I used to think I was the one making things awkward when I talked about my period.
From the age of 12 and on, once a month, I’d have to deal with the severe cramps, nausea, and fatigue that came with my cycle. Sometimes my symptoms got so bad that I would have to miss school or work (which was tough for a young overachiever).
Curious or concerned peers would ask about my absence, and the next thing I knew, we’d be talking about my period in hushed tones, and I’d be squirming — embarrassed about sharing something so personal.
For Dr. Sara C. Flowers, Vice President of Education and Training at Planned Parenthood Federation of America, alleviating the shame around menstruation is crucial.
Flowers has spent her entire career in the field of sex education, and today, that includes addressing how menstruation — and the way we talk about it — affects our mental and emotional well-being.
“It’s important to recognize that our sexual and reproductive health aren’t separate from our overall health and wellness as people,” she says. “They are inextricable parts of who we are as a whole.”
So what’s the impact of spending half our lives avoiding talking about our periods, hiding our tampons, and believing that menstruation is something to be ashamed of?
We spoke with Flowers about her work, her advocacy, and how we can change our reproductive health conversations for better mental health.
This interview has been edited for brevity, length, and clarity.
What are some everyday ways that we reinforce shame and stigma around menstruation in our culture?
You’re absolutely right. Some of the phrases we use to indirectly talk about our periods (e.g., “that time of the month” and “Aunt Flo”) illustrate just how much shame there is around menstruation.
As a society, the fact that we so often wrap our language about an ordinary bodily process in such secrecy is because of stigma, and continuing to use those euphemisms reinforces that stigma.
I can distinctly remember walking to the bathroom from my junior high school’s cafeteria with a tampon shoved up my sleeve so that no one would see it — and so did many of my friends.
Why did we do that? We took the same health classes and everyone knew what periods were. I wish we didn’t feel like this was something we had to hide.
The stigmatization of periods can also start early in a person’s life, sometimes before they even get their very first period, depending on their upbringing.
On one hand, if you’re part of a family where most people menstruate, maybe talking about periods and having period products around is commonplace. But some folks grow up in households where no one else menstruates, or period talk is off-limits and period products aren’t easily found on a bathroom shelf. In those households, it feels like periods themselves are shrouded in mystery and secrecy.
Our society and culture reinforce menstrual stigma from all sides — within interpersonal relationships, the education system, pop culture, and more. It’s really our responsibility to push back on the negative framing that’s persisted for so long.
For example, why do commercials show blue liquid being poured onto pads? This marketing decision sends the message that periods are so dirty or wrong that we can’t handle seeing them portrayed accurately on TV.
And frankly, I’d like us to ask: Whose sensitivities are we protecting? Because every person who menstruates knows that it isn’t blue liquid that we clean up if we have a leak!
What’s the mental health impact of that shame and stigma? Is it different for young people, for menstruating adults, and for people moving into menopause?
We have to look at the mental health impact of menstrual stigma collectively and individually. The collective mental health impact can be far-reaching.
Menstruation has been used to disempower and oppress girls and women, who make up the majority of people who menstruate.
“We have to look at the mental health impact of menstrual stigma collectively and individually.”
— Dr. Flowers
For example, premenstrual syndrome — PMS, for short — is a real condition that refers to the physical and mood-related changes that can happen before a person’s period.
But PMS has been turned into a common “joke” that people use to mock girls and women. This narrative extends to the harmful stereotype that women are overly-sensitive and emotional, making them unfit for positions of power at work or in their communities.
So on a large scale, this stigma reinforces sexism and harmful gender power dynamics.
On an individual level, it’s hard to pinpoint the specific mental health impact of menstrual stigma because each person is different. While some people are comfortable with their menstrual cycles no matter the setting, others may be more greatly influenced by comments, scenarios, or experiences that reinforce menstrual stigma.
The range of emotions can span from embarrassment to fear and anxiety to depression. There isn’t only one way this stigma shows up in people’s lives.
