Sensory sensitivities are common in people with mental illness and Autistics and  (1) can impact on periods & menstrual products. This can include:

·         touch

·         visual input

·         scent

·         coordination and fine motor skills

·         trauma

·         pain and Interoception

·         familiarity and uncertainty

 

Touch

When choosing menstrual products, there can be a variety of different preferences for touch sensations in menstrual products This includes the feeling of a tampon and cup (sometimes lubricant changes the dry tampon feeling) or the feeling of a bulky pad in underwear, or the feeling of the pad against the skin. If new to menstrual cycles it is useful to explore what option is the most comfortable. If the person has a preference then it is important to enable access to this preference. . When someone is sensitive to touch they can be unable to get used to (habituate) a sensation and this can be very irritating, distressing or overwhelming.

Visual

Some people prefer not to see menstrual blood and may choose a product such as period underwear to be able to not sight it. If a person identifies that this is the case then it is trauma informed care to respect this.

Scent

Some people prefer not to smell menstrual blood and may choose a scent that masks the smell. Having access to this scent will be important for comfort.

Some people are sensitive to scents and will dislike a scented menstrual product. If they are sensitive to scent, they will be unable to get used to (habituate) to this scent.

Coordination and fine motor skills

Inserting a tampon or cup can require coordination and dexterity of hands and familiarity of their body.  Even opening the packet can be tricky!

Trauma

A period or menstrual products can be a trauma trigger  and  using a particular menstrual product  may be  their preferred way of managing this trauma. Menstruation can sometimes  result in dissociation or flashbacks.

Pain and Interoception

Some people experience severe pain with periods and may request medication to manage this.  This can also be an opportunity to check if the person has discussed their period pain with their GP and to educate them on the possibility of endometriosis, if needed.

Joining in on walks or exercise programs may not be possible for someone who is having a heavy period, is dizzy or faint or in a lot of pain.

For people who are low in body awareness (Interoception) , it can be difficult to notice the sensations of a period starting, bloating, or the need to change a menstrual product.

 

Other factors impacting menstrual product choice

 

There can be other factors impacting on choice of menstrual products that are not for sensory reasons.

This can include

·         Familiarity and uncertainty

·         Transgender

 

Familiarity and uncertainty

 

Being in a mental health unit can be a very stressful time and it can be a time when someone does not want to try an unfamiliar menstrual product.

 

Transgender

Menstruation may trigger gender dysphoria for some transgender people. Other difficulties can include the lack of access to bins in mens toilets and heavily gendered menstrual products.   

 

Accessing Menstrual products

To summarise, there are many reasons why someone may be requesting a particular menstrual product and providing a range of options can be very important to increase comfort and decrease distress. Some units have products available in

·         Bathrooms

·         Vending machines

·         Shop/canteen on hospital premises (if they do not have a wide range then advocate to increase this).

 

Be mindful of how the person came into hospital. If they were unable to pack their bags they may not have been able to pack menstrual products. Most would have been in a highly stressed state and so may also have overlooked packing it.

Family members or friends may be able to bring preferred products to the unit. This may be useful to include in unit information eg brochures, website, noticeboards.

Some units require people to ask nurses for access to menstrual products. A discreet and private process to do this is preferable. There may also be a need to discreetly access clean sheets and towels,  and cleaning products to soak/launder underwear or clothing.

The range of menstrual products includes:

·         Tampons with or without applicator (cardboard applicators are available)

·         Sports tampons

·         Cups

·         Pads, Liners

·         Period underwear

·         Menstrual sponges

·         Tampons without string (google stringless tampons)

·         Menstrual discs

·         Access to free products if finances are limited

·         Change of underwear

·         Heat products to manage cramps eg electric hot water bottle

 

Another support that may be required for someone who is unwell, dissociated or sedated , may be to provide help to remind them to change products.  

Health professionals’ discussions

This blog was inspired by an excellent article written by Hattie Porter  in which they described the realities of trying to manage menstruation while in a mental health unit.

They recommend that health professionals on mental health and other hospital units:

·         Discuss the availability of menstrual products on the wards.  Are these freely available in bathrooms? Is there enough choice to meet each person’s needs?

·         Discuss needs around menstruation (or menopause as relevant) in assessments.

·         Provide easy access to choice of products to meet individual needs and preferences.

