ArticlePDF Available

Abstract

Menstruation is a salient, and sometimes scary, communication topic for young women. The presentstudy reports on the early communication experiences about menstruation from 165 women usingopen-ended survey data. Through the framework of supportive communication, findings reveal that adiscrepancy occurs between the health and practical information and needs to which young peoplewho menstruate desire access, and their social and emotional needs. The present study indicates aninadequacy of both aspects of menstruation communication from important others in childhood andadolescence. Themes of boundary management, impersonal, silence, and accidents also characterizeearly communication experiences about menstruation. Our participants identified a desire for conversations that normalize menstruation as typical and acceptable, validate period pain and prescribe management tactics, and describe the existence of feminine hygiene products other than pads and tampons.Limitations and directions for future research are discussed.
Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=hhth20
Health Communication
ISSN: 1041-0236 (Print) 1532-7027 (Online) Journal homepage: http://www.tandfonline.com/loi/hhth20
“I Thought I Was Dying:” (Un)Supportive
Communication Surrounding Early Menstruation
Experiences
Valerie Rubinsky, Jacqueline N. Gunning & Angela Cooke-Jackson
To cite this article: Valerie Rubinsky, Jacqueline N. Gunning & Angela Cooke-Jackson (2018):
“I Thought I Was Dying:” (Un)Supportive Communication Surrounding Early Menstruation
Experiences, Health Communication
To link to this article: https://doi.org/10.1080/10410236.2018.1548337
Published online: 21 Nov 2018.
Submit your article to this journal
View Crossmark data
I Thought I Was Dying:(Un)Supportive Communication Surrounding Early
Menstruation Experiences
Valerie Rubinsky
a
, Jacqueline N. Gunning
b
, and Angela Cooke-Jackson
c
a
School of Communication Studies, Ohio University;
b
Unaffiliated Research Assistant;
c
Department of Communication Studies, California State
University
ABSTRACT
Menstruation is a salient, and sometimes scary, communication topic for young women. The present
study reports on the early communication experiences about menstruation from 165 women using
open-ended survey data. Through the framework of supportive communication, findings reveal that a
discrepancy occurs between the health and practical information and needs to which young people
who menstruate desire access, and their social and emotional needs. The present study indicates an
inadequacy of both aspects of menstruation communication from important others in childhood and
adolescence. Themes of boundary management, impersonal, silence, and accidents also characterize
early communication experiences about menstruation. Our participants identified a desire for conversa-
tions that normalize menstruation as typical and acceptable, validate period pain and prescribe manage-
ment tactics, and describe the existence of feminine hygiene products other than pads and tampons.
Limitations and directions for future research are discussed.
My first encounter with menstruation was a toilet bowl full of
blood, which an elementary school classmate showed me giddily
while giggling someone got their period!”…Then one
random day in my tweens some years later, my mom left
a copy of The Discovery Girls Guide To Puberty in my room.
I completely ignored it, but after she uncomfortably asked if
I read it a couple times I gave it a look weeks later, during
my moms half-baked sex talkin which she asked do you
know what a period is?And I nodded, completely unaware.
She breathed a sigh of relief and said good, because she read an
article recently about two sisters that raised their younger
sibling after their mom passed and when it happened to the
youngest, she thought she was dying. I then spent several
months agonizing over the day I, too, would suddenly think
Im going to die. (Participant 76)
Like this participant, many young adults and adolescents
feel unprepared for menstruation, even amid talk that informs
them of its existence (Marván & Molina-Abolnik, 2012).
Communication is the vehicle through which women learn
what menstruation is, make sense of the meaning of men-
struation for themselves and other people who menstruate,
and form attitudes about menstruation. Communication, or
sometimes missing or miscommunication, about menstrua-
tion is important to study because comfort with menstruation
as a normalized and acceptable occurrence is associated with
womens comfort with their sexuality and their bodies
(Rembeck, Moller, & Gunnarsson, 2007). Women who feel
more comfortable with menstruation tend to also feel more
comfortable in their body, are more sexually assertive, and
engage in less sexual risk-taking (Schooler, Ward,
Merriwether, & Caruthers, 2005). However, menarche and
menstruation can be stressful events for young people who
menstruate. Effective emotionl support can reduce the psy-
chological distress associated with stressful circumstances or
events that can undermine an individuals feelings of self-
worth or social acceptance (MacGeorge, Feng, & Burleson,
2011). Socializing messages, support from parents, educators,
and healthcare providers, and other interpersonal communi-
cation about menstruation may help young people who men-
struate make sense of this experience. Thus, the way we
communicatively socialize women and girls into menstruation
has lasting effects on their personal well-being and sexual
health. To address this, the present study attends to how
women recall their early supportive or unsupportive commu-
nicative experiences about menstruation and menarche.
(Un)supportive communication about menstruation
Supportive communication, or communication produced with
the intention of helping someone perceived as needing help,
affects an individuals health and well-being (MacGeorge
et al., 2011). During stressful life circumstances, actual or
perceived availability of social support can offer a buffering
effect that helps individuals reappraise challenging circum-
stances or events, and reduces the harmful impact of these
events on health and well-being (MacGeorge et al., 2011).
Anticipation and onset of menarche and early menstruation
experiences for young people who menstruate (or anticipate
menstruating) are characterized by stress, uncertainty, stigma,
and shifts in the perception of their own and othersidentities
CONTACT Valerie Rubinsky vr225514@ohio.edu 400 Schoonover Center, N. College Street, Athens, OH, 45701, USA.
HEALTH COMMUNICATION
https://doi.org/10.1080/10410236.2018.1548337
© 2018 Taylor & Francis Group, LLC
(Mathew, 2018). For instance, young people who menstruate
and experience premenstrual syndrome may experience dua-
listic discourses and self-silencing that further alter their per-
ceptions of the self (Chrisler, Gorman, & Streckfuss, 2014). As
significant sources of information about menstruation
(Ackard & Nuemark-Sztainer, 2001), parents and healthcare
providers may be uniquely able to provide support to young
people to help make sense of this experience and attend to
competing discourses about menstruation (Lee, 2008).
Given that supportive communication can influence how
individuals perceive stressful life circumstances and the
extent to which those circumstances can be harmful to
their health and well-being, how significant socializing
agents provide social support to young people during their
early menstruation experiences warrants attention.
Specifically, there is a direct connection between supportive
communication and health through the provision or receipt
of health-relevant information (MacGeorge et al., 2011;
Uchino, 2009). In the case of menstruation, young people
navigating menarche may need or receive information about
hygiene products (Jackson & Falmagne, 2013), pain man-
agement, medication, birth control, and other sources of
health-related information (Houston, Abraham, Huang, &
DAngelo, 2006). They may also require informational sup-
port in the form of detailing what symptoms may be
expected, what symptoms suggest the need for medical
intervention, or how to track or what to expect from track-
ing their menstrual cycles (Rubinsky, Cooke-Jackson,
Gunning, & Bartson, 2018). The provision and receipt of
informational and instrumental supportive communication,
in these ways, can help young women navigate menarche
and early menstruation.
Menstruation can be both physically and emotionally distres-
sing. In addition to instrumental and informational support to
manage and track physical symptoms associated with menstrua-
tion, enacted or perceived availability of emotional support may
help reduce the psychological and emotional distress associated
with a stigmatized socializing experience (MacGeorge et al.,
2011). Previous research suggests that emotional support from
parents, friends, and other important figures can reduce the
emotional distress that a range of serious stressful events can
generate (Jones & Burleson, 2003; MacGeorge et al., 2011).
Emotional support provides a sensemaking function and can
trigger processes of cognitive reappraisal that helps the indivi-
dual experiencing the stressful situation view it in a different
light (MacGeorge et al., 2011).
Alternatively, supportive communication can be a face-
threatening experience for both the support providing and sup-
port receiving individuals (Goldsmith, 2004). Menstruations
position as a stigmatized social experience, however common,
may produce feelings of tension and discomfort as
a conversational topic, leading to avoidance and self- and other-
silencing (Chrisler et al., 2014;Jackson&Falmagne,2013). In
addition, the face-threatening nature of period talk may pose
challenges in providing support to young women who are
experiencing or anticipating menarche. As a result, while sup-
portive communication about menstruation can be helpful, like
many stigmatized topics surrounding sexual and reproductive
health, many individuals avoid it.
Taboo sexual and reproductive health talk
Relegating certain communication topics, like menstrua-
tion, to taboo status serves as a powerful social tool
(Kissling, 1996b;Mathew,2018). Societal discourses sur-
rounding menstruation influence how young women make
senseofmenarche(Jackson&Falmagne,2013).
Specifically, Jackson and Falmagne (2013)foundthat
young women experienced feelings of confliction regard-
ing whether or not they were a woman,tend to use
distancing language when discussing menstruation, con-
cealed their menstruating bodies, and experience continual
discomfort with menstruation beyond adolescence and
into emerging adulthood. Perceiving adulthood and bodily
development as desirable seems to relate to more positive
feelings toward menstruation (Rembeck et al., 2007). Even
as some menstrual taboos minimize, menstruation remains
a stigmatized, embarrassing, uncomfortable, and overall
taboo communication topic for many (Jackson &
Falmagne, 2013;Mathew,2018). As a result of its taboo
status, young people who menstruate may be taught to
hide their menstruation and engage in self-silencing beha-
viors (Chrisler et al., 2014).
