tag:theconversation.com,2011:/global/topics/menarche-36567/articlesMenarche – The Conversation2022-12-05T04:08:53Ztag:theconversation.com,2011:article/1952112022-12-05T04:08:53Z2022-12-05T04:08:53ZHow long does menopause last? 5 tips for navigating uncertain times<figure><img src="https://images.theconversation.com/files/498812/original/file-20221204-8737-i0hf3d.jpg?ixlib=rb-1.1.0&rect=23%2C46%2C5145%2C3399&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/mature-female-friends-socializing-backyard-600w-583329838.jpg">Shutterstock</a></span></figcaption></figure><p>Around half of the world’s population are women or people who menstruate – yet the way their body works can be a mystery, even to them. </p>
<p>Most women will experience periods roughly every month, many will go through childbirth and those who live into midlife will experience menopause. </p>
<p>While menopause is a significant time of change, it isn’t talked about much, other than as a punchline. This may contribute to keeping it a <a href="https://www.theguardian.com/membership/2019/sep/21/breaking-the-menopause-taboo-there-are-vital-stories-we-should-continue-to-pursue">taboo topic</a>. </p>
<p>So, what happens during menopause? How do you know when it is happening to you? And – the thing most women want to know – how long will it last? </p>
<h2>What is menopause?</h2>
<p>Menopause is <a href="https://www.nia.nih.gov/health/what-menopause">defined</a> as the permanent cessation of menstruation, which is medically determined to be one year after the final menstrual period. After this time women are considered to be postmenopausal.</p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/26598775/">average age</a> of “natural menopause” (that is not caused by a medical condition, treatment or surgery) is considered to be around 51 years. </p>
<p>However, natural menopause does not occur suddenly. <a href="https://www.researchgate.net/profile/Riitta-Luoto/publication/46425690_Prevalence_of_menopause_symptoms_and_their_association_with_lifestyle_among_Finnish_middle-aged_women/links/5c5704ac458515a4c7553c7b/Prevalence-of-menopause-symptoms-and-their-association-with-lifestyle-among-Finnish-middle-aged-women.pdf">Changes can begin</a> a number of years before periods stop and most often occur in a woman’s 40s but they can be earlier. Changes <a href="https://pubmed.ncbi.nlm.nih.gov/25686030/">can continue</a> for 10 years or more after periods have stopped. </p>
<p>Using hormones such as the oral contraceptive pill or hormone intrauterine devices may make it more <a href="https://pubmed.ncbi.nlm.nih.gov/31934948/">difficult to determine</a> when changes start.</p>
<p>Menopause that occurs <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">before 45</a> is called “early menopause”, while menopause before 40 is called “premature menopause”.</p>
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<h2>What about perimenopause?</h2>
<p>Various <a href="https://www.menopause.org.au/hp/information-sheets/glossary-of-terms">terms</a> are used to describe this period of change, including “menopause” or “the menopause”, “menopausal transition”, “perimenopause” or “<a href="https://pubmed.ncbi.nlm.nih.gov/12188398/">climacteric</a>”. </p>
<p>These terms tend to refer to the period before and after the final menstrual period, when changes are considered to be related to menopause. </p>
<p>The difficulty with the definition of menopause is it can only be decided retrospectively. Yet women can experience changes many years before their periods stop (a lead up usually called “perimenopause”). Also, any <a href="https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0889854518300627/first-page-pdf">changes noticed</a> may not be associated with menopause (because people might not be aware of what to expect) or changes may be associated with a combination of factors such as stress, being busy or other health issues.</p>
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Read more:
<a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">'Brain fog' during menopause is real – it can disrupt women's work and spark dementia fears</a>
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<h2>So, what is going on?</h2>
<p>Through a feminist lens, menopause can be seen as a <a href="https://www.researchgate.net/publication/354652248_The_volcano_within_a_study_of_women's_lived_experience_of_the_journey_through_natural_menopause">complex and diverse experience</a>, influenced by biological, psychological, social and cultural aspects of women’s lives. </p>
<p>However, it is usually viewed from the biomedical perspective. This sees it as a biological event, marked by the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">decline</a> in ovarian hormone levels leading to a reduction in reproductive function. </p>
<p>The female reproductive system operates because of a finely tuned balance of hormones managed by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466056/#:%7E:text=The%20hypothalamic%2Dpituitary%2Dovarian%20(HPO)%20axis%20must%20be,priming%20the%20endometrium%20for%20implantation.">hypothalamic-pituitary-ovarian axis</a>. International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/">experts</a> have developed a staging system for female reproductive ageing, with seven stages from “early reproductive” years to “late postmenopause”. </p>
<p>However, female reproductive hormones do not just affect the reproductive system but <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">other aspects</a> of the body’s function. These include the <a href="https://pubmed.ncbi.nlm.nih.gov/26007613/">neurological system</a>, which is linked to hot flushes and night sweats and disrupted sleep. Hormones may also affect the <a href="https://www.nature.com/articles/nrdp20154">heart and body’s blood circulation</a>, bone health and potentially the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">immune system</a>. </p>
<p>Menopausal hormone changes may <a href="https://www.thewomens.org.au/health-information/menopause-information/menopause-symptoms/">cause</a> hot flushes, night/cold sweats, mood swings, sleep disruption and tiredness, vaginal dryness.</p>
<p>Medical confirmation of menopausal changes in women over 45 years is based on two biological indicators: vasomotor symptoms (those hot flushes and night sweats again) and an <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">irregular menstrual cycle</a>. </p>
<p>In early perimenopause the changes to the menstrual cycle may be subtle. Women may not recognise early indicators, unless they keep a record and know what to watch for.</p>
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<a href="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman writing something at outdoor table" src="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.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>
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<span class="caption">Keeping track of any changes that could be menopausal is a good idea.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/1251832/pexels-photo-1251832.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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Read more:
<a href="https://theconversation.com/what-is-perimenopause-and-how-does-it-affect-womens-health-in-midlife-122186">What is perimenopause and how does it affect women's health in midlife?</a>
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<h2>How long does it last?</h2>
<p>The body demonstrates an amazing ability to change over a lifetime. In a similar way to adolescence where long-lasting changes occur, the outcome of menopause is also change. </p>
<p>Research suggests it is difficult to give an exact time frame for how long menopausal changes occur – the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">average</a> is between four and eight years. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">Penn Ovarian Ageing Study</a> found 79% of the 259 participants experienced hot flushes starting before the age of 50, most commonly between 45 and 49 years of age. </p>
