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Clinical briefing: Menstruation myths and misconceptions

Community pharmacists should help dispel some of the myths and misconceptions that swirl around menstruation, says the author of a new book, as our clinical editor, Mark Greener reports

Menstruating people from some cultures, such as the Native American Hupa, stay with others having periods as well as those who recently gave birth or experienced a miscarriage in a special house called a min’ch. The min’ch is a supportive community.  

In other cultures, however, menstruating people are dangerously ostracised during their periods, reflecting a fear that “menstrual blood can ‘bewitch, deform, and kill’”. 

You may think that western medicine left such ideas behind as historical curios alongside black bile and unicorn horn. Sadly that is not the case. In her new book, Period: The Real Story of Menstruation (Princeton University Press), Kate Clancy, professor of anthropology at the University of Illinois Urbana-Champaign, notes that as late as the 1970s some researchers believed that menstruating people released a ‘menotoxin’. One case study claimed a child developed asthma because her mother was menotoxic during pregnancy. 

“The study of periods exposes the ways in which culture gets into science,” Professor Clancy says. “Misogyny, racism and colonialism challenged our ability to get the science of menstruation right. This placed significant limits on our understanding and made it so that periods become a silent yet contested space. 

“We experience periods for weeks on end for decades of our lives, but hardly talk about them or experience them in a public or overt way.”

Medical distrust

“Part of the problem is that we have not been trained to see menstruation as central to the lives of people who experience it,” Professor Clancy says. “We regard menstruation as something to tell us whether or not someone
is pregnant – and not much more. 

“In healthcare, there has been a lot more attention paid to the fertility aspects of menstruation, rather than all the other ways periods affect a body, such as pelvic pain. 

“The denial of how important changes to menstruation can be to us can lead to significant medical distrust. In turn, distrust can affect
how well a patient follows their doctor’s
recommendations, how often they go to the doctor and the extent to which they trust a diagnosis.”

On average, people who menstruate do so once every 28 days but a healthy regular cycle can vary from 23 to 35 days. Moreover, numerous factors, such as stress, severe dieting and inflammation, can influence menstruation.

“Studying periods offers insight into how bodies respond to the environment, how they vary and why human reproduction is so complex,” Professor Clancy says. “I show in my book that menstruation is supposed to be responsive. Stressors will make menstruation vary and that means the system is working as designed.

“Professionals need to explain and validate the fears or discomfort someone is experiencing. A dismissive ‘that’s nothing to worry about’ only increases the chance that the person loses trust in science and medicine. It is hard across many healthcare settings to give patients the attention and explanations they deserve – but it is crucial that pharmacists and other healthcare professionals start to find a way.”

Tongue tied

The prospect of discussing menstruation can leave some men tongue tied. “Pharmacists should interrogate any negative feelings they may have in discussing menstruation,” Professor Clancy advises. “Menstruating people shouldn’t receive lesser care when their provider is not someone who has menstruated. Male pharmacists must work harder to ensure they pay attention to this biological phenomenon.” 

Many drugs and treatments affect menses. Certain antihypertensives, antipsychotics, opioids and tricyclic antidepressants can cause amenorrhoea, for example. “People who menstruate deserve to be warned when it is a possible side-effect,” she says. 

Sometimes, however, the effect on menses isn’t clear when the treatment is introduced. “Pharmacy could lobby for menstrual changes to be better studied in clinical trials,” she suggests.

“Better relationships with pharmacists are a great start to improving care for menstruating people. Developing and being deserving of patients’ trust is one of the most important things any health provider can do,” Professor Clancy concludes. 

“Pharmacists should initiate conversations around menstrual cycles or menstruation. Have signage at your pharmacy about menstruation and menstrual products to reduce the barriers to initiating conversations. And make sure the menstrual products you do stock are low-cost.”

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