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There were no published research studies recorded in Australia for the entire review period from 1990 to mid 2020.聽

鈥淲e just don鈥檛 know,鈥� says PhD student Alana Munro when asked how periods affect Australia鈥檚 university students. Her goal is to address that knowledge gap in her ongoing research.

Her review, recently published in , showed that globally period pain contributed to university absenteeism, and declining academic performance and it impaired participation and concentration.

While there has been increased awareness and in Australia, the review highlights insufficient research into the impact on Australia鈥檚 university students.

鈥淯ni is very different from high school. The way that learning and attendance are structured means students have less contact with teaching staff and more opportunity to fall through the cracks,鈥� said Ms Munro, lead author and a PhD student in the Faculty of Medicine and Health at the University of Sydney.

鈥淲e know that menstrual cycle-related discomforts are common among university students, but there is more to the story that we must uncover.鈥�

The global review, looking at the impacts of menstruation on university students鈥� experience and education found:

• Only 83 available studies, with most conducted in lower to middle-income countries.
• Studies in high-income countries included Saudi Arabia, Spain, England and the United States but mainly focussed on the prevalence of menstrual pain.
• Painful periods (known as dysmenorrhea) negatively impacted students鈥� ability to attend university, complete assignments, study for exams and participate in class activities. However, these impacts were unnoticed by university teaching staff.
• 路Students were generally dismissed by health professionals when seeking help for pain.
• Poor university sanitation facilities made it difficult for students to manage their menstrual periods, and led to fears of staining their clothes and being ridiculed by peers at university.
• Little research on other aspects of the menstrual experience such as students鈥� knowledge of menstrual biology and their confidence to manage menstruation.
• No studies were conducted with trans and gender diverse students, and only one study explored international students鈥� experiences of menstruation.

An published post-review also focused exclusively on menstrual pain.

Early in her research, Ms Munro undertook an Instagram survey to see what kind of engagement she鈥檇 get on the topic and was shocked to receive over 240 responses in just 24 hours.

鈥淚t showed me that many people wanted to share their experiences of menstruation despite it being a generally taboo topic,鈥� said Ms Munro.

Of the 240 respondents (not exclusively university students):

• 33% felt anxious managing their period outside the home
• 70% said their period impacted their school, university or work attendance
• 28% told their teacher, lecturer or employer that they absented because of their period
• 82% would like access to menstrual leave at school, university or work.

Ms Munro suggests research needs to start addressing questions such as how period stigma affects students鈥� time at university and how teaching staff can create an environment where students feel comfortable discussing menstrual-related impacts on their education.

鈥淭here is this common discourse in the media and community that periods hold students back from their education and that there isn鈥檛 much they can do about it because it鈥檚 out of their control,鈥� said Ms Munro.

鈥淗owever, we are hearing students can be very resourceful. For example, they might rearrange study schedules or assignment preparation to fit their menstrual cycle or they鈥檒l wear double protection on days they have heavy bleeding so they don鈥檛 miss out on university or work.

鈥淭hey are creative in overcoming these challenges, but we need to do more to support them. A critical part of that is actually asking them about their needs.鈥�

The review also showed that research to date has failed to understand how campus bathroom facilities could be improved so students can manage their menstruation using their preferred methods and products 鈥� from pads to menstrual cups.

Earlier this year Ms Munro worked with聽聽to install a vending machine for free period products in the University of Sydney鈥檚 Carslaw bathrooms. This followed a survey of over 300 students (conducted as part of her studies) that showed around a quarter of students have left campus to purchase products instead of attending class. Ninety-two percent also indicated reasonably priced products in student bathrooms would help them manage menstruation.

The University of Sydney Union (USU) also secured Student Services and Amenities fee (SSAF) funding this year to install free聽聽menstrual products in bathrooms across USU facilities in the Holme, Wentworth and Manning buildings as a 12-month pilot program.

However, Ms Munro and co-author Dr聽Erin Hunter聽caution that meeting the needs of students is about more than pads and tampons.

鈥淲hile ensuring students have access to menstrual materials is important, menstrual needs don鈥檛 end there,鈥� said Dr Hunter from the Sydney School of Public Health.

鈥淗ere in Australia, better understanding the needs and preferences of university students is an important first step in working toward policies or programs that can help ensure university campuses are conducive to the needs of students who are menstruating.鈥�

The findings of the聽PLOS One聽review have informed Ms Munro鈥檚 latest study on the menstrual needs of over 400 students attending an Australian university, with findings expected to be published next year.

Declaration: The authors declare no competing interests.

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