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Menstrual management

Information on how education and care services support good practices in menstrual hygiene management.

Menstrual management in education and care

One of the most challenging times for young people is puberty, when the body is going through multiple changes all at once. For girls puberty usually starts between the ages of 8 and 13. The onset of menstruation (periods) can have a more pronounced effect on the quality and enjoyment of education than other aspects of puberty. Menstrual disorders in teenage girls can have a significant physical, emotional and psychological impact on their health and seriously compromise schooling, quality of life and future fertility.

Menstruation can affect all aspects of a girl’s life:

  • education – up to 20% of teenage girls miss school from 1 – 7 days per month because of their periods
  • health – use of improvised menstrual hygiene materials can lead to infection
  • dignity – girls may suffer from discomfort, endure teasing and shaming, and face exclusion from everyday activities
  • participation – girls may be distracted or less productive due to pain, discomfort and fear of leaks.

Young girls are often unprepared or unsupported when they begin menstruating and the information they receive is often selective and surrounded by taboos. With the development of healthy norms and practices in schools young girls can be supported to adjust to the emotional and physical changes, and the negative perceptions, socially constructed myths, embarrassment and taboos around menstruation can be removed. 

Providing accurate and timely information for young girls is critical to create a supportive environment for the healthy and dignified management of menstruation. Education and care staff should talk in an informed and comfortable way about menstruation to both girls and boys. 

Lunette Menstrual Cups and Modibodi developed the Sustainable Period Project in 2016 as a joint initiative; a program designed to educate holistically at a grass roots level so that every person can be empowered to make informed choices regarding their menstrual health and to promote period positivity.  A free kit is provided to schools containing a sample of a broad range of sustainable menstrual products and a USB of teaching resources. To obtain a free resource kit complete on the online form.  

Additional resources over a variety of mediums (slideshows, quizzes, handouts) can be downloaded. The Sustainable Period Project supports the requirement for schools to include an element of sustainability across all areas of the Australian curriculum. 

The Central Australian Youth Link-Up Service (CAYLS) have developed a menstrual hygiene management (MHM) resource designed to specifically address the challenges in central Australian Indigenous communities. However the principals and resources can be used to support all communities to reduce the taboos and myths associated with menstruation. 

Lunette have developed a little booklet about menstruation for young teenagers to provide advice and information as well as encourage easy and open conversations about menstruation. 

Menstrual health and endometriosis in schools program

In August 2017 the Pelvic Pain Foundation of Australia, in association with Endometriosis New Zealand, trailed the Menstrual Health and Endometriosis ‘me’ program in South Australian schools. The program has been run in New Zealand for the past 2 years and is designed to target achievement objectives in the curriculum. More information on the program is available on the Endometriosis New Zealand webpage.  

The Department for Education and Department for Health and Wellbeing are currently reviewing the trial outcomes to determine opportunities to support the continuation and expansion of the program.

Menstrual cramps (period pain) and endometriosis

Endometriosis often starts in teenage years and affects around 10% of women. It can affect the reproductive organs resulting in infertility, as well as affecting the bowel, bladder and other organs near the pelvic cavity. Endometriosis can take around 8 years to be correctly diagnosed. This is often as a result of the misconception about what are normal menstruation symptoms, incorrect advice being given to girls experiencing pain during periods, and misdiagnosis by health professionals.  

Menstrual cramps (period pain) can be common during the first few days of menstruating.  The cramps are caused by the muscles of the uterus contracting.  Cramps can be dull and achy, or sharp and intense.  Cramps can be felt in the back as well as stomach area. Taking anti-inflammatory medicines (ie ibuprofen) or heat bags can help with this pain. 

Symptoms associated with endometriosis include:

  • painful periods that aren’t usually relieved with painkillers
  • persistent pelvic pain which gets worse during periods
  • a sense of heaviness in your pelvis – this is specifically associated with pelvic endometriosis
  • lower backache
  • pain during and after having sex
  • pain while passing urine and moving your bowels. On rare occasions, blood in your stool and urine is associated with endometriosis
  • feeling faint and nauseous.