<p>A later report on the same study found one third of women studied experienced <a href="https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0014-2">moderate to severe hot flushes</a> more than ten years after their periods had stopped. A <a href="https://journals.lww.com/menopausejournal/Abstract/2017/03000/Cultural_issues_in_menopause__an_exploratory.11.aspx">2017 study</a> found a small number of women continued to experience hot flushes and other symptoms into their 70s. </p>
<p>So overall, the research cannot offer a specific window for perimenopause, and menopause does not appear to mark the end of changes for everyone. </p>
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<a href="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person holds phone with period tracking app and menstrual cup" src="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.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>
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<span class="caption">Menopause is ‘official’ once you haven’t had periods for one year.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-woman-calculating-menstrual-600w-2151967283.jpg">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/making-sense-of-menopausal-hormone-therapy-means-understanding-the-benefits-as-well-as-the-risks-124084">Making sense of menopausal hormone therapy means understanding the benefits as well as the risks</a>
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<h2>5 tips for uncertain times</h2>
<p>Shifts and changes can be recognised early by developing knowledge, paying attention to changes to our bodies and talking about menopause and perimenopause more openly.</p>
<p>Here are five tips for moving from uncertainty to certainty: </p>
<p><strong>1.</strong> talk to people and find out as much information as you can. The experiences of mothers and sisters may help, for some women there are familial similarities </p>
<p><strong>2.</strong> notice any changes to your body and make a note of them, this will help you recognise changes earlier. There are <a href="https://www.redonline.co.uk/wellbeing/a36980118/menopause-apps/">menopause tracking apps</a> available</p>
<p><strong>3.</strong> keep a note of your menstrual cycle: start date, duration, flow and note any changes. Again, an app might help</p>
<p><strong>4.</strong> if you are worried, seek advice from a GP or nurse that specialises in women’s health. They may suggest ways to help with symptoms or refer to a specialist </p>
<p><strong>5.</strong> remember changes are the indicator to pay attention to, not time or your age.</p>
<p>Menopause is a natural process and although we have focused here on the time frame and “symptoms”, it can also be a time of freedom (particularly from periods!), reflection and a time to focus on yourself.</p>
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<figcaption><span class="caption">Women speak about their experiences of menopause.</span></figcaption>
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<p class="fine-print"><em><span>Yvonne Middlewick 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>Uncertainty about how long symptoms will last can be tough for women going through hormonal changes that come with menopause. Unfortunately, there isn’t a clear cut time frame.Yvonne Middlewick, Nurse & Lecturer, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1875012022-08-26T12:21:01Z2022-08-26T12:21:01ZThe US lacks adequate education around puberty and menstruation for young people – an expert on menstrual health explains<figure><img src="https://images.theconversation.com/files/478167/original/file-20220808-8307-ysycaa.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many young people receive limited guidance about what to expect as they near menstruation.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-with-cramps-royalty-free-image/503117005?adppopup=true">SolStock/E+ via Getty Images</a></span></figcaption></figure><p>One thing few people have been talking about since <a href="https://theconversation.com/supreme-court-overturns-roe-upends-50-years-of-abortion-rights-5-essential-reads-on-what-happens-next-184697">Roe v. Wade was overturned</a> is how abortion restrictions will affect young girls across the United States. </p>
<p>Around the time of their first period, many young people learn the basic mechanics of managing their periods, such as how to put on a pad or tampon and that it happens once a month. Traditionally they might also receive some admonishment to keep their period hidden. Young people may get information about menstruation from a family member, friends or a teacher, or by searching on the internet. </p>
<p>But often it is only later that they learn and truly understand the more complex details about the menstrual cycle. This includes guidance around regular and irregular patterns and when to seek medical care for any shifts in timing, duration or the overall experience, including the severity of menstrual pain or heavy bleeding. These conversations also have clear implications for <a href="https://www.waier.org.au/educating-tomorrows-women-ovulatory-menstrual-health-literacy-as-a-lifelong-skill/">ovulation and pregnancy prevention</a>.</p>
<p>Now, with <a href="https://theconversation.com/roe-overturned-what-you-need-to-know-about-the-supreme-court-abortion-decision-184692">the overturning of Roe v. Wade</a>, young people who begin to menstruate will also need to learn early on how to recognize a missed period as soon as possible. In the past, a young person’s delay in mentioning that a period was late or skipped a few months might not have presented any particular urgency. However, going forward, in contexts where a ban on abortions beyond a very short period of weeks exists, even one missed period could have serious implications for a young person’s life. </p>
<p>Conversely, it’s critical that young people know that irregular periods can be normal and that it’s not always cause for alarm.</p>
<p>I have been <a href="https://scholar.google.com/citations?user=9PD6D4kAAAAJ&hl=en">researching young people’s experiences with menarche</a> – the onset of menstruation – around the world for almost 20 years. In 2018, my team began to explore the experiences of American girls with their periods, including their recommendations for <a href="https://doi.org/10.1080/02673843.2020.1867207">what all young girls need to know</a> as they enter puberty and begin to menstruate. </p>
<p>Based on those suggestions and insights, we published “<a href="https://www.agirlsguide.org/">A Girl’s Guide to Puberty and Periods</a>,” a body-positive illustrated graphic novel-style book that includes first period stories, advice and questions written by girls. </p>
<p>Globally, I have learned that girls growing up in Africa, Asia and here in the U.S. often receive inadequate information and support about their periods. </p>
<h2>Information about menstruation is inadequate</h2>
<p>Menstrual health literacy, or a <a href="https://doi.org/10.1080/26410397.2021.1911618">person’s understanding of the menstrual cycle</a> and its intersection with one’s health and well-being, is essential from the time leading up to the first menstrual period through menopause. </p>
<p>Both the <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/menstruation-in-girls-and-adolescents-using-the-menstrual-cycle-as-a-vital-sign">American College of Obstetricians and Gynecologists</a> and the <a href="https://doi.org/10.1542/peds.2015-4480">American Academy of Pediatrics</a> have recommended that just as doctors and nurses check someone’s blood pressure or temperature at each visit, they should also ask about periods. </p>
<p>These professional societies suggest that health care providers prepare girls and their families for the onset of menstruation and ensure that they understand the variation in menstrual patterns. </p>
<p>My team’s U.S. study focused on <a href="https://doi.org/10.1080/02673843.2020.1867207">adolescent girls</a> in Los Angeles, New York and Chicago. Our findings, along with research on <a href="https://doi.org/10.1111/josh.13135">state-level menstruation education standards</a> across the country, suggest that the U.S. is a long way from delivering menstrual health literacy to the population. Our research indicated that many girls received no guidance before their first period or had been given information that felt dated and hard to relate to. Think educational videos made in the 1990s. </p>
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<figcaption><span class="caption">The menstrual cycle can lead to highs and lows in mood and energy level.</span></figcaption>
