Experiences of the menstrual cycle in the pursuit of health and wellness.

People often think about their wellness in terms of physical health — nutrition, exercise, weight management, etc., but it is so much more! Wellness also includes: emotional/mental, social, financial, intellectual, spiritual, environmental and vocational dimensions.  

With over 40 million people worldwide reporting Premenstrual Syndrome (PMS) symptoms and the existence of more than 300 physical, psychological, emotional, behavioral and social symptoms associated with PMS, it felt important to explore how experiences of the menstrual cycle impact individuals' pursuit of health and wellness. With the results of this study, My Normative iterated on its existing technology and created a road map to build out more robust representations of the lived experiences of female persons in its technology.

This project was conducted in two stages:

During the first stage, six individuals were recruited through email, social media and newsletter to participate in a one-on-one semi-structured online interview about their menstrual cycle, the symptoms they experience and how those symptoms impact their lives. All participants were between the ages of 18-35, had an active menstrual cycle and provided informed consent before the interviews.

The second stage of this project used a 31 question online survey that was carefully constructed following the interviews to compare the results with a wider population and give depth to the lived experience of a female's menstrual cycle and the language used.

After a testing period and minor revisions to the content and interpretation of the specific questions, the questionnaire was distributed by  email, social media and a monthly newsletter in Fall 2021. 

The objective of this method approach was to create a level of rigour and trust in the initial qualitative approach to data collection. By using a qualitative interview style in the first stage, participants were able to answer open ended questions about their experiences in their own language. After analysing the results, the second stage was used to validate the initial findings on a larger population and create “generalisability.”

Undoubtedly when we think of health and wellness many of us immediately jump to considering our physical health.

To this end, amongst participants who completed the online questionnaire, fitness related goals were the most common (77%) while over half of participants had goals related to their diet or sleep. That said, our results suggest that many individuals experience significant impacts on other aspects of their health and wellness but there weren’t specific goals tied to addressing these particular issues. This gap between experiences and goal setting may indicate a gap in a sense of agency to address female health issues.

In the next section of the results, results will be broken down into the categories discussed above in the introduction.

Broadly, physical wellness can be inclusive of factors that contribute to the health of the physical body both now and in the future. This can include a variety of health oriented behaviours such as: exercise and activity, nutrition management, sleep hygiene, sexual health practices, and substance use.

When discussing physical wellness, physical symptoms were a topic of great saliency amongst participants. 

Physical symptoms during the menstrual cycle were frequently reported amongst participants who completed the online questionnaire, 77% reporting experiencing physical symptoms with the most common being menstrual cramps and food cravings followed by fatigue, bloating, and breast tenderness. 

Only a third of participants felt as though they had an effective strategy(s) to help with their menstrual cycle symptoms. This point is exemplified by one participant's comment that

“Honestly, like I just don't even feel like I can do anything because it's just so it's like this achy, you know and ya, that stuff… so yeah that sucks, I just lie there like a potato waiting for it to be over.”

 When our physical wellness is impacted by injury or illness many people will take action to restore our physical health. Yet the impact of menstrual cycle symptoms on physical wellness was often seen as inevitable and as something to be suffered through. This would suggest that appropriate or effective management for physical symptoms are inaccessible or unrecognizable to the general population.

Usually, emotional and mental wellness can be inclusive of factors such as the ability to recognize, understand, and accept emotional states, as well as the ability to manage effectively through challenges and change.

When discussing emotional and mental wellness, the menstrual cycle was described as having a significant (if mostly negative) impact on respondents' health.  

Less than 50% of questionnaire respondents thought of their menstrual cycle as a positive thing and only 31% considered positive outcomes such as increased motivation, energy, and productivity associated with their menstrual cycle. Irritability (47%) was the most severe and widely experienced psychological menstrual cycle symptom reported by participants while change in libido (27%), insomnia (20%), emotional sensitivity (20%), and depression (20%) were less common. Psychological symptoms were most often reported during the week before a period and lasted a few days in most participants yet, a third of participants experienced these symptoms for a week or longer. 

Some participants expressed this self-acceptance regarding the impact their cycles have on their lives, stating

“But now, especially if it's on a weekend or if I'm in between work or whatever it is. I definitely allow myself the space to just be in whatever it is that I need. So, if we had plans, or whatever. Then, I'll just be like, I just can't today. It needs to be a couch day I just need like, I just can't.” (Participant 2)

and “I do cut myself some slack.  I would never go (to the gym) my entire cycle.” (Participant 6).  

This attribution of the negative to symptoms surrounding the menstrual cycle is important in two ways. One, it highlights the need for accurate and sympathetic tools to help us manage the health experiences associated with the menstrual cycle. And, two, it highlights the need for resources that help leverage the hormonal effects of the menstrual cycle to improve our mental and emotional well-being.

