Public Health

Let’s talk about menstruation…

Women about their menstruation and the taboo surrounding periods (Menstrual Hygiene Day – part 1).

Today, 28 May 2022, is Menstrual Hygiene Day. And unfortunately there is a big chance that you didn’t know that. Even though approximately half of the world population menstruates (part of their life), there is still a stigma around the topic. Even today, millions of women* across the globe are being stigmatised and excluded from society, simply because they menstruate. While perhaps this seems like a distant problem, and not something that would occur in Europe, there are several examples of discrimination against menstruating women here too. In certain (religious) communities, women are considered impure during their menstruation and are not allowed to enter religious buildings, touch certain foods or have physical contact with others. 

The continuing taboo around menstruation causes many women to lack information about good hygiene. Furthermore, a lot of women do not have access to affordable menstrual products. That is why Menstrual Hygiene Day takes place today, on May 28th. This date was chosen because the average menstrual cycle is 28 days, and women menstruate for five days on average, which makes 28-5. The goal of Menstrual Hygiene Day is to normalise menstruation and to break the taboos to create more awareness about menstruation. Hopefully, this will help women not be discriminated against in the future and to stop feeling insecure about their periods. 

To gain more insight into personal experiences with menstruation of women in the Netherlands, we held interviews with several women. In this two-part series, Anna, Bibi, Chaimae, Daphne, Emily, Femke en Gwen** share their thoughts and experiences about the topic. In this first article, the women discuss their struggles, if and how their menstruation affects their daily lives, and if they think that there is still a taboo surrounding menstruation. Moreover, we have added the experiences of some of the members of the Shaping Europe editorial team in this article.

Before we start: in this article, we are talking about menstruation. In case you are not entirely familiar with the meaning of menstruation, check out this video, which explains the menstrual cycle and (severe) menstrual pain. It also explains what you can do to alleviate severe pain, making this video interesting for people who menstruate too.

Psychological struggles: an overview

For many women and other people who get their periods every month, menstruation can be quite a struggle. Research done by gynaecologist Dr Bertho Nieboer (RadboudUMC) concluded that 85% of all respondents experience pain during their menstruation and 38% state that menstruation can get in the way of their daily activities. The official name for menstrual pain is dysmenorrhea. It is mainly present during puberty and early adulthood; between the ages of 30 and 35, or after pregnancy, the pain usually reduces, although this is not always the case. If there is no demonstrable underlying cause for menstrual pain, like a menstrual disorder, the pain is called primary dysmenorrhea. The pain is then caused by prostaglandins, which will be explained in a bit. When there is an organic cause, this is called essential or secondary dysmenorrhea.

It is not weird that menstruating can hurt a lot. The force that comes with the contraction of the uterus (175 mm mercury pressure) is comparable to a completely pumped up blood pressure monitor, not on your arm but around your lower abdomen. In order to contract, the uterus produces the aforementioned prostaglandins, that send painful stimuli to the brain. When the amount of prostaglandins increases, it can cause – besides hormonal fluctuations and bloodloss – (severe) pain like stomach cramps, back pain, restless legs, bloating, headaches, intestinal problems, dizziness, painful breasts, mood swings, exhaustion and, in some cases, cause people to throw up, pass out, or feel depressed. With (one of these) struggles, many women do not feel comfortable exercising or find it more difficult to focus on school or their work.

It is important to mention that severe pain is not a normal part of menstruation. However, it is difficult to estimate when pain is actually severe since everyone experiences it differently. When pain prevents you from functioning properly or if it increases every month, it is wise to contact your general practitioner. For more information, you can visit this website. Moreover, some menstrual issues can be caused by illnesses or disorders (secondary dysmenorrhea), like endometriosis, PCOS, PMS, PMDD, polyps, a malfunctioning thyroid, blood clotting disorders – the list goes on. It is important to mention, however, that symptoms are experienced differently by everyone. Some women barely experience any inconveniences or can manage well after taking some painkillers. 

Physical menstruation issues 

When we asked our respondents how they experience their periods, we received a variety of answers. This is not surprising, since everyone experiences menstruation differently. One respondent says that her symptoms are not too bad, while others find it ‘very unpleasant’. The nature of the complaints also varied enormously. Bibi said that she used to have very severe abdominal pain and nausea. Sometimes, the symptoms were so bad that she could not do anything anymore. Currently, she is taking the minipill (anti-conception) to stop her periods, however, so far this has not worked. Bibi is not the only one who suffers from her menstruation; Chaimae, Femke and Emily also say they feel quite ill during their period, and lack energy. 

