Developing Healthy Attitudes

DHA Home SWR Home Bereavement Body Image & Self-Esteem Bullying Child Marriage Children in Care & Care Leavers Child Sexual Exploitation Domestic Abuse Eating Disorders Female Genital Mutilation (FGM) Gambling Hate Crime & Hate Incidents Healthy Relationships Honour Based Abuse Housing & Supported Accommodation LGBT+ Young People Menstruation Mental Health Online Safety Sexual Health Smoking inc. Vaping Substance Use/Misuse Virginity Testing Young Carers Youth Crime

Menstruation

Overview

The menstrual cycle can be considered a vital sign. Like blood pressure, resting heart rate or temperature, it can indicate good health or illness. Periods are an ordinary biological function that are part of the reproductive cycle. Due to a long history of taboos and stigma around attitudes to reproductive health in general and periods in particular, this topic can produce some anxiety for teachers, parents, carers and young people. Some of this comes from historical and cultural taboos that are passed down from one generation to the next, but for the past century or so, media advertising has also played an influential role. Advertising messages have often made their way into schools in the form of leaflets and free lesson materials from major multinational corporations that manufacture and sell disposable menstrual products. Over many decades, advertising slogans referring to products that are ‘discreet’, ‘invisible’, ‘100% leakproof’ or that customers should ‘whisper’ about have given the false impression that periods should not be talked about. The industry terms ‘sanitary protection’ and ‘feminine hygiene’ also give the message that periods are particularly ‘unsanitary’ or ‘unhygienic’, requiring special products to urgently help keep people clean. For many years, due to taboos, generations did not really question the messages we received and did not teach young people how to question these messages either. For most of us, teachers, parents and carers may have accidentally transmitted the message that periods were bad or should be kept secret. It is important to ensure that we “catch up” on our own learning so we can break this cycle and pass on the most valuable, evidenced-based, accurate information to young people in a way that dispels myths, actively challenges taboos, and improves their menstrual literacy. The goal of better menstrual literacy is that they can all make informed choices about their health and wellbeing.

Encouraging an atmosphere where young people of all genders can speak freely about periods supports a better overall attitude to the changes of puberty as well as a positive sense of wellbeing. It can lead to better focus in the classroom and more open conversations with parents and carers, and it may also help with early diagnosis of STIs, womb-related cancers and other illnesses. A positive attitude around menstruation helps to create an atmosphere in which young people will feel more supported to seek medical help for reproductive health-related medical conditions such as endometriosis, PCOS, PMDD and heavy menstrual bleeding.

It is important to remember that while most people who menstruate are girls and women, not all women do for medical or physiological reasons, and some people who menstruate may be trans, non-binary or intersex. The language in this guidance refers to all pupils who may have periods, whatever their gender, and sensitively omits the assumption that all girls and women have periods. This is in line with the 2010 Equality Act and 2012 Equality Duty for Local Authorities. It is recommended best practice to include all menstruators in this way, and also to ensure that menstrual literacy is taught both to and by non-menstruators as well.

Recent changes to period policy in England include: the Relationships and sex education (RSE) and health education guidance https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education - menstrual wellbeing is now included in statutory education as of 2021. See the proposed Period Positive National Curriculum programme of study https://periodpositive.com/period-positive-menstruation-education-programme-of-study/ for recommendations of what to teach at each age and stage. See further down the document for information and considerations about the Period Product Scheme for Schools and Colleges in England. https://www.gov.uk/government/publications/period-products-in-schools-and-colleges.

Key Facts

• In results from a study by the Sex Education Forum, 1 in 4 young people don’t learn about menstruation in school lessons before they reach puberty.¹
• In a report by the Bolton NHS Foundation Trust in 2010, “menstruation problems” were the fifth most common reason given for school absence.²
• The average menstruator will use 11,000 menstrual products in their menovulatory lifetime, and 4.3 billion disposable menstrual products are used per year in the UK.³

Best Practice

A big shift in how we currently approach the topic of menstruation is needed so that young people can focus on their schoolwork, exams and activities rather than worrying about menstruation management.

