Why talking more about periods benefits everyone
A crippling taboo still hangs over periods. Women are constantly adjusting their lives in the face of a society that remains uncomfortable with menstruation, leaving many unsupported and isolated. This has to change.
The population of the British Isles has been shocked to its core by the horrific murders of Sarah Everard, Sabina Nessa and Ashling Murphy. Women took to social media in their droves to highlight the daily adjustments, struggles and calculations they have to make to avoid unwanted attention or abuse when out alone.
Most men are unaware that women have to do this. The old adage ‘a woman’s work is never done’ springs to mind.
These murders have shone a light on how women are viewed in our society. The cases are extreme but the response is quite routine; women have been asked to adjust their behaviour.
I think it is time to take some of the ‘work’ away from women so they are able to live their best lives. As a consultant gynaecologist and researcher in women’s health, I think medical professionals can make an important contribution.
Modern women can expect approximately 400 periods in their lifetime. If their periods are typical, this equates to between four and eight years of menstruation and its necessary management. This ‘work’ involves remembering to pack the necessary products, purchasing pain relief, adjusting clothing choices, knowing where the nearest toilet is and altering work and leisure patterns. Most men are unaware that women have to do this.
To make matters worse, up to one in three women will experience problematic menstruation at some point in their lives. Many can’t leave the house for one week (or more) every month.
Periods can be so heavy that a blood transfusion is necessary. Problematic menstruation results in missed school and work with a knock-on negative impact on finances. Period poverty is very real, with many unable to buy the products they need to manage their menstruation.
'Just cope with it'
But menstruation remains taboo, meaning it is rarely discussed, under-researched and often sub-optimally managed.
The social stigma means people do not know what comprises typical menstruation, hence are less likely to seek help when necessary. In addition, when women do seek medical help, they may be dismissed.
All too often, those attending specialist menstrual clinics are tearful and tell me they have been suffering for decades. I wonder if this is because some doctors have not been adequately equipped during their training or if it is a lack awareness due to societal norms? Instead of providing treatment, are stressed doctors shifting the ‘work’ back to women with comments like ‘it’s part of being a woman’ and ‘you’ll just have to cope with it’?
A lack of research in this area has often led to those with menstrual problems not obtaining a diagnosis of the root cause. Some progress has been made, with the International Federation of Obstetrics and Gynecology providing globally standardised terminology and a classification system of the underlying causes. This has facilitated scientific collaboration in menstrual research and should drive vital future improvements in clinical care.
However, the treatment options in our armoury are heavily reliant on hormones and surgery. These work brilliantly for many, but hormonal treatments can have intolerable side effects such as mood alterations, breast tenderness and bloating. Surgery can remove fertility – often an unacceptable consequence. Chronic underfunding for women’s health has meant new, improved treatments are slow to emerge and waiting lists for current treatments have recently skyrocketed.
So, what can we do?
Better funding, research, listening
As medical professionals we need to ensure women’s health remains heavily featured in the undergraduate medical curriculum, that doctors maintain their skills in women’s health and that we listen to those who seek help. Reproductive aged women often work and have caring responsibilities; they put themselves last. Gynaecology services must be well funded and streamlined. We have a duty to make excellent care easily accessible for all who need it. Doing our best is not enough; we need to succeed in doing what is necessary.
It is very clear that research improves clinical care. Funding for good quality research will improve diagnosis and develop more precise, effective treatments. Collecting and analysing data can highlight unmet needs and transform the patient journey. Investing in women’s health research will enable women to function at their best and improve the health of the whole nation.
Frank, open conversations about periods will enable women to identify problems, seek advice when needed and access treatments that help. Men must be made more aware of menstruation. These conversations will facilitate menstrual friendly workplaces, create supportive partners, competent parents, understanding teachers and doctors.
To facilitate the discourse surrounding menstruation the menstrual health website ‘Healthy Optimal Periods for Everyone’ provides reliable information for the public, teachers, policy makers and clinicians.
Recent bills passed in Scotland and New Zealand have ensured access to free period products to anyone who needs them, meaning people in these countries no longer need to worry about being ‘caught out’. It is a relatively inexpensive policy that sets a tone for respecting and accommodating women and girls in our society.
Respect and dignity
Decisions regarding women are usually made with the best of intentions. The advice to stay in after dark in the wake of these murders aimed to protect women. However, a loss of freedom was the significant negative off-target effect.
Perhaps the most fitting tribute for Sarah, Sabina and Ashling is that we start listening to voices from all aspects of society to create effective policies to improve lives. If we involve women rather than exclude them and listen instead of dictate, then Sarah, Sabina and Aishling’s legacy will be that society treats women with respect and provides the medical care they require and deserve.
Picture credits: period illustration - Volanthevist/Getty; toilet cubicle - Lucy Lambrix/Getty; period products - FabrikaCr/Getty