Introduction

Menstrual management is recognized as a critical issue for young people internationally, yet it remains a largely silenced topic in the social milieu (Allison & Hyde, 2013; Jackson & Falmagne, 2013). Although a growing body of work examines menstrual health and menstrual health literacy in low- and middle-income countries generally (Hennegan et al., 2019; Holmes et al., 2021), relatively little published research explores the experiences of menstruation in western, high-income countries (Cotropia, 2019). Additionally, there is a particularly visible lacuna existing in the literature relating specifically to this topic in school education in these contexts. This paper, which contributes to addressing this gap, is based on the results of a broader Australian questionnaire of 5007 young womenFootnote 1 aged 13–25 that examined their experiences of menstruation and dysmenorrhea. This discussion specifically reports on the findings from responses of one of two qualitative items included in the study’s questionnaire which addressed the intersection of education and menstruation and sought data about what schools could do better in supporting young people who are menstruating.

Knowing young menstruators’ thoughts around the provision of school-based menstrual health education and support and understanding where schools can improve their engagement in this area, is important for a number of health outcomes, as highlighted below. The successful dissemination of, and engagement with, knowledge related to menstruation is a critical (and perhaps underestimated) issue for schools. This is because discussion around menstrual health concepts and menstrual visibility is often taboo (Allison & Hyde, 2013; Jackson & Falmagne, 2013), although alternative ways of seeking support through social media, such as Twitter, have been reported (Davies et al., 2022). Concealing menstruation and avoiding mention about its associated experiences is expected (Dan, 2013, p. 163; Rubinsky et al., 2020), particularly in relation to men and boys. Dominant discourses of menstruation historically have been negative (Rubinsky et al., 2020) (although some cultures publicly honor menarche), and this general negativity continues into the twenty-first century. Perceptions of this bodily function as being unclean and requiring hygiene management prevail (Jackson & Falmagne, 2013) and may result in young people feeling embarrassed about their bodies (Schooler et al., 2005). Additionally, feelings of shame can affect how young people experience their bodies more generally (Davies et al., 2022; Schooler et al., 2005). Deeming mention of menstruation as inappropriate can result in limited menstrual support from significant adults. Thus, socio-cultural understandings and norms impact on the everyday lives of menstruators (DeMaria et al., 2020).

Discourses related to what constitutes ‘normal’ menstruation are often influenced by outdated information, inaccurate messaging, and mythologies (Rubinsky et al., 2020, p. 224). These discourses are perpetuated through a range of means including hygiene brochures (Jackson & Falmagne, 2013), popular culture, educational resources, intergenerationally (Rubinsky et al., 2020, p. 244) and via the media, although social media, in particular, can be supportive (Davies et al., 2022). Young people receive mixed messages about menstruation, including that it is normal, “traumatic,” “mysterious,” “secret,” and a “symbol of sexual maturity” (Rubinsky et al., 2020, p. 244). As Rubinsky et al., (2020, p. 250) point out, the advent of menstruation suggests that  it “will change them in some meaningful way, be scary and hurt, and that they should be quiet about that pain and the experience of menstruation.” This silencing is apparent even in the language that is used around menstruation, which is often demeaning, dismissive, and filled with euphemism (Jackson & Falmagne, 2013) and stigma (Johnston-Robledo & Christler, 2020). Some menstruators reportedly engage in resourceful linguistic approaches to communicate about menstruation, challenging the dominant paradigm of silence while enabling communication (Kissling 1996b in Rubinsky et al., 2020).

The silence around menstruation may result in young people not listening to their bodies. For instance, period pain (dysmenorrhea) is typically understood to be a normal part of menstruation and is positioned as something that needs to be suppressed and tolerated by the menstruator (Armour et al., 2016). These discourses cut across socio-cultural and geographical borders (Barrington et al., 2021; Holmes et al., 2021) subsequently requiring those who menstruate to undertake everyday activities regardless of the pain or discomfort that they are experiencing while hiding the realities of their experience (Rubinsky et al., 2020). Menstruators are expected to “control and manage their menstruating bodies quietly and secretly” (Jackson & Falmagne, 2013, p. 380; Johnston-Robledo & Chrisler, 2020); a problematic reality for young people as “misinformation or medically inaccurate beliefs about menstruation have a greater potential to have negative expectations regarding menarche and menstruation” (Davies et al, 2022, p. 95).

