Periods are a fact of life for half of the population yet new research highlights a signiï¬cant taboo surrounding women’s health. So how can pharmacy teams help break the silence?
It’s something that is experienced by more than 300 million women worldwide and is simply a fact of life, yet new research from Bodyform highlights the period taboo is still very much alive in the UK.
The research reveals that 40 per cent of British girls aged between 12 and 18 regard periods as dirty, shameful, embarrassing or disruptive to everyday life. Some 24 per cent of women admit they feel uncomfortable buying feminine hygiene products and only 20 per cent of UK mums (and seven per cent of dads) have spoken to their daughters about periods.
Even more shockingly, one in ï¬ve girls (21 per cent) admit no one has ever spoken to them about periods and more than half (52 per cent) say they would rather get bullied at school than discuss periods with their parents.
Culture of silence
In what many regard as an open-minded society, why do we still appear to have a culture of silence surrounding menstruation? Traci Baxter, marketing manager for Bodyform, says: “Whilst periods are slowly starting to be discussed more in public and we’re seeing more activism than ever before, a stigma still undoubtedly exists. The consequence? Thousands of women and girls are suffering in silence. Some are too embarrassed to ask for help, whilst others suffer with conï¬dence issues, affecting their mental health and wellbeing. With silence comes the risk that women may feel less likely to talk about periods and to seek advice, which poses an issue for medical and health promotion.”
Another problem for many women is so-called period poverty where they cannot afford sanitary protection and end up using inappropriate methods and/or miss school and work during their period as a result.
According to a report published in July by HRH Prince of Wales’ charity In Kind Direct, some families have to choose between buying food or buying personal hygiene items. Sue Burchill, Brook’s head of nursing also highlights that young girls are missing school each month for days at a time because they don’t have access to sanitary products. She says: “It really is disgraceful that in the 21st Century, in one of the wealthiest countries in the world, young people’s education is being compromised in this way. The good news is that the [In Kind Direct] report has been widely discussed and a petition calling on the Government to make sanitary products free in schools has now reached 90,000 signatories. In addition, many leading supermarkets have committed to reducing the cost of their sanitary products by ï¬ve per cent to absorb the tampon tax for their customers.” In August, LloydsPharmacy was the ï¬rst community pharmacy chain to drop the price of women’s sanitary products and effectively pay the VAT on behalf of its customers.
Brands are getting on board, too. Bodyform is helping to provide free sanitary protection to women and girls unable to access or purchase products for themselves or their families. The initiative will see 200,000 packs donated to In Kind Direct by 2020, which helps to ensure that everyone has access to life’s essentials.
Bodyform will also be working in partnership with mental health awareness organisation The Self Esteem Team (SET) via free classes to 2,500 girls aged 12-18 to address issues of body conï¬dence and self esteem, as well as taboos surrounding menstruation. Bodyform will also be giving out free feminine hygiene products at participating schools.
Since 11 July, free sanitary products have been provided to women and girls from low-income households in Aberdeen thanks to a pilot scheme tackling period poverty.
The Scottish Government project, backed by £42,500 funding, will ensure access to sanitary products for at least 1,000 women and girls in immediate need across seven regeneration areas across the city, while informing the future approach to the issue nationwide.
The six-month pilot is being run by Community Food Initiatives North East (CFINE), a social enterprise focused on improving health and wellbeing for those in poverty, using established relationships with local partners through the FareShare surplus food network.
Dave Simmers, CFINE chief executive, calls it “a very welcome development” and explains: “CFINE and our 60 partner organisations engaged in Food Poverty Action Aberdeen are very aware of the cost and challenges of accessing sanitary products for many girls and women from low-income households: over a woman’s lifetime, sanitary products cost on average more than £5,000, a signiï¬cant sum for those on low-income. Many cannot afford them and may use inappropriate methods or miss school.”
Women and girls were primarily identiï¬ed from those using the services of CFINE and its partners, with priority given to those who are in receipt of beneï¬ts, including tax credits or free school meals or education maintenance allowance, or who can demonstrate that they are experiencing signiï¬cant ï¬nancial difï¬culties. Those selected are provided with the product of their choice and have the opportunity to report on their experience by completing an evaluation form at the outset and to feedback during and at the end of the pilot. Speciï¬cally, CFINE wants to ï¬nd out:
- The issues and challenges they face in relation to purchasing products
- Any improvement they have experienced in their life from participation in the pilot
- How easy or difï¬cult it was to access the products through the pilot
- What they consider a respectful and digniï¬ed response might be.
CFINE is also working with Aberdeen City Council and North East Scotland College, with a view to extending the scheme to provide sanitary products for school pupils and college students from low-income households.
There is no guarantee or commitment to maintaining the service after December 2017, but beyond the pilot Dave says the approaches tested out will “inform the Scottish Government’s response, hopefully with some form of national roll out”. He adds: “The pilot – noticeably through promotion and publicity – is attempting to address the taboo of menstruation, raise awareness that this is a natural bodily function and get the topic discussed. My view is a universal scheme would be ideal, given this is a health issue, and arguably an NHS issue. But cost has got to be factored in, in these times of very tight budgets.”
