4 Areas of Menstrual Health Research that Need Focus: Improving the Experience of Menstruation
By Dr. Marybec Griffin
Menstruation is a natural biological occurrence that occurs among half the world’s population yet common menstrual experiences are rarely discussed and are often under-researched. Given that the average menstruator will have 450 periods in their lifetime – or 3500 days of their life bleeding – those of us in the menstrual research community seek to improve the experience of all menstruators. Here, I describe four broad areas of menstrual health research that warrant future work.
Sociocultural Aspects of Menstruation
According to the 2021 State of the Period, 76% of high school students in the United States knew more about frog biology than the human female. This lack of understanding of basic biology combined with substandard sexual health education means many menstruators don’t have all the information they need to fully understand their menstrual cycle. For people who don’t menstruate, the realm of periods remains even more of a mystery. This gap in knowledge creates the perfect environment for menstrual myths to flourish – the idea that periods are gross, dirty, and a time of mental instability. While we know these things aren’t true, these myths are further spread by popular culture that depicts menstruation as a joke, an embarrassment, or a sign of paranormal instability (i.e. Stephen King’s Carrie).
Not only are we not talking about periods, when we do we use slang to hide what we’re talking about. In her seminal work, The Vernacular of Menstruation (1948), Natalie Joffe noted that we talk about menstruation as something foreign happening to us instead of something that originates from within. Most of our menstrual slang includes the ideas of visitors (i.e. Aunt Flo), illness or disability (i.e. the red curse), or sexual unavailability (i.e. too much sorority juice down there). But is this really any surprise when the very companies making and marketing period products didn’t say the word period until 1985 and still used blue liquid to demonstrate menstrual flow until 2017?
Legal Aspects of Menstruation
Recent increased awareness of period poverty and the lack of access to menstrual supplies has led to several legislative efforts to improve access to collection devices. In the United States, only 18 of the 50 states do not tax menstrual products. In Europe, 8 countries have either proposed or enacted legislation to remove VAT on menstrual products. Canada and Australia have removed taxes on menstrual products in 2015 and 2019, respectively. And a handful of countries around the world – specifically Colombia, India, Jamaica, Kenya, Lebanon, Malaysia, Mauritius, Namibia, Nicaragua, Nigeria, South Africa, Tanzania, and Rwanda have similarly removed taxes on menstrual products. Despite these efforts, many low-income menstruators are without access to menstrual products which has spillover effects that persist such as lower levels of educational attainment and employment opportunities, both of which reinforce the cyclical nature of poverty. Two additional legal aspects of menstruation are also of note: increased calls for menstrual leave such as the recent Spanish law granting three days paid leave every month (one of only six countries including Indonesia, Japan, South Korea, Taiwan, and Zambia to offer menstrual leave) and government sponsored menstrual surveillance in Texas and Florida.
Medical Aspects of Menstruation
Heavy menstrual bleeding – defined as needing to change a pad/tampon more frequently than every two hours – has been normalized as just a part of having a period. For members of the bleeding disorders community, heavy bleeding goes undiscussed because many patients are not aware of what a “normal” period is. There is also the pervasive myth that menstruators don’t suffer from bleeding disorders due to their XX chromosomes. Additional areas of research include the effect of fibroids which increases menstrual flow and polycystic ovary syndrome (PCOS) that suppresses menstruation. Both PCOS and fibroids are more common among Black women and the lack of medical research in these areas contributes to both medical mistrust and the invisibility of femme pain, most commonly Black femme pain under the guises of the Superwoman Schema.
Underrepresented Aspects of Menstruation
In addition to all of the other aspects of menstruation, special focus in our research efforts should include trans menstruators, menstruators in carceral settings, and those experiencing menopause. For trans menstruators, having a period may increase feelings of dysphoria. Many trans menstruators have created ways to help reduce these feelings such as using a collection method that isn’t visible and creating specific slang that is gender affirming (i.e. manstruation). An area of growing research studies the effects of T (testosterone) on the menstrual cycle and the gender affirmation resulting from menstrual suppression.
Menstruating while in prisons or jails brings up questions of dignity and respect for persons. Many people experiencing incarceration have reported not being able to access menstrual supplies, being subject to strip searches, and forced free bleeding.
Finally, while menopause is held in the collective common knowledge, menstruators are not commonly educated about the signs and side effects of this natural phenomenon. This is especially true for those experiencing premature menopause (menopause before the age of 40). For menstruators experiencing premature menopause, many report feelings of isolation and increased mental health issues such as depression.
The research highlighted here focuses on the menstrual experiences of white cisgender women in North America and Europe. Much more research is needed on the sociocultural aspects of menstruation such as menstrual education, period poverty, access to menstrual supplies, menstruation in prison, menstruation among transgender men, effects of menstrual legislation, and community activism around menstruation.
Additionally, more research is needed in various medical aspects of menstrual health such as polycystic ovary syndrome (PCOS), fibroids, decidual cast, the effects of testosterone on menstruation, and early menopause.
To work towards this, I am guest-editing a Special Collection for Women’s Health, to bring together current knowledge on all aspects of menstrual health and to identify the next steps for research in this field. Submissions are open until 1 September 2023, and we welcome any questions from authors who may be interested in submitting.
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