A Conversation on Menstrual Health Matters

An average woman (or a menstruating person) has periods approximately 500 times over a lifetime, that is almost seven years of their life, and 29 liters of blood [1]. Periods are such an ingrained reality of all of our experience, and yet we are not sure how it is supposed to be. The experience varies widely from person to person. Bleeding can last anywhere from three to seven days, with flow ranging from light spotting to heavy loss exceeding 80ml (which can be considered menorrhagia). Symptoms like cramps, bloating, and fatigue also differ significantly, leaving many to question what constitutes a “normal” period. Despite this variability, society has normalized period pain (dysmenorrhea), with many dismissing severe discomfort as an unavoidable part of womanhood—even when it disrupts daily activities like work or school. This dismissive attitude often leads to underdiagnosed conditions, such as endometriosis or polycystic ovary syndrome (PCOS), perpetuating stigma and delaying necessary medical care. Our goal was to delve deeper into these experiences, spark dialogue, and compare the diverse realities of menstruating individuals.

                         

To gather insights, we conducted a questionnaire, but we acknowledge that our responses come from a specific subset of society—social media users who speak English. While this data does not represent society as a whole, our focus was on personal experiences rather than comprehensive statistical analysis. Our responses revealed that less than 15% of women find their periods comfortable. Around 75% experience cramps, 70% report mood swings, and 60% deal with bloating. Many struggle to maintain normalcy at work while managing these symptoms. Sleep disruptions due to nighttime cramps and the difficulty of handling mood swings were also common concerns. One respondent humorously described herself as a “rampaging animal” in the days leading up to her period.

Access to comfortable, effective menstrual products remains a major issue, especially for those with heavy bleeding. While sustainable alternatives like cups and tampons exist, they may not be comfortable for everyone. At workplaces, women face difficulties in discreetly managing hygiene due to a lack of proper disposal methods and washrooms. Travel further complicates period management, with concerns over stains and limited access to clean facilities. In India, period poverty remains a significant issue, with nearly 23 million girls dropping out of school annually due to a lack of proper menstrual hygiene facilities. A 2021 study by the National Family Health Survey (NFHS) found that only 64% of Indian women aged 15–24 use hygienic methods like sanitary pads, tampons, or menstrual cups, while others rely on cloth, husk, or other unsafe alternatives [2]. Rural areas are disproportionately affected, with women often lacking access to affordable period products and clean toilets. Additionally, cultural taboos surrounding menstruation persist, limiting discussions and access to necessary health interventions. 

When asked about their coping strategies, many women expressed resignation, with statements like, "I don’t manage, I succumb to it" or "I just accept and prepare for a crappy time."  While many resign themselves to the discomfort, common coping strategies include rest, pain medication, heat therapy, and self-care activities like watching movies or journaling. Some women advocate for a long-term approach to menstrual health, emphasizing the importance of a balanced diet, regular exercise, and home remedies like fenugreek-infused water. They also highlighted the role of non-allopathic remedies in supporting overall menstrual well-being. One respondent noted that since hormonal fluctuations play a significant role, maintaining healthy daily habits—such as staying active, practicing mindful eating, and getting enough rest—is key to managing menstrual health. However, for many women, rest and self-care remain privileges they cannot always afford. Even when they are "not working", household responsibilities and childcare demands often take precedence. These insights prompted us to reflect on the need for period leave, a critical step that could enable women to manage their health more effectively.

When we asked women about how their immediate circle responds to their period struggles, most expressed gratitude for having supportive people around them. However, a common concern was the lack of institutional support. Some shared positive experiences, such as one respondent who noted, "My supervisor allows nearly unlimited time off or work-from-home options." On the other hand, many highlighted dismissive attitudes. One woman mentioned that her family had normalized period struggles to the point of indifference, adding that they did not care as long as she was not too vocal about her periods or related issues. Another respondent observed that people were often oblivious, brushing it off as just a "feeling" and dismissing its impact simply because it was a common experience among women. A particularly thought-provoking response was, "They don’t understand—and, at times, I feel like I don’t fully understand other women’s struggles either. Each on their own in this one." Another respondent reflected on generational differences, saying, "My mother tells me I show anger because I can. She insists they never had such issues because they couldn't."

Menstrual health is influenced by various medical conditions that often go undiagnosed or are poorly managed [3]. Conditions like PCOS lead to irregular periods, excessive bleeding, cramps, weight gain, acne, and hair loss. Symptoms are frequently dismissed or wrongly attributed to stress or lifestyle factors.  Endometriosis, a chronic condition where tissue similar to the uterine lining grows outside the uterus, causes intense pain, heavy bleeding, and, in some cases, fertility problems. Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS, is another condition that affects mental health, causing depression, anxiety, and mood swings. Despite its profound impact, PMDD is often mistaken for mild PMS, leaving many women without proper medical or psychological support [4]. Women endure these symptoms for years before receiving a proper diagnosis and treatment. 

