Period poverty, reuse needs, and depressive symptoms among refugee menstruators in Jordan's camps: a cross-sectional study.

BACKGROUND: Period poverty is a significant issue that impacts the physical and psychological well-being of menstruators worldwide which can further contribute to poor mental health outcomes. For menstruators living in refugee camps, access to menstrual hygiene products is often limited or non-existent, leading to increased anxiety, shame, and embarrassment. Therefore, this study aimed to assess the prevalence of the period poverty and to comprehensively analyze the association between period poverty, reusing menstrual products, and depressive symptoms among menstruators living in refugee camps in Jordan. METHODS: A cross-sectional study surveyed refugee menstruators living in camps in Jordan, aged post-menarche to pre-menopause. Data collection included socio-demographics, menstrual practices, and depressive symptoms using the Patient Health Questionnaire (PHQ-9). Period poverty was assessed through affordability and frequency of struggles with menstrual products. Chi-squared test, independent sample t-test, One Way Analysis of variance (ANOVA) followed by Post hoc, and logistic regression models were used in the analysis. RESULTS: The study included a diverse sample of 386 refugee menstruators living in camps in Jordan (mean age 32.43 ± 9.95, age range 13-55). Period poverty was highly prevalent, with 42.0% reporting monthly struggles to afford menstrual products, and 71.5% reusing menstrual products. Univariate analysis revealed that experiencing period poverty was significantly associated with a younger age of marriage, increased number of children, lower education level, lower mother and father education levels, unemployment, decreased monthly income, absence of health insurance, lower reuse need score, and increased PHQ-9 score (p < 0.05). Menstruators experiencing monthly period poverty were 2.224 times more likely to report moderate to severe depression compared to those without period poverty (95% CI 1.069-4.631, P = 0.033). CONCLUSION: This study highlights a significant association between period poverty and depressive symptoms among refugee menstruators in living in camps in Jordan, as high rates of period poverty were associated with a 2.2-fold increased likelihood of reporting moderate to severe depression. Addressing period poverty in refugee settings is crucial for mitigating depression risks and enhancing overall well-being.

Menstrual poverty scale: reliability and validity study.

The tendency toward poverty in the globalizing world significantly affects women. Unlike men, women have mandatory expenses every month. Especially poor women have difficulty in accessing to the hygienic products they need during the menstrual period. That is why, this study aims to develop a measurement tool that can effectively and widely assess women's menstrual poverty. This study is a methodological study that evaluates the psychometric properties of the scale. The study included 420 women living in a middle-income province in the north of Türkiye between April - July, 2023. The data were collected using the Menstrual Poverty Scale, and the items on the scale were developed based on a review of existing literature and expert opinions (CVI = 0.85-0.95). The sample was divided into two parts. It was made exploratory factor analysis and confirmatory factor analysis. Before conducting the study, an ethics committee decision and informed consent of the women were obtained. The collected data were analyzed using the SPSS 23 and AMOS 23 programs. The EFA revealed a structure consisting of 13 items and four factors. The four factors considered were as follows; access to hygiene products, quality of life, embarrassment, and receiving information, and education about menstruation. The item factor loadings varied from 0.46 to 0.91. The Cronbach's alpha coefficient was determined to be 0.69. The corrected item-total correlations for the scale items ranged from 0.62 to 0.84. According to the confirmatory factor analysis, the structural equation modeling results of the Menstrual Poverty Scale were found to be meaningful (p = .000; RMSEA 0.64; CMIN/Df 1.70). It is suggested to conduct validity and reliability studies in different cultures by applying the scale to women from different cultural backgrounds.

Menstrual Practice Needs Scale short form (MPNS-SF) and rapid (MPNS-R): development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda.

