Blog of the Society for Menstrual Cycle Research

Menstrual Health Education: How and why to make it better

January 28th, 2016 by Editor

Peggy Stubbs and Evelina Sterling advocate for comprehensive menstrual education

For nearly forty years, the Society for Menstrual Cycle Research (SMCR) has been promoting the perspective that the menstrual cycle is central to girls’ and women’s overall health. But this connection seems to be nearly invisible to the public, and even in the public health arena. A recent informal, but telling, series of Internet searches reveals that many agencies provide minimal or no information about the menstrual cycle. This information deficit was discussed at SMCR’s June 2015 conference in a session offered by Evelina Sterling, Heather Guidone, Diana Karczmarczka and Peggy Stubbs.  For example, the menstrual cycle is not listed in the Healthy People Goals, and so is not seen as a priority by groups such as the CDC. Instead, the prevailing attitude seems to be that other public health issues are more important and that, beyond basic biology and management, girls and women (and boys and men) don’t need to know much more about the menstrual cycle. Menstruation, from menarche to menopause, is not presented as an integral component of women’s health. Menstruation is not associated with long-term health and wellness, nor is it considered as relevant to the experience of specific illnesses, disabilities or mental health conditions.

Menstrual product companies fill a public health gap by providing menstrual education materials to schools.

Menstrual product companies fill a public health gap by providing menstrual education materials to schools.

The public health gap in menstrual education has been filled by menstrual product manufacturers whose materials are used in many schools and whose online presence is influencing what girls first learn about menstruation. While menstrual management is of great importance, and while we applaud recent efforts by some product manufacturers (e.g., Kotex) to address and try to reduce menstruation stigma, so much more could and should be done to help girls and women learn about how the cycle serves as a “vital sign” of health, as opposed to what too many consider a normative but inconvenient at best, debilitating biological necessity.

We think a coalition of biomedical public health and psychosocial researchers promoting menstruation as a vital sign, and countering one of today’s most facile conceptions of menstruation—that it is a lifestyle choice—can do much better.

While we appreciate there are many public health issues relevant to girls’ and women’s health, we believe it is time for menstruation to take center stage, to be more broadly considered in relation to women’s lives and well-being. SMCR researchers and others have long promoted a comprehensive, lifespan approach to menstrual education, one that is both broad and deep, and features the interconnection of its biological and psychosocial aspects. This means addressing the connections between our biology and what we (both as individuals and as a culture) think about it and do about it.

This means moving beyond a nuts and bolts approach to menstruation, whatever the age group, not forgetting to include boys and men in our efforts. This means that all educators—family members, teachers, public health workers, product manufacturers, health care providers and the like—should strive to learn about and convey how the cycle influences well-being. This means consulting not only the latest biomedical research but also the treasure trove of social science research on the topic. Educators can begin with the American College of Obstetricians and Gynecologists (ACOG) 2015 paper (1) on using the menstrual cycle as a vital sign in the education of young girls and adolescents. AGOC researchers have also provided guidelines for health-care providers about how to take a menstruation history and how to help parents convey information about menstruation to daughters (See Hilliard, 2014) (2). In addition, educators should study the many papers and presentations by SMCR researchers and other scholars to learn how psychosocial aspects of the cycle can impact such things as self-image and sexual-decision making. (e.g., Stubbs, 2008; Erchull, 2002, 2015; Johnston-Robledo, Stubbs & Walch, 2013) (3).

Our challenge is to make collective and collaborative use of this material, thereby helping the public to think about menstruation—from menarche to menopause—as a window into well-being instead of an experience simply to put up with. Providing full disclosure about the cycle, weaving its complexities into education programs without overcomplicating or unnecessarily alarming audiences, will require ongoing work. But knowledge is power and girls and women deserve nothing less.

1. Committee Opinion No. 651. (2015).  Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstetrics and Gynecology,  126:e, 143-146.

2. Hilliard, P.J.A. (2014).  Menstruation in Adolescents: What Do We Know? and What Do We Do with the Information? Journal of Pediatric and Adolescent Gynecology, 27(6), 309-319.  doi: 10.1016/j.jpag.2013.12.001

3. Stubbs, M.L.  (2008). Cultural perceptions and practices around menarche and adolescent menstruation in the United States. Annals of the New York Academy of Science, 1135, 58-66.

Erchull, M.J., Chrisler, J.C., Gorman, J.A. & Johnston-Robledo, I. (2002). Fact or fiction: A content analysis of educational materials about menstruation. Journal of Early Adolescence, 22, 455-474.

Erchull, M.J., & Richmond, K. (2015). “It’s normal…Mom will be home in an hour”: The role of fathers in menstrual education. Women’s Reproductive Health, 2, 93-110.

Johnston-Robledo, I. Stubbs, M.L. and Walch, A.  (2013). Oxford Bibliographies in Childhood Studies. Menstruation.  www.oxfordbibliographies.com

Margaret L. (Peggy) Stubbs is a professor of psychology at Chatham University in Pittsburgh, PA, and a member of re: Cycling’s editorial board. Her areas of expertise include psychosocial aspects of menstruation; attitudes towards menstruation, pubertal development; and menstrual education throughout the lifespan. 