Women’s experiences with medical care for menstrual health were largely disheartening. Many voiced frustration, with some even "giving up" on seeking help. Despite the prevalence of these issues, medical professionals often downplay their severity, offering little support. Many reported that their concerns were dismissed, with doctors attributing symptoms to personal factors like weight rather than providing meaningful solutions. Additionally, the mental health impact of menstrual struggles was frequently overlooked. One respondent recounted facing dismissive attitudes when seeking help for difficulties using a menstrual cup, while another shared her experience of being prescribed contraceptives to regulate her periods, which led to side effects like hormonal imbalances and weight gain. Similarly, one woman hesitated to take medication for heavy bleeding due to concerns about potential hormonal disruptions and side effects.

One particularly insightful response highlighted how menstrual healthcare can differ significantly based on a doctor's approach. The respondent explained: "I was diagnosed with PCOS at an early age, and the medications have always been a matter of trial and error. Most doctors focus on irregular periods and how that might affect pregnancy in the future. However, the last gynecologist I consulted actually cared about how my period-related mood swings and headaches affected my quality of life. She prescribed medication accordingly and even suggested a hormonal IUD. But since research on its long-term effects is limited, other doctors advised against it due to potential risks for future pregnancies. This left me confused. I often feel unsure about what to do, so I choose to do nothing." 

Despite the prevalent dissatisfaction, some women did report positive experiences. One respondent mentioned successfully managing PCOS with a year-long medication plan combined with dietary guidance from a nutritionist. Another shared that her doctor had recommended lifestyle changes, emphasizing that small adjustments, such as exercising more and eating healthier, could make a significant difference. Furthermore, hormonal contraceptives are often over-prescribed as a one-size-fits-all solution for menstrual irregularities. While these medications may offer relief for some, they can also lead to side effects such as mood swings, weight gain, and hormonal imbalances. 

Another problematic trend is the medical system’s tendency to prioritize fertility over overall well-being. Many women seeking treatment for severe menstrual symptoms are met with questions about their plans for pregnancy rather than their immediate health concerns. For instance, patients with PCOS or endometriosis are often given treatment options centered around future fertility rather than managing their chronic pain or improving their quality of life. This approach leaves many feeling unheard and unsure about their healthcare choices.

When we asked women what could be done to improve the menstrual experience, many had valuable suggestions. The most common demand was for period leaves. Countries like Japan and Indonesia already offer menstrual leave, recognizing the physical toll of menstruation. In Spain, a new law grants paid menstrual leave, setting a precedent for workplace policies worldwide. Many emphasized the need for cleaner, healthier, and more affordable period products, with menstrual cup users advocating for its wider adoption to enhance comfort. One respondent stressed the importance of awareness, explaining that she endured severe rashes for years before discovering alternatives to pads. She believed that many girls might be facing similar struggles and emphasized the need to educate men about menstruation to foster empathy and move beyond dismissive attitudes. Greater investment in menstrual health education, subsidized products, and improved sanitation infrastructure is crucial to addressing these challenges. Women also called for free and more comfortable period products, personalized rather than generalized medical care, and an end to the stigma surrounding menstruation. 

Many women called for increased research and better treatment options. One person pointed out that while past efforts focused on making periods more manageable through products like pads, it is now clear that menstrual health goes beyond bleeding. She believed it was time for science to develop sustainable medical solutions addressing the physical and emotional challenges of menstruation. Another respondent echoed this, emphasizing that long-term side effects of different treatments should be studied, and that the quality of life for women should take priority over potential future pregnancies. To improve menstrual healthcare, there needs to be a shift away from merely suppressing symptoms and towards a more holistic approach. Despite affecting nearly half the population, menstrual health research remains underfunded compared to conditions like erectile dysfunction. More investment is needed in developing sustainable medical solutions and studying long-term treatment effects. This should include pain relief, mental health support, and a focus on improving quality of life. Increased research, better medical training, and patient-centered care are essential to addressing the long-standing issues in menstrual health care.  

Early education on menstrual well-being was also a key suggestion. Comprehensive menstrual education remains limited in many parts of the world, with one survey finding that 48% of young girls in India were unaware of menstruation before their first period [5]. A respondent noted that children should be taught about the menstrual cycle, including the fact that period pain is not normal and requires intervention. Several respondents insisted that boys and men should be educated and actively involved in the conversation. Others highlighted the need for public acknowledgment of period-related pain and discomfort, along with better institutional support at workplaces, in social movements, and at home.

Periods are a deeply personal and diverse experience, yet our findings underscore the critical need for societal support and access to affordable, comfortable menstrual hygiene products. The widespread dismissal of period pain as a minor inconvenience has far-reaching consequences. We must continue the conversation, challenging outdated stigmas and advocating for essential workplace policies, such as period leave. Creating a culture of openness and support will empower menstruating individuals to prioritize their health without guilt or hesitation. Menstrual health deserves the same urgency as other medical issues, from research to workplace policies. Normalizing the conversation is the first step toward meaningful change. As one respondent put it: "(We need) a lot. We need community, we need rest, we need paid leaves, we need more love." We agree.  

Written by Janaky S. and Parvathy Ramachandran @ThinkHer.

References:

1.https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation

2.Achuthan, K., Khobragade, S., & Kolil, V. K. (2025). Beyond access to sanitary pads: a comprehensive analysis of menstrual health scheme impact among rural girls in Northeast India. Health policy and planning, 40(2), 218–233.

3.https://www.medicalnewstoday.com/articles/322643

4.https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd

5.https://pmc.ncbi.nlm.nih.gov/articles/PMC6286883/