OBJECTIVES: Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36). DESIGN: Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency and validity in multiple cross-sectional surveys. SETTING AND PARTICIPANTS: Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49). RESULTS: The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: root mean square error of approximation (RMSEA)=0.064, 90% CI 0.043 to 0.084, Comparative Fit Index (CFI)=0.94, Tucker-Lewis Index (TLI)=0.92. Cohort baseline: RMSEA=0.050, 90% CI 0.039 to 0.062, CFI=0.96, TLI=0.95. Uganda: RMSEA=0.039, 90% CI 0.028 to 0.050, CFI=0.95, TLI=0.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092, 90% CI 0.000 to 0.158, CFI=0.93, TLI=0.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable. CONCLUSIONS: The MPNS-SF offers a reliable and valid measure of adolescent girls' menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to short surveys and including menstrual health within broader research topics.

"If I use pad, I feel comfortable and safe": a mixed-method analysis of knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in a Nigerian city.

BACKGROUND: Adolescence is a pivotal stage in human development that presents unique challenges, especially for girls navigating the complexities of menstruation. Despite the importance of menstrual hygiene management for adolescent girls' well-being, this vital aspect of personal health is often overlooked, particularly in regions where cultural stigma prevails. This study examines knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in Abuja, Nigeria. METHODS: The study employed a cross-sectional mixed-method design, integrating quantitative surveys with focus group discussions. A survey was conducted among 420 adolescent girls across four government junior secondary schools through a multistage sampling technique. Also, Focus Group Discussions were conducted among 80 respondents in groups of 10 discussants. The quantitative data set was subjected to descriptive and inferential statistical analysis, while the qualitative data were analysed using content analysis. RESULTS: Findings revealed that the majority (53.45%) of the respondents had good knowledge of menstruation and menstrual hygiene management. Junior Secondary School (JSS) 3 students [OR = 2,09; 95% CI = 1.24-3.52] and those who started menstruation at age 15 years and above [OR = 7.52; 95% CI = 1.43-39.49] were associated with increased odds of having good knowledge of menstrual hygiene management. The attitude of most respondents (70.08%) towards menstrual hygiene management was good. Those in the JSS 3 class [OR = 6.47; 95% CI = 3.34-12.54], respondents who are Muslim [OR = 2.29; 95% CI = 1.63-5.48], and those whose parents had tertiary education [OR = 3.58; 95% CI = 1.25-10.25] were more likely to demonstrate more positive attitudes compared to their counterparts whose parents do not have tertiary education. In relation to practice, about 3 in 5 (57.80%) reportedly practise good menstrual hygiene management. Respondents who practice traditional religion [OR = 0.33; 95% CI = 0.02-4.56] were less likely to practise good menstrual hygiene management, while respondents who are the third child of their parents [OR = 2.09; 95% CI = 1.04-4.23] were more likely to practise menstrual hygiene compared to respondents with other birth orders. Qualitative results showed that participants had good knowledge of menstruation and menstrual hygiene management, and mothers were the main source of menstruation-related information. Participants had mixed feelings and reactions during their first menstruation, with 3 in 5 participants reporting experiencing menstruation-related stigma restrictions when menstruating. CONCLUSIONS: In-school adolescent girls in Abuja, Nigeria, have good menstruation-related knowledge and positive attitudes, as well as practise menstrual hygiene management. Students' class and age at first menstruation were major factors associated with good knowledge of menstruation and menstrual hygiene management; respondents' class, religion and parents' educational qualification were associated with a positive attitude, while respondents' religion and parity line were associated with menstrual hygiene practice. Future interventions should focus on conducting school and community-level awareness programs to increase knowledge and dispel myths and misconceptions about menstruation and menstrual hygiene management.

Human Menstrual Blood-Derived Stem Cells Protect against Tacrolimus-Induced Islet Dysfunction via Cystathionine ß-Synthase Mediated IL-6/STAT3 Inactivation.