Dysmenorrhea is a common gynaecological disorder (French, 2008), affecting nearly three-quarters of mostly young people who menstruate across the globe (Armour et al., 2019a, 2019b). Dysmenorrhea can often include, but is not limited to, abdominal cramping, vomiting, nausea, insomnia, depression, and headaches, or a combination of these symptoms. In Australia, this condition reportedly affects 90% of menstruators under 25 years of age (Armour et al., 2021); yet, not even half of those experiencing such pain seek medical advice (Armour et al., 2021; Subasinghe et al., 2016; Treloar et al., 2010). This is a critical issue, considering that dysmenorrhea may be related to other serious conditions such as endometriosis. This under-diagnosed condition can interfere with an individual’s education, impacting life opportunities and choices (Moradi et al., 2014).

Young menstruators are often unprepared for menstruation. The anticipation of menarche, as well as managing menstruation, can result in fear, stress, anxiety, shame, and stigma that calls for the provision of emotional, social, material, and health supports (Cotropia, 2019; Rubinsky et al., 2020). Such stressors are compounded for those who experience early menarche, which may impact on the social context of the young person, potentially occasioning sexual harassment and experiencing a “loss of childhood” (Allison & Hyde, 2013, p. 59). Additionally, around menarche, there are significant bodily changes arising from puberty, resulting in a range of material, social and emotional consequences, including gendered expectations related to relationships and morality.

The practicalities of menstruation can also be problematic for young people and impact their daily lives. For instance, menstrual hygiene management at school is an issue, not only in low/middle-income countries, but in high-income countries. Cotropia (2019) found in a US survey of young women aged 18–25, of the 693 respondents, 12.7% missed school and nearly 24% left school early in order to access menstrual hygiene products. Of the respondents, 42.13% attended a school where such products were available, although students had to pay for these products in most cases. Australian research shows that just under 50% of menstruators regularly miss school because of their period, while just over three-quarters report issues with classroom concentration due to their period (Armour et al., 2020a, 2020b). Additionally, menstruators are constantly aware of the risk of bleeding through clothes, resulting in risk management behaviors, such as avoiding attire that may show leakages (Jackson & Falmagne, 2013). This possibility and the potential embarrassment of such an occurrence can distract a young person from their academic work.

Schools are in an excellent position to provide critical health education around menstruation, and to explore strategies with young people that alleviate symptoms of dysmenorrhea, including pharmacological and alternative therapies. Importantly, they have the capacity to alert young people to avenues for interventions, arming them with tools to support more positive health outcomes. However, findings from our related research examining the menstrual health experiences of young people in Australia (Armour et al., 2020a, 2020b), found that the provision of menstrual health education and support in some schools was limited (see Curry et al., 2022). Several key themes emerged, which demonstrated that inadequate information was provided to participants during their schooling experiences possibly resulting in poor menstrual health literacy presaging possible future negative health consequences. For instance, some participants claimed that teachers’ focus only on the biological aspects of menstruation, including anatomy and function, thus ignoring complex understandings of physical, emotional, and relational maturation (see also Romeo & Kelley, 2009).

Moreover, practical information about menstruation, including pain management, was not provided, ignoring the “messiness, nuances, [and] discomfort” that often accompanies menstruation (Curry et al., 2022, p. 7). Participants reported that menstruation was largely positioned as unproblematic and that their education did not provide adequate guidance about what was and was not ‘normal’. This meant, for some, that critical signs of endometriosis, for instance, were missed. Many participants reported that their formal education about menstruation came too late, sometimes well after menarche had occurred. Additionally, what occurs in classrooms around these topics is uneven. Some teachers feel ill-equipped to discuss menstruation with young people, claiming a lack of knowledge or embarrassment. For some male teachers, a lack of personal experience or awareness may compound these feelings (Harvey et al., 2020).

