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Srinivasa Gopalan S, Mann C, Rhodes RE. Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review. Prev Med 2024; 184:107980. [PMID: 38704099 DOI: 10.1016/j.ypmed.2024.107980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/13/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population. METHODS Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training. RESULTS The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours. CONCLUSION The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.
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Affiliation(s)
- Sharan Srinivasa Gopalan
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Caitlin Mann
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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2
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Olsson SE, Friedlich N, Bolds A, Hodge A, Jamali T, Lagomichos M. Exploring Menstrual Education via TikTok: A Descriptive Content Analysis. J Adolesc Health 2024:S1054-139X(24)00229-5. [PMID: 38852086 DOI: 10.1016/j.jadohealth.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/16/2024] [Accepted: 04/11/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE TikTok has rapidly emerged as one of the foremost social media platforms for young adults and adolescents, becoming the most-downloaded app in 2022. With its broad reach across demographics, TikTok may be leveraged as a tool for teaching and destigmatizing topics such as menstruation. This study is the first to analyze the quality of menstruation-related content on TikTok. METHODS This cross-sectional study of TikTok videos and corresponding accounts examined six pre-determined menstruation-related hashtags in May 2023. Deductive qualitative analysis was performed between three coders to identify themes and content of the available videos. RESULTS A total of 140 videos created by 107 unique accounts were identified. The videos had varying purposes including audience education (66%), entertainment (35%), and product advertisement (17%). Videos mentioned various menstrual hygiene products, menstruation-related advice, and symptoms of menses. A vast majority of videos appeared to be created by laypersons with only 8% being led by health-care professionals. DISCUSSION With TikTok's usage as a social platform among youth, it displays potential as a tool to enhance menstrual education and destigmatization. There is a need for more menstruation experts to join the platform and provide quality material for users.
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Affiliation(s)
- Sofia Eva Olsson
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas.
| | - Nicole Friedlich
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Alexis Bolds
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Alison Hodge
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Taylor Jamali
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Melanie Lagomichos
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
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3
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Sebert Kuhlmann A, Teni MT, Key R, Billingsley C. Period Product Insecurity, School Absenteeism, and use of School Resources to Obtain Period Products among High School Students in St. Louis, Missouri. J Sch Nurs 2024; 40:329-335. [PMID: 34962178 DOI: 10.1177/10598405211069601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Menstrual hygiene management (MHM) among female students is a neglected public health issue in the U.S. This study documented period product insecurity, school absenteeism, and use of school resources to obtain period products among high-school students in St. Louis, MO. Female students completed an anonymous, self-administered survey in English (n = 119). Descriptive statistics were used to determine the prevalence of period product need, resources used to obtain period products, and period-related absenteeism. The mean age of participants was 15.78 ± 1.28. Nearly two-thirds (64.4% (95% CI 55.1%-73.0%)) reported period product insecurity. Two-thirds (66.9% (95% CI 57.7%-75.3%)) reported using at least one of the school's resources to obtain period products. One-third of the participants (33.6% (95% CI 25.0%-43.1%)) reported missing school due to a lack of period products. School nurses need to be cognizant of how MHM affects their students' attendance at school and what measures they can take to help reduce menstruation-related absenteeism.
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Affiliation(s)
- Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Rhonda Key
- Jennings School District, Jennings, Missouri, USA
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4
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Bigalky J, Mackey A, Safaralizadeh T, Petrucka P. Degendering Menstruation: A Scoping Review Exploring the Experiences of Transgender and Non-Binary People. JOURNAL OF HOMOSEXUALITY 2024:1-29. [PMID: 38767881 DOI: 10.1080/00918369.2024.2353057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Menstruation is a biological process experienced by up to 800 million people on any given day. Historically, menstruation has been studied from the female perspective. However, it should be considered that not all who menstruate are women. Therefore, the purpose of this research was to determine the status of evidence on transgender and non-binary individuals' experiences with menstruation. Arksey and O'Malley's (2005) framework for conducting a scoping study was used to guide this review. The authors used five steps of the six-step process to identify the research problem and search strategy, select studies based on defined inclusion and exclusion criteria, extract key information from five selected studies, and chart, summarize, and report the results as themes. The analysis resulted in the identification of four themes: (1) gender dysphoria and the influence on identity; (2) menstrual management and transformation as a turning point; (3) managing menstruation in precarious spaces; and (4) moving toward an open dialogue. Findings suggest a need for awareness of diverse and inclusive menstrual experiences. Inclusive advertising and menstrual products are needed to support transgender and non-binary people and reduce gender dysphoria. Policy initiatives should support the reconceptualization of infrastructure so that bathrooms are safe and comfortable places. Future opportunities for research exploring menstrual management within transgender and non-binary populations with emphasis on global research with diverse cultures and social structures is necessary to address gaps in the existing literature.