Diabetes imposes a huge burden worldwide. Islet transplantation is an alternative therapy for diabetes. However, tacrolimus, a kind of immunosuppressant after organ transplantation, is closely related to post-transplant diabetes mellitus. Mesenchymal stem cells (MSCs) have attracted interest for their potential to alleviate diabetes. In vivo experiments revealed that human menstrual blood-derived stem cells (MenSCs) treatment improved tacrolimus-induced blood glucose, body weight, and glucose tolerance disorders in mice. RNA sequencing was used to analyze the potential therapeutic targets of MenSCs. In this study, we illustrated that cystathionine ß-synthase (CBS) contributed to tacrolimus -induced islet dysfunction. Using ß-cell lines (MIN6, ß-TC-6), we demonstrated that MenSCs ameliorated tacrolimus-induced islet dysfunction in vitro. Moreover, MenSC reduced the tacrolimus-induced elevation of CBS levels and significantly enhanced the viability, anti-apoptotic ability, glucose-stimulated insulin secretion (GSIS), and glycolytic flux of ß-cells. We further revealed that MenSCs exerted their therapeutic effects by inhibiting CBS expression to activate the IL6/JAK2/STAT3 pathway. In conclusion, we showed that MenSCs may be a potential strategy to improve tacrolimus-induced islet dysfunction.

Transforming adolescent menstrual health through policy: the role of value added tax exemptions in improving access to sanitary products.

In Namibia, the Value Added Tax (VAT) Amendment Act 2022, which reclassified the supply of sanitary pads as zero-rated, has significant implications for adolescent girls' menstrual health and education. The policy change responds to the need to address period poverty by making essential menstrual products more accessible and affordable. Menstruation is a normal biological process, and access to sanitary products is a human right. Taxing menstrual products reinforces gender inequalities and raises concerns about the basic rights and dignity of women and girls. The VAT-free policy creates a system to reduce the financial burden on girls and women, making it easier for them to manage their periods safely and with dignity. It has the potential to reduce absenteeism from school, ultimately improving educational outcomes for adolescent girls. However, VAT exemptions alone are insufficient to address the broader accessibility issues that impact menstrual hygiene. Evidence-based policies that focus on the availability and affordability of a full range of sanitary products, in conjunction with regulatory mechanisms for price and quality control, are necessary to ensure that menstrual products are safe, affordable, and accessible for all.

Raman Spectroscopy for the Time since Deposition Estimation of a Menstrual Bloodstain.

Forensic chemistry plays a crucial role in aiding law enforcement investigations by applying analytical techniques for the analysis of evidence. While bloodstains are frequently encountered at crime scenes, distinguishing between peripheral and menstrual bloodstains presents a challenge. This is due to their similar appearance post-drying. Raman spectroscopy has emerged as a promising technique capable of discriminating between the two types of bloodstains, offering invaluable probative information. Moreover, estimating the time since deposition (TSD) of bloodstains aids in crime scene reconstruction and prioritizing what evidence to collect. Despite extensive research focusing on TSD estimations, primarily in peripheral bloodstains, a crucial gap exists in determining the TSD of menstrual bloodstains. This study demonstrates how Raman spectroscopy effectively analyzes biological samples like menstrual blood, showing similar aging patterns to those of peripheral blood and provides proof-of-concept models for determining the TSD of menstrual blood. While this work shows promising results for creating a universal model for bloodstain age determination, further testing with more donors needs to be conducted before the implementation of this method into forensic practice.

Menstrual education programs for girls and young women with intellectual and developmental disabilities: A systematic review.

BACKGROUND: Providing menstrual education and guidance for menstrual management for girls and young women with intellectual disabilities is recommended to ensure smooth pubertal transitions and to support menstrual self-agency. METHOD: The purpose of this systematic review is to explore menstrual education interventions for girls and young women with intellectual disabilities. RESULTS: Nine studies were included. Interventions were provided in small groups (n = 4) and individually (n = 5). Most studies used dolls (n = 7) and task analysis (n = 7) to teach pad-replacement skills. All reported significant improvements in participant skills and/or knowledge following the intervention. Only one study addressed self-agency and self-esteem as an outcome of the intervention. Menstrual education for girls and young women with intellectual disabilities is largely focused on pad-replacement skills. CONCLUSION: Further research is needed to understand the impact of menstrual health and hygiene education on variables apart from skill improvement such as self-agency and long-term health outcomes related to menstrual health.