This paper explores what schools in Australia, a high income country, could do better in supporting young people who are menstruating. Using the voices of young people, it simultaneously highlights some of the problems that menstruating young people encounter at school. Through listening to these participants, this research draws attention to what young people would like to see occurring in schools to enable a better menstrual experience in the educational context.

Theoretical Framework

Schools, like other social institutions, constitute and are constituted by dominant discourses of binary gender and (hetero)sexuality (Ferfolja & Ullman, 2020). These discourses are produced through policy and curriculum as well as through everyday interactions (Ullman & Ferfolja, 2015); they construct understandings about how schooling subjects should look, think, feel and act in relation to their gender and sexuality, and these constructions are actively policed by the institution, interpersonally and via self-regulation. Those who do not conform may experience punishment in the Foucauldian sense (1978) via harassment, ostracism, reprimand or by other means, although this does not mean that there is no resistance (Allen, 2014).

However, this acknowledgement of sexuality (in particular) through its regulation, is paradoxical; it occurs within a space that is simultaneously (and contradictorily) socially constructed as asexual. In schools, bodies are “materially present in classrooms but “ideally” invisible/expendable to the “real” project of schooling” (Allen, 2014 p. 89) which is essentially intellectual. This is despite the fact that feminine bodies are constructed as hypersexual (Pomerantz, 2007) and require surveillance and control. Thus, in schools, where sexuality is institutionally downplayed, feminine bodies must be contained.

Menstruation, a signifier of sexuality, is thus problematic, and requires regulating in these spaces. Additionally, the messiness and dysregulation of menstruation positions it, and the bodies in which it is present, as the antithesis to the ‘acceptable’ socially constructed performances by feminine bodies. Discourse related to menstruation position those who menstruate as defective, dirty and as an ‘abomination’” (Johnston-Bobledo & Chrisler, 2020, p. 182). This kind of discourse is reinforced in schools, where awkwardness and silence around menstruation act as the other side of discourse (Foucault, 1978), reinforcing negative understandings. This is experienced, for example, through the health and physical education curriculum which privileges masculine bodies (Allen, 2014). Thus, menstruation becomes something that is “rarely cause for celebration or even contentment” and rather needs to be “manage[d] properly as an essential component of ‘doing (feminine) gender’” (Roberts, 2020 p. 177). Thus, students who menstruate are required to self-monitor. This is despite the fact that bodies can be said to have their own agency (Allen, 2014) and will not necessarily be either contained or regulated.

Furthermore, these discourses related to menstruation that silence and make invisible what can be said and done in schools, simultaneously suppress student consultation about their menstrual needs. This paper provides space for the voices of menstruating young people. It outlines their suggestions for resisting the dominant menstruation discourses which circulate in schools and highlights their calls for the normalisation of the menstruating body.

Methods

Setting and design

The findings reported upon in this paper relate to one of three qualitative questions included in a 59-item online questionnaire. These questions were part of a national cross-sectional study of 5007 young people. The study sought information on the experiences of menstruation, with a focus on impacts at school and higher education. The questionnaire was developed by the research team who have multidisciplinary expertise in menstrual health, education, and health promotion. The questionnaire sought out information about participant demographics, oral contraceptive use, age of menarche, period regularity, presence of dysmenorrhea/pelvic pain, the management and impact of pain on daily and school activities, health literacy and sources of information. It was first piloted with 10 young people and minor changes were made based on their feedback. The final questionnaire was hosted via Qualtrics online surveys (Qualtrics Ltd), took approximately 20 min to complete and needed to be undertaken in one sitting (Armour et al., 2020a, 2020b). The qualitative questions aimed to give young people a voice and to provide deeper understandings about experiences and education of menstruation at school. Specifically, this paper reports on the findings from the question which asked participants about what schools could do better in relation to menstruation.