Marketing menstrual products to tweens raises concern

December 23rd, 2015 by Editor

Guest Post by Victoria Velding

On a recent trip to the U by Kotex box store I came across U by Kotex for Tweens. It seems this product has been on the market for a number of years, but since I don’t frequent the femcare aisle on a regular basis, I only recently discovered it. Immediately I took issue with its messages. What concerns me is not the existence of the product (that in itself is an entirely separate conversation), as certainly those of the tween age menstruate and need to have products available for their use. No, what I take issue with is the packaging and marketing of the product—the obvious exploitation of the consumer, the mixed messages it sends, and the body and self-esteem issues it exacerbates.

The box itself is a classic example of how marketers attempt to attract the tween consumer: glitter, bright colors, and “cutesy” designs. Must we cover everything in glitter just to designate it as for tweens only? The box is also covered in hearts and stars, a theme I would later discover is represented on the contents inside the box as well. The U by Kotex products are notorious for being packaged in a variety of colors (red excluded, of course). When the U by Kotex line was introduced, the brand sought to change the conversation about women’s health and challenge menstrual stigma. I was not surprised to see the tween version offered in multiple colors, nor did it surprise me when I researched the product online and discovered the wrappers also have hearts and stars on them. The designs cleverly resemble drawings from a young girl’s notebook. The U by Kotex website even describes the pads as having “vibrant colors with cool patterns” as if that is going to get a tween girl excited about menstruating! What really surprised me, however, was that there are hearts and stars on the actual pad. Designs! On the pad! Do you know what else has designs on them? Infant diapers.

U by Kotex-PadMenstruating is often seen as a rite of passage, and menarche, as Janet Lee ascertained, represents the heterosexualization of young girls. By taking this rather adult concept and adding designs to the packaging and actual product, Kotex is infantilizing the tween consumer and, in a sense, the act of menstruating. Pads, like infant diapers, are intended to absorb bodily fluids, and these pads, just like infant diapers, come with cute designs on them.

While I was immediately drawn to the glittery package labeled “tween,” it was actually the words in smaller print—“protection for smaller sizes”—that really drew me into the product and caused me a bit of concern. I couldn’t help but think of myself and my tween niece when I saw this. As a tween, I did not require, nor does my tween niece require, a pad that presumably offers less surface area of protection than an adult pad. Tweens want to fit in, to be accepted, to not draw too much attention to themselves. How might a tween feel when she can’t buy the product designed specifically for her age-group because her body is not the size Kotex has deemed it should be? There is a bevy of research on girls and women and body image issues, with many describing the pressure to adhere to society’s idealized conception of the thin female form. Must the slightly larger than “average” tween be made to feel bad about herself, or not “normal” because she needs to use the same femcare product as her teen sister or mom, and not the same one as her tween friends?

The issue, however, concerns not only overweight tweens, but also petite adult women. U by Kotex for Tweens might actually be the perfect size for some adult women, women who have difficulty finding products in their sizes that are not intended for children. Must we continue to infantilize these women by offering “protection for smaller sizes” that is adorned with hearts and stars?

While a pad for “smaller sizes” may be needed, I question Kotex’s approach to specifically targeting the tween consumer. Girls are taught that menstruating is part of growing up, yet a product intended specifically for their menstruating body has elements that are strikingly similar to an infant’s diaper. Tweens are at a confusing time in their lives, experiencing social, emotional, and physiological changes. The mixed messages sent by this product line are only exacerbating their confusion about what it means to grow-up, to menstruate, and to be a girl.

Victoria Velding is a Visiting Assistant Professor of Sociology at West Virginia University. Her research interests include tweens, gender, and sexuality.

Lizzy and the Light Below: Menstruation as a pillar of human culture

December 7th, 2015 by Editor

Guest Post by Jacqueline Thomas

Lizzy and the Light Below small thumbnailHaving entered my Ph.D. program in English already aware of the general need to better prepare girls for menarche, I wrote Lizzy & the Light Below in the midst of my studies to give moms a tool for starting the conversation with their daughters. Based on the anthropological part of my research, Lizzy is a simple Alice-in-Wonderland kind of story about a girl who gets her first period at school one day, takes a shortcut home through the woods, and discovers a magical cave in which a wise old woman named Ciela shares a different story about menstruation than the one she has learned at school. While I kept the story simple and pitched it at preteen girls, I included a preface summarizing the research that underpins its message: Not only is menstruation a natural process that we should not be ashamed of; it is a pillar of human culture that we should take pride in.

In my studies, I explored two anthropological theorists in depth—Christopher Knight and Annette Weiner—who, in different ways, proposed that menstruation was the basis of human culture. This disruptive idea runs counter to prevalent cultural origins theories, which—with little evidence— mostly take for granted that men were the (violent) prehistoric agents of human development. Moreover, Knight contends that any cultural origins theory should comport with the time-tested theory of evolution. Instead, he says, most origins theories simply project the hierarchical social structure of the present (i.e., patriarchy/patriliny) onto the prehistoric past, without proposing any evolution-friendly triggers of the primate-to-human shift. At the heart of this critique is the insight that, for culture to have emerged during the Paleolithic period (which lasted from 2.6 million years ago until 12,000 years ago) and persisted for millennia, early hominids had to have found a way out of the animal state that entails perpetual battle over food and sex. That is, without having established a relatively peaceful and egalitarian social structure—as seen in present-day hunter-gatherer groups—humans could not have developed a system of shared meaning (culture) and passed it on to succeeding generations. Both Knight and Weiner posit an original matrilineal social structure as the likely (peaceful) crucible of the “creative explosion,” the burst of symbolic culture in Africa around 90,000 years ago that has persisted to this day.