Despite its taboo status, women and girls create vehicles
through which to address their communication needs
about their reproductive health (Kissling, 1996b), and par-
ental attitudes toward menstruation may be shifting (Lee,
2008). Although talking about menstruation and offering
support about the topic may be face threatening
(Goldsmith, 2004), some evidence suggests that maternal
scripts toward period talk may be changing (Lee, 2008).
Specifically, Lee (2008) finds that young women who
started their period around or after the year 2000, reported
having supportive mothers who emotionally engaged the
subject of menstruation with them during menarche.
Emotionally supportive mothers, to some degree, can miti-
gate the feelings of shame and humiliation associated with
menarche and early menstruation (Lee, 2008). In addition,
adolescent girls may develop creative linguistic strategies in
order to meet their communication needs while avoiding
the associated embarrassment with menstruation talk
(Kissling, 1996b). For instance, girls developed slang
terms, circumlocutions, pronouns, and euphemisms as
communication strategies to maintain the normative
silence around menstruation, while violating that norm to
engage in menstrual communication (Kissling, 1996b).
Despite these shifts, even women who reported having
warm maternal emotional support may still recall very
negative experiences associated with menarche, so it is
not alone a guarantee of positive outcomes (Lee, 2008).
Given evidence that supportive communication and atti-
tudes around early menstruation and menarche shift with
time (Lee, 2008;Mathew,2018), more recent investigations
into the subject may be necessary. In addition, the present
study offers explicit attention to the processes of suppor-
tive communication rather than broader, ambient socializ-
ing experiences that result in specific discursive practices,
and aims to offer specific, practical recommendations to
individuals socializing young people who menstruate.
2V. RUBINSKY ET AL.
Menstruation and gendered socialization
Communication and support, or lack thereof, surrounding
menstruation serves as a form of gendered socialization for
young people who menstruate (Kissling, 1996b). Young peo-
ple who menstruate receive mixed messages from family and
other socializing systems about menarche, including that it is
traumatic but also a typical experience, as well as mysterious
and secret, but also a symbol of sexual maturity (Jackson &
Falmagne, 2013; Kissling, 1996a). Menstruation can be an
important source of social stigma (Fingerson, 2005), which
is transmitted through communication as a socializing agent
in popular culture, advertisements, and through educational
materials (Johnston-Robledo & Chrisler, 2013). However,
young people who menstruate also learn this stigma interper-
sonally, with their families and peers socializing them into
their understanding of menstruation.
Families constitute an important site for communication about
menstruation and other reproductive and sexual health issues for
young women. Messages about menarche and menstruation are
intergenerational (Field-Springer, Randall-Griffiths, & Reece,
2018), with mothers occupying an especially pivotal role
(Lee, 2008). Often, communication between mothers and daugh-
ters about menstruation is negative, with mothers frequently
delivering grin-and-bear-itmessages that reflect traditional fem-
inine gender roles (Costos, Ackerman, & Paradis, 2002, p. 51).
Alternatively, adolescent girls who report having a discussion with
their mothers about the more emotional aspects of menstruating
are more likely to identify feeling prepared to start menstruating at
menarche compared to adolescent girls who did not have these
discussions (Marván & Molina-Abolnik, 2012). As previously
noted, mothersapproaches toward menstruation may also be
shifting to more emotionally supportive communication (Lee,
2008). These findings are important because feelings of prepara-
tion to start menstruation predict more positive attitudes toward
menstruation (Marván & Molina-Abolnik, 2012). Thus, mothers
communication about menstruation with their daughters may be
especially consequential in how young people who menstruate
interpret the experience of menstruation at menarche and
throughout the lifespan. In particular, emotionally supportive
communication can aid in more positive interpretations of
a common experience.
Furthermore, children and adolescents learn about men-
struation through communication with formal socialization
agents. For young people who menstruate, menarche and
menstruation are constructed as embarrassing, hidden, and
shameful, especially in school-related contexts (Burrows &
Johnson, 2005). Young women perceive a distinction between
different kinds of menstrual education that is scientific, focus-
ing on physiological functioning, and pragmatic, focusing on
the lived experience and management of a menstruating body
(Kissling, 1996a). In addition, women report more negative
than positive communication experiences surrounding early
menstruation (Costos et al., 2002). Communication around
menstruation, particularly early communication around men-
struation, has the transformative potential to shape conflict-
ing, negative, or demeaning attitudes about the self and
others. Thus, the present study investigates the characteristics
of support in early communication about menstruation.
(Self)silencing and absence of menstrual communication
Silence often characterizes early communication around men-
struation (Kissling, 1996a). Women are socialized into under-
standing menstruation as something that is secretive and to be
dealt with independently and in private. Many women are
socialized to view their menstrual pain as something that they
should suppress and manage as an aspect of being a woman
(Chen, Shieh, Draucker, & Carpenter, 2018). Women who
have negative views of menstruation are more likely to engage
in menstrual suppression (Andrist, Hoyt, Weinstein, &
McGibbon, 2004). These self-silencing messages may lead to
women not listening to their bodies. For example, in cases of
endometriosis, the average delay from onset of symptoms to
diagnosis was 7.96 years in the United Kingdom and
11.73 years in the United States (Hadfield, Mardon, Barlow,
& Kennedy, 1996). In part, this extended timeline may be
attributed to embarrassment in discussing menstrual ailments
with physicians and the degree to which women have normal-
ized their pain (Seear, 2009). This teaches women to ignore
abnormal symptoms, often suffering through dysmenorrhea
in silence so not to be deemed dramatic (Seear, 2009). The
implementation of menstrual health education programs in
schools could increase awareness of abnormal pain and sub-
sequent disorders (Bush, Brick, East, & Johnson, 2017).
However, the absence of informative early menstrual educa-
tion communication and subsequent encouraged silencing
fosters a culture of embarrassment and fear in regard to
asking questions about menstruation. Instrumental or infor-
mational support that enables open environments in which
individuals who menstruate can ask practical questions may
also buffer against these harmful outcomes.
While some research suggests shifts in warmth and
increasing amounts of emotionally supportive communi-
cation, others indicate continued shame and silencing
(Chen et al., 2018;Lee,2008;Mathew,2018). Silence and
the absence of consequential supportive communication
may still characterize early menstrual communication. In
addition, young women indicatethatabsentmessages
about sexual health, especially from important others,
could redirect negative messages and prepare them to
become sexual adults (Rubinsky & Cooke-Jackson, 2017),
as well as provide comfort and guidance (Holman &
Koenig Kellas, 2018). The present study attends to these
gaps by addressing not only what communication occurs
about menstruation, but also what communication people
who menstruate believe would have been important to
receive, but did not. In doing so, the present study
attempts to resolve discrepant findings among recent
scholarship investigating communication experiences and
contradictory narratives present in early menstrual dis-
courses, provide more recent data on the subject, and
attend to the conversations or topics about menstruation
adult women feel were absent from their early commu-
nication experiences. To accomplish this, we pose the
following research question: What characteristics of sup-
portive communication were (1) enacted and (2) desired
surrounding menarche and menstruation for adult women
who recall their early menstruation experiences?
HEALTH COMMUNICATION 3
Methods
Sample and recruitment
To address the research questions, we employed a survey meth-
odology to preserve anonymity, reach a more diverse sample,
and speak to larger patterns of period talkacross different groups
of women. Participants (n= 165) included predominantly indi-
viduals who were assigned female at birth, with one participant
who was identified as a transgender woman and was assigned
male at birth, between the ages of 18 and 37 (M=23.52,
SD = 3.78). Participants were white (n= 100, 61.2%), Hispanic
or Latina (n= 32, 19.6%), Asian (n= 17, 10.4%), Black, African
American or Afro-Mexican (n=6,3.7%),Indian(n=3,1.8%),
twoormoreraces(n=3,1.8%),Slavic(n= 1, .6%), and
Armenian (n= 1, .6%). In addition, participants identified
their sexual orientation as straight or heterosexual (n=108,
66.3%), bisexual (n= 30, 18.4%), pansexual (n=7,4.3%),lesbian
(n= 7, 4.3%), queer (n= 5, 3.1%), asexual (n= 4, 2.5%), and two
participants chose not to identify their sexual orientation (1.2%).
Following IRB approval, purposive, volunteer sample recruit-
ment occurred via the second and third authorssocial media
accounts, including Facebook, Reddit, CRTNET, Twitter, and
Tumblr.
Procedure
Individuals chose to participate were taken to an online ques-
tionnaire hosted on Qualtrics.com. The portion of the ques-
tionnaire addressed in this article concerns questions about
early menstruation experiences. Specifically, participants were
asked to recall their first encounter with the topic of men-
struation, the age when they first started menstruating, the
first conversation about menstruation, what they wish they
were told about menstruation and from whom they wish that
information originated, and significant events that occurred
in their early adolescence revolving around menarche or
menstruation.
Data analysis
In total, the results presented in this article reflect 886 open-
ended questionnaire reflections that range in length from
a few words to a few paragraphs. To address the research
questions, the first and second author first read through all
open-ended questions. During first-order coding, each author
identified in vivo and conceptual codes (Saldaña, 2014) that
preserve participant language and core concepts (e.g., tam-
pons). After meeting to discuss first-order codes, the first two
authors read through the data again and began to generate
a codebook using Owens thematic analysis (Owen, 1984)as
a guide. The first two authors examined the data again to
synthesize first-order codes and identify themes that met
these conditions. For example, during this process, the first-
order codes of other than tampons or pads,”“menstrual
cups,and reusable productswere combined into the
theme of hygiene products beyond pads and tampons.The
first two authors met again to discuss the final codebook. To
assess reliability of the analysis, all the authors independently
coded 10% of the data according to the final codebook.