Participant recruitment

Adolescents and young people between 13 and 25 were eligible to participate in the study. (See Table 1 for demographic information). This age range enabled participants to share experiences, both current and retrospective, in relation to education. They had to be living in, or attending/ed school or tertiary education, in Australia and had at least 1 previous menstrual period. Individuals who did not menstruate regularly for whatever reason were still eligible to participate. Participants also needed to be attending school (year 6–12) or undertaking further education (at a university, technical and further education (TAFE) institution, or other tertiary education provider). Information about the research was posted on Facebook and Twitter and disseminated through the research team’s personal networks. Distribution of information about the study was also undertaken by key organizations such as Family Planning NSW, the Australian Council of Health, the Australian Council for Health, Physical Education and Recreation and U by Kotex (Kimberly Clark). Interested participants were emailed the participant information sheet detailing the study’s intent and approach as well as a link to the questionnaire. A hard copy of these documents was available upon request.

Table 1 Participant characteristics
Full size table

Data analysis

The qualitative data were analyzed thematically using a bottom-up approach (Castleberry & Nolen, 2018). This enabled the data to determine the themes rather than the specific research questions or theory. Initially, three of the researchers on the team read the data closely then undertook a first round of coding. The codes were discussed and shared within the coding team. Discussion resulted in a review and revision of the coding process. Although there was some overlap, the semantic themes (Castleberry & Nolen, 2018), which arose from the coded data included: sanitation; pain management; removing stigma; adequate breaks; and being considerate. These themes reflected respondents’ experiences and in illustration, we use their voices in the following sections.

Results and discussion

Sanitation

Many respondents felt that sanitation provided by their school could be improved. This included a desire for the provision of hygiene-related products such as soap as well as period products. Some respondents highlighted how more sanitary disposal bins were needed. Others reported that the potential for the school to provide extra uniforms and/or underwear in the case of a leakage would be of assistance. These simple steps could be taken by schools to address some of the concerns encountered by individuals during menstruation.

When you're at school there isn't a way to access hygiene products if you need them, leaving you to rely on your friends for them; however, this can leave you in an uncomfortable situation as they might not have any on them or the type of hygiene product you feel comfortable with using. If schools could create a comfortable and easy way of access to hygiene products in this situation it would help a great deal. [P910—Age 15, NSW].

Schools should have free pads that are easier to access. My school has them in the school nurse’s office, so if I get my period during class and I forgot my own things I have to go to the nurse’s office (which sometimes is at the opposite end of the school) to get a pad and waste a good 15 mins of valid class time [P1648—Age 17, Victoria].

At my school … the sanitary bins overflow and used pads and tampons are spilt all over the floor. It’s disgusting and makes me not want to go to the bathroom (which doesn’t help when I’m on my period and have no choice but to bleed through my clothes or go to the stinky toilet) … [P2236—Age 15, NSW].

Since the implementation of this questionnaire, government-funded schools across Australia have increasingly provided period products in school bathrooms, with Victoria initiating a program in 2020 and Western Australia being the last state to do so in 2022 (Ho, 2022). Whilst an important initiative, some jurisdictions have only installed product dispensers in secondary schools, depriving easy access to primary school-aged menstruators while simultaneously disempowering them from attending to their bodily needs. It is unclear why this distinction has been made: on a practical level it may be seen as economic. On another, there is little acknowledgement that menstruation may begin earlier than in high school (Bellis et al., 2006). However, the social construction of childhood requires that adults ‘protect’ young people from dangerous knowledges, including those related to sex/sexuality (Robinson, 2013); menarche is a ‘sign’ of sexual maturation. Thus, having to explain the role of period product dispensers to primary school-aged children may be perceived as inappropriate, particularly as menstruation is a signifier of sexual reproduction.

Pain management

Respondents also felt that schools should teach about pain management and provide pain alleviation options such as hot packs and pain medications. A key issue that arose from these comments was the need for teachers to acknowledge the reality of period pain as being debilitating and as a potentially serious medical issue that requires attention.