Reflect on your own attitudes to menstruation and when and how they may have formed. Develop your own knowledge so that, if approached, you can confidently support young people with their menstruation queries.

Carry out an audit of your school or organisation to ensure that stigma isn’t built into your policies, procedures or built environment. Incorporate the Period Positive Pledge into your everyday practice. The Period Positive Pledge is guidance created for schools and organisations to use to ensure their work around menstrual literacy is fair, accurate, inclusive, and community focussed. The Period Positive Project developed from research conducted for Sheffield by Chella Quint, head of PSHE at Firth Park Academy, and grew out of action research with pupils at the school. The Period Positive Pledge and Charter Award, lessons plans and curriculum model have all been piloted with pupils and staff at Firth Park Academy since the start of the project and have now been disseminated to other schools in Sheffield and beyond. This research was made possible with generous financial support and support in kind from Firth Park Academy, Sheffield Hallam University, Development Education Centre South Yorkshire (DECSY), Learn Sheffield, and Sheffield City Council. (See training opportunities below.)

Try not to make assumptions about who has periods. Whether for physiological, gender identity, trauma or medical reasons, be sensitive to individuals. For trans and non-binary-identifying young people (who may not have indicated their gender identity to all staff), gender-neutral language can be critical to ensuring they receive valuable information that does not exclude.

Use teachable moments to remove any sense of secrecy around menstruation. Be alert for off-the-cuff opportunities and avoid expressing disgust, as that creates a sense of shame about periods. How you handle these moments sets the tone – humour, neutrality and matter-of-factness work well – and ignoring these incidents can speak volumes.

Make menstruation education into an ongoing conversation rather than a “big talk”. As well as teaching about periods in PSHE and Science, consider incorporating the Period Positive National Curriculum proposed programme of study into each subject. You can start by mapping the curriculum subject against the Period Positive Programme of Study to ensure that any crossover opportunities are appropriate for each age and stage of learners.

Look into whether menstruation management is made easy and practical for pupils and staff. Ensure that toilets accommodate people who menstruate by providing small pedal bins (including in the men’s, unisex and disabled toilets) and that there is soap, hot water and drying facilities. In schools, allow pupils to go to the toilet when needed, and ensure that toilets are unlocked at all times.

When teaching about or providing menstruation management, show examples of a range of several different brands, styles and types of reusable and disposable menstrual products.

Provide a range of free menstrual products that are easily accessible. Do not use one brand or promote free samples or lessons with logos – this can unduly influence young people and may promote advertising tactics that use shame and secrecy. (See information about the free products scheme below.)

Add a menstruation management and menopause policies to your HR policy to ensure staff are also supported. It can be frustrating to be working hard to make these changes for young people if you or your colleagues are feeling unsupported.

Taboos & Myths

In the past, menstruation management in the global north was practical and, while not necessarily as convenient as today, did not carry the negative connotations that have built up over the past hundred years or so. While historic taboos evolved from religious customs, superstitions and inaccurate medical beliefs, the 20th century saw a focus on advertising influencing most of the public discourse around menstruation. Companies selling disposable menstrual products found it lucrative to send a representative into schools, offer schools free samples, and even provide mothers, teachers and school nurses with branded educational booklets. This still goes on today, and in many schools across the country one can still find these materials. Market research companies issue reports that recommend companies continue doing this to gain loyal customers, and experts reviewing or vetting these resources frequently find them lacking valuable information.

