Frances Dixon on medical education about menstruation

A couple of weeks ago my year-group had to plan and carry out an experiment as part of our teaching. I won’t bother going into details, but this experiment involved urine collection and sampling, with ourselves as the subjects. During the planning of this experiment some people were worried about contamination of the samples with blood from girls who were on their periods. Listening to and reading these discussions got me thinking about just how little boys know about the actual process of menstruation. Everything they were saying was based on anecdotal evidence (“According to girls…” etc) and mostly they just didn’t have a clue. They know which hormones control which part of the cycle, but that’s not going to help reassure a worried patient.

I don’t want to attack male medical students here, or medical education in general, but I think it’s a rather flawed system that allows people to become doctors without understanding what it’s actually like to have a period. I mean, 50% of patients have to deal with it, and will have questions about it, and if 50% of doctors don’t know the answers then that’s a pretty poor outcome. We have countless lectures on the physiological and hormonal basis of periods, but no one ever talks to us about how you feel or even just the actual mechanics of having a period! Starting in primary school, the girls and the boys are separated so girls can talk about periods and tampons, and boys can talk about…who knows?! Actually, that raises the point that the opposite is true; that whatever the boys talk about is probably something female doctors should know about, but that’s another blog post!

I’m sure at that point the separation is probably a good thing, but by the time you are late teens/early twenties and a medical student I think you should be past the embarrassment stage. The trouble is that it’s just not socially acceptable to talk about periods. People talk about it euphemistically, mentioning “that time of the month,” or jokingly saying a women must be on her period if she’s irritable or snappy. Women are expected to just shut up and deal with it, and in doing so help continue the mindset that it’s something “shameful” and not to be mentioned. I realise that this isn’t going to change in society in general but perhaps amongst medical students and doctors, who deal with the body in all its phases, it could be discussed a bit more openly.
I’m not sure what the solution would be. Perhaps a video where several different women just talk about their periods? But that could so easily end up like those adverts where women meet for lunch and discuss how bloated they feel! We sometimes have patients who come to talk to us about their experience of disease, and I find that this really helps understand a condition and see it from another point of view. If you could persuade a woman (or women) to come and talk to us (although I wouldn’t want to stand up in front of 300 people and talk about my period!) and just tell us about her experiences, then I think it would help a lot. I know that menstruation is not an illness, but there’s no reason this format wouldn’t work anyway.

With this post I just wanted draw attention to the lack of education on this point. Obviously, I’m not proposing that women talk to everyone about their cycles all the time, just that it is recognised as something we all need to know about. As I said above, menstruation is not an illness, but it is a major contributory factor in women’s health issues. It causes problems (mood swings, water retention, anaemia etc) and it can also affect the presentation of non-related conditions. Doctors really need to understand this, and just because it’s never talked about does not mean that it isn’t a real issue.

Frances Dixon is a medical student at Imperial College School of Medicine, London.