering <a href="https://twitter.com/kaleidobarks/status/1541589930501033986">“junk” data into apps designed for tracking menstrual cycles</a>. </p>
<p><a href="https://doi.org/10.1145/3025453.3025635">People use period tracking apps to</a> predict their next period, talk to their doctor about their cycle and identify when they are fertile. Users log everything from cravings to period flow, and apps provide predictions based on these inputs. The app predictions help with simple decisions, like when to buy tampons next, and provide life-changing observations, like whether you’re pregnant.</p>
<p>The argument for submitting junk data is that doing so will trip up the apps’ algorithms, making it difficult or impossible for authorities or vigilantes to use the data to violate people’s privacy. That argument, however, doesn’t hold water.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1541589930501033986"}"></div></p>
<p>As <a href="https://scholar.google.com/citations?user=-R9W7IkAAAAJ&hl=en">researchers</a> <a href="https://scholar.google.com/citations?user=eAys7JgAAAAJ&hl=en">who develop</a> <a href="https://scholar.google.com/citations?user=xXYaU8YAAAAJ&hl=en">and evaluate</a> technologies that help people manage their health, we analyze how app companies collect data from their users to provide useful services. We know that for popular period tracking applications, millions of people would need to input junk data to even nudge the algorithm. </p>
<p>Also, junk data is a form of “noise,” which is an inherent problem that developers design algorithms to be robust against. Even if junk data successfully “confused” the algorithm or provided too much data for authorities to investigate, the success would be short-lived because the app would be less accurate for its intended purpose and people would stop using it. </p>
<p>In addition, it wouldn’t solve existing privacy concerns because people’s digital footprints are everywhere, from <a href="https://theconversation.com/impending-demise-of-roe-v-wade-puts-a-spotlight-on-a-major-privacy-risk-your-phone-reveals-more-about-you-than-you-think-182504">internet searches to phone app use and location tracking</a>. This is why advice urging people to delete their period tracking apps is <a href="https://www.nytimes.com/2022/06/30/technology/period-tracker-privacy-abortion.html">well-intentioned but off the mark</a>.</p>
<h2>How the apps work</h2>
<p>When you first open an app, you input your age, date of your last period, how long your cycle is and what type of birth control you use. Some apps connect to other apps like physical activity trackers. You record relevant information, including when your period starts, cramps, discharge consistency, cravings, sex drive, sexual activity, mood and flow heaviness.</p>
<p>Once you give your data to the period app company, it is unclear exactly what happens to it because the algorithms are proprietary and part of the business model of the company. Some apps ask for the user’s cycle length, which people may not know. Indeed, researchers found that 25.3% of people said that their cycle had the oft-cited duration of 28 days; however, <a href="https://doi.org/10.1093/hropen/hoaa011">only 12.4% actually had a 28-day cycle</a>. So if an app used the data that you input to make predictions about you, it may take a few cycles for the app to calculate your cycle length and more accurately predict the <a href="https://www.healthline.com/health/womens-health/stages-of-menstrual-cycle">phases of your cycle</a>. </p>
<p>An app could make predictions based on all the data the app company has collected from its users or based on your demographics. For example, the app’s algorithm knows that a person with a higher body mass index <a href="https://doi.org/10.2196%2F17109">might have a 36-day cycle</a>. Or it could use a hybrid approach that makes predictions based on your data but compares it with the company’s large data set from all its users to let you know what’s typical – for example, that a majority of people report having cramps right before their period.</p>
<h2>What submitting junk data accomplishes</h2>
<p>If you regularly use a period tracking app and give it inaccurate data, the app’s personalized predictions, like when your next period will occur, could likewise become inaccurate. If your cycle is 28 days and you start logging that your cycle is now 36 days, the app should adjust – even if that new information is false.</p>
<p>But what about the data in aggregate? The simplest way to combine data from multiple users is to average them. For example, the most popular period tracking app, <a href="https://flo.health/">Flo</a>, has an estimated 230 million users. Imagine three cases: a single user, the average of 230 million users and the average of 230 million users plus 3.5 million users submitting junk data.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line graph showing 0 to 15 on the x-axis and -2 to 2 on the y-axis. One line is jagged, while two other lines appear as smooth sine waves. There's a small difference between the the two sine waves, visible as a difference in the size of the peaks and troughs." src="https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472900/original/file-20220706-22456-z1n7gv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The blue line represents a single user. The orange line is the average of 230 million users. The green line combines 230 million users submitting good data with 3.5 million users submitting junk data. Note that there is little difference between the orange and green lines.</span>
<span class="attribution"><span class="source">Alexander Lee Hayes</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>An individual’s data may be noisy, but the underlying trend is more obvious when averaged over many users, smoothing out the noise to make the trend more obvious. Junk data is just another type of noise. The difference between the clean and fouled data is noticeable, but the overall trend in the data is still obvious.</p>
