Summary
- Menstruation is a widely stigmatised experience, leading to people concealing their periods and potentially normalising severe menstrual pain. Policy initiatives are needed to support open communication about periods and potentially troubling symptoms.
- Menstrual pain may have no underlying cause or can be related to a range of debilitating and common conditions. Many of these conditions are overlooked in the Women’s Health Action Plan for 2024/2025, which talks about menstrual pain only in relation to endometriosis.
- Individuals with painful periods are often forced to act as advocates for their symptoms, potential diagnoses, referral pathways and treatment options, resulting in high patient burden.
- There is a need for new educational initiatives to address this under-managed experience, including the introduction of mandatory women’s health training for GPs, who are often the first port of call for menstrual concerns.
Introduction
Menstrual pain, known medically as ‘dysmenorrhea’, is moderate-severe pelvic and/or abdominal pain during menstruation (1) and may affect up to 71.3% of girls, women and individuals who menstruate worldwide (2). Menstrual pain can happen without any clear cause, though a number of conditions can cause painful periods, such as endometriosis, adenomyosis, or the newly termed ‘Polyendocrine Metabolic Ovarian Syndrome (PMOS)’, which recently replaced the term PCOS (3). For individuals with menstrual pain, this monthly experience can negatively affect quality of life (4,5), mental health (6) and participation in everyday activities (7). Moreover, those with conditions causing these painful experiences often wait years for diagnosis and subsequent medical care (8,9). On an international policy level, undermanagement of these pain experiences can also greatly affect many UN Sustainable Development Goals, including the goals of achieving gender equality, quality education, and good health and well-being (10).
In Ireland, difficulty managing painful periods is a real health concern for many who menstruate; national research suggests that it’s challenging to get information on menstrual pain management methods and skills (11,12). There are also financial, capacity and access-related barriers to receiving timely medical support for those in need of guidance or care in Ireland (13,14). In everyday conversations, discussing painful periods can also be met with dismissive comments that period pain is ‘a normal part of womanhood*’, where social norms around menstruation place the priority on concealing menstruation rather than managing troubling symptoms (12,15).
Across Ireland, painful periods are a clear healthcare issue for individuals who menstruate, deserving of policy support to ensure debilitating symptoms do not limit everyday participation. This policy brief summarises current policy gaps for menstrual pain in Ireland, with reference to the current Women’s Health Action Plan (16). We outline the ongoing impact of menstrual stigma, the need for updated professional education and new communication initiatives to address ongoing stigma and to ensure diverse experiences can be addressed in a timely and understanding manner. We also draw attention to the limited focus on the breadth of menstrual pain experiences in the current plan, which centres almost exclusively on endometriosis. We conclude with recommendations for the upcoming edition of the plan.
Menstrual Stigma as a Policy Gap
A common belief about menstruation is that menstrual pain, however severe, is a normal and expected part of the menstrual cycle (17). This belief of pain ‘normality’ is a major issue blocking care-seeking for painful periods (18–20) and relates to low levels of menstrual knowledge and skills, a result of widespread menstrual stigma (21). Instead of receiving clear information on managing wellbeing with periods, menstrual stigma reinforces the need for ‘menstrual concealment’, where a social priority is placed on keeping menstruation hidden from others (15). Stigma can also leave individuals too embarrassed or ashamed to approach medical professionals about concerning symptoms (20) or leave misinformation or inaccurate beliefs about menstruation unchallenged (22). While a central issue in menstrual health, stigma has largely only been tackled in the context of period poverty in Ireland (23) and not in relation to pain or other worrying experiences.
Improving menstrual health and wellbeing requires a clear policy focus on minimising the negative impact of stigma on all individuals who menstruate. Not only can stigma affect the management of painful symptoms, but can limit widespread discussion of menstruation, as periods continue to be viewed as an inappropriate topic for general media. In Ireland in 2020, a Tampax™ tampon advert called ‘Tampons and Tea’, whichinstructed individuals on how to appropriately insert a tampon,was removed from public television for receiving 84 complaints (24). These complaints included claims that the advert was demeaning to women, related to ‘sexual innuendo’, and/or was unsuitable for children. More recently, in March 2026 (25), Independent.co.uk™ reported that popular social media platforms have been censoring information on women’s health, including posts containing the word ‘menstruation’, due to it being incorrectly classified as ‘adult content’. Though menstruation is becoming a more visible topic in political life, due primarily to period poverty awareness campaigns (23) and the efforts of NGOs such as Plan International (26), we lack national policy to address ongoing menstrual ‘taboo’ in wider public spheres. As an influential barrier to care and improved management skills for menstrual pain, menstrual stigma needs to be addressed at all public levels. As such, the next iteration of the Women’s Health Action Plan would benefit from including communication and awareness campaigns to explicitly target misinformation and stigma associated with menstruation and pain management.
Endometriosis is not only painful periods; painful periods are not all endometriosis
To address painful menstrual experiences, health policy in Ireland indicates a rising interest in endometriosis, a chronic and painful disease where endometrium-like tissue grows outside the uterus (27). The Irish Women’s Health Action Plan (2024) detailed new measures to address ongoing gaps in endometriosis care, including providing a National Endometriosis Framework and creating new regional and supraregional hubs for endometriosis-focused care (16). Moreover, efforts to move towards providing timely endometriosis care are to be supported by a new educational awareness programme, known as Menstrual Information Specialising in Endometriosis (MISE) (28). The same emphasis on endometriosis care can also be seen in the research field. A forthcoming scoping review of factors affecting healthcare access for menstrual pain (18) observed that 70% of 176 eligible peer-reviewed papers on menstrual pain in high-income countries focused on endometriosis. The remaining 30% combined accounted for menstrual pain without cause, or other conditions incurring painful periods, such as adenomyosis, PMOS, uterine fibroids, chronic pelvic pain, and ovarian cysts.