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<p>A recent publication from the U.S. Centers for Disease Control and Prevention found that the median age of onset of menstruation <a href="https://www.cdc.gov/nchs/data/nhsr/nhsr146-508.pdf">decreased from 12.1 years old in 1995 to 11.9 by 2017</a>. This means that nowadays, many girls are in elementary school when they get their first period. </p>
<p>For this reason, it’s clear that young people in fourth or fifth grade need to be receiving health education that addresses menstruation. <a href="https://doi.org/10.1016/S0140-6736(19)30300-9">Girls who do not receive education and support</a> – particularly those who get their first period at a young age – are more likely to experience depression and low self-esteem. Low-income and minority girls are <a href="https://doi.org/10.1016/j.jadohealth.2016.10.008">particularly vulnerable</a>. </p>
<p>Yet many American girls still do not learn the basic facts about their menstrual cycles at home or school or from health care providers. As our study found, parents are <a href="https://doi.org/10.1080/02673843.2020.1867207">often uncomfortable discussing periods</a>, perhaps because it feels too linked to sexuality. </p>
<p>Our research also <a href="https://storymaps.arcgis.com/stories/4f8da19484ea46e0abaacee95312f26c">captured American girls’ first-period stories</a> across 25 states and found that many young people are afraid, ashamed and do not know whom to ask for advice when their menstruation starts. </p>
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<figcaption><span class="caption">How to discuss the menstrual cycle with a young person.</span></figcaption>
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<h2>Missed opportunities</h2>
<p>The internet and social media, which are important sources of news and guidance for many young people, may <a href="https://keep.lib.asu.edu/_flysystem/fedora/c7/Santora_asu_0010N_20765.pdf">deliver misinformation or reinforce menstrual stigma</a>. And a 2020 study of members of the American Academy of Pediatricians found that 24% of pediatricians surveyed <a href="https://doi.org/10.1515/ijamh-2019-0179">do not regularly provide guidance</a> before the first period. Furthermore, 33% do not discuss periods with their menstruating patients. Male pediatricians were also less likely to assess a patient’s menstrual cycles and provide information, perhaps because of discomfort with the topic. </p>
<p>Schools also may not be delivering the necessary guidance. In New York state, where I work, there is no requirement for the provision of menstrual health education, and sexual education <a href="https://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx">is not required to be taught or to be medically accurate</a>. Only 30 states and Washington, D.C., mandate sexual education in schools, but not all of them require medical accuracy. </p>
<p>It’s hard to know if many states are even including menstrual health in the curriculum, as data is limited and public information is not always available. I believe that, given the critical importance of some menstrual health literacy by late elementary school, schools could consider delivering puberty education – including menstrual health – separate from sexual education. This is particularly true in states that are hesitant to mandate sexual education.</p>
<h2>Menstrual health literacy translates to health literacy</h2>
<p>One survey of women of childbearing age suggested that <a href="https://doi.org/10.1111/birt.12237">fewer than 50% knew</a> the average number of days of a regular menstrual cycle. Not knowing what is “normal or not normal” in relation to an average menstrual cycle – ranging from how often you get your period to the extent of bleeding or pain experienced – increases the health risk for an adolescent girl or woman. </p>
<p>Health – including menstrual health – is a <a href="https://www.ohchr.org/sites/default/files/Documents/Publications/Factsheet31.pdf">basic human right</a>. For those who menstruate, this means a right to menstrual health literacy, along with being able to seek care for the myriad menstrual and reproductive health disorders. These range from <a href="https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods">dysmenorrhea</a>, or severe pain, to <a href="https://www.womenshealth.gov/a-z-topics/endometriosis">endometriosis</a>, a condition in which endometrial tissue grows outside the uterus and can cause menstrual irregularities and significant discomfort. Both require diagnosis and treatment. </p>
<p>Menstruation is <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2014.302525">an issue of public health</a>, and one long overdue for increased attention and resources, starting with – but not limited to – menstrual health literacy. The fall of Roe adds urgency to this public health priority.</p><img src="https://counter.theconversation.com/content/187501/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marni Sommer receives funding from the Bill & Melinda Gates Foundation to develop guidance on indicators and related measures for improving national level monitoring of progress on menstrual health and hygiene globally. </span></em></p>Research shows that many girls are in elementary school when they have their first period. But often they have not received adequate health education.Marni Sommer, Associate Professor of Sociomedical Sciences, Columbia 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/1589522021-05-25T19:39:30Z2021-05-25T19:39:30ZIt’s time to teach the whole story about ovulation and its place in the menstrual cycle<figure><img src="https://images.theconversation.com/files/395615/original/file-20210419-19-18akch3.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5751%2C3811&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>Health education frequently fails to teach the menstrual cycle in its full entirety, focusing mostly on the bleeding part of the story and glossing over the ovulation chapter. In other words, many girls* often only get half the story about how their bodies work. </p>
<p>That’s a shame because knowledge of your own reproductive function is useful for monitoring and making decisions about personal health. Focusing on the period part of the cycle is like skipping to the last chapter of a book. In reality, ovulation is the protagonist of the menstrual story rather than a minor character to skim over. </p>
<p>For those who want to get pregnant, understanding ovulation is clearly crucial but research shows <a href="https://pubmed.ncbi.nlm.nih.gov/22764878/">few can accurately identify their fertile window</a>. </p>
<p>Beyond that, however, understanding ovulation can help you understand more about your <a href="https://femmhealth.org/research/ovulation-a-sign-of-health-understanding-reproductive-health-in-a-new-way/">health in general</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Explainer: what is polycystic ovary syndrome?</a>
</strong>
</em>
</p>
<hr>
<h2>What exactly is ovulation?</h2>
<p>Ovulation occurs when an ovary releases an egg (sometimes more than one). A typical teaching describes a 28-day cycle with Day 1 as the start of period bleeding and ovulation around Day 14 or 15. </p>
<p>But this textbook 28-day cycle is not meant to be a one-size-fits-all and is not everyone’s experience. There are healthy ranges across the different stages of life (such as adolescence, adulthood and in the later years).</p>
<p>The simple skills for recognising ovulation have been around <a href="https://billings.ecwid.com/The-Billings-Method-by-Dr-Evelyn-Billings-&-Dr-Ann-Westmore-p36860362">for over 40 years</a>. Once taught what to look out for, most women find it easy to tell if they are likely ovulating. One tell-tale sign is <a href="https://billings.life/en/how-the-billings-ovulation-method-works9/key-to-fertility-control-the-mucus.html">changes in cervical mucus</a> which a woman can recognise from different sensations at her vulva.</p>
<p>Understanding the cycle is a useful way to <a href="https://theconversation.com/from-energy-levels-to-metabolism-understanding-your-menstrual-cycle-can-be-key-to-achieving-exercise-goals-131561">get the most out of exercising</a> and <a href="https://www.factsaboutfertility.org/charting-the-menstrual-cycle-as-a-tool-for-mental-health/">supporting good mental health</a>.</p>