Cohens kappa revealed good reliability, k= .86, demonstrat-
ing sufficient agreement between coders.
Findings: Support in early communication
experiences about menstruation
To address the research question, the thematic analysis
revealed several themes that may be categorized as enacted
or desired instrumental, informational, and emotional sup-
port. First, we discuss forms of instrumental and informa-
tional support that were enacted or desired. These include: (1)
impersonal, (2) accidents, (3) period pain validation and
management, (4) hygiene products, and (5) medical versus
practical information. Second, we discuss emotional support,
which includes: (1) dread or excitement, (2) silence(ing), (3)
boundary management, (4) normalizing messages, and (5)
becoming a woman. We describe each theme in turn.
Instrumental and informational support
Impersonal
A number of women noted never having an interpersonal con-
versation with someone (e.g., a parent, sibling, friend, or nurse)
about menstruation. The American Girl Book(i.e., The Care
and Keeping of You)andthe videowere mentioned frequently
among participants as their salient early experience with the
topic of menstruation. For example:
I believe I was in fifth grade when I learned about menstruation.
There was a formal educational part of school, but my parents
also had this caring about you bookmade by the American Girl
Doll company that discussed how your body is supposed to look.
(Participant 22)
Often, participants characterized salient early communication
around menstruation as occurring in a classroom, through
exposure to a TV show, or because a parent provided them
with a book instead of a conversation. For example, We
watched a video about why menstruation occurs, and other
changes the female body goes through during puberty. It was
not very interactive as I went to a catholic school and such topics
were not really discussed(Participant 60). These public con-
versations occurred in mediated settings with an absence of
interpersonal conversations about the subject. Although imper-
sonal in nature and not providing emotional support or opening
a communication channel, these messages often served as infor-
mational support by providing the individual with information
they needed to manage their menstrual experience.
Accidents
Many participants identified early menstruation communica-
tion experiences revolving around the occurrence or fear of
menstruation-related accidents,like leaking through pants.
As previous literature suggests, the stigma around menstrua-
tion may result in women fearing any visible marker of
menstruation. For example:
I was still getting used to pads and when to change them, and
I was mortified at being the first girl in my class to start. I ended
up leaking through a pad, my underwear, and my jeans and onto
the desk chair during computer class. I had to walk around the
4V. RUBINSKY ET AL.
rest of the day with my jacket tied around my waist
(Participant 11)
Although this theme does not point to a specific form of
enacted instrumental support, it does highlight a desire for
or absence of a type of support. Frequent fear of accidents,
which occurred as both a recurrent and repetitive theme in
our analysis, comprised a salient concern for many of our
participants who did not identify important others providing
them with resources for addressing the concern. Another
participant identified this fear of menstrual accidents translat-
ing to shame when she was young, noting:
I wish I had been taught what it was and how to better handle it.
I frequently bled through my pants at school, because you were
only allowed to use the bathroom once a day during class. I felt
very ashamed of having a period, especially at such a young age.
I wish someone had told me it was normal or I had a peer to
speak to about it. (Participant 91)
Period pain validation and management
Many participants expressed a desire for education on men-
strual pain and the differing levels that define and exceed the
idea of normal(i.e., as appears to be conceptualized by our
participants, what constitutes a typical menstrual experience
that would not require medical intervention or treatment).
One participant wrote:
I wish that I had been told how much pain to expect and at what
level was too much pain. I wish someone had told me that even
though this will happen every month, the world wont give you
a pass to acknowledge your symptoms. (Participant 90)
A lack of validation of pain was noted by numerous partici-
pants. For instance, this participant wrote:
I wish I knew that it could be really painful for some people. I had
very aggressive periods and in school everyone always talked
about how it didnt hurt and nurses would always think I was
just being dramatic when I was asking to go home sick for the day
because I wasnt able focus in class due to the general symptoms
and then the additional pain of bad cramps. (Participant 7)
Others noted the suppression of their pain, discomfort, and
menstrual experience. For example, this participant states:
I had intense period cramps for a long time before I ever realized
that they werent normal. When I tried to dismiss the pain as
normal, I minimized it so other women wouldnt think I was
a baby. Finally, my mom became concerned and asked me if
I was having a bad stomach achewhich opened up the con-
versation that made me realize that the severity of my cramps
were far beyond normal. (Participant 95)
Further, participants expressed a desire to have been taught
tactics on how to manage menstrual pain. For example, this
participant wrote:
I had some pretty mortifying misconceptions about what was
happening at the beginning there. I could also have used a ruler
for how much pain was normal/acceptable, which medications
treat which symptoms, and how your diet has an impact on how
awful you feel, all of which has been sort of a slow and painful
process to discover (Participant 14).
Thus, participants expressed a desire for communication and
education validating menstrual pain, information on how to
manage painful symptoms, and how to recognize pain that
exceeds the threshold of normaland requires attention. While
we situate this theme under instrumental and informational sup-
port, as participants largely highlight a desire for information, the
desire to have their pain validated also points to an absence of
emotional support. Importantly, as this participant points out,
a ruler for how typical pain is for people who menstruate con-
stituted an absent form of support among participants.
Hygiene products beyond pads and tampons
Womensdesire to have been introduced to available men-
strual hygiene products beyond pads and tampons (i.e. men-
strual cups, reusable pads, period underwear, sponges, etc.)
also constituted a recurring theme, and generally an absence
of enacted instrumental and informational support. For exam-
ple, a participant notes that she wished she had known, that
there are healthier alternatives for tampons other than the
standard drug store tampons. I would have liked to know
about menstrual cups from a younger age(Participant 96).
In addition, many participants expressed a desire for more
agency in choosing products to manage their menstruation. For
example, If anything, I wish my mother was more open to other
options like tampons, menstrual cups, THINX, etc. I wish I had
the option of choosing which way would be best and most
efficient for myself(Participant 185). A number of participants
described simply being, given a pad and used it(Participant 43),
often deferring to the products their parent used or products their
parent or school provided them. One participant noted that I
actually didntevenhaveasayinmyowndamnproductselection
until I was about 16 or 17…” (Participant 24). These responses
demonstrated a desire for education of all available menstrual
hygiene products, how to use them, and in many cases, the health
benefits and implications of using alternatives to tampons and
pads. Thus, both tangible and informational support about
hygiene products was enacted, but participants often point to an
absence concerning alternative options to pads and tampons that
may alleviate additional health concerns.
Medical versus practical
Participants also identified a tension between experiencing or
desiring medical or practical approaches to conversations about
menstruation. Some participants desired more medicalized, clin-
ical, or technical conversations about menstruation that provide
them with specific, and technical informational or instrumental
support. Other participants desired more practical conversations
about what to actually do when they have their period. Some of
these tensions occurred in the same response. One participant
notes, I wish I had been taught more about what was *actually*
happening to my body in medically accurate terms and given
more information about ways to manage menstruation …”
(Participant 66). Additionally, a different participant states:
I talked to my sisters; asking them questions. I was asking them
why I get my period? Why do I bleed for a week? When will it
stop? Am I going to die? Whats the difference between tampons
and pads? (Participant 160)
These responses demonstrate both a desire to understand the
process of menstruation from a technical perspective, but also
a desire to have the information needed to function as
a menstruating body.
HEALTH COMMUNICATION 5
Others experienced a preference toward a more medical
approach or a more practical approach. Participants who desired
a more medical approach wanted an explanation of what was
actually happening in their body. For instance, one participant
identified wanting more communication about menstruation
from, A medical professional privately, who could answer all
my questions in an informed way(Participant 138). Another
participant expressed a desire for medical-based, anatomical
information from her pediatrician, stating:
I think it would have served me to understand how hormones
play into it and to expect changes to my body and my brain/
emotions. I also had never really thought about tracking my
periods until I went to my first non-pediatrician doctors apt and
was asked about my cycle. (Participant 73)
Lastly, participants described wanting less clinical informa-
tion, and more practical information about what to do when
they have their periods. A 20-year-old participant observes,
I just remember my first encounter with the topic was in 5th or
6th grade, I cant remember, when we had to watch the video on
our bodies and had to get a permission slip signed to watch it.
I didnt get my period until I was 13 and didnt get a talk about it
just got told what to do with a pad. (Participant 162)
As this participant describes, some young women received
more technical information as instrumental or informational
support about menstruation, but recall insufficient practical
informational support on how to manage the experience of
menstruation in ways they would find meaningful. Thus,
young women experience a desire to know what is happening
in their bodies, but also what to practically do about it (e.g.,
how to use pads or tampons, how to manage period pain, etc.).
Although most participants expressed specific desired or
enacted informational and instrumental support surrounding
menstruation, some participants expressed more ambiguous
desires for more information, or listed many types of infor-
mation they wish they had received. In addition, a few
participants expressed that there was nothing else they wish
would have characterized their early communication about
menstruation.
