Research has shown that menstruation and menstrual cycle symptoms can be disruptive and detrimental to physical, mental and social wellbeing. As many as 93% of teen girls experience dysmenorrhea (severe cramps) and girls with a typical cycle experience 11 menstrual cycle-related symptoms on average, potentially including mood changes, stomach cramps and increased levels of anxiety and fatigue. Adolescents with problematic symptoms have reported a negative impact on school attendance, behaviour, confidence around peers and participation in physical activity.

In the United Kingdom, evidence suggests that menstrual health education delivered by teachers generally focuses on menstrual cycle biology, as opposed to management of menstruation and menstrual cycle related symptoms. Our latest researcher of the month, Dr Natalie Brown, set out to understand young people’s perceptions of menstrual education in schools and their experiences of menstruating whilst at school, including within physical education.

Her study involved nine focus groups with 10-15 year old female pupils attending primary and secondary schools across England and Wales. Pupils highlighted that, in their experience, menstrual education is limited and noted that the menstrual cycle impacts negatively on their school experience, affecting participation in sport and school attendance generally. Participants highlighted a need for more support and information regarding understanding and managing periods in school.

Summary

During the focus groups, a range of factors relating to menstrual education were discussed. Dr Brown's analysis revealed four main themes: education preferences, the need for a period positive environment, personal experiences and the impact on school.

Participants clearly voiced that boys should receive education about the menstrual cycle to increase their understanding and compassion. However, they also preferred to have some discussions separately from boys, to increase their levels of comfort and reduce feelings of being judged or embarrassed. Where menstrual education was taught in mixed-sex classes, some participants shared how boys’ responses affected the content and reduced the opportunity for conversation and questions. Most participants preferred to receive menstrual education from female teachers due to their lived-experiences, and female teachers were generally perceived to be more understanding about this issue than males. Most felt that the lessons that they received focused only on the biology of periods, rather than how to manage symptoms. The girls tended to lack awareness about many aspects of the menstrual cycle including an understanding of anatomy, what is deemed a normal cycle and how to seek support.

Access to toilets was discussed in all focus groups with many participants revealing that this was limited or not possible during lessons. Mixed or unisex toilets caused unease due to comments from peers when changing period products. All focus groups reported that period products were available in their schools, yet there were varying degrees of embarrassment associated with accessing them. Participants did share positive examples of supportive environments that had been created within their schools, such as posters with information and supportive teachers.

Participants reported experiencing a wide range of menstrual-related symptoms (both physical and psychological), but lacked education on management strategies to use whilst in school. The physical symptom of bleeding was associated with negative experiences and words such as ‘embarrassing’, ‘suffering’, ‘inconvenience’ and ‘annoying’ were used to describe periods whilst at school. This was enhanced by the fear of boys' reactions (and occasionally girls'). Worries about irregular periods and bleeding unexpectedly were also evident. Sometimes, lack of symptom management was related to limited knowledge of what constitutes a healthy menstrual cycle, access to products and confidence to have conversations.

The majority of participants discussed the negative impact that menstrual-related symptoms can have on learning, engagement and attendance at school. Generally, participants reported that the first two days of their period were the worst for affecting their learning and engagement in lessons, and often referred to being distracted by stomach pain or worries about leaking. They also talked about challenges with managing emotions and concentration, low motivation and increased levels of tiredness. Many preferred to miss a day of school when they were bleeding heavily.

Whilst not all girls felt that their menstrual cycle impacted their ability to move and exercise, PE was the most affected aspect of school. Cramps, breast pain and the fear of leaking affected participation and many girls preferred not to exercise or take part in PE whilst menstruating, particularly avoiding certain types of exercise such as running and jumping, gymnastics and swimming. Girls were largely unaware that exercise can help in the management of menstrual symptoms and some requested having the option to take part in PE lessons in a different capacity, such as coaching.

Implications

“The findings highlight the lack of menstrual education received and subsequent impact of menstruation and menstrual-related symptoms in school and PE. The abundance of information requested by pupils highlights the deficit in understanding about how to manage periods in school and remain engaged in physical activity. Schools can utilise information from the current study to create period positive environments, consider lesson content and format, and explore how to support girls to stay physically active in PE.” (Dr Natalie Brown, et al., 2024)

Implications for schools

Consider how to deliver lessons most effectively and when to involve boys. Dr Brown recommends that in co-ed schools, boys and girls are taught about the basics of the menstrual cycle together, including biology and symptoms. After this point, it is worth considering giving additional information about products and management strategies to girls only as this may help them to feel more comfortable and confident.

Think carefully about access to toilets and period products. Products should be kept somewhere girls feel comfortable to go. Ideally, this will not be at a main reception where pupils have to ask for them in public, as this can be a barrier to use. Girls report that it is helpful when products are kept in the PE department, alongside a girls’ only toilet or changing room.

Use Dr Brown’s menstrual education lesson plans. You can find them on the Period Education website, where they can be downloaded for free. The first lesson focuses on menstrual cycle essentials. Lesson two focuses on a range of period products, including swimwear, activewear, pants and menstrual cups. The third lesson considers symptom management options and aims to empower girls with strategies they can use and suggestions for initiating conversations with teachers. The fourth lesson is about staying active during periods and participating in PE. The resources also contain further guidance for PE teachers in terms of providing alternative activities for pupils struggling with menstrual symptoms, slides to help with delivery of the information, suggested activities and additional information which supports teachers to feel confident delivering menstrual education.

Look out for Period Education's video support. Teachers have suggested that they lack confidence in delivering menstrual education. To help, Dr Brown and her colleagues are in the process of putting together video training. It will be on the website soon, so keep your eyes peeled.

Implications for home

Consider menstrual tracking. Encouraging girls to get into the habit of tracking their cycle can help them to learn more about their own symptoms and manage them more effectively. Cycles can be tracked either in a paper diary or on an app. Integrating tracking into something that they are already using can be a good way of encouraging consistency.

Notice problematic symptoms and seek help. It is not normal to experience really bad stomach cramps which affect day-to-day activities, bleeding so heavy that it requires period products to be changed every hour or two, severe anxiety or symptoms of depression. Girls should not ‘put up with’ these symptoms or accept them as normal. Remember that there is plenty of support out there. If this sounds familiar, encourage girls to visit the doctor.

Cultivate open conversation. Talk about periods and the menstrual cycle at home. Let children know that bleeding is a normal biological process and that it’s normal to experience symptoms. If you have periods, talk about your own experiences. Shift the narrative away from awkwardness and embarrassment.

If you are a dad, male teacher or coach… the Hey Girls website contains a section called pads4dads designed to help males feel more confident about having conversations about the menstrual cycle. Dr Brown’s research has found that conversations between girls and men can often feel awkward for both parties. A consistent finding is that girls would like male coaches or dads to initiate conversations about periods, rather than having to initiate them themselves. Having conversations about menstruation, even if they are brief, is invaluable as it opens the door to further discussion and help seeking if it is needed.

Be curious. Ask girls what they already know and want they might like to know.

Be aware of where they are getting information from. Whilst social media has some great resources, there is also a lot of misinformation around periods. Talk to girls about where they are accessing information and help them to be assess the quality of the resources they use and to question anything that rings alarm bells. The Well HQ has helpful social media platforms. In January, Period Education will launch social media channels, containing posts for both teachers and girls themselves.

Listen to our podcast interview with Dr Brown here.