In Blood Relations: Menstruation and the Origins of Culture, Knight proposes that hominid females, after having moved from the expansive but drought-stricken central savanna to the cramped riverine East African Rift, where they had to live in closer quarters than ever, began menstruating and ovulating in synchrony. He argues that they ultimately leveraged this menstrual/ovulatory synchrony to undermine alpha males’ sexual monopoly of them (in what would have been the existing primate social system), in order to get provisioning help for their young from less dominant males. This led to a relatively egalitarian distribution of food and sex, which in turn established the peace required to perpetuate (matrilineal) culture through the generations until the Bronze Age (about 8,000 years ago).

In the primate social system on the savanna, alpha males would have sexually monopolized any asynchronously ovulating females; but, Knight argues, after moving east, these early women broke that monopoly by taking advantage of the “un-policeability” of their mass ovulation and by imputing cosmic significance to their collective monthly bleeding.  That is, by “magicalizing” the apparently moon-governed cycle and by standing in ritualized solidarity, first as sexually unavailable and secluded during the menstrual half, and then as sexually available to the less dominant males during the ovulatory half—in exchange for meat hunted during the menstrual seclusion— women in effect forged the first standing contract.

Since women’s reproductive imperative would have been to get provisioning help for their young, who, with their large crania, had to be born in a much more helpless state than the young of any other species, this social innovation would have been adaptive in evolutionary terms. What’s more, the fairly equal distribution of food and sex occasioned by the contract would have established the peace needed to share meaning and then pass it on to successive generations—that is, it established the ground for sustained culture. Seen in this light, the nearly universal modern stigma on menstruation begins to look like a very deliberate and comprehensive reversal of what appears to have been a nearly universal reverence for it. Indeed, the feminine images and themes of the earliest art and literature seem to show respect for menstruation. And, since menstrual seclusion rituals appear to have involved “disguising” women as the wrong species for sex, it is not surprising that in much prehistoric art, women and goddesses were figured as animal-human hybrids, particularly as bird-women. The delicate forms and vulnerable expressions of many of these prehistoric figurines seem to indicate that it was particularly important to honor girls menstruating for the first time.

Weiner’s main work, Inalienable Possessions: The Paradox of Keeping-while-Giving, challenges the anthropological chestnut that men initiated culture when they began exchanging women as gifts. In her study of traditional Oceanic cultures, she too found evidence of archaic female solidarity and, like Knight, saw it as rooted in an original matrilineal system. According to Knight, for women and men alike, prehistoric social identity would have come from one’s mother group, such that women’s brothers, uncles, and nephews would have been their allies and protectors, even as they brought the meat they hunted to their wives in other mother groups. Looking at patrilineal societies in Melanesia, Micronesia, and Polynesia, Weiner saw vestiges of this matrilineality in their current marriage and exchange traditions.

Period Politics and Menstrual Social Activism

October 5th, 2015 by Editor

Guest Post by Margaret L. Stubbs

Menstruation Matters…Period! This phrase has become a rallying point for many advocates who seek to understand and improve menstrual life for girls and women. Advocates world-wide are concerned with access to menstrual supplies, especially in time of natural disasters like the recent earthquake in Nepal. Some focus on the need to improve basic sanitation in support of menstrual hygiene. Others focus on access to supplies for underserved women, for example, those who are homeless or incarcerated.  Some focus on product safety; some focus on the impact of product disposal on the environment, others promote alternative products like menstrual cups, or reusable pads.

All through October at re: Cycling, we’ll feature social and political activism around a range of menstrual issues. But, in a call-back to #MenarcheMonthre: Cycling’s September focus, for these efforts to succeed, menstrual education should highlight, early and often, the central place that menstruation holds in girls’ and women’s well-being, broadly considered.

Unfortunately, public menstrual education for our pre-menarcheal and newly-cycling girls is currently inadequate and in need of an update. We applaud those who are trying to remove menstrual stigma from product advertising, educational materials, and the social sphere. But stigma, along with a catalog of associated menstrual woes that can be expected, is still too often represented to our youngest girls.

 

 

 

 

 

After reviewing a plethora of books for young girls and a few websites on the topic, I gathered my observations into the paper Current Menstrual Education Resources: Still Room for Improvement, Stubbs, M.L. (2013, June) presented at the 20th Biennial Conference of the Society for Menstrual Cycle Research, New York, NY. They included the following:

  • Puberty is described as problematic, a period of being out of control.
  • Hormones are in control. (Subtext: you’re not).
  • Mixed messages abound and are confusing: e.g.,
    • Expect to feel weird. It’s normal!
    • Symptoms (e.g., feeling a little sick, tired, irritable; having sore breasts, cramps) are normal, but don’t let them ruin your day.

