Young Feminist--Menstruation Education: The Impact of its Shortcomings

By Nicole Shah

I was 12 years old when I got it. My nana had picked me up from school that day, and was watching me until my mom got off work. I went to the bathroom and did my business as usual, but on this particular occasion, there were dark brown stains on my panties. My first thought—I didn’t wipe well enough—was so embarrassing. I was confused about how I could have been so careless, and wondered what else it could possibly be. Then it hit me, I might have just gotten my period! After assessing the situation, my nana confirmed that I had just been initiated into womanhood. In retrospect, it seems significant that while she expressed her excitement for me with a congratulatory hug, I felt overwhelmed by the idea of having to remember to change my pad every couple of hours.

When my mother got home from work that evening, I had a million questions: When would the bleeding stop? How often is this going to happen? Can I keep playing sports? You see, I attended to a private, Catholic school, where sexual and reproductive education was virtually non-existent, and I had learned very little about menarche. My mother explained that this was an inevitable change in every woman’s life, and she taught me how to care for myself while on my period. More importantly to me at the time, she reassured me that I could continue being an active adolescent, and that my period would not be a hindrance.

It didn’t take long for me to realize, however, that something about my monthly experience wasn’t turning out the way my mother had said it would. Each month I would bleed for nine days straight without fail, and the flow was no less heavy on the last day than it had been on the first. At 12, I wasn’t comfortable with the idea of inserting a tampon, so I resorted to wearing the super-sized pads, which I still had to change at least every two hours. I often felt too weak to walk, and had to find ways to conserve my energy. My parents soon grew concerned about this debilitating cycle and felt something had to be done. Thus, I had my first visit to the gynecologist at 12.

At 24 years old I still have friends who have never gone to the gynecologist; and it was a completely foreign experience for me as a 12-year old. This was all the more evident to me as I sat in the waiting room surrounded by pregnant women who were all decades older than me, waiting patiently for my doctor’s advice. Clearly, adolescent heavy menses was nothing new to my gynecologist, because she immediately suggested that I start taking oral contraceptive pills (OCPs) to control the bleeding and to give me some relief. While my parents winced at the idea of starting me on exogenous hormones at such a young age, they were unaware of any alternatives.

Considering that I was overwhelmed by the mere thought of having my period at age 12, it’s no surprise that the concept of taking OCPs at that age was unfathomable. There was so much that I had to learn quickly that I didn’t completely understand. I had hardly even begun discussing sex with my parents, and yet I had been prescribed the very medication that sexually active adult women took. I felt ashamed and embarrassed that I had to take this pill, about which I had only negative associations. What I now know that I wish I had known then is that approximately one in five U.S. women experience abnormal bleeding during menstruation, and that it is normal for a young girl to experience an irregular menstrual cycle for two to three years after menarche.¹  The fact that I was unaware of these facts only magnified the emotional impact of my experience, and left me traumatized.

Twelve years later, I still ponder the question, whose responsibility is it to educate adolescent girls about menarche? I am not sure that this responsibility should lie solely in the hands of any one entity, whether that may be a parent, teacher, or someone else. Collaboration on this topic among parents and the education system is paramount. A qualitative study that analyzed 85 personal stories written by women between the ages of 18 and 61 revealed that women’s experiences with menarche were similar whether they went through puberty 10 or 40 years before the study.²  Sadly, the evidence suggests that menstrual education has not been revamped in the last 30-plus years, in terms of method and content.2 What’s more, research shows that women who report that they had an inadequate or lack of education about menarche when they were an adolescent were the most likely to report having a negative attitude about their experience2. The opposite was found as well: women who felt they had been adequately prepared for this inevitable change reported a more positive attitude about menarche.²

Given the significant influence that menstrual education has on the attitudes women have about this experience, more emphasis should be placed on refining the education that adolescent girls receive about menarche.²  A comprehensive introduction to the experience of menarche should address both the experience’s biological and emotional aspects.²  While most women report that their mothers (or another maternal figure) were their primary source of information about menarche, evidence suggests that mothers need more support and information to effectively and comfortably educate their daughters on this subject.²  Additionally, school curricula on menarche needs to be reformed to emphasize the biological process of menstruation in order to prevent misconceptions; allow more class time for presentation and discussion of this topic, so that the material can be adequately addressed; and implement a small-groups strategy to increase teen’s comfort in asking questions about a topic often described as “embarrassing” when addressed in large peer groups.²  For an example of a good resource, see http://www.girlshealth.gov, which offers thorough explanations about menses as well as an information about what happens on each day of a woman's menstrual cycle, and other unique and helpful features.

Had I been introduced to the topic of menarche at a younger age, I am confident that my personal experience would have been less daunting. While I, too, looked to my mother as my primary source of knowledge during my first year of menstruation, I can’t help but wonder if I could have avoided my emotional turmoil had I been sufficiently educated at school about puberty, as well as OCPs. I’m disheartened that so little has changed in the 12 years since my experience because, until the appropriate changes are implemented, I fear that more young girls will continue to be traumatically catapulted into womanhood.

References:
1. Gray, SH and Emans, SJ. Abnormal Vaginal Bleeding in Adolescents. Pediatrics in Review. 2007; vol 28:175-182
2. Beausang, CC and Razor, AG. Young Western Women’s Experiences of Menarche and Menstruation. Health Care for Women International. 2000; vol 21 (issue 6):517-528

Nicole Shah was a NWHN intern during Summer 2008. She recently graduated from the CAM program at Georgetown University, with a Masters in Physiology and Biophysics. She is currently applying to Osteopathic Medical school for Fall 2009 admission, and looks forward to a career devoted to women’s health.