<p>This simple example illustrates three problems. People who submit junk data are unlikely to affect predictions for any individual app user. It would take an extraordinary amount of work to shift the underlying signal across the whole population. And even if this occurred, poisoning the data risks making the app useless for those who need it.</p>
<h2>Other approaches to protecting privacy</h2>
<p>In response to people’s concerns about their period app data being used against them, some period apps made public statements about creating an <a href="https://flo.health/press-center/flo-launches-anonymous-mode">anonymous mode</a>, using <a href="https://www.thestardustapp.com/privacypolicy">end-to-end encryption</a> and <a href="https://helloclue.com/articles/abortion/clue-s-response-to-roe-vs-wade">following European privacy laws</a>. </p>
<p>The security of any “anonymous mode” hinges on what it actually does. <a href="https://flo.health/press-center/flo-launches-anonymous-mode">Flo’s statement</a> says that the company will de-identify data by removing names, email addresses and technical identifiers. Removing names and email addresses is a good start, but the company doesn’t define what they mean by technical identifiers. </p>
<p>With Texas paving the road to <a href="https://www.texastribune.org/2021/09/03/texas-republican-abortion-civil-lawsuits/">legally sue anyone aiding anyone else seeking an abortion</a>, and <a href="https://dataprivacylab.org/projects/identifiability/paper1.pdf">87% of people in the U.S. identifiable by minimal demographic information like ZIP code, gender and date of birth</a>, any demographic data or identifier has the potential to harm people seeking reproductive health care. There is a <a href="https://theconversation.com/data-insecurity-leads-to-economic-injustice-and-hits-the-pocketbooks-of-the-poor-most-116231">massive market for user data</a>, primarily for targeted advertising, that makes it possible to learn a frightening amount about nearly anyone in the U.S.</p>
<p>While end-to-end encryption and the European General Data Protection Regulation (GDPR) can protect your data from legal inquiries, unfortunately none of these solutions help with the digital footprints everyone leaves behind with everyday use of technology. Even users’ search histories can identify <a href="https://doi.org/10.1145/2702123.2702427">how far along they are in pregnancy</a>.</p>
<h2>What do we really need?</h2>
<p>Instead of brainstorming ways to circumvent technology to decrease potential harm and legal trouble, we believe that people should advocate for <a href="https://arxiv.org/pdf/2012.08571.pdf">digital privacy protections and restrictions of data usage and sharing</a>. Companies should effectively communicate and receive feedback from people about how their data is being used, their risk level for exposure to potential harm, and the value of their data to the company.</p>
<p>People have been <a href="https://www.pewresearch.org/fact-tank/2019/11/15/key-takeaways-on-americans-views-about-privacy-surveillance-and-data-sharing/">concerned about digital data collection</a> in recent years. However, in a post-Roe world, more people can be placed at legal risk for doing standard health tracking.</p><img src="https://counter.theconversation.com/content/186257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Siek receives funding from the National Science Foundation. She is affiliated with the Computer Research Association and the Computing Community Consortium. </span></em></p><p class="fine-print"><em><span>Alexander L. Hayes and Zaidat Ibrahim do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It would take huge numbers of people submitting bad data to affect the algorithms behind period tracking apps, but even then it would be more harmful than helpful.Katie Siek, Professor and Chair of Informatics, Indiana UniversityAlexander L. Hayes, Ph.D. Student in Health Informatics, Indiana UniversityZaidat Ibrahim, Ph.D student in Health Informatics, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1861072022-07-05T12:15:03Z2022-07-05T12:15:03ZHow the tampon shortage is exacerbating period poverty in the US<figure><img src="https://images.theconversation.com/files/472097/original/file-20220701-24-qbmo7y.jpg?ixlib=rb-1.1.0&rect=8%2C53%2C5982%2C3934&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tampons are the latest product to be in scarce supply at U.S. stores.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/box-of-tampax-pearl-tampons-are-seen-on-a-shelf-at-a-store-news-photo/1241307437?adppopup=true">Stefani Reynolds/AFP via Getty Images)</a></span></figcaption></figure><p><em>Tampons have become the latest household product to <a href="https://time.com/6184644/tampon-shortage-supply-chain/">fall foul of supply chain</a> issues.</em></p>
<p><em>Reports of a <a href="https://www.nytimes.com/2022/06/13/well/live/tampon-shortage.html">scarcity of the menstrual product</a>, used by millions of women in the U.S., have combined with general inflationary pressure on the price of goods to create cost and access barriers.</em></p>
<p><em>The Conversation asked Marni Sommer, an <a href="https://www.publichealth.columbia.edu/people/our-faculty/ms2778">expert on public health and menstruation</a> at Columbia University, what was causing the current shortage and how it has affected the plight of low-income women and adolescent girls who may already face barriers to sufficient, high-quality menstrual products.</em></p>
<h2>What is behind the tampon shortage?</h2>