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Affiliation(s)
- Jodie Bigalky
- College of Nursing, University of Saskatchewan, Saskatoon
| | - April Mackey
- College of Nursing, University of Saskatchewan, Saskatoon
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Kuhlmann AKS, Palovick KA, Allen C, Teni MT, Marshall C. Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses. J Sch Nurs 2024:10598405241247553. [PMID: 38646704 DOI: 10.1177/10598405241247553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.
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Affiliation(s)
- Anne K Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kirstin A Palovick
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Casey Allen
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Cheleia Marshall
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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6
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Marván ML, García-Prieto C, Alcalá-Herrera V, Vacio-Muro MDLÁ. Menarcheal experience, beliefs about and attitudes toward menstruation in Mexico: Changes in the last 20 years. Health Care Women Int 2024:1-14. [PMID: 38635371 DOI: 10.1080/07399332.2024.2342474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
We explored how menarcheal experiences and attitudes toward menstruation of Mexican adolescents have changed in the last 20 years. Two questionnaires were applied to female adolescent students, and the results were compared with those obtained in 2002-3 when adolescents of the same ages were surveyed using the same questionnaires. Although some aspects of menstrual education have not changed, the secrecy surrounding menstruation has diminished. In contrast, the belief that menstruation is disabling and keeps women from their normal activities has increased. It is important that adolescents receive adequate preparation about psychosocial and physical aspects of the menstrual cycle.
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Affiliation(s)
- Ma Luisa Marván
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, Mexico
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7
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Orellana M, DSouza KN, Yap JQ, Sriganeshan A, Jones ME, Johnson C, Allyse M, Venable S, Stewart EA, Enders F, Balls-Berry JE. "In our community, we normalize pain": discussions around menstruation and uterine fibroids with Black women and Latinas. BMC Womens Health 2024; 24:233. [PMID: 38610011 PMCID: PMC11010402 DOI: 10.1186/s12905-024-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Uterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment. METHODS Community engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis. RESULTS Participants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids. CONCLUSION Despite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.
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Affiliation(s)
- Minerva Orellana
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Karen N DSouza
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Jane Q Yap
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - M Elena Jones
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA
| | - Charis Johnson
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA
| | - Megan Allyse
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Felicity Enders
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine & Science, Rochester, MN, USA
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Joyce E Balls-Berry
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA.
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Botello-Hermosa A, González-Cano-Caballero M, Guerra-Martín MD, Navarro-Pérez CF, Arnedillo-Sánchez S. Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach. Healthcare (Basel) 2024; 12:560. [PMID: 38470671 PMCID: PMC10931084 DOI: 10.3390/healthcare12050560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/14/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components.
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Affiliation(s)
- Alicia Botello-Hermosa
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (A.B.-H.); (S.A.-S.)
| | | | - María Dolores Guerra-Martín
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (A.B.-H.); (S.A.-S.)
- Institute of Biomedicine of Seville (IBiS), 41013 Seville, Spain
| | - Carmen Flores Navarro-Pérez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (A.B.-H.); (S.A.-S.)
| | - Socorro Arnedillo-Sánchez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (A.B.-H.); (S.A.-S.)