Commonly, social wellness can be thought of as how we interact with our community and those around us.

In the larger social context, nearly all participants felt that there was a social stigma (i.e. disapproval of, or discrimination against, an individual or group based on perceivable social characteristics that serve to distinguish them from other members of a society) around menstrual cycles (92% yes; 8% maybe; 0% no). 

Participants also noted their concerts over needing to have a certain type of cycle, sharing that

“It was just it was one of those things where I feel like you're always told if it's not regular something's wrong with you, so then I was like, oh I should probably watch this [her period regularity], what if something's wrong with me.” (Participant 2)

When considering their immediate social cycles, 69% of participants reported that their menstrual cycle impacted their personal life at least some of the time. Most participants reported that life partners or spouses were the most affected by menstrual cycle symptoms (67%), sharing that “I find myself more irritable or more sensitive too, usually it’s directed at my husband” (Participant 3) and “unfortunately my husband's kind of the one that gets the end of that one all the time” (Participant 2).  Those who weren’t in relationships also reported the impacts their symptoms had on family members.  Participant 1 reported ”it's like the worst time of the month because like that's when [my mom and I]  fight the most.” Personal life (44%), work (33%), family (22%) and friends (22%) were mentioned as also being affected by participant menstrual cycle symptoms.

In these results we see a clear division between the public and the private, the insiders and the outsiders… and as a result some of the remaining stigma around menstrual health.

Broadly, financial wellness can be described as the ways in which our finances contribute to our overall wellness. Alignment between our goals and our financial obligations can create a sense of financial security and wellness.

Most (85%) survey respondents  reported that they treat their menstrual cycle symptoms differently at home compared to at work. Participants of both female and male dominated spaces shared that “I just put up with it [symptoms]” (Participant 6),  “you just have to suck it up” (Participant 2), or that “I don’t want to use that as an excuse” (Participant 5), suggesting that menstrual cycle symptoms were seen as a threat to meeting those financial responsibilities.

Participants 2 explained that “Regardless of how bad it was, I was never really allowed to feel those [symptoms] or that it was okay to do any of that [time off work]. So that's part of the suppressing, so I feel like I just got a really good pain tolerance and worked through it.”  While Participant 6 said “There's no such thing as like pushing a meeting a week away, when you're in a better mood, it was honestly, I don't think I've ever thought about that as an option.” 

Yet, Participant 4 reminds us that just because they we may be trying to leave those feelings at home doesn’t mean that we aren’t experiencing them, mentioning that,

“it's just the fact that we're expected to work through horrendous cramping pain, or being like we're gonna cry in a second. It’s not a nice feeling.” 

Excitingly, many parts of the world are changing as it pertains to the financial burden placed on people who menstruate. From innovations on parental leave, to paid menstrual leave at both corporate and governmentally mandated levels, the world is finally starting to provide support to the financial wellness of its female population.

Generally, intellectual wellness centers around the ability to expand upon your knowledge or skills.

When it comes to the menstrual cycle, participants found this was one area that was “definitely not something we talk about” (Participant 3).  

Participant 2 shared “it's definitely something that was never talked about, never allowed to be talked about, never even in my direct family. There's three women, and just my dad. And even then, we never talked about it.”

Participant 5 explained that

“Because we're not taught at a young age, either, right, like, just things happen to our body and… some people are fortunate they have someone or they have really good mom to talk to you but… my mother was 100% conservative, not talking about her menstrual cycle or like girls health so you can figure it out on your own and you're like, ‘guess that's normal’.”

This self-education about their menstrual cycle was reported by nearly two thirds of survey respondents. Participant 4 went on to explain how the lack of information feeds into the larger ideas around menstrual cycles and health, saying

“I think even just like the lack of talking about it, it just creates such shame… Or like it's a taboo topic that you're not you don't talk about. And then it creates this whole like, you have to hide it and like, pretend that you're fine -even when you're not.”

In an era in which female health and menstrual advocacy are starting to become more common place, participants are excited for what’s next: “times have changed and [periods are] something that people can talk about now and I'm definitely much more mindful of it, and like reducing stigma around periods” (Participant 3).

 Additionally, participants noted how everyone is starting to talk about menstrual cycles sharing that “I really do hope it can change. And I am very hopeful for it, because I do see a lot of younger fathers, be more open about it and stuff. And even in our group of friends, like, we very openly talk about our menstrual cycle, or at least the women do. And the men are really understanding and engaging”(Participant 2) and that in “future generations, even boys are taking more, I think that they're not as embarrassed I feel like as when we were young.” (Participant 5).

By sharing and acknowledging the wide impact the menstrual cycle can have on different dimensions of health and wellness we hope to contribute to rewriting the narrative around the menstrual cycle and provide individuals with the tools to take control of their wellness.