Whereas Bibi has many physical problems, Anna’s symptoms are not so bad. She does have issues like abdominal pain and backache, but she can live with them. She says: “[…] Generally speaking, I have been able to accept it as a part of my life. That was more difficult when I was younger.” The differences in complaints are also seen in the Dutch editorial team of Shaping Europe. One member is currently suffering from almost nothing, however, that was not always the case. For years, she (almost) fainted every time she had her period – not from the pain, by the way, it was a fairly isolated symptom that lasted half an hour at the most. During those moments, she had ringing ears, her vision disappeared, she had fever attacks, her legs and hands trembled and she was very dizzy. Very occasionally, ‘the light’ actually went out, but almost every time it happened, she sat or laid down just in time. She has since ‘outgrown’ this, but as a precaution, she takes monthly iron supplements and tries to slow down a bit on the first day of her period, especially in the morning. Another member of the editorial team has a completely different complaint. She mainly suffers from severe backache. She can not sit or stand straight without ibuprofen. Furthermore, she has more acne during her period. Other than that, she, fortunately, does not have any other complaints. 

Almost all interviewees indicated that they were sometimes (very) hindered or held down by menstrual complaints. Anna says: “The most ‘annoying’ thing is that I can no longer concentrate well when I have backache or stomach ache. I want to […] do my work, but I just can’t.” Emily has a similar experience. Because she does not feel well physically, it is more tiring to have an active day. She, therefore, prefers to plan around her period, but that is not always possible. Furthermore, the threshold for exercising is also somewhat higher. Training in white sports shorts, for example during gymnastics, football or hockey, is unpleasant for some, as of course is ballet or swimming. Bibi says that her menstruation hindered her, especially in the past: “Sometimes it was so bad that I could not ride my bicycle to school until the medication worked”. Chaimae says she is often exhausted by the loss of blood and the pain, which makes it harder to get through the day. Fainting has hampered the editorial board member in the sense that it came always unexpected and inconvenient. On holiday, in the queue at customs, in the shower, in the train, on the bike, at competitions… Having to take this into account every time was just very irritating. In addition, (almost) fainting caused her to have less energy for the rest of the day. On the other hand, there were also respondents who suffered less. Gwen, for example, indicated that she never had to plan around her period and did everything normally just like she would normally do. 

Psychological issues

Besides physical issues, the menstrual cycle can also result in psychological issues, as shown by the aforementioned research by Dr Nieboer. 70% of the respondents in his research experience psychological difficulties and exhaustion prior to or during their menstruation. Those issues can be relatively innocent, like mood swings, but some experience more severe issues. Daphne, for example, mentions that she suffers from PMS (Premenstrual Syndrome); physical and in her case psychological issues that start about a week prior to her actual period. Moreover, she suspects that she suffers from PMDD (Premenstrual Dysphoric Disorder). Whether she does have this chronic disorder has never been medically confirmed, even though she has visited her doctor. PMDD is a severe reaction to the increase and decrease of the hormones estrogen and progesterone. This can lead to insomnia, mood swings and periods of depression. In the case of Daphne, PMDD even led to suicidal thoughts.*** Her negative thoughts continue for about a week and end around the same time as the start of her menstruation.

It will not come as a surprise then that these issues hinder Daphne quite a lot during her daily activities. PMDD causes her to struggle with insomnia and nightmares, resulting in her being more exhausted. Trying to remain positive requires a lot of energy as well. Due to her struggles, she finds it harder to focus and participate in social activities. Usually, doing fun things can serve as a distraction but because she needs that distraction to make it through the day, she has less time to work on school assignments. 

Daphne mentions that most general practitioners lack knowledge about PMDD. The solutions that were offered to her were not ideal. The options were (1) to start taking contraceptive pills (which had given her issues in the past), (2) to take antidepressants during the week when she experiences issues, and (3) ‘to take good care of herself’ by for example ‘getting some fresh air’. Due to the stories about the sometimes lacking knowledge of physicians, and the common perception that pain and inconveniences are part of the deal, very few women decide to visit a doctor when they experience severe issues, which this is not a normal part of menstruation.

Fortunately, not all women experience psychological issues. Some respondents experience menstruation as something positive, even though they experience physical inconveniences. Gwen, for example, says that she considers her menstruation to be a beautiful period in which she takes extra care of herself. She also sees her menstruation as a relief because it means that she is not pregnant. Emily is grateful for her menstruation as well, while she also experiences pain during her period: “I am glad that I menstruate every month because I know that that means that I am probably fertile. Some women do not get their period, so, taking that in consideration, I can only be grateful.” Both women mention that their menstruation makes them feel like a woman and gives them a feeling of empowerment. They are not the only ones who experience this. Several athletes attribute their achievements to their menstruation. For example, Dutch racing cyclist Leontien van Moorsel broke the world record when she got her period. However, not everyone thinks positive about menstruation during exercise; some athletes think that menstruating negatively influences their performances. So far, there has been no scientific proof for either side.

