To bleed or not to bleed: young women's attitudes toward menstrual suppression

The purpose of this study was to investigate women's knowledge about and attitudes toward the medical suppression of menstruation. One hundred and three female undergraduate students completed several questionnaires. Thirty-five percent of the participants were familiar with menstrual suppression, and 12% reported using birth control methods to suppress their menses; oral contraceptive users were more knowledgeable about menstrual suppression than other women. Women who regarded menstruation as bothersome and shameful were more supportive of suppression than women with more positive attitudes. Women who scored higher on measures of body consciousness were not more likely to support menstrual suppression or to report a desire for more information about menstrual suppression. Future investigations of women's attitudes toward menstrual suppression could inform reproductive health care and health education.     

Young women's attitudes toward continuous use of oral contraceptives: the effect of priming positive attitudes toward menstruation on women's willingness to suppress menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was "media," and their primary concern was "safety." Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.     

Relationships Between Menstrual and Menopausal Attitudes and Associated Demographic and Health Characteristics: The Hilo Women's Health Study

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as “natural,” to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.     

Young Women's Attitudes Toward Continuous Use of Oral Contraceptives: The Effect of Priming Positive Attitudes Toward Menstruation on Women's Willingness to Suppress Menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was “media,” and their primary concern was “safety.” Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.     

Menstruation across time: Menarche, menstrual attitudes, experiences, and behaviors

This study explored the relationship between early and current menstrual experiences. The primary hypothesis was that women who reported positive menarcheal experiences (including menstrual education and menarche) would tend to report positive current menstrual attitudes, experiences, and/or behaviors, and vice versa for women who reported negative menarcheal experiences. In this survey-based study, college-aged women (n = 327) were screened by completing a questionnaire concerning their menarcheal experiences. Women who had extremely negative ("negative group," n = 46) or extremely positive ("positive group," n = 38) early menstrual experiences returned to complete questionnaires concerning current menstrual attitudes, experiences, and behaviors. Early and current menstrual experiences were most strongly associated in the domain of menstrual attitudes. Women in the negative group reported more negative menstrual attitudes than did women in the positive group. There were additional associations between early menstrual experiences and measures of body image and health behaviors. Positive group participants reported more positive body image and better general health behaviors. Results suggest that early menstrual experiences may be related to menstrual experiences later in life. This study invites further investigation of the psychology of menstruation and suggests connecting menstruation with other women's health issues.     

"Nobody told me nothin": communication about menstruation among low-income African-American women

The purpose of this study was to explore communication about menstruation among low-income African American women and the impact of this communication on their understanding of and attitudes toward the menstrual events that will occur throughout their lives. This is of particular importance since minority women disproportionately face greater menstrual problems than those experienced by majority women in the United States. A grounded theory design was used for this study. Seventeen African American women from a public housing project were interviewed. The core theme that emerged from the qualitative data was the avoidance or negative discussion of menstrual events throughout the women's lives. The women had few sources of and very limited menstrual learning from school, their mothers, and other women. This led to confusion and inaccurate beliefs about and negative attitudes toward menstruation, menopause, and menstrual-related health conditions. While these women desired to have better communication, their history of avoidance of and negative discussions surrounding menstruation will likely continue to make it difficult for them to have positive and informative discussions with others in the future unless some type of educational intervention occurs.     

合肥市2所初级中学女生月经状况及月经知信行调查

目的 了解青春期女生月经的基本情况和月经相关知识、态度与行为,以及青春期女生月经知识的获得情况,为开展青春期女生健康教育和保健工作提供科学依据。方法 在安徽省某市随机选取2所普通初级中学,对792名女生进行问卷调查,调查内容包括一般情况、月经状况、月经相关知识-态度-行为、经期卫生知识获得情况等。结果 776名女生已经月经初潮,平均初潮年龄为13.44±0.91岁;发生轻度痛经、中重度痛经者分别占54.2%,14.2%;认为月经对学习、生活产生一定影响的比例为57.3%,72.6%。本次调查青春期女生月经相关知识、态度和行为得分分别为6.8±1.2、14.2±3.3和25.5±3.6。仅有28.0%的青春期女生在月经来潮前获得了月经相关知识,通过老师和书籍途径获得月经相关知识的仅分别占5.2%和13.7%,青春期女生对月经知识和经期保健知识较满意者仅占25.6%和31.3%,其中64.7%青春期女生认为有必要在青春期普及相关月经知识教育。结论 现阶段仍需通过科学途径加强初中女生月经相关知识、态度和行为教育。     

Exploring the bio-psycho--social approach to premenstrual experiences.

