Preparing girls for menstruation: recommendations from adolescent girls

Adolescence, Winter, 1995 by Elissa Koff, Jill Rierdan

As the menstrual cycle has come to occupy an increasingly important place in discussions of women's health (Dan & Lewis, 1992; Golub, 1993), attention is again focusing on the impact of the onset of menarche. Studies of girls' responses to menarche have determined that it is a highly salient, intensely experienced event, and a turning point in female development; they also have demonstrated that more adequate preparation is associated with a more positive initial response (Golub & Catalano, 1983; Koff, Rierdan, & Sheingold, 1982; Ruble & Brooks-Gunn, 1982). Despite a sense of being prepared for and even excited about the impending event, however, most girls still find menarche mildly stressful. When it occurs, they greet it with mixed feelings, including some degree of negativity (Koff, Rierdan, & Jacobson, 1981; Ruble & Brooks-Gunn, 1982; Whisnant & Zegans, 1975; Williams, 1983). Older adolescents and adult women looking back on menarche remember and relate feelings similar to those recounted by early adolescent girls (Golub & Catalano, 1983; Woods, Dery, & Most, 1982).

One interpretation of such findings is that menarche may be the type of experience for which it is virtually impossible to be sufficiently prepared (Brooks-Gunn & Ruble, 1982b); another is that the explanations we provide to girls as we prepare them for menstruation may be inadequate or misdirected, and may foster a subjective sense of being somewhat unprepared. For example, explanations may fail to include important aspects of the experience (e.g., what it feels like to menstruate); they may fail to address the personal concerns of maturing girls (e.g., reactions to bodily changes); they may be in a form that is difficult for girls to assimilate; or they may be presented off-time - too early or late to be informative or reassuring.

Girls today have access to a variety of sources of information about menstruation (Abraham et al., 1985; Brooks-Gunn & Ruble, 1982a; Havens & Swenson, 1988, 1989). They learn about it from mothers, siblings and peers, teachers and health providers, booklets and films, and advertisements of menstrual products in the teen media. Despite this plethora of resources and efforts to improve the content, mode of presentation, and cognitive accessibility of educational materials (Havens & Swenson, 1989), much of the information remains impersonal and abstract, and difficult for girls (Abraham et al., 1985) and their mothers (Lei, Knight, Llewellyn-Jones, & Abraham, 1987) to assimilate.

There is still a tendency to focus on the immediate and obvious biological and hygienic aspects of menstruation such that knowledge is disconnected from girls' own body experience (Sommer, 1981). It must be a challenge for girls who lack familiarity with the body parts involved in the menstrual cycle, and in particular with the internal reproductive organs, to relate the abstract information they receive about anatomy and physiology to themselves and their maturing bodies. They also must reconcile directions to minimize or ignore internal bodily signals while simultaneously being cautioned to monitor themselves for the possibility of accidents or odors that might be observable to others. It undoubtedly is difficult for fourth, fifth or sixth graders to find personal meaning in abstractions linking menstruation with femininity, womanhood, and reproductive potential. Also, it must seem paradoxical to be told that menstruation is normal and natural and something to be happy about while being instructed both to conceal its occurrence and to carry on as if nothing were happening.

Characteristic of this approach to menstrual preparation is the emphasis on menstruation as normal and natural and the relative neglect or minimization of its bothersome aspects (Golub, 1993). Letting girls discover these on their own inadvertently promotes feelings of inadequacy, shame, and disgust, as well as a sense of somehow having been misled. Interestingly, although educational and commercial materials generally downplay variations in menstrual experience and tend to discount distress associated with dysmenorrhea, along with the nuisance aspects, these are the very factors that are emphasized and pathologized in the menstrual myths and stereotypes of our culture (Delaney, Lupton, & Toth, 1988; McKeever, 1984).

Perhaps it is not surprising then that despite perceiving themselves as prepared for menstruation, many girls experience it with some degree of ambivalence and continue to evaluate menstruation somewhat negatively (Brooks-Gunn & Ruble, 1982a). Educating females for menstrual life is complex and multidimensional (Dan & Lewis, 1992; Golub, 1993). College women, asked how they would prepare a premenarcheal girl for menstruation (Rierdan, Koff, & Flaherty, 1983), supported this multivariate perspective, identifying three distinct aspects of preparation - knowledge about the biology of menstruation and menstrual hygiene, emotional support and reassurance, and psychosocial meaning. Preparation has tended to focus on the first of these, knowledge, and indeed, college women stressed this dimension as well. Asking college women to reflect back on their own menarche and suggest ways to improve preparation has both advantages and disadvantages. While college students are mature enough cognitively to be able to analyze and abstract from a relatively recent experience, their data are retrospective, and thereby subject to distortion and a tendency to minimize negative affect (Yarrow, Campbell, & Burton, 1970). While this study tells us what college women now believe they would have wanted to know before menarche (Rierdan et al., 1983), their views may not necessarily parallel those of more recently menarcheal girls, and might actually misdirect efforts to improve preparation. Thus, it seems important to determine how more recently menarcheal girls would define adequate menstrual preparation. A benefit of studying such girls is that menstruation, by virtue of its recency and novelty, should be highly salient. A potential disadvantage is that girls often are reluctant to describe their menstrual experiences directly or right at the time of menarche (Ruble & Brooks-Gunn, 1982). However, they generally are willing to do so indirectly (Koff et al., 1981; Ruble & Brooks-Gunn, 1982), and are more forthcoming after they have experienced several menstrual cycles (Brooks-Gunn & Ruble, 1982a).