Emotional support
Dread or excitement
While participants identified individual feelings of dread and
excitement regarding early menstruation communication,
some participants expressed that early communication about
menstruation was marked by both or a tension between the
two. Sometimes, participants personally experienced multiple
emotional reactions, and in other cases, participants identified
that their communication experience varied as negative or
positive based on emotional support provided by the person
with whom they were speaking about menstruation. For
example, this participant wrote, I was given The Care and
Keeping of YouAmerican Girl book when I was 7 and was
excited for my period. However, I was extremely embarrassed
when I got it …” (Participant 31). Another participant wrote:
I remember getting a goody bag with deodorant and feeling
pretty excited about that! I also remember my mom told me that
nobody had ever told her mother (my grandmother) about getting
your period and when she got hers, she thought she was dying.
(Participant 78)
Aspects of menstruation communication may elicit feelings of
excitement while others are marked by communication that
emphasizes negative feelings. Fear of dying or believing men-
struation meant they were dying also emerged as a frequent
description. Participants described negatively valenced emo-
tions about menstruation (e.g., dread, fear, embarrassment,
shame, guilt) as characteristic of their early communication
experiences surrounding menstruation. For example, this par-
ticipant wrote, I remember not knowing about it until I got my
first period in 5th grade. My mom cried as soon as I told her
what happened to me and I instantly felt guilty(Participant
172). This participant identifies feelings of guilt emerging not
from the onset of menarche itself, but her mothers reaction
and her feeling unprepared. Thus, lack of support or more
intense nonverbal reactions to menstruation can elicit nega-
tively valenced emotional experiences. For example:
My first period started early morning at school. I didnt have any
pads or tampons with me, and I was too ashamed to ask anyone.
All my friends (seemingly) got their periods before me and
I didnt want to admit I had just started so I didnt ask for any
hygiene products When I went home I told my mom. I was
embarrassed, but I figured she had to know as she would find out
anyways. (Participant 44)
For another example:
My mom made my sister explain it to me after she accidentally
left a used pad in plain sight. My mom said that it was my sisters
fault, so she had to do the deed. It made me scared, thinking that
it must be something really bad and gross if my mom was too
embarrassed to talk to me about it. (Participant 118)
As these responses exemplify, feelings of shame and embar-
rassment sometimes manifest in inaction or self-silencing and
may result from a lack of supportive communication, which
we will explore in more detail next.
Silence(ing)
Early communication about menstruation that women recall
also involved messages about self- or other-silencing, where
participants describe feeling they have to either silence or
quiet themselves (self-silencing), or someone else explicitly
directed them to keep their period quiet or hidden. For
example, one participant wrote:
I told my Mom when I first started and she gave me a talk about
how to insert tampons, how I might prefer pads then told me to
bury them far down in the garbage so as not to bother my Dad
and Brother. (I ignored this almost immediately). (Participant 26)
Other participants described learning to silence themselves as
a result of socializing experiences that teach them to mini-
mize, hide, or quiet their experience of menstruation. For
example, this participant wrote:
I remember feeling [disgust], and I also remember watching as
the one girl who had said she was menstruating, was made fun of
heartily, in a way that she carried a stigma of being grosswith
my classmates for at least 2 years after this event. In this way,
I learned that menstruation was normal, but dirty and a possible
catalyst for becoming a social outcast if you discussed menstrua-
tion openly. (Participant 95)
6V. RUBINSKY ET AL.
Another participant recalled being socialized into silence from
a young age, sharing:
I started my period at school and had to go to the nursesoffice.
The nursesoffice had a co-ed bathroom and I went in to put in
the pad and a boy leaving the restroom could tell what I was doing
from the slit in the stalls. That was the beginning of feeling the
need to hide my period and my discomfort with it. Two years
later, I was still uncomfortable talking about it and I started my
period in class. I asked the (female) teacher to be excused for the
bathroom and she wouldnt let me. I ended up bleeding through
my pants and onto the chair, but I was so uncomfortable with this
natural thing my body was doing that I didnt tell anyone. I just
wore a sweater around my waist. (Participant 25)
Some participants noted that silencing behaviors did not dissi-
pate into adulthood. For example, one participant reflects, Even
at 21 years old, when at work my managers who were even older
than me still whispered when asking for a tampon like you
shouldnt let it out that you are on it(Participant 40).
Silencing of the self and others silencing young women
then occurs in early adolescent communication about men-
struation, but appears to also carry into adulthood. An
absence of supportive communication that would contextua-
lize or problematize these messages from peers and authority
figures characterized early communication about menstrua-
tion for some of our participants.
Boundary management
Participants also identified a need or concern to control who had
access to information about their own menstruation, or to manage
the boundaries around this information (Petronio, 2002). Often,
participants described being most concerned with their female
caregiver knowing they had started menstruating, and not want-
ing them to inform male relatives (e.g., their father). For example,
I do remember being mad and upset when I found out that
others in my family knew (aunts, grandparents, dad). I didntwant
anyone else to find out, and I especially wanted to make sure my
dad didnt know(Participant 149). For another example, Iwas
crying and told mom not to tell dad, she immediately did
(Participant 155). Another participant recalls:
I started my period at my dads house. When I asked to use my
sisters phone to call my mom she said no unless I told her why
and told me to ask my dad. My dad also wouldnt let me call my
mom unless I told him why. I remember being so frustrated and
embarrassed because I didnt want to tell anyone about it. I cried
a bunch and just put some toilet paper in my panties until my dad
finally let me call my mom. (Participant 174)
Thus, young women may desire control over information sur-
rounding their menstruation experience specifically in light of
their mothers sharing their information with their father or
other family members. Participants appear to interpret viola-
tions of these privacy requests as emotionally unsupportive.
Normalizing messages
Participants also expressed an overwhelming desire for messages
that normalize menstruation, or that depict menstruation as
a common and acceptable experience.Thisincludesvalidation
of the experience of menstruation, offering an open dialogue, and
recognition of periods as a common experience for women. One
participant expressed a desire for messages, that it was a normal
thing and nothing to worry about(Participant 191). Another
participant expressed that they, wish it had been normalized. It
was made to feel so secret and shameful…” (Participant 108). The
narrative of shame and blame carried into this theme. For
instance, this participant said, IwishIwastaughtthatitsnormal
and I wasnt treated like I made my period happen to myself
(Participant 172). These examples demonstrate that women desire
normalizing messages that treat menstruation as common and
manageable, but validate the sometimes negative experiences are
associated with menstruation.
In addition, a desire for empowerment and acceptance was
threaded through these absent supportive messages. Participants
highlighted that directly countering shameful societal messages
about menstruation would have provided a more supportive line
of communication and left them with feelings of empowerment
rather than embarrassment. One participant observes:
Theres nothing to be ashamed of! We shouldnt have to
hide our pads or tampons in
our jacket or purse, we should be able to walk to the bathroom
with it in our open hand and just be fearless. (Participant 20)
Another participant said that they are, a grown adult and
I still stress sometimes about if my period is abnormal or not
(Participant 6). Normalizing messages and the removal of
stigma allows for open communication, through education,
and the feeling that one is not alone in their experience.
In addition, participants desired normalizing messages that
highlight what may be considered abnormal compared to normal
in terms of menstruation, indicating a desire for both instrumen-
tal and emotional support in the process. One participant
expressed that they wished, that it hadntbeensuchataboo
topic at school and among boys. It was already hard being 11
and in middle school. But now I had to juggle getting a period and
learning what that means(Participant 22). Similarly, participants
expressed a desire for more informative communication sur-
rounding menstruation, including medical explanations and prac-
tical application like how to manage their menstruation and
menstrual pain. This included a desire for an open dialogue
surrounding menstruation, with one participant expressing that
they, would like to have been encouraged to ask more questions
about even minute aspects of menstruation(Participant 95).
Participants also expressed a desire for normalizing, reassuring
messages. One participant said they, wish someone told me it was
OK to get my period so early in life, it doesnt affect anyone outside
of myself and I can handle it(Participant 64). Reassuring, emo-
tionally supportive messages participants desired might have miti-
gated fear and uncertainty from the experience of menstruation,
exemplified by a participant who said they, wish someone would
have told me that if I start bleeding not to worry and get a pad
I was so scared(80). Similarly, this participant said, That if its
not regular its okay too. Or that the symptoms you experience
with it can change over time(Participant 191). Open and normal-
izing messages reassure young people who menstruate that what is
happening in their body is common, or establish what is common
and acceptable so that they can be aware when something that is
uncommon might require attention. This shared experience fos-
ters a bond and commonality that removes questioning and fear
from menstruation. It also allows for menstruating individuals to
HEALTH COMMUNICATION 7
identify characteristics of their menstruation that may not be
normal(e.g., extreme or excessive pain).
Becoming a woman
Emerging in the form of tension among participant responses,
some participants described feeling drawn to the idea of matura-
tion through menstruation (e.g., they wanted to have their
period to feel more grown up or fit into the pace of maturation
they believed friends were experiencing). Alternatively, some
participants identified feeling either uncomfortable with the
rhetoric of menstruation as maturation, or accepted the idea
and did not want to grow up.Thus, participants often appre-
ciated emotionally supportive communication that enabled
them to frame the experience of menarche as an aspect of
development into a more mature identity, viewing it with excite-
ment rather than fear. However, others problematized this
explanation for menstruation, either identifying that it caused
an additional anxiety, or rejecting it altogether as a way to frame
the experience. For example, Ifeltlikemybodywasbetraying
me because I wanted to stay innocent(Participant 19). Another
participant recalls a similar introduction and subsequent confu-
sion as to what becoming a woman meant, sharing:
I started it in school and the nurse had me change pants and put
on a pad. My mom and sister were surprisingly happy/emotional
about it, which I didnt understand at the time. They told me
I was becoming a woman, which I had no clue what meant for
me. (Participant 177)
Another participant notes moral and gendered expectations
laced in to their becoming a woman,stating:
I remember being told I was going to begin becoming a woman and
I had to remain responsible for myself and with others. And to use
pads because tampons were just like having sex and losing my virginity
was supposed to be saved for my wedding day. (Participant 182)
Other participants rejected the idea that menstruation meant
becoming a woman. For example:
I remember talking to my aunt about it before I had gotten my
period and she said that means youre becoming a woman and at
the time I didnt really agree with that. I told her growing up and
becoming a woman is about responsibility not about your men-
struation. (Participant 18)
This participant thus identified a disagreement with the idea
that menarche means one is becoming a woman.