<p>There are a couple of things at play here. First off, it appears tampons are another casualty of the <a href="https://www.npr.org/2022/06/12/1104393549/tampons-are-the-latest-supply-chain-casualty-women-took-notice-months-ago">supply chain problems</a> that have been around since the beginning of the pandemic. But this has been compounded by a particular issue with the <a href="https://www.bloomberg.com/news/articles/2022-06-09/inflation-is-pushing-tampon-prices-up-10">rising price of raw materials</a> used in tampons: cotton, rayon and plastic.</p>
<p>On top of this, there has been the <a href="https://www.fitchratings.com/research/sovereigns/china-covid-19-lockdowns-to-intensify-global-inflation-concerns-10-05-2022">impact of the recent lockdown in China</a> on production worldwide, as well as<a href="https://www.bloomberg.com/news/articles/2022-06-28/p-g-worker-shortage-puts-a-third-of-us-tampon-market-at-risk?sref=Hjm5biAW"> general staffing issues</a> at manufacturers in the U.S.</p>
<p>Meanwhile, the impact of inflation has hit menstrual products in general, and tampons in particular. Inflation trackers say the price of tampons has <a href="https://nielseniq.com/global/en/insights/analysis/2022/the-numbers-behind-the-feminine-product-shortage/">surged nearly 10%</a> over the last year.</p>
<h2>Does the shortage impact some women more than others?</h2>
<p>It is a good question. Unfortunately, no one has studied how the current shortage is affecting different women – it is just too soon. But we are hearing from organizations that help women who traditionally have difficulty accessing menstrual products, such as those experiencing homelessness and lower-income women, that it is directly affecting them. </p>
<p>These organizations are <a href="https://www.cbsnews.com/news/tampon-shortage-supply-chain-pandemic/">also seeing a</a> <a href="https://www.washingtonpost.com/wellness/2022/06/15/tampon-shortage-explainer/">shortfall in donations</a> of tampons, which makes it harder to distribute these products to vulnerable groups.</p>
<p>The shortage may affect women who use tampons more so than other menstrual products, such as pads or menstrual cups. And women who experience heavier bleeding will be hit harder by the rising costs as they may need more tampons for each menstrual cycle.</p>
<p>Clearly, the most affected will be women who simply can’t afford the jump in prices. The shortage, alongside of the impact of inflation, will likely exacerbate what is called “<a href="http://doi.org/10.1001/jamahealthforum.2021.3089">period poverty</a>.”</p>
<h2>What is period poverty and who does it affect?</h2>
<p>Period poverty is the inability to access sufficient, quality menstrual products. And even before the recent price increases, many women in the U.S. were affected by period poverty. Unfortunately, we don’t have rigorous data on the extent or scale of period poverty across the country.</p>
<p>But a <a href="https://doi.org/10.2105/AJPH.2021.306674">study I conducted</a> in 2021 with colleagues at the CUNY School of Public Health found that the pandemic exacerbated the problem of period poverty. Loss of income as a result of the economic fallout of the pandemic was a <a href="https://doi.org/10.2105/AJPH.2021.306674">strong predictor of menstrual product insecurity</a>, especially for women already on low incomes or with lower formal education. Respondents to our survey indicated increased challenges when it came to accessing menstrual products.</p>
<h2>What is the impact of period poverty on women’s lives?</h2>
<p>There isn’t a lot of data on period poverty in this country – we have only really started talking about it in recent years. It isn’t a subject that, traditionally, women have <a href="https://policylab.chop.edu/blog/period-poverty-public-health-crisis-we-dont-talk-about">felt comfortable talking</a> about.</p>
<p>Alongside the financial burden, there is importantly the ongoing stigma and <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01149-5">stress for women</a> who are unable to access or afford menstrual products. Menstrual product insecurity can affect a woman’s confidence to go about her daily life and create anxiety.</p>
<p>Another thing we found in our study looking at how the recent pandemic affected access to menstrual products was that women described using various coping mechanisms when not able to afford or access them. This included, for example, using diapers, socks and cloth in place of menstrual products such as pads and tampons. This is happening now in America, but many women are embarrassed to talk about it.</p>
<p>Period poverty and the tampon shortage may also mean that women are having to use inferior products. Yes, you might be able to get cheaper tampons at the dollar store, but they might not work as well, and using lower-quality products might mean a woman has to buy even more of them. </p>
<p>This quality issue came up in a <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01133-8">study</a> I was involved with looking at populations experiencing homelessness. Respondents complained that the products available in shelters or at service providers, oftentimes the results of donations, were not of a high quality. Others have <a href="https://www.aclu.org/news/prisoners-rights/why-im-fighting-for-menstrual-equity-in-prison">described</a> similar product quality challenges for those who are incarcerated.</p>
<h2>What are the alternatives for women amid the tampon shortage?</h2>
<p>There are a number of other products on the market – indeed, one thing I found out in a study of adolescent girls and menstruation was how overwhelmed they felt by the many options available to them.</p>
<p>Our understanding is that many more women use pads than tampons. Then you have <a href="https://theconversation.com/menstrual-cups-vs-tampons-heres-how-they-compare-120499">menstrual cups</a>, which have been around for decades but have seen a resurgence in recent years. They are environmentally friendly, but not every woman is comfortable with the idea of inserting cups, and the upfront costs can be higher.</p>