What would normalizing menstruation look like? Can you share some examples of what it might look like in families, medical contexts, and community spaces like schools?
In an ideal world, everyone would understand that menstruation is a natural part of life — period!
There would be no shame around talking about periods, buying pads or menstrual cups from a store, or walking down a school hallway with a tampon in hand. And people who have periods would feel comfortable talking about PMS symptoms without fear of being labeled as “emotional” or “incompetent.”
Families are a great place to begin the process of normalizing menstruation.
In my home, we talk openly about the resources we use to navigate life because it’s important for my child to understand that there’s no shame in using those resources to help us. We can also create more open and honest conversations about menstruation with people in our family who don’t menstruate.
Families are a great place to begin the process of normalizing menstruation.
— Dr. Flowers
Beyond the household, we need systemic solutions to address the disparities that exist in sexual and reproductive healthcare and education, including menstrual health disparities.
According to PERIOD, a global nonprofit fighting against period poverty and stigma, a quarter, or 23%, of students struggle to afford period products.
In some states in the United States, menstrual hygiene items like tampons are taxed in ways that other basic necessities are not, so people who menstruate are forced to pay more for the resources they need.
When we make an effort to use inclusive language, what are the benefits? How does it make a difference for marginalized people and all of us to have access to inclusive sexual and reproductive health education information?
Inclusive language is more accurate and respectful of people’s identities. Not everyone who has a period identifies as a girl or woman.
Some transgender men and nonbinary people who have a uterus menstruate and therefore may experience many of the physical and mood-related symptoms we’re discussing today.
Also, not all women naturally menstruate — whether because they’re transgender, intersex, or have certain health conditions.
When we provide sex education, our goal is to help people get, understand, and act on the information. In order to accomplish this, it’s important to provide information that’s medically accurate and inclusive of every person so that they can apply it to their lives.
Do you have tips for advocating for your needs and talking with your doctor about mental health? Any tips for how someone can track their support needs or changes to those needs?
First, remember that you know your body best.
Not every person who menstruates will have painful or severe symptoms, but some people will. If you’re someone who does experience severe emotional or physical symptoms during your period — especially if they affect your daily life — see a doctor who can help you get the right treatment to manage those symptoms, including things like hormonal birth control.
Don’t feel like you just have to suck it up and deal with it. Sometimes severe pain is a sign that something is wrong. A doctor can figure out if there’s an underlying condition that could be causing your symptoms and help you come up with a plan to help.
All the aspects of our health and wellness work together.
— Dr. Flowers
Tracking your physical and emotional symptoms can help you get to know your body and cycle more.
So, I also recommend using tools that can help you get in tune with your body’s menstrual, mental, and emotional patterns. This type of data can be useful to share during conversations with your doctor so you can confidently describe what you’re experiencing and get the care you need.
Planned Parenthood’s free birth control and period tracker apps Spot On and Spot On en Español can help you understand your entire menstrual cycle — including your period and the time between periods — and manage your birth control.
Unlike most other period tracking apps, Spot On focuses on pregnancy prevention, with over 180 birth control brands in its database. You can also track your mood and emotions, which can help you notice mental health trends across your cycle.
What else is important to understand with respect to mental health and reproductive rights?
Overall, I think it’s important to acknowledge that while we often separate sexual and reproductive health into their own categories, we are whole people.
All the aspects of our health and wellness work together. Looking at your sexual and reproductive health as a part of your whole body and its well-being is essential.
When thinking about sex education, we sometimes overlook one important aspect: how we relate to each other.
Healthy relationships, communication, setting boundaries and respecting them, figuring out your identity and supporting others in their identities and expressions — all of these things are integral to our mental health as well.
Taking care of ourselves, our people, and our communities is embedded in sex education and our mental health.
For information on menstruation and mental health, and to find support for your mental health, check out these resources:
