tag:theconversation.com,2011:/uk/topics/menstruation-3367/articlesMenstruation – The Conversation2024-03-12T17:51:11Ztag:theconversation.com,2011:article/2220162024-03-12T17:51:11Z2024-03-12T17:51:11ZMenstrual health literacy is alarmingly low – what you don’t know can harm you<figure><img src="https://images.theconversation.com/files/580119/original/file-20240306-27-eeqobz.jpg?ixlib=rb-1.1.0&rect=8%2C17%2C5982%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stone-sculpture-female-genitals-covered-hands-1024757548">Len-art/Shutterstock</a></span></figcaption></figure><p>Given that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541669/#:%7E:text=In%20fact%2C%20approximately%2098%25%20of,the%20elephant%20shrew%20%5B6%5D.">98% of mammals</a> do not have periods, do you know why humans do?</p>
<p>When I ask my menstrual health workshop participants – including doctors – there’s usually a lot of shrugging and shaking of heads. If given multiple choice options, most think that periods either “clean the womb” or somehow “help prepare for pregnancy”. </p>
<p>Not only are these beliefs inaccurate, but they also reproduce damaging myths about the inherent impurity and <a href="https://www.perlego.com/knowledge/study-guides/what-is-abjection/">abject status</a> (responses of repulsion and horror to aspects of women’s bodies such as menstruation and childbirth) of the female body. Wombs are not dirty, or toxic. They do not need to be cleaned. <a href="https://www.menstrual-matters.com/top-10-period-myths/">Menstrual fluid</a> is not an excretory product like urine or faeces. </p>
<p>Yes, the blood part can stain clothing, but there is nothing pathological, contaminating, or dangerous about periods. The idea that the womb and vagina are dirty or toxic directly contributes to <a href="https://www.ncbi.nlm.nih.gov/books/NBK565611/">menstrual stigma</a> and associated discrimination, such as the exclusion of menstruating people from certain <a href="https://www.ncbi.nlm.nih.gov/books/NBK565592/">religious</a> places or practices, or the reports of intentional humiliation of <a href="https://www.ncbi.nlm.nih.gov/books/NBK565595/">female prisoners</a> on their periods.</p>
<p>As part of <a href="https://www.menstrual-matters.com/black-box/">my research</a>, <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">I reviewed</a> the menstrual cycle content of 16 of the most used biology and physiology textbooks in UK secondary schools, university level natural sciences, medicine, and specialist gynaecology education – and what I found was pretty alarming.</p>
<p>Nobody, it seems, is taught about the function of periods.</p>
<h2>So, why do we have periods?</h2>
<p>The most <a href="https://www.menstrual-matters.com/why-humans-menstruate/">robust evidence based theory</a> we have is described by evolutionary biologist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528014/">Deena Emera and colleagues</a>. Periods likely evolved as a kind of preemptive abortion, to protect women from unviable or dangerous pregnancies. </p>
<p>Humans have exceptionally high rates of genetically abnormal eggs, sperm and fertilised eggs, highly invasive placental attachments, and pregnancy and childbirth are risky – even potentially fatal – experiences for human females. As a result, we have <a href="https://academic.oup.com/humrep/article/32/2/346/2713082">low rates of conception</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/11023804/">high rates of miscarriage</a>, and extremely high rates of maternal mortality in comparison to other mammals. In fact, despite advances in modern medicine, nearly <a href="https://www.who.int/news-room/fact-sheets/detail/maternal-mortality">300,000 expectant mothers</a> still die every year, globally.</p>
<p>If there is no pregnancy, as in the case for most menstrual cycles, or an unviable fertilised egg is detected, a period is triggered. </p>
<p>Periods cannot possibly help a pregnancy. Just think about it for a minute. How can the removal of the contents of the womb – including any eggs that may be present – possibly help conception or maintain a pregnancy? My research suggests that this assumption is influenced by sexist beliefs that position the female body, and all women, as <em>for</em> having babies – rather than eligible for equal opportunities in education, paid employment, and leadership. </p>
<p>Take a look at this quote from one of the <a href="https://global.oup.com/academic/product/oxford-textbook-of-obstetrics-and-gynaecology-9780198766360?cc=gb&lang=en&">medical textbooks</a> reviewed for <a href="https://global.oup.com/academic/product/experiences-of-menstruation-from-the-global-south-and-north-9780197267578?cc=gb&lang=en&">the study</a>. It explicitly positions the entire menstrual cycle (not just ovulation) as critical for having babies, and childbearing as the sole purpose of the female reproductive body. The fact that humans evolved a means to terminate potentially dangerous unviable pregnancies is not so much omitted, as denied. </p>
<blockquote>
<p>The principal functions of this (female reproductive) system are to produce an ovum, enable its fertilisation and implantation, and allow growth and safe expulsion of the foetus into the external world. The menstrual cycle is critical for facilitation of the initial steps of this raison d’être of the female reproductive system.</p>
</blockquote>
<h2>What else don’t we know?</h2>
<p>Well, where do I begin? Perhaps with the fact that the second phase of the cycle from ovulation to menstruation is a series of <a href="https://pubmed.ncbi.nlm.nih.gov/36304016/">highly inflammatory processes</a>. This was only very briefly mentioned in three out of 16 textbooks. </p>
<p>Given that common premenstrual changes reflect the <a href="https://www.verywellhealth.com/signs-of-inflammation-4580526">“cardinal signs”</a> of inflammation – temperature increase, swelling, pain, and blood flow changes – and anti-inflammatory <a href="https://www.menstrual-matters.com/tips-and-tricks/all-changes/">interventions</a>, including diet, lifestyle and medications, <a href="https://www.cochrane.org/CD001751/MENSTR_nonsteroidal-anti-inflammatory-drugs-dysmenorrhoea">alleviate cyclical changes</a>, this is quite the omission. We really ought to be taught from puberty how to reduce period pain and blood loss – this is not difficult science.</p>
<p>In fact, only around half of the textbooks even mentioned blood loss, and only four went on to explain how regular periods typically result in iron deficiency – leading to anaemia in some cases. </p>
<p>Fewer than half of the textbooks mentioned any associated health issues, such as endometriosis, heavy menstrual bleeding, fibroids, polycystic ovarian syndrome, <a href="https://pubmed.ncbi.nlm.nih.gov/33347177/">premenstrual syndrome</a>, premenstrual dysphoric disorder, or the cyclical exacerbation of asthma, migraine, epilepsy, irritable bowel syndrome, auto-immune disorders, or anxiety and depression. So, even doctors are <a href="https://metro.co.uk/2022/07/22/why-wasnt-it-mandatory-for-doctors-to-be-taught-about-womens-issues-before-now-17052718/">not taught enough</a> about female-prevalent illnesses, which must surely have a negative impact on the health outcomes of their patients.</p>
<h2>Why aren’t we taught this stuff?</h2>
<p>In <a href="https://www.menstrual-matters.com/black-box/">my review</a>, no textbooks mentioned the purpose or embodied – typically painful – experiences of periods, and all effectively reduced the entire menstrual cycle to fluctuating sex hormones. </p>
<p>There is no scientific reason for this. My research shows that the exclusive focus on the female sex hormones in menstrual education is informed by societal influences, such as the myth of the hysterical or hormonal female. </p>
<p>For hundreds of years, women’s experiences of emotional and physical distress were <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">blamed on the womb</a> – as the essence of femininity – rather than distressing life experiences, pain, or underlying health conditions. There is a <a href="https://wellcomecollection.org/articles/ZN-ELxEAACMABO5a">familiar western</a> stereotype of the pathologically emotional <a href="https://www.medicalnewstoday.com/articles/the-controversy-of-female-hysteria#Female-hysteria-in-the-18th-century">“hysterical woman”</a>, who is biologically prone to invent, exaggerate, and imagine things, especially pain or distress. This gender myth is still alive and well, although now we tend to <a href="https://sciencebasedmedicine.org/the-hormone-myth/">blame the (female sex) hormones</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=755&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=755&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=755&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=949&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=949&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580533/original/file-20240307-22-57sogj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=949&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The doctor’s visit by Frans van Mieris, 1657.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:A_physician_taking_the_pulse_of_a_female_patient_who_is_touc_Wellcome_V0016033.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As soon as the female sex hormones were <a href="https://academic.oup.com/endo/article/160/3/605/5250672">first identified</a> in the late 1920s, textbooks containing information about menstrual physiology <a href="https://www.taylorfrancis.com/books/mono/10.4324/9780203421529/beyond-natural-body-nelly-oudshoorn">switched</a> from being about its inflammatory processes to hormonal models and explanations. Again, there was no scientific reason for this change in focus, although it reflected <a href="https://www.tandfonline.com/doi/pdf/10.1080/09612020000200260">existing societal beliefs</a> about the inherently <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">irrational behaviour of women</a>. </p>
<p>Unfortunately, menstrual health literacy has not yet recovered from this shift in physiological models.</p>
<h2>So what?</h2>
<p>Once the purpose and inflammatory nature of the menstrual cycle are understood, premenstrual changes are no longer mysterious or difficult to treat. It also becomes much easier to differentiate premenstrual changes from underlying health conditions, since the latter will not be substantially alleviated by anti-inflammatory interventions alone.</p>
<p>Teaching the reductive hormonal model of the menstrual cycle unintentionally provides pseudo-scientific evidence for the damaging hormonal or hysterical female gender myth. This myth contributes <a href="https://theconversation.com/womens-pain-is-often-not-believed-heres-how-to-make-your-voice-heard-when-seeking-help-207866">to disbelief</a> in women’s accounts of painful or distressing symptoms, and even reports of <a href="https://www.tandfonline.com/doi/full/10.1080/1369118X.2020.1770832">abuse and discrimination</a>.</p>
<p>It is time we taught more comprehensive menstrual health literacy to all.</p><img src="https://counter.theconversation.com/content/222016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters- the world's first evidence-based info hub on menstrual health and rights <a href="http://www.menstrual-matters.com">www.menstrual-matters.com</a>. Her doctoral research and current research fellowship were funded by the ESRC (Economic and Social Research Council). </span></em></p>No one seems to be taught about the function of periods. It’s time to take menstrual literacy seriously.Sally King, Menstrual Matters Founder & Research Associate in Menstrual Physiology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242572024-02-28T19:11:15Z2024-02-28T19:11:15ZThere is a knowledge gap around menstruation in NZ – and this puts people at risk<p>New Zealand girls and young women, as well as nonbinary persons who bleed every month, have a limited understanding of menstruation. This lack of knowledge about their own bodies is affecting their overall health and wellbeing. </p>
<p>Our ongoing research, currently under peer review, looks at the menstrual health literacy of premenopausal females between 20 and 34 years old (in this article the term “female” is used to refer to individuals with the reproductive organs and hormones that enable menstruation. However, the authors do acknowledge that sex is not binary). We examined how people understood the purpose of hormonal changes and health outcomes (acute and long-term) associated with the menstrual cycle.</p>
<p>The results are concerning in a country where more than half the population is female, and where health education <a href="https://hpe.tki.org.nz/health-and-physical-education-in-the-curriculum/">starts in the first year of school</a>. </p>
<p>But this lack of knowledge is not just a health issue. Anxiety over menstruation, what is normal and what isn’t, spills over to every element of a person’s life, affecting participation in activities such as sport, work, and school. </p>
<p>If New Zealand wants to encourage equal participation in life, then we need to start by properly educating females about how their bodies work. </p>
<h2>A lack of general understanding</h2>
<p>We used a 25-question survey to test menstrual cycle literacy. The questions were divided into four categories: the menstrual cycle, menstruation, symptoms and health outcomes. The final online survey was shared online and completed by 203 females aged 16-40 years. </p>
<p>We found the overall knowledge score for functional menstrual health literacy was low (less than 50%). This means more than half of menstruating individuals may not have an understanding of how hormones within their body can affect them and what symptoms are associated with menstrual cycle changes or disruption. </p>
<p>In particular, we have found a gap in knowledge around the second key hormone governing a person’s menstrual health. While respondents were familiar with <a href="https://www.ncbi.nlm.nih.gov/books/NBK538260/">estrogen</a> and its effects on the body, few were aware of how the second <a href="https://www.ncbi.nlm.nih.gov/books/NBK558960/">key reproductive hormone progesterone</a> affects their bodies.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-rags-and-pads-to-the-sanitary-apron-a-brief-history-of-period-products-203451">From rags and pads to the sanitary apron: a brief history of period products</a>
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</em>
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<p>Progesterone is a key hormone for fertility and has roles in maintaining bone health, body fluid regulation and body temperature. It is also the first hormone to change when there is a subtle menstrual cycle disruption.</p>
<p>Failing to understand the importance of this hormone means most females are unaware of how to identify these subtle disruptions. They would most likely miss a lot of the initial warning signals from their body.</p>
<p>Approximately 38% of survey respondents were not aware of what is considered a normal length of the menstrual cycle. This may be associated with increased stress and anxiety commonly experienced with the “unexpected” arrival of their period.</p>
<p>Interestingly, we noted that females tended to score higher on questions where they could use or refer to personal experience (for example, menstrual cycle symptoms and menstruation).</p>
<p>But even here only 50% of females could correctly quantify normal or heavy menstrual blood loss values. Only 10% knew of the changes to cervical mucous that occur with ovulation and are recommended for fertility tracking. </p>
<h2>Missing the danger signs</h2>
<p>The lowest health literacy was reported for the awareness of adverse health outcomes associated with menstrual cycle disruption. </p>
<p>The majority (65%) were unable to correctly identify adverse health and wellbeing outcomes. </p>
<p>High stress, dieting, substantial weight loss and over-training are factors that independently and cumulatively have been found to increase the risk of menstrual cycle disruptions. </p>
<p>These changes in the menstrual cycle will often result in increased gastrointestinal upset, decreased immune response – and in severe cases increase the risk of bone stress injuries. </p>
<p>But the majority (95%) of survey participants only selected “increased risk of bone stress injuries”, the most severe outcome. They were unable to identify any of the other common negative health outcomes that may present first. </p>
<p>It is not uncommon for females to see multiple health or medical professionals when they are concerned with their reproductive health. </p>
<p>The lack of knowledge about what is happening in their body means there can be diagnostic delays or lack of diagnosis. In New Zealand, the average time for a <a href="https://pubmed.ncbi.nlm.nih.gov/35292715/">endometriosis and polycystic ovary syndrome (PCOS) diagnosis</a> is between two and eight years. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lydia-kos-time-of-the-month-comment-showed-how-far-sportswomen-have-come-and-how-much-still-has-to-change-182421">Lydia Ko’s 'time of the month' comment showed how far sportswomen have come – and how much still has to change</a>
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</em>
</p>
<hr>
<p>Similarly, the majority of females were unable to identify all the factors that could affect the menstrual cycle. Most selected exercise as a key factor responsible for any menstrual cycle disruption. </p>
<p>As a result, most females reported that stopping exercise was what was needed to help menstrual cycle health. </p>
<p>This perception may be a contributing factor to the <a href="https://sportnz.org.nz/itsmymove/overview/?gad_source=1&gclid=Cj0KCQiA5-uuBhDzARIsAAa21T9m5ud_9QUhsW9UO5v8C4yHVhsw1ML_vlUa3a-S-DfKXG_0sLrCEjgaAqa1EALw_wcB">participation in sports gap</a> between young females and males – rising from a 17% gap in sport activity per week at age 16 to a 28% gap at 17. </p>
<h2>Talking about what is (and isn’t) normal</h2>
<p>Our survey results show a pervasive knowledge gap in menstrual cycle health. Most females we surveyed were not aware of what is “normal” for their menstrual cycle, nor did they have a good understanding of the health outcomes associated with menstrual cycle disruptions. </p>
<p>There is a high risk that many females may have a poor quality of life, health and wellbeing due to not being able to access, understand or communicate menstrual health information when it is needed.</p>
<p>This ongoing research is the first step to understanding this pervasive knowledge gap in menstrual cycle health within New Zealand. More research is required to quantify menstrual health literacy in adolescent girls and peri- and post-menopausal women. </p>
<p>Understanding the gaps will give researchers, advocates and educators insight into where we can help improve this basic knowledge – and achieve better outcomes for all those who bleed.</p><img src="https://counter.theconversation.com/content/224257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Badenhorst has received funding from the Health Research Council. </span></em></p><p class="fine-print"><em><span>Stacy T. Sims 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>Education needs to address the big gaps in the knowledge around the menstrual cycles and the impact menstruation has on a wide range of health outcomes.Claire Badenhorst, Senior Lecturer, Massey UniversityStacy T. Sims, Associate research scientist, Auckland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2216842024-01-28T13:55:15Z2024-01-28T13:55:15ZThe contraceptive pill also affects the brain and the regulation of emotions<figure><img src="https://images.theconversation.com/files/570657/original/file-20231221-19-oxth15.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C988%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Like natural hormones, known as endogenous hormones, the artificial hormones contained in the pill, known as exogenous hormones, can have effects on the brain.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Oral contraceptives, also known as birth control pills, are <a href="https://doi.org/10.18356/1bd58a10-en">used by more than 150 million women worldwide</a>. Approximately one-third of teenagers in <a href="https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2015010/article/14222-eng.pdf">North America</a> and <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">Europe</a> use them, making them the most prescribed drug for teenagers.</p>
<p>It is well known that oral contraceptives have the power to alter a woman’s menstrual cycle. What’s less well known is that they can also have an effect on the brain, particularly in the regions that are important for regulating emotions.</p>
<p>As a doctoral student and professor of psychology at UQAM, we were interested in the impact of oral contraceptives on the brain regions involved in emotional processes. We published our <a href="https://doi.org/10.3389/fendo.2023.1228504">results in the scientific journal Frontiers in Endocrinology</a>.</p>
<h2>How does the pill work?</h2>
<p>There are several methods of hormonal contraception, but the most common type in North America is the contraceptive pill, more specifically, <a href="https://doi.org/10.1016/j.yfrne.2022.101040">combined oral contraceptives</a> (COCs). These are made up of two artificial hormones that simulate one of the types of estrogen (generally ethinyl estradiol) and progesterone.</p>
<p>Like natural hormones, known as endogenous hormones, the artificial hormones contained in the pill, known as exogenous hormones, <a href="https://doi.org/10.1016/j.yfrne.2022.101040">have an effect on the brain</a>. They bind to receptors in different areas and signal the brain to reduce the production of endogenous sex hormones. It is this phenomenon that leads to the cessation of menstrual cycles, preventing ovulation.</p>
<p>In other words, while using COCs, users’ bodies and brains are not exposed to the fluctuations in sex hormones typically seen in women with a natural cycle.</p>
<h2>The pill’s effects on the brain: neuroscience to the rescue!</h2>
<p>When they start taking COCs, teenage girls and women are informed of their different side effects, mainly physical (nausea, headaches, weight changes, breast tenderness). However, the fact that sex hormones affect the brain, particularly in areas important for regulating emotions, is not generally discussed.</p>
<p>Studies have associated the use of COCs with <a href="https://doi.org/10.1016/j.psyneuen.2018.02.019">poorer ability to regulate emotions</a> and a <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">higher risk of developing psychopathologies</a>.</p>
<p>In addition, women are more likely than men to suffer from <a href="https://doi.org/10.1016/j.jpsychires.2011.03.006">anxiety and chronic stress disorders</a>. Given the widespread use of COCs, it is important to gain a better understanding of their effects on the anatomy of the brain regions that are responsible for emotional regulation.</p>
<p>We therefore conducted a study to examine the effects of COCs on the anatomy of brain regions involved in emotional processes. We were interested in the effects associated with their current use, but also in the possibility of lasting effects, i.e. whether COCs could affect brain anatomy even after women stopped taking them.</p>
<p>To do this, we recruited four profiles of healthy individuals: women currently using COCs, women who had used COCs in the past, women who had never used any method of hormonal contraception, and men.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magnetic resonance imaging" src="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.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">Magnetic resonance imaging (MRI) is used to analyze the morphology of certain regions of the brain.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Using brain imaging, we found that only women currently using COCs had a slightly thinner ventromedial prefrontal cortex than men. This part of the brain is known to be essential for regulating emotions such as fear. The scientific literature shows that <a href="https://doi.org/10.1073/pnas.0502441102">the thicker this region is, the better the emotional regulation will be</a>.</p>
<p>COCs could therefore alter emotional regulation in women. Although we have not directly tested the link between brain morphology and mental health, our team is currently investigating other aspects of the brain and mental health, which will allow us to better understand our anatomical findings.</p>
<h2>An effect associated with the dose, but that doesn’t last</h2>
<p>We tried to better understand what could explain the effect using COCs on this region of the brain. We discovered that it was associated with the dose of ethinyl estradiol. In fact, among COC users, only those using a low-dose COC (10-25 micrograms) – not a higher dose (30-35 micrograms) – were associated with a thinner ventromedial prefrontal cortex.</p>
<p>It may seem surprising that a lower dose was associated with a cerebral effect…</p>
<p>Given that all COCs reduce concentrations of endogenous sex hormones, we propose that estrogen receptors in this brain region may be insufficiently activated when low levels of endogenous estrogen are combined with a low intake of exogenous estrogen (ethinyl estradiol).</p>
<p>Conversely, higher doses of ethinyl estradiol could help to achieve adequate binding to estrogen receptors in the prefrontal cortex, simulating moderate to high activity similar to that of women with a natural menstrual cycle.</p>
<p>It is important to note that this lower grey matter thickness was specific to current COC use: women who had used COCs in the past showed no thinning compared to men. Our study therefore supports the reversibility of the impact of COCs on cerebral anatomy, in particular on the thickness of the ventromedial prefrontal cortex.</p>
<p>In other words, the use of COCs could affect brain anatomy, but in a reversible way.</p>
<h2>And now?</h2>
<p>Although our research has no direct clinical orientation, it is helping to advance our understanding of the anatomical effects associated with the use of COCs.</p>
<p>We are not calling for women to stop using their COCs: adopting such discourse would be both too hasty and alarming.</p>
<p>It’s also important to remember that the effects reported in our study appear to be reversible.</p>
<p>Our aim is to promote basic and clinical research, but also to increase scientific interest in women’s health, an area that is still understudied.</p><img src="https://counter.theconversation.com/content/221684/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexandra Brouillard is a student member of the Research Centre of the Institut universitaire en santé mentale de Montréal. She holds a doctoral scholarship from the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Marie-France Marin is a regular researcher at the Centre de recherche de l'Institut universitaire en santé mentale de Montréal, a professor in the Department of Psychology at the Université du Québec à Montréal and an associate professor in the Department of Psychiatry and Addictology at the Université de Montréal. She was supported by a salary grant from the Fonds de recherche du Québec - Santé (2018-2022) and currently holds a Canada Research Chair in Hormonal Modulation of Cognitive and Emotional Functions (2022-2027). The project discussed in the article is funded by the Canadian Institutes of Health Research and has received support from pilot project funds from the Research Centre of the Institut universitaire en santé mentale de Montréal and the Quebec Bioimaging Network.</span></em></p>Oral contraceptives modify the menstrual cycle. What’s less well known is that they also reach the brain, particularly the regions important for regulating emotions.Alexandra Brouillard, Doctorante en psychologie, Université du Québec à Montréal (UQAM)Marie-France Marin, Professor, Department of Psychology, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183442023-12-21T23:19:57Z2023-12-21T23:19:57ZGot period pain or cramps? What to eat and avoid, according to science<figure><img src="https://images.theconversation.com/files/566750/original/file-20231219-27-7x7oaq.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938362/">Sora Shimazaki/Pexels</a></span></figcaption></figure><p>Painful periods are common. More than half of people who menstruate have some pain for up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">three days a month</a>, typically throbbing or cramping in the lower abdomen. </p>
<p>Digestive changes – such as vomiting, gas, bloating, diarrhoea and a “bubbling gut” – are also <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0538-8">common</a> around the time of menstruation. </p>
<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">treatments</a> for period pain (known medically as dysmenorrhoea). Not all these treatments are well-tolerated or work for everyone.</p>
<p>We’re learning more about food’s role in influencing <a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">inflammation</a> in our body. So, could eating or avoiding certain foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963185/">help</a> with painful periods? Here’s what we know based on high-quality research.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
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<h2>Foods that may relieve period pain or cramps</h2>
<p><strong>Foods containing omega-3 fatty acids</strong></p>
<p>Foods rich in omega-3 fatty acids include chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters and edamame beans. Omega-3 fatty acids are naturally present in oils including fish, cod liver, algal, krill, flaxseed (linseed), soybean and canola oils.</p>
<p>Omega-3 fatty acids <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/">affect</a> how our cells function and the signalling pathways associated with inflammation and pain. </p>
<p>Earlier this year, researchers published a <a href="https://pubmed.ncbi.nlm.nih.gov/37545015/#:%7E:text=Meta%2Danalysis%20(n%20%3D%208,0.51)%20at%20reducing%20dysmenorrhoea%20pain.">meta-analysis</a> where they combined and analysed all data available on the impact of omega-3 fatty acids on period pain. They found diets high in omega-3 fatty acids (including supplements of 300-1,800 milligrams a day) over two to three months may reduce pain, and pain medication use, in people with painful periods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open sardine can, parsley, cut lemon on wooden table." src="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sardines and other oily fish are rich in omega-3 fatty acids.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/open-can-sardines-preserves-oil-on-1636046179">BearFotos/Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/are-fish-oil-supplements-as-healthy-as-we-think-and-is-eating-fish-better-212250">Are fish oil supplements as healthy as we think? And is eating fish better?</a>
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<p><strong>Foods high in vitamin D</strong></p>
<p>Foods high in vitamin D include trout, salmon, tuna and mackerel, as well as fish liver oils. Small amounts are also found in beef liver, egg yolk and cheese. Mushrooms contain varying levels of vitamin D, and you can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/">boost</a> this by exposing them to direct midday sunlight for 15-120 minutes. </p>
<p>The body can make vitamin D when it gets sunlight exposure and you can also get vitamin D from supplements.</p>
<p>Vitamin D <a href="https://pubmed.ncbi.nlm.nih.gov/24262718/">may help</a> reduce the factors that cause inflammation in the uterus. This includes levels of hormone-like molecules called prostaglandins. </p>
<p>A 2023 <a href="https://www.mdpi.com/2072-6643/15/13/2830#B11-nutrients-15-02830">meta-analysis</a> showed women who received weekly doses of vitamin D greater than 50,000 IU (or international units) had relief from period pain, regardless of how long and how often women took the vitamin.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
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</em>
</p>
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<p><strong>Foods high in vitamin E</strong></p>
<p>Foods rich in vitamin E include seeds (particularly sunflower seeds), nuts (particularly almonds, hazelnuts and peanuts) and spinach, broccoli, kiwifruit, mango and tomato. </p>
<p>There is some evidence vitamin E supplements reduce period pain. In a well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/15777446/">trial</a> run over the course of four periods, women took vitamin E supplements (90 milligrams, twice a day) for five days, beginning two days before the expected start of the period. This significantly reduced the severity and duration of period pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman tipping out nut mix into palm of hand" src="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Seeds and nuts are rich in vitamin E.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-jar-nuts-dried-fruits-1112521214">NazarBazar/Shutterstock</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
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</em>
</p>
<hr>
<h2>Foods that may worsen period pain or cramps</h2>
<p><strong>Highly processed foods</strong></p>
<p>Highly processed foods include energy-dense, nutrient-poor foods such as takeaways, chips, biscuits, doughnuts, processed meats and soft drinks. </p>
<p>Research findings on the impact of a diet high in processed foods on period pain vary. A 2019 <a href="https://karger.com/goi/article/84/3/209/153726/Nutrition-as-a-Potential-Factor-of-Primary">review</a> found sugar consumption had little association with painful periods. </p>
<p>However, some observational studies (which do not involve an intervention) suggest women who eat more processed foods may have more intense period pain. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/19468949/">2009 study</a> found adolescent females who ate fast or processed foods for two days or more a week reported more period pain compared with those who did not. Therefore, eating less processed food may be something to consider. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
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<p><strong>Caffeine</strong></p>
<p>Foods high in caffeine include coffee, energy drinks and some processed energy bars. Caffeine intake is <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwij7LmPxfSCAxV5d_UHHRnyDyUQFnoECBIQAQ&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4222008%2F&usg=AOvVaw2mEjyMadOB1D6geQgAwckc&opi=89978449">associated with</a> menstrual pain. </p>
<p>Although we don’t know the precise underlying mechanism, researchers think caffeine may narrow blood vessels, which limits blood flow, leading to stronger cramps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired woman staring at bowl of breakfast, cereal and cup on kitchen table" src="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding coffee may help your period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-does-not-want-eat-her-151886987">Lolostock/Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">Nope, coffee won't give you extra energy. It'll just borrow a bit that you'll pay for later</a>
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</p>
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<p><strong>Alcohol</strong></p>
<p>Drinking alcohol is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859868/">not</a> a recognised risk factor for painful periods. However, chronic heavy alcohol use reduces levels of <a href="https://academic.oup.com/alcalc/article/55/2/164/5734241">magnesium</a> in the blood. Magnesium is an important factor in relaxing muscles and supporting blood flow.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
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<hr>
<h2>A healthy, balanced diet is your best best</h2>
<p>Having a healthy, balanced diet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">one of the best ways</a> we can support our own health and prevent future chronic conditions. This can help reduce inflammation in our bodies, thought to be the main way diet can help people with painful periods.</p>
<p>If you are looking for tailored dietary advice or a menstrual health meal plan, speak with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitian</a>.</p>
<p>It’s important to stress, however, that diet alone cannot treat all forms of menstrual pain. So if you are concerned about your painful periods, check in with your GP who can discuss your options.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
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<p><em>This article has been updated to reflect the correct date of a review that found sugar consumption had little association with painful periods.</em></p><img src="https://counter.theconversation.com/content/218344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch is an Accredited Practising Dietitian and member of Dietitians Australia. She works for Southern Cross University. </span></em></p><p class="fine-print"><em><span>Pui Ting Wong is a PhD Candidate at The University Queensland (UQ) Centre for Community Health and Wellbeing, and receives the UQ Tuition Fee Offset and Stipend Scholarship. She is also an Accredited Practising Dietitian and a member of Dietitians Australia.</span></em></p>A cup of coffee might help you kick-start your day, but it may actually make painful periods worse. Here’s what else to avoid (and eat) if you have period pain.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Lecturer, Southern Cross UniversityPui Ting Wong, PhD Candidate, culinary education and adolescent mental health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114182023-09-05T20:06:11Z2023-09-05T20:06:11ZHow much period blood is ‘normal’? And which sanitary product holds the most blood?<figure><img src="https://images.theconversation.com/files/544687/original/file-20230825-19-mnnz4r.jpg?ixlib=rb-1.1.0&rect=26%2C17%2C5881%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-hand-reusable-menstrual-disc-on-2331704445">Shutterstock</a></span></figcaption></figure><p>Heavy menstrual bleeding or heavy periods affect up to a <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Heavy-Menstrual-Bleeding-Clinical-Care-Standard.pdf">quarter of women</a> and people who menstruate, and <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">can impact quality of life</a>. Women who have had heavy periods for a long time often consider this normal, or <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">something to be simply put up with</a>. </p>
<p>Diagnosing heavy periods has traditionally been based on the nature of bleeding. Women might describe bleeding through clothing, having to change pads and tampons every two hours or sooner, or passing clots larger than a 50 cent coin. Doctors consider a woman to have heavy periods if she <a href="https://www.ncbi.nlm.nih.gov/books/NBK279294/#:%7E:text=Doctors%20consider%20a%20woman%20to,fitness%20and%20other%20individual%20factors.">regularly loses more than 80 millilitres of blood</a> during one menstrual period. That’s four Australian tablespoons’ worth. Women diagnosed with heavy bleeding should follow up with their doctor to establish the cause of their bleeding and guide treatment. </p>
<p>But estimating blood loss and getting a sense of when it’s outside the normal range can be difficult. Recent research on how best to manage menstrual blood could help.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">Heavy periods are common. What can you do, and when should you seek help?</a>
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<h2>More period options than ever</h2>
<p>There are now a variety of menstrual products for women to choose from.</p>
<p>These include disposable pads and tampons, as well as reusable products such as menstrual cups and discs, washable pads and period underwear. There are multiple factors which influence choice of menstrual product, including comfort, cost, capacity, environmental benefits and <a href="https://www.healthdirect.gov.au/toxic-shock-syndrome">potential health risks</a>. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2468784721001987?via%3Dihub">2022 French survey</a> of over 1,100 women showed traditional sanitary protection was still the most widely used there (81% used disposable pads and 46% used tampons) but 16% of respondents were using alternative products. A <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02197-3">recent study in Victoria</a> indicated many young people are choosing reusable products, with environmental impacts an important motivator. </p>
<p>Another benefit of reusable <a href="https://www.healthline.com/health/menstrual-cup-dangers#cups-vs-pads-and-tampons">menstrual cups</a> and <a href="https://www.healthline.com/health/menstrual-disc">menstrual discs</a> is they can remain in the vagina for up to 12 hours. A menstrual cup sits in the vagina below the cervix and extends into the canal. A menstrual disc, on the other hand, fits back into the vaginal fornix, which is where your vaginal canal meets your cervix. Discs are usually wider and shallower than cups and <a href="https://pubmed.ncbi.nlm.nih.gov/36791417/">can be worn during sex</a>. There are now reusable and disposable options for menstrual discs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line diagrams of various menstrual products: pads, tampons, cups, discs" src="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=137&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=137&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=137&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=172&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=172&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=172&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/simple-minimalist-lineart-period-products-including-2193917377">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-anyone-have-a-pad-tv-is-finally-dismantling-the-period-taboo-122258">Does anyone have a pad? TV is finally dismantling the period taboo</a>
</strong>
</em>
</p>
<hr>
<h2>What holds the most blood?</h2>
<p>There has been very limited research into the maximum capacity of different menstrual products. Manufacturers can report collection capacity of their products using liquids such as water. </p>
<p>A <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">recent research study from the United States</a> aimed to more accurately measure the capacity of menstrual products in the laboratory using expired donated human blood, which is more similar to menstrual blood. </p>
<p>Some 21 different menstrual products were tested in the study. Menstrual discs showed the greatest capacity (61ml on average) and period underwear held the least (2ml on average). </p>
<p>Tampons, pads, and menstrual cups held similar amounts of blood (approximately 20–50mL). The authors noted it is difficult to accurately approximate capacity for patients with heavy menstrual bleeding due to “flooding” (high-velocity flow) and passing clots. </p>
<p>The comparison shows period underwear, despite its advertised capacity, may actually only absorb a small amount of blood and very slowly. Women with heavy periods tend to use period underwear as “back up” for another method. </p>
<h2>We need a standardised scale for menstrual bleeding</h2>
<p>Currently, the ways to determine whether someone is having heavy menstrual bleeding is through asking detailed questions and using the <a href="https://www.rch.org.au/uploadedFiles/Main/Content/rch_gynaecology/PBAC.pdf">Pictorial Blood Loss Assessment Chart</a>, which relates to the saturation of menstrual pads and tampons. </p>
<p>The overall impact of the heaviness of menstrual bleeding on a woman’s quality of life is also important. </p>
<p>Even with pads and tampons, there is significant variability in terms of capacity. The introduction of newer products potentially introduces more confusion, with both users and clinicians uncertain about the storage capacity of each category of product, and specific brands within these categories. </p>
<p>With heavy menstrual bleeding often <a href="https://pubmed.ncbi.nlm.nih.gov/33840528/">underdiagnosed and undertreated</a>, clinicians need to ask specifically about the menstrual products used and how they are used to better understand a person’s bleeding patterns. The fresh US research could help women and their doctors better assess the heaviness of their periods. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
</strong>
</em>
</p>
<hr>
<h2>3 tips for managing heavy flow</h2>
<ul>
<li><p><strong>1. Experiment with period products.</strong> It may be good to try out different types of products (and even different products in the same category) to find the ones that suit you best. The advertised capacity of each product may not ring true with your own experience, due to the nature of your flow (particularly if it is heavy or “gushes”). </p></li>
<li><p><strong>2. Monitor the heaviness of your period.</strong> The capacity of different menstrual products varies widely. Menstrual discs have very high storage capacity in comparison to other products. That can actually lead to an underestimation of menstrual loss. Looking up the storage capacity of each product can help you work out whether you are having heavy periods or not, even though we know this may be based on liquids like water. This information can be found on the product website or the <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">new study</a>. </p></li>
<li><p><strong>3. When to seek medical advice.</strong> If you think you might be having heavy periods, feel tired or dizzy during your period, or you feel your periods are interfering with your life, talk to your GP or other healthcare professional. It can help to track the heaviness of your periods and how often you are changing your period product and to bring this record to your appointment. Your GP can <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">talk to you about treatment</a> with medications (both hormonal and non-hormonal) and other management options.</p></li>
</ul><img src="https://counter.theconversation.com/content/211418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Working out how much blood you’re losing and getting a sense of when it’s outside the normal range can be difficult. Recent research on the capacity of different period products could help.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyBianca Cannon, GP and Lecturer at Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085022023-09-05T12:56:59Z2023-09-05T12:56:59ZFive ways to take control of your menstrual cycle and improve your sports performance<figure><img src="https://images.theconversation.com/files/542580/original/file-20230814-25-aydj9i.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taking a proactive approach to your menstrual cycle can help promote your sports performance every day.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-young-woman-lifting-barbells-looking-417189208">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Menstruation is often seen as a negative experience, with symptoms that can be disruptive to daily life. Participation in sport and physical activity is particularly affected, with <a href="https://womeninsport.org/press-release/more-than-1-million-teenage-girls-fall-out-of-love-with-sport/#:%7E:text=Women%20in%20Sport's%20research%20found,them%20take%20part%20in%20activity.">78%</a> of teenage girls reporting they avoid exercise while on their period. </p>
<p>Elite athletes have also <a href="https://www.bbc.co.uk/sport/53705777">reported</a> their performance is negatively affected by their period. So, how do we reduce or manage period-related symptoms? The first step is understanding our menstrual cycle.</p>
<p>There are <a href="https://optimalperiod.com/menstrual-cycle-101/">phases of the menstrual cycle</a>, based upon hormonal fluctuations, where certain symptoms are more frequently experienced. The two main phases are the follicular phase and the luteal phase and they are divided by ovulation. A menstrual cycle should last between 21 and 35 days, with menstruation indicating day one of the cycle and the number of days until the next bleed. Ovulation is approximately half way through the cycle.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>This is different for those taking hormonal contraceptives, as their natural hormone levels are suppressed by the synthetic hormones and any bleed is known as a “withdrawal bleed”, which is not equivalent to a period.</p>
<p>During the follicular phase, hormone levels are low to begin with. The first three to five days are the time of menstruation and an increase in oestrogen occurs prior to ovulation. For some, this phase provides many positive symptoms of increased confidence, energy and motivation. </p>
<p>After ovulation, hormone levels are higher, with a peak in progesterone and a secondary peak in oestrogen. It is during this time that the menstrual cycle is frequently associated with negative symptoms such as bloating, fatigue and changes in mood.</p>
<p>But we know that menstrual-related symptoms can be improved through diet, sleep, reducing stress and exercising. So taking a proactive approach can help to promote sports performance on every day of the menstrual cycle.</p>
<figure class="align-center ">
<img alt="A hand holds a smartphone which is displaying a menstrual calendar app." src="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are apps which can help you track your menstrual symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tracking-periods-by-using-menstrual-1940658049">Kaspars Grinvalds/Shutterstock</a></span>
</figcaption>
</figure>
<h2>1. Track your cycle</h2>
<p>Tracking your menstrual cycle and related symptoms is crucial to taking a proactive approach. Note the first day of your period to check you are having a regular cycle. This is an <a href="https://pubmed.ncbi.nlm.nih.gov/32707266/">important marker</a> for both reproductive and holistic health. </p>
<p>Record any <a href="https://optimalperiod.com/menstrual-cycle-101/">symptoms</a> such as stomach cramps, fatigue and tiredness, changes in mood, anxiety and breast tenderness, along with life events. This helps to determine what’s caused by the menstrual cycle as opposed to other factors. </p>
<p>Complete this for at least three cycles to identify your own pattern. Everyone has a unique experience of the menstrual cycle and related symptoms. </p>
<p>See a doctor if your cycle consistently lasts less than 21 days, is longer than 35 days or absent for three months or more, after the first two years of having periods. If any symptoms are debilitating and affect your daily activities, this is not normal and you need to seek medical advice.</p>
<h2>2. Improve your diet and hydration</h2>
<p>Eat a <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/">well-balanced diet</a>, because this will help give you the energy for training and sport, while also reducing bloating and managing <a href="https://optimalperiod.com/exploring-symptoms-3-what-causes-food-cravings-with-top-tips-on-management/">cravings</a>. </p>
<p>If you train hard, ensure you are <a href="https://optimalperiod.com/wp-content/uploads/2023/02/FAH-carbohydate.pdf">fuelling your training</a> appropriately to support your menstrual cycle. This changes according to what activity you’re participating in. For example, for high intensity workouts, you will need some quick releasing carbohydrate such as a banana or an energy drink during your session, as well as before and after.</p>
<p>If you can, don’t eat too many processed foods such as takeaways, sugary drinks and crisps. Try to eat at least five portions of fruit and vegetables every day. Batch cooking meals can help achieve this – have food prepared in the freezer ready for when you are tired, lacking motivation or short on time. </p>
<p>Drinking plenty of water is also important, as it will help to reduce bloating. </p>
<h2>3. Get better sleep</h2>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079200901382">Sleep</a> is vital because a lack of sleep or poor sleep quality can make many menstrual cycle-related symptoms <a href="https://www.semanticscholar.org/paper/The-Relationship-of-Premenstrual-Syndrome-Symptoms-A%C5%9Fc%C4%B1-G%C3%B6kdemir/cb2222a23d05cf64f804bbcab9a2d730437b6176">worse</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988893/">Sleep hygiene</a> strategies can help prevent symptoms. These include going to bed and getting up at a similar time each day, starting the day with sunlight and limiting your caffeine intake (especially in the afternoon).</p>
<h2>4. Reduce your stress</h2>
<p><a href="https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/">Stress</a> increases the severity and duration of symptoms related to the menstrual cycle and is therefore an important factor to manage. </p>
<p>This is individual and finding a strategy that works for you will differ from person to person. Some ways to reduce stress could include socialising with friends, or meditating. Plan these in advance to prevent stress rather than reacting once you are already stressed.</p>
<h2>5. Stay active</h2>
<p>Sometimes getting to training is the hardest part when experiencing menstrual-related symptoms. Consider other activities such as walking or yoga to manage symptoms like stomach cramps while you are implementing the above strategies. And if there are days when you have more energy and motivation, maximise them while you are getting to understand your menstrual cycle.</p>
<p>You can use heat and pain relief for symptoms such as stomach cramps. Have these to hand if stomach cramps are affecting your ability to train around the time of menstruation. You could also speak to your trainer to adapt a session if required.</p>
<p>The menstrual cycle has long been seen as a negative thing. And there has not been enough information on how to manage symptoms. But we must change that narrative. Symptoms can be managed or reduced so you can continue to participate in sports and other activities. Don’t feel ashamed of your period – take control and be proactive in managing it.</p><img src="https://counter.theconversation.com/content/208502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Brown is affiliated with Arc'Teryx. </span></em></p>Understanding our menstrual cycle and taking a proactive approach to our periods is vital to improving sports performance.Natalie Brown, Research officer for the Welsh Institute of Performance Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2069672023-08-22T11:37:31Z2023-08-22T11:37:31Z‘Dirty red’: how periods have been stigmatised through history to the modern day<figure><img src="https://images.theconversation.com/files/534079/original/file-20230626-18276-xgl2o6.jpg?ixlib=rb-1.1.0&rect=32%2C0%2C3648%2C2424&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/feminine-hygiene-tampons-on-red-background-2101295386">IKagadiy/Shutterstock</a></span></figcaption></figure><p>About a year ago, at a friend’s wedding, a fellow guest asked whether I knew that modern sanitary towels owe their origins to resourceful World War I field nurses who discovered the efficacy of <a href="https://graphics.wsj.com/100-legacies-from-world-war-1/sanitary-products">repurposing military bandages</a> as period pads. I did not.</p>
<p>As a historian interested in the relationship between technology and the body – and someone who menstruates – the conversation had me wondering why I’d never considered the evolution of menstrual products. The answer, I believe, lies in the pervasive <a href="https://www.ncbi.nlm.nih.gov/books/NBK565666/">culture of shame</a> that has long surrounded menstruation, stifling open dialogue around the subject.</p>
<p>That, I thought, must change. So, I embarked on a <a href="https://universityofleeds.medium.com/challenging-taboo-why-its-time-to-put-periods-in-plain-sight-1a34f5622219">research project</a> with a team of colleagues at the University of Leeds into the history of menstrual stigma.</p>
<p>What we’ve discovered so far are examples of stigma and shame surrounding periods from many thousands of years ago through to the modern day.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>Not a new problem</h2>
<p>A frequently cited example of menstrual stigma is the Bible’s <a href="https://www.christianity.com/bible/kjv/leviticus/15-19-33">Leviticus chapter 15, verses 19-33</a>. This passage asserts that women (along with anything they lie or sit on) become “unclean” during menstruation. If a non-menstruating person touches either the menstrual blood, or anything the woman has touched, they too will become unclean. </p>
<p>This association between menstruation and corruption (not just of the menstruating person, but also of people and objects around them) has been persistent among male scholars through history. </p>
<p>For example, writing around AD70, <a href="https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.02.0137%3Abook%3D28%3Achapter%3D23">Pliny the Elder</a> says menstruation “is productive of the most monstrous effects”. He writes that crops “will wither and die”, and bees “will forsake their hives if touched by a menstruous woman”. </p>
<p>In the seventh century AD, <a href="https://sfponline.org/Uploads/2002/st%20isidore%20in%20english.pdf">Isidore of Seville</a> expanded on Pliny’s accusations, claiming: </p>
<blockquote>
<p>If they are touched by the blood of the menses, crops cease to sprout, unfermented wine turns sour, plants wither, [and] trees lose their fruit. </p>
</blockquote>
<p>Even as late as 1694, we find <a href="https://quod.lib.umich.edu/e/eebo2/B26427.0001.001?view=toc">books on midwifery</a> that liken menstruating women to the cockatrice (a mythical beast with venomous breath) on account of their allegedly shared ability to disperse poison through the air. </p>
<h2>From history to today</h2>
<p>Unfortunately, discussions of menstruation have continued to reinforce shame around the issue through the 20th and 21st centuries, <a href="https://www.tandfonline.com/doi/full/10.1080/23293691.2022.2124041">portraying periods</a> as something to be embarrassed about and to be kept hidden.</p>
<p>In 1950, Good Housekeeping, the popular women’s magazine, <a href="https://repository.duke.edu/dc/adaccess/BH0132">published an advert</a> for Modess’ newly packaged sanitary towels, which read: “So skilfully shaped not to look like a napkin box, that the sharpest eyes couldn’t guess what’s inside the wrapping.”</p>
<p>Although the tone of this advertisement is upbeat and chatty, it reinforces the idea that menstrual products should be kept hidden. Some 70 years later, in 2020, Tampax was <a href="https://www.dailymail.co.uk/femail/article-8986283/Tamax-blasted-stigmatising-silent-wrappers-promise-discretion-opening-tampons.html">criticised</a> for <a href="https://tampax.co.uk/en-gb/our-tampons/pearl-compak-with-applicator/regular/">advertising tampons</a> that “open silently for full discretion”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/solving-period-poverty-is-about-more-than-just-making-products-free-195245">Solving period poverty is about more than just making products free</a>
</strong>
</em>
</p>
<hr>
<p>Another example of the stigmatisation of menstruation can be seen in the long history of euphemisms. A <a href="https://www.tandfonline.com/doi/pdf/10.1080/00437956.1948.11659341">study published in 1948</a> identified a range of harmful menstrual euphemisms including “the curse”, “dirty red” and describing a woman as “in season”. </p>
<p>A <a href="https://link.springer.com/article/10.1007/BF00287209">similar study</a> from 1975 discussed 128 menstrual euphemisms, many of which are still used today (such as “Aunt Flo” and “on the rag”). While some of these euphemisms might provoke a giggle (my personal favourite being “riding the cotton pony”), they’re designed to obscure discussions of menstruation and, in doing so, they reinforce the shame that surrounds it.</p>
<h2>The harms of stigma</h2>
<p>This long history of menstrual stigma continues to inform contemporary culture, having a negative effect on people who menstruate today. In 2021, a group of researchers <a href="https://www.webofscience.com/wos/woscc/full-record/WOS:000678124300032?SID=EUW1ED0CDDKqxdvp1VlfLU9D6rBGE">concluded</a> that feelings of stigma and shame perpetuate the expectation that people should hide their menstruation.</p>
<p>This may take the form of hiding sanitary supplies at school and at work, or concealing symptoms of menstruation, for example.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534081/original/file-20230626-29-3vz70v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Periods remain stigmatised today.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-sad-africanamerican-teen-student-sitting-2196946065">nimito/Shutterstock</a></span>
</figcaption>
</figure>
<p>We know this secrecy prevents people from identifying when their experiences of menstruation are unusual and from subsequently seeking healthcare. For example, a <a href="https://plan-uk.org/media-centre/girls-too-embarrassed-to-see-their-gp-about-period-related-symptoms-survey-reveals">2018 survey</a> found that 79% of girls and young women had faced symptoms linked to their period that concerned them, but they hadn’t seen a doctor or health professional. </p>
<p>Similarly, <a href="https://www.endometriosis-uk.org/press-release-time-end-stigma">statistics from charity Endometriosis UK</a> reveal that 62% of women aged 16-54 would put off going to a doctor with symptoms of endometriosis because they don’t think it’s serious enough to bother a doctor with, or they’d be embarrassed, or don’t think they’d be taken seriously, or think symptoms including painful periods are normal.</p>
<h2>What can we do?</h2>
<p>Stigma around menstruation is deeply entrenched in society. But there are numerous small actions each of us can take, which collectively can make a significant difference. First of all, we can all (irrespective of age, gender or sexuality) embrace open conversations about menstruation. </p>
<p>We can discard the use of menstrual euphemisms, as continually relying on these perpetuates the notion that this natural bodily function should remain concealed and shrouded in shame.</p>
<p>We can also use our collective voices, for example by engaging with companies on social media, to demand a more truthful portrayal of menstruation in the media (such as, as Kotex has done, banishing the absurdity of using blue liquid to <a href="https://www.wsj.com/articles/kotex-decides-womens-blood-is-red-not-blue-11579800492">demonstrate their products</a>).</p>
<p>Of course, we also need to do work on a larger scale. We need to tackle period poverty, ensure access to clean water and private toilets, and encourage employers to develop positive menstrual policies. </p>
<p>But we can start by talking. If we can end the secrecy and silence that has long surrounded menstruation, we can begin to create a future that empowers all who menstruate.</p><img src="https://counter.theconversation.com/content/206967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Gillibrand receives funding from the Leeds Arts and Humanities Research Institute, University of Leeds. With thanks to Katie Carpenter, Sophie Turbutt, and Claire Turner for their work on the ‘Stigma and Shame? Challenging Menstrual Taboo Through Time’ project.</span></em></p>Stigma and shame around menstruation can be found as far back as the Bible.Rachael Gillibrand, Lecturer in Premodern History, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059632023-08-15T09:14:14Z2023-08-15T09:14:14ZScience experiments traditionally only used male mice – here’s why that’s a problem for women’s health<figure><img src="https://images.theconversation.com/files/532978/original/file-20230620-25-ktr7u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5967%2C4158&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/small-experimental-mouse-on-laboratory-researchers-605226554">unoL/Shutterstock</a></span></figcaption></figure><p>If you have ever taken a medicine, then you have benefited from research in animals. But ten years ago, if you looked at a scientific report involving mice or rats, it would probably have used only male animals.</p>
<p>This means that, even now, if you’re a woman and the medicine has only been developed and tested using male animals, we don’t know how that medicine is going to affect you.</p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>Scientists long assumed that <a href="https://books.google.co.uk/books?hl=en&lr=&id=KDicAgAAQBAJ&oi=fnd&pg=PT19&ots=SWnevYYdZn&sig=yWbWfMXIzm32BhXKVG984Lgs-3Y&redir_esc=y#v=onepage&q&f=false">females would respond the same way as males in drug trials</a>. But today, that situation is changing. More and more studies use both female and male animals – and new science is emerging about important sex differences as a result.</p>
<p>For example, a growing body of evidence from animal studies is highlighting <a href="https://www.frontiersin.org/articles/10.3389/fnins.2020.583477/full#B110">complex sex differences in rodent brains</a>, relating to their size, shape, and how nerve cells connect with one another. </p>
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<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<hr>
<p>So it’s no surprise that research is also increasingly showing sex differences in human medical issues. For example, <a href="https://pubmed.ncbi.nlm.nih.gov/12890270/">women are twice as likely as men</a> to be diagnosed with depression, and sex differences are also clear in <a href="https://pubmed.ncbi.nlm.nih.gov/30082889/">people’s response to antidepressants</a>. Women have a stronger response than men to selective serotonin reuptake inhibitors (SSRIs), whereas men have a better response to tricyclic antidepressants. </p>
<h2>Never assume</h2>
<p>Excluding females from research for so long has had worrying consequences for women’s health. One example is adverse drug reactions – the unintended consequences of taking a medicine, which can include things like nausea, headaches, seizures or heart problems.</p>
<p>Women typically have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275616/">double the risk</a> for adverse drug reactions (although men have increased risks of some side-effects). One reason is that women, on average, are smaller than men, yet the recommended dosage for many medicines is <a href="https://news.uchicago.edu/story/women-are-overmedicated-because-drug-dosage-trials-are-done-men-study-finds">based on men</a>.</p>
<p>For example, women who take <a href="https://academic.oup.com/ehjcvp/article/3/3/163/3058007?login=true">beta blockers</a>, used to treat heart problems, have higher concentrations of it in their blood. This is not only because the same amount of drug in a smaller blood volume will give you a higher concentration. Women also <a href="https://bsd.biomedcentral.com/articles/10.1186/s13293-020-00308-5">metabolise many medicines differently to men</a>, because of sex hormone levels and enzyme activity. </p>
<h2>Why were females excluded?</h2>
<p>In science, we like to reduce variability as much as possible, to have more confidence that any changes in an animal or human are because of the experimental intervention we have made.</p>
<p>Females were largely excluded from both animal and human clinical trials because of the menstrual cycle. Fluctuating hormone levels make data difficult to interpret, results more variable, and research more expensive. While males have the same sex steroid hormones, female hormone levels rise and fall. This can impact brain function and behaviour as well as female response to medication. </p>
<p>However, the rodent oestrous cycle is much shorter than in women, only four or five days long – and research over the last decade has shown that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962440/">female rat behaviour is not more variable</a> as a result. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="White laboratory mice, mother with pups" src="https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533216/original/file-20230621-19-qag769.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If we don’t use female mice in studies, we won’t properly understand how medicine affects women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-laboratory-mice-mother-pups-which-71556859">Shutterstock/tilialucida</a></span>
</figcaption>
</figure>
<p>In part, the male-centric approach to clinical human trials was also because women of child-bearing age could be pregnant and not yet know it. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573415/">thalidomide tragedy</a> fed into this mentality. Thalidomide was developed in the 1950s as a sedative and became a popular treatment for morning sickness – but the drug had not been tested on pregnant animals or humans.</p>
<p>Doctors soon realised thalidomide was linked to developmental abnormalities in children born to mothers taking the drug. But it was too late for the <a href="https://pubmed.ncbi.nlm.nih.gov/15172781/">estimated 10,000 infants worldwide born</a> with underdeveloped legs and arms, and other birth defects.</p>
<h2>Are things getting better?</h2>
<p>There is a growing field of research looking at the interaction between medicines and the menstrual cycle, changes during pregnancy, and hormonal contraception. For example, <a href="https://www.sciencedirect.com/science/article/pii/S105913111400137X">some anti-epileptic drugs</a> can reduce the effectiveness of hormonal contraception, while hormonal contraception can reduce the effectiveness of some anti-epileptic drugs to control seizures. But the many years that females were excluded from studies means there is still so much we don’t know. </p>
<p>Women were only legally required to be <a href="https://orwh.od.nih.gov/toolkit/recruitment/history#:%7E:text=In%201986%2C%20NIH%20established%20a,Grants%20and%20Contracts%20in%201987">included in clinical trials in the 1990s</a> in the US. Some 30 years later, research shows that about half of research participants in
clinical studies funded by the National Institutes of Health (NIH), the American medical research agency, <a href="https://orwh.od.nih.gov/in-the-spotlight/all-articles/nih-publishes-report-on-research-on-womens-health-for-fiscal-years-2019-2020">are now women</a>.</p>
<p>These policies are also evolving to integrate both biological sex (genetically defined) and gender (a person’s self-identity) into the design, analysis and reporting of clinical research. Many <a href="https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bph.14761">scientific journals</a>
are also <a href="https://journals.physiology.org/doi/full/10.1152/ajpheart.00605.2021">joining the drive</a> to only publish studies that have considered sex in the design, analysis and reporting. </p>
<p>Meanwhile, it has taken a very long time for female mice to be part of the research picture. In 2014, the NIH, one of the largest funders of medical research in the world, <a href="https://doi.org/10.1038/509282a">announced</a> that all grant applications needed to include a balance of male and female cells and animals. This policy has since been taken up by major research funders in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475217/">other countries</a>, such as the Canadian Institutes of Health Research and the European Commission. </p>
<p>Change takes time. Timescales vary dramatically, but it often takes 10-15 years to develop a new medicine. Next there are the clinical trials, which can take a long time depending on the difficulty of recruiting participants.</p>
<p>We are moving to an era of personalised medicine, where medicines can be prescribed on the basis of an individual diagnosis, with targeted interventions based on understanding how an individual patient’s genomes (set of DNA instructions) affect treatment response. But women will miss out on many of the benefits if we don’t understand exactly how the drug they are prescribed affects females.</p><img src="https://counter.theconversation.com/content/205963/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>All views expressed in this article are the author's and not those of the organisations with which they are affiliated. Sarah Bailey receives research funding from Camurus and DevelRx, is vice-president for engagement at the British Pharmacological Society, and is the UK Bioscience Sector Coalition co-chair (academic).
</span></em></p>Clinical trial funders now insist studies use female participants. But it will still take a long time for our understanding of how medicine affects women to catch up.Sarah Bailey, Senior Lecturer, Neuropharmacology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088912023-08-04T13:54:29Z2023-08-04T13:54:29ZWomen’s World Cup: what still needs to be done to improve the lot of elite female footballers<p>The <a href="https://www.fifa.com/fifaplus/en/tournaments/womens/womensworldcup/australia-new-zealand2023">Fifa Women’s World Cup</a> is just 32 years old and on its eighth official edition, while the men’s competition began 93 years ago and has enjoyed 22 tournaments.</p>
<p>After the success of the 2019 WWC in France, the women’s competition has progressed to new heights for 2023 in Australia and New Zealand. There are <a href="https://www.bbc.co.uk/sport/football/49184181#:%7E:text=The%20Women%27s%20World%20Cup%20will%20increase%20from%2024,the%20process%20opens%20on%204%20October%20this%20year.">more teams than ever competing</a>, in front of the <a href="https://www.fifa.com/tournaments/womens/womensworldcup/australia-new-zealand2023/media-releases/fifa-womens-world-cup-2023-tm-breaks-new-records">biggest TV audiences</a>, with each player to be paid directly, <a href="https://www.theguardian.com/football/2023/jun/07/fifa-2023-womens-world-cup-australia-new-zealand-fee-payments">guaranteeing prize money for the first time</a>.</p>
<p>It’s fair to assume that this Women’s World Cup is probably the most significant women’s sporting event in history, although this won’t be the last time we hear that phrase. The trajectory of women’s sport is <a href="https://www.fearlesswomen.co.uk/about-documentary">continually rising</a> – and arguably there has never been a better time to be involved in sport as a woman.</p>
<p>But for so long women have fought for a more equal footing within the male-dominated world of sport, and researchers have long highlighted the <a href="https://books.emeraldinsight.com/book/detail/the-professionalisation-of-womens-sport-by-ali-bowes/?k=9781800431973">lack of equality in the game</a>. So, as participation levels rise, TV viewing figures increase and sponsorship income improves year on year, we might ask: what’s left to achieve for women in football?</p>
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<p>Alongside other researchers, I have written about the <a href="https://books.emeraldinsight.com/page/detail/women%EF%BF%BDs-football-in-a-global-professional-era/?k=9781800710535">gender gap</a> in professional and elite-level women’s football in the last few years. This body of work pays attention to some key – and in many ways overlapping and interlinked – issues in women’s sport, including equal pay, injury, menstruation and maternity rights.</p>
<p>One of the most significant developments for women’s sport is the <a href="https://www.emerald.com/insight/content/doi/10.1108/978-1-80071-052-820230013/full/html">discussion on equal pay</a> in football, <a href="https://www.tandfonline.com/doi/full/10.1080/14660970.2021.1977280">advanced mainly</a> by the US women’s national team.</p>
<p>This World Cup has seen the <a href="https://fifpro.org/en/who-we-are/what-we-do/foundations-of-work/collective-action-fifpro-celebrates-players-improved-women-s-world-cup-pay-and-conditions/">biggest investment of money from Fifa</a> yet: US$152m (£118m) to ensure that all players are paid and prize money is increased and on a “<a href="https://sports.yahoo.com/womens-world-cup-prize-money-equal-pay-142958181.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuYmluZy5jb20v&guce_referrer_sig=AQAAAJkNUU2zeIuTwaYlfa4w7yVRFrmraWk2tEOmxXtg2nhBCPf4_TXou7cnjOA0R0P_y9tBH3swhVijtZ-VQd7ttQUG3k_yfwa6oIOrU2qhZeixMtHSn144AXirq_WY_GNJ71faGZz9gZ7AisV7ezmcxRfcw0wd4m9zcoXRkzj5UZTh">pathway to equality</a>” with the men’s tournament. Fifa has also ensured that standards across staffing, base camps, accommodation and travel are delivered to the same level as the men’s competition.</p>
<h2>Facilities and healthcare</h2>
<p>However, despite the starry heights reached by the qualified teams, a recent report by the world players’ union <a href="https://fifpro.org/en/">Fifpro</a> found that there remain <a href="https://fifpro.org/en/who-we-are/what-we-do/foundations-of-work/new-fifpro-report-warns-of-uneven-women-s-world-cup-qualifying-across-confederations">stark inequalities in women’s football</a> across the globe.</p>
<p>A total of 362 women across teams attempting to qualify for this World Cup were surveyed, with 70% reporting poor gym facilities, 66% reporting poor or non-existent recovery facilities, and 54% saying they were not provided with a pre-tournament medical. </p>
<p>In addition 66% players had to take unpaid leave or vacation from work and almost 33% did not receive any compensation. So there is work to be done in the elite women’s game.</p>
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<h2>Injuries</h2>
<p>Given the <a href="https://fifpro.org/media/iv2cvxt5/2023-qualifying-conditions-report_en_web.pdf">findings</a> from Fifpro on facilities, pitches and payment, it comes as no surprise that injury has become a hot topic of interest within women’s football. According to sports medicine specialists, women are <a href="https://www.skysports.com/football/news/11095/12926431/future-of-football-why-acl-injuries-have-been-on-rise-in-womens-game-and-the-technology-and-solutions-to-fix-it#:%7E:text=Football%2Dfocused%20studies%20suggest%20women,likely%20to%20return%20after%20recovery.">six times more likely</a> to rupture their anterior cruciate ligament (ACL), and for this World Cup, <a href="https://www.emerald.com/insight/content/doi/10.1108/978-1-80071-052-820230013/full/html">nine of the top players</a> are <a href="https://www.skysports.com/football/news/35730/12748748/inside-the-wsl-why-are-acl-injuries-so-common-in-womens-football">absent with the injury</a>.</p>
<h2>Gendered environment</h2>
<p>The field of sport science has been heavily criticised for its <a href="https://journals.humankinetics.com/view/journals/wspaj/29/2/article-p146.xml?alreadyAuthRedirecting">male-dominated approach</a>, where only 6% of research looks exclusively at women. Only now are we seeing a drive to develop female-specific equipment in <a href="https://www.bbc.co.uk/sport/football/65985681">response to player concerns</a>, as scientists start to <a href="https://link.springer.com/article/10.1007/s12283-022-00384-3">address the gender imbalance</a> in sports technology.</p>
<p>A <a href="https://bjsm.bmj.com/content/55/17/984.full">powerful piece</a> published in the British Journal of Sports Medicine highlights a gendered environment approach to understanding ACL injuries. This work describes how the social construction of gender affects the ACL injury cycle across the whole life of the athlete.</p>
<p>This includes how boys and girls learn to move (often differently) alongside inadequate training and competition environments for girls, and gendered cultural body norms – often women competing in sport are considered “unfeminine”, with athletic, muscular bodies traditionally associated with masculinity. </p>
<p>In some countries, like Brazil, for example, female players in the past have <a href="https://blogs.lse.ac.uk/equityDiversityInclusion/2012/07/the-body-image-of-female-athletes-diversity-in-sport/">struggled to be accepted in the face “cultural disapproval”</a>. It’s an interesting and useful approach that highlights the complexity of women and girls’ involvement in sport.</p>
<h2>Proper football kit</h2>
<p>Menstruation, menopause and female hormone profiles across puberty, have been thought to have some impact on <a href="https://link.springer.com/article/10.1007/s40279-020-01319-3">sports performance </a>and <a href="https://journals.sagepub.com/doi/pdf/10.1177/03635465980260050301?casa_token=vanOJh635i8AAAAA:7K0VbM-p8AiFY-dE0RRTmWXlj9EbkMnWU-jXcq3zoGNAOf7vAVPaSr1Qkl17CgRcAHAAp4rrYptz">injury</a>. However, we’re only now seeing changes made to player uniforms – <a href="https://www.femtechworld.co.uk/news/ditching-white-shorts-only-touches-on-the-support-women-need-in-sport-say-experts/">namely no white shorts</a> – in response to player fears around menstruation and leaking, to take one example.</p>
<p>This is part of a broader shift in sportswear manufacturers finally creating women-specific kit instead of the “<a href="https://www.msn.com/en-au/sport/other/women-s-world-cup-from-hand-me-downs-to-period-proofing-the-matildas-kits-reflect-the-evolution-of-women-s-football/ar-AA1ezeqQ">hand-me-down men’s kit” culture</a> many ex-players experienced.</p>
<h2>Women’s bodies and experiences</h2>
<p>This World Cup will see a number of players <a href="https://keepup.com.au/news/mom-squad-behind-us-quest-for-world-cup-glory/">taking to the pitch as mothers</a>. Despite the increasing number of professional women footballers, their employment rights as mothers have often been overlooked. This has led to numbers of women quitting the sport early to have children, and research has shown that players have <a href="https://www.frontiersin.org/articles/10.3389/fspor.2021.730151/full">struggled</a> to combine professional football careers with motherhood.</p>
<p><a href="https://digitalhub.fifa.com/m/033101649cc3c480/original/f9cc8eex7qligvxfznbf-pdf.pdf">Fifa regulations launched at the end of 2020</a> provided players with paid maternity leave for the first time. However, we know in some cases <a href="https://www.frontiersin.org/articles/10.3389/fspor.2021.730151/full">players have concerns</a> about taking maternity leave. </p>
<p>For example, would their clubs think they are less committed to the sport? Would their bodies recover to their pre-pregnancy form? Here, access to health support and adequate facilities, as well as being properly paid, becomes key, as well as broader cultural change within the sport to normalise pregnancy and motherhood.</p>
<p>It’s clear that women’s football has never been in a better place, and the World Cup is currently a fine showcase for it, but it’s crucial that the female game to continues to strive for improvement in areas that fundamentally affect the lives and careers of its players.</p><img src="https://counter.theconversation.com/content/208891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ali Bowes 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>As participation levels rise, TV viewing figures increase and sponsorship income improves year on year, what’s left to achieve for women in football?Ali Bowes, Senior Lecturer in Sociology of Sport, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067002023-07-23T19:58:45Z2023-07-23T19:58:45ZDoes a woman’s menstrual cycle affect her athletic performance? Here’s what the science says<p>During the Women’s FIFA World Cup, it has been wonderful to see the spotlight turn to female athletes. </p>
<p>There’s always been <a href="https://pubmed.ncbi.nlm.nih.gov/24766579/">more research on male athletes</a> compared to female athletes, but the gap is narrowing. </p>
<p>One thing we still don’t know enough about is the effect of the menstrual cycle on athletic performance. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/explainer-why-do-women-menstruate-13744">Explainer: why do women menstruate?</a>
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</em>
</p>
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<h2>What does the menstrual cycle do to a woman’s body?</h2>
<p>The menstrual cycle is a complex cascade of events typically lasting 28 days. The primary female sex hormones oestrogen and progesterone rise and fall as the body cycles through four phases, beginning at menstruation, maturation and releasing of an egg (ovulation), preparation for pregnancy, and restarting the cycle if the egg is not fertilised.</p>
<p>Fluctuations in female sex hormones have been associated with changes in inflammation, metabolism, muscle activation and body composition, which <a href="https://pubmed.ncbi.nlm.nih.gov/33572406/">can influence athletic performance</a>. </p>
<p>For instance, <a href="https://pubmed.ncbi.nlm.nih.gov/22306563/">inflammation decreases</a> when the body is preparing to ovulate, reaching its lowest point around ovulation. It then increases following ovulation and peaks during menstruation. </p>
<p>This peak coincides with lower perceived performance among many female athletes.</p>
<p>The menstrual cycle can also give rise to symptoms including pain, cramps, weakness, and poor sleep and focus, <a href="https://pubmed.ncbi.nlm.nih.gov/35911030/">challenging performance</a> during training and competition. </p>
<p>For example, <a href="https://doi.org/10.1080/24733938.2021.2020330">research</a> conducted in elite female soccer players found over 87% of players perceived reduced power and increased fatigue during menstruation, while over 66% perceived their reaction time and recovery to be affected.</p>
<p>Considering the approximate maximum career length of soccer players (21 years) and a woman’s fertile life, that adds up to about 250 times throughout a woman’s soccer career that performance may be compromised. </p>
<p>Trends observed among female soccer players closely mirror the experiences of other female athletes, with over <a href="https://pubmed.ncbi.nlm.nih.gov/37389782/#:%7E:text=Results%3A%20Sixty%20studies%20involving%206380,the%20most%20prevalent%20MC%20disorder">74% reporting</a> negative effects mainly during the first days of menstruation. </p>
<p>For some, this may lead to reduced training participation, potentially compromising skill development, fitness levels, and even their chances of being selected for competition. </p>
<p>But the menstrual cycle is complex, and its effects can vary between athletes and sports. Consequently there is disagreement regarding whether the menstrual cycle universally affects athletic performance, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076834/#:%7E:text=Findings%20suggest%20that%20strength%2Drelated,cause%20variations%20in%20strength%20performance">some research</a> <a href="https://pubmed.ncbi.nlm.nih.gov/32661839/">indicating</a> no influence of the menstrual cycle on certain performance measures. But these studies are few and had various logistical limitations, including a small number of participants.</p>
<p>Also important to note is that most studies to-date have excluded women using hormonal contraceptives, which is about <a href="https://pubmed.ncbi.nlm.nih.gov/29283683/">50% of female athletes</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35475746/#:%7E:text=Conclusion%3A%20Most%20WSL%20players%20do,minimise%20discomfort%20and%20maximise%20performance.">28% of female soccer players</a>. The use of hormonal contraceptives suppresses natural hormonal fluctuations and replaces them with external synthetic versions of female sex hormones, affecting the athlete differently. </p>
<p>Clearly the extent and severity to which the menstrual cycle impacts athletic performance is highly variable and complex, with more research needed. So for now it’s sensible to consider the effects of the menstrual cycle on an individual basis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/supporting-menstrual-health-in-australia-means-more-than-just-throwing-pads-at-the-problem-161194">Supporting menstrual health in Australia means more than just throwing pads at the problem</a>
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</p>
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<h2>How to support athletic performance at all cycle stages</h2>
<p>It’s essential for players to familiarise themselves with their own cycles to understand how they’re affected throughout, as well as communicate any menstrual cycle-related issues to support staff (physicians and coaches). This awareness can guide adjustments in training and nutrition when required.</p>
<p>For example, oestrogen has an important influence on iron levels in females, such as chronic oestrogen deficiency is <a href="https://pubmed.ncbi.nlm.nih.gov/23041085/">linked to iron deficiency</a>. Iron status can also be compromised by blood loss during menstruation, depending on the heaviness and duration of bleeding.</p>
<p>Iron is essential for human function, facilitating energy production and the transportation of oxygen around the body. In soccer, about <a href="https://pubmed.ncbi.nlm.nih.gov/16521852/#:%7E:text=Of%20the%20investigated%20female%20soccer,at%20the%20top%20international%20level">60% of elite female players</a> present as iron deficient, compared to <a href="https://pubmed.ncbi.nlm.nih.gov/18384395/">less than 12% of their male counterparts</a>. For an iron deficient midfielder, this might translate into covering less distance at lower speeds. </p>
<p>It’s therefore important female athletes have their iron levels regularly checked by qualified practitioners. Addressing deficiencies through diet, supplementation, or iron transfusions, will ensure athletic performance during training and competition is not compromised.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1631298254078894082"}"></div></p>
<p>Individual athletes’ training loads can also be strategically managed to accommodate severe menstrual symptoms. </p>
<p>Football clubs around the world have been <a href="https://www.tandfonline.com/doi/full/10.1080/24733938.2020.1828615">experimenting with this strategy</a> since it gained popularity during the 2019 Women’s FIFA World Cup. But how does it look in practice? </p>
<p>For team sport athletes, such as soccer players, this can be a demanding logistical task. It’s not easy to track the menstrual cycles of more than 25 players concurrently, and hold training sessions at convenient times for all of them. The complexities are heightened when training and game days cannot be avoided. </p>
<p>But performance coaches must consider athletes’ needs and ensure they’re prepared for competition, while minimising the risk of injury and menstrual discomfort. Coaches should also ensure athletes maintain adequate nutrition for both competition and to support their menstrual cycle. </p>
<p>For an athlete who reports severe menstrual symptoms during the first days of menstruation (such as increased pain and weakness), this might translate into reduced training intensity, additional recovery days, and an anti-inflammatory diet that also supports the restoration of iron levels (increased intake of nuts, seeds, berries, lean red meats, and fibre and Omega-3 rich foods). </p>
<p>And it’s important to keep in mind some athletes might experience menstrual cycle issues in phases other than menstruation. So, training and nutrition should be flexible and individualised across the cycle. </p>
<p>Using this approach, athletes can mitigate the influence of the menstrual cycle on their performance, giving them the best opportunity to achieve their athletic potential and success during competition.</p>
<img src="https://counter.theconversation.com/content/206700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara Chica-Latorre receives funding from the Australian Department of Education</span></em></p><p class="fine-print"><em><span>Michael Pengelly and Michelle Minehan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fluctuations in sex hormones are associated with inflammation peaks and troughs. These could potentially influence athletic performance.Sara Chica-Latorre, Phd Candidate and Research Assistant, Research Institute for Sport and Exercise, University of CanberraMichael Pengelly, PhD Candidate, Research Institute for Sport and Exercise, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055702023-07-12T05:25:17Z2023-07-12T05:25:17ZPeriod shame stops countless girls from continuing sport. The Women’s World Cup can help break this stigma<p>In the lead up to the first FIFA Women’s World Cup hosted in the Southern Hemisphere, host nations Australia and Aotearoa New Zealand are forging other firsts, including efforts to break the shame, stigma and taboo that <a href="https://www.westernsydney.edu.au/__data/assets/pdf_file/0003/1932321/Final_White_Paper_Menstrual_Equity_in_Educational_Institutions_and_Workplaces_V.2.pdf">continue to shroud periods</a>.</p>
<p>In April, both teams unveiled new kits that <a href="https://www.theguardian.com/football/2023/apr/04/matildas-unveil-first-period-conscious-kit-design-for-womens-world-cup">included period leak protections</a>, together with materials and tailoring that specifically respond to the needs of high performance women footballers.</p>
<p>New Zealand has also swapped out its <a href="https://www.nzfootball.co.nz/newsarticle/126803?newsfeedId=1253670">traditional white shorts</a> for teal blue to help combat period anxiety.</p>
<p>Similar changes are occurring across the global sporting landscape, albeit more slowly in some quarters.</p>
<p>Despite initial reluctance, last year the All England Club <a href="https://www.skysports.com/tennis/news/32498/12749640/wimbledon-relaxes-all-white-kit-rule-for-female-players-after-fresh-criticism-from-billie-jean-king-and-judy-murray">relaxed</a> the long-held tradition that Wimbledon players wear all white, so women can now wear <a href="https://www.abc.net.au/news/2023-07-03/wimbledon-whites-rule-change-women-period-female-athletes/102554006">dark undershorts</a>.</p>
<p>In rugby, the <a href="https://www.rugbypass.com/news/ireland-statement-womens-team-to-stop-wearing-white-shorts/">Irish national women’s team</a> have permanently switched white shorts for navy, while <a href="https://www.nzherald.co.nz/sport/nz-rugby-invests-in-new-shorts-for-referees-due-to-menstrual-concerns/BDDOZ3TYN5CBROYS5M2KEMUJMA/">New Zealand</a> referees are no longer required to wear white shorts.</p>
<p>The impact of these changes should not be underestimated. The shame and taboo associated with periods stops <a href="https://www.theaustralian.com.au/sport/nrl/nrlw-star-tiana-penitani-working-to-break-sport-taboo-of-female-athletes-and-periods/news-story/5324dde42e6b77dc7e25d5bd8ce6bc54">many young girls from continuing sport</a>, and misinformation about menstruation affects the performance and health of countless elite athletes. The 2023 FIFA Women’s World Cup is an opportunity to dispel period myths and put a focus on the specific needs of athletes who menstruate.</p>
<h2>Women athletes aren’t small men</h2>
<p>Women’s elite sport continues to be professionalised, yet their training protocols have often been based on <a href="https://www.fasttalklabs.com/fast-talk/why-women-are-not-small-men-with-dr-stacy-sims/">research evidence derived from male cohorts</a>.</p>
<p>This research doesn’t consider the physical and psychological changes that women athletes may experience at <a href="https://journals.sagepub.com/doi/pdf/10.1177/1747954120916073?casa_token=zYiabLH-iMIAAAAA:r5Ul9YjFvOhrZEufH6pyIZmB3sxBYtlV9v_diTl76LjAZFgLn0-QBRcbgW-PTHMtJZFWbb8W5XZT">each phase of the menstrual cycle</a>, nor how that may affect peak performance.</p>
<p>Research into how the menstrual cycle affects the performance of women athletes is growing. Teams are employing methods to <a href="https://www.theguardian.com/lifeandstyle/shortcuts/2019/jul/10/how-period-tracking-can-give-all-female-athletes-an-edge">work with the period cycle</a>, rather than against it.</p>
<p>Reigning FIFA Women’s World Cup champions the United States say that menstrual tracking is one of their <a href="https://www.fitrwoman.com/post/fitrwoman-in-the-news-ending-the-period-taboo">performance weapons</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-study-much-of-what-were-told-about-gym-exercises-and-resistance-training-is-from-studies-of-males-by-men-205753">New study: much of what we're told about gym exercises and resistance training is from studies of males, by men</a>
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<h2>No longer a mark of honour</h2>
<p>Ignoring and generalising the needs of women athletes not only hurts performance, but can damage health. </p>
<p>Overly intense training can cause some athletes to stop having periods. This has often been considered normal by coaches and a <a href="https://www.abc.net.au/news/2023-03-19/carla-papac-periods-menstrual-health-women-athletes/102074230">mark of honour</a> among athletes themselves. Indeed there’s a dangerous notion in many high performance sporting cultures that the absence of menstruation equates to an ideal elite athlete.</p>
<p>But this can lead to serious health consequences, including a condition called RED-S – relative energy deficiency in sport. <a href="https://www.perthsportsmedicine.com.au/relative-energy-deficiency-in-sport-perth-claremont-cockburn-wa.html">Symptoms</a> include periods stopping or becoming irregular, reduced performance, mood changes, and recurrent illnesses and injuries including stress fractures.</p>
<p>Australian research involving 112 women elite and pre-elite athletes found almost 80% of participants demonstrated <a href="https://bjsm.bmj.com/content/55/1/38">at least one symptom consistent with RED-S</a>. Nearly 40% experienced at least two symptoms.</p>
<p>Like women in other workplaces, elite athletes are often reluctant to discuss the impact of their periods fearing assumptions they are a liability in team environments, less capable, and not deserving of development opportunities.</p>
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<h2>Change is happening, albeit slowly</h2>
<p>Across some high performance pathways, road maps are being developed to specifically support women athletes. For example, the Australian Institute of Sport launched an <a href="https://www.ais.gov.au/fphi">initiative</a> in late 2019 to “improve female athlete specific knowledge and systems of support”. And in March, the South Australian government started its “I’m an athlete. Period” <a href="https://www.orsr.sa.gov.au/news/elite-athletes-help-remove-the-stigma-around-periods-and-sport">campaign</a> which aims to promote positive menstrual health in sport.</p>
<p>Many women athletes themselves have started to <a href="https://www.abc.net.au/news/2023-03-19/carla-papac-periods-menstrual-health-women-athletes/102074230">speak up</a> about the taboo associated with menstruation and are lobbying for change.</p>
<p>Earlier this year, decorated Australian Olympic swimmer Cate Campbell shared the performance struggles she has experienced managing her periods.</p>
<p>While her training and nutrition regimens were monitored with precision, the absence of information and access to a network of women’s health professionals saw her suffer a <a href="https://www.abc.net.au/news/2023-02-01/cate-campbell-katja-dedekind-swimming-womens-health-periods/101848960">near career-ending injury</a>.</p>
<p>To try and manage her periods, she had a contraceptive bar inserted into her arm, which is meant to be inserted into the fat layer above the muscle. But because she’s an elite athlete, she has a very low body fat percentage, so the bar was inserted next to her muscle. A botched attempt to retrieve the bar caused her permanent nerve damage. </p>
<p>She’s now using her profile to raise awareness of <a href="https://www.abc.net.au/news/2023-02-01/cate-campbell-katja-dedekind-swimming-womens-health-periods/101848960">women’s health issues</a> and to try and reduce the taboo around periods.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Clmm_2lBpxM/?hl=en","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Girls’ barriers to sport</h2>
<p>Puberty, and the start of periods, is a time when girls’ participation in grassroots sport <a href="https://www.independent.co.uk/voices/girls-periods-sport-body-image-b1936093.html">falls off sharply</a>.</p>
<p>A UK survey of more than 4,000 teenagers published last year found there are <a href="https://www.theguardian.com/education/2022/mar/07/uk-girls-lose-interest-in-sport-as-teenagers-women-in-sport-survey">complex barriers</a> and deep-rooted negative attitudes affecting girls’ enjoyment of sport, including period shame and body image issues. </p>
<p>It found, of girls in the survey who used to be sporty, 78% said they avoided sport when they had their period, and 73% of this cohort said they didn’t like others watching them take part in physical activity.</p>
<p>Of girls who avoided exercise on their periods, 73% said it was due to pain and 62% did so out of fear of leakage.</p>
<p>Various state governments are investing in grassroots sport facilities that <a href="https://footballfacilities.com.au/2022/08/25/female-facilities-set-to-flourish/">better attend to the needs of women</a>. But many facilities continue to lack basic amenities <a href="https://www.newsofthearea.com.au/public-amenities-in-port-stephens-to-be-more-inclusive">including menstrual bins</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/celtic-fc-leads-way-in-tackling-period-poverty-now-other-clubs-need-to-follow-96748">Celtic FC leads way in tackling period poverty, now other clubs need to follow</a>
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<p>An important way to address these issues is for sporting clubs to develop “period positive” <a href="https://www.ccyp.com.au/wp-content/uploads/2023/05/Period-Positive-Sports-Clubs.pdf">cultures</a>. </p>
<p>Clubs should undertake measures such as:</p>
<ul>
<li><p>providing comfortable and period-friendly uniforms</p></li>
<li><p>supplying sanitary bins and ample period products for free </p></li>
<li><p>and having open discussions about periods and how they may impact athletes. </p></li>
</ul>
<p>These can help girls and women be empowered to manage their periods in ways that will enable them to continue their participation and not feel ashamed or embarrassed.</p>
<p>With the world cup media spotlight, we have an unprecedented opportunity to break menstrual shame, silence and taboo.</p><img src="https://counter.theconversation.com/content/205570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The tournament is an opportunity to dispel period myths and put a focus on the specific needs of athletes who menstruate.Michelle O'Shea, Senior Lecturer, School of Business, Western Sydney UniversityHazel Maxwell, Senior Lecturer, Western Sydney UniversityKylie A Steel, Senior Lecturer in Motor Learning and Skill Acquisition, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2018712023-06-27T02:14:36Z2023-06-27T02:14:36ZHow do I insert a tampon?<figure><img src="https://images.theconversation.com/files/532313/original/file-20230616-19-ay9uyd.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C3320%2C1705&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">pexels sora shimazaki</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>If you’ve just decided to start using tampons and you’re finding it tricky, you’re not alone! Lots of young teens and first-time tampon users have told me they experience “tampon trauma” – meaning it hurts, won’t go in or gets stuck coming out. But with a little bit of practice, it’s super easy.</p>
<p>Tampons are safe and convenient, especially if you’re going to the beach, swimming or doing something physically active. You can’t feel a tampon once it’s inserted properly, which is why some people prefer tampons to pads or period undies. Tampons are used by <a href="https://www.nationalgeographic.com/environment/article/how-tampons-pads-became-unsustainable-story-of-plastic#:%7E:text=Did%20You%20Know%3F,-Usage&text=Recycling-,5.8%20billion%20tampons%20were%20sold%20in%20the%20U.S.%20in%202018,ocean%20when%20sewer%20systems%20fail.">millions of people</a> around the world. They’re made from natural cotton, rayon fibre or both, and absorb fluid, including menstrual blood. </p>
<p>In Australia, tampons are classified as “medical devices” which means they have to meet certain safety standards. So even though there’s a confusing array of brands available in Australia it’s good to know they all pass the safety test.</p>
<p>Just like pads and period undies, tampons come with different absorbencies, such as “mini” or “light”, “regular” and “super”. As you get to know your own periods and cycle, you’ll also get to know which tampons suit you best over the course of your period. It’s common for the first couple of days of a period to be heavier, meaning you might need a tampon with higher absorbency.</p>
<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>
<h2>How to insert</h2>
<p>A tampon is designed to sit inside the vagina, right up high against the cervix. The vagina is a stretchy muscular tube and has plenty of room to accommodate a tampon. </p>
<p>The vagina slopes upward and backward, towards the spine. A common difficulty first-time tampon users encounter is pushing the tampon straight up rather than slightly backwards, so it hits the front wall of the vagina and feels like it can’t go up any further. The same can happen in reverse when pulling a tampon out – it needs to be pulled slightly forward, not straight down, or it could hit the back wall of the vagina and feel stuck.</p>
<p>If you want to, you can practise using a tampon between your periods, or when your flow is light. Wash your hands first, then get a mini-sized tampon and make it slippery by putting some water-based lubricant on it. Some people might dab a tiny bit of Vaseline on the tip of the tampon instead. Vaseline shouldn’t be put on tampons during a period, as it reduces absorbency. </p>
<p>Pull the string so it reaches its full length before you insert it. Stand in front of a mirror and have a look at where the opening of your vagina is by pulling the vaginal lips apart. Then either squat, or put one leg up on a stool, shelf, or side of the bath, which gets you in a comfortable position to practise. </p>
<p>Gently put the tip of the tampon into the opening and then push it up and back with your finger. You can put your fingers inside your vagina first, to get a feel of the way your vagina slopes. (If you have long nails, take care not to scratch yourself!)</p>
<p><iframe id="tc-infographic-879" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/879/daa47e958c4391e8fa586f1fc90bb0554872c2d7/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Some tampons come with an “applicator”. This is made of two cardboard or plastic tubes, one inside the other. The larger tube has the tampon inside it, and the smaller one sits just below the tampon. When inserting, you hold the smaller part and push the applicator inside your vagina rather than putting your fingers inside. When the applicator has gone all the way in, you push the tampon out by “plunging” the smaller tube up, pushing the tampon out. </p>
<p>It’s virtually impossible to put a tampon into the wrong hole! There are three holes in that part of the body – the vagina, the urethra (where wee comes out) and the anus, or bum hole, where poo comes out. Most people are familiar with where the bum hole is, because (hopefully) they wipe their bums a lot! </p>
<p>The urethra is very small, and you wouldn’t be able to fit a tampon into it. It sits high up towards the top of the vulva – where your inner vaginal lips meet in the middle, and just below the tip of the clitoris.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram showing a vulva" src="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=561&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=561&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=561&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=704&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=704&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533054/original/file-20230621-20-ocbi2q.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=704&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vulva diagram.</span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Tampons can be left in for up to six hours. If your period is heavier than anticipated and the tampon has become “soaked”, you might have to change it earlier. You’ll know when that happens because some menstrual fluid will leak onto your undies. </p>
<p>Don’t panic though – it’s something you’ll be able to feel and deal with before anyone else notices! If you know you have heavy flow days and want to take extra precautions, you can wear a light pad on your undies (or period undies) as well as using a tampon. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">Heavy periods are common. What can you do, and when should you seek help?</a>
</strong>
</em>
</p>
<hr>
<h2>Toxic shock syndrome</h2>
<p>You might have heard about something called Toxic Shock Syndrome. This is caused by a bacterial infection that releases toxins into the blood and is a serious condition. </p>
<p>It can happen anywhere in the body but is known to be associated with the use of ultra super absorbency tampons. There are now guidelines and regulations worldwide for tampon manufacturing to reduce the risk of infections. </p>
<p>These days toxic shock syndrome is extremely rare (about <a href="https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome#:%7E:text=Toxic%20shock%20syndrome%20affects%201,absorbent%20tampons%20during%20their%20period.">0.001%</a> of people), and still only occurs if tampons are left in for several hours, allowing the bacteria to multiply. </p>
<p>Symptoms are high fever, vomiting, diarrhoea, muscle aches, headaches and a rash.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Environmentally friendly options</h2>
<p>It’s important to NEVER flush a tampon down the toilet. If you’re in a public toilet, there should be bins inside toilet cubicles for all disposable period products. At home, you could wrap it in tissue and put it in a rubbish bin. You might also be aware people are now looking at environmentally friendly alternatives to disposable pads and tampons. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman throwing a used tampon into a bin" src="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532314/original/file-20230616-21-1p38kv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Never flush a tampon down the toilet, put it in a bin.</span>
<span class="attribution"><span class="source">Pexels/Karolina Grabowska</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Reusable pads and period undies were designed to help reduce waste from disposable pads. There’s now also an alternative to tampons, which is the modern “menstrual cup”. These are made of medical grade silicone that you fold over, push up inside your vagina using two fingers, and then pop! It springs open inside the vagina and catches any menstrual fluid. </p>
<p>Unlike a tampon, they sit a little lower down in the vagina, and just like tampons, they can take practice getting used to. These can be used for up to 12 hours which makes them super convenient. You can try a menstrual cup anytime – and some people might switch between tampons and a cup or pads or period undies, depending on what feels right on the day.</p>
<p>Managing periods is something almost half the population deals with. It can feel scary, but it might help to know that just about everyone who has periods goes through the same process of figuring it out! The more you arm yourself with information and know how much choice is out there, the more confident you’ll feel. And don’t forget there are always adults out there who are willing and able to give you advice and help. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-queues-for-womens-toilets-are-longer-than-mens-99763">Why queues for women's toilets are longer than men's</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/201871/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Kang has received funding from the National Health and Medical Research Councill, Australian Research Council and Medical Research Futures Fund. She is affiliated with the Australian Association for Adolescent Health and the International Association for Adolescent Health. She has co-authored Welcome to Your Period, Welcome to Consent, Welcome to Your Boobs and Welcome to Sex.</span></em></p>Lots of young teens and first-time tampon users are intimidated by tampons. But they’re easy once you get the hang of it.Melissa Kang, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028542023-05-31T01:58:39Z2023-05-31T01:58:39ZTrying for a baby? What you need to know about a vital part of your womb (and how to look after it)<figure><img src="https://images.theconversation.com/files/525306/original/file-20230510-19-vyabvw.jpg?ixlib=rb-1.1.0&rect=50%2C101%2C4128%2C2720&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/closeup-photo-young-woman-picking-sanitary-528070513">Shutterstock</a></span></figcaption></figure><p>Human reproduction is completely dependent on the healthy function of an underestimated but vital organ: the endometrium. This is the spongy tissue that lines the inner surface of the womb.</p>
<p>In the first half of the menstrual cycle, a healthy endometrium expands in response to the estrogen produced by a growing egg. The endometrium is then shed each month during menstruation. </p>
<p>Or, in the case of pregnancy, the endometrium accepts and nurtures the embryo.</p>
<h2>So you’re trying to get pregnant. What happens?</h2>
<p>When ovulation is triggered, the ovary starts to produce the hormones estrogen and progesterone. Progesterone causes the endometrial cells to prepare to accept an embryo, in a unique transition called “decidualisation”.</p>
<p>During decidualisation, endometrial cells display proteins that indicate it’s receptive for embryo attachment. After attachment, the junctions between endometrial cells loosen so an embryo can move beneath the endometrial surface. </p>
<p>Endometrial cells secrete substances that nurture the embryo, while immune cells protect the embryo and the endometrium while they move together and the placenta develops. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-to-get-pregnant-30529">Health Check: how to get pregnant</a>
</strong>
</em>
</p>
<hr>
<p>The surface of the endometrium is covered by a shield of glycoproteins (proteins attached to sugars) which protects it from bacteria and viruses. This shield can also <a href="https://doi.org/10.1038/s41598-021-03425-2">prevent an embryo from attaching to the lining</a>.</p>
<p>Progesterone helps to remove this glycoprotein shield about five days after ovulation. This is carefully timed so a fertilised egg will have developed into a blastocyst-stage embryo and be starting to hatch from its shell ready to interact with the exposed endometrial cells.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525307/original/file-20230510-19-t3k1xt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The stages of embryo development.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock</a></span>
</figcaption>
</figure>
<h2>It prevents the body rejecting the father’s sperm</h2>
<p>The endometrium must also retrain its immune cells to accept an embryo that contains the father’s foreign biological material, or “antigens”. </p>
<p>Tissues bearing these foreign antigens would usually provoke an immune rejection response, but the endometrium has adapted its immune response so an embryo can be accepted, and implant and grow, without rejection. </p>
<p>Although not essential for pregnancy, prior contact with the father’s semen <a href="https://www.jci.org/articles/view/122182">primes the mother’s immune response</a> and promotes acceptance of an embryo. Sexual activity enables paternal antigens, which are present in the fluid around sperm, to interact with the mother’s immune cells in the cervix and endometrium. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-point-of-sex-its-communication-at-a-biological-level-67847">What's the point of sex? It's communication at a biological level</a>
</strong>
</em>
</p>
<hr>
<p>Paternal antigens are taken to lymph glands in the pelvic cavity where they are processed in a way that encourages the mother’s immune response to tolerate – not reject – these paternal antigens. </p>
<p>When paternal antigens on the embryo are next seen by the mother’s endometrial immune cells, they accept the embryo and nurture it. Implantation and placental development can then occur, maximising the chance of progression to a healthy pregnancy.</p>
<h2>Then what happens?</h2>
<p>For an embryo to grow beyond being a blastocyst, it must secure access to a robust blood supply. Oxygen and nutrients are sourced from the mother’s endometrium (called decidua in early pregnancy) during implantation via the placenta which is formed from outer cells of the embryo.</p>
<p>The process of implantation involves a complex sequence of cellular steps that must progress correctly for pregnancy to occur. </p>
<p>The endometrial tissues have to be reorganised so the blood vessels grow towards the embryo. These vessels then open up to allow blood to flow into blood-filled spaces (called lacunae) that bathe the surface of the placenta. This allows oxygen and nutrients to move from the mother’s to the fetus’s blood supply.<br>
As these connections form, there can be minor bleeding a few days before a menstrual period is due. This is called “implantation bleeding”.</p>
<p>If any of these steps go awry, the embryo may fail to implant, there may be a brief interaction between the embryo and the endometrium that becomes disrupted (a “biochemical pregnancy” or very early miscarriage), or there may be implantation faults that cause a miscarriage some weeks later. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1188930437558820865"}"></div></p>
<h2>What can go wrong?</h2>
<p>The events at implantation have consequences for the rest of the pregnancy. </p>
<p>Even minor defects in the embryo or endometrial interaction at implantation can <a href="https://doi.org/10.3389/fimmu.2019.00478">increase the risk</a> of common pregnancy conditions such as:</p>
<ul>
<li>preterm labour</li>
<li>high blood pressure (preeclampsia)</li>
<li>sub-optimal fetal growth</li>
<li>premature delivery</li>
<li>pregnancy loss.</li>
</ul>
<h2>What conditions affect the endometrium?</h2>
<p>Inflammation is the hallmark of an unhealthy endometrium and contributes significantly to implantation disorders and miscarriage.</p>
<p>Endometritis (infection of the endometrium) and inflammatory fluid from blocked fallopian tubes (hydrosalpinx) can damage endometrial cells. </p>
<p>Dying and damaged cells attract immune cells that attack and engulf them. When damaged or dying cells are in the endometrium (decidua), the placenta doesn’t grow well and the pregnancy can be affected. </p>
<figure class="align-center ">
<img alt="Woman holds. her pelvis" src="https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525109/original/file-20230509-26-5qvg2s.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">Inflammation can contribute to implantation disorders and miscarriage.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/close-up-photo-of-woman-touching-her-abdomen-3958579/">Pexels/Polina Zimmerman</a></span>
</figcaption>
</figure>
<p><a href="https://theconversation.com/au/topics/endometriosis-2405">Endometriosis</a> (endometrial tissue outside the uterus) and <a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">adenomyosis</a> (endometrial tissue in the muscle of the uterus) also increase inflammation. In these conditions, endometrial cells in the wrong location grow and then die in response to cyclic menstrual cycle hormones. The immune system then has to be activated to clear the dead cells, creating an inflammatory environment. </p>
<p>Autoimmune conditions and metabolic disorders such as diabetes and insulin resistance also activate the immune system and create an inflammatory endometrial environment. These conditions <a href="https://pubmed.ncbi.nlm.nih.gov/36192117/">have been linked</a> to recurrent miscarriage. </p>
<h2>How can you improve your endometrial health?</h2>
<p>There are several things you can do to support a healthy endometrium. </p>
<p>First, manage the lifestyle factors that increase stress on cells and promote inflammation. This will decrease the chances of implantation problems and miscarriage. </p>
<p>Cutting down on <a href="https://academic.oup.com/humrep/article/22/2/543/2939206">smoking</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890623819300073?via%3Dihub">marijuana</a>, too much <a href="https://academic.oup.com/biolreprod/article/99/6/1266/5049471">coffee</a> or <a href="https://academic.oup.com/humrep/article/36/9/2538/6294415">alcohol</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0002916522007663?via%3Dihub">avoiding</a> sugary and processed foods will make it easier for the endometrium to stay healthy. </p>
<p>For some women, the diagnosis and treatment of medical conditions that cause inflammation, such as diabetes and autoimmune problems, ensures treatments can start. Treating these conditions can reduce the risk of miscarriage and pregnancy complications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Hull is Professor and leader of the endometriosis and endometrium group at and at the Robinson Research Institute at the University of Adelaide.
She works as a Fertility Specialist (FRANZCOG, CREI) and is also the Medical Director / Owner of Embrace Fertility, Adelaide.
Louise has previously received funding from the Federal Government Grant for the EndoZone project and MRFF Funding for Imagendo.
Louise Hull also works as a Staff Specialist Consultant at the Women's and Children's Hospital Adelaide </span></em></p><p class="fine-print"><em><span>Sarah Robertson receives funding from the National Health and Medical Research Council of Australia, and the Australian Research Council.</span></em></p>Human reproduction is completely dependent on the health of an underestimated but vital organ: the endometrium. Here’s how it works.Louise Hull, Professor and Endometriosis Group Leader, The Robinson Research Institute, University of AdelaideSarah Robertson, Professor and Director, Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995682023-04-27T15:01:40Z2023-04-27T15:01:40ZWhy menstrual leave could be bad for women<figure><img src="https://images.theconversation.com/files/519854/original/file-20230406-18-29woex.jpg?ixlib=rb-1.1.0&rect=0%2C98%2C6000%2C3898&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bad-period-full-length-view-caucasian-2064704318">NFstock/Shutterstock</a></span></figcaption></figure><p>Spain recently <a href="https://www.euronews.com/next/2023/02/16/spain-set-to-become-the-first-european-country-to-introduce-a-3-day-menstrual-leave-for-wo">adopted a menstrual leave policy</a>, which makes additional (paid or unpaid) days off work available to “<a href="https://doi.org/10.1007/978-3-030-53269-7_9">only and all cisgender women</a>”.</p>
<p>It’s so great that we’re having more public conversations about menstrual and menopausal health, but I’m getting very tired of being told that menstrual leave is the solution.</p>
<p>As someone with a background in policy evaluation and the founder of the world’s first evidence-based <a href="https://www.menstrual-matters.com/">menstrual health website</a>, I am well placed to comment on this topic. When I evaluated existing menstrual leave policies around the world, I found that they were not progressive or beneficial for <a href="https://doi.org/10.1007/978-3-030-53269-7_9">female reproductive health or gender equality</a>. </p>
<p>The thing is, it is really hard to argue against something that sounds good, even if the available evidence suggests otherwise. Humans seem to be bad at going beyond surface thoughts and we may even prefer stories that align with <a href="https://www.tandfonline.com/doi/abs/10.1080/1350178X.2014.939691">rather than challenge gender stereotypes</a>. </p>
<p>So, here is a quick outline of what I think you should know about this policy.</p>
<h2>What is the problem?</h2>
<p>There are <a href="https://doi.org/10.1007/978-3-030-53269-7_9">four main arguments</a> used by those promoting menstrual leave policy:</p>
<ol>
<li><p>It will make the workplace fit for the menstruating female body.</p></li>
<li><p>It will improve menstrual health.</p></li>
<li><p>It will reduce menstrual shame and stigma, and associated discrimination.</p></li>
<li><p>It will improve gender equality in the workplace and beyond. </p></li>
</ol>
<p>However, it has never been made clear exactly how the policy will deliver these outcomes. In fact, based on what we know about existing menstrual leave policies, it might not contribute to any of them.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life._</p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-important-things-you-should-have-learned-in-sex-ed-but-probably-didnt-202177?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five important things you should have learned in sex ed – but probably didn’t</a></em></p>
<p><em><a href="https://theconversation.com/postpartum-exercise-can-have-many-benefits-heres-how-to-do-it-safely-200388?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Postpartum exercise can have many benefits – here’s how to do it safely</a></em></p>
<p><em><a href="https://theconversation.com/joy-can-help-us-be-better-at-work-heres-how-to-find-it-198260?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Joy can help us be better at work – here’s how to find it</a></em></p>
<hr>
<p>For instance, the policy does not make it easier to manage your period at work because your employer doesn’t have to change a thing. Instead, you are encouraged to stay away from the workplace. </p>
<p>The policy also does nothing to improve menstrual health. The 90% of people who menstruate and <a href="https://abdn.alma.exlibrisgroup.com/discovery/delivery/44ABE_INST:44ABE_VU1/12152380480005941">do not regularly experience severe symptoms</a> do not need to take a whole day off work during their periods. </p>
<p>Meanwhile, the minority who do regularly experience severe symptoms almost always have <a href="https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/">an underlying health issue</a>, such as endometriosis, heavy menstrual bleeding, polycystic ovary syndrome, fibroids, auto-immune disorders, depression or premenstrual dysphoric disorder. Encouraging people to cope with severe symptoms alone at home every month, is not an effective or humane solution.</p>
<p>These health conditions deserve effective and timely medical diagnosis and treatment, sick leave and reasonable workplace adjustments. The same things that apply to all chronic health conditions and are already covered by <a href="https://www.legislation.gov.uk/ukpga/2010/15/contents">EU and UK labour policies</a>. </p>
<p>Menstrual leave also does not help to reduce menstrual shame, stigma or discrimination. It actually encourages the removal of menstruation – and by extension women – from the public realm by hiding it at home.</p>
<p>This sex-based policy conflates healthy periods with debilitating menstrual health conditions, which both pathologises the normal female body and undermines health conditions that mainly affect women. This is partly why women and conditions that mainly affect women are <a href="https://doi.org/10.1155/2018/6358624">more likely to be dismissed by doctors</a>, sometimes taking <a href="https://www.medicalnewstoday.com/articles/gender-bias-in-medical-diagnosis#how-does-it-affect-diagnosis">years to get a formal diagnosis</a>.</p>
<p>Finally, by medicalising the menstrual cycle (that is, positioning it as an illness rather than a healthy process) these policies reinforce sexist beliefs that make it seem like all women are <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">biologically inferior (mentally and physically)</a>. This is a major contributing factor in gender discrimination, especially in the workplace, since these ideas are <a href="http://www.beacon.org/Inferior-P1278.aspx">used to undermine</a> the value, contribution and leadership potential of women.</p>
<figure class="align-center ">
<img alt="A woman clutches a hot water bottle to her body." src="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Period leave policies keep menstruation at home where employers don’t have to deal with it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-cropped-view-unhealthy-30s-woman-2113290665">Fizkes/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Menstrual leave might even make things worse</h2>
<p>Not only have existing menstrual leave policies failed to address the problems they set out to solve, they have also directly resulted in <a href="https://www.menstrual-matters.com/ml-gender-4/">discrimination against female workers</a>. This is largely due to the gender myths reinforced by the policy. It makes all women seem like more expensive and less consistent and productive employees. It can also lead to a backlash from colleagues and employers <a href="https://books.google.co.uk/books/about/Periodic_Struggles.html?id=F5YvQwAACAAJ&redir_esc=y">against a sex-based benefit</a>.</p>
<p>We already know that shared parental leave (for parents regardless of gender) is a <a href="https://doi.org/10.2307/j.ctvfrxngh">more effective policy than maternity leave</a> (which is female sex-based). It improves the gender pay gap, women’s hiring, promotion and leadership opportunities, child health outcomes, fatherhood experiences and gender equality in wider society.</p>
<p>These improvements occur because the policy avoids the gender-based backlash associated with maternity leave. This backlash is driven by the conscious or unconscious resentment of, and associated discrimination against, working women due to a perceived unfair advantage (paid time off work) and/or biological liability (the female reproductive body). The <a href="https://www.menstrual-matters.com/ml-gender-4/">same issues</a> apply to menstrual and menopausal health workplace policies.</p>
<p>We need to improve workplace (and school, and medical) knowledge of reproductive health and wellbeing. We should all know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">what’s normal</a> or the sign of an underlying health condition. Likewise, it’s shocking that some people do not know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">why we menstruate</a> or how to reduce cyclical changes.</p>
<p>We also need to make <a href="https://www.bloodygoodemployers.com/">workplaces (including schools) fit for those who have periods</a> and to promote more <a href="https://www.menstrual-matters.com/ml-alternatives-5/">flexible and equitable work cultures and practices</a> that benefit all employees. For instance, challenging “presenteeism” if employees feel obliged to work even when feeling unwell, and ditching <a href="https://www.ndtv.com/feature/amazon-staff-in-uk-claims-their-toilet-breaks-were-timed-3727431">“timed” toilet breaks</a>. </p>
<p>While these <a href="https://www.menstrual-matters.com/ml-alternatives-5/">actions</a> are not quite as simple or catchy as “menstrual leave”, they would at least make a positive difference in the lives of millions of workers – without unintentionally worsening gender inequalities.</p><img src="https://counter.theconversation.com/content/199568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters. Her doctoral research was funded by the ESRC (Economic and Social Research Council). She is affiliated with the Women's Equality Party and a board member of the Society for Menstrual Cycle Research. </span></em></p>Sex-based policies can lead to backlash and further discrimination in the workplace.Sally King, PhD Candidate, Department of Global Health & Social Medicine, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034512023-04-25T17:32:33Z2023-04-25T17:32:33ZFrom rags and pads to the sanitary apron: a brief history of period products<figure><img src="https://images.theconversation.com/files/522746/original/file-20230425-26-nzw4m7.jpg?ixlib=rb-1.1.0&rect=260%2C35%2C5721%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tampons-feminine-sanitary-pads-pattern-on-2185561705">Skrypnykov Dmytro/Shutterstock</a></span></figcaption></figure><p>Period blood: it’s not something many people want to talk about. Taboos around menstruation and menstrual blood have been around for centuries. Even today, despite menstrual blood being <a href="https://www.ncbi.nlm.nih.gov/books/NBK565646/">featured in contemporary art</a>, this basic part of many women’s identities still isn’t something that can be easily mentioned in public. </p>
<p>Menstruation is generally seen as something to be managed and contained – with period leaks considered <a href="https://www.womenshealthmag.com/health/a19938692/period-leaks-in-public/">a source of embarrassment</a>. This is despite <a href="https://periodpositive.com/">campaigns</a> aimed to help younger people feel more able to talk about menstruation. </p>
<p>For many women, the time of the month means relying on tampons, pads or a menstrual cup to collect the <a href="https://www.ncbi.nlm.nih.gov/books/NBK279294/">two to three tablespoons of blood</a> that are lost over the four to five days of their period.</p>
<p>But a <a href="https://www.theguardian.com/global-development/2019/apr/13/cloth-cow-dung-cups-how-the-worlds-women-manage-their-periods">2019 study</a> of how women around the world manage menstruation showed that many still use leaves, sheep’s wool, newspaper, grass or even cow dung, as an absorbent substance. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5y1_pgqTow8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>A <a href="https://blogs.worldbank.org/education/globally-periods-are-causing-girls-be-absent-school">2016 report from Unesco</a> found that 10% of young women in Africa did not attend school during their periods. Indeed, one way of avoiding leaks is simply not to go outside the home when menstruating, which is why menstruation still has important consequences for women’s education. </p>
<h2>Periods of the past</h2>
<p>It’s likely that <a href="https://www.getty.edu/news/education-periods-facts-women-medieval-history-past-before-pads-tampons/">women in the past</a> had fewer periods, with <a href="https://helloclue.com/articles/culture/what-was-it-like-to-get-your-period-in-ancient-greece">lighter bleeding</a>, not only because they spent more of their lives pregnant but also because their <a href="https://www.theguardian.com/society/2022/jan/06/women-losing-their-periods-because-of-restrictive-diets-and-excessive-exercise">diet was poor</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Early period pad." src="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=221&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=221&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=221&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=277&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=277&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522753/original/file-20230425-3095-mvgd9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=277&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sanitary napkin from around 1942 – from military stocks for nurses.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene#/media/File:Camelia_Popul%C3%A4r_sanitary_napkins_from_stocks_of_the_Wehrmacht_Third_Reich_with_acceptance_stamping_-_Intim_hygiene_supply_nurses_around_1942_-_content_10_pieces_per_pack_-_D.R._WZ_No._378543_and_386768_-_Image_002.jpg">Wikipedia</a></span>
</figcaption>
</figure>
<p>Yet medical texts going back to <a href="https://www.diva-portal.org/smash/get/diva2:937408/FULLTEXT01.pdf">ancient Greece</a> seem to propose that the ideal bleed should be heavy. This was due to the belief that menstruation happened because women’s bodies had a more spongy texture compared to men’s bodies, so their flesh absorbed more fluid from what they ate and drank. Blood that did not come out was even thought to <a href="https://diotima-doctafemina.org/translations/links-to-translations/the-illness-of-maidens/">cause mental illness</a>. </p>
<p>Medical texts up to the 19th century still reflected these ideas from ancient Greece, but there is evidence from early modern Europe that men were comfortable discussing menstruation. The 17th-century man of letters Samuel Pepys even mentioned his wife’s menstrual cycle <a href="http://earlymodernmedicine.com/review-menstruation-and-the-female-body/">in his diary</a>. </p>
<p>As for dealing with the bleeding, historian <a href="http://earlymodernmedicine.com/review-menstruation-and-the-female-body/">Sara Read</a> has concluded that at this time most women just bled on their clothes. Rags placed between the thighs or attached to clothing were also used. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sanitary belt shown in black and white." src="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522748/original/file-20230425-14-3hj3h.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An early commercial menstrual product in the form of a menstrual belt. Illustration from 1911.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene">Wikipedia</a></span>
</figcaption>
</figure>
<p>It was in the 19th century that the market for special menstrual clothing was developed: from belts and pads to the <a href="http://www.mum.org/sanapron.htm">“sanitary apron”</a> which was worn over the buttocks to stop leakage onto clothing when sitting down. Until disposable cotton pads were developed in the late 1890s, pads still needed to be washed out and dried (though reusable pads have recently made a comeback). </p>
<p>From the late 1960s, the use of a sticky strip meant that pads could be secured in the underwear rather than needing to be fixed to a special belt. </p>
<h2>Return to reuse</h2>
<p>Historian <a href="https://muse.jhu.edu/article/399411/pdf">Lara Freidenfelds</a> has shown that in the US by the 20th century, menstruation was increasingly seen as a normal part of life – no longer requiring a few days of rest as was previously the case. And commercially produced products came to be valued as a status symbol.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram showing folded fabric." src="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1731&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1731&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1731&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=2176&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=2176&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522751/original/file-20230425-2394-ff4dto.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=2176&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Instructions on how to fold a piece of fabric for a menstrual pad. At the bottom, how to fasten the pad with a cord to the waistband is demonstrated – from the German book The Woman as a family doctor, 1911.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Feminine_hygiene">Wikipedia</a></span>
</figcaption>
</figure>
<p>In the 1930s the <a href="http://www.mum.org/faxAd.htm">first tampons</a> came onto the market. They were described as “internal sanitary napkins”. Menstrual cups made from rubber also date back to the 1930s – although they have largely been replaced these days by silicone cups which come in a <a href="https://www.nytimes.com/wirecutter/reviews/best-menstrual-cup/">wide range of sizes</a>. The risk of leakage with a cup of the correct dimensions appears to <a href="https://www.nytimes.com/wirecutter/reviews/best-menstrual-cup/">be lower</a> than with a pad or tampon. </p>
<p>Modern menstrual products damage the environment. Tampon applicators and wrappers are made of plastic and pads contain it too. There is also an increased awareness of the <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.122-A70">risks of chemicals</a>, such as dioxins, used in both tampons and pads. This has boosted the market for products containing natural materials. </p>
<p>Disposable or reusable menstrual discs are also available – basically, a round silicone disc that collects blood. And period pants, invented in 2017, are sold as <a href="https://www.modibodi.co.uk/pages/howitworks">“better for the planet”</a>. </p>
<p>Rather than marketing commercial products in the world’s poorest countries, charities such as <a href="https://www.actionaid.org.uk/our-work/period-poverty/reusable-sanitary-pads-and-sustainability">ActionAid</a> run training sessions on making your own pads. Women in wealthier countries have been <a href="https://www.actionaid.org.uk/blog/2019/06/05/would-you-make-and-wear-your-own-reusable-sanitary-pads?gclid=Cj0KCQjwuLShBhC_ARIsAFod4fJvB_9i5cFjtYAvqacKtiWwfevD7n4TRyl4XGdWfgAIeE9fzkpK7e0aAqWBEALw_wcB">surprised</a> at how comfortable these are to wear. </p>
<p>Today’s promotion of reusable pads or period pants is a return to a past way of dealing with menstruation – though it’s clearly now much easier for most women to wash and dry these items. </p>
<p>Their use suggests our attitude to menstrual blood may be shifting. Indeed, seeing menstrual products as “waste” that needs to be hidden and disposed of “hygienically” doesn’t go with the idea of washing out your pads and hanging them up to dry on the line.</p><img src="https://counter.theconversation.com/content/203451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Breaking the taboo: the fascinating history of menstrual products.Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006562023-03-07T19:04:50Z2023-03-07T19:04:50ZHealth care offered to women in prison should match community standards – and their rights<figure><img src="https://images.theconversation.com/files/513093/original/file-20230302-28-lwt15j.jpg?ixlib=rb-1.1.0&rect=0%2C95%2C8000%2C5233&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/close-womans-hand-cell-prison-psychiatric-2208373333">shutterstock</a></span></figcaption></figure><p>On this <a href="https://www.un.org/en/observances/womens-day">International Women’s Day</a>, let’s not forget women in prison.</p>
<p>There are 3,088 women <a href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/justice/corrective-services">imprisoned in Australia</a> on any given day, representing 7.5% of the prison population. Aboriginal and Torres Strait Islander women are <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/corrective-services-australia/latest-release#:%7E:text=The%20Aboriginal%20and%20Torres%20Strait,from%20423%20persons%20last%20quarter.">over-represented</a> in these numbers.</p>
<p>Australia spends <a href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/justice/corrective-services">$4.44 billion</a> on prisons. Despite this, reproductive health care equivalent to that in the community is often not available where women are being detained.</p>
<p>This includes care related to <a href="https://search.informit.org/doi/abs/10.3316/ielapa.727381003357278">menstruation</a>, <a href="https://journals.lww.com/menopausejournal/Documents/Experiences%20of%20menopause%20during%20incarceration.pdf">menopause</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14837">contraception</a>, preventive health care such as <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-1155-3">cervical screening tests</a>, and <a href="https://www.osce.org/files/f/documents/f/b/427448.pdf">access to abortions</a>. </p>
<p>Adequate health care <a href="https://www.ohchr.org/sites/default/files/Documents/ProfessionalInterest/BangkokRules.pdf">during pregnancy</a>, <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">birth</a> and <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">after birth</a> is often unavailable in these prisons.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-un-committee-against-torture-has-found-australia-still-has-work-to-do-195420">The UN committee against torture has found Australia still has work to do</a>
</strong>
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<h2>Protecting women’s dignity and health</h2>
<p>Reproductive health care must be delivered in appropriate ways to those who require it. Aboriginal and Torres Strait Islander people require <a href="https://www.ahpra.gov.au/About-Ahpra/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/health-and-cultural-safety-strategy.aspx">culturally safe</a> health care, free from racism. There must also be inclusive care for <a href="https://yogyakartaprinciples.org/principle-9/">non-binary and transgender people</a>.</p>
<p>Failing to provide access to sanitary pads and tampons is a form of degrading treatment, according to the <a href="https://rm.coe.int/1680696a74">European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment</a>. It can leave women and people who menstruate <a href="https://www.wcl.american.edu/impact/initiatives-programs/center/documents/gender-perspectives-on-torture/">vulnerable to exploitation</a>. For example, limited access to sanitary pads can lead to them being traded for favours. </p>
<p>In addition to menstrual items, underwear also needs to be available for people in prison. A 2019 consultation by the <a href="https://www.qhrc.qld.gov.au/__data/assets/pdf_file/0003/17139/2019.03.05-Women-In-Prison-2019-final-report-small.pdf">Queensland Human Rights Commission</a> reported one woman’s experience of being detained in a Brisbane watch-house. The woman had to stick a menstrual pad to her tracksuit, because she was not given underwear. “There was blood everywhere,” the woman’s cellmate recalled. “They eventually gave her an incontinence nappy, and a clean pair of pants.” </p>
<p>The <a href="https://www.ics.act.gov.au/reports-and-publications/critical-incident-reviews/critical-incident-reviews/use-of-force-to-conduct-a-strip-search-at-the-alexander-maconochie-centre-on-11-january-2021">ACT Inspector of Correctional Services</a> conducted a review into the Alexander Maconochie Centre, a prison in Canberra. The review investigated the use of force during a strip search on an Aboriginal woman. The woman had become distressed after being advised she was not allowed to attend her grandmother’s funeral and participate in Sorry Business. She was menstruating at the time, and was a victim-survivor of sexual assault.</p>
<p>The woman described her experience: </p>
<blockquote>
<p>At this time I was menstruating heavily due to all the blood thinning medication I take on a daily basis. Here I ask you to remember that I am a rape victim. So you can only imagine the horror, the screams, the degrading feeling, the absolute fear and shame I was experiencing [during the strip search].</p>
</blockquote>
<p>On another issue at the same prison, the ACT office <a href="https://www.ics.act.gov.au/__data/assets/pdf_file/0011/2111888/11432RR-ACT-ICS-Healthy-Prison-Review-Nov-2022_Full-report_FA-tagged.pdf">recommended</a> “condoms, water-based lubricants and dental dams be made freely available in the units so detainees can access them without having to make a request to staff”. </p>
<p>In its prison review, the inspector had been told detained people in the Alexander Maconochie Centre wanting to practice safe sex were “making do” by “cutting open latex gloves”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-some-context-missing-from-the-mparntwe-alice-springs-crime-wave-reporting-199481">Here's some context missing from the Mparntwe Alice Springs 'crime wave' reporting</a>
</strong>
</em>
</p>
<hr>
<h2>Access to terminations and care following miscarriages</h2>
<p>The <a href="https://www.ohchr.org/sites/default/files/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf">United Nations Special Rapporteur on Torture</a> has stated “denial of legally available health services such as abortion and post-abortion care” amounts to “mistreatment of women seeking reproductive health services”. Forcing people to continue their pregnancy is a form of <a href="https://www.osce.org/files/f/documents/f/b/427448.pdf">sexual and gender-based violence</a>. </p>
<p>The <a href="https://rm.coe.int/1680696a74">European Committee for the Prevention of Torture</a> has affirmed that respect for a detained “woman’s right to bodily integrity” requires they have the same access to the “morning after pill and/or other forms of abortion at later stages of a pregnancy” as “women who are free.”</p>
<p>It is also crucial for <a href="https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2021/08/Womens-Expectations-FINAL-July-2021-1.pdf">people who miscarry</a> to be provided with the appropriate mental health and physical care.</p>
<p>Increased transparency and oversight is needed to ascertain whether minimum standards for reproductive health care are being met in Australian prisons. However, accounts from women in prison have <a href="https://apo.org.au/sites/default/files/resource-files/2020-04/apo-nid306852.pdf">indicated</a> access to even basic healthcare is often a challenge.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1589480262156447745"}"></div></p>
<h2>Birth and separation</h2>