Long overdue is a shift to presenting menstruation as a vital sign of women’s health, and a normal part of girls’ and women’s lives, as well as an accurate, but not alarming, girl-centered approach to talking about what’s normal and what’s not. This clearly exists in the biomedical literature on the topic: Menstruation in adolescents: What’s normal, what’s not. Annals of New York Academy of Science, 1135, 29-35, Hilliard, P. J. A. (2008). How about including some positive information about pubertal growth? And maybe some references to historical research about origin myths, and rituals or celebration that took place to celebrate menstruation? Can we reference women’s accomplishment, even while menstruating?

While we wait for public menstrual health education to catch up, advocates are out there taking on the challenge. Individuals like Kylie Matthews, known as @AuntFlo_28 on Twitter, regularly asks the question: How can I help you? and invites her 2000+ followers to share their best period advice. Suzan Hutchinson at Period Wise is committed to breaking the menstrual taboo by empowering girls and women to be more open and knowledgable about menstruation. Be Prepared Period offers online resources for parents, women and girls, helping all to prepare for positive menstrual experiences.

Menstrupedia, a site originating in India that offers a a “friendly guide to healthy periods,” is also a good example of what can be done to promote a more positive context for girls entering menstrual life.

Let’s embrace the spirit of all the menstrual social activists and inspire others to work for the enhancement of menstrual health and awareness.

 

Margaret L. (Peggy) Stubbs is a professor of psychology at Chatham University in Pittsburg, PA, and a member of re: Cycling’s editorial board. Her areas of expertise include psychosocial aspects of menstruation; attitudes towards menstruation, pubertal development; and menstrual education throughout the lifespan. 

Menarche on Degrassi: The Next Generation – Emma’s Dilemma

September 30th, 2015 by David Linton

Emma and Manny from Degrassi: The Next Generation

Menarche month began at re: Cycling with reference to the brilliant first period talk Roseanne gave her daughter Darlene in a 1989 episode of Roseanne. We’ve chosen to end it with another TV reference from the beloved Canadian series of series named for the fictional street near which it is set–Degrassi. 

The word “menarche” is commonly defined with reference to the biological changes that occur within a female’s reproductive system at the point when the menstrual cycle begins to function. However, the onset of menstruation is also a social occurrence that has been layered with significance in every culture and time. In contemporary societies with “advanced” media of communication, menarche has been depicted in a wide variety of ways, sometimes reflecting prevailing taboos and superstitions, and at others in ways that are informative or even liberating. The focus is often on what I have labeled “menstrual transactions,” that is, the way interactions with other individuals, frequently boys or men, structure the meaning of menstruation for both the girl and others in her surroundings. This post explores one example of how this transitional moment in a girl’s life has been represented in a broadcast television series.

 


Emma’s Dilemma

One of the most positive and explicit portrayals of a girl’s first period appeared in the popular Canadian series directed at a young audience, DeGrassi: The Next Generation. Emma, the main character in the series, a girl known for her activism and responsible behavior, gets her period while sitting outside of school talking to her best friend. She is wearing a light-colored skirt and in several shots a bright red stain is visible on the back. On this particular day Emma and her friend, Manny, are scheduled to give an oral book report in front of their class and the only thing they can find for Emma to wear is a pair of gym shorts that are much too large for her. As they give the report, two young boys sitting in the front row tease her for her baggy shorts asking, “Has Emma peed her pants?”  She silences and stuns them by frankly responding, “No, I just got my period, for the first time.” They shrink in their seats. However, a somewhat more mature boy sitting in the back of the room, one who Emma has a flirtation with, is aroused from his torpor to a state of interest and appreciation for her courage as well as her implicit sexuality.

The DeGrassi clip demonstrates a rich variety of menstrual transactions. Emma’s close girlfriend comes to her rescue and even another girl, who is normally antagonistic toward Emma, gives her a pad and some “womanly” advice. Menstrual needs supersede social competition or status differences–a classic case of menstrual bonding. Perhaps most interesting is the behavior of the boys. The two young kids who tease Emma are silenced and stunned by her blunt assertion. I think of this as an effective use of her WMD–her Weapon of Menstrual Destruction. In contrast, the more mature boy, appreciates her for her assertiveness.

Missing from the four-minute clip of the transaction described above is an earlier scene in which Emma and her mother are seen walking through a shopping mall eating ice cream cones where a leering man says as they pass, “Hmmm, I’d like to lick that.” Emma shrinks away but her mother turns and confronts the man saying, “Don’t you ever talk to a woman that way!” The scene acts as a role modeling moment for Emma who replicates it in her response to the teasing boys.

Unfortunately, not all TV menarche moments are this positive. But let’s hope for more first period talks from moms like Roseanne and more socially significant, self-structured menstrual experiences from girls like Emma.

David Linton is an Emeritus Professor at Marymount Manhattan College. He is also Editor of the SMCR Newsletter and a member of the re: Cycling editorial board. His research focus is on media representations of the menstrual cycle as well as how women and men relate to one another around the presence of menstruation.