I think they [teachers] should realize that periods and the pain that comes with them is horrible, sometimes excruciating, and that sometimes girls need to go home for it and aren’t just trying to get a day off, and not everybody wants to take medicine (health reasons usually). I also think that we should be able to reschedule tests if we are on our period because I really cannot concentrate, but I don’t believe this will ever happen [P2247—Age 17 Queensland].

Provide pads, tampons, heat pads, and medicines. Also, for those who have extreme pains and can't attend school, perhaps have an online class for them to participate in at home [P1049—Age 16 Queensland].

I am diagnosed with endometriosis. … The pain is excruciating and all I’m told is to shrug it off, I have had to leave mainstream schooling and resort to distance education because of this. [P107—Age 15 Queensland].

Have better empathy towards girls in times of pain and better deal with the effects it has on working capabilities i.e. taking [it] into consideration in exams and allowing for time out if in pain in classes, allowing permanent bathroom access, and not locking bathrooms in class times [P445—Age 17 NSW].

Further educate teachers, as not only male teachers but also female teachers believe that you can simply wait before leaving to go to the bathroom, which can be a problem if it [period] comes unexpectedly and you’re not prepared [P92—Age 17 South Australia].

Adult constructions of young people within discourses of childhood, including that they are irrational, irresponsible and by extension, not to be trusted, are implied by these respondents’ voices. Teachers, thus, who are in loci parentis, surveill students’ movements, regulating student bodies through the locking of bathrooms. This may not be perceived by schools as problematic, as schools like other public spaces are constructed for the ‘normal’ human (read ‘male non-menstruator’). However, it disregards students’ human rights to sanitation (United Nations, no date). Additionally, discourses that deny young people’s rationality enable adults to deny their menstrual pain or position it within discourses that normalise it as something that menstruators must endure.

Additionally, period pain is not factored into the structural imperatives of the institution but is privatised and positioned as a problem that must be addressed by the individual. The impact of discomfort and dysmenorrhea experienced by menstruating students which can impact performance, is irrelevant to neoliberal testing regimes which dominate education. Although schools have a duty of care to their charges, students are generally not offered alternative options to sitting tests or different ways to participate in classes; at least not in any conscious, institutionally-regulated way.

Removing stigma

The importance of schools to remove the stigmatizing discourses surrounding menstruation through menstrual education was another issue raised by respondents. Greater exposure in the curriculum and normalizing discussion around menstruation for all genders are critical and may help to destigmatize the experience. The effects of stigma can be embodied, constraining behaviour and impacting well-being (Johnston-Robledo & Chrisler 2020). The silences around menstruation perpetuate discourse that position menstruation as shameful; education and visibility can promote resistant discourses and reinforce young menstruators as agentic subjects rather than as victims of bodies that should be hidden.

Remove the stigma and shame surrounding it by openly discussing it and stressing that it is natural and not shameful so that people who have periods do not feel ashamed or embarrassed to ask for help if/when needed. [P2049—Age 17 Victoria].

Have more conversations about periods to make them more normal to talk about and for girls to feel comfortable to openly talk about any problems they have with them. [P346—Age 17 NSW].

Giving boys and girls the same information and normalizing periods. Schools divide us when it comes to ‘tricky subjects’ because we are told boys don't need to know about it. They do need to know. Girls, especially those in younger grades, feel alienated from friends and feel as if they can't talk or ask for help because it's ‘gross’ [1938—Age 15 Queensland].

The last quote above raises a critical issue. Menstruation and menstrual health are historically constructed as a ‘girls’ problem and as something for which the menstruating body is solely responsible. There is limited imperative for schools, as social institutions, to address these issues structurally across a coeducational student population, which revolves around the (white, able-bodied) non menstruating (read masculine) human subject. Through approaches such as “dividing” students by binary gender, schools perpetuate communication guidelines that mark menstruation as problematic (Johnston-Robledo & Chrisler, 2020), consigning it to the domain of the feminine.Footnote 2 Thus, menstruators, and those who educate about this topic, conceal this bodily process, and in doing so, contain and regulate the waywardness of the menstruating body (Ryan et al., 2022). However, of interest here, is the resistance of the respondent, who rather than acquiescing to dominant social rules of silence and suppression, agentically demands change to counter the negative discourse in which younger students position menstruation, and by extension, their own bodies.

