Don’t go with the flow – Why period products haven’t been tested with blood until now?

Photo by Natracare on Unsplash

The first study ever to test absorption levels of menstrual products using blood was conducted this year. Yes, you read right, this year.

The study was published in August 2023 and for the first time it has compared absorbencies of different menstrual products, including tampons, pads, cups, discs and period underwear, using blood. Previous studies have usually used water or saltwater for testing, despite the fact that periods are more viscous and could contain secretions and endometrial tissue. These differences could have led to inaccurate absorbency evaluations.

And this is exactly what the authors of the study found – differences between the absorbency levels products previously reported and absorbency levels their testing revealed. It seemed that most of the products claimed to have higher absorbency levels than the study results indicated. In addition, the study team also found substantial variability in the amount of menstrual blood different products can absorb, meaning that, for example, there is a huge difference between the capacity of a menstrual cup compared to the capacity of period underwear.

Combined, the findings of this study have pointed to a gap in how doctors determine heavy menstrual bleeding and the amount of blood lost.  Identifying heavy bleeding could be essential in diagnosing different gynaecological conditions (like polycystic ovary syndrome and endometriosis)  or even determining whether there is a need for an emergency treatment. And yet, the current criteria for determining heavy menstrual bleeding is based on tampons’ and pads’ capacity to absorb, found through testing without using blood. Moreover, there is no criteria for more recent products, like cups.

In light of their findings, the study authors warn that if the absorbencies that products report are not accurate, and there is a substantial variability across different products, there could be over-diagnosing or underdiagnosing of different conditions depending on the period products used. In other words, if we don’t know exactly how much a certain product can hold, it is impossible to tell whether the bleeding is heavy and if it could be a cause for concern.  

Given the repercussions that testing menstrual products without blood might have had, it seems surprising that there were no studies like this one prior to it. Why period products haven’t been tested with blood until now?

Cultural stigma surrounding menstruation

One part of the answer to that question probably lies in the deeply ingrained cultural stigma surrounding menstruation as well as in the long history of tabooing and shaming period blood.

Menstrual products have used blue liquids in advertisements of menstrual products for a long time, with the first ad showing a red dot appearing only in 2011. Following that, an ad that showed red fluid pouring onto a pad appeared in 2017, but was soon banned on some social media.

Multiple studies from different fields have exemplified taboos and restrictions around menstruation. What is even more important, they have identified how these taboos and restrictions can negatively affect different aspects of life.

Starting from early ages, stigmatising menstruation negatively affects girls’ engagement and participation in schools. Studies across the world have documented significant connections between school absenteeism and menstruation, especially the first one (menarche). A lot of girls experience their first menstrual period without prior information about it, in fear, thinking that they are ill or even that they are dying. They usually don’t have sufficient support and feel ashamed and embarrassed. Studies mostly from Asia and Africa suggest that in some regions students miss a fifth of their school year because of the period, with a not negligible number of girls even dropping out of school once they start menstruating.

“Period poverty” 

Class plays a crucial role in heightening negative consequences of stigmatising menstruation. Many girls from working-class families report missing school because they cannot afford period products. Moreover, they report wearing menstrual products for longer than recommended, which could lead to infections of the reproductive system and serious long-term health consequences.

A specific term “period poverty” has been coined to describe the lack of access to menstrual products or any other necessities (services, facilities…) needed to deal with one’s menstruation effectively and with dignity. One of the significant contributors to period poverty is assumed to be the period product taxing (also known as “tampon tax”). Even though some countries have recently abolished period taxing, in a lot of countries period products are still subject to sales tax or value-added tax (VAT), while other products considered as basic necessities are exempt from such taxes. Menstrual hygiene products are also basic necessities and should be treated as such.

Both period poverty and period taxing are also believed to reflect the cultural stigma around menstruation. But the list of its consequences doesn’t end there. Across studies of menstrual experiences different participants reported numerous negative effects of their menstrual experience, including adverse effects on their involvement in activities and personal relationships. They also commonly reported elevated psychological burden, as a result of managing so many different aspects of menstruation (physical, emotional, financial, social…), many of which are shamed and stigmatised.

Normalisation of period pain 

Furthermore, another negative consequence of the stigma is believed to be the normalisation of period pain. It is presumed that people who experience periods lack knowledge and understanding of menstruation due to the strong cultural stigma. The stigma is also believed to lead to less sharing of personal experiences and fewer chances for comparing one’s amount of pain to the amounts of pain others are experiencing. In addition, there are indications that period pain reports are not always treated with the seriousness they deserve from the side of doctors, which contributes to the perpetuation of normalising period pains.

It is also important to note that most of the studies about menstrual experiences have been conducted with white, middle-class, heterosexual women. The small amount of existing studies with more diverse populations suggest that socio-economic context massively shapes menstrual experiences, so risks and negative consequences for some could be much worse than illustrated here.

So, there you go, when put in the broader cultural context surrounding menstruation, along with the associated norms, regulations, and practices, it’s not so surprising that there was no study that tested menstrual products with blood until this year, isn’t it?

As the stigma is deeply rooted and a lot of the mentioned problems are structural, it is not an easy task to talk about solutions or predict the timeline for their achievement. However, on a smaller scale, we could all make small steps to dispel the stigma.

It is estimated that an average woman will menstruate once a month for approximately 35 to 40 years of her life. When put together, that is approximately 8 years. 8 years of menstruating in one lifetime. So please, don’t make us spend 8 years of our lives in shame, pain, secrecy, hiding pads (if we’re privileged enough to afford them) on our way to bathrooms, worrying about potential leakage or visible stains, whispering with colleagues or using code names…. The list goes on. Try to avoid insulting jokes, negative comments, and taking part in this cultural play in which many are acting like something spectacularly unusual is happening. It’s not. It’s just a period. (Period)

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