Enhancing client engagement and alleviating period product insecurity: A cross-sectional study of community-based period supply banks' distribution of free period products through intermediary partner agencies in the United States.

BACKGROUND: Period products like pads, tampons, and a variety of disposable and reusable hygiene supplies constitute just one facet essential for effectively managing menstruation in a way that allows an individual to feel comfortable carrying out their daily routine. Given the absence of comprehensive public policies ensuring access to period products for economically disadvantaged menstruating individuals, community-based basic needs banks, particularly period supply banks, were established to alleviate the challenges faced by those experiencing period product insecurity. These initiatives specifically aim to furnish essential menstrual products to individuals in need. OBJECTIVES: This study aimed to assess any organizational benefits experienced by community-based organizations distributing period products on behalf of period supply banks. DESIGN: This cross-sectional study is a formative evaluation of the distribution of free period products by period supply banks, which provide access to essential menstrual hygiene products for individuals in need through partnership with community-based partner agencies. METHODS: Staff members at agencies distributing period products were invited to complete an anonymous web-based survey at two different time points about their agency's experiences distributing free period products. All participants provided informed consent via the web-based survey. RESULTS: Agency staff reported that since they started providing period products, clients were more likely to: start a conversation about other needs (66.7%), extend the length of their relationship with the agency (60.0%), keep scheduled appointments (62.1%), ask for assistance with another need (75.0%), communicate between visits (42.4%), participate in other agency programming (55.9%), and seek other agency services (73.5%). Due to a shortage of period products, 41% of agencies have had to turn away clients needing period supplies. CONCLUSION: Period supply banks, in collaboration with community-based partner agencies, enhance access to both menstrual products and the associated support, fostering engagement with diverse resources and opportunities among recipients. However, addressing unmet needs necessitates policies and additional funding to ensure universal access to essential hygiene supplies for everyone to thrive and actively participate in society.

Positive benefits for agencies giving away free period products from a period supply bank in the United StatesWhy we did this study: In the United States, many people with periods cannot afford to buy period supplies when needed. When people do not have enough period products, they may have to stay home from places they want to go, like work, school, or community spaces. Period supply banks want to help ensure everyone has period supplies, so that, they take in donations and buy more supplies. Then, period supply banks partner with other agencies that give period supplies for free to individuals experiencing need.What we wanted to learn: We wanted to know if the agencies that give away free period products through partnerships with period supply banks have any benefits from doing so.What we did: We asked people who work at an agency that gives away free period products received through a partnership with a period supply bank to take an online survey at two different times, when the agency began the collaboration with the period supply bank and after distributing period supplies for several months. Only people who wanted to be in the study did the survey.What we learned: Agencies who give away free period products benefit because clients are more likely to talk to them about other needs they have, enroll in a program or receive another resource from the agency, miss fewer appointments, and stay in an agency program longer. Sometimes, agencies do not have enough products for everyone who needs period supplies. More funding and policies are needed to help period supply banks buy enough period products for everyone who needs them.

Identification of the body fluid donor in mixtures through target mRNA cSNP sequencing.

In forensic practice, mixture stains containing various body fluids are common, presenting challenges for interpretation, particularly in multi-contributor mixtures. Traditional STR profiles face difficulties in such scenarios. Over recent years, RNA has emerged as a promising biomarker for body fluid identification, and mRNA polymorphism has shown excellent performance in identifying body fluid donors in previous studies. In this study, a massively parallel sequencing assay was developed, encompassing 202 coding region SNPs (cSNPs) from 45 body fluid/tissue-specific genes to identify both body fluid/tissue origin and the respective donors, including blood, saliva, semen, vaginal secretion, menstrual blood, and skin. The specificity was evaluated by examining the single-source body fluids/tissue and revealed that the same body fluid exhibited similar expression profiles and the tissue origin could be identified. For laboratory-generated mixtures containing 2-6 different components and mock case mixtures, the donor of each component could be successfully identified, except for the skin donor. The discriminatory power for all body fluids ranged from 0.997176329 (menstrual blood) to 0.99999999827 (blood). The concordance of DNA typing and mRNA typing for the cSNPs in this system was also validated. This cSNP typing system exhibits excellent performance in mixture deconvolution.

Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review.

OBJECTIVE: The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population. METHODS: Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training. RESULTS: The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours. CONCLUSION: The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.

A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus.

BACKGROUND: In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. OBJECTIVES: The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. DESIGN: An online cross-sectional study from February to May 2023. METHODS: Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. RESULTS: Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. CONCLUSION: Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.

Students' experiences of menstrual periods while on an urban university campusIn the United States, many girls, women, and other menstruators encounter challenges while managing their menstrual periods. Such barriers include period poverty, or the inability to afford resources and menstrual products such as tampons or pads. In this study, we explored how period poverty impacts college/university students. We shared an online survey with 106 students who were older than 18 years, had a period in the last 12 months, and attended the University of Illinois Chicago. We asked them about their menstrual, social, and academic experiences. We found that approximately one in six students could not afford menstrual products at some point in their lives, over half missed all or portions of class due to their period, and about one in two students avoided changing their menstrual products on campus. The relationships between these three menstrual experiences were statistically significant. Many students also reported that periods were largely painful, disruptive, and unpredictable and that their campus had few physical resources and more obstacles to managing menstruation. From our findings, we identified several steps that universities and colleges can take to prioritize a more inclusive and supportive educational environment for all students.

Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi.

BACKGROUND: Menstrual hygiene management (MHM) is associated with the menstrual process in women and adolescent girls who face cultural and financial challenges in rural areas of many developing countries. As part of the pilot study, we assessed the sustainability and effectiveness of the approaches and lessons learned from the MHM project intervention in rural areas of Lilongwe, Malawi. METHODS: Rural primary schools (n = 4) were purposively selected where an MHM intervention was implemented in Lilongwe, Malawi. The study employed a mixed-method research design. Assessments and data collection were performed through surveys of learners, literature reviews, key informant interviews (KIIs) (n = 90), and 20 focus group discussions (FGDs). The study participants included boys and adolescent girls (n = 100, 11-19 years; grades 5-8), teachers, mother groups, and community leaders from the selected schools. RESULTS: All the schools had water sanitation and hygiene facilities and latrines (45% improved, 54% ventilated improved pit latrines - VIPs) that promoted menstrual hygiene for adolescent girls. However, two of the schools studied (50%, n = 4) did not have separate washrooms for changing sanitary materials. There was a slight increase in latrine coverage in Kabuthu zone communities (90% at baseline versus 93.4% at midterm). However, the coverage dropped to 85.7% at the final evaluation, which was attributed to too much rain received in the area that damaged most of the latrines. There was a significant reduction (p < 0.05) in the number of girls failing to attend classes due to menstruation (70% at baseline versus 14% at final evaluation). Furthermore, the project resulted in the majority of girls (94.4%) having access to school. There was a strong uptake and adoption of sanitary products (reusable pads and menstrual cups) among adolescent girls of all age groups. The study has demonstrated that the inclusion of key stakeholders such as health workers, parents, mother groups and community leaders promoted the uptake and sustainability of reusable pads and menstrual cups and MHM interventions and programs. CONCLUSION: The MHM project implementation improved adolescent girls' education in the area. The inclusion of boys and other key stakeholders in the health education talks addressed issues of stigma and discrimination. The study, therefore, calls for comprehensive training on MHM and hygiene education to remove discrimination and harmful cultural practices.

Experimental study on the effects of human amniotic membrane in combination with menstrual blood-derived stem cells on wound healing in a diabetic rat model.

