Written by Regan Moss
Menstrual equity advocates and public health researchers have stated the need for gender-responsive approaches to understanding the needs of all menstruators, including in healthcare provision, to support menstrual well-being across the life course. Yet, significant disparities still exist in the quality of care received between trans individuals and their cis peers. This is unfortunately not exclusive to menstrual health care, as science and medicine are constructed with a binarized view of gender and sex. These binarized frameworks are evident in how menstruation is viewed and how the health of bodies surrounding periods is understood. It’s important to note that these views are also intertwined with patriarchal views of the female body and functions that are secondary to the male body. Trans and queer bodies are abjected further, leading to poor (and non-individualized) healthcare provision.
The stigma surrounding menstruation, as well as forces of transphobia, contribute to poor menstrual health care. The stigma associated with being Queer, which doctors and healthcare providers perpetuate, causes individuals who are trans to avoid talking to their doctor about menstruation. This compounds the general stigma surrounding periods. Individuals who do not talk to their doctor about menstruation are unable to receive support for heavy bleeding, severe pain, and a variety of other benign to severe menstrual health needs. Trans individuals also experience period poverty, associated with many adverse social, psychological, and biological health consequences. Experiences of period poverty among people not cis-gendered remain under researched and under-supported by service and policy efforts. Needs related to period poverty or inadequate infrastructure for healthy menstrual health practices may also go unidentified and unmet because of transphobia and associated patterns of seeking care.
As menstruation is also associated with gynecologic health and other facets of sexual and reproductive well-being, individuals may also avoid talking to their doctor about these aspects of health as well. A general lack of medical education and knowledge regarding the unique needs of Queer menstruators is also driven by transphobia, which leads to poor health care, even for individuals that are able to access it. For example, some individuals that are trans are not ever asked about their period in medical settings, or the lack of competency leads medical providers to ask about menstruation when the use of hormone therapy may have made menstruation impossible for many years. The lack of competency is also associated with issues of safety for trans patients. Healthcare provider trans competency is critical to overcoming “barriers to managing menstruation safely and accessibly,” shares the National Library of Medicine.
When menstruation is viewed as a social and health experience rather than a lack of reproduction among women, all individuals who menstruate can be recognized. Queering menstruation is also necessary to buffer the harmful effects that feminine normative views often have on the mental health of individuals who are transgender: “Menstruation or the anticipation of menarche for many transgender males is often met with worsening of dysphoria, anxiety, depression, and suicidal ideation” reports researcher Eric Weiselberg.
Stigma can also lead to feelings of dysphoria and have a harmful impact on a patient’s sense of self. However, “for some trans and gender diverse people, getting their period is a normal and okay part of being in their body, and for others, it’s uncomfortable and even an actively distressing experience.” When menstruation is not viewed as an inherently feminine experience, individuals that are transgender may be more comfortable experiencing menstruation, resulting in better mental health. Ultimately, Queering menstruation helps all menstruators, as the multiplicity of menstruation is recognized, and the nuance in this health and human rights matter is seen in medical practice, knowledge, policies, and procedures.
The menstrual health of trans individuals requires a commitment to research the trans experience of menstruation and the implementation of such research into medical curricula and continuing education platforms. Trans experiences should be championed at all levels of medical care, from bathroom signage to pronoun usage among providers. Creating a comfortable and welcoming space for patients is a critical aspect of the healthcare experience but cannot alone address inadequacies in trans (menstrual) healthcare provision. Medical education surrounding trans needs and experiences is paramount. Such education can be best informed through additional research – both within and outside the academy–highlighting the (health) needs/wishes and menstruating experiences (from menarche to post-menopause) of trans individuals. Training programs specific to transgender care in obstetric and gynecological settings more broadly are associated with improved knowledge and preparedness. These programs should be developed and applied in menstrual healthcare settings. Medical providers should be troubled to be competent in the menstrual health needs of their patients, including their social and psychological needs. Medical systems must move away from a binarized view of health that ties menstruation to femininity. Overall, in creating gender-responsive approaches to health and moving beyond a gender-binarized view of bodies and health, medical health care, including menstrual health care, for trans individuals will improve. It’s critical that providers champion the spectrum of Queer menstrual experiences and do not create a homogenized view of trans medical care.
Ultimately, in order to improve trans menstrual healthcare, general healthcare on menstruation must improve, as conditions that premenstrual dysphoric disorder and endometriosis are underdiagnosed and undertreated. Menstrual taboos, sexism, transphobia, and hierarchies within the medical system are barriers to adequate menstrual care. Providers must work to create relationships with their patients to transcend these taboos and forces of oppression and welcome patients to share their experiences. This includes believing patients' experiences of pain, dysphoria, and irregular cycles.