Some participants described experiencing excitement at the
prospect of growing up associated with menstruation. For
example, It seemed very strange to me but the idea of getting
older and becoming more mature was very exciting
(Participant 47). This tension may be especially meaningful as
it highlights the identity-laden nature of early communication
around menstruation and one vehicle through which impor-
tant others can provide emotional support that may result in
more positive reframing of menstrual experiences.
Discussion
As the participant in our opening excerpt exemplifies, menstrua-
tion is a salient and sometimes scary subject young people
encounter.Womeninthisstudyoftenvividlyrecalltheirfirst
menstruation experience and the nature of their early commu-
nication about menstruation. Many, like the young woman who
first encountered menstruation in a toilet bowl full of blood
(Participant 76), feared they were dying or believed they were
seriously ill as a result of missing or misinformation about men-
struation. Findings from the present study suggest that while
many young people dread the experience of menstruation, some
alternatively view the prospect of menarche with excitement. This
tension was sometimes reflected in contradictory reactions to the
enacted emotional supportive communication that frames
menarche as an aspect of becoming a woman. In addition, we
found themes that reflect the enacted and desired instrumental,
informational, and emotional support of boundary management,
impersonal, silence, accidents, normalizing conversations, valida-
tion and management of period pain, and the existence of hygiene
products beyond pads and tampons, and medical versus practical
approaches to menstruation. We discuss these findings in light of
research on menstruation communication and support and make
recommendations for future research.
Received and desired support in period talk
In a cultural moment that may indicate shifting attitudes
toward menstruation, increased attention to personal and
health experiences associated with menstruation (Chen et al.,
2018), and the potential for more open dialogue on the subject,
especially between mothers and daughters (Lee, 2008), stigma
and taboos (Jackson & Falmagne, 2013) still pose significant
challenges to constructive, supportive communication about
menstruation and menarche for young adults. The present
study argues that based on our findings, a distinct, significant
difference occurs between the health and practical information
and needs to which young people who menstruate desire
access, and their emotional and social needs. Specifically, the
participants in the present studys plethora of absent or desired
communication about menstruation indicate that they are not
being adequately supported in either capacity. From our find-
ings, it may be possible that one reason women are not being
supported in these ways is because that support is sometimes
delegated from medical professionals and parents to mass
media or institutions (e.g., television, books, schools). Thus,
young people who menstruate often encountered the subject
cloaked in stigma, mystery, and fear. To address these findings,
we discuss the implications and contributions of the present
study in terms of emotional support that participants received
and desired and instrumental and informational support par-
ticipants received and desired.
Emotional support
Menstruation experiences and associated emotionally supportive
or unsupportive communication from important socializing fig-
ures constitute a form of gendered socialization for people who
menstruate (Kissling, 1996b; Malefty & McCabe, 2016).
Specifically, the present study investigated how early menstruation
communication served this purpose. Consistent with previous
research (Burrows & Johnson, 2005; Johnston-Robledo &
Chrisler, 2013), our participants report others approaching the
subject of menstruation in ways that reinforce stigma and shame
surrounding the process. Several participants in the present study
8V. RUBINSKY ET AL.
reported communication that elicited guilt for a process that
happened naturally in their bodies, and desired messages that
normalize a common bodily process as emotionally supportive
communication in place of the shaming messages they often
received. Taken together, participantsrecollections suggest that
young women are socialized to feel that menstruation will change
them in some meaningful way, be scary and hurt, and that they
should be quiet about that pain and the experience of
menstruation.
Specifically, young women report silencing communication
and messages that encourage them to hide their menstruating
bodies. Self-silencing narratives are recurrent in our findings.
These narratives, consistent with previous research, simulta-
neously teach young women to understand their menstruation
as a natural and normal female experience, while also socializing
them to keep it a secret (Jackson & Falmagne, 2013). Social
support buffers against the harmful effects of stress through
enabling a shift in perspective, or reappraisal, of the stressful
event (MacGeorge et al., 2011). As previous research (Lee, 2008)
and the women in the present study indicate, both the prospect
and onset of menarche results in feelings of stress and anxiety for
young women. One vehicle through which important socializing
agents can offer support around menstruation is through reap-
praisal (MacGeorge et al., 2011). This was evidenced in
responses that desire normalizing messages. Normalizing mes-
sages may indicate that an absence of being explicitly told by
aparentthatwhattheywereexperiencingwasacommonand
normal experience left them unable to reframe a stressful experi-
ence as a positive or at least accepted aspect of their socialization.
Some participants report attempts at emotional supportive com-
munication that try to reframe menarche and menstruation are
viewed as core landmarks of the female experience. Some parti-
cipants reported positive reactions to supportive communication
that aimed to reframe menarche as an aspect of growing up
rather than an ambiguously scary experience, indicating that it
left them with feelings of excitement rather than dread at the
prospect of beginning to menstruate. Other participants either
rejected this narrative altogether, or problematized it.
Specifically, participants in our study were still socialized to
suppress and hide this bodily function, thus associating being
awomanwith silence. Through hiding menstruation, women
may be encouraged to embrace a more docile, non-menstruating
body, which perpetuates a larger societal discourse teaching
women to be quiet and small (Kissling, 2013). These discourses
further distance people who menstruate from the inner workings
of their bodies and the role that menstruation plays in their
overall health, creating a rhetoric of choice regarding menstrua-
tion and femininity (Woods, 2013).
In addition, emerging evidence suggests that an indivi-
duals personal standards for support may indicate the effect
of enacted or received support on health and well-being
(Joseph, Afifi, & Denes, 2016). Specifically, discrepancy
between desired and received emotional support, or the emo-
tional support discrepancy, may lead to whether or not an
individual successfully reappraises the stressor (Joseph et al.,
2016). Although some participants in the present study felt
their instrumental and emotional support needs were met,
most participants indicated severe discrepancies that left
them unable to reappraise pain or fear and provided
insufficient emotional resources for navigating the experience.
In addition, the present study emphasizes a desire for both
emotional and informational support regarding period pain.
Instrumental and informational support
Participants in the present study often reported receiving
hurried, directive instrumental or informational supportive
communication as a result of the unexpected onset of
menarche in which parents or school nurses provided
them with a hygiene product or briefly told them what
a period was. However, fewer participants reported com-
prehensive information about menstruation prior to the
start of menarche. Many participants indicated that an in-
depth explanation of what was happening to their body and
how they could manage the experience of menstruation
through a more expansive list of hygiene products beyond
pads and tampons, exposure to information about pain
management, and an in-depth explanation about the phy-
siological process of menstruation would be more effective
(i.e., why it occurs, what is happening). Early scholarship
on menstruation suggested that young people who men-
struate see a distinction between menstrual education that
is scientific and education that is pragmatic (Kissling,
1996a). Findings from the present study support a similar
distinction, as well as messages that normalize the experi-
ence of menstruation and pair instrumental and informa-
tional support with emotional support.
Pairing emotional and instrumental support
Findings from the present study also suggest that young adults
might be receptive to conversations that manage both support
needs. Reconciling the necessity to attend to these needs while
delivering information that is both pragmatic and scientifically
informative may have practical value for parents, educators, and
healthcare providers. Our findings suggest that interpersonal
discussions about menstruation between young people who
menstruate and important others may be best approached in
such a way that validates their emotional experience within
which the discussion occurs, to which future research should
attend. A contribution from the present study that may help
guide this trajectory concerns the finding that people who men-
struate desire both normalizing, emotionally supportive com-
munication and validation, and abnormalizing, instrumentally
and informationally supportive communication about men-
struation. Given young peoples discomfort with the subject,
parents, educators, and healthcare providers may be in a better
position to initiate this supportive communication about men-
struation (Ackard & Nuemark-Sztainer, 2001;Lee,2008).
Findings from the present study also suggest that people who
menstruate desire both normalizing and abnormalizing messages
about menstruation during childhood and adolescence. Notably,
participants desired normalizing, emotionally supportive mes-
sages that validate common menstruation experiences and enable
them to understand common occurrences related to menstrua-
tion. Alternatively, participants also desired abnormalizing mes-
sages that highlight when period pain is not normaland
warrants medical attention. These themes are important because
as previous literature suggests, the absence of meaningful conver-
sations resonates over time, especially in sexual and reproductive
HEALTH COMMUNICATION 9
health contexts (Holman & Koenig Kellas, 2018;Rubinsky&
Cooke-Jackson, 2017). Absent messages highlight communication
that needs to but does not occur in familial, education, and
healthcare contexts. Future researchshouldcontinuetoattend
to the absence of important sexual and reproductive health sup-
portive communication, as well as what scholars, healthcare pro-
viders, educators, and parents can do to fill the void.
