I have spent the past six years researching menstrual cycle-related health. The most striking aspect for me is how the menstruation taboo persists, despite all the progress made in global scientific knowledge and gender equality. This taboo prevents people from knowing, or feeling good about their own bodies, or seeking medical help when needed, and it directly contributes to gender discrimination.

Here are the ‘Top 10 Menstruation Myths’ that underpin this taboo. I routinely encounter them in the words and actions of people who menstruate, as well as their teachers, colleagues, community leaders, family, friends, and even doctors.

It’s time for some more evidence-based myth busting!

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1. Periods are dirty…

• Periods can sometimes stain clothing but this does not justify associating them with a ‘moral stain’ on the character of all people who menstruate [1]. Ink can also stain clothing but society does not restrict the activities and rights of people who carry a pen in their suit pocket.
• Menstrual fluid contains hardly any ‘bad’ bacteria, especially when compared to other parts of the body and items that we regularly touch- e.g. hands, mobile phones, cash, credit cards, or uncooked meat [2].
• Menstrual fluid is not an excretory product like urine or faeces; it is not removing toxins from the body. Periods just help keep the lining of the womb in a healthy condition.
• Periods are only a ‘hygiene’ issue if people cannot access clean water to wash their hands or period products [3]. This makes poverty the problem, not periods.
• Menstrual fluid only smells bad if there is an infection (typically thrush or Bacterial Vaginosis), or it has come into contact with the air, sweat, or the chemicals found in disposable menstrual management products [4].
• While it is possible to transmit blood-borne viruses/ infections though menstrual fluid, the chances of this happening are extremely low. It would involve an individual’s menstrual fluid somehow entering the blood system of another person e.g. through broken skin. Blood-borne infection transmission is far more likely through unprotected penetrative sex or accidental injury [5].

2. Periods are monthly…

As outlined in an earlier post, menstrual cycles are typically variable. Cycle length usually varies by 2-4 days each cycle, with most people’s cycles being between 21- 40 days in length. 28 days is just the average cycle length [6]. Many people may have irregular and/ or infrequent periods, too. For example, if you are under or over-weight, taking hormonal medication, or have Polycystic Ovarian Syndrome, you may stop menstruating completely, or only have a few irregular periods per year.

3. Periods are expensive…

Periods are effectively managed by a range of products, check out our ‘top of the mops’ chart to see how they compare. If clean water is accessible, reusable products (such as menstrual cups or washable cloth pads) are much cheaper (in the long term), as well as healthier, more environmentally sustainable, and more comfortable to use [7].

Based on ten years of approx. 12 periods per year, in UK;

Menstrual cup = approx. £0.16 per period

Washable pads = approx. £1.66 per period

Disposable pads/ tampons = approx. £3.20 per period

Notes: People who experience heavy bleeding will spend even more on disposable products. Some people find the upfront cost of the cup (£20) or washable pads (£5 each) too much, which is why menstrual activists across the UK are campaigning for government- subsidised menstrual management products and education for people who cannot otherwise find out about, or access cheaper options [8].

4. Periods are shameful…

Periods are a sign of health and something to be celebrated since they are critical to the survival of the human species. No aspect of a natural human body should be considered morally or spiritually ‘bad’.

Shame is incredibly damaging to self-esteem, and an individual’s mental and physical health [9]. Shaming an entire gender is also incredibly damaging to society; it can lead to violence, inequality of rights and opportunities, a lower quality of life for everyone, and difficult interpersonal relationships [10].

5. Periods are an illness…

Periods are a normal and healthy experience . Whilst they can be associated with discomfort or heavy bleeding (leading to iron deficiency anaemia), periods are not classified as an illness. The menstrual cycle may trigger or worsen illness, but it is also not an illness, itself. We would never call the human cardiovascular system an illness, just because some people have heart attacks!

6. Periods are very painful…

Period cramps are usually only mildly – moderately painful for the majority (70-90%) of people who menstruate [11]. For the remaining 10-30%, their severe cyclical pain is likely to be caused by a health issue such as PMS, fibroids, or endometriosis and requires medical support. If you experience severe period pain (i.e. you are unable to perform daily tasks), please do not suffer in silence, seek professional advice. The good news is that there are some simple evidence-based dietary and lifestyle changes that can alleviate cramps- find out about them here [12].

7. Periods are like an injury…

Periods are part of a process of renewal, a bit like the way we constantly produce new skin cells, or grow new finger nails. Menstrual fluid is not the same as the blood from a cut, it is the lining of the womb plus some other special substances.

Blood makes up about 50% of menstrual fluid, which also contains stem cells (yes, that’s right, the biological building blocks of our bodies), a unique enzyme called ‘plasmin’ that prevents the blood from clotting (cool, eh?), clear silky vaginal fluid (to provide lubrication), cervical mucus (the stuff that prevents bacteria from entering the womb), water (refreshing!), common electrolytes (keeping the body well-balanced), and at least 14 proteins, including glycoproteins (the stuff that makes various useful things like hormones and collagen!) [13].

8. Periods are a sign of adulthood…

Periods are just a sign of the beginning of puberty, but there is a widespread myth (even in the UK) that once a person starts menstruating, that they are somehow automatically ‘ready’ to reproduce i.e. to have sex, get married or give birth [14].

This is partly why the age of consent (for sex and marriage) was previously much lower, and still is in cultures that practice child-marriage. However, while it is possible for children under 16 years old to get pregnant [although, in the case of the UK, this would mean that they must have experienced ‘statutory rape‘] they are not physically developed enough to give birth without increased risks to their health [15]. In fact, child pregnancy was, and still is in many parts of the world, a major contributing factor to maternal and, therefore, also infant mortality (deaths) [16].