<p><a href="https://www.nytimes.com/wirecutter/reviews/thinx-period-panties/">Period underwear</a> made of absorbent materials is a newer product that some women use. But for women who are used to tampons but are finding them difficult to access, pads may be the easiest substitute.</p><img src="https://counter.theconversation.com/content/186107/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marni Sommer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A severe shortage of tampons alongside sharp price increases have sparked concerns that lower-income women may have difficulty accessing menstrual products.Marni Sommer, Associate Professor of Sociomedical Sciences, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849912022-06-15T10:45:26Z2022-06-15T10:45:26ZPeriod delay tablets can help you temporarily skip your period – here’s how they work<figure><img src="https://images.theconversation.com/files/468962/original/file-20220615-24-6jm8ji.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women don't know period delay tablets are available to them.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-illness-woman-blue-dress-holding-1150619087">ViDI Studio/ Shutterstock</a></span></figcaption></figure><p>There’s an underlying law of the universe which dictates a woman’s period will always arrive just in time to disrupt important plans. For any woman who’s ever had a special trip or event spoiled thanks to the arrival of her period, having a way of skipping it temporarily would be life-changing. </p>
<p>Users of the combined contraceptive pill are able to postpone or skip their period by starting their next packet of birth control instead of taking the break week. For women on different types of contraceptives (or no contraceptive at all), they’ve had no choice but to deal with their period and all its inconveniences – whenever it arrives. But recently, more and more high-street pharmacies have started selling period delay tablets on prescription – which may just be the solution many women have been waiting for. </p>
<h2>Delaying your period</h2>
<p>For many years, doctors have been able to prescribe a course of hormone tablets to delay a period. But more recently, retail pharmacists in the UK (such as Boots) have started selling the period delay tablet Utovlan via <a href="https://onlinedoctor.boots.com/period-delay">online consultation</a> with a doctor.</p>
<p>These tablets contain an artificial hormone, similar to the body’s progesterone, which helps to delay the end of a natural cycle – ultimately delaying a period. These pills are only designed to be used by women not already taking the combined oral birth control pill.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/people-with-endometriosis-and-pcos-wait-years-for-a-diagnosis-attitudes-to-womens-pain-may-be-to-blame-179500?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame</a></em></p>
<p><em><a href="https://theconversation.com/birth-control-what-to-expect-if-you-choose-to-come-off-it-182964?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Birth control: what to expect if you choose to come off it</a></em></p>
<p><em><a href="https://theconversation.com/ivf-add-ons-why-you-should-be-cautious-of-these-expensive-procedures-if-youre-trying-to-conceive-180198?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">IVF add-ons: why you should be cautious of these expensive procedures if you’re trying to conceive</a></em></p>
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<p>The timing of periods is controlled by hormonal changes which take place every month. In simple terms, the hormone oestrogen – produced by the ovaries – causes the lining of the womb to thicken in the first two weeks of each month. After the woman has ovulated, progesterone (another hormone) maintains that womb lining for the next two weeks to prepare for the arrival of a fertilised egg. But if pregnancy doesn’t happen, progesterone levels drop steeply – causing the womb to shed its lining and the woman’s period to begin. </p>
<p>Period delay tablets contain norethisterone, an artificial version of progesterone. These work by keeping the progesterone levels in the body artificially higher for longer – ultimately delaying the arrival of a period. But there is a limit to how long the thickened womb lining can be maintained – so usually it’s only possible to delay a period using these tablets for about two weeks after it was due. </p>
<figure class="align-right ">
<img alt="A box of the period delay tablet Utovlan." src="https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468965/original/file-20220615-19-d7lxvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Utovlan is the period delay tablet available in the UK.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/144891950@N08/48671074198">Doctor 4U/ flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Anyone who wants to use a period delay tablet will need to start them about three days before their period is due. They will need to take the tablets three times a day for as long as they want their period to be delayed (up to a maximum of 17 days of tablets). The delayed period will arrive about two or three days after stopping the norethisterone tablets. Of course, each woman is different, so the effectiveness and timing of the delay can vary a little from person to person.</p>
<h2>Not a contraception</h2>
<p>While period delay tablets may temporarily delay your period, it is not a contraceptive method and cannot be used to prevent pregnancy. Women who don’t use contraception or use non-hormonal contraception (such as the copper IUD) will need to continue to taking measures to prevent pregnancy while using period delay tablets if they don’t want to become pregnant.</p>
