Study exposes gaps in menstrual health education in English schools

A new study reveals inadequacies in menstrual health education provision in English schools. Findings highlight a lack of practical information being offered, pupils being taught too late, and attitudes that perpetuate stigma. The research is published in Women's Reproductive Health.

Of young women surveyed in the study, which sought to understand what and how menstrual health education information was delivered in English schools, 10% did not receive or remember receiving any menstrual health education. Of those pupils who did, up to 1 in 5 did not receive education until after they had started their period.

The publication of the research, led by the University of Bristol and Anglia Ruskin University, coincides with the current Relationships, Sex and Health Education (RSHE) draft guidance consultation, which is proposing new age limits for several RSHE topics, including banning children from being taught about the menstrual cycle before Year 4.

In this study, researchers surveyed 140 young women aged 18–24, who had attended either a private or state-funded primary and secondary school, on their menstrual health education. Of these, 99.3% had experienced menstruation. The average age of the survey respondents was 21.9 years.

Participants were asked to take part in online surveys and in-depth interviews to share their experiences, including what and how information was provided at school and reflect on their thoughts and feelings about their education taught under the previous Relationships and Sex Education (RSE) guidelines delivered from 2000.

From the survey results, researchers found lessons focused on biological content with a lack of practical information needed to help students manage menstruation and menstrual health, with nearly seven in ten participants having reportedly received no practical information. None of the participants were taught about menstrual health conditions and only 3.2% learned about abnormal symptoms.

Serious long-term impacts were reported, as several participants put off seeking medical attention for debilitating symptoms because they thought their pain was normal, only to be later diagnosed with conditions such as endometriosis.

Overall, participants left school lacking basic knowledge and feeling ill-equipped with 62.4% rating their education as "poor" or "very poor" in preparing them for managing menstruation. In extreme cases, some were so unprepared that when they started their periods, they thought they were ill or even dying.

While schools were seen as an important source of information, many had to rely on other sources—particularly the internet and social media—which poses its own risks, as well as barriers for those who lack access to such resources.

Poppy Taylor, Ph.D. researcher in Population Health Sciences at the University of Bristol, and corresponding author, responding to the proposals of the RSHE draft guidance, said, "Given the evidence that girls are starting their periods at ever-younger ages, there are concerns this will be too late for an increasing number of people. Denying young people with information about their bodies risks significant long-term harm.

"Our research provides strong evidence that the education system has been failing young girls and people who menstruate. We were shocked and disappointed, but sadly not surprised, with our findings."

Globally, menstrual health is a key issue for gender equality. When menstrual needs are unmet, it can create barriers to education and employment, pose long-term health risks and threaten human rights. Evidence suggests that persistent stigma and lack of public understanding about menstruation is preventing such needs from being met in the U.K. It is appropriate that schools provide timely and comprehensive menstrual health education.

Poppy Taylor added, "Our findings suggest that for many young people, the menstrual health education they received failed to prepare them physically, mentally, or socially for their first period.

"We recommend that menstrual health education is improved through the delivery of earlier, more inclusive lessons with more practical content to ensure all young people are equipped to manage their menstrual health in a supportive environment.

"To support the U.K. government's target of eradicating period stigma and poverty by 2030, universally accessible and comprehensive menstrual health education must be prioritized."

The authors acknowledge that the reported experiences in the study, particularly from older participants, may not reflect current practices. Due to the small sample size, further research is needed to explore the experiences of students who are currently in the schooling system and to understand whether and how practices have changed.