- Institute of Biomedicine of Seville (IBiS), 41013 Seville, Spain
- Midwifery Training Unit, Department of Materno-Fetal Medicine, Genetics and Reproduction, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
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9
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Notice B, Soffer E, Tickle K, Xiang Y, Gee BE, Sidonio RF, Sokkary N, Batsuli G. Assessment of menstrual health in adolescent and young adults with sickle cell disease. Pediatr Blood Cancer 2024; 71:e30727. [PMID: 37845801 DOI: 10.1002/pbc.30727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with hypercoagulability, but adults with SCD also have an increased incidence of bleeding including heavy menstrual bleeding (HMB). HMB is common among adolescent females, but the impact of HMB in pediatric SCD is unclear. The objectives of this study were to examine menstrual health status, knowledge, and quality of life (QOL). METHODS We performed a single-institutional multi-clinic cross-sectional study comprised of a five-part survey in pediatric participants with SCD. The survey included the validated Menstrual Bleeding Questionnaire (MBQ) and Self-administered Bleeding Assessment Tool (Self-BAT). RESULTS Forty-eight participants with a median age of 16 years (range: 12-21 years) completed the study. The mean age at onset of menarche was 13 ± 1.3 years. On the MBQ, 29% reported heavy/very heavy menstrual flow, 61% reported moderate or severe dysmenorrhea, and 96% had menses lasting less than 1 week. The Self-BAT revealed that 42% of participants reported a history of HMB. Participants with severe dysmenorrhea or HMB had higher MBQ scores, corresponding to worse QOL. Despite this, less than 20% of participants had attempted any hormonal therapy for menstrual regulation. The odds of hormonal therapy utilization were comparable among participants on hydroxyurea versus not on hydroxyurea (odds ratio 1.58, 95% confidence interval [CI]: 0.33-7.56). CONCLUSIONS The prevalence of HMB and dysmenorrhea is high among adolescents and young women with SCD. Strategies that incorporate menstrual health assessment into routine medical care in this population would help address this important area of pediatric health.
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Affiliation(s)
- Brittany Notice
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Soffer
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Kelly Tickle
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Nursing & Allied Health Research & Evidence-Based Practice Department, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Yijin Xiang
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Pediatrics, Biostatistics Core, Emory School of Medicine, Atlanta, Georgia, USA
| | - Beatrice E Gee
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Robert F Sidonio
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nancy Sokkary
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
| | - Glaivy Batsuli
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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10
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LeBlanc SS. School nurses and menstrual communication: Destigmatizing the stigma among adolescents. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241247793. [PMID: 38733209 PMCID: PMC11088806 DOI: 10.1177/17455057241247793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE The purpose of this study is to understand how school nurses, often the first line of defense for menstruating adolescents, use communication to assist adolescents in destigmatizing menstruation. DESIGN I conducted semi-structured narrative interviews with nine nurses employed in a large school district in Northeast Indiana. METHODS Interviews were coded, categorized, and used a phronetic iterative approach. RESULTS Analysis determines that nurses assist menstruating students using steps toward accepting menstruation and suggesting ways to avoid menstrual stigmatization. CONCLUSION This study suggests that school nurses use positive language to assist students in handling their menstruation problems, develop allyships with parents and other teachers, and stress menstrual education. This study highlights the need for more funding for menstrual products and additional school nurses.
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Taim BC, Lye J, Suppiah HT, Chan TW, Chia M, Clarke A. Menstrual cycle characteristics, perceived impact on performance, and barriers to communication: Perspectives of high-performance adolescent athletes in Singapore. Scand J Med Sci Sports 2024; 34:e14488. [PMID: 37682006 DOI: 10.1111/sms.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
The purpose of this study was to examine the menstrual cycle (MC) characteristics, explore the impact on performance, and identify barriers to and facilitators of MC-related communication among high-performance female adolescent athletes in Singapore. Ninety athletes (15.4 ± 1.8 years) from multiple sports completed an online questionnaire. Eighty-four athletes were postmenarcheal (menarcheal age 11.9 ± 1.3 years), including two who were using an oral contraceptive pill (OCP). Secondary amenorrhea, current or history of, was self-reported in 16% of athletes. Sixty-two percent and 67% of non-OCP athletes perceived that the MC affected their ability to train and compete, respectively. Athletes preferred speaking to a parent (85%) and a female figure (67%) about MC-related concerns. Through thematic analysis, three barriers to communication were constructed: (1) pervasive menstrual stigma, (2) constraints of the training environment, and (3) the low value placed on MC-related conversations. Two facilitators of communication were constructed: (1) respect athletes' individual experiences as menstruating girls and (2) foster a safe space for MC-related conversations. Findings demonstrated that menstrual irregularities are common in adolescent athletes and screening for MC disorders, particularly primary amenorrhea should be undertaken in this population, with clear support pathways for management including symptom mitigation. To support athletes in raising MC-related concerns when needed, structured communication pathways that consider individual preferences and involve a (female) point of contact should be established within the training environment. Improving menstrual health literacy among adolescent athletes before any misinformation or negative perceptions are firmly established may contribute to longevity in their athletic careers.