Many recent myths are around the length of cycle and volume of flow. It’s important to share that there is a range of averages when talking about the menstrual cycle and not just share one average number for each characteristic. Young people find it reassuring to know they’re within a typical range, rather than worrying their experience sits outside one ‘average’ figure. This approach also supports pupils to know when to seek help. For example:

• 21-35 days is the range of days in an average cycle
• 3-7 days is the range of days in an average period
• 30-80 ml is considered an average flow
• 9-16 is the average age range for getting your first period

One thing that has been highlighted in recent years is that learning about the four stages of the cycle is really valuable in managing symptoms and improving mood. In the run up to ovulation people may feel more productive and creative, in the lead up to the period people may feel more like they want to rest or not start new projects. Knowing about all four stages gives young people a sense of ownership and also helps with contraception and fertility support later on. Pupils who menstruate can find cycle charting extremely helpful and this should be included as a typical part of period education. They should be made aware about online safety and protecting their personal data if they choose to use an app as a tracker, but can also track menstrual cycles offline using a planner, chart or diary.

There is also a recent concern that the focus on period poverty, while highlighting the needs of many during the recent financial crisis, can also overly focus on the perceived fear and urgency of not having products. Whilst charities and campaigners have found the language of urgency and crisis useful in completing their campaigning goals, researchers have been noticing that this can unintentionally have the opposite effect on pupils themselves. Recent research in menstrual scholarship suggests that this focus can intensify period taboos rather than dispel them. Although there is a very issue of rising prices of food and toiletries, including menstrual products, recent campaign and policy language has also caused some staff and pupils to focus excessively on leakage fear, feeling there must always be a product to hand, leading to more worry and potentially more shame if leaks occur.

It's worth noting that over the past few years this topic has opened up a lot more, but even if individual teachers, pupils and parents report feeling more comfortable or confident with the topics themselves, focus groups with staff and young people have shown that there is a significant population of the school community who remain ‘quietly uncomfortable’. This may be due to embodied shame or being afraid to ask questions, but can also be down to a pervasive cultural echo or ‘institutionalised menstrual stigma’. Every step staff can take toward further educating themselves or others using reputable sources can build toward creating a more open and comfortable atmosphere about menstruation in policies and practices as well as lessons and everyday conversations.

Biology Glossary

Cervix The lower part of the uterus that contains the opening to the vagina.

Cervical mucus The discharge that comes from the cervix and changes texture throughout the cycle. Around ovulation it has the consistency of egg white.

Clitoris Organ providing sexual pleasure, part of which is visible just inside the top of the labia.

Discharge Fluid produced by glands in the cervix or vagina that indicate different states of health, eg fertility, arousal.. Most types of discharge are healthy and normal. Sometimes discharge can indicate an infection. Healthy discharge shouldn’t be itchy or painful, but unhealthy discharge can be (although some infections may go unnoticed because they have no symptoms).

Endometrium The blood-filled tissue that creates the lining of the uterus.

Endometriosis A painful condition where endometrial tissue accidentally starts to build up outside the uterus and can attach to other organs in the abdomen and pelvis.

Fallopian tubes The tubes that eggs travel along from the ovaries to the uterus.

Follicle-stimulating hormone (sometimes called FSH) Is a hormone in the pituitary gland in the brain which along with LH stimulates eggs to grow inside follicles in the ovaries.

Hormones Chemicals in the body that control various biological functions.

HPO Axis The group of glands, hypothalamus, pituitary, and ovaries that work together to regulate menstrual cycles by releasing hormones. Changes in general health can upset the balance that these three glands need to work well in harmony.

Hysterectomy/oophorectomy a type of surgery where the uterus or uterus and ovaries are removed for medical reasons.

Labia The inner and outer folds of the vulva.

Luteinising hormone (sometimes called LH) A hormone by the pituitary gland that triggers ovulation.

Menarche When someone begins their very first menstrual cycle.

Menopause The time when someone has experienced their last period. After this time, they would be post-menopausal.

Menstrual cycle The menstrual cycle is each step from the period to preparing for ovulation and the uterine lining building up and round again to the period.

Menstruation When the uterus sheds its lining, resulting in bleeding from the uterus, through the vagina.

Menstruator A person who menstruates.

Oestrogen The hormone that triggers egg maturation.

