Breaking the Stigma of menstrual health: We need to talk about periods
The long term impact of the Women’s Health Strategy, published earlier this year, will become apparent in time. But in the short term, it appears to have at least one achievement of note already – it’s got us talking more about periods.
Destigmatising periods
Too often women’s menstrual health concerns are stigmatised – taboo subjects that parents, teachers, sometimes even clinicians, are reluctant to discuss.
And there are few areas to which this applies more than heavy menstrual bleeding (HMB).
The stigmatisation of a condition that affects 1 in 5 women means that too many people suffer in silence.1 Currently, more than half a million women in the UK are on waiting lists for gynaecological appointments, and women with heavy menstrual bleeding make up 12% of secondary gynaecological referrals.2 Of those suffering from heavy menstrual bleeding, 74% experience anxiety and 69% suffer from depression.1
That’s why Hologic, working with experts from across the continuum of menstrual healthcare, has launched a report called ‘The right patients, the right setting, the right clinicians’. The report reflects on what collectively needs to be done to improve patient pathways for heavy menstrual bleeding, and can be read here.
Improvement begins with giving women the confidence to talk about their periods and ensuring that clinicians are well placed to recognise the condition when a woman approaches them for help.
Giving women the confidence to talk about their periods…
Most women have twelve periods a year for nearly forty years and yet people are still reluctant to discuss the topic. It is recognised that openly talking about periods can help women to identify whether their experiences are normal for them or if they need to seek advice from a healthcare professional.
This process begins in school. Currently the focus of the curriculum is on the science of periods, but talking about the reality of what a “normal” period is, can equip girls and women with the knowledge to confidently speak to a healthcare professional about their experiences of menstruation.
The acknowledgement in the Women’s Health Strategy that all children should receive high-quality, evidence-based education on menstrual and gynaecological health from an early age is welcomed. However, this should go further; the inclusion of a specific module on healthy menstruation, in the Relationships and Sex Education (RSE) curriculum, would provide all girls with an understanding of what could signify abnormal periods or heavy bleeding, and the related conditions.
Beyond school, more and more people seek out their health information online and from social media. While this allows people to share their experiences with a broad audience, there is a risk that people are exposed to misinformation.
The NHS and the Office for Health Improvement and Disparity (OHID) should deliver a public information campaign to destigmatise HMB and related menstrual health conditions. This should use existing channels, including NHS websites, and social media platforms, such as TikTok and YouTube. This would ensure the correct information and guidance is reaching more people through the most widely used channels, and helping to lift the stigma that too often prevents conversations.
…and ensuring they are heard
Empowering women to talk about their periods, to recognise symptoms of heavy menstrual bleeding, and to seek help, is just one aspect of improving diagnosis. We also need to make sure that when a woman summons the courage to speak to a healthcare professional, they are met by a receptive audience.
Too often women have to make repeated visits to General Practice before being offered treatment or receiving a referral appointment, with symptoms brushed off as something to put up with.
Educating GPs is essential so that when a woman comes to her doctor with her experiences, she goes away feeling heard.
GPs cannot be experts in every area and as they continue to do more with limited resources, it is even more vital they are supported to better understand HMB. This is a point echoed by the Women’s Health Strategy, which has the ambition of healthcare professionals in primary care being well informed and trained in menstrual and gynaecological health.3 The greater use of Women’s Health Hubs, as one example, would allow more specialised care for women, and provide an opportunity for clinicians to build up greater knowledge of women’s health conditions.
Developing a specific OHID communication campaign targeted at primary care networks, highlighting key symptoms of HMB and the various routes for treatment, is the first step in helping GPs to effectively recognise and diagnose HMB. This could take a number of forms, including an online continual professional development training module, or a dedicated NHS website as a ‘one stop shop’ on HMB. A focus should be on health care professionals not just building up their own knowledge of HMB, but also an understanding of how to educate their patients on healthy menstruation, through existing resources such as Menstrual Cycle Support social prescribing.
In addition, the Government should set an aspirational target for the time taken for the average referral for HMB, to drive a more responsive approach from GPs.
Breaking the stigma around periods and heavy menstrual bleeding
Silence and stigma around periods only serve to harm women’s health and wellbeing. Prioritising menstrual health education, both in schools and as part of GP training, will create a more open dynamic that gives women with HMB the confidence and knowledge to speak to their GP, and feel heard.
‘The right patients, the right setting, the right clinicians’, Hologic’s report on HMB, provides a series of recommendations about how to improve education around healthy menstruation, diagnose HMB, and improve patient treatment pathways for the condition. The full report can be read here.
[1] Hologic. (2017). Am I Number 5? Market Research Summary Report. MISC-05659-GBR-EN Rev 001
[2] National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management: NICE guideline [NG88]. Available from https://www.nice.org.uk/guidance/ng88/chapter/Recommendations (last accessed 10 August 2022)
National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management: Context. Available from https://www.nice.org.uk/guidance/ng88/chapter/Context (last accessed 29 July 2022)
[3] Department of Health and Social Care. Women’s Health Strategy for England. Available from https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england (last accessed 7 October 2022)
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