Tackling the taboo: Medical students break through the stigma of period education

By Grace McOmber
School of Medicine

Ishika Singh starts every presentation to groups of tweens and teens with the same question: "Does it feel weird to talk about this?"

Standing behind a table displaying tampons, pads and menstrual cups, she's often met with giggles, whispers and uncomfortable nods - but Singh is used to working through that awkwardness. As a third-year medical student at Virginia Commonwealth University and president of the Period Education Project at VCU student interest group, she volunteers in the community to lead discussions on a part of life that billions of people experience every month: menstruation.

Since its founding last year, the Period Education Project at VCU - also known as PEP at VCU - has been training VCU School of Medicine students to become community educators and health advocates at schools, community centers and events across Richmond. With the goal of breaking down the stigma of discussing periods, the student group is preparing both future physicians and patients to approach the topic with the knowledge they need to make informed health decisions.

"We want to create an environment where kids can learn to feel comfortable talking about their bodies without feeling embarrassed," Singh said. "This is a part of life and being knowledgeable about your period and other aspects of your health sets you up to be an advocate for yourself."

Correcting myths and misinformation around menstruation

According to a 2024 analysis of menstrual education in the U.S., only 13 states and Washington, D.C., included menstruation in their standardized public school curriculum. While Virginia has a standardized curriculum for menstrual education, it is up to individual school districts to approve the inclusion of this material in health, physical or sex education classes. Among states that provide curriculum frameworks, only one begins in 3rd grade, the physician-recommended timeline, as girls can get their period as young as 8 years old.

"There are girls that don't have someone in their life that is comfortable talking about this, and if they do, they might still be receiving misinformation due to longstanding and popular myths about periods," Singh said.

A lack of, delayed or inaccurate period education not only contributes to increased feelings of shame around discussing periods, but it can also prevent women and girls from being able to identify and get help when something is wrong. Debilitating conditions like endometriosis, polyendocrine metabolic ovarian syndrome and premenstrual dysphoric disorder can begin around the onset of menstruation. Common symptoms of these conditions, including heavy bleeding, severe cramping, irregular cycles and extreme mood disturbances, can often be misinterpreted by both physicians and patients as "just having a period."

Nicole Karjane, M.D., a professor in the Department of OB-GYN and advisor to PEP at VCU, said providing comprehensive menstruation education can help address the gaps in knowledge that she sees among some of her pediatric and adolescent patients.

The Period Education Project is a national nonprofit doing just that. Founded in 2020 by physician experts, including VCU Health OB-GYN residency alum Melisa Holmes, M.D., the organization trains medical students to deliver medically accurate menstruation education to kids, adolescents and teens at community events. Across the country, 23 medical school PEP chapters receive location assignments from the national PEP organization to host educational sessions, known as "PEP rallies," at schools, community centers and after-school programs.

Using materials provided by the national organization, PEP at VCU teaches medical students how to create a stigma-free environment where kids feel safe talking about their own experiences and asking questions. The educators learn how to explain the menstrual cycle, ovulation and female reproductive anatomy to different age groups, ranging from older elementary students to younger high schoolers. They also learn how to navigate the awkwardness inherent to speaking about a historically stigmatized topic.

"It's great practice for us as well, because as a physician, you are responsible for creating an environment in which patients don't feel embarrassed about asking questions," Singh said. "It's helping us learn how to meet patients where they are."

Kiara Mehta, a first-year medical student and new member of PEP at VCU, said she joined the group because she's seen firsthand how impactful this education can be in empowering girls to speak up. As a member of a similar student group during her undergrad years in Atlanta, Mehta met a tween girl who confided in her that she was scared after missing her period for a few months.

"I couldn't fully answer her question because I was only a college student, but I encouraged her to talk with her parents about it, and she said she felt more comfortable doing that after our presentation," Mehta said. "That meant a lot to me, because I don't think young girls should be afraid to talk about something that we all go through. I wanted to continue making that difference in medical school."

Easing anxiety for kids about the topic of periods

After going over mechanisms of menstruation and what to expect with a period, medical student educators invite the kids to share common myths or misinformation they may have heard from friends, family or online, that can cause stigma around periods. In a game called "normal or not," they present the audience with different period scenarios and ask whether they think each is normal and healthy, or abnormal and should be discussed with their parents or a healthcare expert.

"Everybody's family and background is different, so you don't really know what people know or think they know about periods until you ask them," Singh said. "It's about gently correcting them, because anything that comes off condescending is just counterproductive."

When Singh presents to young audiences, she's unfazed by the awkward giggles and nervous whispering - she considers those responses normal. But how educators convey health information can be just as important as the information itself, she said, and the comfort she and her peers have when discussing periods can help ease kids' anxiety around the topic.

"I remember a girl who came up to us afterward and asked, 'So you guys don't feel weird talking about this stuff?'" Singh said. "Moments like those remind me of how much I would've appreciated learning about periods like this, even if I didn't recognize it at the time."

This article was originally published on the School of Medicine website.