Ovaries The organs that store and mature eggs inside the body.

Ovulation When an egg is released from the ovaries.

Ovum An egg cell which, if fertilised by sperm, can implant into the uterine wall, leading to pregnancy.

Perimenopause The time in life when a change in oestrogen levels means that menstrual cycles begin to come to an end, which is around age 45 - 55 for most people but can be earlier for those who experience early menopause due to a hormone issue, a hysterectomy/oopherectomy or particular types of cancer treatment that can bring on early menopause.

Premenstrual dysphoric disorder (PMDD) Severe and debilitating mental health symptoms experienced before or at the start of each cycle.

Premenstrual syndrome (PMS) Minor to moderate physical and emotional symptoms experienced in the run-up to (and sometimes during the start of) each menstrual period (formerly referred to as PMT). Research has shown that masking these symptoms can make them feel worse.

Progesterone The hormone responsible for the build-up of the uterine lining.

Puberty The time at which young people’s bodies and brains develop, when they mature into young adults and become able to reproduce and have more complex cognition.

Toxic shock syndrome (TSS) A very serious bacterial infection that studies have linked to tampon use.

Urethra The passage that leads from the bladder to the outside of the body. This is not part of the reproductive system, but the urethral opening can be found in the vulva, between the clitoral hood and the vaginal opening.

Uterus An organ inside the body that grows a lining to protect an egg each month. If the egg is fertilised it may implant into the wall of the uterus which would begin a pregnancy.

Vagina Internal passage to the uterus.

Vulva External genitalia consisting of the hood and glans of the clitoris, labia, urethral opening and vaginal opening– not to be confused with the vagina.

Menstruation Management

There are four types of menstrual products: internal, external, disposable and reusable.

Most people are familiar with disposable menstrual products like pads, tampons and panty liners. These are used once and thrown away. There are many different brands, varieties and material variations, and it may take time to find one that is the right price and the right design for each menstruator. Companies work hard to advertise these products as part of a very profitable industry.

Reusable menstrual products are gaining popularity because they are good for the environment and for personal budgets. These include menstrual cups, which are inserted into the vagina to collect blood. They are designed to be taken out, rinsed or wiped with loo roll and reinserted. Cloth pads are also reusable and are often familiar to those who use cloth nappies. They can be bought or homemade. Period pants are underwear with a built-in absorbent fabric layer – they absorb a light flow of blood and then can be washed and worn again.

Internal menstrual products, such as tampons and menstrual cups, are used inside the vagina.

External menstrual products, such as disposable pads, cloth pads and period pants, are worn outside the body.

There is a period product scheme for schools and colleges in England that runs until July 2023. https://www.gov.uk/government/publications/period-products-in-schools-and-colleges. If you choose to participate in the scheme you should familiarise yourself with the process of ordering products, then speak to or survey pupils to find out what products they’d prefer you to stock, but you should first ensure they have been made familiar with the wide variety of menstrual products that are now available, including period pants and plastic free disposable products. You should be prepared to update these choices with frequent feedback sessions with pupils on whether what is being provided is what they still want throughout the school year.

Products are most effectively used when placed in pupil toilets. Pupils using the scheme have reported that putting them in other locations in the school has not been as effective, however, putting information about menstrual products being available in the toilets in other places around the school has been very effective. Exam halls are a particularly useful place to advertise that free products are available in the toilets, and exam invigilators should ensure as part of invigilation preparation that these posters are displayed, and the toilets are stocked for all genders outside of the exam halls. This is because pupils are not allowed to take bags out of the exam hall with them if they go to the toilets. For more information, see the Exams Period campaign. https://periodpositive.files.wordpress.com/2018/05/exams-period-campaign-school-pack.pdf.