Limitations and future directions
While the present study makes an important contribution to the
growing literature on menstruation communication, there are
several limitations that warrant mention. First, as with any survey
methodology, we were unable to ask our participants follow-up
questions where warranted. The survey methodology enabled us
to obtain a larger sample to assess patterns across a large number
of people who menstruate; however, future research can further
this line of inquiry by engaging focus groups or in-depth inter-
views to study communication about menstruation and follow-up
by adding more depth to the broader themes we attained in the
present study. In addition, survey methodologies tend to attract
more educated and less racially diverse demographics. Future
research may benefit by specifically seeking out marginalized
groups and focusing specifically on their experiences with men-
struation communication. Further, our participant age range
expands from 18 to 37. There are certainly differences both in
the temporal proximity to early menstruation experiences and the
societal circumstances occurring at the time of their own experi-
ences with menarche that participants who are 18 and 37 years old
would have encountered. Although we believe these perspectives
are all worthwhile, future research may attend to issues of suppor-
tive and unsupportive menstruation communication for more
specific age cohorts.
Conclusion
Menarche and early menstruation experiences constitute
pivotal moments in the gendered socialization of young peo-
ple who menstruate. Communication with parents, educators,
and peers at this time crystallize into memorable moments
that may influence later attitudes and behaviors regarding
sexual and reproductive health. Tensions and inadequate sup-
port characterize early communication about menstruation in
competing and relationally- and identity-challenging ways.
The present study finds that women are communicatively
socialized to hide their menstrual experiences, view it as
a marker of adulthood, and feel they lacked both practical
and scientific information on the process that left them with
gaps in their pragmatic menstrual management as well as
their own knowledge of their reproductive and sexual health.
References
Ackard, D. M., & Nuemark-Sztainer, D. (2001). Health care information
sources for adolescents: Age and gender differences on use, concerns,
and needs. Journal of Adolescent Health,29, 170176. doi:10.1016/
S1054-139X(01)00253-1
Andrist, L. C., Hoyt, A., Weinstein, D., & McGibbon, C. (2004). The
need to bleed: Womens attitudes and beliefs about menstrual
suppression. Journal of the American Academy of Nurse
Practitioners,16,3238. doi:10.1111/j.1745-7599.2004.tb00369.x
Burrows, A., & Johnson, S. (2005). Girlsexperiences of menarche and
menstruation. Journal of Reproductive and Infant Psychology,23,
235249. doi:10.1080/02646830500165846
Bush, D., Brick, E., East, M. C., & Johnson, N. (2017). Endometriosis
education in schools: A New Zealand model examining the impact of
an education program in schools on early recognition of symptoms
suggesting endometriosis. Australian and New Zealand Journal of
Obstetrics and Gynaecology,57, 452457. doi:10.1111/ajo.12614
Chen, C. X., Shieh, C., Draucker, C. B., & Carpenter, J. S. (2018). Reasons
women do not seek health care for dysmenorrhea. Journal of Clinical
Nursing,27, e301e308. doi:10.1111/jocn.13946
Chrisler, J. C., Gorman, J. A., & Streckfuss, L. (2014). Self-silencing,
perfectionism, dualistic discourse, loss of control, and the experience
of premenstrual syndrome. Womens Reproductive Health,1, 138152.
doi:10.1080/23293691.2014.966597
Costos, D., Ackerman, R., & Paradis, L. (2002). Recollections of
menarche: Communication between mothers and daughters regarding
menstruation. Sex Roles,46,4959. doi:10.1023/A:1016037618567
Field-Springer, K., Randall-Griffiths, D., & Reece, C. (2018). From
menarche to menopause: Understanding multigenerational reproduc-
tive health milestones. Health Communication,33,733742.
doi:10.1080/10410236.2017.1306910
Fingerson, L. (2005). Agency and the body in adolescent menstrual talk.
Childhood (Copenhagen, Denmark),12,91110. doi:10.1177/
0907568205049894
Goldsmith, D. J. (2004). Communicating social support. New York, NY:
Cambridge University Press.
Hadfield, R., Mardon, H., Barlow, D., & Kennedy, S. (1996). Delay in the
diagnosis of endometriosis: A survey of women from the USA and the
UK. Human Reproduction,11, 878880. doi:10.1093/oxfordjournals.
humrep.a019270
Holman, A., & Koenig Kellas, J. (2018). Say something instead of noth-
ing: Adolescentsperceptions of memorable conversations about sex-
related topics with their parents. Communication Monographs.
Advance online publication. doi:10.1080/03637751.2018.1426870
Houston, A. M., Abraham, A., Huang, Z., & DAngelo, L. J. (2006).
Knowledge, attitudes, and consequences of menstrual health in
urban adolescent females. Journal of Pediatric and Adolescent
Gynecology,19, 271275. doi:10.1016/j.jpag.2006.05.002
Jackson, T. E., & Falmagne, R. J. (2013). Women wearing white:
Discourses of menstruation and the experience of menarche.
Feminism & Psychology,23, 379398. doi:10.1177/0959353512473812
Johnston-Robledo, I., & Chrisler, J. C. (2013). The menstrual mark:
Menstruation as social stigma. Sex Roles,68,918. doi:10.1007/
s11199-011-0052-z
Jones, S. M., & Burleson, B. R. (2003). Effects of helper and recipient sex
on the experience and outcomes of comforting messages: An experi-
mental investigation. Sex Roles,48,119. doi:10.1023/
A:1022393827581
Joseph, A., Afifi, T. D., & Denes, A. (2016). (Unmet) Standards for emotional
support and their short- and medium-term consequences. Communication
Monograms,83, 163193. doi:10.1080/03637751.2015.1068432
Kissling, E. A. (1996a). Bleeding out loud: Communication about
menstruation. Feminism & Psychology,6, 481504. doi:10.1177/
0959353596064002
Kissling, E. A. (1996b). Thats just a basic teenage-rule: Girlslinguistic
strategies for managing the menstrual communication taboo. Journal
of Applied Communication Research,24, 292309. doi:10.1080/
00909889609365458
Kissling, E. A. (2013). Pills, periods, and postfeminism. Feminist Media
Studies,13, 490504. doi:10.1080/14680777.2012.712373
Lee, J. (2008). A kotex and a smile:Mothers and daughters at menarche.
Journal of Family Issues,29,13251347. doi:10.1177/0192513X08316117
MacGeorge, E. L., Feng, B., & Burleson, B. R. (2011). Supportive com-
munication. In M. Knapp & J. Daly (Eds.), Handbook of interpersonal
communication (pp. 317354). Los Angeles, CA: Sage.
Malefyt,T.D.W.,&McCabe,M.(2016). Womens bodies, menstruation and
marketing protection:Interpreting a paradox of gendered discourses in
10 V. RUBINSKY ET AL.
consumer practices and advertising campaigns. Consumption Markets &
Culture,19, 555575. doi:10.1080/10253866.2015.1095741
Marván, M. L., & Molina-Abolnik, M. (2012). Mexican adolescents
experience of menarche and attitudes toward menstruation: Role of
communication between mothers and daughters. Journal of Pediatric
and Adolescent Gynecology,25, 358363. doi:10.1016/j.jpag.2012.05.003
Mathew, R. R. (2018). The crimson journey from taboo to etiquette.
Language In India,18, 398406. Retrieved from http://www.languagei
nindia.com/march2018/rosemariacrimsonjourney1.pdf
Owen,W.(1984). Interpretive themes in relational communication. Quarterly
Journal of Speech,70, 274287. doi:10.1080/00335638409383697
Petronio, S. (2002). Boundaries of privacy: Dialectics of disclosure. Albany,
NY: State University of New York Press.
Rembeck, G. I., Moller, M., & Gunnarsson, R. K. (2007). Attitudes and
feelings toward menstruation and womanhood in girls at menarche.
Acta Paediatrica, Nurturing the Child,95, 707714. doi:10.1111/
j.1651-2227.2006.tb02319.x
Rubinsky, V., & Cooke-Jackson, A. (2017). Tell me something other
than to use a condom and sex is scary: Memorable messages women
and gender minorities wish for and recall about sexual health.
Womens Studies in Communication,40, 379400. doi:10.1080/
07491409.2017.1368761
Rubinsky, V., Cooke-Jackson, A., Gunning, J., & Bartson, C. (2018). You can
use the app instead of guessing:Womens use of period-tracking mobile
applications for menstrual management. International Journal of Health &
Media Research,2, 101117. Retrieved from http://ijhmr.hallym.ac.kr/
Saldaña, J. (2014). Coding and analysis strategies. In P. Leavy (Ed.), The
Oxford handbook of qualitative research (pp. 581605). New York,
NY: Oxford University Press.
Schooler, D., Ward, M. L., Merriwether, A., & Caruthers, A. S. (2005).