<p>In Australia, there have been instances of an Aboriginal woman <a href="https://www.oics.wa.gov.au/wp-content/uploads/2018/12/Birth-at-Bandyup-Media-release.pdf">giving birth</a> alone in a locked prison cell while staff observed through the hatch. Another example featured attempts to remove a baby from their Aboriginal mother <a href="https://www.hrlc.org.au/news/2018/4/27/aboriginal-baby-to-stay-with-her-mother-at-bandyup-womens-prison">against medical advice</a> due to insufficient capacity at the prison. And an Aboriginal woman was <a href="https://www.vals.org.au/wp-content/uploads/2022/05/VALS-Submission-to-Inquiry-into-Children-of-Imprisoned-Parents-FINAL-version.pdf">denied</a> the right to bond with her newborn and breastfeed them.</p>
<p>Yet the UN <a href="https://www.ohchr.org/sites/default/files/Documents/ProfessionalInterest/BangkokRules.pdf">Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders</a> state women “shall not be discouraged from breastfeeding their children, unless there are specific health reasons to do so”. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1632873701581664257"}"></div></p>
<h2>We need more transparency in prisons, so we can fix these issues</h2>
<p>Implementation of the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/optional-protocol-convention-against-torture-and-other-cruel">UN Optional Protocol</a> to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment could bring attention to what is happening in Australian prisons. </p>
<p>This protocol calls for <a href="https://theconversation.com/why-has-a-un-torture-prevention-subcommittee-suspended-its-visit-to-australia-193295">regular visits</a> to places of detention by independent bodies to prevent ill-treatment of detained people, including denial of reproductive health care.</p>
<p>But <a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">in January</a> Australia missed its implementation deadline. Australia is currently at risk of being added to the <a href="https://www.ohchr.org/en/treaty-bodies/spt/non-compliance-article-17">UN list of non-compliant countries</a>. Australian commonwealth, state and territory governments have some work to do before this tool can be effectively used to prevent mistreatment of incarcerated women.</p>
<p>And while shining a light in the dark corners of prisons is essential, there are concrete steps governments can take now to improve reproductive health care and provide community-equivalent care. </p>
<p>These include ending the <a href="https://www.theguardian.com/australia-news/2023/jan/20/people-before-profits-victoria-to-ditch-private-health-providers-in-womens-prisons">privatisation of prison health care</a>, having <a href="https://www.coronerscourt.vic.gov.au/sites/default/files/2023-02/COR%202020%200021%20-%20Veronica%20Nelson%20Inquiry%20-%20Form%2037%20-%20Finding%20into%20Death%20with%20Inquest%20-%2030%20January%202023%20-%20Amended.pdf">accessible health services</a> provided by Aboriginal Community Controlled Health Organisations, and reducing the number of women who are incarcerated in the first place.</p><img src="https://counter.theconversation.com/content/200656/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreea Lachsz is currently contracted to the ACT government as the ACT National Preventive Mechanism (NPM) Coordination Director. The opinions expressed herein are those of the author and do not necessarily reflect those of ACT government, ACT NPM or any extant policy.</span></em></p>Despite Australia spending so much money on prisons, incarcerated women’s reproductive health care is lacking to the point of being degrading.Andreea Lachsz, PhD Candidate, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992282023-02-21T13:25:09Z2023-02-21T13:25:09ZFlorida will no longer ask high school athletes about their menstrual cycles, but many states still do – here are 3 reasons why that’s problematic<figure><img src="https://images.theconversation.com/files/510662/original/file-20230216-20-2sy4zs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If female athletes have to answer menstruation-related questions in order to play team sports, that could be a form of sex-based discrimination. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/arvada-and-columbine-face-off-at-jeffco-stadium-in-lakewood-news-photo/1431460237">AAron Ontiveroz/MediaNews Group/The Denver Post via Getty Images</a></span></figcaption></figure><p><a href="https://www.forbes.com/sites/brucelee/2022/10/05/florida-high-schools-are-asking-female-athletes-5-questions-about-their-menstrual-periods/">Concerns are being raised</a> across the U.S. about whether schools have a right to compel female athletes to provide information about their menstrual cycles.</p>
<p>The <a href="https://fhsaa.com/index.aspx">Florida High School Athletic Association</a> Board of Directors <a href="https://www.palmbeachpost.com/story/news/education/2023/02/07/florida-legislators-call-on-fhsaa-to-scrap-menstrual-history-questions/69882335007/">rejected a proposal</a> in February 2023 that would have required high school girls to answer <a href="https://fhsaa.com/documents/2023/1/19//SMAC_PPE_Draft_1_17_2023.pdf?id=3887">four questions about their menstrual cycles</a> in order to play on school sports teams. The questions had previously been optional.</p>
<p>The four questions were: Have you had a menstrual cycle? How old were you when you had your first menstrual period? When was your most recent menstrual period? How many periods have you had in the past 12 months? </p>
<p>The answers, along with the rest of students’ medical history, would have been entered into an online platform and stored on a third-party database called <a href="https://www.aktivate.com/">Aktivate</a>. <a href="https://www.nytimes.com/2023/02/09/us/florida-student-athlete-periods.html">School personnel</a> would have had access to this information.</p>
<p>While Florida decided to scrap the questions from their student forms, many states currently ask similar questions of their female athletes prior to participation in their sport.</p>
<p>As researchers who are experts in <a href="https://scholar.google.com/citations?user=dYfhb9sAAAAJ&hl=en">Title IX</a>, sports and health care equity, and <a href="https://law.umn.edu/profiles/david-schultz">constitutional law</a>, we have identified three reasons why schools and states tracking female athletes’ menstrual history may conflict with federal laws.</p>
<p><iframe id="M8CbI" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/M8CbI/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>1. It may violate federal anti-discrimination law</h2>
<p><a href="https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html">Title IX</a>, a federal policy passed in 1972, prohibits federally funded schools from discriminating against students based on sex, sexual orientation or gender identity. The goal of the policy is to <a href="https://www.ed.gov/news/press-releases/us-department-education-releases-proposed-changes-title-ix-regulations-invites-public-comment">end sex discrimination, sex-based harassment and sexual violence </a> in education.</p>
<p>While Title IX applies to all school settings, it is <a href="https://doi.org/10.1123/wspaj.2022-0053">often most associated with athletics</a>. </p>
<p>Requiring female student-athletes to submit menstrual cycle data to their schools could be a form of <a href="https://www2.ed.gov/policy/rights/guid/ocr/sexoverview.html">sex discrimination</a> and therefore violate <a href="https://www.nfhs.org/articles/nine-ways-title-ix-protects-high-school-students/">Title IX</a>. The reason it is potentially discriminatory is because girls are the only students at risk of being denied the opportunity to play sports if they choose not to provide schools with details about their menstrual cycles.</p>
<p>In a <a href="https://scholarworks.law.ubalt.edu/cgi/viewcontent.cgi?article=2114&context=all_fac">2020 Harvard Journal of Law and Gender study</a>, three scholars argue that schools should create educational settings free of “unnecessary anxiety about the biological process of menstruation.”</p>
<p>“Because menstruation is a biological process linked to female sex,” they write, “educational deprivations connected with schools’ treatment of menstruation should be understood as a violation of Title IX’s core proposition.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Screenshot of a medical form with questions about menstrual history" src="https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510680/original/file-20230216-18-n8pjoe.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Questions about students’ menstrual history were removed from the Florida High School Athletic Association’s physical evaluation form.</span>
<span class="attribution"><a class="source" href="https://fhsaa.com/documents/2023/1/19//SMAC_PPE_Draft_1_17_2023.pdf?id=3887">Florida High School Athletic Association</a></span>
</figcaption>
</figure>
<h2>2. It threatens constitutional rights</h2>
<p>Tracking female athletes’ menstrual history may be downright unconstitutional. </p>
<p>Forcing only females to disclose private medical information may violate the <a href="https://constitutioncenter.org/the-constitution/amendments/amendment-xiv/clauses/702">equal protection clause</a> of the <a href="https://constitution.congress.gov/browse/essay/amdt14-S1-8-8-1/ALDE_00000830/">14th Amendment</a> of the U.S. Constitution, which prohibits sex-based discrimination.</p>
<p>Also, <a href="https://www.npwomenshealthcare.com/privacy-rights-in-state-constitutions-may-protect-their-abortion-access/">11 states</a> have a “right to privacy” written into their state constitutions. For example, the <a href="https://www.flsenate.gov/laws/constitution#A1S23">Florida Constitution</a> states that “all natural persons, female and male alike, are equal before the law and have inalienable rights,” including “the right to be let alone and free from governmental intrusion into the person’s private life.”</p>
<p>While other states do not explicitly provide a right to privacy in their constitutions, legal precedent has determined that this right is <a href="https://www.dataguidance.com/jurisdiction/arkansas">implicit in the U.S. Constitution</a>.</p>
<p>And finally, federal laws that protect <a href="https://www.cdc.gov/phlp/publications/topic/hipaa.html">medical</a> and <a href="https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html">educational</a> records do not have <a href="https://rems.ed.gov/docs/2019%20HIPAA%20FERPA%20Joint%20Guidance.pdf">standards</a> for maintaining medical records that are shared with schools and stored on third-party databases. This lack of precedent may result in privacy breaches.</p>
<h2>3. It could be used against transgender students</h2>
<p>The recent passage of several anti-LGBTQ+ policies in Florida made the Florida High School Athletic Association’s attempts to track and digitally store menstrual data particularly worrisome to trans rights advocates.</p>
<p>In June 2021, Gov. Ron DeSantis <a href="https://www.flsenate.gov/Session/Bill/2021/1028">signed a bill</a> <a href="https://www.npr.org/2021/06/02/1002405412/on-the-first-day-of-pride-month-florida-signed-a-transgender-athlete-bill-into-l">prohibiting trans girls from playing on girls athletic teams</a>. </p>
<p>In March 2022, DeSantis signed the Parental Rights in Education bill, better known as the <a href="https://www.npr.org/2022/03/28/1089221657/dont-say-gay-florida-desantis">“Don’t Say Gay” bill</a>. It prohibits classroom instruction on sexual orientation and gender identity in K-3 public school classrooms. </p>
<p>And just one week after the proposed mandate was struck down, a <a href="https://www.tampabay.com/news/florida-politics/2023/02/16/fhsaa-desantis-board-private-homeschool-prayer-announcements-menstrual/">Florida House committee advanced a bill</a> that would place the Governor’s office in control of the Florida High School Athletic Association.</p>
<p>As more states try to <a href="https://apnews.com/article/ron-desantis-health-business-florida-government-and-politics-78e417a184718de8b9e71ff32efbc77f">ban trans youth from receiving gender-affirming medical care</a> – including hormone therapy, surgical procedures and other treatments – menstrual tracking in athletes could serve as another mechanism to harm and criminalize transgender youth. </p>
<p>Tracking menstrual cycles could “out” trans youth if they are required to disclose information about their menstrual cycle – whether that is the presence or absence of a cycle. If a school is responsible for outing trans kids, they violate both <a href="https://www.aclu.org/news/lgbtq-rights/trans-students-should-be-treated-with-dignity-not-outed-by-their-schools">constitutional rights</a> and <a href="https://www.knowyourix.org/college-resources/title-ix-protections-lgbtq-students/">Title IX policy</a>, and they risk endangering the outed students’ welfare. </p>
<h2>Protecting period privacy</h2>
<p>While the proposed Florida mandate was rejected, we have found that most states do in fact collect data on high school athletes’ menstrual cycles. </p>
<p>Based on our collection of sports pre-participation forms, only four states – Mississippi, New Hampshire, New York and Oklahoma – as well as Washington, D.C., do not currently ask any questions about menstrual history on the sport pre-participation medical forms provided by their state athletic association. </p>
<p>Following the vote on the Florida proposal, <a href="https://www.news-press.com/story/news/education/2023/02/09/congress-introduces-menstrual-questions-legislation-aimed-at-florida/69889797007/">three House Democrats introduced legislation</a> called the Privacy in Education Regarding Individuals’ Own Data Act, or <a href="https://www.washingtonexaminer.com/news/house/schiff-omar-bill-menstruation-desantis">PERIOD Act</a>. It would prohibit schools from collecting menstrual information altogether. </p>
<p>If this legislation is adopted, the estimated <a href="https://www.nfhs.org/media/5989280/2021-22_participation_survey.pdf">3 million American high school girls</a> who play sports in a state that still asks about menstrual history will no longer have to share this information.</p><img src="https://counter.theconversation.com/content/199228/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 organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When schools ask student-athletes about their menstrual cycles, they may be infringing on anti-discrimination and privacy laws.Lindsey Darvin, Assistant Professor of Sport Management, Syracuse UniversityDavid Schultz, Professor of Political Science, Hamline University Tia Spagnuolo, Doctoral Student in Community Research and Action, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952452023-01-24T12:48:29Z2023-01-24T12:48:29ZSolving period poverty is about more than just making products free<figure><img src="https://images.theconversation.com/files/505623/original/file-20230120-16-dyu9td.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-caucasian-woman-reaches-top-shelf-2053114151">STEKLO</a></span></figcaption></figure><p>Upwards of <a href="https://www.unicef.org/press-releases/billions-people-will-lack-access-safe-water-sanitation-and-hygiene-2030-unless">2.8 billion people</a> do not have access to safe sanitation. <a href="https://www.theguardian.com/society/2015/jul/01/billions-have-no-access-to-toilets-says-world-health-organisation-report">A third</a> of the world’s population doesn’t have a toilet.</p>
<p>This broad, international issue links to poverty, destitution and environmental risk. It also provides the backdrop to the struggles women and girls the world over face in dealing with their period. At least <a href="https://www.worldbank.org/en/news/feature/2018/05/25/menstrual-hygiene-management">500 million</a> women and girls lack access to adequate facilities to manage menstruation. </p>
<p>“Period poverty” describes these <a href="https://theconversation.com/it-will-take-a-lot-more-than-free-menstrual-pads-to-end-period-poverty-120189">barriers</a>, from the cost of sanitary products and access to toilets to being excluded from activities ranging from the <a href="https://www.theguardian.com/commentisfree/2017/dec/19/british-girls-period-poverty-menstruation-sanitary-products">classroom</a> to <a href="https://www.globalcitizen.org/en/content/period-poverty-sports-study-uk/">sport</a>. But the challenges <a href="https://theconversation.com/it-will-take-a-lot-more-than-free-menstrual-pads-to-end-period-poverty-120189">don’t stop there</a>. </p>
<p>Research shows that in communities shaped by repressive <a href="https://link.springer.com/book/10.1007/978-1-349-21176-0">patriarchal</a> systems, menstruating is still seen as a <a href="https://theconversation.com/it-will-take-lot-more-than-free-period-products-to-end-stigma-around-menstruation-151711">taboo</a> subject. And with that comes shame and embarrassment. Further, when you’re young and just getting used to having a period in the first place, commercial advertising that, as Australian communication design expert Jane Connory <a href="https://researchbank.swinburne.edu.au/file/0d14c97b-4ad3-44c2-9462-053a15a7c01a/1/2021-connory-sanitary_secrets_exhibition.pdf">has shown</a>, sexualises or suggests needing to keep your period a secret, is damaging.</p>
<figure class="align-center ">
<img alt="Period products in containers on a bathroom shelf" src="https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505116/original/file-20230118-22-4ignci.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">Free period products are a big step forward.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tampons-menstrual-pads-on-counter-bathroom-2069245310">New Africa</a></span>
</figcaption>
</figure>
<h2>Why free products are only part of the solution</h2>
<p>In Britain, it is estimated that up to <a href="https://borgenproject.org/top-10-facts-about-period-poverty-in-the-uk/#:%7E:text=An%20estimated%2049%20percent%20of%20girls%20have%20missed,or%20discussing%20their%20period%20in%20an%20academic%20setting">49%</a> of girls have missed school due to their period. This appears to be primarily linked to the cost of period products. The simple solution, here, is to make these accessible and free. </p>
<p>Of the four UK nations, <a href="https://theconversation.com/ending-period-poverty-scotlands-plan-for-free-menstrual-products-shatters-taboos-and-leads-a-global-movement-103138">Scotland</a> in particular is taking steps towards this. Following a successful pilot scheme in Aberdeenshire, in 2018 the Scottish administration made <a href="https://www.gov.scot/news/providing-free-sanitary-products-1/">period products free</a> for people from low-income households across the nation.</p>
<p>Research shows, however, that money is only part of the problem. Many women and girls are <a href="https://www.proquest.com/docview/1987646421/30D311C7F210419FPQ/1?accountid=8630">socially disadvantaged</a>, with information and education about periods seriously lacking. </p>
<p>When shame is felt in relation to an issue, it results in people being reluctant to search out the information they need, to their own detriment. Embarrassment is compounded by a lack of adequate sex education, the latter often taught to girls only. </p>
<p><a href="https://plan-uk.org/media-centre/almost-half-of-girls-aged-14-21-are-embarrassed-by-their-periods">Research shows</a> that up to half of girls in the UK are embarrassed by their period and that support in school is lacking. According to the <a href="https://www.sexeducationforum.org.uk/news/blog/getting-timing-right-when-should-children-learn-about-periods">Sex Education Forum</a>, a charity focused on relationships and sex education, one in four young women did not learn about periods before they got theirs, a number which appears to be rising. <a href="https://theconversation.com/the-pandemic-made-period-poverty-worse-in-the-uk-but-also-led-to-new-ways-to-combat-it-175978">This may have</a> been <a href="https://plan-uk.org/sites/default/files/Documents/Policy/Reports%20and%20Briefs/plan-uk-state-of-girls-rights-coronavirus-report.pdf">further affected</a> by the <a href="https://theconversation.com/the-pandemic-made-period-poverty-worse-in-the-uk-but-also-led-to-new-ways-to-combat-it-175978">pandemic lockdowns</a> and resulting school closures. </p>
<p>Girls and women may be forced to lie about periods so as not to take part in certain activities, such as <a href="https://plan-uk.org/media-centre/almost-half-of-girls-aged-14-21-are-embarrassed-by-their-periods">physical education</a>, due to the <a href="https://www.ncbi.nlm.nih.gov/books/NBK565616/">taboo</a> and ingrained <a href="https://www.ncbi.nlm.nih.gov/books/NBK565666/">stigma</a> around periods that endure in wider society. This appears to stem from periods, historically, being framed as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463372/">a medical issue</a> rather than a positive indication of the natural workings of the reproductive system and body.</p>
<p>Opening up the dialogue across genders within relationships and improving sex education within schools is crucial. But business has a lot to answer for, too.</p>
<h2>How companies can make things worse</h2>
<p>Misguided advertising campaigns that seemingly aim to break down stigma often inadvertently feed into it instead. This compounds the feelings of shame that surround periods. </p>
<p>In November 2022, Tampax US <a href="https://twitter.com/tampax/status/1596512639332540417">deleted</a> a tweet from its official account, apologising for “messing up” and not being respectful while pledging to “do better”. The tweet, which <a href="https://www.msn.com/en-gb/news/newslondon/tampax-sparks-controversy-on-twitter-with-e2-80-98vulgar-e2-80-99-viral-tweet/ar-AA14sEYc">read</a>: “You’re in their DMs. We’re in them. We are not the same”, drew <a href="https://twitter.com/xjennaaaxo/status/1594846411497021441?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1594846411497021441%7Ctwgr%5E5afed50f119f9d6f37f8263eabe4be57449280e9%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.standard.co.uk%2Fnews%2Fuk%2Ftampax-tampon-twitter-viral-tweet-controversy-b1042046.html">particular ire</a> for appearing to sexualise the use of a tampon, referencing the social media trope of “sliding” into someone’s DMs – direct messaging them as a flirting strategy. </p>
<p>This messaging harked back to the 1970s <a href="https://theconversation.com/friday-essay-i-looked-at-100-ads-for-menstrual-products-spanning-100-years-shame-and-secrecy-prevailed-152685#:%7E:text=Even%20during%20the%201970%20and%201980%E2%80%99s%2C%20sexist%20and,Weekly%20sexualises%20a%20prepubescent%20girl%20to%20sell%20tampons">adverts</a> for Dr White’s which showed women in bikinis and underwear to advertise sanitary products. In the 1980s, Tampax used scantily clad prepubescent girls to advertise its products. Decades on, in 2015, advertisers for Thinx period pants opted for pictures of halved grapefruit and runny eggs, <a href="https://www.thedrum.com/news/2020/10/12/gory-glory-the-evolution-period-advertising">imagery</a> suggestive of female anatomy. </p>
<p>Advertising that attempts to make sanitary products fun and edgy often links <a href="https://link.springer.com/chapter/10.1007/978-981-15-0614-7_24">periods to sex</a>. That’s because periods are profitable for those companies that make disposable products such as tampons and sanitary towels, and sex sells.</p>
<p>However, some girls start their periods as early as age nine, which makes such sexualisation of period products even more damaging. Research has shown that the common age for periods to start is indeed early, anywhere from <a href="https://pubmed.ncbi.nlm.nih.gov/12319855/">ten years old</a>. </p>
<p>What’s more, this type of advertising co-opts the language of empowerment for women and girls, thereby driving home the point about periods being something to be ashamed of. It can also be a subtle steer away from low-cost products such as menstrual cups, washable pads and period pants. </p>
<p>It is a common misconception that period poverty is only an issue for those who are menstruating. Many men and those who do not have periods also suffer as a result, either due to the financial impact of buying disposable products on a family’s budget, or the indirect impact that missed school and work days have on the wider class or workforce. </p>
<p>For many women and girls, menstruation can cause isolation and negatively affect their self-esteem and sense of dignity. Free period products and <a href="https://journals-sagepub-com.bham-ezproxy.idm.oclc.org/doi/full/10.1177/0095399713481601">being able to</a> deal with your period without shame or restrictions should be a basic human right.</p><img src="https://counter.theconversation.com/content/195245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie King-Hill 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>Free period products and being able to deal with your period without shame or restrictions should, however, be a basic human right.Sophie King-Hill, Senior Fellow at the Health Services Management Centre, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955782022-12-27T19:20:14Z2022-12-27T19:20:14Z6 non-fiction reads for kids this summer, recommended by kids aged 9 to 11<figure><img src="https://images.theconversation.com/files/499962/original/file-20221209-25000-8w73ee.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5607%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Drew Perales/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Kids are often gifted books for Christmas, but the trick is to get them to read them! </p>
<p>No one likes nagging their kids to read, though we know <a href="https://www.smh.com.au/education/read-the-room-it-s-time-to-act-on-our-children-s-literacy-20220904-p5bf7w.html">reading is crucial</a> to their <a href="https://www.cambridge.org/au/academic/subjects/education/teacher-training-and-professional-develop/english-and-literacies-learning-how-make-meaning-primary-classrooms">critical and literacy development</a>. </p>
<p>But what do <em>they</em> think about books and reading over the summer? Kids’ voices are often overlooked when it comes to cultural criticism. </p>
<p>For the past two years, I have been facilitating a children’s book club. In our most recent session, I asked the participants – aged 9 to 11 – to share their summer reading recommendations. </p>
<p><a href="https://www.bloomsbury.com/au/children-and-biography-9781350236370/">My research</a> has found that kids respond positively to non-fiction books in social reading environments. Reading non-fiction impacts positively on their civic and critical literacy. So, we focused on non-fiction recommendations.</p>
<p>These tips – straight from the kids themselves – might help adult readers to know what books to buy this Christmas, or to hunt out at the library over summer.</p>
<hr>
<h2>1. You Don’t Know What War Is: The Diary of a Young Girl from Ukraine by Yeva Skalietska</h2>
<p>This is <a href="https://www.bloomsbury.com/au/you-dont-know-what-war-is-9781526660138/">an eye-opening and heart-breaking story</a> about a 12-year-old girl called Yeva Skalierska, living through the Ukraine war of 2022. </p>
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<a href="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=908&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=908&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=908&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1142&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1142&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499963/original/file-20221209-19531-ygz235.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1142&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>A normal girl who loves school and spending time with friends, she suddenly goes through shelling and bombing right out the front of her own house. She travelled around Ukraine with her grandmother, and many other Ukrainians, trying to escape the war and danger. This book is Yeva’s personal diary account of the experiences of the war through her eyes. </p>