<p>There’s virtually no evidence about what happens if a woman using progesterone-only contraceptive methods (such as <a href="https://www.nhs.uk/conditions/contraception/contraceptive-implant/">the implant</a> or progesterone-only pill) takes a period delay tablet. It’s likely that it won’t be harmful to combine these on a once-off basis – but it should be discussed first with the doctor who is prescribing them. </p>
<p>Women using combined oral contraception should not use norethisterone to delay periods. If they want to <a href="https://www.nhs.uk/common-health-questions/travel-health/how-can-i-delay-my-period/">delay their period</a>, they can skip their pill-free break and start the next pack. This is not harmful and does not affect how well the combined pill works as a contraceptive.</p>
<h2>Side effects and risks</h2>
<p>Like any medication, norethisterone can have some <a href="https://www.medicines.org.uk/emc/product/1717/pil">side effects</a>. The most common ones are acne, menstrual spotting (light bleeding), low mood, loss of libido, breast pain or nausea. Not everyone will experience these.</p>
<p>However there are some women who should not use norethisterone to delay a period. These are women who are or could be pregnant, women who have just given birth and women who are breastfeeding. They also aren’t suitable for women with liver tumours, breast cancer and some other uncommon medical conditions. </p>
<p>The way that norethisterone is metabolised in the body may also increase the likelihood of blood clots. So women who have had blood clots before or are at a higher risk of clotting should avoid using period delay tablets. For the same reason, it’s important for any woman who takes period delay tablets to stay hydrated and move around often, especially on long plane flights. Norethisterone can also interact with some prescribed drugs (such as anti-epileptic or anti-TB medication) and the doctor prescribing the period delay tablets will check what other medication is being taken. </p>
<p>Most women will want to delay a period from time to time, and period delay tablets are one way to do this. Because they are not suitable for every woman, and they still need to be prescribed after a consultation with a doctor. But the option to delay a period once in a while, and the convenience of doing this through a high-street pharmacist, gives women control of their menstrual calendar.</p><img src="https://counter.theconversation.com/content/184991/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has received funding from Bayer PLC.</span></em></p>Period delay tablets may help you take control of your menstrual cycle – but only if used properly.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779202022-06-08T02:00:16Z2022-06-08T02:00:16ZFirst periods can come as a shock. 5 ways to support your kid when they get theirs<figure><img src="https://images.theconversation.com/files/466511/original/file-20220601-48614-fvk05q.jpg?ixlib=rb-1.1.0&rect=29%2C39%2C6626%2C4390&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/teenage-lady-girl-holding-sanitary-600w-2046842183.jpg">Shutterstock</a></span></figcaption></figure><p>It’s a tale as old as time. Around half of adolescents going through puberty will get their period. </p>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310774/#:%7E:text=In%20many%20high%2Dincome%20countries,%5B8%5Ddespite%20global%20variations.">high-income countries</a>, an adolescent’s first period (known as “menarche”) happens on average between ten and 14 years of age, with most occurring between 12 and 13 years. </p>
<p>Why then does this extremely common event still sometimes create shock, awkwardness or distress to parents and young people alike? In a world where gender equality and gender diversity are increasingly acknowledged and understood, it’s time to end period stigma – and where better to start than at home.</p>
<h2>Questions, so many questions</h2>
<p>In an <a href="https://academic.oup.com/fampra/article/26/3/196/511883?login=true">analysis</a> of 1,000 questions emailed to me when I was writing Dolly magazine’s Dolly Doctor column in 2004, questions about periods made up over 13% of all possible questions and topics. Typical questions included: </p>
<ul>
<li><blockquote>
<p>I’m 15 and havn’t gotten my periods yet. My sister who is two years younger then me has got hers Is there something wroung with me? </p>
</blockquote></li>
<li><blockquote>
<p>Every time i get my period it comes at different times (dates) and they are so confusing one day its heavy then its gone for two days and comes back for another 4 it is realy annoying and its sumtimes heavy and sumtimes light and it alwayz leaks onto my bed but im too scared to use tampons what can i use to stop it leaking? </p>
</blockquote></li>
<li><blockquote>
<p>Is having really bad Period Pains ‘Normal’? but these are not Normal period pains these are one’s that i can not get out of bed and i go through 4 pads a day is this BAD OR IS IT NORMAL????’ </p>
</blockquote></li>
<li><blockquote>
<p>im confused, where do u put the tampon in?? and when u have sex is that the same hole? please help. </p>
</blockquote></li>
</ul>
<p>The questions continue today. A 2021 <a href="https://www.sciencedirect.com/science/article/abs/pii/S1083318820303600?casa_token=1DbtkP75YZkAAAAA:Fa1BrmB_Ex5IZ7s8_TbFRcI07Ri6n3Gebk2XYUdK1QFYf6CeQKasiFo499eX2M95H0DeCFcJ#bib9">survey</a> of more than 4,200 Australian 13 to 25-year-old girls and women found only around one third asked their mothers for advice about menstruation and menstrual pain. Less than a third consulted a doctor. Only around one in five learned from school about whether their experiences of menstruation were normal and about half turned to the internet for information and advice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-10-girls-skip-class-because-of-painful-periods-and-most-wont-talk-to-their-teacher-about-it-150286">3 out of 10 girls skip class because of painful periods. And most won't talk to their teacher about it</a>