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.     

Menstruation and amenorrhea: opinion of Brazilian women

Contemporary women experience more menstrual cycles than their predecessors, and their menstrual patterns are modified by contraceptives. Amenorrhea is one side effect that has recently been advocated as desirable. This qualitative study investigated Brazilian women's views regarding the suppression of menstruation using hormones. Data were collected through eight focus groups, following a semistructured guideline. Sixty-four women, 21-51 years old, all menstruating regularly and all of whom had already initiated sexual activity and had no perceived infertility participated. Discussions were recorded, transcribed and entered into the computer, using the Ethnograph V 5.0 software to aggregate similar patterns. Thematic content analysis revealed that menstruation and amenorrhea were both seen with ambiguity. Although regarded as a nuisance, menstruation was associated with femaleness, youth, fertility and health. Most women, although they would like to be free from menstruation, feared negative consequences of induced amenorrhea and even regarded the proposition as a male intrusion into what they consider a natural female condition.     

Sociocultural Attitudes Surrounding Menstruation and Alternative Menstrual Products: The Explanatory Role of Self-Objectification

We extend objectification theory research to consider the relationship between self-objectification and attitudes toward an alternative menstrual product in a diverse sample of female undergraduates from the United States (N = 151). We use a survey design to investigate attitudes toward one's menstruation as a potential mechanism that may explain this relationship. Reactions to an alternative menstrual product were predominantly negative, supporting prior research on stigma and shame surrounding menstruation. Exploratory structural equation modeling revealed attitudes toward one's menstruation mediated the relationship between self-objectification and participants’ reactions to an alternative menstrual product. Implications for women's health are discussed.     

Women's and providers' attitudes toward menstrual suppression with extended use of oral contraceptives

The United States Food and Drug Administration approved a dedicated extended regimen of oral contraceptive (OC) pill in the fall of 2003. Few studies have explored how women or providers feel about menstrual suppression. This study describes women's and providers' attitudes toward menstrual suppression. A national sample of 1470 women and 512 providers responded to surveys asking about attitudes toward menstrual suppression. Seventy-eight percent of the women sample had never heard of menstrual suppression with OCs. Fifty-nine percent of women would be interested in not menstruating every month and one third would choose never to have a period. Only 7% of the providers thought it was physically necessary to have a period every month and 44% thought that menstrual suppression is a good idea. While 57% of providers said that their patients do not ask about extended use of OCs, 52% do prescribe them; patient request was the most common reason. Both samples thought that more research should be conducted and that the factors that would influence their decisions included long-term health effects, side effects, future fertility and cost. Results demonstrate that providers need to discuss this option with their patients.     

陕西高职女生月经及经期保健知识调查分析

目的：了解陕西高职院校女生月经及经期保健情况,为进一步做好学生生殖健康教育提供资料支持。方法采用随机整群抽样的方法选择陕西某高职院校590名大一女生进行月经情况及月经保健知识问卷调查。结果该组大学生的平均月经初潮年龄为14．11±1．42岁;89．3％的学生月经周期及75．3％的学生经期在正常范围内。在对月经的认知方面,认为在月经期可以适当运动、认为经期可以淋浴的城市来源学生要优于农村来源学生,差异均有统计学意义（χ^2值分别为80．531、45．859,均P＜0．05）。有64．1％的学生在月经来潮期间会出现不同程度的痛经,仅有28．8％的人在月经异常时向医护人员求助。结论针对女大学生的月经状况特点,应加强对女大学生月经相关知识的健康教育,对提高女大学生的学习生活质量有重要意义。     

Attitudes toward menstruation. International Committee on Applied Research in Population.

Historically, various interpretations of the menstrual process have been reflected in a wide, and usually negative, range of social attitudes toward menstruation. Recent clinical experience with continuation of the modern hormonal and mechanical methods of contraception that induce changes in the normal menstrual pattern suggests the need to understand current variations in attitudes and practices related to menstruation. This paper briefly outlines historical Western, Orthodox Jewish and Muslim, and contemporary US women's attitudes toward menstruation and begins to explore their relationship to contraceptive continuation.     