<p>I found it fascinating that a girl so similar to me can be going through something so drastically different. This is happening at this very moment, not in the history books, which makes me wonder why we have to have more war like this. This is a good book for anyone wanting to understand the impact of war on children and families and to put into perspective the things we might complain about that don’t really matter. </p>
<p><strong>– Chloe, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-must-read-books-about-russia-and-ukraine-our-expert-picks-179832">5 must-read books about Russia and Ukraine: our expert picks</a>
</strong>
</em>
</p>
<hr>
<h2>2. Goodnight Stories for Rebel Girls: 100 Inspiring Young Changemakers by Jess Harriton and Maithy Vu</h2>
<p>This is <a href="https://www.rebelgirls.com/products/100-inspiring-young-changemakers">the latest book</a> in the amazing <a href="https://www.rebelgirls.com/products/good-night-stories-for-rebel-girls">Goodnight Stories for Rebel Girls</a> series. </p>
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<a href="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=804&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=804&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=804&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1011&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1011&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499964/original/file-20221209-25181-s12rbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1011&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>The book contains 100 short stories about young changemakers. A changemaker is someone who has achieved something in the world to make it a little bit better. These changemakers are from all parts of the world with different abilities. </p>
<p>The book is introduced by conservationist Bindi Irwin. The subjects in this book include Greta Thunberg (activist), <a href="https://en.wikipedia.org/wiki/Isabella_Springmuhl_Tejada">Isabella Springmuhl</a> (fashion designer) and Zendaya (actor and singer). </p>
<p>I think this book is wonderful because this Rebel Girls book focuses on young people only. Young girls aren’t usually recognised as having an impact in the world, so that’s what makes this book special. People who read this will see how great young people are at making the world a better place.</p>
<p><strong>– Darcy, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/empathy-starts-early-5-australian-picture-books-that-celebrate-diversity-153629">Empathy starts early: 5 Australian picture books that celebrate diversity</a>
</strong>
</em>
</p>
<hr>
<h2>3. Welcome to Your Period by Melissa Kang and Yumi Stynes</h2>
<p>This is <a href="https://www.hardiegrant.com/au/publishing/bookfinder/book/welcome-to-your-period-by-yumi-stynes/9781760503512">a very informative book</a> about welcoming you to your period and what is going on with your body as you grow up and start changing into a young woman. The authors are two women that have experienced everything you’re starting to go through and know all the tricks to managing your period. </p>
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<a href="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=769&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=769&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=769&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=967&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=967&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499965/original/file-20221209-30762-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=967&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>They understand what you’re going through and how you may feel about the situation. The book makes you feel as if it’s nothing to worry or be scared about. The authors act like your big sisters; they’ll guide you and teach you everything you need to know about your body. They make you feel comforted, with different alternatives to manage your period to suit your body type, and help you talk to somebody you can trust and help you through that process. </p>
<p>I think that this book is a really great preparation for when you don’t have your period but when you feel like you need to start managing it or talking to a helpful adult who can help you through this tough time.</p>
<p><strong>– Arly, age 10</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-periods-can-come-as-a-shock-5-ways-to-support-your-kid-when-they-get-theirs-177920">First periods can come as a shock. 5 ways to support your kid when they get theirs</a>
</strong>
</em>
</p>
<hr>
<h2>4. Barefoot Kids by Scott Pape (2022)</h2>
<p><a href="https://www.harpercollins.com.au/9781460763650/barefoot-kids/">This book</a> is all about money and how to invest properly. It teaches you about money and how to use it a “smart” way. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499966/original/file-20221209-25362-uu9du9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
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<p>Usually, when I think of a book about money, I think “oh no I’m not reading that!”. But this book was super fun, exciting and interesting. I loved it. It included short interviews of children who started a business and got heaps of money. It was really inspiring and amazing for giving ideas. It had good instructions of what to do to earn money, and I found it interesting that children five and up can have their own business. </p>
<p>I definitely recommend this book to other kids aged nine and up, because I gave it to my cousin who is nine years old, and she loved it. It definitely helps children to be “smarter” with money than most adults. I think it would be very intriguing for kids with a short attention span. </p>
<p>It tells kids that they are the boss, while also telling them to get parents’ permission and help. It tells you how to separate money into four buckets and has apparently changed lives. I give this book a five-star rating.</p>
<p><strong>– Sienna, age 11</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teaching-kids-about-maths-using-money-can-set-them-up-for-financial-security-85327">Teaching kids about maths using money can set them up for financial security</a>
</strong>
</em>
</p>
<hr>
<h2>5. How to Speak Dog: a Guide to Decoding Dog Language by Aline Alexander Newman</h2>
<p><a href="https://www.harpercollins.com.au/9780008257910/how-to-speak-dog/">How to Speak Dog</a> is a fantastic book about how to communicate with dogs. This book tells you when your dog is sick, sad, happy or scared. It has many interesting facts about dogs. It even tells you how to deal with an aggressive dog and what to do if a dog attacks you. How to Speak Dog even has some pages on how to train your dog.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1126&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1126&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499967/original/file-20221209-28456-qh64s7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1126&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>I think people will like this book because it has lots of information about dogs and dogs are a common pet. They could have a new puppy with some bad habits, and they might need help training their pup. </p>
<p>I have a dog and this book was very helpful to me because I learnt from it that my dog is scared when he shows the whites of his eyes. My favourite thing about this book is that they have funny facts on every page. Facts like: “A dog can smell half a teaspoon of sugar dissolved in an Olympic sized swimming pool.”</p>
<p><strong>– Avery, age 9</strong></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-pat-or-not-to-pat-how-to-keep-interactions-between-kids-and-dogs-safe-182419">To pat or not to pat? How to keep interactions between kids and dogs safe</a>
</strong>
</em>
</p>
<hr>
<h2>6. Against all Odds: Young Readers’ Edition by Richard Harris and Craig Challen</h2>
<p>This is <a href="https://www.phoenixdistribution.com.au/against-all-odds-young-readers-edition">an interesting, educational, and suspenseful</a> book, with exhilarating and thrilling twists all through it. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=923&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=923&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=923&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1160&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1160&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499968/original/file-20221209-25682-10j1q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1160&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>(Editor’s note: the book tells the inside story of the cave rescue of a boys’ soccer team in Thailand, back in 2018. It’s written by the two Australian cave divers involved in the rescue.)</p>
<p>This book explained everything in great detail, giving the reader a real idea of what’s happening. I liked how they made the book extremely fascinating, and the authors went far to explain everything to an understandable degree. </p>
<p>I disliked how such a large chunk of the book was an autobiography about Craig and Richard. I would recommend this for 10-15 year olds, since younger children may not understand the complex vocabulary used in the book. I would rate it 7.5/10.</p>
<p><strong>– Molly, age 11</strong></p><img src="https://counter.theconversation.com/content/195578/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Douglas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How can you get your kids to read this summer? Research has found they respond well to reading non-fiction – so we’ve gathered 6 top non-fiction books, recommended by the kids themselves.Kate Douglas, Professor of English, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915112022-12-20T23:29:15Z2022-12-20T23:29:15ZHeavy periods are common. What can you do, and when should you seek help?<figure><img src="https://images.theconversation.com/files/501199/original/file-20221215-15837-s4jucz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Heavy-Menstrual-Bleeding-Clinical-Care-Standard.pdf">one in four women</a> of reproductive age experience heavy periods, also known as heavy menstrual bleeding. Periods are a very personal experience and women (and people with uteruses) who have had heavy periods for a long time will often consider this normal, or something to be simply put up with. </p>
<p>A woman with normal periods loses between six to eight teaspoons of blood with each period. On average, bleeding lasts for five days, but a normal period can last for up to eight days. Trying to work out the amount of blood loss can be tricky, but if you have <a href="https://wearwhiteagain.com.au/is-my-period-heavy/">any of these symptoms</a> you probably have heavy periods: </p>
<ul>
<li><p>bleeding through clothing </p></li>
<li><p>having to change pads and tampons every one to two hours </p></li>
<li><p>passing clots larger than a 50 cent coin </p></li>
<li><p>avoiding leaving the house on the heaviest days </p></li>
<li><p>periods that interfere with your physical, emotional, or social life. </p></li>
</ul>
<p>Many women with heavy periods also experience severe period pain. If you are having heavy periods, talking with your doctor can help you choose the right treatment option for you. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Causes</h2>
<p>Heavy periods are most often caused by: </p>
<ul>
<li><p>hormone-related problems. Causes include <a href="https://www.jeanhailes.org.au/resources/perimenopause-fact-sheet">perimenopause</a>, <a href="https://www.jeanhailes.org.au/resources/pcos-fact-sheet">polycystic ovarian syndrome</a>, or thyroid conditions</p></li>
<li><p>changes within the uterus (womb), such as <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Heavy-menstrual-bleeding.pdf">fibroids</a> or polyps (benign tissue growths from the wall of the uterus). Less commonly, cancer or precancerous changes may be the cause of heavy bleeding. Some of the red flags doctors look for are sudden changes in bleeding patterns or vaginal bleeding after menopause</p></li>
<li><p><a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Heavy-menstrual-bleeding.pdf">blood disorders</a>.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two images of wombs - one showing dangly growths, and one showing mounded growths." src="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501230/original/file-20221215-12-axdekc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Uterine polyps and fibroids.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Some women can have more than one contributing cause. However, around <a href="https://www.racgp.org.au/getattachment/b1da25d9-03e0-44b1-9622-bd75d2ef6fef/20041031farrell.pdf">half of women</a> with heavy bleeding will not have any recognisable cause, even after testing. Nevertheless, the symptoms will still need treating. </p>
<h2>Tests</h2>
<p>All women with heavy periods need to have some tests performed to establish the potential cause of their bleeding, and to guide the treatment options. This may include a: </p>
<ul>
<li><p>physical exam </p></li>
<li><p>cervical screening test, if not up-to-date </p></li>
<li><p>blood test to check for low iron levels, and possibly thyroid and clotting function </p></li>
<li><p><a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">pelvic ultrasound</a>.</p></li>
</ul>
<p>The doctor may suggest further tests, such as a test for chlamydia, pregnancy or a biopsy of the uterus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pad with blood and bloodclot" src="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501203/original/file-20221215-15837-kp93jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Passing clots larger than a 50 cent coin is a marker of heavy menstrual bleeding.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Treatments</h2>
<p>Don’t just put up with heavy periods, there are now many good treatment options. </p>
<p>You can consider starting initial treatment for heavy bleeding before your first visit to the GP. Oral non-steroidal anti-inflammatories such as ibuprofen or naproxen can be taken regularly from the first day of the period for up to five days. Many women are aware anti-inflammatories treat period pain, but they can also <a href="https://assets.jeanhailes.org.au/Tools/Heavy_menstrual_bleeding_tool.pdf">decrease the volume of bleeding by up to 50%</a>.</p>
<p>Another oral treatment for heavy bleeding which may be prescribed by your GP is <a href="https://www.nhs.uk/medicines/tranexamic-acid/">tranexamic acid</a>. This is taken for the first four days of the period. Anti-inflammatories and tranexamic acid can also be taken together. </p>
<p>Another effective medical treatment is the <a href="https://www.fpnsw.org.au/sites/default/files/assets/HORMONE%20RELEASING%20IUD.pdf">hormone-releasing IUD</a> (brand names Mirena and Kyleena). These provide reliable contraception and reduce bleeding. These can be inserted by a GP who has experience in IUD insertion, by a family planning clinic, or by a gynaecologist. </p>
<p>Oral hormonal options for treatment include the <a href="https://www.fpnsw.org.au/factsheets/individuals/contraception/combined-hormonal-contraceptive-pill">combined oral contraceptive pill</a> or <a href="https://www.healthnavigator.org.nz/medicines/n/norethisterone/">progesterone tablets</a>. </p>
<p>Another important part of treating heavy bleeding is replacement of iron stores if you’re deficient. You can try to increase your <a href="https://www.healthdirect.gov.au/how-to-meet-your-iron-needs-infographic">dietary iron intake</a>, but your GP may also recommend oral iron supplements. These can cause side effects such as constipation or nausea, so your GP may recommend an iron infusion instead. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in underwear holding her lower abdomen" src="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501204/original/file-20221215-22556-5pwq8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many options for treating heavy menstrual bleeding. Talk to your GP.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Do I need to see a specialist?</h2>
<p>Your GP may <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">refer you to a specialist</a> if there are red flags, an abnormality on the pelvic ultrasound or if the bleeding doesn’t improve after six months of trialling treatment. </p>
<p>The gynaecologist may offer a <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Hysteroscopy-pamphlet.pdf">hysteroscopy</a>, where a camera is inserted into the uterus. This can be used to treat abnormalities such as fibroids or polyps. </p>
<p><a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Endometrial-Ablation.pdf">Endometrial ablation</a>, where the lining of the uterus is purposefully damaged, can be used to reduce or completely cease monthly bleeding. But it’s not suitable for women who are planning a future pregnancy. </p>
<p>The final option for treating heavy bleeding is surgical removal of the uterus via <a href="https://ranzcog.edu.au/wp-content/uploads/2022/06/Hysterectomy-pamphlet.pdf">hysterectomy</a>. Historically, this was often used due to a lack of other treatments. While it does permanently resolve heavy bleeding, it has more risks than the other treatments, and is obviously not suitable for women who still wish to bear children. Hysterectomy is considered when other treatments are ineffective or inappropriate, or <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Consumer-Fact-Sheet-.pdf">at the patient’s request</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imagine-having-your-period-and-no-money-for-pads-or-tampons-would-you-still-go-to-school-156570">Imagine having your period and no money for pads or tampons. Would you still go to school?</a>
</strong>
</em>
</p>
<hr>
<h2>5 tips for getting help for heavy periods</h2>
<ol>
<li><p><strong>Don’t delay.</strong> See your GP if you think your periods are heavy or if they’re interfering with your work or personal life </p></li>
<li><p><strong>keep a diary</strong> of symptoms and track your cycle to help your GP understand your periods. Jot down some notes, fill out a period tracking chart or use a free app to keep track</p></li>
<li><p><strong>allow enough time.</strong> Make an appointment specifically to discuss your heavy periods and get answers to any questions you have. Consider making a double appointment</p></li>
<li><p><strong>don’t be embarrassed</strong> to discuss your symptoms or ask your GP questions. This is a common and important problem</p></li>
<li><p><strong>go back for review</strong> if your bleeding isn’t improving after starting treatment. It might be time to discuss other options.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191511/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around a quarter of women experience heavy periods. It probably seems normal to them, but it’s not something you just have to put up with.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyBianca Cannon, GP and Lecturer at Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1913522022-11-24T19:06:08Z2022-11-24T19:06:08ZFrom sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms<figure><img src="https://images.theconversation.com/files/488439/original/file-20221006-20-jjy784.jpg?ixlib=rb-1.1.0&rect=8%2C51%2C5742%2C3776&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Period pain is a common symptom of the menstrual cycle, affecting about <a href="https://www.liebertpub.com/doi/10.1089/jwh.2018.7615">70% of young women</a> – but it’s far from the <a href="https://www.dovepress.com/the-comorbidities-of-dysmenorrhea-a-clinical-survey-comparing-symptom--peer-reviewed-fulltext-article-JPR">only symptom</a>.</p>
<p>Here are five lesser-known symptoms associated with the menstrual cycle – and what’s going on in your body to cause them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>1. Bowel disturbances (period poos)</h2>
<p>Some people experience disturbances in their bowel habits leading up to their period and this commonly manifests as <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a>.</p>
<p>This happens because when you menstruate, your body releases a special chemical called prostaglandins. Prostaglandins help the uterus to cramp, which helps push menstrual blood out of the uterus and into the vagina so it can leave the body.</p>
<p>When you get period pain (especially if a person has endometriosis) a nerve in the back called the <a href="https://youtu.be/O172DUJ-_BY">dorsal root ganglion</a> is activated. </p>
<p>This can cause a range of symptoms, including back pain. This same process can make the bowel sensitive, which can lead to bowel pain or irritable bowel syndrome and contributes to changes in bowel habits like <a href="https://link.springer.com/article/10.1186/s12905-020-01000-x">diarrhoea</a> or constipation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman sits on the toilet." src="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488442/original/file-20221006-26-jjy784.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people experience disturbances in their bowel habits leading up to their period.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-using-her-cellphone-while-in-the-toilet-7623575/">Photo by Miriam Alonso/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>2. Stabbing pains</h2>
<p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. </p>
<p>For some, this pain can shoot up the vagina or back passage.</p>
<p>This is related to the cramping that occurs when prostaglandins are released in the body and the nerve in the back (the dorsal root ganglion) is activated. </p>
<p>This can trigger spasms of the pelvic floor muscles (a group of muscles in the bottom of the pelvis that supports the bladder, bowel and uterus).</p>
<p>Seeing a <a href="https://www.endozone.com.au/treatment/53">pelvic health physiotherapist</a> and learning to relax these <a href="https://www.endozone.com.au/treatment/pelvic-floor-muscle-relaxation">muscles</a> can help manage this type of pain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman clasps her thigh as if in pain." src="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488449/original/file-20221006-22-x9wcn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>3. Fatigue</h2>
<p>It’s common to feel a bit run down around the time of your period. But for some people this can go beyond just regular tiredness.</p>
<p>A recent <a href="https://www.ajog.org/article/S0002-9378(19)30427-2/fulltext">survey</a> of 42,879 women showed about 70% experience this symptom. It is often <a href="https://doi.org/10.1186/s41687-020-00200-1">described</a> as feeling “exhausted”, “drained”, “tired”, “lethargic”, “worn out”, and/or “weak”.</p>
<p>Fatigue can be due to the brain’s experience of pain. We can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698023/">measure</a> changes in the brain when people experience pelvic pain. Ongoing <a href="https://youtu.be/O172DUJ-_BY">pain signalling</a> to the brain causes these changes, which results in extreme tiredness and sometimes headaches and nausea.</p>
<p>Having a <a href="https://www.endozone.com.au/endometriosis-related-fatigue">good sleep schedule</a>, exercising and eating well can help with fatigue.</p>
<h2>4. Ovulation pain</h2>
<p>Ovulation occurs when a mature egg is released from the ovary. </p>
<p>During this time, estrogen levels are high, and a lot of clear watery mucus is produced by cells in the cervix (which is why seeing extra clear watery mucus at this time is a sign ovulation is approaching). </p>
<p>Most people feel pretty good when their estrogen levels are high. But when the follicle the egg is in gets bigger near ovulation, the pressure of the follicle and its release can cause pain. This ovulation pain is sometimes called <a href="https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122#:%7E:text=Mittelschmerz%20is%20one%2Dsided%2C%20lower,doesn't%20require%20medical%20attention.">mittelschmerz</a>, which is German for “middle pain”.</p>
<p>This can feel like a sharp, relatively short-lived stabbing pain in the lower abdomen on one side.</p>
<h2>5. Mood changes</h2>
<p>Between <a href="https://doi.org/10.2147/JPR.S179409">50%</a> and <a href="https://doi.org/10.1016/j.ajog.2019.02.048">70%</a> of people who have periods experience changes to their mood leading up to or during their period.</p>
<p>But for between <a href="https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x04_Depressive_Disorders">1-5%</a> of people, the impacts on mood can be more severe and may be associated with a condition called premenstrual dysphoric disorder (PMDD).</p>
<p>This occurs when people experience severe mood changes, anxiety or depression in the week before their period, which usually improves within a few days of their period starting.</p>
<h2>When should you see a doctor?</h2>
<p>Symptoms vary so much between people, there is a huge range of “normal” and it can be tricky to decide when to follow up with your doctor. But it is worth chatting to a GP if:</p>
<ul>
<li><p>your period pain interrupts daily activities such as work, school or caring responsibilities</p></li>
<li><p>the pain associated with your cycle is severe or changes</p></li>
<li><p>you have difficulty going to the bathroom, pain with urination or bowel movements or your bowel habits change</p></li>
<li><p>you feel emotionally or mentally overwhelmed</p></li>
<li><p>you experience pelvic pain at other times (outside of your period).</p></li>
</ul>
<p>When these symptoms are severe, they can be due to conditions such as endometriosis.</p>
<p><a href="https://www.endozone.com.au">EndoZone</a> – an evidence-based website co-created with people affected by endometriosis – has a <a href="https://www.endozone.com.au/health-report-form#no-back">self-test</a> for people trying to decide if their period symptoms require further medical care, and tips on how to describe them to a doctor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-10-girls-skip-class-because-of-painful-periods-and-most-wont-talk-to-their-teacher-about-it-150286">3 out of 10 girls skip class because of painful periods. And most won't talk to their teacher about it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca O’Hara received funding from the Department of Health (Commonwealth) and Jean Hailes for Women’s Health for the development of EndoZone. </span></em></p><p class="fine-print"><em><span>Louise Hull received funding from the Department of Health (Commonwealth) and Jean Hailes for Women's Health for the development of EndoZone. She is affiliated with Endometriosis Australia (Medical Advisory Board). </span></em></p>Sometimes, the arrival of your period can come with stabbing pains down the legs, abdomen or into the buttocks. For some, this pain can shoot up the vagina or back passage.Rebecca O'Hara, Grant Funded Researcher: Endometriosis, Robinson Research Institute, University of AdelaideLouise Hull, Professor and Endometriosis Group Leader, The Robinson Research Institute, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920692022-10-24T14:58:38Z2022-10-24T14:58:38ZIn China, a debate over sanitary pads on trains reflects long-held beliefs about women and menstruation<figure><img src="https://images.theconversation.com/files/490418/original/file-20221018-12-6bd51t.jpg?ixlib=rb-1.1.0&rect=107%2C71%2C5856%2C3458&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/menstrual-tampon-pad-isolated-on-red-721566655">tommaso79 / Shutterstock</a></span></figcaption></figure><p>Discrimination against and repression of women is a global problem. In authoritarian states, it is also intertwined with regime survival. Take recent events in Iran, where women-led protests against strict hijab laws are <a href="https://theconversation.com/iran-hijab-protests-challenge-legitimacy-of-islamic-republic-191958">challenging the country’s ruling powers</a>. Nearly 3,000 miles away in China, a different feminist debate is taking hold, over whether sanitary pads should be sold on high-speed trains.</p>
