Have you talked to your daughter about menstruation lately?

 In mainstream media and pop culture, periods have gone from something that should be hidden to something that should be celebrated.

“It’s a unique time for menstruation,” said Andrea DeMaria, an expert in public health, especially women’s reproductive health, and an assistant professor in the College of Health and Human Sciences at Purdue University. “We’re seeing things like an Oscar-winning documentary about menstruation, a period emoji that people can use and share, and more attention given to eliminating the ‘tampon tax’ on these necessary products for girls and women to manage their menstruation.”

Recent research, however, found that these discussions were lacking or absent among family members, in doctors’ offices or at schools, providing most young girls with insufficient information to physically and mentally cope with their first period, resulting in ill-prepared and more difficult experiences.

“Menstruation is a huge part of reproductive health, it’s usually one of the first signs of entering into womanhood and the reproductive years, and it continues to be a taboo topic in many facets of our society,” said DeMaria, lead author of the study. “It’s something that nearly every girl and woman experiences for the majority of their reproductive years, but we as a society still fail in making menstruation an informed, healthy experience.”

DeMaria collaborated with an interdisciplinary research team, including history, health and communication scholars from Purdue, the College of Charleston and Johns Hopkins University, that conducted 70 in-depth interviews of women 19-78 years old in South Carolina. The research was part of an oral histories project recording and archiving women’s reproductive health experiences, such as contraception, childbirth and sexual violence, across generations.

The most recent findings on menstruation are published online in the journal Women & Health and expose a “culture of silence,” as well as myths, misconceptions and fear-mongering, surrounding periods. Previous findings on postpartum sexual activity were published in January.

“The majority of women didn’t have the type of information or even a discussion about menstruation prior to it happening,” said Stephanie Meier, a graduate student at Purdue and co-author of the study. “Clinicians, doctors, nurses were rarely discussed as someone they had learned from, and I don’t think anyone brought up having a conversation with a health care provider about that. So, if they’re not getting it in any of those places, it’s difficult.”

Women who did have discussions with family members or other adults said the conversations focused more on sex education and the new risk of pregnancy rather than what to expect and how to manage their first period. Others recalled being told myths, such as not to bathe or wash their hair, or to avoid the ocean for fear of attracting sharks.

“Sometimes these myths come up in conversations within families and with friends, the people that they trust the most, and they carry these myths on throughout their life span even though they’re not true,” said Jaziel Ramos-Ortiz, a graduate student at Purdue and co-author of the study.

Several interview participants, however, recalled having educational experiences that imparted practical knowledge. Similarly, adults should incorporate age-appropriate discussions with children at an earlier age, before their first period, reinforcing that menstruation is healthy and should not be feared, DeMaria said.

Social media, movies and TV will also be an important source of information as women’s reproductive health becomes more openly discussed, she added.

“There’s been more conversation in the media about menstruation than I have seen in recent years. I think that’s also going to be a good way to provide information. When we have movies, TV shows and celebrities including menstruation as an experience or as a key topic, people listen, and they remember.”

Andrea DeMaria, assistant professor of Purdue University Public Health Graduate Program

The research is an initiative of the College of Charleston’s Women’s Health Research Team, which investigates health issues specific to women and adolescent girls, promotes interdisciplinary research collaborations, and communicates research findings and health-related information to empower women and girls in South Carolina and beyond.

The work aligns with Purdue’s Giant Leaps celebration, acknowledging the university’s global advancements made in health, longevity and quality of life as part of Purdue’s 150th anniversary. This is one of the four themes of the yearlong celebration’s Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues. 

---

ABSTRACT

“My mama told me it would happen”: Menarche and menstruation experiences across generations

Andrea L. DeMaria, PhD, MS; Cara Delay, PhD, MA; Beth Sundstrom, MPH, PhD; Audrey Wakefield, MPH; Zeina Naoum, BS; Jaziel Ramos-Ortiz, MS; Stephanie Meier, MA; Kristin Brig, MA

The purpose of this study was to understand women’s menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.