Adequate breaks

Being permitted to take breaks and to use the bathroom as needed was another issue raised. Participants highlighted how they had to respond to embarrassing questions, often by teachers, when they needed to use the bathroom outside of formal lesson breaks. A special mention was made about male teachers’ lack of understanding surrounding this issue, where some respondents were restricted from using the bathroom.

Allow all girls to leave through class for this reason, with no questions. Many of my teachers will not allow any students to leave the classroom for any reason. Mainly the male teachers [P496—Age 15 Queensland].

Inform male teachers that we should be allowed to go to the bathroom. I have never had a problem with female teachers, but some male teachers seem to forget there’s more than one reason to go to the bathroom. Some male teachers also have a problem with girls taking their bags. These teachers should be educated [P482—Age 17 NSW].

However, it was not only male teachers who regulated students’ bathroom access.

Let me go to the bathroom to clean up when I have bled through my uniform (a female teacher refused for me to leave the classroom despite blood all over my dress and chair, and pleas from fellow classmates) [P1224—Age 15 NSW].

Let people go to the toilet not just say “should’ve gone at lunch” cuz [sic] bitch I don’t choose when my tampon needs changing … [P2081—Age 16 Western Australia].

These quotes highlight the seemingly arbitrary rules imposed on students by teachers whose key role is to pursue the institution’s intellectual project, and while doing so, simultaneously regulate students’ bodies. This regulation, however, works against the menstruating body, which cannot be contained, and does not abide by institutional regimes around time and place. This inflexibility requires students who menstruate to negotiate the system’s rules and expectations, which may result in them coming into conflict with teachers who are not only more powerful in the adult/child binary (Robinson, 2013) but also in the teacher/student binary. The negotiation work demanded of young people just to be able to manage their menstruation at the most practical of levels, is challenging, even potentially intimidating, adding additional burdens to the everyday educational experience of these young people.

Being considerate

Many respondents felt that their teachers should be more considerate towards them and what they were going through during menstruation. Participants felt that teachers needed to provide help with homework and the opportunity to postpone tests and assignments so that menstruating students could cope better. Thus, respondents wanted structural change. Many respondents’ suggestions related to consideration around greater compassion by teachers.

Allow us to wear jumpers around our waist to add security from bleeding through and less worries and self-consciousness [P2232—Age 15 Australian Capital Territory].

Be more considerate and understanding of how much periods can affect you, e.g., a teacher once advised me to suck it up and play sport when I complained of the pain [P223—Age 16 NSW].

Understanding that it does affect [sic] our concentration and ability to learn. It's a serious issue and a lot of us can't help it and we don't want to feel humiliated because we can't focus and seem stupid [P189—Age 17 Tasmania].

There were also institutional regulations and requirements that added an additional layer of complexity to young people’s lives, such as requiring medical documentation every time the student was absent. This was impractical, time-consuming and likely costly, resulting in financial inequities for them and their families.

Perhaps have an absence from assessment tasks specifically for periods, this year we need a medical certificate to miss an exam but going to a doctor every time I have my period is impractical and wastes my time and the doctor's [P763—Age 16 NSW].

These quotes not only illustrate a need for adults to be more compassionate and aware, but they highlight how young people’s voices around these issues, if listened to, provide suggestions for change, many of which could be relatively easily employed by the institution to support student menstruators.

Conclusion

The data above illustrate a range of teacher, school and system issues that increase the difficulties students experience at school in relation to menstruation. They also articulate ways that schools and teachers can be more supportive of menstruators. Menstruation management and pain impacts a significant proportion of the school population. Having a culture that is supportive of menstruators is critical to ensure that menstruating students have equal access and opportunity to education as those who do not menstruate. This highlights a limitation of the study: Although there was no gender requirement to participate, participants needed to have had at least one period (though they did not have to be currently menstruating). No gender diverse individuals reportedly participated in this study, although the perspectives of transgender students are important. More research is required on the experience and needs of this group who may experience a range of menstruation-related stressors at school not experienced by cisgender female-identifying students (Lane et al., 2021).

