Menstrual health literacy for increased knowledge and earlier diagnosis

Neglecting women’s menstrual pain has had a long history, which affects their well-being and ability to progress in societies today. By raising the menstrual health literacy, Mike Armour, Postdoctoral Research Fellow working in Women’s Health at Western Sydney University, Australia, wants to increase women’s knowledge about their menstrual cycle and reduce the delay in diagnosis for menstrual pain disorders, such as endometriosis.

The perception that period pain is normal can have severe effects. Several studies conclude that the knowledge of effective treatments is low16 and girls with period pain experience reduced classroom performance and class attendance17. However, there is often a culture of silence around periods in schools. A study conducted by Plan International UK among British girls age 14-21 found that only one in five girls feel comfortable discussing their period with a teacher, and of the girls that have missed school due to period pain, 59% made up an alternative excuse.18

With regard to work life, a recent YouGov study among Australian women found that as many as 77% of working women said that their period pain affects their ability to work. Yet, only around a third of them have discussed it with their employer.19

Two young women on an escalator (photo)

– Women can go through days sitting in long meetings or lectures with severe pain, but because it is not socially acceptable to talk about menstrual pain, they do not tell their teacher or boss – especially if it is a man. It can have a large impact on your life, especially if you have endometriosis, where the pain can be hard to predict.

The cost of menstrual pain disorders reaches further than personal costs. A review of studies on the economic burden of endometriosis in different countries found that the indirect costs resulting from sick leave and unemployment were up to USD 15,737 dollar per woman per year.20

One problem identified by Armour and his colleagues is that women often lack in understanding about what happens during the menstrual cycle, despite learning about it in school.

– They mostly learn the mechanics, but not how it actually looks and feels. While menstrual cycles and symptoms vary from person to person, it is important to understand when things go beyond the realm of normalcy.

We want to empower women by giving them the knowledge about menstrual cycles, and the ability to identify problematic symptoms in earlier stages.

To address this, Armour and his research team are developing online educational materials to improve menstrual health literacy among young women. Armour hopes that it will lead to earlier diagnosis of conditions, like endometriosis.

– For endometriosis the time between the onset of symptoms and the diagnosis is around seven years. We want to empower women by giving them the knowledge about menstrual cycles, and the ability to identify problematic symptoms in earlier stages.

16 I. Thirza et al., ‘ Primary Dysmenorrhea in Young Western Australian Women: Prevalence, Impact, and knowledge of Treatment’, Journal of Adolescent Health, vol.25, 1999, pp 40–45.

17 Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on hispanic female adolescents. Arch Pediatr Adolesc Med. 2000;154(12):1226-1229; Chiou MH, Wang HH. Predictors of dysmenorrhea and self-care behavior among vocational nursing school female students. J Nurs Res. 2008;16(1):17-25; Khamdan HY, et al., The Impact of Menstrual Period on Physical Condition, Academic Performance and Habits of Medical Students, Journal of Womens Health Care, 2014; Chia CF, et al., Dysmenorrhoea among Hong Kong university students: prevalence, impact, and management. Hong Kong Medical Journal. 2013;19(3):222-228.

18 Plan International UK, 2017,, accessed 2018-02-14.

19 YouGov, 2017,, accessed 2018-02-14.

20 A. M. Soliman H. Yang E. Xiaoyan Du C. Kelley C. Winkel, The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod. 2016 Apr;31(4):712-22.