</strong>
</em>
</p>
<hr>
<h2>The real dangers of not talking about periods</h2>
<p>Menstrual stigma plays a large part in menstrual illiteracy and can have very <a href="https://www.unfpa.org/menstrual-health">real and harmful consequences</a> for adolescents. These include exclusion from school, child marriage (because periods are considered a sign of sexual maturity) or loss of dignity for displaced people. </p>
<p>This problem is not confined to <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0293-6">low- and middle-income countries</a>. Attitudes to menstruation remain problematic in <a href="https://www.mdpi.com/1660-4601/18/5/2260/htm#B9-ijerph-18-02260">high-income countries</a> too, where researchers have found menstrual pain is widely normalised and self-managed. This can thwart early detection of conditions including endometriosis. </p>
<p>The cultural meanings of menstruation and menarche can also contribute to <a href="https://pubmed.ncbi.nlm.nih.gov/35123055/">distress and dysphoria</a> among trans boys and non-binary adolescents. </p>
<hr>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CbYCc2lJKNu","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imagine-having-your-period-and-no-money-for-pads-or-tampons-would-you-still-go-to-school-156570">Imagine having your period and no money for pads or tampons. Would you still go to school?</a>
</strong>
</em>
</p>
<hr>
<h2>5 tips for first period support</h2>
<p><strong>1. Focus on what to expect</strong></p>
<p>The first period can be light and fleeting – a few painless brown-black streaks, rather than an obvious flow of blood lasting days. Focus on what your child might expect that FIRST time, and for a short time afterwards. </p>
<p>The menstrual cycle does not fully mature after menarche for one to two years, and periods can be irregular throughout that time. This doesn’t need to be a concern. </p>
<p>Tell them a period might feel a bit like wetting their pants, it might be painless or there might be cramps or low back pain. </p>
<p><strong>2. Check out all the period products on offer together</strong></p>
<p>Sit down and show your child period products that might be in the home already. </p>
<p>If there are none, there is no harm in buying a packet of disposable pads, a pair of period undies, and perhaps a box of mini tampons to look at, along with website images other options like reusable pads and menstrual cups (which can be a bigger investment). </p>
<p>Disposable pads are still the <a href="https://www.alliedmarketresearch.com/australia-period-care-market-A14316">most popular</a> period products in Australia. Young people are also taking up <a href="https://www.nytimes.com/2022/01/20/well/sustainable-period-products.html">more sustainable options</a>. </p>
<p>Explain how to dispose of non-reusable used products and how to wash reusable products. Reassure them that tampons (and cups) are safe to use. Adolescents who swim, play sport, dance, do gymnastics or other activities may want to learn to use tampons or cups as soon as they get their first period.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="series of menstrual pads with red sequins to represent blood flow" src="https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466509/original/file-20220601-48614-aa1qhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">First periods can range from a few brown streaks to a heavier blood flow.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/menstrual-pad-red-glitter-on-600w-778705048.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-anyone-have-a-pad-tv-is-finally-dismantling-the-period-taboo-122258">Does anyone have a pad? TV is finally dismantling the period taboo</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Talk through how to manage tricky period situations</strong></p>
<p>Even though the first (or first few) periods can be painless, they aren’t always. Explain most period pain can be managed effectively. Over-the-counter period pain tablets work best if taken at the first hint of a period. </p>
<p>Other tricky situations might involve leaks, being caught without period supplies when at school, out and about, or at sleepovers. If your child moves between homes, ask about how they manage periods at the other home and whether they want your help talking with the other parent.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman and teenager sit on window sill and chat" src="https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466519/original/file-20220601-48778-sh1t2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This is a good chance to talk through tricky period situations.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/mother-talking-her-daughter-while-600w-623013362.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/menstrual-cups-vs-tampons-heres-how-they-compare-120499">Menstrual cups vs tampons – here's how they compare</a>
</strong>
</em>
</p>
<hr>
<p><strong>4. Let them know about private and confidential help available</strong></p>
<p>If your child does have any menstrual problems, there are effective ways to manage them that might involve medical assessment or intervention. </p>
<p>The era of “normalising” period pain, heavy bleeding and premenstrual syndrome should be long gone. Each young person has the right to health, no matter what! If your child experiences unease or distress related to gender and periods, help them source <a href="https://www.transhub.org.au/menstruation">support</a>.</p>
<p><strong>5. Make a period toolkit together</strong></p>