Distressing symptoms are often downplayed due to lack of education about what is normal period pain,, embarrassment, and not knowing where to find support. Where there is a combination of any of the above symptoms a health professional should be consulted Early intervention is important to reduce the risk of infertility and other long term health complications. 

Endometriosis Australia have developed an Endometriosis Paintracker to record pain and symptoms that can assist with communicating with health professionals to enable a correct and timely diagnosis. Other resources are available on the Endometriosis Australia website.

Dr Susan Evans and the Pelvic Pain Foundation of Australia website has a free pelvic pain booklet as well as endometriosis and pelvic pain for purchase.

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) refers to the range of physical and emotional symptoms may girls and women experience in the lead-up to menstruation.  

PMS symptoms differ with each person; the wide range of symptoms can include (but are not limited to):

  • acne
  • anxiety
  • confusion
  • depression and lowered mood, which may include suicidal thoughts
  • difficulties in concentration, memory lapses 
  • digestive upsets, including constipation and diarrhoea
  • drop in self-esteem and confidence leading to social isolation
  • feelings of loneliness and paranoia 
  • headache and migraine
  • increased sensitivity to sounds, light and touch
  • irritability, including angry outbursts 
  • mood swings, weepiness
  • sleep changes, including insomnia or excessive sleepiness.

Premenstrual dysphoric disorder (PMDD) is a more serious form of PMS.  Prolonged and regular PMDD and PMS symptoms may have a significant impact on learning, lead to school absence and if not treated can develop into severe mental health issues. Information on supporting young people with PMS and PMDD can be found on the depression webpage.

Sustainable period products

Cultural taboos, embarrassment and lack of knowledge can prevent open discussions about options when it comes to menstrual products and the environmental impact of disposable products.

Traditional education around menstrual products focuses on disposable products such as pads, panty liners and tampons. The statistics on the environmental impact of periods is alarming; with the average woman throwing away between 10.000 and 12.000 disposal menstrual products in her lifetime. A pad can take around 500-800 years to biodegrade.

Some alternatives to disposable products include:

  • Reusable cloth pads: In Australia, companies such as Hannahpad, Paisley Pads and Mense Sense sell cloth pads that can be washed and reused.
  • Menstrual cups: a bell shaped, silicone-based cup that sits in the vaginal canal and collects blood flow. They are reusable and can be washed using boiling water. Lunette, Juju and Divacup are some of the companies selling menstrual cups in Australia.
  • Menstrual underwear: specifically designed underwear with a built-in absorbent layer stitched into the underwear, protected by another leak resistant layer. They are washable and reusable. Modibodi are an Australian company that make beautiful, comfortable and scientifically support menstrual underwear.

A free kit for schools is available from the Sustainable Period Project containing a sample of a broad range of sustainable menstrual products.

CHOICE conducted a user trial of period underpants and menstrual cups to see how they stack up against their disposable counterparts in terms of reliability, comfort, convenience, cost and impact on the planet.

Health support for menstrual management

Care plans

In some cases a continence care plan - HSP230 (DOC 215KB) or non-specific health care plan - HSP110 (DOC 167KB) may be developed by a treating health professional, supported by a menstruation management care and learning plan - HSP234 (DOC 209KB).

Health support agreement

A health support agreement - HSP120 (DOC 167KB) and safety and risk management plan - HSP121 (DOC 147KB) can be completed where a parent indicates their child requires additional support and assistance with menstrual management. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service. 

The health support agreement should clearly identify cultural, spiritual and language needs. 

Medication agreement

Where medication (prescribed by a health professional or over the counter medicines) is required to be administered during attendance at school a medication agreement - HSP151 (DOC 142KB) is required.

A carrying and/or self-administration of medication form - HSP154 (DOC 190KB) can be completed by the school, parent and young person for over the counter medicines (like ibuprofen) without a medication agreement. 

Refer to medication management for further information.

Contact

Disability and complex needs team

Phone: 8226 3620
Email: education.health [at] sa.gov.au