<p>If cycle difficulties such as painful periods or pre-menstrual tension emerge, knowing the fixed days between ovulation and the next period gives a fair heads-up to put self-care strategies in place. </p>
<p>A practical example is the <a href="https://pubmed.ncbi.nlm.nih.gov/22984937/">preventative use</a> of non-steroidal anti-inflammatory drugs such as ibuprofen for primary period pain; in other words, taking painkillers <em>before</em> the pain arrives, because you know when it is coming. </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>
<p>If cycle difficulties become more complex, <a href="https://heinonline.org/HOL/LandingPage?handle=hein.journals/ilmed32&div=32">understanding the cycle</a> helps a woman work with doctors to get the care she needs. </p>
<h2>A role for educators and teachers</h2>
<p>When it comes to teaching cycles in schools, the period dominates the story; probably because it is bleeding obvious and you have to manage it. </p>
<p>Educating boys about the cycle needs more research. At this stage, it is task enough to give girls the knowledge and confidence they need.</p>
<p>A recent <a href="https://www.waier.org.au/educating-tomorrows-women-ovulatory-menstrual-health-literacy-as-a-lifelong-skill/">review</a> found school programs tended to focus on menstrual problems. </p>
<p>While these are important topics, it would also help to frame the cycle in a positive light, explain it fully and talk about the connection between biology, psychology, and socio-environmental factors (what researchers call the “<a href="https://en.wikipedia.org/wiki/Biopsychosocial_model#:%7E:text=The%20biopsychosocial%20model%20is%20an,disease%20models%20to%20human%20development.">biopsychosocial</a>” aspects).</p>
<p>It is a wise teacher who is vigilant about both misinformation and pedagogically appropriate information. But professional development support is often limited for teachers and the curriculum is overcrowded. </p>
<p>This may explain the tendency for schools to parachute in <a href="https://www.tandfonline.com/doi/abs/10.1080/14681811.2011.558423?journalCode=csed20&">external facilitators</a> for sexuality education teaching.</p>
<p>The problems with this approach are a lack of available specialist expertise, potential loss of capacity-building within the school and the infrequent learning opportunities for students. External facilitators are there to reinforce what is already taught rather than be a substitute for it. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401794/original/file-20210520-23-6q5clg.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">Health education frequently fails to teach the menstrual cycle in its full entirety, focusing too much on the bleeding part of the story.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>A role for parents</h2>
<p>One role for parents is to encourage their adolescent children to start taking responsibility for their own health. This includes adopting healthy lifestyle choices (such as nutritious eating, keeping fit and getting enough sleep). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/back-to-school-how-to-help-your-teen-get-enough-sleep-153624">Back to school: how to help your teen get enough sleep</a>
</strong>
</em>
</p>
<hr>
<p>These choices can impact the menstrual cycle. Parents can support their daughters’ discipline in tracking their cycles and understanding their unique patterns. </p>
<p>Knowing this information can also help young women advocate for themselves and make informed health-care choices if cycle difficulties arise. </p>
<p>A <a href="https://bmjopen.bmj.com/content/9/3/e023582">research team</a> at Curtin University has worked on developing a program called <a href="https://myvitalcycles.com/">My Vital Cycles</a>, which is currently being trialled in Western Australia. This school-based ovulatory-menstrual health literacy program aims to give teachers, parents and teenagers the tools they need to understand the whole cycle, including ovulation’s place in it.</p>
<p>Given the span of years from menarche (a girl’s first bleed) to menopause, ovulatory-menstrual cycle knowledge and skills are useful over a lifetime. They are what women ought always to have had, and it is time for the whole story to be told. </p>
<hr>
<p><em>The information in this article is for general information purposes only and is not intended to be a substitute for professional medical advice, diagnosis or treatment. The terms *girls, women, and daughters are used in relation to a person’s sex, namely their biological characteristics or reproductive organs. This may differ from gender identity. The author believes anyone who menstruates should have the knowledge and skills necessary to understand and manage their cycle.</em></p><img src="https://counter.theconversation.com/content/158952/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Felicity Roux currently receives a scholarship through the Australian government's Research Training Program. In 2020, the project received awards from the Western Australian Institute for Educational Research and Fogarty Foundation, Curtin Medical School and Curtin Business School. She serves on the Board of Directors for the Australasian Institute for Restorative Reproductive Medicine, and she volunteers on the 2021 committees of the Gynaecological Awareness Information Network, Positive Education Schools Association and the Western Australian Institute for Educational Research. </span></em></p>When it comes to teaching about cycles in schools, the period dominates the story — but it’s important we teach about the ovulation part of the cycle, too.Felicity Roux, Researcher, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/903002018-03-19T01:24:42Z2018-03-19T01:24:42ZUnusual conditions: MRKH syndrome, when a woman’s uterus never develops<figure><img src="https://images.theconversation.com/files/204181/original/file-20180131-38229-uic5qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The causes of MRKH syndrome are still unknown.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Reaching reproductive age is an important milestone, and for women this is usually marked by their first period.</p>
<p>But for some young women, it never comes. In medical terms this is called primary amenorrhea, and one of the major causes is a congenital condition called Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. </p>
<p>In MRKH syndrome, named after the four specialists who collectively over 100 years contributed to the description and understanding of the syndrome, the female reproductive tract never fully develops. The uterus, cervix, and upper vaginal canal are underdeveloped or not present. </p>
<p>MRKH Syndrome occurs in <a href="https://journals.lww.com/obgynsurvey/Abstract/2000/10000/M_llerian_Agenesis__Etiology,_Diagnosis,_and.23.aspx">one in every 4,500-5,000 women</a>, and can present in two forms:</p>
<ul>
<li><p>type I, which involves underdevelopment or absence of the uterus and vagina</p></li>
<li><p>type II, which is also associated with other malformations, typically of the kidney and spine.</p></li>
</ul>
<p>Usually, affected women won’t be aware of the condition until puberty, when their first period never comes. A first physical examination would reveal an absent or underdeveloped vagina. If hormone levels are normal, then MRKH syndrome is suspected, and medical imaging can be used to confirm the diagnosis. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204183/original/file-20180131-38198-1ph0o55.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In MRKH syndrome the upper vagina, cervix and entire uterus never develop.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Management</h2>
<p>Surgery, or therapy with vaginal dilators (an implement that causes elongation in the vaginal canal when inserted and pressure is applied) can be used to expand or create a vagina. But the absence of a uterus means that a biological pregnancy is not possible.</p>
<p>It’s possible for most women with MRKH syndrome to have biological children where assisted reproductive technology and surrogacy are an option.</p>
<p>Being diagnosed with MRKH syndrome can be very distressing, and usually leaves the affected woman with more questions than answers.</p>