<p>A period toolkit ideally consists of information and practical stuff. </p>
<p>Books include <a href="https://www.goodreads.com/book/show/46036654-welcome-to-your-period?from_search=true&from_srp=true&qid=5hkt8RiATd&rank=1">Welcome to Your Period</a> (which I co-authored) and there are relevant chapters in books by <a href="https://www.goodreads.com/author/show/145445.Kaz_Cooke?from_search=true&from_srp=true">Kaz Cooke</a> and <a href="https://www.goodreads.com/en/book/show/35887214-the-girl-guide">The Girl Guide</a> by Marawa Ibrahim. </p>
<p>It’s also good to prepare a handy little case or pouch containing:</p>
<ul>
<li>period pads or undies (or their preferred product)</li>
<li>spare undies</li>
<li>a couple of period pain tablets. </li>
</ul>
<p>The awkwardness of adolescence will likely resonate with most of us. But wouldn’t it be wonderful if something as commonplace as getting one’s first period was not so tainted with stigma, shame or embarrassment? </p>
<p>Setting up good communication early will help ease young people into this stage of life and also create a dynamic where they can raise concerns with you along the way.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="purse with period products spilling out" src="https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466521/original/file-20220601-49381-d0qzfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Getting a handy kit together is a good idea.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/top-view-period-stuff-toilet-600w-1465416404.jpg">Shutterstock</a></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/177920/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am co-author of Welcome to Your Period and receive royalties from sales.</span></em></p>Even though every second person will get their period, it can still come as a shock. Parents can help with good information and support.Melissa Kang, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1802462022-06-05T20:02:06Z2022-06-05T20:02:06ZYou no longer need surgery to be diagnosed with endometriosis. Here’s what’s changed<figure><img src="https://images.theconversation.com/files/462151/original/file-20220510-12-ou0owr.jpg?ixlib=rb-1.1.0&rect=85%2C38%2C5090%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-upset-unhappy-woman-suffering-menstruation-1357975778">Shutterstock</a></span></figcaption></figure><p>By age 44, endometriosis affects around <a href="https://www.ncbi.nlm.nih.gov/pubmed/32757329">one in nine women</a> and people assigned female at birth in Australia.</p>
<p>It’s caused by the presence of tissue similar to the lining of the uterus found outside the uterus. While endometriosis is most commonly found in the pelvic cavity, it can sometimes be found in the diaphragm, lungs and elsewhere. </p>
<p>Symptoms include severe period pain, pain below the belly button when not menstruating, fatigue, digestive problems (often mistaken for irritable bowel syndrome), pain with bowel motions and/or urination, painful intercourse, and infertility. </p>
<p>It previously took, on average, <a href="https://www.ncbi.nlm.nih.gov/pubmed/33050751">6.4</a>-<a href="https://www.nature.com/articles/s41598-020-73389-2">8 years</a> for endometriosis to be diagnosed with surgery. But with doctors now able to give a clinical diagnosis of “suspected endometriosis” based on symptoms and a physical examination, the time to diagnosis is likely to reduce. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/endometriosis-can-end-womens-careers-and-stall-their-education-thats-everyones-business-179846">Endometriosis can end women's careers and stall their education. That's everyone's business</a>
</strong>
</em>
</p>
<hr>
<h2>Why diagnose endo through surgery?</h2>
<p>Endometriosis has <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.24892">historically been diagnosed</a> through surgery. When performed by a skilled surgeon, this is still the <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16865">most accurate</a> method of diagnosis. </p>
<p>The most common surgical procedure for endometriosis is laparoscopy (or key-hole surgery). A thin telescope (called a laparoscope) is inserted into the belly button to see and access the organs inside the abdomen and pelvis. </p>
<p>Ideally, when the surgeon sees abnormal tissue during the procedure, they biopsy or remove a sample and send it to a lab. The pathologist then looks for endometrial-like cells under a microscope to provide confirmation of endometriosis. Occasionally, what a surgeon sees is not confirmed to be endometriosis but something else or normal tissue. </p>
<figure class="align-center ">
<img alt="A woman with dressings from a laparoscopy holds her tummy." src="https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464919/original/file-20220524-43418-hp61rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sometimes endo will be diagnosed and treated in the same surgery, but this isn’t always the case.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bandaid-on-stomach-abdomen-after-laparoscopy-1646031907">Shutterstock</a></span>
</figcaption>
</figure>
<p>The endometriosis might be fully treated during that same diagnostic surgical procedure, or it might be incompletely treated or not treated at all. This depends on the extent of the endometriosis and the surgical skill of the surgeon, among other things.</p>
<p>Overall, surgery to remove endometriosis is effective in relieving <a href="https://pubmed.ncbi.nlm.nih.gov/31676397/">pain symptoms</a>, reducing <a href="https://doi.org/10.1093/hropen/hoac009">infertility</a> and improving <a href="https://doi.org/10.5301%2Fje.5000187">quality of life</a>. </p>
<p>However surgery is a very expensive way to achieve a diagnosis, both for the patient and the health system.</p>