Menarche and the Growing Up of Menstrual Cycles and Ovulation

September 28th, 2015 by Editor

Guest Post by Dr. Jerilynn C. Prior, UBC, Centre for Menstrual Cycle and Ovulation Research

16-year-old Jody is anxious to talk to someone. This is what she wants to say:

“My period is out of whack!  I never know when it is coming. I only get it a few times a year. . . . Is that normal?”

To answer Jody we need to ask her how old she was when her period started. In asking that we’re trying to figure out how far she is into the normal process that our cycles must go through before they are fully mature. What she describes is perfectly natural for the first year after menarche. But if her period came when she was 11 (meaning she has a gynecological age of 5), she’s experiencing something that needs careful consideration. In this post, as someone who has studied menstrual cycles for at least 30 years  and who cares deeply that all girls mature into normally menstruating and ovulating women, I’ll ask the questions that Jody might ask, and answer as honestly as the evidence allows.

Menarche is a marker of our entry into womanhood. But it is not the start of our reproductive maturation. It is rather one lone step on a reproduction growing up pathway that has been going on for several years already. If you are a mother/grandmother with a preteen child you will one day become aware that her/his sweat is now strong and smelly, like a hot and bothered adult. Or that there is longer, darker hair on his/her arms and legs. These changes are officially called “adrenarche” and are evidence that the sex-hormone-producing layers of the adrenal glands (that also make the stress hormone, cortisol, a salt-retaining hormone and sympathetic nervous system hormones epinephrine and norepinephrine) are now growing up and making male-type hormones.

“What’s a  normal age to start your period?”

Jody got her first period a few months before she turned 16. All her friends (at least those who didn’t keep it a secret) had gotten their periods long before then. Her parents had divorced when she was 12, she was upset because she was close to her dad and rarely saw him anymore.   

In well-nourished girls and young women the first period occurs between the ages of 10 and 14 with an average in North America of about 12.5 years. The average age at menarche is now a year or two younger than it was about 50 years ago, perhaps because of better nutrition and health care. If a girl is 14 and has no flow, this is normal if she is showing some breast development. Getting first flow after age 16 is not normal and is associated with later life risks for fragility fracture (breaking a bone with a fall from standing height). This is usually caused by stresses and is something from which she can totally recover called hypothalamic amenorrhea. Rarely is it something genetic or a disease but rather a protective response because of stress of several kinds—emotional/social, nutritional, illness or over-exercise, and often a combination of several.

We now know that Jody has hypothalamic delay of her menarche.

“What’s normal for cycles in the first year after your period starts?” 

I would like to tell you that we’ve carefully studied large random groups of girls through their first year after menarche from whole populations. However, that would be untrue. One Swiss physician and his wife collected information from hundreds of girls and women with some of them recording from their first flow until menopause. Here’s what they found in that first year: cycles were quite far apart (about 40-50 days on average), quite irregular and unpredictable (R. Vollman, 1997). In a random population study of about 300 teens ages 15-19 from Copenhagen County in Denmark, 77% said their cycles were regular (between 21 and 35 days apart), 22% said they were irregular, and 2 of 100 had not yet reached menarche or were experiencing amenorrhea (Munster, 1992).

“Will I ever be able to have children?”

Obviously, to become pregnant and to carry a pregnancy to a normal childbirth, requires a grown-up reproductive system. The key part of that is ovulating, releasing an egg that could be fertilized, embed into the endometrium and eventually make a placenta and the very complex blood vessel system required for a healthy baby. So what’s normal for ovulation in the first year after menarche? Susan Barr (professor of nutrition at the University of British Columbia) and I studied girls ages 9 to 11 who had not yet menstruated over two years (Barr 2001). During that time some of them got their period. When they did, we asked them to collect morning saliva one day a week and especially during the third and fourth weeks from their flow. We measured progesterone in saliva and discovered that none seemed to have ovulated until 10 months from menarche (Kalyan, 2007).

Vollman, in studying young women from after their first menstruation, found that fewer than four of any 10 cycles showed evidence of ovulation during that first year (Vollman, 1977). That rare ovulation, however, was unlikely to support a pregnancy based on a Canadian study of exercising teens ages 15-19 and averaging 2.5 years after menarche. It showed that these young women might have regular cycles and that they often ovulated, but that the luteal phase (the length of the time after ovulation until flow) was very short (Bonen 1981). It takes many days for progesterone, produced during the luteal phase, to transform the endometrial uterine lining into something secretory that supports a fertilized egg. If the adult and fertile luteal phase length is 10-16 days, as evidence suggests, these teens experienced luteal lengths of 4-8 days (Bonen, 1981) that would not be fertile.

What happens when a seven-year-old gets her period?

September 24th, 2015 by Editor

Guest Post by Suzan Hutchinson

Do you remember being seven years old? Engage your imagination for a few minutes and try re-entering your seven-year-old world. Remember what fun life was. Recall what grade you were in, and what you enjoyed about school. Reconnect with your friends and with a few special memories.