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Affiliation(s)
- Bernadette Cherianne Taim
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
- National Youth Sports Institute, Singapore
| | - Jamie Lye
- National Youth Sports Institute, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Haresh T Suppiah
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | | | - Michael Chia
- Physical Education and Sports Science Group, National Institute of Education, Nanyang Technological University, Singapore
| | - Anthea Clarke
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Francis L, Meraj S, Konduru D, Perrin EM. An Update on State Legislation Supporting Menstrual Hygiene Products in US Schools: A Legislative Review, Policy Report, and Recommendations for School Nurse Leadership. J Sch Nurs 2023; 39:536-541. [PMID: 36217851 DOI: 10.1177/10598405221131012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Access to menstrual products is important to support adolescent health. Advocacy to increase access to menstrual products in schools is growing; however, ideal access requires policies that will require schools to support the menstrual health of menstruating students. We conducted a legislative review on the existence and status of state legislation related to the provision of menstrual products in US schools and categorized by state's political control (political party affiliation of governors and state legislature). Of 50 states and 6 territories, 21 had legislation to support menstrual products in schools, 7 had bills pending, 10 had bills failed, and 18 states had no policies introduced in the state legislature. States with Democrat control have significantly more menstrual product state laws compared to states with Republican control [z = 2.54, p = 0.01]. There is a need, especially in Republican states, to accelerate efforts to pass laws that will support menstrual product access in schools.
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Affiliation(s)
- Lucine Francis
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
- Johns Hopkins Consortium for School-Based Health Solutions, Baltimore, MD, USA
| | - Shafkat Meraj
- Johns Hopkins University Homewood Campus, Baltimore, MD, USA
| | - Divya Konduru
- Johns Hopkins University Homewood Campus, Baltimore, MD, USA
| | - Eliana M Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Sundstrom B, Dempsey A, Finke S, Maness SB, Delay C, Hayes N, DuBose-Morris R, Lazenby GB. "Do you want a period?" Launching and evaluating a brief contraceptive decision-making educational intervention. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100887. [PMID: 37454586 DOI: 10.1016/j.srhc.2023.100887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Do you want a period? empowers people who menstruate to better understand their reproductive health and contraceptive choices through informed patient-centered contraceptive decision-making. METHODS Researchers partnered with the WISE (Women in the South-East) Telehealth Network to design, implement and evaluate the Do you want a period? brief educational intervention. Participants completed a longitudinal research study, including a web-based survey at baseline and a mobile-optimized text-based survey up to 6 weeks following baseline. RESULTS Do you want a period? was believable (93%, n = 79), informative (89%, n = 76), and helpful (85%, n = 72). Participants who reported that the intervention was helpful were significantly more likely to be satisfied with the usefulness of information provided (OR 5.61 [95% CI 1.65-19.12]), the overall quality of services (OR 3.39 [95% CI 1.04-11.08)], and obtaining necessary medical care (OR 2.40 [95% CI 1.08-5.33)]. At longitudinal follow-up, participants who received contraceptive services reported high acceptability of intervention (4.51 (±0.53) out of 5). CONCLUSIONS Do you want a period? envisions a new dialogue between women and clinicians, family, and friends. This brief educational intervention supports people who menstruate to determine if a safe and effective tailored contraceptive regimen is right for them.
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Affiliation(s)
- Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC, USA.
| | - Angela Dempsey
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Shira Finke
- Women's Health Research Team, College of Charleston, Charleston, SC, USA
| | - Sarah B Maness
- Women's Health Research Team, College of Charleston, Charleston, SC, USA
| | - Cara Delay
- Women's Health Research Team, College of Charleston, Charleston, SC, USA
| | - Natalia Hayes
- WISE Telehealth Network, Charleston County Public Library (CCPL) System, USA
| | - Ragan DuBose-Morris
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Rawat M, Novorita A, Frank J, Burgett S, Cromer R, Ruple A, DeMaria AL. "Sometimes I just forget them": capturing experiences of women about free menstrual products in a U.S. based public university campus. BMC Womens Health 2023; 23:351. [PMID: 37403058 DOI: 10.1186/s12905-023-02457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Studies have proven that lack of access to menstruation products negatively affects school attendance, academic performance, and individual health. Implementing "period policies," or programs offering free menstruation products, are becoming popular in schools, businesses, and communities in high-income countries. U.S.-based Purdue University announced in February 2020 that free pads and tampons would be stocked in all women's and gender-neutral restrooms in campus buildings. This study aimed to capture the experiences of menstruators about free menstrual products and the impact of a university-wide free menstruation management product policy and program. A second purpose was to understand how access to menstrual management products is intertwined with broader socio-cultural experiences of a menstruator. METHODS As part of a larger study, virtual focus group discussions (n = 32 across 5 focus groups) were conducted in February 2021. Eligible participants were student-menstruators attending Purdue University. We used thematic analysis techniques for data analysis, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS Focus group discussions revealed vivid menarche and menstruation experiences, shifting period culture, recollections of shame and stigma, and use of various technologies to manage menstruation. Recommendations for community-based programs offering free products included maintaining stock, making informed product choices, and broadly distributing program information to increase awareness of free product placements. CONCLUSIONS Findings offer practical recommendations that will contribute to menstruation management and period poverty solutions for university communities.