Menstruation Education

The Period Positive Pledge

The Period Positive Pledge is a framework developed from feedback and workshops with young people in Sheffield. It gives a list of suggestions for being fair, respectful, and inclusive when learning or teaching about menstrual education, activism, charity or policymaking. The pupil edition is below. For a journal article on the grown up edition, follow this link: https://centreforfeministforeignpolicy.org/journal/2020/3/9/the-period-positive-pledge-an-international-standard-for-co-operative-non-corporate-menstrual-literacy-policy

1. 1. Use the phrase ‘menstrual products’ instead of ‘sanitary products’, ‘feminine hygiene’ or ‘femcare’. It’s time to move on from phrases that make periods (and people who menstruate) sound dirty or bad – because that’s definitely not true.
2. Include people who don’t menstruate in your period conversations, because everyone deserves to learn. Remember that you can’t tell if someone menstruates just by looking at them.
3. Find out how to use sustainable menstrual products like period pants, menstrual cups and cloth pads or plastic-free disposables and aim to cut single-use plastics out of your menstruation management. Tell people why you’re doing that.
4. Remind yourself of details about the whole menstrual timeline – from before menarche to menopause and beyond. Remind others, too.
5. Check out your home or school or any other place you regularly visit (and re-check every so often) to make sure it has everything and every place someone who menstruates would need. If it doesn’t, ask for help to make changes.
6. Study up on the biology of menstruation and reproductive health so that you understand how hormones and glands help the organs in your body to function healthily and so you can recognise if things are going wrong.
7. Fight for the rights of people whose menstruation causes extra problems because they are facing unfairness or discrimination in another part of their lives.
8. Remember that no one thing will make it easier for people to manage menstruation. It’s a combination of education about biology, understanding negative messages, awareness of different products, choice, availability and taboo breaking – all working together.
9. Challenge companies who still use stereotypes, fear or taboos in advertising for their products, or use their influence on kids. They need to become better role models!
10. If you like some work you’ve seen that a menstrual activist or researcher or company is doing, or find something you read funny or interesting, make sure that when you share it you give credit to the person who created it. People are working hard to break menstrual taboos and they all deserve credit.
11. If you find out something about periods that you want to share, make sure it is true and comes from a trustworthy source. There are a lot of myths out there!
12. When you see companies working with schools or charities, try to figure out whether they are doing it so they can advertise to you and other new customers and make money, or because they really want to help people first of all.
13. If a person or organisation makes a mistake when they’re talking about periods, first try to correct them in private so they don’t keep making the same mistake or telling people the wrong information. Telling them off in public may embarrass them or it may backfire and make them want to ignore you.
14. There is lots of information about periods still being discovered and there is always more to learn, so as you grow up, keep learning and reading about it.
15. You do not ever have to feel ashamed or embarrassed about your body, puberty or periods. Feeling that way can make you feel worse about other things in your life so it’s healthier to get rid of menstrual shame.
16. It’s good to question and challenge the messages you see in adverts, films, online, in books, on television and in other media if they show periods in a negative or embarrassing way. This way of presenting menstruation is inaccurate, out of date, and doesn’t help anyone anyway.
17. Be proud to call menstruation what it is instead of whispering, using negative euphemisms or secret gestures to keep it hidden from the people around you. There are lots of ways to choose to be private about bodily functions, but you never have to keep periods a secret.
18. Comparing notes with friends and relatives who menstruate really helps you work out what is healthy for your body, and it will support you and others to recognise and see a doctor about any menstrual problems if they happen.
19. Anyone of any age, class, gender, sexuality, ability, race or culture can talk about menstruation. When you talk about menstruation, especially if you are fighting taboos or unfairness, make sure the people affected the most have space to speak for themselves. If this is you, be proud and take up space!
20. Be open and welcoming of new ways of looking at menstruation as more people start to become Period Positive!