Photo provided by Suzan Hutchinson

Menarche is not a word in a seven-year-old’s vocabulary, but there are girls who experience their first menstrual periods at age seven or even younger as a result of precocious puberty. Leaving aside the multiple medical causes of such early onset, let’s focus on how this pubertal milestone differs for those among us who experience precocious puberty. While no two experiences are identical, some of the common realities include:

  • Discovering blood on your underclothing or on toilet paper, then, at best, not being able to figure out why you are bleeding since you did not cut or hurt yourself, or, at worst, being scared you are bleeding to death
  • Having adults treat you differently from your peers, sometimes because they know you are menstruating, other times because they expect you to be able to do things a much older child would do because physically your body appears older than its chronological age
  • Learning new hygiene habits, like how to wear, change, and dispose of pads (nearly all girls who start this young begin exclusively with pads or a combination of pads and liners)
  • Navigating a world that doesn’t account for seven-year-olds who are menstruating, including schools that don’t accommodate children who might need to carry purses or other items into the bathroom, or provide bins in bathroom stalls for disposing of used products
  • Feeling isolated and alone with parents and other adults constantly telling you what to do, when, and how, while also being reminded that it is private and that you cannot tell your friends about your bleeding

This is challenging enough, but it is only the tip of an iceberg. While there are some helpful resources for parents to help their daughters with these practical issues related to menstruation, there are no easy answers to managing the moodiness or easing the emotional edges while dealing with other hormonally driven changes.

Because of these and other challenges, some families choose medical intervention to halt pubertal progression and suppress menstruation until their daughter is older. This response is also the default with preschool-aged girls and an option for any girl who is diagnosed with precocious puberty.

For those families that do not intervene, menarche will be her first of many childhood menstrual periods. In most cases these girls menstruate for several years before they can comfortably confide in peers who are then experiencing their own menarches.

Whether or not your family is ever directly impacted by precocious puberty, it is important that you have a general awareness. Here are some key facts about menarche in the United States:

  • For girls, puberty starts well before menarche. For most girls the onset of puberty is first evidenced by the development of breast buds (pubic hair appears first for the rest). If your daughter has breast buds before age seven, pubic hair before age eight, or menarche before age 10, then it is worth discussing this early development with her pediatrician and, quite likely, she receive a referral to a pediatric endocrinologist for further evaluation.
  • It is also important to know that normal puberty starts in girls at a younger age than most parents expect. Today, more than 1 in 7 (15%) American girls start puberty at age seven, and that number climbs to more than 1 in 4 (28%) by age eight. And while the average age of pubertal onset continues a decades-long decline, the average age for menarche has been much more stable. Today the average African-American girl will start puberty at age eight years, nine months; the average Hispanic girl at age nine years, three months; and the average Asian American or Caucasian girl at nine years eight months. Among all girls, the average age for menarche is now around 12 years, six months.

Do you remember much about second grade? Whatever you remember, remember that girls with precocious puberty often have some rather grown-up memories by the time they are in the second grade.

Suzan Hutchinson, a menstrual educator, coach and activist, is the founder of Period Wise. She works for Lunette and has held multiple volunteer roles with the Toxic Shock Syndrome Awareness non-profit organization You ARE Loved. Follow Suzan on Twitter @periodwise and like PeriodWise on Facebook.

How do mothers pass on knowledge about menstruation to their daughters?

September 21st, 2015 by Editor

Guest Post by Sheryl Mendlinger, PhD

The impetus of my research on menstruation started many years ago when my daughter Yael was in her teens in the 1990s, and came home from school and told me that her friends said, “If you use tampons you could lose your virginity.” Therefore, none of them were using tampons. We lived in a diverse community and many of her friends’ parents had immigrated from North Africa, Iraq and Europe to Israel. I started thinking that what we learn from our mothers, especially about menstruation, can impact our lives in so many ways. Years later when I chose my topic for my PhD, I examined mother-daughter dyads from North Africa, Ethiopia, Europe, North America, the Former Soviet Union, and Israeli born, in order to better understand how mothers transmit knowledge about health behaviors, specifically about  menstruation, to their daughters.

Photo of a menstrual hut provided by Sheryl Mendlinger

A model of knowledge acquisition for learning about menstruation was developed that included:

  • Traditional knowledge—informal knowledge passed through the generations
  • Embodied knowledge—observing others or experiencing oneself
  • Technical knowledge—the products used, and
  • Authoritative knowledge—learning from books, professionals, etc.

One of the most interesting aspects of this research is the stories the women shared about their menarche experiences. Certain celebrations that have continued through the generations may give either a positive or negative valence to the way women view menstruation. Traditional knowledge and rituals often provide strong emotional support for daughters allowing a comfortable transition through this key developmental stage. Several women whose origins were from Europe spoke about “the slap.” One mother told the story that when she got her first period her mother slapped her across the face, which she did to both of her daughters. The mother said the reason was something about the blood coming back and the daughter said it was something about the blood not going to your mind. The actual historical reasons for the slap vary and include: the manner in which it was performed could determine the duration of menstruation; it was necessary for a girl when she becomes a woman as protection against disgrace; and the rush of blood will make the girl have a wonderful color of her life. Often the rituals continue, but the rationale for the tradition has been lost.