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Affiliation(s)
- Meghana Rawat
- Department of Communication, College of Humanities and Social Sciences, Utah Valley University, 800 W University Parkway, Orem, UT, 84058, USA.
| | - Allison Novorita
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Jaclyn Frank
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Stevie Burgett
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, IN, USA
| | - Risa Cromer
- Department of Anthropology, College of Liberal Arts, Purdue University, West Lafayette, IN, USA
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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15
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Sebert Kuhlmann A, Palovick KA, Teni MT, Hunter E. Period Product Resources and Needs in Schools: A Statewide Survey of Missouri's School Nurses. THE JOURNAL OF SCHOOL HEALTH 2023; 93:557-564. [PMID: 36893763 DOI: 10.1111/josh.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/13/2023] [Accepted: 02/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND School nurses play a vital role in ensuring the health and well-being of their students, but little is known about menstrual products and resources available in schools. This study assessed period product resources and needs in Missouri schools from the perspective of school nurses and analyzed differences by district enrollment characteristics. METHODS An electronic survey was emailed to public, charter, private, and parochial school nurses in Missouri who served fourth grade or older. From January through March 2022, 976 self-administered surveys were completed (40% response rate). Logistic regressions examined the associations between student needs and district characteristics. RESULTS Among the sample, 70.7% knew students who could not afford period products, and 68.0% knew students who had missed school because of their period. When controlling for district size, race/ethnicity, and urban/rural classification, as the percentage free- or reduced-lunch (FRL) eligibility increases in a school, awareness of students struggling to afford products increases (AOR = 1.008, 95% confidence interval 1.000, 1.015). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY School nurses need the resources and educational materials to support students to help reduce menstruation-related absences. CONCLUSIONS Issues of period poverty cut across districts of differing enrollment characteristics, yet FRL percentage is an important predictor.
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Affiliation(s)
- Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Kirstin A Palovick
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Mintesnot T Teni
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
| | - Emily Hunter
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO
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16
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Sommer M, Schmitt ML. Taking Stock: An Adaptable Research and Partnership Model for Developing Puberty Education in 10 Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200498. [PMID: 37348938 DOI: 10.9745/ghsp-d-22-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/04/2023] [Indexed: 06/24/2023]
Abstract
There is a growing global interest in puberty and early adolescence and the importance of ensuring young people have the information and support they need during this critical phase of transition in the life course. This article highlights an adaptable model being used to support the development of contextually appropriate puberty education, in the form of illustrated and often bilingual books, for early adolescent girls and boys in countries around the world. This youth-centered participatory research and design model, which relies on the generation of community and government partnerships, has been employed in 10 countries thus far. Valuable learning has been documented from various contexts, including the approach's flexibility in adapting to the inputs of government and community members, incorporating local buy-in as a key ingredient for sustainability, using in-country experts for social and cultural appropriateness of illustrations and translations, and ensuring that the authentic youth voices captured through the participatory data collection and field-testing shape the educational content. The continuous integration of insights and perceptions of adults who influence young people's lives into the development process is also essential to enabling the uptake of puberty content in each new country. Parents, educators, youth service providers, and government officials are often the gatekeepers to young adolescents receiving puberty content and are thus critical to the process. This review of more than a decade of experience using this model underscores the essentiality of 2 key components-local partnership and participatory data collection-and highlights the importance of flexible approaches that are adapted to the unique sociocultural and environmental conditions in each country context.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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17