Cycles of shame: Menstrual shame, body shame, and sexual
decision-making. Journal of Sex Research,42, 324334. doi:10.1080/
00224490509552288
Seear, K. (2009). The etiquette of endometriosis: Stigmatisation, men-
strual concealment and the diagnostic delay. Social Science &
Medicine,69, 12201227. doi:10.5172/hesr.18.2.194
Uchino, B. N. (2009). Understanding the links between social support
and physical health: A life-span perspective with emphasis on the
separability of perceived and received support. Perspectives on
Psychological Science,4, 236255. doi:10.1111/j.1745-
6924.2009.01122.x
Woods, C. S. (2013). Repunctuated feminism: Marketing menstrual
suppression through the rhetoric of choice. Womens Studies in
Communication,36, 267287. doi:10.1080/07491409.2013.829791
HEALTH COMMUNICATION 11
... Schmitt et al. (2022) found that girls in general lack knowledge on how to deal with menstruation in schools or the impact menstruation has on them when engaging in sports. The lack of menstruation knowledge is established in menstruation research, often exploring the messages older menstruators remembered from their experiences, such as beliefs about tampon use and parents expecting schools to provide the education (Aragón & Cooke-Jackson, 2021;Rubinsky et al., 2020). Many families attempt to communicate about menstruation (Aragón & Cooke-Jackson, 2021;Cooper & Koch, 2007;Costos et al., 2002;McKeever, 1984;Rubinsky et al., 2020); however, not all families do so effectively (White, 2013). ...
... The lack of menstruation knowledge is established in menstruation research, often exploring the messages older menstruators remembered from their experiences, such as beliefs about tampon use and parents expecting schools to provide the education (Aragón & Cooke-Jackson, 2021;Rubinsky et al., 2020). Many families attempt to communicate about menstruation (Aragón & Cooke-Jackson, 2021;Cooper & Koch, 2007;Costos et al., 2002;McKeever, 1984;Rubinsky et al., 2020); however, not all families do so effectively (White, 2013). This is despite the large body of research that supports parents and children discussing sex and sexuality-related questions (Coffelt, 2021;Manning, 2021). ...
... In addition, silence impedes instrumental and emotional support . In a study of 165 girls between the ages of 18 and 37, Rubinsky et al. (2020) determined that participants want healthy and practical menstruation information; however, they do not receive this from family members, school, or health professionals . Silence is thus experienced as a memorable message of menstruation (Aragón & Cooke-Jackson, 2021). ...
Article
Full-text available
To better understand adolescent experiences of menstruation, the CODE Red project was initiated to examine period poverty and menstruation stigma. As part of the project, a survey was posted online through Qualtrics, and the link was posted to social media sites. One hundred and eighty-seven individuals completed the open-ended questionnaire between January and August 2022. The individuals are based in the United States, with most coming from northeastern Indiana. Using an iterative analysis, the data were analyzed using the theory of memorable messages. Three themes emerged supporting memorable messages: the negative cycle of self, talk silence breeds silence, and my mom wasn’t there. The study concludes that grin n’ bear it and silence are the predominant types of memorable messages first-time menstruators’ experience. Moreover, first-time menstruators experience self-silencing and other-silencing. Implications include that silence negatively impacts the mother-daughter relationship and that attention should be paid to the importance of communication before menarche.
... 7,8 A large body of recent research worldwide reveals the inadequate practical knowledge and needs of girls who menstruate sought access in preparation for menarche. 5,9,10 In Malawi, there remains limited evidence regarding the preparation of adolescent girls for menstruation before menarche for much attention is given to menstruating girls and menstrual hygiene management. 11 Much of the existing information on prior education in Malawi regarding girls' menstrual experiences is derived from anecdotal evidence and grey literature, which primarily focuses on the challenges experienced by menstruating women and girls. ...
... 17 However, previous studies have shown that girls whose mothers prepared them for menstruation before menarche had more positive attitudes towards this period. 5,10 This signifies that communication between the mother and daughter before and during menarche develops familial discourse patterns that affect how menstruation and other elements of reproductive health are discussed in cultural and gendered contexts. [43][44][45] Mother-daughter communication before, during and after menarche is crucial to a girl's positive attitude towards reproductive health milestones, since the majority of girls believe they could discuss menstruation with their mothers. ...
... [43][44][45] Mother-daughter communication before, during and after menarche is crucial to a girl's positive attitude towards reproductive health milestones, since the majority of girls believe they could discuss menstruation with their mothers. 5,[46][47][48] From this perspective, mothers continue to be the most influential source from which young women seek assistance when making significant health choices. ...
Article
Full-text available
Background While studies have explored various aspects of menstruation, an evident gap remains in the literature concerning the perspectives of young women and female health workers. By shedding light on this unexplored terrain, the study provides novel insights that can inform targeted interventions and foster a more inclusive understanding of menstrual health. As such, this investigation stands at the forefront of academic endeavour in menstrual health research, making an original and valuable impact in the field. Objectives The objective of this study was to explore the experiences of reproductive-aged women during menstruation in Malawi. The specific objectives were to examine the experiences of reproductive-age women related to menstrual preparation, identify factors influencing the choice of menstrual products for women in Malawi, and identify the public health implications of menstrual products. Design This cross-sectional study employed qualitative research methods to explore the acceptance and implementation of menstrual cups as a feminine hygienic product for women in Malawi. Methods The study involved focus group discussions and interviews with reproductive-age women aged 18–54 years and health providers at Bwaila and Mitundu family clinics and Lighthouse HIV management centres. Thematic content analysis was performed using NVivo 12. Ethical approval was obtained from the College of Medicine Research and Ethics Committee (P.08/21/3379). Results Education on menstruation is provided as early as 10 years before menarche by sisters, friends, mothers, aunties and grandmothers. Parents remain silent on menstrual issues. Commonly used menstrual products include disposable pads, cloths, reusable pads and cotton wool. While a few mentioned using tampons, pieces of blankets and flex foam, the majority demonstrated widespread ignorance about menstrual cups. Mentors or counsellors, affordability, accessibility, comfort and disposal issues influence women’s choice of products being used. Conclusion Parents need to break the silence on menstrual issues. Messages on menstruation and menstrual products are explicit in forming female adolescents what to expect with menarche, how to manage menses including health-related impacts, and ways of mitigating menses-related misconceptions, discrimination and stigma, and could be incorporated into the primary school curriculum. Safe menstrual products are accessible free of charge or at a subsidised cost.
... Whereas this call to action focuses on education, many participants indicated they first began discussing menstruation in school. The systemic and deeply engrained taboos towards menstruation, seen around the world, can be broken only by cultivating a framework of supportive communication from an early age (Gottlieb, 2020;Rubinsky et al., 2020). Organizational and governmental policy change can promote instrumental and informational support leading to the desocialization of menstrual-related shame and embarrassment. ...
Article
Full-text available
The practice of feminine hygiene for adolescents needs to be considered. Mistakes in practicing feminine hygiene are caused by a lack of knowledge and understanding. Teenagers who come into contact with social media often get inaccurate information. This study aims to determine the influence of media literacy and its impact on feminine hygiene awareness among adolescent girls. The research method used is quantitative by approaching cross sectional studies. The research was conducted in junior and senior high schools in the city of Mamuju in September-November 2023. The population is all young women in Mamuju City with junior high and junior high school education levels. The sample taken was randomly 50 students from 25 people at the junior high school level and 25 people at the high school level. The results obtained show that social media literacy has a positive effect on the awareness of young women in practicing feminine hygiene. ABSTRAK Praktek feminine hygiene bagi remaja perlu diperhatikan. Kesalahan dalam melakukan praktek feminine hygiene disebabkan oleh pengetahuan dan pemahanan yang kurang. Remaja yang banyak bersinggungan dengan media sosial sering kali mendapatkan informasi yang tidak akurat. Penelitian ini bertujuan untuk mengetahui pengaruh literasi media dan dampaknya terhadap kesadaran feminine hygiene di kalangan remaja putri. Metode penelitian yang digunakan adalah kuantitaf dengan mendekatan
Article
The study sought to explore barriers to menstrual education between maternal figures and young girls. Menstruation is a key part of the reproductive process and affects young adolescent girls. Menstrual blood is perceived as contaminating and impure, leading to the socialization of women and girls undergoing menstruation to feel soiled and impure. Menstruation is enveloped in feelings of disgust and shame, and societal expectations, dictating that women should conceal the appearance and odor of menstrual blood. Prevailing cultural narratives depict menstruation as a “hygienic crisis” necessitating management and concealment. In sub‐Saharan Africa, menstruation is afflicted with shame and stigma, with cultural and religious practices that support its concealment and secrecy. This is explained in the pollution theory which sees menstruation as dirt. This study used qualitative research to get the lived experiences of 10 maternal figures and 10 young adolescent girls through semi‐structured interviews. Maternal figures are the mothers/guardians of adolescent girls. The data was coded using similarities/differences in three themes (knowledge about menstruation, source of information, and quality of information shared). In the first theme, due to the concealment and treatment of menstruation with secrecy, knowledge about menstruation is not often provided. In the second theme, due to norms of concealment, maternal figures do shy away from being sources of information. In the last theme, stigma and shame limit the quality of information shared, leaving misinformation and further perpetuation of menstrual taboos. The study concluded that shame and stigma limit menstrual education and awareness. The information deficit has long‐lasting effects on young girls, creating a complex relationship that adversely affects their ability to embrace their womanhood and further pass on knowledge to future generations of adolescent girls.
Article
Introduction Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community. Methodology In partnership with No More Secrets (NMS), a Philadelphia menstrual health non‐profit, we conducted a community‐based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18–45 recruited from NMS' catchment in Philadelphia participated in semi‐structured interviews about their menstrual experiences and communication ( N = 20). A deductive, theory‐driven approached based on the social‐ecological model was used to analyze the data. Results Varying emotional responses arose across social‐ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma. Discussion Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community‐based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non‐binary individuals who menstruate.
