Talking openly about menstruation

Menstruation is a natural part of life that has important health and societal implications, yet it remains rarely spoken about and stigmatized. Our November issue discusses why talking openly about menstruation matters and what to include in the conversation. A stigma-free and inclusive environment for discussion will help to address period poverty and gender inequity, and ensure health and dignity for all.

Every day around the world, over 300 million women are menstruating, and every month 1.8 billion people menstruate. Unfortunately, period poverty (lack of access to safe menstrual products, services, facilities and education¹) is just as prevalent. About half a billion women lack access to products or facilities for menstrual health worldwide. Poor menstrual health brings various risks, such as reproductive infections. Despite being part of the lives of billions, menstruation bears secrecy and taboos, and is rarely discussed openly. Societal stigma and silence dominate across cultures and reinforce myths, shame and exclusion, which makes safe menstrual health management more challenging.

Credit: andrew payne/Alamy Stock Photo

Yet menstruation is part of life, for us and many other primates. It is the monthly shedding of blood and tissue from the lining of the womb when pregnancy does not occur, and is regulated by hormonal changes. Regular and consistent menstrual cycles signal a balanced endocrine system, which is vital for mood², energy, sleep quality, and metabolic and cardiovascular health. Menstruation is a physiological and emotional wave in the cycle, much like the way tree leaves fall and return with the seasons.

So why the ‘shush’? The silence on menstruation is dangerous for physical and mental health as well as societal development. When periods are considered inappropriate or shameful to discuss openly, women, girls and all who menstruate are discouraged from seeking help for menstrual-related problems. Girls may miss school during menstruation, which hinders their future careers, deepens poverty and widens gender gaps. Further, not talking about menstruation openly reinforces the impression that women’s health is secondary. In a world where men hold greater economic and political power across all regions, continued stigma around menstruation further suppresses the voices of women and people identifying with other genders in public discourse.

We advocate for an open discussion about menstruation, with an intersectionality focus — one that is inclusive across genders, regions and lifespans. It should be a dialogue that engages all genders to create a stigma-free environment where we support whoever menstruates, rather than stereotyping it as a girls’ and women’s issue only. An inclusive conversation should place continued emphasis on ending period poverty, especially in contexts in which educational and healthcare resources are scarce. It needs to consider the challenges of extreme climate conditions and humanitarian crises. People often face immediate menstrual health risks due to the lack of sanitation infrastructure and menstrual products in these situations. We also need to extend this openness to menopause³, too, for a fuller understanding of the menstrual lifecycle to combat stereotypes beyond youth. Open and inclusive communication creates a nuanced understanding of the diverse needs of women, girls and all who menstruate, and lays the foundation for effective menstrual health practices.

To foster an environment in which menstruation can be openly discussed, researchers and policymakers need to make joint efforts. Inclusive early education helps to raise awareness that menstruation is a fundamental part of human health, and not something to be ashamed of. Health professionals can contribute by exploring menstrual symptoms and treatment to ease the physical and emotional waving, maintain well-being, and combat the wrong — yet popular — characterization of menstruating women being emotionally unstable. Accordingly, policy should be evidence-based. Public education campaigns should expand access to menstrual knowledge and resources, and health initiatives need to correct misperceptions, help to normalize menstrual needs, reduce cultural taboos and mitigate period poverty. It is vital that policies avoid reinforcing existing stigmas and gender disparities.

Modern technology has brought much convenience to managing menstruation. In addition to advanced menstrual products, smart menstrual trackers and wearable health monitors are here to assist in managing symptoms. These devices allow health information to be readily shared with healthcare providers, including artificial intelligence-powered chatbots for personalized care and educational resources. Nonetheless, these rapid technological developments pose ethical challenges regarding data privacy, security and the possible misuse of sensitive information.

It is time to talk openly about this ever-present, yet hidden, topic. In this Focus, we discuss menstruation — one of the most natural human experiences — in the hopes of breaking the silence, challenging biased narratives and advocating for inclusive actions through a multidisciplinary lens. Only by having an open conversation can we ensure that menstruation is no longer a barrier to safety, comfort or dignity for all.