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Ramsay C, Hennegan J, Douglass CH, Eddy S, Head A, Lim MSC. Reusable period products: use and perceptions among young people in Victoria, Australia. BMC Womens Health 2023; 23:102. [PMID: 36906569 PMCID: PMC10006563 DOI: 10.1186/s12905-023-02197-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Reusable menstrual products have expanded the choices available for menstrual care and can offer long-term cost and environmental benefits. Yet, in high-income settings, efforts to support period product access focus on disposable products. There is limited research to understand young people's product use and preferences in Australia. METHODS Quantitative and open-text qualitative data were collected through an annual cross-sectional survey of young people (aged 15-29) in Victoria, Australia. The convenience sample was recruited through targeted social media advertisements. Young people who reported menstruating in the past 6 months (n = 596) were asked questions about their menstrual product use, use of reusable materials, product priorities and preferences. RESULTS Among participants, 37% had used a reusable product during their last menstrual period (24% period underwear, 17% menstrual cup, 5% reusable pads), and a further 11% had tried using a reusable product in the past. Reusable product use was associated with older age (age 25-29 PR = 3.35 95%CI = 2.09-5.37), being born in Australia (PR = 1.74 95%CI = 1.05-2.87), and having greater discretionary income (PR = 1.53 95%CI = 1.01-2.32). Participants nominated comfort, protection from leakage and environmental sustainability as the most important features of menstrual products, followed by cost. Overall, 37% of participants reported not having enough information about reusable products. Having enough information was less common among younger participants (age 25-29 PR = 1.42 95%CI = 1.20-1.68) and high school students (PR = 0.68 95%CI = 0.52-0.88). Respondents highlighted the need for earlier and better information, challenges navigating the upfront cost and availability of reusables, positive experiences with reusables, and challenges for use, including cleaning reusables and changing them outside the home. CONCLUSIONS Many young people are using reusable products, with environmental impacts an important motivator. Educators should incorporate better menstrual care information in puberty education and advocates should raise awareness of how bathroom facilities may support product choice.
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Affiliation(s)
- Caitlin Ramsay
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caitlin H Douglass
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah Eddy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Alexandra Head
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Megan S C Lim
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia.
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18
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Trant AA, Espinal M, Kisanga EP, Vash-Margita A, Lundsberg L, Sheth SS, Fan L. Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100808. [PMID: 36563412 DOI: 10.1016/j.srhc.2022.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH. METHODS The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem. RESULTS The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities. CONCLUSION A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.
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Affiliation(s)
| | - Mariana Espinal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | | | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Linda Fan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States.
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19
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Schmitt ML, Gruer C, Hagstrom C, Ekua Adenu-Mensah N, Nowara A, Keeley K, Sommer M. “It always gets pushed aside:” Qualitative perspectives on puberty and menstruation education in U.S.A. schools. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1018217. [PMID: 36339773 PMCID: PMC9635341 DOI: 10.3389/frph.2022.1018217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls in the U.S.A. often lack sufficient education on pubertal and menstrual health topics. This educational gap may be growing given the current decline in American elementary and middle schools' delivery of sexual health education. Furthermore, little is known about the actual scope and quality of existing menstruation and puberty education in U.S.A. schools. This paper provides insights into some of the challenges with the delivery of menstruation and puberty education in schools. Qualitative and participatory research methodologies were utilized with Black and Latina girls ages 15–19 and adults working with youth in three U.S.A. cities (Chicago, Los Angeles, and New York City), exploring experiences of menstruation within school and family contexts. Findings revealed tension between school responsibility and family authority in providing menstruation and puberty education in schools, school- and teacher-related delivery challenges, and inadequate and disengaging menstruation and puberty content. Further research is needed on the effectiveness and best practices for providing this education in schools, including improved understanding on student and parent preferences, delivery mediums and the scope of content.
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Affiliation(s)
- Margaret L. Schmitt
- Mailman School of Public Health, Columbia University, New York City, NY, United States
- Correspondence: Margaret L. Schmitt
| | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Christine Hagstrom
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | | | - Azure Nowara
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Katie Keeley
- Office of Clinical and Community Trials, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
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20
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Menstrual Health and Hygiene among Adolescents in the United States. J Pediatr Adolesc Gynecol 2022; 35:277-287. [PMID: 34999229 DOI: 10.1016/j.jpag.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening. DESIGN Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews. SETTING Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center. PARTICIPANTS Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible. INTERVENTION Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health. MAIN OUTCOME MEASURES Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets. RESULTS The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management. CONCLUSION Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.