The older Ethiopian women talked about their experiences at menarche which included special foods that their mother’s prepared, and then the young girl would go to the menstruation hut where she would stay until the completion of her period and be pampered by other women of the community. Women often looked forward to that time as a fun week away from chores and a brief vacation from everyday life, and a time to be with their women friends. As one woman said “In Ethiopia there is no rest until you go to the hut; only during menstruation does the woman rest.” The mothers however did not continue these traditions, even preparing special foods, following immigration to Israel.

The older women born in North Africa spoke with joy and excitement when they reminisced about getting their periods for the first time and the celebrations that surrounded this event. Their mothers were an integral part of this transition in life from child to woman. Some of the traditions included: mothers giving their daughters pieces of jewelry and preparing special foods; performing the ritual of putting three of the daughters’ fingers in flour so that they should only get their period for three days; and the oil ceremony. Mothers told their daughters to look and smile at their reflection in a bowl of olive oil, and then their faces were rubbed with oil. These girls were told that the image they saw on that day should continue and they should enjoy a happy life. The women noted that the oil would smooth a woman’s passage into womanhood. This oil ceremony was accompanied by a festive meal with traditional foods including honey-dipped, oil-fried cakes. When these women, the elders, were asked if they continued this tradition with their daughters, they all answered an emphatic no, of course not.

These special traditions and ceremonies that were so important from the past were often not continued into the next generation. It appears that the change and adaptation to the new culture and environment took precedence and provides an explanation for why these mothers did not continue these traditions with their daughters.

Recently however, there has been a movement to find positive and meaningful ways for young adolescent girls to celebrate the onset of menstruation in the western modern society. In my study there was an example of the daughter of an American immigrant who grew up on a Kibbutz, an agricultural collective community in which children grow up together in children’s homes.  She spoke with enthusiasm, excitement and had positive memories when remembering how each time a girl in her age group got their period, they would celebrate with gifts. These celebrations took place together with the girls in their age cohort rather than with their mothers.

Through this research we gained a better understanding of the influences and attitudes related to menarche that a mother passes on to her daughter, and the changes that take place following immigration and acculturation to the new society.

The 1970s and the Menstrual Dance: Naturally … a Girl

September 10th, 2015 by Saniya Lee Ghanoui

“Menstruation is just one routine step in a normal and natural cycle that is going on continuously in the body,” says the female narrator of the 1946 film by Walt Disney called The Story of Menstruation. “There’s nothing strange nor mysterious about menstruation. All life is built on cycles, and the menstrual cycle is one normal and natural part of nature’s eternal plan for passing on the gift of life.” That film is believed to be the first in the United States to discuss openly the female body and the process of menstruation, including the first film to use the word vagina. In this blog I will focus on one particular menstrual education film, Naturally … a Girl, to explore how it differed from previous other prominent films.

Naturally … a Girl, released in 1973 and produced by the Personal Products Company (Modess—the same makers involved in Molly Grows Up), presents a playful, colorful, and a new technique not seen in menstrual education films before: the interview.  While an authority figure is present throughout the thirteen minute film, she only performs as a guide to keep structure in the film and provide the basic biological information. It is the numerous interviews—with racially diverse girls from pre-period to those menstruating for over six years—that execute the reliability factor so important in advertising.

Throughout the film young girls are shown dancing in brightly-colored tights and leotards against a black screen. Sometimes there is a single girl dancing and other times there is a group of young women, and in all instances the dancing creates a sense of voyeurism that the girls are there to perform for the audience’s eye—whether they know the audience is watching or not is never fully revealed. The girls are all said to be twelve years old and are in varying stages of physical development. Some still possess the more square shape of a young child while others have fuller breasts and wider hips. The camera is above the girls and looks down as they lie on the black background, thus giving the viewer a shot of the girls’ entire bodies. The allure of this shot is created through a sense of scopophilic eroticism at the girls as the audience voyeuristically gazes at them moving their bodies in a tight space and close to each other.

As with the menstrual education films before it, Naturally … a Girl has an omnipresent authority figure who works as a narrator and makes an appearance at the end of the film noting how lucky she feels to be a woman. Employing montages the film narrativized the notion that all girls are different yet experience the same problems and concerns growing up. Doing so deletes the need to break the fourth wall, as with Molly Grows Up and As Boys Grow, since the numerous faces and distinctive interviews form a feeling of relatability by difference. While this creates a viewer interest it does not necessarily promote any involvement on the part of the audience. To solve this the film utilizes questions throughout; basically the film functions as a pop quiz for the audience members by asking them questions, often with multiple choice answers, and a brief moment to answer.

Overall, though, the film better encapsulates women as multifaceted beings than its predecessors. By the end of the film the narrator is introduced as a woman who, as she says, used to dream of acting and is now an actress. She reassures the audience that being is better than dreaming and what follows is a montage of working women: nurses, teachers, police officers, flight attendants, lineworkers, and mothers. The last line of the film sums up the film’s overall message from a young girl (still missing teeth) who concludes that being a woman “is better than being a boy.”

Saniya Lee Ghanoui is a PhD student in media history at the University of Illinois at Urbana-Champaign. Her dissertation looks at the history of sex education films in the United States and Sweden.