 

Other points

Mental Health Units that have limited access to menstrual products may be inspired to implement changes through the following points:

·         If risk is a concern, consider that string on teabags is often allowed and is similar to tampon string. The risk is not considered to be so high that tampons are not allowed in a prison environment.  However if this policy is in place, it is possible to use sponges and tampons without string as an alternative.  For example https://www.beppy.com/en/beppy-tampons/

·         WHO calls for menstrual health to be recognised, framed and addressed as a health and human rights issue, not a hygiene issue. More information is available in the reference section of this blog.

·         The UK Home Office has a policy of free sanitary products to all female and transgender male prisoners to “help ensure menstruating detainees are “treated with dignity”.

 

Medical Conditions

Some people experience medical conditions that impact their experiences of menstruation. This includes:

·         Heavy bleeding

·         PCOS : Poly Cystic Ovary Syndrome

·         Endometiriosis

·         PMDD/PME Pre Menstrual Dysphoric Disorder/Premenstual Exacerbation

·         Menopause

 

Universal Design

At Sensory Modulation Brisbane, we are calling for Universal Design in Mental Health Units for Sensory Sensitivities and this would include access to menstrual products that meet sensory and other preferences.  There are other blog posts in this series eg reducing scents, sounds in mental health unit.

Sensory Modulation Brisbane also has recorded an online course which includes information on the importance of changing the environment in healthcare settings. (The webinar does not include further information on menstrual products) : tinyurl.com/4yz7hb4k

https://sensorymodulationbrisbane.ticketspice.com/sensory-modulation-using-a-sensory-lens-with-clients

Acknowledgement

Hattie Porter contributed to this article – thanks for your time, your words and your work in this area.  

References and further information

Porter, Hattie, RCOT News “ It’s about bloody time we talk about periods” : https://www.rcot.co.uk/news/your-september-issue-otnews-0 or on twitter:   @hat_teaa 

 

World health organisation

https://www.who.int/news/item/22-06-2022-who-statement-on-menstrual-health-and-rights

WHO calls for menstrual Health to be recognized, framed and addressed as a health and human rights issue, not a hygiene issue:

WHO calls for three actions. Firstly, to recognize and frame menstruation as a health issue, not a hygiene issue – a health issue with physical, psychological, and social dimensions, and one that needs to be addressed in the perspective of a life course – from before menarche to after menopause. Secondly, to recognize that menstrual health means that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need;  water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured. 

UK Home Office

Britain said on Wednesday that it will provide free sanitary products to all female and transgender male prisoners to help ensure menstruating detainees are "treated with dignity".

The Home Office (interior ministry) said it would change the law to make it mandatory for police to ask every female detainee at the earliest opportunity if they need free pads or tampons.

All detainees will also be able to speak in private to a police staffer of the same sex about their health, welfare and hygiene needs, the government said.

The Home Office told the Thomson Reuters Foundation that transgender male detainees will also be able to request period products and speak privately to a staff member of a sex of their choosing.

"I have been clear that everyone who enters custody should be treated with dignity and have their personal needs met," Nick Hurd, minister for policing, said in a statement.

The Independent Custody Visiting Association (ICVA), which works to improve custody conditions, said some women had been stripped of all clothing, including underwear, and placed in paper suits in police cells without sanitary products.

Britain had about 3,760 female detainees in 2018 - who accounted for less than five percent of the total prison population - ministry of justice figures showed.

"These changes ensure that the needs of female detainees are addressed, that detainees have basic privacy to use a toilet and access to menstrual products and that dignity is promoted within the police custody environment," said ICVA's head Katie Kempen.

https://www.weforum.org/agenda/2019/04/uk-to-provide-all-female-prisoners-with-free-sanitary-products/

 

Period Poverty article

Period Poverty affects 500 million people world wide

https://www.medicalnewstoday.com/articles/period-poverty

Below, we list some period poverty statistics:

• Globally, an estimated 500 millionTrusted Source people who menstruate lack access to menstrual products and hygiene facilities.

• There are an estimated 16.9 million people who menstruate living in poverty in the United States.

• A study  involving college-aged individuals who menstruate reported that 14.2% had experienced period poverty in the past year. An additional 10.0% experienced it every month.

• Research found that almost two-thirds of women in the U.S. with a low income could not afford menstrual products in the last year, while nearly half sometimes had to choose between buying food or menstrual products.