In this feature article, Felicity Roux (PhD Candidate, Curtin University) explores the power of the ovulatory-menstrual cycle as a personal health monitor and ovulatory-menstrual health literacy. Felicity is a member of the WAIER Committee for 2021.
* The terms girls and women are used in relation to a person’s sex (i.e. their biological characteristics or reproductive organs). It is recognised that this may differ from gender identity. For example, someone who menstruates may or may not identify as “female”.
The span of years from menarche to menopause can extend 40 years or more. Throughout this time, the ovulatory-menstrual cycle can be used as a personal health monitor. According to the American College of Obstetricians & Gynecologists, the cycle is a “powerful tool” to assess overall health, and menstruation can be considered a vital sign [1]. This means that the cycle is of equal significance to a beating heart and breathing lungs. So it stands to reason that the ability of a woman to understand her own cycles as her personal health monitor would be a useful lifelong skill. The way in which these basic skills can be learnt has been available to the general public since the 1980s [2]. However, a recent systematic literature review describes how, some forty years later, these health literacy skills are insufficiently taught [3].
It is a mistake to believe that all things menstrual are covered in the puberty lessons for Years 5 to 7. The immaturity of the average girl’s hypothalamic-pituitary-ovarian axis means that post-menarche cycles are mostly anovulatory [4]. It can take up to three years for ovulatory processes to mature [5]. Years 8 to 10 are when girls become most likely capable of appropriating the complexity of the cycle [6]. Coincidentally, common menstrual problems are increasingly reported, such as painful periods [7], premenstrual syndrome [8] and abnormal bleeding patterns [9]. Some problems are associated with absenteeism [7, 8], reduced classroom performance [7, 8], body dissatisfaction [10], eating disorders [11], non-suicidal self-injury [12], and poor quality of life [13].
The review [3] suggested that a crowded Health & Physical Education curriculum results in insufficient time to teach girls ovulatory-menstrual health literacy skills. As a taboo topic shrouded in shame and stigma [14], there may also be a reluctance to teach it.
Where there have been initiatives to address menstrual health, programs tended to focus on a single problem (such as painful periods or irregular cycles) rather than addressing all of the most commonly experienced problems. Furthermore, by predicating programs on a menstrual problem, there is likely a missed opportunity to frame the cycle positively as an indicator of good health first and foremost. Whilst there has been some progress towards teaching girls ovulatory-menstrual health literacy, the review3 found no programs which covered all the health literacy dimensions (functional, interactive and critical), upon which the Western Australian curriculum is based [15].
The review’s recommendations [3] informed the development of the My Vital Cycles program which will be trialled in Term 2 and 3 of 2021.
[1] American College of Obstetricians & Gynecologists Committee. (2015). Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstetrics & Gynecology, 126(6), e143-e146 doi:10.1097/AOG.0000000000001215
[2] Billings, E., & Westmore, A. (1980). The Billings Method: Controlling fertility without drugs or devices. Richmond, Victoria Australia: Anne O’Donovan Pty Ltd.
[3] Roux, F., Burns, S., Hendriks, J., & Chih, H.J. (2021). Progressing Towards Adolescent Ovulatory menstrual Health Literacy: A Systematic Literature Review of School-based Interventions. Women’s Reproductive Health, 8(2). doi:10.1080/23293691.2021.1901517
[4] Carlson, L., & Shaw, N. (2019). Development of Ovulatory Menstrual Cycles in Adolescent Girls. Journal of Pediatric and Adolescent Gynecology, 32(3), 249-253. doi:10.1016/j.jpag.2019.02.119
[5] Jamieson, M. (2015). Disorders of Menstruation in Adolescent Girls. Pediatric Clinics of North America, 62(4), 943-961. doi:10.1016/j.pcl.2015.04.007
[6] Klaus, H., & Martin, J. L. (1989). Recognition of Ovulatory/Anovulatory Cycle Pattern in Adolescents by Mucus Self-Detection. Journal of Adolescent Health Care, 10, 93-96
[7] Armour, M., Parry, K., Manohar, N., Holmes, K., Ferfolja, T., Curry, C., . . . Smith, C. A. (2019). The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. Journal of Women’s Health, 28(8), 1161-1171. doi:10.1089/jwh.2018.7615
[8] Parker, M., Sneddon, A., & Arbon, P. (2010). The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population‐based study of Australian teenagers. BJOG, 117(2), 185-192. doi:10.1111/j.1471-0528.2009.02407.x
[9] Maslyanskaya, S., et al. (2017). Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children’s Hospital. Journal of Pediatric and Adolescent Gynecology, 30(3), 349-355
[10] Ambresin, A.-E., Belanger, R. E., Chamay, C., Berchtold, A., & Narring, F. (2012). Body Dissatisfaction on Top of Depressive Mood among Adolescents with Severe Dysmenorrhea. Journal of Pediatric and Adolescent Gynecology, 25(1), 19-22. doi:10.1016/j.jpag.2011.06.014
[11] Abraham, S., Boyd, C., Lal, M., Luscombe, G., & Taylor, A. (2009). Time since menarche, weight gain and body image awareness among adolescent girls: onset of eating disorders. Journal of Psychosomatic Obstetrics & Gynecology, 30(2), 89-94. doi:10.1080/01674820902950553
[12] Liu, X., Liu, Z. Z., Fan, F., & Jia, C. X. (2018). Menarche and menstrual problems are associated with non-suicidal self-injury in adolescent girls. Archives of Women’s Mental Health, 21(6), 649-656. doi:10.1007/s00737-018-0861-y
[13] Knox, B., Nur Azurah, A., & Grover, S. (2015). Quality of life and menstruation in adolescents. Current Opinion in Obstetrics and Gynecology, 27(5), 309-314. doi:10.1097/GCO.0000000000000199
[14] Chrisler, J. C. (2013). Teaching Taboo Topics. Psychology of Women Quarterly, 37(1), 128-132. doi:10.1177/0361684312471326
[15] SCSA – School Curriculum and Standards Authority, Government of Western Australia. (2017). Health and Physical Education Curriculum 2017/9396 [2017/9397] https://k10outline.scsa.wa.edu.au/__data/assets/pdf_file/0007/364552/Health-and-Physical-Education-Curriculum-Pre-primary-to-Year-10.PDF Accessed 2020 06 16