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21
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Hennegan J, Swe ZY, Than KK, Smith C, Sol L, Alberda H, Bukenya JN, Kibira SPS, Makumbi FE, Schwab KJ, Azzopardi PS. Monitoring Menstrual Health Knowledge: Awareness of Menstruation at Menarche as an Indicator. Front Glob Womens Health 2022; 3:832549. [PMID: 35400130 PMCID: PMC8988033 DOI: 10.3389/fgwh.2022.832549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
As initiatives to support menstrual health are implemented globally, monitoring progress through a set of comprehensive indicators provides important feedback to direct policies and programs. One proposed core indicator is awareness of menstruation at menarche. That is, at the time of menarche an adolescent girl knowing that menstrual bleeding is something she will experience. In this investigation, we undertook secondary analysis of data collected across four studies to support interpretation of this indicator. We (1) describe the proportion of each sample aware of menstruation at menarche, (2) test variations in awareness according to sociodemographic characteristics, and (3) describe the associations between this indicator and self-reported experience at menarche, social support, and confidence to manage menstruation. Studies included cross-sectional survey data from 421 schoolgirls in Magway, Myanmar, 537 schoolgirls in Soroti, Uganda, 1,359 schoolgirls in Netrokona, Bangladesh, and 599 adult women working in Mukono, Uganda. Awareness of menstruation at menarche varied from 84% in Myanmar to 34% in Bangladesh. Older age at menarche was associated with awareness. Awareness at menarche was not associated with household poverty in the adolescent samples, but greater poverty was associated with lower levels of awareness among adult women. In Myanmar, girls aware of menstruation had significantly higher odds of reporting that they felt prepared (2.85 95% CI 1.34–6.08), happy (OR = 3.81 95% CI 1.74–8.37) and knew what was happening at menarche (OR = 2.37 95% CI 1.34–4.19). However, they also reported higher levels of embarrassment (OR = 1.76 95% CI 1.04–2.97) and did not report significantly less fear (OR = 1.24 95% CI 0.82–1.85). Awareness of menstruation at menarche was associated with higher scores on a menstrual knowledge quiz in both Myanmar (b = 9.51 95% CI 3.99–15.04) and Bangladesh (b = 4.78 95% CI 1.70–7.87). In these studies girls aware of menstruation at menarche also had higher odds of reporting they felt confident discussing menstruation with support sources and managing menstruation at school, while these differences were not significant among schoolgirls in Uganda. Findings support the usefulness of awareness of menstruation at menarche as an indicator to describe minimal knowledge of menstruation and suggest that awareness may signal greater knowledge, social support, and confidence in some settings.
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Affiliation(s)
- Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Julie Hennegan
| | - Zay Yar Swe
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Kyu Kyu Than
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Calum Smith
- Irise International, Sheffield, United Kingdom
| | - Lidwien Sol
- School of Business and Economics, Maastricht University, Maastricht, Netherlands
| | | | - Justine N. Bukenya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick E. Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter S. Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing Program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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22
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Casola AR, Luber K, Riley AH, Medley L. Menstrual Health: Taking Action Against Period Poverty. Am J Public Health 2022; 112:374-377. [PMID: 35196038 PMCID: PMC8887146 DOI: 10.2105/ajph.2021.306622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Allison R Casola
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Kierstin Luber
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Amy Henderson Riley
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Lynette Medley
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
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23
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Schmitt ML, Booth K, Sommer M. A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:725805. [PMID: 36303999 PMCID: PMC9580679 DOI: 10.3389/frph.2021.725805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.
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Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Margaret L. Schmitt
| | - Kathleen Booth
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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24
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Munro AK, Keep M, Hunter EC, Hossain SZ. Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey. WOMEN'S HEALTH 2022; 18:17455065211070666. [PMID: 35001743 PMCID: PMC8744198 DOI: 10.1177/17455065211070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university. Methods: An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant. Results: A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors. Conclusion: Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.
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Affiliation(s)
- Alana K Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Syeda Z Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Gruer C, Goss T, Schmitt ML, Sommer M. Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:787277. [PMID: 36304028 PMCID: PMC9580624 DOI: 10.3389/frph.2021.787277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years there has been growing momentum in the USA around addressing issues of “menstrual equity” and “period poverty,” including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success. Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4–6 per school). Data from the desk review and interviews were analyzed using thematic analysis. Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy. Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.
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Affiliation(s)
- Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Caitlin Gruer
| | - Taylor Goss
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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