Is menstruation still a taboo?

In the media and beyond, talk about menstruation, period poverty and menstrual leave are increasing. The respondents agree that the taboo, at least in the Netherlands, has become less prominent. Anna and Daphne notice that the topic is not avoided within their friend group or family and that people actually talk about it more often. However, the respondents agree that the taboo is still prevalent. Many think that it is not talked about often enough and that especially boys and men find it an awkward topic to talk about. Gwen showed us a NOS Stories video about the research from PlanNederland, which demonstrates that a big part of young boys from Brazil, Indonesia, Uganda and the Netherlands, consider menstruation to be ‘disgusting’, ‘gross’, and ‘shameful’. While they also think menstruation is ‘healthy’ and ‘natural’; an interesting contradiction. Furthermore, more than 33% of all boys think that women should keep their menstruation a secret. The taboo among young children has also been noticed by Anna and Gwen. Menstruation is still seen as something to be laughed about in primary schools and the first classes of secondary school, while mainly young girls are often very insecure about their menstruation.

The other results of the PlanNederland research are quite shocking too. Almost a quarter of the boys say they are hardly or not not all informed about menstruation. That means that they do not know what menstruation is, or what it entails. 70% of the boys have heard other boys or men make negative comments about menstruation. In the Netherlands, 25% of these comments came from male teachers. 29% of the boys find it embarrassing for girls when they have to buy period products, and over 40% find it embarrassing for girls when they walk to the toilet with pads or tampons in their hands. Moreover, more than half of the Dutch boys and young men have never bought menstrual products. 

In the Netherlands, the taboo surrounding menstruation is not as big as it, unfortunately is in some other countries. Research by PlanNederland shows that more than half of Indonesian young men think that girls/women should not be allowed to go to school or work during their periods. Almost three quarters believe that women who are menstruating are not allowed to enter places of worship. Moreover, more than half the Ugandan boys and men think that girls should not be allowed to stay unmarried after their first period. Mind you, the first menstruation usually occurs between the ages of eleven and sixteen. And then there are stories of Indian women who have to spend their entire periods in a shed/period huts isolated from others, also because of ideas of impurity. Closer to home, the taboo around menstruation is also still strong. In Poland, for example, the continuing taboo means that women still do not have enough information about their periods, which leads many women to believe, for example, they cannot become pregnant during their periods. In addition, there is still a great deal of superstition about menstruation; one in five Polish women, e.g., believe that they should not bake cakes or pickle cucumbers during their periods. 

Menstruation is not only a taboo subject for some men. Emily believes that the fact that women try to make as little noise as possible when ripping open their sanitary pads, or that menstrual products are secretly passed on to someone who has forgotten them, says enough. She also notes that ‘blood’ in adverts for menstrual products is never red, but blue. Also, advertisements pretend that women never suffer from their periods, but can happily and easy live their normal lives. And are you searching for an image on the internet about menstruation? Chances are you will find many pictures of sanitary products with (red) glitter. 

Fortunately, we can end this article on a positive note. The research done by PlanNederland shows that almost all boys, 92%, want to normalise menstruation, for example by providing better education at schools, and by giving information through the media. They are willing to break the taboo. However, this does not mean that the problems end there. Period poverty is a worldwide problem, which means that it also occurs in the European Union. It is estimated that one in five women in the European Union cannot afford to buy enough menstrual products every month. Moreover, there is a fierce ongoing discussion in several European countries about the introduction of menstrual leave for women who are severely hindered by their menstruation. In the next article on menstruation, we will period poverty and menstrual leave more in-depth, so stay tuned!

*We are aware that not everyone who menstruates identifies as a woman and that not all women menstruate. 

**Pseudonyms were used in this article. The real names of the respondents are known to the Dutch editors. 

***Do you ever have suicidal thoughts? You can talk (anonymously) with 113 Suicide Prevention (Dutch): chat via or call for free 0800-0113. Are you an English speaker, please check for help.

Loes ter Horst is a bachelor’s student Liberal Arts and Sciences at Utrecht University with a specialisation in International Governance (Utrecht School of Governance).

Sabine Herder is a bachelor’s student Liberal Arts and Sciences at Utrecht University with a major in International Relations in Historical Perspective.

Featured Image: Shutterstock

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