<p>This debate was kindled on September 16 2022 on the Chinese social media site Weibo. A woman <a href="https://weibo.com/6004281123/M5ZCL0FJt">posted about her irritation</a> at not being able to purchase period products while travelling on the country’s high-speed rail network: “I don’t want more women to feel embarrassed, so I’m bringing this up in the hope that it may be addressed”. </p>
<p><a href="https://www.scmp.com/news/people-culture/trending-china/article/3193156/sorry-only-snacks-and-souvenirs-china-railways">China Railway responded</a> that feminine pads were private items that women should prepare for themselves in advance. <a href="https://weibo.com/1591684244/M61m92hjv?refer_flag=1001030103_">Some commenters</a> agreed that it was “inappropriate” and “dirty” to sell sanitary pads on trains. “Only food is served on train. You don’t want sanitary pads sold alongside food, do you?” one wrote. Comments revealed an ignorance among men about menstruation, notably evidenced by the <a href="https://weibo.com/1846455225/MavT27mcw">question</a> “why can’t women just hold it in?”</p>
<p>In China, menstruation <a href="https://www.sciencedirect.com/science/article/abs/pii/S1521693416301250">taboo</a> has roots in a traditional culture that associates the physiological phenomenon with bad luck and uncleanness. Women are excluded during their menstruation from entering public realms such as temples, ceremonies and ancestral halls. Even today, menstruating women are still not allowed to <a href="https://radii.co/article/menstrual-period-poverty-shame-china">honour the dead</a> in some rural areas.</p>
<p>Some accused women of demanding privileges and <a href="https://weibo.com/2590306201/M67GGDMY0?refer_flag=1001030103_">extra rights</a> by asking for period products to be sold. “Women need feminine pads, so they require that high-speed trains MUST sell those products. It is a <a href="https://weibo.com/1786902461/M64kqwTac?refer_flag=1001030103_">hegemonic logic</a>”, said a male Chinese social media user with 889,000 followers. <a href="https://m.weibo.cn/status/4814635163452012">Opponents</a> of selling feminine pads on high-speed trains call this demand “pseudo” feminism and dismiss it as taking advantage of feminist movements. </p>
<h2>Feminism and ‘pseudo’ feminism</h2>
<p>In China, the post-2000 growth of consumer culture and the internet has converged with an influx of post-feminist ideas from the west. In such an environment, female digital influencers often use feminist ideals to attract followers on social media. In what’s been critiqued as “pseudo-feminism”, some influencers have been known to
<a href="https://link.springer.com/book/10.1007/978-3-030-59969-0">encourage their female followers</a> to use their “gender strengths”, such as delicate or fragile beauty, biological vulnerabilities, and sexual attractions, to “tame” men in both romantic relationships and workplaces. </p>
<p>This particular brand of feminism, while seeking to help women achieve “happiness” and “success”, reinforces traditional gender roles at the expense of women’s wellbeing and social needs. While this criticism is justified in some cases, some opponents have used the label “pseudofeminism” to <a href="https://www.tandfonline.com/doi/abs/10.1080/14680777.2022.2075909">stigmatise entire feminist movements</a>. In this debate, some <a href="https://weibo.com/2876764851/M6x1V1HrK">opponents</a> consider proponents to be “pseudo-feminists”. They argue that truly independent women should be responsible for preparing feminine pads in advance for themselves, rather than taking advantage of their biological vulnerabilities to force companies to provide products specially for them, just as they use “female gender strengths” to “tame” men in relationships. </p>
<figure class="align-center ">
<img alt="A Chinese woman films herself on a mobile phone, she is holding her hands up around her face and a number of beauty products are on the desk in front of her" src="https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490413/original/file-20221018-8251-2h6fgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some say female influencers are peddling ‘pseudo-feminism’ to followers in China.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-brunette-shoulder-length-hair-female-2152426121">aslysun / Shutterstock</a></span>
</figcaption>
</figure>
<p>There is a similar dynamic in the disconnect between the positive and negative perceptions of menstruation that persist in China. Menstrual blood is not only considered dirty but also <a href="https://www.jstor.org/stable/3814221#metadata_info_tab_contents">polluting</a>, posing a danger to those come into contact with it. This is the basis for the argument that sanitary pads should not be sold alongside food. </p>
<p>At the same time, the celebration of menstruation as a symbol of female fertility reduces women to their reproductive function. “Menstruation is the basis of fertility. For thousands of years, human life and civilisation were born from menstruation”, said one <a href="https://weibo.com/5948735783/M6hv4rTWJ?refer_flag=1001030103_">social media user</a> defending the sale of sanitary pads on trains. The former reflects the misogyny of Chinese society, while the latter panders to the regime’s policy of incentivising women to have more children to address the current <a href="https://blogs.soas.ac.uk/china-institute/2022/10/14/why-is-china-banning-boys-love-bl-and-what-should-we-care/">population crisis</a>. While the debate over sanitary pads may appear trivial, it reflects a much wider structural system that hurts mothers and all women.</p>
<p>On October 3 2022, a social media user happily <a href="https://chinadigitaltimes.net/chinese/687831.html">posted</a> that she was able to find sanitary pads being sold on another high-speed train. While it’s not clear if there was a change in policy or simply a positive decision by a different <a href="https://www.thenanjinger.com/news/nanjing-news/sanitary-pad-sales-controversy-eased-by-train-out-of-nanjing/">train line</a>, the discussion and responses from influential social media users shows that gender equality and changing menstruation stigma has a long way to go in China.</p><img src="https://counter.theconversation.com/content/192069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chi Zhang receives funding from British Academy. This research is conducted together with Ming Zhang of the UK-China Media and Cultural Studies Association, who made important contributions to this piece. </span></em></p>Social media commentary about the sale of menstrual products on trains is a glimpse into modern feminist debates in China.Chi Zhang, British Academy Postdoctoral Fellow, University of St AndrewsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927112022-10-18T17:51:42Z2022-10-18T17:51:42ZMenopause can affect every workplace – here’s how to start supporting every worker experiencing it<figure><img src="https://images.theconversation.com/files/490328/original/file-20221018-18-oism73.jpg?ixlib=rb-1.1.0&rect=51%2C51%2C5699%2C3776&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Working life.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-concentrating-working-her-home-office-1634689192">pixelheadphoto digitalskillet / Shutterstock</a></span></figcaption></figure><p>Menopause is receiving a wave of increased attention about its relevance to businesses and economic prosperity more broadly. Many high-profile <a href="https://www.theguardian.com/us-news/2020/aug/13/michelle-obama-menopause-account-spotify-podcast">initiatives</a>, including British TV presenter Davina McCall’s documentary, <a href="https://www.channel4.com/programmes/davina-mccall-sex-mind-and-the-menopause">Sex, Mind and the Menopause</a>, are working to increase people’s understanding of how symptoms can affect working lives. But whose menopausal workplace experiences are being taken into account to shape this understanding?</p>
<p>This was a question that my colleague <a href="https://www.linkedin.com/in/margaret-rees-38040912/?originalSubdomain=uk">Margaret Rees</a> and I asked ourselves recently when exploring the <a href="https://www.sciencedirect.com/science/article/abs/pii/S245196502200076X">evidence</a> about the diversity of menopause experience and work. And what we found was that how we think about menopause at work is heavily skewed towards the experience of women in professional occupations, and often those who are white and middle class.</p>
<p>Menopause is a shared yet unique time of life for women and people who menstruate. While menopause marks the one-year anniversary of a person’s final period, it often includes symptoms in the years running up to and after this time. Awareness, education and acceptance are key to supporting menopause at work.</p>
<p>But using a diversity lens suggests that the way people experience menopause at work can be significantly affected by socioeconomic position, ethnicity and racialised cultures. It can also be <a href="https://www.tandfonline.com/doi/abs/10.1080/14681994.2021.1881770?journalCode=csmt20">particularly complex</a> for people who go through menopause but do not identify as women. These are all groups that are already more likely to face discrimination at work, marginalisation in the labour market, and are more likely to be in poverty in later life.</p>
<p>One of our key findings is that we need to better understand and account for the menopausal experiences of those who are in low-paid and precarious modes of work. These areas of the labour market are often less likely to see provision and support that proactively challenges inequality or discriminatory practices surrounding menopause.</p>
<p>Research has found that socioeconomic conditions affect where women are located in the labour market as well as their experience of menopause. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611109/">reviews</a> suggest that women in manual jobs may experience more psychological menopausal symptoms such as anxiety or low mood than those in white-collar workplace settings. <a href="https://www.sciencedirect.com/science/article/pii/S0277953612002730">Others suggest</a> women in casual or irregular work will experience more muscular skeletal symptoms during the menopausal transition.</p>
<figure class="align-center ">
<img alt="Women ironing clothing in a laundromat dry cleaning service." src="https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490358/original/file-20221018-7404-c797sk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/johannesburg-south-africa-october-2-2012-1910148628">Sunshine Seeds / Shutterstock</a></span>
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<p>For many, there is a financial necessity that requires someone to continue working, even if experiencing severe symptoms. Estimates by the <a href="https://www.livingwage.org.uk/sites/default/files/The%20Insecurity%20Complex%20-%20Low%20Paid%20Workers%20and%20the%20Growth%20of%20Insecure%20work_1.pdf">Living Wage Foundation</a> also suggest that around 17% of women of typical menopausal age also experience insecure work (temporary contracts, agency work or self-employment, for example). This adds additional pressure at a time of life when they are more vulnerable to age and gender inequality – also called “<a href="https://www.forbes.com/sites/bonniemarcus/2021/09/20/gendered-ageism-affects-womens-job-security-and-financial-viability/?sh=2cc3ca772bc4">gendered ageism</a>” – in the workforce.</p>
<p>This is even more important for the economic landscape of menopause, given that those in lower socioeconomic groups or within minoritised ethnic communities in the UK are <a href="https://www.independentage.org/poverty-later-life-how-people-older-age-move-and-out-of-poverty-and-what-should-be-done-to-reduce">more likely to face</a> financial insecurity and poverty in later life. Such patterns are similar in OECD countries, such as Australia, where older women represent the <a href="https://www.mercyfoundation.com.au/our-focus/ending-homelessness/older-women-and-homelessness/">fastest-growing group</a> experiencing homelessness.</p>
<h2>Ethnicity and race</h2>
<p>As valuable resources such as <a href="https://www.thekarenarthur.com/menopausewhilstblack">Menopause whilst Black</a> and work by <a href="https://www.balance-menopause.com/menopause-library/034-menopause-taboo-in-women-from-different-ethnic-groups-dr-nighat-arif-dr-louise-newson/">Dr Nighat Arif</a> highlight, ethnicity and race is important to consider in relation to menopause. This is not only because of the experience of different menopausal symptoms and their differential effects such as hair thinning and melasma (skin pigmentation), or the impact of previous health episodes such as uterine fibroids, but also due to intersectional discrimination at work.</p>
<p>Checking inclusivity around menopause health access is also vital if we are to support all employees working through menopause. An employee’s ability and motivation to continue working is influenced by what health-related help, support or resources they feel are open or relevant to them during menopause. </p>
<p>For example, while hormone replacement therapy (HRT) is only one of many routes to support menopausal transition, those from <a href="https://www.sciencedirect.com/science/article/pii/S0306545600000760?casa_token=GjhOfgYkI6IAAAAA:Bi39HVG4C3QhMFnr62D9_tqEtPfwKFU4m2xtdZB8jXn17vaF_sbaXkRX5-HeYtvbvE7-HMWM">poorer backgrounds</a> or from <a href="https://link.springer.com/article/10.1046/j.1525-1497.1999.10118.x">minority ethnic groups</a> are far less likely to use this treatment, suggesting institutional or cultural barriers to access.</p>
<p>Black women are also less likely to have <a href="https://www.tandfonline.com/doi/full/10.1080/09581596.2017.1307323?casa_token=OVGc1cRgLU8AAAAA%3AFUAazOW2X3A_360yK1XJ02YD_nQCzMvnYTXb2bKsty8LhK49ajGN5RqgYbx9lRrwGOGajVGVOBg">affirming healthcare encounters</a> that can improve an ability to work through menopause. We lack published evidence about the experience of those from minority communities who do seek healthcare advice about menopause. But studies of other health-seeking experiences linked to a wide variety of conditions including <a href="https://link.springer.com/article/10.1007/s10826-015-0351-z">mental health</a> suggest they may be more likely to receive under-diagnoses, misdiagnoses and late diagnoses.</p>
<p>All of this is central to the economic consequences of menopause for black and minority ethnic groups who are already <a href="https://www.jrf.org.uk/report/poverty-ethnicity-labour-market">twice as likely to be in poverty</a> in the UK than white groups, and to be disproportionately represented in lower-paid employment.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1485929480006905860"}"></div></p>
<h2>Raising awareness and inclusivity</h2>
<p>The UK has made some positive inroads in highlighting menopause as a workplace concern. And the recent release of the concluding inquiry report by the government’s <a href="https://menopause-appg.co.uk/wp-content/uploads/2022/10/APPG-Menopause-Inquiry-Concluding-Report-12.10.22-1.pdf">All-Party Parliamentary Group on Menopause</a> recommended that “the government must coordinate and support an employer-led campaign to raise awareness of menopause in the workplace”. But without a clear inclusivity lens, a wider range of menopausal experiences will not be heard. </p>
<p>We also need to ensure all businesses consider supporting menopause as being in their interest. Calls for policy or legislation to make menopause a <a href="https://committees.parliament.uk/committee/328/women-and-equalities-committee/news/172500/new-report-mps-call-for-new-menopause-ambassador-to-keep-women-in-the-workplace/#:%7E:text=%22The%20omission%20of%20menopause%20as,a%20disability%2C%20to%20get%20redress.">protected characteristic</a> may not attract employers of those in low-paid or insecure workforce settings. They may view this as “another thing to do” simply to avoid litigation.</p>
<p>However, forums that have a low barrier or cost to entry for inclusive menopause and work information-sharing could help businesses of all sizes. The research community – myself included – can also do better by listening and generating evidence to show a more diverse menopause experience to government, the media and business.</p>
<p>Being sensitive in how we choose to represent menopause at work, as well as in social and political spaces, is important. But without more knowledge of the wide range of menopausal experiences that employees face, we can only reproduce a rather pale and privileged picture of menopause.</p><img src="https://counter.theconversation.com/content/192711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Riach receives funding from The British Academy. She sits of the Scottish Government's Menstrual Health and Menopause Advisory Group and advised the BSI (British Standards Institute) on their forthcoming Menstruation and Menopause in the Workplace Standard.</span></em></p>The information about how menopause affects workers should be more diverse.Kathleen Riach, Professor in Management,, University of GlasgowLicensed 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>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WOi2Bwvp6hw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The menstrual cycle can lead to highs and lows in mood and energy level.</span></figcaption>
</figure>
<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>
<figure>
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<figcaption><span class="caption">How to discuss the menstrual cycle with a young person.</span></figcaption>
</figure>
<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/1876172022-07-28T20:03:46Z2022-07-28T20:03:46ZPeople stationed in Antarctica menstruate too – and it’s a struggle. Here’s how we can support them<figure><img src="https://images.theconversation.com/files/476442/original/file-20220728-15-wakxb4.jpeg?ixlib=rb-1.1.0&rect=0%2C634%2C6134%2C3449&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>Women have been doing fieldwork in Antarctica for more than 40 years. Yet they comprise just 25% of expeditioners in the Australian Antarctic Program. Despite decades of progress, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209983">historical issues</a> with sexism and gender bias continue in extreme field environments set up for men. </p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2022.2066635">Managing menstruation</a>, in particular, is an overlooked challenge for women working in Antarctica and other extreme, male-dominated environments.</p>
<p>If we want to build a diverse and inclusive polar workforce, we need to openly and willingly address the challenges that women, trans and non-binary menstruators face in the field. </p>
<h2>Who gets to work in Antarctica?</h2>
<p>Over the decades, toileting has been a primary way for men to control who has access to extreme environments. For instance, until the late 1970s women were being told they couldn’t work in Antarctica because there were no <a href="https://www.tandfonline.com/doi/full/10.1080/2154896X.2017.1373915">facilities</a> for them on station. </p>
<p>Women have been similarly excluded from space travel because their hormonal bodies were deemed to be too <a href="https://heinonline.org/HOL/Page?handle=hein.journals/grggenl19&div=26&g_sent=1&casa_token=72OeEM7szM0AAAAA:tgtCvnSQJPkYNQRiCUBu4SVHPqarTDVPNFS2ZI2sgSY0puKfBMYxBU1OMh-qV56_rU8oclCo&collection=journals">unpredictable</a> by NASA’s male leaders.</p>
<p>Sally Ride’s 1983 mission on the Space Shuttle Challenger heralded a new era of progress for women’s access to Antarctic fieldwork. If women could go to space, they could certainly go to Antarctica! It was around this time the British, United States and Australian National Antarctic Programs began to <a href="https://www.tandfonline.com/doi/full/10.1080/2154896X.2017.1373915">allow women</a> to do fieldwork in Antarctica.</p>
<p>Ride’s mission also uncovered NASA’s inexperience with menstruation. In re-designing the space flight kit for her, NASA engineers famously asked Ride if <a href="https://www.nationalgeographic.co.uk/space/how-do-women-deal-with-having-a-period-in-space">100 tampons</a> would be enough for a one-week mission.</p>
<p>In my latest <a href="https://www.tandfonline.com/doi/abs/10.1080/0966369X.2022.2066635">research</a>, I spoke to dozens of women expeditioners about how they negotiated the hurdles associated with menstruating in Antarctica. They revealed that managing menstruation remains taboo, and has been made even more difficult by a culture of silence. </p>
<p>As one expeditioner told me:</p>
<blockquote>
<p>I haven’t had great conversations with other women because there haven’t been any that I’ve worked with. I’ve been very much by myself with these things.</p>
</blockquote>
<h2>Life as a woman expeditioner</h2>
<p>So why is menstruating in Antarctica difficult?</p>
<p>Well, for one, you can only toilet in certain places due to environmental protection laws. You must collect all your bodily waste in sealed containers, which are carried back to a station for incineration. </p>
<p>Because expeditioners may have to keep used menstrual products with them for several weeks in the field, they need to consider not only what products they will use, but how they will dispose of them. </p>
<p>Re-usable menstrual cups are often preferred because they produce no waste and can be left in the body longer (4-8 hours) than disposable products. However, cups must be emptied and <a href="https://www.mooncup.co.uk/blog/toxic-shock-syndrome/">cleaned</a> at least three times within 24 hours to minimise the risk of toxic shock syndrome.</p>
<p>As one expeditioner explained:</p>
<blockquote>
<p>Cups are amazing but [they are] also a huge learning curve. I started
learning to use them for [an expedition] because I’m like I can’t carry used tampons around in my bag anymore […] The hard thing is cleaning them discreetly.</p>
</blockquote>
<p>Menstruators must also be prepared to manage their menstruation in small, shared spaces. The women I interviewed described the complexity of doing this in male-dominated teams:</p>
<blockquote>
<p>The first time I went to Antarctica I was out on a boat […] It was me and [a group of] men. It’s my period and I’m like, oh, my god, what do I do here?</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Menstrual products line the supermarket shelves" src="https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476443/original/file-20220728-23-xvx9rw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women on the field in Antarctica work in extreme conditions, yet the onus is on them to figure out how to menstruate with limited resources, sanitation and support.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>All Antarctic expeditioners wear many thick layers to protect themselves from the extreme conditions. However, women need to be able to change menstrual products without exposing their skin to the cold for prolonged periods. The participants in my study came up with creative ways to cope: </p>
<blockquote>
<p>I sewed myself underpants that I could Velcro on the side so that I didn’t have to take all the layers off my legs and my feet to change my undies…</p>
</blockquote>
<p>To avoid these challenges during long-duration expeditions, menstruators often rely on menstrual suppression <a href="https://theconversation.com/how-women-can-deal-with-periods-in-space-58294">technologies</a>. These include the combined oral contraceptive pill, or long-acting reversible contraception (LARC) such as an intrauterine device or injection. </p>
<p>These methods prevent a period and pregnancy. And this is critical in extreme environments, where pregnancy is extremely high-risk. </p>
<p>LARC is convenient because it requires no extra supplies and little maintenance following insertion. That said, <a href="https://www.mayoclinic.org/healthy-lifestyle/birth-control/expert-answers/seasonale-side-effects/faq-20058109#">breakthrough bleeding</a> or spotting can be a side effect:</p>
<blockquote>
<p>Having my period [in Antarctica] was a nightmare. Somebody told me that they had an [Depo Provera] injection before they went […] and I thought, “Well, that wouldn’t be a bad idea, to not have a period for that particular time” […] but I had my period the whole time I was in the field. </p>
</blockquote>
<h2>How to support menstruators</h2>
<p>Apart from their other already-demanding work, my research shows women must also undertake additional psychological and physical labour to manage menstruation in extreme environments. Whether in Antarctica or on military deployment, women will often:</p>
<ul>
<li><p>change their menstrual products without privacy or adequate sanitation</p></li>
<li><p>carry bloody menstrual products around with them in the field for a long time</p></li>
<li><p>improvise menstrual products when none are available</p></li>
<li><p>keep menstrual products in their bodies for longer than recommended because they aren’t provided with adequate toilet stops </p></li>
<li><p>alter their hormonal balance with medication to make menstruation less inconvenient. </p></li>
</ul>
<p>The bottom line is this: menstruation in these settings has largely been treated as an individual problem, and not a site for organisational attention. This needs to change. </p>
<p>Some simple changes can be applied in any field environment where menstruation is difficult for women. Organisations should make it a priority to: </p>
<ol>
<li><p>destigmatise menstruation and acknowledge the unique needs of diverse menstruators, including trans people and non-binary folk</p></li>
<li><p>update field manuals to include relevant information about toileting and menstruation </p></li>
<li><p>provide menstrual health education to all expeditioners – especially cisgender men leading field teams</p></li>
<li><p>make toilet stops standard operating practice</p></li>
<li><p>provide menstruators with free menstrual products, and make period underwear available as part of field gear. </p></li>
</ol>
<p>I recently supported the Australian Antarctic Program to revise its field manual and help reconsider how field environments can be sensitised to the needs of menstruators. This is an important first step. But success will only come when inclusive operational measures happen by default.</p>
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Read more:
<a href="https://theconversation.com/supporting-menstrual-health-in-australia-means-more-than-just-throwing-pads-at-the-problem-161194">Supporting menstrual health in Australia means more than just throwing pads at the problem</a>
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<img src="https://counter.theconversation.com/content/187617/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meredith Nash was Senior Advisor - Inclusion, Diversity, and Equity at the Australian Antarctic Division from 2020-22.</span></em></p>We’ve come a long time since women were deemed too “hormonal” to be sent into space. Yet gender bias is an issue women in the field still reckon with every day.Meredith Nash, Professor and Associate Dean - Community, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.