<h2>Causes</h2>
<p>The causes of MRKH syndrome are still unknown. Although some cases could be the result of environmental exposures, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/">researchers have not found</a> a clear association. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/">Recent studies</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25707337">have shown</a> that there may be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/24975471">genetic cause</a>, but so far no single gene or mutation has been identified as being responsible for MRKH. It may be that multiple factors and genes are involved.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/unusual-conditions-what-are-gigantism-and-acromegaly-64000">Unusual conditions: what are gigantism and acromegaly?</a>
</strong>
</em>
</p>
<hr>
<p>Several genes are <a href="https://www.omim.org/entry/277000?search=mrkh&highlight=mrkh">currently being investigated</a>, but research on MRKH syndrome is still deemed challenging due to its rarity and emotional impact. These make it difficult to recruit patients for genetic analysis.</p>
<p>Nonetheless, it is crucially important to study the genetics of MRKH and to identify the genetic variants associated with it, so as to provide explanations of the causes and implement therapeutic strategies. This is important for several reasons: </p>
<ol>
<li><p>We need to better understand the genes and pathways that enable genitalia to grow and function, and how these genes and pathways interfere with uterine and vaginal development when interrupted</p></li>
<li><p>If we understand the causes, we can find ways to manage the clinical and psychological well-being of affected women and describe clearly the diagnosis and management. A <a href="http://www.sistersforlove.org/the-research-.html">recent survey</a> showed that most participants felt MRKH was not explained in a way they understood</p></li>
<li><p>With more awareness, better psychological and emotional support can be made available in the form of peer support networks and guidance from health-care professionals to both the patients and their families. With better support, women would be less likely to feel isolated and traumatised by an MRKH diagnosis.</p></li>
</ol>
<h2>Where to from here?</h2>
<p>The <a href="http://www.sistersforlove.org/">Sisters for Love MRKH Foundation</a>, founded by two women with MRKH syndorme, Alison Hensley and Jaqi Quinlan, is a support group that aims to connect, inform, and help MRKH women and their families.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/unusual-conditions-what-is-rapunzel-syndrome-and-why-do-some-people-eat-hair-66761">Unusual conditions: what is Rapunzel syndrome and why do some people eat hair?</a>
</strong>
</em>
</p>
<hr>
<p>In association with Sisters for Love MRKH Foundation, I’m <a href="https://form.jotform.com/80528831568970">currently undertaking research</a> alongside Professor Peter Koopman at the University of Queensland, and collaborators at the Murdoch Children’s Research Institute. We’re aiming to identify the genetic causes of MRKH syndrome and to provide women with MRKH with the answers they seek. </p>
<p>The results of this project may help doctors provide a more detailed diagnosis, thus improving the diagnostic experience for the patient, and also providing women with MRKH and their families an enhanced support system. </p>
<hr>
<p><em>For more information and enquiries regarding research and recruitment, please <a href="https://theconversation.com/profiles/emanuele-pelosi-436780">contact me here</a>.
For information and support regarding MRKH, visit the <a href="http://www.sistersforlove.org/">Sisters for Love MRKH Foundation</a>.</em></p><img src="https://counter.theconversation.com/content/90300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emanuele Pelosi 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>Most affected women won’t be aware of the condition until puberty, when their first period never comes.Emanuele Pelosi, Senior Research Officer, Institute for Molecular Bioscience, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/868382017-11-13T02:31:28Z2017-11-13T02:31:28ZCups, lingerie and home-made pads: what are the reusable options for managing your period?<figure><img src="https://images.theconversation.com/files/193888/original/file-20171109-14177-chvag5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Menstrual cups are carving out a market beyond earth mothers.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-woman-hand-holding-menstrual-cup-633545540?src=O77SnIHDxnv6zbYrVFQDAA-3-13">David Pereiras/Shutterstock</a></span></figcaption></figure><p>The multi-million dollar feminine hygiene market is dominated by two products: pads and tampons. Most women will use one of the two – <a href="https://theconversation.com/tampon-versus-pad-why-more-women-still-choose-the-latter-to-manage-periods-64546">pads most commonly</a> – for reasons including ease of purchase, convenience, comfort, discrete packaging, disposability and, of course, advertising.</p>
<p>Pads and tampons, however, are not the only choices. </p>
<p>While you can <a href="https://hellogiggles.com/lifestyle/things-you-need-to-know-about-free-bleeding/">free bleed</a> at one end of the spectrum or <a href="https://www.nytimes.com/2016/10/19/well/live/how-to-stop-your-period.html">period suppress</a> at the other, in this article I focus on those of us electing to manage the <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/menstruation-abnormal-bleeding">40-ish millilitres of blood</a> we lose each each month.</p>
<p>Be it because of concerns over <a href="https://www.prnewswire.com/news-releases/world-feminine-hygiene-products-market-is-expected-to-reach-427-billion-by-2022-575532151.html">big femcare</a>, <a href="http://www.slate.com/articles/health_and_science/the_green_lantern/2010/03/greening_the_crimson_tide.html">landfill</a>, <a href="http://www.huffingtonpost.com.au/entry/period-cost-lifetime_n_7258780">cost</a>, <a href="https://www.huffingtonpost.com/dr-mercola/feminine-hygiene-products_b_3359581.html">toxic ingredients</a> or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/toxic-shock-syndrome-tss">toxic shock syndrome</a>, some menstruators seek solutions outside of the Kotex box. These are those choices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tampon-versus-pad-why-more-women-still-choose-the-latter-to-manage-periods-64546">Tampon versus pad: why more women still choose the latter to manage periods</a>
</strong>
</em>
</p>
<hr>
<h2>Absorption approaches</h2>
<p>Tampons and pads work by absorbing blood. These products are generally single usage and afterwards are discarded and replaced with a new product. </p>
<p>“Rags” hasn’t always been a crude euphemism for menstruation; it references a time when cloth was used, bled on, and then washed and used again. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193891/original/file-20171109-14193-11hnt28.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">Reusable pads often have press studs to secure them to your underwear crotch.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/369806810?src=nWInZp-IsILfBwM8m9JTuw-1-32&size=medium_jpg">ayakaphoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>Wealth in the West, and the clout of the feminine hygiene industry however, has meant that today most of us won’t consider reusable options. But such products are readily available and seek to overcome many of the problems created by disposables.</p>
<p>In Australia, companies such as <a href="https://www.hannahpad.com.au/">Hannahpad</a>, <a href="https://paisleypads.com.au/">Paisley Pads</a> and <a href="http://www.mensesense.com.au/">Mense Sense</a> sell cloth pads that can be reused. Less like the rags of old, reusable pads resemble the winged and form-fitting supermarket versions – often boasting press studs to secure them to your underwear crotch – and are designed to be washed and reworn.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=740&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=740&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=740&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=930&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=930&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193889/original/file-20171109-14202-1jv6m9v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=930&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 fabric options for reusable pads are endless.</span>
