How menstruation stigma puts women in US at risk

Elizabeth Gould’s uterus is beautiful. It’s hand-stiched and made of soft orange felt; her egg is a tiny pearl attached to ovaries studded with mini-conch shells, and its beaded fallopian tubes lead to a red satin uterine lining.

Gould uses this uterus — a stuffed fabric prop made by a friend — as a visual aid to encourage a conversation between mothers and daughters about their periods. Holding the pearl fastened by a pink thread, she traces the egg’s monthly journey through the uterus to explain the process of menstruation at the occasional workshops she holds in Berkeley, California. Many women don’t feel comfortable discussing the topic, she says, as if it were a "curse" that's passed down from one generation to the next, and Gould wants to break that spell.

Her workshops are part of a small but growing number of programs across the country — some taught by therapists, some by activists — to remove the shame and the reluctance to talk about their periods that puts women’s reproductive health at risk. Gould, a 49-year-old mother of two, wanted her daughters to have more information than she did growing up with four brothers and one much younger sister. “The wish was, let’s normalize this,” Gould says. “Let’s not apologize for it or make it like an illness.”

Katie Malinski, a licensed clinical social worker from Austin, Texas, organizes the Mother-Daughter Puberty & Communication workshop. “What you need is to feel like you can go to an expert in your own house, who’s right there,” Malinski said. “My whole goal is just to get that conversation started."

Katharine Krueger, a mechanical engineer and self-described "youth mentor" from Minneapolis, Minnesota, gives a series of talks about puberty and menstruation over the course of a year for girls aged 9-14, their mothers and their fathers. “Lots of girls are either under-informed or not informed,” she said. “Blood is associated with violence, with being hurt, with being ill. Everything involving our vulva and genitals is associated with shame.” With the workshops, she explains, “You’re de-schooling girls from the cultural messages and trying to give their parents some help.”

Malinski, who has also tried, with less success, to get men to sign up for a puberty workshop with their daughters, says that involving fathers in the conversation on menstruation is a key to erasing that unease. “Men being able to talk to their daughters about that would be incredibly empowering and normalizing.” 

The lack of frank discussion about periods has real consequences for women’s health. Paula Hillard, professor of obstetrics and gynecology at Stanford University, said up to 90 percent of adolescents and young adults report menstrual pain that interferes with daily activities. Up to 40 percent of those women miss school or work because of the discomfort.

It is the most common gynecological complaint among adolescent girls, but doctors and patients often dismiss menstrual pains as insignificant, she said. “One of the biggest issues is neither teens nor their moms know what’s normal. It’s sort of expected that periods will be irregular and that there will be pain,” Hillard said. 

But these complaints can be symptoms of underlying problems, she added. Conditions such as Von Willebrand’s disease or endometriosis can go undetected and lead to infertility.

“We have evidence that over half of our patients have to see three clinicians before somebody takes [missed periods] seriously,” said Lawrence Nelson, a gynecologist at the National Institutes of Health (NIH) who researches primary ovarian insufficiency, a condition marked by irregular periods that signal endocrinal dysfunction. “Some women themselves don’t take this seriously,” he added. If one’s period “isn’t valued, it doesn’t get evaluated properly.”

The challenges are steep. Nelson said his patients reported that their symptoms of missed periods sometimes were just blamed on stress — echoes from the era in which women were once diagnosed with hysteria, a condition derived from the ancient Greek word for womb. Hillard says the under-valuing of periods by the medical profession is due, in part, to its male-centric past. “It’s not something that is part of the experience of men,” she said.

Rebecca O'Brien, a member of the Committee on Adolescence at the American Academy of Pediatrics (APP), said discussing one’s period should be a regular part of one’s doctor’s visit. “The menstrual cycle should be a vital sign — as we all talk about blood pressure we should also talk about periods,” she said. A 2006 paper on the issue will be reaffirmed later this year by AAP and the American Congress of Obstetricians and Gynecologists, she said.

"Our Bodies, Ourselves" revolutionized talk about health and sexuality when it was published 45 years ago. Today’s menstruation workshops pick up where that book left off, trying to break what may be the last remaining taboo in the U.S. around female sexuality.