9. Periods are affected by the moon…

Periods are not affected by the moon. As regular readers already know, this is just a story based on the similarity between the average length of menstrual cycle (28 days) and the lunar cycle (29.5 days) [17].

10. Periods are the same for everyone…

Periods are very common, but are never experienced in exactly the same way. Making any generalisations about ‘women’, or ‘people who menstruate’, based on their shared experiences of periods, or the menstrual cycle, is inaccurate, and probably sexist [18].

Cycle length, blood loss, period-related symptoms, fluid colour, and consistency are all highly variable, even for just one person! Experiences cannot be easily generalised, so make sure you know what is normal for you, so you can spot any signs of ill health [19].

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References and notes:

[1] If you are interested in learning more about how ‘period stains’ have been associated with ‘moral stains’ see: Johnston-Robledo, I. and Chrisler, J. C. (2013) ‘The Menstrual Mark: Menstruation as Social Stigma’, Sex Roles. Springer US, 68(1–2), pp. 9–18. doi: 10.1007/s11199-011-0052-z.

[2] Sadly, nobody has ever bothered doing a proper clinical comparison… However, we do know that although the bacteria ‘flora’ of the vagina is diverse and variable between individuals, the primary colonizing bacteria are always of the ‘good’ genus Lactobacillus. The lactic acid these bacteria produce is thought to protect against infection by pathogenic species, by keeping a low vaginal pH. Whereas, hands, cash, credit cards, mobile phones, and uncooked meat are known to harbour faecal bacteria (from poo!)- a major cause of illness- check out these pages, if you’re feeling brave! https://www.bbc.co.uk/news/magazine-19834975  and https://www.cdc.gov/handwashing/why-handwashing.html

[3] Without access to clean water, people are unable to properly clean their hands, or their menstrual products, which may lead to vaginal infections (although robust data to prove causality is lacking- see chapter 4 of Bobel (2019) ‘The Managed body’). The menstrual fluid itself is not a cause of infection, unless it is unable to leave the body (e.g. in the case of an imperforate hymen), or that individual happens to have a blood-borne disease like hepatitis, or HIV. Used disposable products can also become unhygienic if there is no waste disposal process to get rid of them. Again, this is a problem caused by a lack of access to water, and sanitation infrastructure- not periods.

[4] While it is normal for menstrual fluid to have a musty/ metallic smell (like any other part of the body or blood), a ‘bad’ smell is an indication of infection. A fishy smell indicates BV. A non-fishy smell plus creamy discharge indicates thrush.

[5] The UK Health & Safety Executive lists the most common forms of blood-borne infection transmission as; sex, sharing injecting equipment (needles), accidental skin puncture by needles, and childbirth/ breastfeeding. http://www.hse.gov.uk/biosafety/blood-borne-viruses/spread.htm

[6] See this blog for an overview of cycle length variation – https://menstrual-matters.com/blog/cycle-length/

[7] See this blog for a comparison of menstrual management products- https://menstrual-matters.com/blog/top-mops/

[8] I contributed to this excellent report on period poverty and the state of sex and menstruation education, commissioned by Plan UK- and now the basis for national-level activism – https://plan-uk.org/act-for-girls/girls-rights-in-the-uk/break-the-barriers-our-menstrual-manifesto

[9] Shame can negatively impact self-esteem, which is linked to higher rates of depression and suicidal behaviours- Jang JM, Park JI, Oh KY, Lee KH, Kim MS, Yoon MS, Ko SH, Cho HC, Chung YC. (2014) Predictors of suicidal ideation in a community sample: roles of anger, self-esteem, and depression. Psychiatry Res. Apr 30;216(1):74-81. Shame can also prevent people from going to see their doctor about a health issue- we know that people have died from gynaecological cancers, after they did not know the signs to look out for, or were too embarrassed to tell anyone about them. See- https://menstrual-matters.com/blog/without-expression-part-2/

[10] Here is a great overview of how inequality negatively impacts society-    https://www.equalitytrust.org.uk/about-inequality/impacts

[11] Estimates vary widely from between 2-29%, but this still means that a significant majority of people who menstruate do not typically experience severe pain. Ju H, Jones M, Mishra G. (2014) The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 36:104-13.

[12] See this page for an overview of how to manage period pain- https://menstrual-matters.com/tips-and-tricks/period-pain/

[13] Yang H, Zhou B, Prinz M, Siegel D. Proteomic Analysis of Menstrual Blood. Molecular & Cellular Proteomics?: MCP. 2012;11(10):1024-1035. doi:10.1074/mcp.M112.018390.

[14] I have heard phases such as ‘if there’s grass on the wicket, let’s play cricket’ which refers to pubic hair, but also reinforces this idea that the very earliest stages of puberty somehow signal sexual maturity- which is absolutely not the case, as the maternal mortality statistics starkly portray.

[15]  Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally. Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years. WHO. (2016) Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: WHO

[16]  For example, see the data in the table, taken from this publication- Guerrier, G. et al. (2013) High maternal and neonatal mortality rates in northern Nigeria: An 8-month observational study, International journal of women’s health. pp 495-499 doi: 10.2147/IJWH.S48179.

[17] See this 2-part blog for an overview of the moon myth- https://menstrual-matters.com/blog/over-the-moon-1/

[18] See these blogs- ‘not all women; understanding biological variation‘ –  https://menstrual-matters.com/blog/not-all-women/ and ‘bio-illogical; the myth of the irrational female‘- https://menstrual-matters.com/blog/bio-illogical/ 

[19] See this blog for the reasons why tracking your cycle can improve health and wellbeing- https://menstrual-matters.com/blog/know-thyself/