One of the serious challenges in diabetic patients is the occurrence of complications caused by the disease. One of the most important side effects is wounding in limbs. Due to the multifactorial nature of these wounds, treatments require a multifaceted approach. Therefore, the aim of the present study was whether the human amniotic membrane (HAM) in combination with menstrual blood-derived stem cells (MenSCs) could promote wound healing in diabetic rats. Thirty days after induction of diabetes, the animals were randomly allocated into four equal groups (n=15): the control group, HAM group, MenSC group, and HAM+MenSC group. Sampling was done on days 7, 14, and 21 for histological, molecular, and tensiometrical evaluations. The results showed that the wound healing rate, collagen deposition, volumes of new epidermis and dermis, as well as tensiometrical characteristics were significantly increased in the treatment groups compared to the control group, and these changes were more obvious in the HAM+MenSC ones (P<0.05). Moreover, the expression levels of TGF-ß, bFGF, and VEGF genes were considerably increased in treatment groups compared to the control group and were greater in the HAM+MenSC group (P<0.05). This is while expression levels of TNF-α and IL-1ß decreased more significantly in the HAM+MenSC group than the other groups (P<0.05). We concluded that the combined use of HAM and MenSCs has a more significant effect on diabetic wound healing.

School nurses and menstrual communication: Destigmatizing the stigma among adolescents.

OBJECTIVE: The purpose of this study is to understand how school nurses, often the first line of defense for menstruating adolescents, use communication to assist adolescents in destigmatizing menstruation. DESIGN: I conducted semi-structured narrative interviews with nine nurses employed in a large school district in Northeast Indiana. METHODS: Interviews were coded, categorized, and used a phronetic iterative approach. RESULTS: Analysis determines that nurses assist menstruating students using steps toward accepting menstruation and suggesting ways to avoid menstrual stigmatization. CONCLUSION: This study suggests that school nurses use positive language to assist students in handling their menstruation problems, develop allyships with parents and other teachers, and stress menstrual education. This study highlights the need for more funding for menstrual products and additional school nurses.

Examining menstrual health experiences in Philadelphia, PA: A qualitative investigation.

BACKGROUND: While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators. OBJECTIVES: The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia. DESIGN: This project was a qualitative research study. METHODS: We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach. RESULTS: Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies. CONCLUSION: Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.

"Just" a painful period: A philosophical perspective review of the dismissal of menstrual pain.

Science and society typically respond to dysmenorrhea-or painful menstrual cramps-as a normal, natural, and inevitable part of menstruation. This normalization has greatly contributed to the systemic dismissal of painful menstrual cramps. Stigma, secrecy, and the expectation to "cope" fuel the normalization of menstrual pain. In this article, I argue that the normalization of menstrual pain restricts the ability to share an excruciating menstrual pain in a way that would otherwise elicit alarm or concern. This can cause clinicians to downgrade menstrual pain, and even menstruating persons to downgrade their own pain. I refer to the dismissal of menstrual pain as an example of a pain-related motivational deficit. A pain-related motivational deficit describes instances in which an utterance fails to motivate due to societal practices and ideas that make it difficult to recognize the import of the embodied experience being shared.

"Just" a painful period: why we are not concerned by reported menstrual painIt is widely believed that painful menstrual cramps are just a normal part of the menstrual cycle; something that all menstruating persons are expected to deal with. There is also a stigma around periods and an expectation to keep the experience of periods hidden. This creates a process known as normalization. Because painful menstrual cramps are normalized, it is easier to dismiss patients who report painful menstrual cramps. In this article, I argue that the idea that painful menstrual cramps are normal makes it difficult for others to be concerned or alarmed by reports of menstrual pain. Reports of menstrual pain are downgraded or are seen as not that bad. When we are unable to see how bad a pain is because society believes the reported pain is normal, the pain report fails to elicit concern from the listener. I call this process a pain-related motivational deficit.