Most of the suggestions raised by respondents in this paper are relatively simple to execute. For instance, the provision of enough sanitary bins in schools to meet the need so that students have clean bathrooms to use that do not have ‘overflowing’ bins is a basic hygiene issue. Uniform requirements could be less stringent to enable menstruating students to ‘wrap jumpers around their waist’ as an extra layer of protection in relation to visible leakage. Making access to menstrual products convenient and less embarrassing for students who find themselves unprepared for their period may involve the ability to access menstrual products from various locations/contact points across the school. These products also need to be available in all genders and ‘male’ bathrooms, to provide appropriate support to gender diverse students to use facilities that match their gender identity.

Akin to this, ensuring bathrooms are unlocked and available for student use during class time is essential. Although some schools lock bathrooms to prevent vandalism, loitering and misdemeanors, this practice disadvantages menstruating students and hampers their attempts at basic menstrual management while creating unnecessary stress. Additionally, not permitting students to leave class discreetly is an issue that could be reasonably addressed through awareness raising and education for school staff. This may be particularly useful for male cisgender teachers who have not personally experienced menstruation and lack a consciousness about this experience. Menstruating students have a right to their dignity, and as participants illustrated, it is not uncommon for individuals to feel very uncomfortable about articulating that they cannot participate in an activity because they feel unwell because of their period, or that they need to access the bathroom.

Issues around the provision of pain management are more complex. In Australia, schools are generally not legally permitted to administer medication to students. However, explicit education for students about how to self-manage their pain, through both over-the-counter medication and alternative therapies (e.g. heat), may enable young people to create their own recourse. Additionally, offering more support and empathy to students in pain rather than having their symptoms ‘dismissed’ by teaching staff seems critical. Dismissal, which is likely influenced by discourses that normalize menstrual pain or position it as something that menstruators must ‘just put up with’, does not assist the young person in managing their circumstances nor does it contribute to a positive student/teacher relationship. Furthermore, teacher assumptions that a student is using a claim of pain to seek attention or avoid an activity needs to be critically scrutinized. Although no research has been undertaken on the use of menstrual pain as an excuse to resist participation, one cannot assume that all, or even most, students are pretending considering the statistical evidence pointing to the prevalence of dysmenorrhea among young people. More teacher education about menstruation and dysmenorrhea may be useful.

Furthermore, such pain can be completely debilitating for some students requiring days off school and impacting learning and assessment. Pain impacts academic performance, yet students may not have the confidence to discuss or express this with their teachers. Thus, it may be of benefit for schools to develop policies that support students who suffer from dysmenorrhea. For instance, such policies might enable examination and assessment submission dates to be rescheduled. Similarly, participating online from home during a painful period could be made an option for some students. Undoubtedly, this idea would require some consideration around implementation, but this is less of an impediment for schools since the Covid pandemic, which required schools to facilitate student learning from home. Online classes may allow students to have equal access to learning and keep them at school (rather than enrolling in educational alternatives such as distance education). It may also reduce absenteeism for students who experience difficult menstruation and could reduce the need to seek medical documentation; it may also enable students to keep up with their lessons. Thus, the development of explicit menstruation policy could, overall, make school education more equitable.

Mandating exposure through the school curriculum could help to normalize menstruation and facilitate conversations in the home. As DeMaria et al. (2020, p. 94) point out, individuals who are “provided with practical experiential knowledge from trusted sources, like family members, experienced more positive menstruation perceptions and felt better able to manage their expectations and experiences.” Education may also confirm that non-menstruators learn about this area and ensure that students of all genders receive the information that they need. Normalization through education could also diminish incidences of harassment, stigma and humiliation, potentially changing the everyday experiences of young menstruators.