Initiatives such as thehomelessperiod.com have petitions to provide free sanitary towels and tampons to homeless women and reaching women and girls further aï¬eld, and donatepads.org provides a list of organisations that accept donations of sanitary products on behalf of
women around the world.
To support these initiatives, and tackle period poverty and taboos around menstruation from a practical point of view, pharmacy teams are perfectly placed, thanks to their insight and expertise, to initiate such conversations. This will encourage even more women and girls to talk about the subject without feeling ashamed and embarrassed.
If pharmacy staff and customers want to help other girls and women in period poverty, Traci Baxter, marketing manager for Bodyform, suggests setting up donation boxes to encourage the donation of sanitary products, which could then be given to local food banks. Find one in your area.
A role for pharmacy
Pharmacy teams play an important role in helping to open up conversations about periods with girls and their parents/carers, but like so many health issues it needs some sensitivity.
Dr Karen Gardiner, managing director of women’s self care company Purple Orchid Pharma, says: “Period problems start when girls are young, so when a girl has the courage to ask for help, it’s essential that she is met with a helpful response from someone who isn’t uncomfortable with the subject and the words.
“UK households aren’t comfortable discussing women’s issues or anything relating to ‘down below’ so there is no open dialogue round the dinner table about periods or vaginal health issues, whether normal or abnormal. Until we get comfortable with the word vagina these topics will remain taboo.
“Because of this, pharmacy teams can play a crucial role by getting used to it amongst themselves, perhaps using role play as a tool, so that when they are in their customer-facing moments, they are using the necessary vocabulary with ease, which will in turn put their customers at ease,” Dr Gardiner says.
Brook’s Sue Birchill points out that straightforward merchandising in store is also important. She says: “Sanitary products should be clearly visible and easy to reach and it can be useful to have display boards or cards with more information or to encourage customers to ask for advice if they feel they need it.”
She also advises that talking about periods shouldn’t only be aimed at women and girls, adding: “Pharmacy teams should be prepared to have the same conversations with men and boys, and it is also vital to work with local organisations such as Brook and know where to refer people to if they need further assistance.”
Premenstrual syndrome (PMS) – also known as premenstrual tension (PMT) – can occur in the days leading up to a woman’s period, and includes symptoms such as bloating and weight gain, stomach cramps, breast tenderness, headache, skin problems, tiredness, back ache and mood swings.
Cutting down on alcohol and avoiding caffeine, sugary foods and salt can help. Some women ï¬nd alternative treatments and supplements helpful, such as evening primrose oil, which can help maintain hormone balance.
It is estimated that over half of women in the UK get period pain (dysmenorrhoea), which is caused naturally by contractions of the muscles of the uterus as the body releases prostaglandins, which help expel the lining of the womb during a period.
While your customer’s GP could prescribe strong pain relief, there are OTC options you can recommend ï¬rst, such as paracetamol or non-steroidal antiinï¬‚ammatory drugs (NSAIDs) like ibuprofen or naproxen. Other ways to relieve pain is to place a hot water bottle or heat patch on the stomach.
Menorrhagia is the medical term for very heavy and painful periods. It can lead to excessive blood loss, interfere with quality of life and can occur alone or in combination with other symptoms.
It’s important to be assessed by a GP, and there are medications that help reduce blood ï¬‚ow and pain. Pharmacy staff can also advise customers to take an iron supplement to help prevent anaemia due to the blood loss experienced.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) affects ï¬ve to 10 per cent of women, and is the name given to a condition in which women have ovaries that contain many small cysts located just below the surface. Women may also have one or more additional symptoms, which can include irregular or a complete lack of periods, irregular or no ovulation, difï¬culty becoming pregnant, unwanted facial or body hair, oily skin or acne, weight problems, alopecia, depression and mood changes.
If customers have concerns about any of these indicators then referral to their GP is necessary. Pharmacy is ideally placed to help with issues such as weight management, as weight gain can make symptoms worse.
Thrush is a yeast infection caused by the candida fungus. It occurs when the pH or acid balance in the body becomes disturbed, causing the fungus to multiply, resulting in intense itching and soreness.
Treatments usually contain an antifungal agent such as clotrimazole, which aims to reduce the level of candida infection in the body. These are available in pessaries, intravaginal or topical creams, or oral tablets containing ï¬‚uconazole.
Despite bacterial vaginosis (BV) being the most common vaginal infection, 57 per cent of UK women do not know about it, and 66 per cent confuse it with thrush. BV is a change in pH levels and symptoms include vaginal odour and a thin, white-grey discharge.
OTC products that help restore and preserve the natural pH balance are available.
Some 24 per cent of women admit they feel uncomfortable buying feminine hygiene products