Programme of Study: A Period Positive National Curriculum for England

The programme of study offered here https://periodpositive.com/period-positive-menstruation-education-programme-of-study/ is suitable for menstrual literacy curriculum planning across all Key Stages of the National Curriculum in England. As well as guiding lesson plan creation or selection within PSHE and Science, It can be mapped across all subject areas and allows teachers to incorporate menstrual learning into their specialist subjects, in order to normalise a culture of menstrual literacy, challenge period taboos, and swiftly upskill staff and pupils together. The model grew out of master’s research by Chella Quint with pupils and staff in Sheffield in response to the Wellcome Trust-funded Prepared for Puberty Project with the Sex Education Forum, and the EU-funded Gender Respect Project with Development Education Centre Sount Yorkshire (DECSY). It has been developed and evaluated with the support and feedback of teachers, pupils, parents and young people and in consultation with fellow researchers, period poverty and menstrual wellbeing charities, menstrual activists and medical professionals.

Menstruation Education should be...

• Free, unbranded, objective, inclusive of reusables (like menstrual cups and cloth pads), evidence-based, and easy to understand.
• Consistently taught by trained staff, factually accurate, up-todate and well-researched, with learners’ needs in mind, and regularly evaluated with pupils and menstruation education practitioners, including excellent communication with other departments, parents and community partners about the content of lessons.
• Aimed at different age groups, starting well before puberty (and ensuring the use of correct names for body parts, even with very young children) and revisited regularly.
• Inclusive of all genders, cultures, abilities and sexualities (the way all high-quality RSE should be), with adapted resources where appropriate.
• Supportive of easy menstruation management in school and equipped to signpost diverse and effective ways of menstruation management now and in future, including offering as-needed disposable menstrual products and ensuring that pupils are made aware of reusables and supported in using them.
• Delivered in planned curriculum lessons, as well as in teachable moments as they arise.
• Actively challenging messages of shame in media, advertising, current cultural discourse etc through activities that teach media literacy.
• Avoid using euphemisms like “Aunt Flo” or “sanitary products” – reinforce the use of correct terms: “menstruation”, “period” and “menstrual products”.
• Able to scaffold and complement lessons on fertility, puberty and reproductive health, with an awareness of physiological differences and medical conditions related to reproductive health and of healthy menstrual cycles as a vital sign.
• Supported more comprehensively across the curriculum, particularly in science and PSHE but also in media studies, PE, maths, graphics and textiles.

Resources

The Period Positive Pledge https://periodpositive.com/the-period-positive-pledge/

The Period Positive Pledge Pupil Edition: https://periodpositive.com/pupil-edition/

A Period Positive National Curriculum for England: Programme of Study https://periodpositive.com/period-positive-menstruation-education-programme-of-study/.

Own Your Period A Fact-Filled Guide to Period Positivity, by Chella Quint https://www.amazon.co.uk/Own-Your-Period-Chella-Quint/dp/0711256632.

Be Period Positive Reframe Your Thinking and Reshape the Future of Menstruation, by Chella Quint https://www.amazon.co.uk/Be-Period-Positive-Thinking-Menstruation/dp/0241483395/.

How Period Positive are you? A simple self-assessment baseline data collection resource for gauging your own or young people’s attitudes to menstruation.

A short video demonstrating the Menstrual Product Mambo for teaching the four types of menstrual products and dance steps projector slide.

A resource booklet with photos explaining how to change a pad for young people with learning disabilities.

STAINS^TM – activities based around Chella Quint’s spoof company combating leaking taboos and promoting confidence in menstruators to “reclaim the stain”.

The education resource magazine for the Wellcome Trust and Sex Education Forum co-produced Prepared for Puberty Project edition of the Sex Educational Supplement magazine including an audit you can use in a school/college/workplace to ensure that there is supportive provision for menstruation management.

References

¹ Sex Education Forum Prepared for Puberty Project (NCB 2016).

² Ovarian Cancer Action Survey, 2015.

³ WaterAid Survey, 2017.

⁴ Davies, J., & Hindley, D. (2010). Managing frequent medical absences from school. Archives of Disease in Childhood.

⁵ Menstruation and Sanpro/Femcare Market Facts and Fig’s, AHPMA.