Why young teens need real periods–not the Pill

September 8th, 2015 by Laura Wershler

Guest Post by Dr. Lara Briden, ND

Photo supplied by Lara Briden

The onset of menstruation (menarche) is an important time for girls. It heralds their future fertility, of course, but it’s much more than that. Menarche is also when girls start to make female hormones for the first time.

Making hormones is not easy. It requires regular ovulation, and that can take a few years to become established. That’s why the early years of menstruation are exactly the wrong time to take hormonal birth control. Yet, unfortunately, that’s when more and more girls start taking it. According to a new study [1], this decade has seen a 50 percent jump in the number of young teens (12-15 years old) using medication such as Pills, injection, implant, and Nuvaring. These girls are at risk for many of the side effects of hormonal birth control including:

  • impaired bone density [2]
  • altered brain structure [3]
  • increased risk for depression [4]
  • suppressed libido [5]

Side effects occur partly from the synthetic hormones themselves and
partly from lack of girls’ own estrogen and progesterone.

Ovulation is How Girls Make Hormones

Ovulation is not just about making a baby. It’s also the main hormonal event in a menstrual cycle, and the only way to make estrogen and progesterone. When we shut down ovulation with hormonal birth control, we rob girls of the hormones they need for metabolism, bone health, cardiovascular health, mood, and more.

Girls who take synthetic pseudo-hormones via the Pill lose the ability to produce their own hormones. Pseudo-hormones have some similarities to real human hormones, but they also have many differences. For example, the progestin levonorgestrel causes hair loss, but the body’s own progesterone stimulates hair growth. The progestin drospirenone increases the risk of blood clots, but progesterone improves cardiovascular health. Ethinylestradiol, the synthetic estrogen in the Pill, impairs insulin sensitivity [6], but estradiol improves it. These synthetic hormones do not have the health benefits of the human hormones they replace.

Pill Bleeds Are Not Periods

Hormonal birth control is often prescribed to “regulate” periods, but that is nonsensical because a pill-bleed is not the same as a real period.

A real period is the end result of a series of important hormonal events including ovulation. In contrast, a pill bleed is a withdrawal bleed dictated by the dosing regimen of the drug manufacturer.

Newly menstruating girls often have irregular or heavy periods. That can make it tempting for doctors to suggest and for mothers to agree to give them hormonal birth control to mask the problem. But irregular and heavy periods are normal at that age. They occur because girls have not yet established regular ovulation. Hormonal birth control further suppresses ovulation, and that’s why it’s exactly the wrong thing to do. Hormonal birth control won’t promote future ovulation or menstrual regularity, and will probably make it even harder to ovulate in the future.

Better Treatment for Menstrual Problems

Teens have many non-hormonal treatment options for troublesome period symptoms.

Heavy periods: Teens will usually outgrow heavy periods after a couple of years. In the meantime, they can use natural treatments such as a dairy-free diet and the herbal medicine turmeric. Short term use of ibuprofen can also be helpful. I discuss these strategies in this article on Natural Treatment of Very Heavy Periods.

Irregular periods: Irregular periods are common in the first couple of years of menstruation and they usually do not require treatment. If periods do not start to become more regular, then please seek a medical diagnosis. The best treatment will not be the Pill, but rather it will be something to address the underlying cause of irregular periods. For example, the common hormonal condition polycystic ovarian syndrome (PCOS) requires diet and exercise to normalize blood sugar. The Pill is not appropriate treatment for PCOS, contrary to what your doctor might say.

Acne: Teen acne responds extremely well to a dairy-free, sugar-free diet and to the nutritional supplement zinc. Natural acne treatments work more slowly than the Pill, but they’re a better choice in the long term because they’re a permanent cure. In contrast, the Pill’s synthetic estrogen will only mask acne for the duration that it’s used. As soon as the Pill is stopped, acne will typically return even worse than it was before.

Better Birth Control

For those teens who need birth control, there are a couple of good non-hormonal methods. The advantage of a non-hormonal method is that it permits healthy ovulatory cycles and hormone production.

  1. Copper intrauterine device (IUD): Unlike hormonal birth control, the copper IUD does not suppress ovulation or hormones. Instead, it prevents pregnancy by impairing sperm motility and implantation. It is also highly effective with a failure rate of just 0.6 percent. The September 2012 guidelines from American College of Obstetricians and Gynecologists (ACOG) state that copper IUDs are safe for women who have never had children and for teenagers. This overturns a pervasive—but unfounded—opinion that IUDs should not be used until after childbirth.
  2. Combination condoms and Fertility Awareness Method: Teens should use condoms on every occasion of intercourse. In this way, they can avoid sexually transmitted disease as well as unwanted pregnancy. Teens can also learn to recognize their peak fertile days (charted according to fertility awareness-based methods), and then abstain on the those few days per month. Strategic, short-term abstinence will greatly reduce their risk of pregnancy in the unlikely event of a broken condom. Fertility awareness also teaches girls body literacy which is important for their future health choices. For Fertility Awareness information and a list of instructors, please visit Justisse Healthworks for Women.
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