Young western women's experiences of menarche and menstruation

A qualitative approach was used to examine young women's experiences of menarche and menstruation that were included in personal stories of growing up sexually. The personal experiences were examined by cross-case analysis to learn more about the narrators' attitudes toward menarche and their menstrual-related education. This was a secondary analysis using data collected for a study of common themes in the stories gathered in a 1998 study by Beausang. The data came from 332 stories written by students taking a sexuality course in a Midwestern community college. Of 227 stories written by women, 85 stories included menstrual experiences. Eleven narrators described menarche as a positive experience. In 10 of these stories, the mother was the primary teacher. The two most frequently identified sources of information by narrators were mothers and schoolteachers, with most narrators having a primarily negative view of their menstrual education regardless of the source. Problems with menstrual-related education were described as perceptions of unwillingness by teachers to discuss menstruation, time limits for education, unclear instruction leading to misconceptions, and the presence of peers in group learning situations that lead to embarrassment.     

‘This is a natural process’: managing menstrual stigma in Nepal

Menstrual stigma has been demonstrated in many societies. However, there is little research on menstrual attitudes in South Asia, despite religiously-based menstrual restrictions imposed on women. To understand menstrual stigma in this context, we conducted qualitative research with women in Nepal. Nepali Hinduism forbids menstruating women to enter a temple or kitchen, share a bed with a husband or touch a male relative. During menstruation, women are ‘untouchable’. There has been virtually no research on how Nepali women make meaning of these practices. The current study employed focus groups and individual interviews to understand how some Nepali women experience menarche and menstrual stigma. We explored how women describe their experiences and the strategies they adopt to manage age-old stigma in a rapidly modernising society where they have multiple roles as workers, wives and mothers. Participants reported they experienced menarche with little preparation, which caused distress, and were subjected to ongoing stigmatisation as menstruating women. They described coping strategies to reduce the effects of this stigma. This study provides a unique perspective on coping with menstrual stigma in South Asia.     

YOUNG WESTERN WOMEN'S EXPERIENCES OF MENARCHE AND MENSTRUATION

A qualitative approach was used to examine young women's experiences of menarche and menstruation that were included in personal stories of growing up sexually. The personal experiences were examined by cross-case analysis to learn more about the narrators' attitudes toward menarche and their menstrual-related education. This was a secondary analysis using data collected for a study of common themes in the stories gathered in a 1998 study by Beausang. The data came from 332 stories written by students taking a sexuality course in a Midwestern community college. Of 227 stories written by women, 85 stories included menstrual experiences. Eleven narrators described menarche as a positive experience. In 10 of these stories, the mother was the primary teacher. The two most frequently identified sources of information by narrators were mothers and schoolteachers, with most narrators having a primarily negative view of their menstrual education regardless of the source. Problems with menstrual-related education were described as perceptions of unwillingness by teachers to discuss menstruation, time limits for education, unclear instruction leading to misconceptions, and the presence of peers in group learning situations that lead to embarrassment.     

Attitudes Toward Menstruation,Menstrual-Related Symptoms,and Premenstrual Syndrome Among Adolescent Girls: A Rural School-Based Survey

Folk culture surrounding menstrual-related matters has considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to examine these associations. With a higher score indicating a more positive attitude toward menstruation, the mean attitude score was 3.84 (SD ± 1.62) out of a maximum of six. No significant association was observed between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI 1.01–1.10) and menstrual phase (OR 1.04, 95% CI 1.01–1.07), were more likely to consult a physician for premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05–0.83). The findings imply the need for education to help adolescent girls manage menstrual symptoms and increase awareness of the benefit of treating them. Given that menstrual-related information was widely available from mothers, family, and social culture are potentially important in shaping good menstrual attitudes.     

“The state of mind tells me it’s dirty”: menstrual shame amongst women using a vaginal ring in Sub Saharan Africa

ABSTRACT

Socio-cultural beliefs and practices surrounding menses influence women’s sexual and reproductive health behaviors and decision-making. We analyzed menstrual experiences within the context of the MTN-020/ASPIRE clinical trial during which women were asked to use a monthly vaginal ring for HIV prevention. The qualitative component of the trial was conducted during February 2013-June 2015, included interviews and focus group discussions with 214 women aged 18–42, in Malawi, Zimbabwe, Uganda, and South Africa. Emotions of shame, embarrassment and disgust relating to menses emerged. Menstruation was referred to using euphemistic terms or language about dirtiness. Women were uncomfortable touching their own menstrual blood when removing vaginal rings and felt embarrassed about study staff seeing blood on returned rings. Despite reassurances, women felt ashamed performing study procedures while menstruating, leading to missed study visits. Women’s aversion to menstrual blood was linked to narratives about avoiding sex during menses and beliefs about its potential harms. Women associated men’s disgust pertaining to menstrual blood with men’s willingness to use condoms for sex only during menses, highlighting another way through which socio-cultural beliefs and practices around menstruation affect HIV protective behaviours. These findings provide novel insight into menstrual shame among women in these four countries.