<span class="attribution"><a class="source" href="https://www.etsy.com/listing/261882633/donald-trump-fabric-custom-absorbency">Screenshot from Etsy</a></span>
</figcaption>
</figure>
<p>Such pads are marketed to eco-conscious consumers who like not having to buy new products every month from big companies, who prefer non-bleached materials, who appreciate the comfort of natural fabrics and who are, perhaps, drawn to the whimsy: if you’ve ever yearned to bleed on <a href="https://www.etsy.com/listing/261882633/donald-trump-fabric-custom-absorbency">Donald Trump’s face</a>, rest assured you now can. And Etsy will also be more than glad to offer you a range of festive designs featuring <a href="https://www.etsy.com/au/listing/541907678/dirty-dancing-dbp-8-regular-csp-cloth?ga_order=most_relevant&ga_search_type=all&ga_view_type=gallery&ga_search_query=reusable%20sanitary%20napkin&ref=sr_gallery_42">Dirty Dancing</a>, <a href="https://www.etsy.com/au/listing/529130432/cloth-sanitary-pad-blue-unicorns-csp?ga_order=most_relevant&ga_search_type=all&ga_view_type=gallery&ga_search_query=reusable%20sanitary%20napkin&ref=sr_gallery_7">unicorns</a>, <a href="https://www.etsy.com/au/listing/550954737/95-rounded-fit-reusable-menstrual-cloth?ga_order=most_relevant&ga_search_type=all&ga_view_type=gallery&ga_search_query=reusable%20sanitary%20napkin&ref=sr_gallery_34">rapsberries</a> and pretty much anything else you’ve ever craved to drip, clot and smear over.</p>
<p>Equally, if you’re keen to break out the sewing machine, <a href="https://www.wikihow.com/Make-Your-Own-Reusable-Menstrual-Pads">you can sew your own</a>. Ditto those who want to <a href="https://www.etsy.com/au/listing/525785937/instructions-only-knit-your-own-feminine?ga_order=most_relevant&ga_search_type=all&ga_view_type=gallery&ga_search_query=reusable%20sanitary%20napkin&ref=sr_gallery_45">knit their own pads</a>. </p>
<p>For those seeking non-pad absorption methods, welcome to the world of menstrual lingerie. Brands like <a href="https://www.shethinx.com/">Thinx</a> and <a href="https://www.modibodi.com/">Modibodi</a> sell absorbent underwear that can be worn without any additional protection: Thinx, for example, claims that some of their knickers can hold up to two tampons’ worth of blood. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193892/original/file-20171109-14193-nl47dd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Period knickers absorb blood.</span>
<span class="attribution"><a class="source" href="https://www.shethinx.com/pages/press">Thinx</a></span>
</figcaption>
</figure>
<p>Reviews caution that you don’t want to be a heavy bleeder in such garments, but then if you are, they can serve as a backup if you’re prone to bleeding through your other protection.</p>
<p>If internal products are your preference, perhaps resuable tampons should be on your radar. Less common than washable pads, nonetheless, flannel ones – and crocheted ones for those who don’t harbour the same <a href="https://theconversation.com/just-when-we-thought-wed-exhausted-all-uses-for-the-vagina-20675">internal-wool squeamishness that I do</a> – <a href="https://www.etsy.com/au/market/reusable_tampons">abound on Etsy</a>. For the crafty you too can <a href="https://www.youtube.com/watch?v=AsrNCt0pZSM">make your own</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AsrNCt0pZSM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Sea sponges are also a product in this category. When Elaine on TV sitcom Seinfeld debated a man’s <a href="https://www.youtube.com/watch?v=sfQBKB4s1ks">sponge-worthiness</a> she was talking about a <a href="contraceptive%20sponge">contraceptive sponge</a>, but their use for blood absorption is emerging as a niche, albeit not <a href="https://drjengunter.wordpress.com/2016/05/18/glamour-gives-risky-period-advice-recommends-dangerous-sea-sponges/">uncontroversial method</a> (think concerns about grit and disintegration inside the vagina). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-why-do-women-menstruate-13744">Explainer: why do women menstruate?</a>
</strong>
</em>
</p>
<hr>
<p>While there are price and planet reasons for considering resuables, there are also some notable downsides. </p>
<p>To reuse any kind of feminine hygiene product you have to wash it. If you’ve ever stained your sheets, clothes, or the carpet, you’ll be well aware that the scarlet stuff is a bastard to remove. If you’re bleeding away from your laundry, you’ll also need to think about transporting your blood-soaked pads or tampons back to your bucket, before soaking, washing and drying them.</p>
<p>Advertising’s heavy-handed messages about hygiene and discretion help explain our disproportionate reliance on brand-name pads and tampons, but convenience is just as potent a factor.</p>
<h2>Collection choices</h2>
<p>Menstrual cups – an option increasingly available in bricks and mortar stores and also one <a href="https://www.seattletimes.com/life/wellness/why-menstrual-cups-are-becoming-more-popular-for-women/">carving out a market beyond earth mothers</a> – are a menstruation management premised on the collection of blood.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=355&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=355&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=355&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=446&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=446&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193896/original/file-20171109-14202-wlhfwx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=446&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cups are inserted into the vagina and collect blood, then are washed and reinserted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-hand-holding-menstrual-cup-703010620?src=O77SnIHDxnv6zbYrVFQDAA-2-34">Martin Grincevschi/Shutterstock</a></span>
</figcaption>
</figure>
<p>Brands like <a href="https://www.mooncup.co.uk/">Mooncup</a>, <a href="http://www.juju.com.au/">Juju</a>, <a href="https://lunette.com.au/">Lunette</a> and <a href="http://divacup.com/">DivaCup</a> offer cups made from silicone, rubber or latex which get inserted into the vagina using fingers and your <a href="https://www.menstrualcupsaustraliaonline.com.au/menstrual-cup-folds/">favoured folding technique</a>. Once inside, they unfurl to collect blood and then later get removed, emptied and then washed (or, at least wiped) and reinserted. </p>
<p>While there’s no soaking or pegging products out on the washing line, menstrual cups have some of the same cons as tampons: some users report difficultly inserting them; others are reluctant to have so much contact with their own bleeding vaginas. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-ongoing-taboo-of-menstruation-in-australia-53984">The ongoing taboo of menstruation in Australia</a>
</strong>
</em>
</p>
<hr>
<p>Equally, while you may not have to soak your cup, you’re certainly going to have to sterilise it at the end of each cycle. (For those wanting to skip this step, <a href="http://softcup.com/">Softcups</a> and <a href="https://flexfits.com/">Flex</a> offer disposable versions). </p>
<p>And if you’re choosing cups because of the real but <a href="https://uk.news.yahoo.com/toxic-shock-syndrome-fear-not-only-one-182844708.html">often exaggerated</a> fears of toxic shock syndrome, you’ll want to make sure that your hands are pristine before fiddling about with insertion.</p>
<p>Some menstruators will spend 30-ish years using the same products they were introduced to at menarche; commonly whatever their mother, sister or friend handed them at that moment of crotch calamity. </p>
<p>We’re also, apparently, a <a href="http://connection.ebscohost.com/c/articles/108388687/brand-loyalty-prevails-feminine-hygiene">brand loyal</a> lot, sticking with the names we’re familiar with. The leakage and odour fears <a href="http://www.smh.com.au/lifestyle/diet-and-fitness/is-hollywood-making-us-fear-menstruation-20120712-21xze.html">drilled into us from youth</a> have meant that we commonly need a very good reason to deviate from the methods we’ve successfully used to stem the crimson tide. </p>
<p>That said, for some women, economics, the environment and the eschewing of <a href="http://www.businessinsider.com/10-companies-control-the-food-industry-2016-9/?r=AU&IR=T">ever-enlarging enterprises</a> might prove such a reason.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KOrzHMEBgi8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dolly Parton, “PMS Blues” (1994)</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/86838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Rosewarne 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>Be it because of concerns over big femcare, landfill, cost, toxic ingredients or toxic shock syndrome, some menstruators seek solutions outside of the Kotex box. These are those choices.Lauren Rosewarne, Senior Lecturer, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808772017-08-15T02:26:33Z2017-08-15T02:26:33ZBook review: The New Puberty<figure><img src="https://images.theconversation.com/files/181916/original/file-20170814-28472-ffp03x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We're still not really sure whether puberty is starting earlier. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Puberty is a topic we often feel uncomfortable talking about in society, let alone with our children. But Amanda Dunn’s book The New Puberty takes the reader on a journey through the complex and sometimes seemingly mysterious world of puberty. </p>
<p>By interviewing experts and critically reviewing the literature, Dunn provides an up-to-date and accurate review of current research on puberty. With a relaxed, chatty tone and including her own personal stories, Dunn explains the biological processes of puberty, associated medical conditions, the changing world children are growing up in, and examines what this all means for education.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-ongoing-taboo-of-menstruation-in-australia-53984">The ongoing taboo of menstruation in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>So what is puberty?</h2>
<p>Dunn describes when she first became aware of puberty when standing on a crowded tram at 11 years of age.</p>
<blockquote>
<p>Without warning, the man standing in front of me turned around and accidentally elbowed me in the chest. The pain was terrible, like something hard yet tender and a little bit alien had taken residence in my body, shocking me so much I almost burst into tears […] I had no idea what breast buds were, but they had introduced themselves to me in no uncertain terms.</p>
</blockquote>
<p>But why is so little known about puberty? When asked the question “when does puberty begin?” – most people will answer around 12 years of age. But we now understand that the earliest hormonal changes of puberty begin long before then. In fact, they begin around seven years of age with a surge in hormones called <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1532-7795.2010.00722.x/full">“adrenarche”</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=927&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=927&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=927&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1165&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1165&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181917/original/file-20170814-28461-n9h904.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1165&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 New Puberty, by Amanda Dunn.</span>
<span class="attribution"><span class="source">Screenshot, MUP</span></span>
</figcaption>
</figure>
<p>“True puberty” is sometimes referred to as gonadarche, which is a rise in the hormones testosterone (the male hormone) and oestradiol (the female hormone) and leads to the development of secondary sexual characteristics. These secondary sexual characteristics include breast development in females, and voice deepening and facial hair in males.</p>
<p>These are complex processes that we still don’t fully understand and as such there is even disagreement among scientists about how best to describe these processes. Yet Dunn accurately explains them in an accessible way.</p>
<p>Where the book is perhaps less clear is when exploring whether puberty is starting earlier. Certainly our more recent knowledge of adrenarche has led us to understand that the hormonal changes of the pubertal cascade are starting earlier than we first thought. </p>
<p>But this is a different question from whether the timing of puberty has actually changed and this distinction could be made clearer. </p>
<p>With regards to the timing of the physical events, as Dunn reviews, there is now compelling evidence that <a href="http://pediatrics.aappublications.org/content/123/5/e932?__hstc=241005276.f325666d716fad139a5cfb34edb32d91.1474243200076.1474243200078.1474243200079.2&__hssc=241005276.1.1474243200079&__hsfp=1773666937">breast development is starting at an earlier age</a>. The same study showed that although there was a decline in the age of onset of later events, such as menarche (first period), this was not as dramatic as the decline seen with breast development and so this suggests the overall length of puberty may be increasing.</p>
<h2>Puberty and brain development</h2>
<p>Until a couple of decades ago, we thought brain development stopped in mid childhood. But with the introduction of magnetic resonance imaging (MRI), we now know the <a href="http://psycnet.apa.org/record/2005-07183-000">brain undergoes significant reorganisation</a> in the transition from childhood to adolescence. </p>
<p>Importantly, as Dunn notes, there is increasing evidence suggesting pubertal hormones have an impact on brain development during this time. So rather than this being a quiet or “latent” period of life, we now realise it’s a critical phase of development and is in fact a foundational phase of life.</p>
<h2>The changing world</h2>
<p>Dunn also examines the increasing rise of social media and its effects on how children are growing up today. Dunn notes “there’s really little point in trying to defeat social media – it is a forlorn pursuit”. But there are practical steps that parents can take and important skills that can be provided to students to help them navigate the online world. With some studies suggesting around <a href="http://jamanetwork.com/journals/jamapediatrics/fullarticle/1212181">a third of youth are involved in sexting</a>, the advice to parents and teachers is particularly timely.</p>
<p>The role of sexualisation is also explored. Dunn reports findings from an <a href="http://www.sciencedirect.com/science/article/pii/S1740144514000357">Australian study</a>, which showed girls aged 6-11 years reported levels of self-objectification that were similar to those of older girls and adult women. Self-objectification was in turn linked with body image problems and eating disorders. This chapter is filled with expert advice for parents and carers to help them provide a safe and supportive environment for their children to grow up in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/twelve-going-on-20-are-girls-reaching-puberty-earlier-1383">Twelve going on 20: are girls reaching puberty earlier?</a>
</strong>
</em>
</p>
<hr>
<hr>
<h2>What does this mean for education?</h2>
<p>Given our increasing understanding of pubertal development, Dunn explores what this means for education and in particular the need to revisit how sexuality education is taught in schools. As Dunn suggests, sexuality education </p>
<blockquote>
<p>is not an easy subject to teach. But it would be a lot easier if teachers were properly trained in it. </p>
</blockquote>
<p>Dunn describes her own sexuality education and how thankful she was when her Year 8 teacher showed how a tampon worked by placing it into water:</p>
<blockquote>
<p>we watched in wonder as its white fluffy body took on the water and expanded.</p>
</blockquote>
<p>Dunn argues that providing students with information about puberty once they have already started the pubertal process (or in some cases completed puberty) is too late. We need to be talking to children in the first years of primary school about their bodies and relationships, and then the curriculum should develop throughout primary and secondary school to meet the age-appropriate needs of students.</p>
<p>The New Puberty is a timely book for parents and teachers; concisely explaining puberty, its impact on development and dispelling many of the myths associated with puberty along the way. But it goes much further than this by providing the advice and strategies required to support young people through this foundational phase of life.</p>
<hr>
<p><em>The author of The New Puberty, Amanda Dunn, is an editor at The Conversation. She was not involved in commissioning or editing this review.</em></p><img src="https://counter.theconversation.com/content/80877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Mundy receives funding from NHMRC and the Commonwealth Department of Education and Training. Lisa Mundy has previously received funding from Australian Rotary Health, the Invergowrie Foundation and the Victorian Department of Education and Training.</span></em></p>A new book on puberty has explored why we find it so difficult to talk about puberty, and why we need to start talking about it earlier.Lisa Mundy, Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/739132017-03-07T19:24:30Z2017-03-07T19:24:30ZGirls with early first periods become women with greater risk of gestational diabetes<figure><img src="https://images.theconversation.com/files/159701/original/image-20170307-20756-1i9knd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Western societies, average age of first period has dropped from 17 to 13 years over the past century. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/justanotherhuman/27448588632/in/photolist-HPxc79-4pN4PD-foCbk5-55ucKn-qVJgbB-4Kyj2S-fnXLsA-4kq3Lh-55yGqb-p177e3-4CnSjg-nwez1e-foBtCh-avGoyL-9qk8P4-foAzxb-fnJtpB-fondQ8-fo5oXG-nPmnCe-r1iASv-dxTNMh-foBnxC-4kq345-4Uufqh-a3b1gZ-pJfqWe-9F4dKY-foAzL7-ddVKBU-fnXTvw-nyYn36-gP7CjH-d4sSE5-foCaMj-4kq3Ys-bpFkbt-4UpZxP-gN7gLp-cdKSvN-biHqSa-fo4LA5-55uuUH-fomgWa-7ANPHM-5u3bw8-4km1ep-vsKHF-foBrp7-Qh156i">justanotherhuman/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>As a young girl, getting your period for the first time is a big deal. It comes with mental and social expectations around “becoming a woman” and a host of cultural practices that act to celebrate or stigmatise menstruation. </p>
<p>But <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">evidence</a> now suggests the timing of this event could also have health implications for girls who get their first period earlier than their peers. </p>
<p>During puberty our bodies change and sexually mature, and a girl’s first period is an important point in this process. The age when girls get their first period varies, however younger than 12 years is generally considered to be “early”. The possibility that a first period before the age of 12 is linked with pregnancy health was explored in our <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">recent study</a>. We found that girls who had early first periods were more likely to develop diabetes when they later became pregnant as an adult. </p>
<p>Gestational diabetes is a <a href="https://www.diabetesaustralia.com.au/gestational-diabetes">serious pregnancy complication</a>, as it increases the risk of pre-term labour and giving birth to a large baby. It is also considered a “stress test” for the later development of type 2 diabetes; both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990903/">mother</a> and <a href="http://diabetes.diabetesjournals.org/content/60/7/1849">child</a> in affected pregnancies face a six to seven fold increased risk of developing type 2 diabetes. </p>
<h2>Age of first period and diabetes during pregnancy</h2>
<p>We studied a group of more than 4,700 women from the <a href="http://www.alswh.org.au">Australian Longitudinal Study on Women’s Health</a> (also known as Women’s Health Australia). This longitudinal study has collected detailed health and well-being information from the same women at multiple points in time over the past 20 years. The women were 18-23 years old in 1996 when the study started. The women reported on the age of their first period and were followed throughout their pregnancies. </p>
<p>Most women experienced their first period between age 12 and 13, but 12% had early first periods. We found girls who had their first periods before age 12 were more likely to be from a disadvantaged background in childhood. They were also more likely to report being overweight in childhood and in adult life, compared with women who had their first period at a later age. While taking these early life and adulthood characteristics into account, women with earlier first periods were still <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">50% more likely to develop diabetes during pregnancy</a>. </p>
<h2>Is the age at first period changing?</h2>
<p>The age of first menstruation has decreased in most Western countries, from an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16757103">average of 17 more than a century ago, to around 13 today</a>. This decline seems to have <a href="http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-175">stabilised</a>, however discussion persists about whether the trend is continuing at a slower rate. The initial decline is likely explained by improved health and nutrition. The more recent declines may also be largely attributable to environmental and lifestyle factors. </p>
<p>We know circumstances in early life – including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287288/">psychosocial stressors</a>, such as parental divorce and abuse, as well as <a href="http://www.sciencedirect.com/science/article/pii/S1043276009000587">childhood obesity</a> – can trigger early reproductive development. Other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065309/">recent environmental changes</a> – such as the use of hair products, plastic water bottles, and food packaging – have also been examined as a possible cause of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958977/">early age at first period</a>.</p>
<h2>What does this mean for women’s health?</h2>
<p>An early transition to adulthood can be characterised by increased stresses and challenges as girls have to adapt to their new social roles. Girls with an early first period are at greater risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927128/">depression and anxiety</a>, and display higher rates of risky-behaviours such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892192/">smoking, drinking, illicit drug use</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19958543">unprotected sex</a>. </p>
<p>The falling age of first menstruation is concerning as it also increases the risk of health conditions. In addition to the higher risk of <a href="https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww201">diabetes during pregnancy</a> found in our study, early menstruation has also been shown to increase the risk of developing chronic conditions in later life, such as <a href="http://link.springer.com/article/10.1007%2Fs00592-014-0579-x">type 2 diabetes</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/">breast cancer</a>. </p>
<h2>What can we do?</h2>
<p>Ideally we would one day be able to prevent girls from having their first period too early, but there is no one single cause that determines when this happens. However, supporting healthy environments and behaviours from early in life are important strategies. Childhood obesity is a well-known factor increasing the likelihood of early age at first period. Given that <a href="http://www.aihw.gov.au/overweight-and-obesity/">one in four children in Australia are overweight or obese</a>, promoting healthy eating and physical activity should be a priority for young mothers, schools, and health policy. </p>
<p>Clinicians including GPs and specialists, who provide advice and treatment for women, should be aware of the importance of early age at first menstruation as a potential marker of future health issues. Early monitoring and advice on a healthy diet and weight and physical activity may help women to lower these risks.</p><img src="https://counter.theconversation.com/content/73913/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>Girls who have their first period at a young age are more likely to experience poorer health as a adult, including an elevated risk of diabetes during pregnancy.Danielle Schoenaker, PhD Candidate and Research Officer, The University of QueenslandGita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.