Article
In modern society, people engage in social interactions and activities outside their own home. When in public settings people may need to eliminate bodily waste, so public toilets are required. Accessibility, availability and adaptability are essential principles for safe, private, and purposeful visits to public toilets. A diverse range of individuals use public toilets: various age profiles, all gender groups, vulnerable individuals and people with additional needs. Public toilets essentially need to be a place of privacy, safety and cleanliness to facilitate elimination of urine, evacuation of faeces, management of menstruation, and changing/disposing of continence wear products in a secure environment.
Article
Objective This paper examines the ways in which young people in Eastern Canada learn about menstruation and construct personal period pedagogies through embodied experiences and encounters with digital and social media. Design A qualitative exploratory approach was undertaken to elicit the stories and voices of young people who menstruate. Menstruation is conceptualised as a deeply bio-social phenomenon and knowledge was understood as created, contested and negotiated across settings and contexts. Methods Semi-structured interviews were conducted with nine university students (ages 19–23 years) in Eastern Canada as part of a pilot project informing a broader study about menstruation education and menstrual experiences. To be eligible for inclusion, participants were required to have experienced one menstrual cycle in the past 6 months and engaged with social media at least once per week. Setting This project was conducted in a small University town in Maritime Canada. Results Young people interviewed learned about menstruation through knowledges assembled from conversations family members and peers, educational and medical settings and content encountered on social and digital media. Three themes were developed from the analysis. The first two capture how young people actively try to ‘Fill in the Gaps’ left by conventional menstrual education approaches and therefore turn to informal and narrative knowledges circulating on social media in efforts to answer the question ‘Am I normal’. The third theme describes how participants actively ‘Balance Authority and Intimacy’ when seeking menstrual information that resonates with their embodied experiences. Conclusion Substantial gaps exist in the menstrual knowledges available to young people, particularly in relation to the embodied and emotional dimensions of having and managing a period. Digital and social media have the capacity to contribute to personal period pedagogies by acknowledging and exploring aspects of menstruation not adequately addressed in other contexts.
Article
Full-text available
This study investigated how 191 women use period-tracking mobile applications. Findings revealed that approximately half of our respondents use some form of period-tracking mobile application. Women who use period-tracking mobile applications report using them to track and predict their menstrual cycle, keep track of menstrual symptoms, and use the information for easier and more accurate communication with their healthcare provider. In addition, women report using period-tracking mobile applications to track fertility as a means of pregnancy prevention. Women who did not use period-tracking mobile applications frequently reported that they did not feel a need to use them because their hormonal birth control predicted and regulated their period for them, and thus there was no need for a mobile application to do it. Lastly, several participants identified not using period-tracking mobile applications because they did not trust them. Reinforcing and extending previous literature, the present study highlights a tension concerning self-monitoring and self-care (Lupton, 2014), usefulness (Moglia et al., 2016), and opportunity for autonomy. Key words: Mobile applications, period-tracking, menstruation, women’s health, menstrual management �
Article
Full-text available
This study examined adolescents’ (n = 389) perceptions of parent–adolescent communication about sex, including what their parents say about sex, what types of conversations adolescents report as memorable, the degree to which messages are perceived as effective, and how parental messages predict adolescents’ sexual attitudes and behaviors. Six conversation types emerged: underdeveloped, safety, comprehensive talk, warning/threat, wait, and no talk. When adolescents were asked to report how those could have been improved, five types emerged from the analysis of their responses: no change, be more specific/provide guidance, talk to me, appropriateness, and collaborate. Comprehensive talk and safety were perceived as significantly more effective than all other types of conversations. Safety conversations predicted the lowest levels of permissive sexual attitudes and risk-taking.
Article
Full-text available
This study explores how the memorable messages we receive and those we do not receive complicate the negotiation of sexual health and well-being among women and gender minorities. These powerful accounts reveal the tensions women and gender minorities experience managing what they were told about their sexual identity and sexual health by their parents and educators and those messages they wish they had received instead. Women and gender minorities recall memorable sexual health messages about abstinence, protection, and danger. Their recollections suggest that they want messages that center around positivity, pleasure, and dialogue, and that affirm diverse sexualities and genders. This work emphasizes that for parents and educators especially, what they do not say about sexual health may be just as impactful as what they do say.
Article
Full-text available
Aims and objectives: The purpose of this study was to identify and describe reasons women do not seek health care for dysmenorrhea symptoms. Background: Although dysmenorrhea is highly prevalent among women, can cause significant disruptions in their daily lives, and may increase their risk for future chronic pain conditions, few women seek health care for dysmenorrhea. A better understanding of why women do not seek health care is necessary to develop strategies that facilitate care seeking and optimal symptom management. Design: A Qualitative Descriptive design was used to guide the study and summarize text responses to an open-ended survey question. Methods: Participants in an online survey study who had not sought health care for dysmenorrhea (N=509) were asked to write about their reasons for not seeking care. Data were collected in January and February 2015. Participants' text responses were analyzed using qualitative content analysis. Results: Nine categories of reasons were identified: assuming symptoms are normal, preferring to self-manage symptoms, having limited resources, thinking providers would not offer help, being unaware of treatment options, considering symptoms to be tolerable, being wary of available treatments, feeling embarrassed or afraid to seek care, and not seeking health care generally. Conclusions: Findings can guide the development of strategies to promote care seeking and inform policy and clinical practice to improve dysmenorrhea management. Relevance to clinical practice: Findings underscore the need to provide routine screening for dysmenorrhea, avoid dismissing dysmenorrhea symptoms, initiate discussions and provide education about dysmenorrhea, provide treatments options based on evidence and women's preferences, and raise public awareness of dysmenorrhea and its impact. This article is protected by copyright. All rights reserved.
Article
Full-text available
ABSTRACT This essay explores the various associations, conflicts, and resolutions that converge in consumer research to produce an advertising campaign for a feminine hygiene product. Ethnographic research identified a correspondence in beliefs and values among women who discuss menstruation as a natural process of rhythms and flow in their changing bodies. Building off the work of gender discourses in advertising, this paper claims women’s “natural” discourse located in research differs from “protection” discourse in advertising, which holds a binary view of menstruation and associates menstruation socially with shame and secrecy. The research reveals that while women adopt a “natural” discourse of menstruation, discourses of “protection” still dominate marketing. Paradoxically, women incorporate both discourses in assemblages of constructing “feminine identities.” This research proposes a correspondence model that regards the consumption of consumer personal-care products in terms of embodiment rather than binary categories as a way to interpret such paradoxes.
Article
Full-text available
The purpose of this study is to explore the effects of emotional support discrepancy (ESD), or the degree to which people feel their standards for emotional support are met, immediately after a supportive interaction and in the days following the interaction. One hundred thirteen dating couples discussed in the laboratory a topic that was stressful for one of the partners and then completed daily diary logs for seven days. Immediately following the laboratory interaction, a smaller ESD was indirectly associated with more positive affect, less negative affect, and greater relationship satisfaction through cognitive reappraisal. In the days following the laboratory interaction, ESD was not associated with future conversations about either the laboratory stressor or stressors that emerged during the week, but was marginally and positively associated with brooding rumination about the laboratory stressor and positively associated with brooding rumination about the partner's support in general. In addition, both types of rumination were associated with less positive affect, more negative affect, and less relationship satisfaction over the course of the week.
Article
Our study aims at understanding multigenerational communication among grandmothers, mothers, and daughters experiencing reproductive health transitions from menarche to menopause. Thirty women, 10 triads of grandmothers, mothers, and daughters, participated in narrative interviews to recount their menarche and menopause experiences. Analysis was read using a multilayered approach to interpret discourse positioned from self, reflexive others, and those stories informed by societal meanings. Four dialectical themes informed by generational discursive shifts in talk included (1) covert versus overt talk, (2) recollection of versus indifference to menarche, (3) bound to versus freedom from menstruation, and (4) controlling versus managing bodily changes. The theoretical significance of this piece indicates a slight, transformative change in how messages about menarche and menstruation are communicated or passed down from one generation to the next.
Article
Background: Menstrual morbidity plays a significant role in adolescent females' lives. There are no studies to date reporting such data from menstrual health education programs in schools. Aims: The aim of our study was to report results from an audit of a menstrual health and endometriosis education program in secondary schools and observe age patterns of young women presenting for menstrual morbidity care. Materials and methods: Audit data from education in secondary schools and audit data of patients from an Endometriosis and Pelvic Pain Coaching clinic operating in a private endometriosis specialised centre are reported. Results: In a region of consistent delivery of the education program, student awareness of endometriosis was 32% in 2015. Overall in 2015, 13% of students experienced distressing menstrual symptoms and 27% of students sometimes or always missed school due to menstrual symptoms. Further, in one region of consistent delivery of the menstrual health education program, data show an increase in younger patients attending for specialised endometriosis care. Conclusions: There is strong suggestive evidence that consistent delivery of a menstrual health education program in schools increases adolescent student awareness of endometriosis. In addition, there is suggestive evidence that in a geographical area of consistent delivery of the program, a shift in earlier presentation of young women to a specialised health service is observed.
Article
We often turn to our friends, family, spouses, and partners for help in coping with daily stress or major crises. Daena Goldsmith provides a communication-based approach for understanding why some conversations about problems are more helpful than others. In contrast to other research on the social support processes, Goldsmith focuses on interpersonal communication - what people say and how they say it, as well as their reactions to the conversations. Her studies cover adults of all ages and various kinds of stresses, ranging from everyday hassles to serious illnesses and other major crises.