<p>Laparoscopic surgery also comes with the risks of infection, major bleeding, and injury to important structures like the bowels or bladder. Recovery takes about four weeks. </p>
<h2>How is the diagnostic process changing?</h2>
<p><a href="https://doi.org/10.1016/j.ajog.2018.12.039">Some experts have argued</a> surgery shouldn’t be used as a diagnostic test. This has prompted a move in recent years towards a “<a href="https://doi.org/10.1016/j.ajog.2018.12.039">clinical diagnosis</a>”, where a doctor makes an assessment based on symptoms and/or abnormal findings during a physical examination. </p>
<p>For most people, endometriosis symptoms begin with cyclical pain with their periods. That pain process evolves and pain can exist every day, with bowel motions or urination (often worse during the period), and during intercourse. </p>
<p>On physical examination, the doctor can sometimes feel endometriosis nodules in the vagina with the tips of their fingers. The lack of movement of the uterus as the doctor tries to move it with two hands may also raise suspicion, as can tenderness during this examination. </p>
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Read more:
<a href="https://theconversation.com/considering-surgery-for-endometriosis-heres-what-you-need-to-know-102254">Considering surgery for endometriosis? Here's what you need to know</a>
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<p>There are <a href="https://doi.org/10.1177%2F228402651000200303">some drawbacks</a> to clinical diagnosis. Most notably, the wrong diagnosis may lead a person down an incorrect treatment plan, inevitably delaying treatment for the true diagnosis. </p>
<p>People who receive a clinical diagnosis may also feel less able to access surgery, if that’s their preferred treatment, as a clinical diagnosis usually <a href="https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline">prioritises</a> hormonal medications and other drug treatments in place of or before surgery.</p>
<h2>Imaging techniques</h2>
<p>Over the past <a href="https://dx.doi.org/10.1002%2F14651858.CD009591">five to ten years</a>, there has been an increasing ability to “see” endometriosis using imaging such as transvaginal ultrasound (an internal scan where the ultrasound wand is inserted into the vagina) and magnetic resonance imaging (MRI). </p>
<p>Diagnosing endometriosis through medical imaging is gaining <a href="https://academic.oup.com/hropen/article/2022/2/hoac009/6537540">popularity</a> because it allows doctors and patients to understand the diagnosis and extent of the endometriosis without having to <a href="https://doi.org/10.1016/j.jmig.2020.02.014">perform surgery</a>. </p>
<figure class="align-center ">
<img alt="Woman undergoing an MRI talks to her nurse." src="https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464943/original/file-20220524-24-oa7svy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some endometriosis can be see on MRIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-talking-patient-mri-scan-machine-1866109276">Shutterstock</a></span>
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<p>The ability to see endometriosis relies heavily on the expertise of the person doing and interpreting the <a href="https://doi.org/10.1002/uog.24892">imaging test</a>, just as seeing endometriosis at surgery relies on the expertise of the surgeon. </p>
<p>Not all types of endometriosis are yet reliably seen on an imaging test. For example, severe endometriosis with deep nodules and adhesions (bands of scarring which can attach to other organs) is easier to see than superficial endometriosis, which sometimes consists of a few deposits no larger than a few millimetres. </p>
<p>If the imaging is done by someone with expertise, it is generally possible to “rule out” moderate to severe endometriosis but minimal to mild disease <a href="https://doi.org/10.1016/j.jmig.2020.02.014">may not be detected</a>. </p>
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Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
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<p>Ideally, an imaging-based diagnosis should eliminate the need to have a two-step surgery (diagnostic surgery followed by treatment surgery), as the surgeon has a better understanding of the location and extent of the disease before starting the first surgery. This increases the likelihood of success with a single treatment surgery. </p>
<p>However, there are legitimate concerns that a move to use an imaging-based diagnosis will leave those with a “normal scan” falsely reassured because the disease is not visible on the scan. So, doctors should never tell someone they don’t have endometriosis based on an imaging test alone.</p><img src="https://counter.theconversation.com/content/180246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Armour is the chair of the Endometriosis Australia research committee. He reports receiving funding from Metagenics, Canopy Growth, and Sci-Chem, outside the submitted work. </span></em></p><p class="fine-print"><em><span>Cecilia Ng receives funding from the Medical Research Future Fund (MRFF). </span></em></p><p class="fine-print"><em><span>ML reports receiving grant funding from OZWAC, Endometriosis Australia, AbbVie, CanSAGE, MRFF, HHS; honoraria for lectures/writing from GE Healthcare, Bayer, AbbVie, TerSera, consulting fees from Imagendo, outside the submitted work. </span></em></p>Clinicians now able to give a clinical diagnosis of “suspected endometriosis” based on symptoms and a physical examination.Mike Armour, Senior research fellow in reproductive health, Western Sydney UniversityCecilia Ng, Adjunct Senior Lecturer, Clinical Trials Network Manager, UNSW SydneyMathew Leonardi, Gynaecological Surgeon and Sonologist, McMaster University; Adjunct Lecturer, University of Adelaide, University of SydneyLicensed as Creative Commons – attribution, no derivatives.