This developing focus on endometriosis is a defining feature of women’s health policies in Ireland. Of note, the current Irish Women’s Health Action Plan of 2024/2025 lacks any clear mention of menstrual pain beyond recognising it as a common endometriosis symptom (16). Growing interest in endometriosis research and care is a welcome development towards addressing the unmet needs of those with this debilitating condition, estimated globally at 1 in every 10 individuals who menstruate (27). From the perspective of under-managed menstrual pain, however, there is concern that the scope of Ireland’s national action plan is too narrow. Though not identified in the plan, other conditions that might cause painful periods, such as PMOS and adenomyosis, are not uncommon and can also cause substantial disruption to daily life (29,30). Recent estimates for PMOS suggest that 10-13% of individuals with a menstrual cycle are affected by it (3). Moreover, a sole focus on endometriosis in Irish health policy also ignores the fact that many of the conditions contributing to painful periods, as well as other debilitating symptoms, may occur together (31). Co-occurrences of conditions can require more complex care structures to suit patient needs (32). Future iterations of the Action Plan would benefit from outlining clear steps to meet demand for care for lesser-represented conditions causing painful periods, such as PMOS and adenomyosis, in light of their prevalence, burden on the individual, and their care needs being separate from that of endometriosis.
Menstruation is missing from education
In Ireland, menstruation is taught under the relationships and sexuality (RSE) portion of the Social, Physical and Health Education (SPHE) programme and delivered in primary and post – primary schools (33). However similar to international experiences, this education can be limited or insufficient (34, 35). Crucially, in the 2018 review by the National Council for Curriculum and Assessment (NCCA) of the RSE education delivered in schools across Ireland, there was no mention of menstruation. As a result, this review has led to an update in RSE specifications or guidelines for teachers. The updated primary cycle specifications outline learning outcomes of third and fourth class to include learning about the stages of pregnancy, and for 5th and 6th class students to ‘understand sexual intercourse, conception, pregnancy and birth’ (36).Menstruation is noted briefly as a change that can occur during puberty, alongside pubic hair, facial hair and voice changes. The senior cycle specifications do not have any reference to menstruation (37). The updated 2023 specifications for the Junior Cycle mention menstruation once, in the context of reproductive health and fertility (38). There are no formal guidelines for teachers to help them explain what menstruation is, what is a typical experience, and, importantly, what is not, and how to seek help. In reality, most information about menstruation is passed from mothers and caregivers to younger women (39,40). Whilst there are benefits to these more informal avenues, any stigma experienced by family members or trusted caregivers may contribute to normalisation of pain amongst younger generations (41).
The most recent efforts made by the Department of Education and the Health Service Executive (HSE) to tackle the lack of education include the MISE programme highlighted above (28). Whilst this is a worthwhile effort to increase menstruation knowledge across schools, workplaces and sports clubs, there is a need to also emphasise other chronic and/or gynaecological conditions causing women in Ireland to suffer. There is a need for education that will inform women when they should seek help for their menstrual pain, not only in the context of endometriosis. The onus should not be solely on the patient to recognise, diagnose and decide on appropriate treatment for menstrual pain. However, many women with symptoms and experiences of menstrual pain are dismissed by primary care practitioners, including general practitioners (GPs) (41). This dismissal may reflect the normalisation of menstrual pain and related stigma, rather than the denial of the experience (41). Primary care practitioners represent an essential element of women’s health in Ireland, yet much of women’s health training is optional (42,43). Thus, menstrual health can still be viewed as a ‘specialist’ area, despite dysmenorrhea being one of the most common gynaecological concerns for menstruating individuals (2). GPs are the first port of call for many individuals suffering and act as the gatekeepers to specialist referrals. Adequate menstrual education needs to be central to an updated Women’s Health Action Plan to address these gaps present across primary, post primary and undergraduate levels. This may work closely with stigma reduction efforts and ultimately help to inform people when they may need to seek healthcare. Importantly, it will enable healthcare providers to accurately recognise and treat the variety of conditions that can cause menstrual pain.
Conclusion & Policy Implications
Menstrual pain is a very common experience among girls, women, and all individuals who menstruate. Despite its prevalence and impact, we are urgently lacking services and support for those who suffer. This is due to many factors, including widespread menstrual stigma, a lack of targeted education for public and professionals, as well as a narrow focus on the realities of menstrual pain.
Menstruation remains a taboo subject across many settings, leading to the concealment and normalisation of pain, and which may stop people from discussing their symptoms with healthcare providers altogether. Education in Ireland’s school system does not emphasise menstruation and related phases of health, like menopause, but focus more so on sex and pregnancy. This leaves many unclear of what a ‘normal’ period is supposed to feel like; the lack of open discussion in this formal educational setting may exacerbate the stigma experienced socially. Pain is commonly treated by doctors, however, GPs in Ireland do not receive specific training on the menstrual cycle. As just over 50% of individuals in Ireland will experience menstruation, the absence of mandatory training in the Irish healthcare system is a glaring oversight. Thus, patients are forced to be their own educators with limited external guidance, often determining causes and treatment options for their pain. There has been a concerted effort by the Government of Ireland to tackle these issues of stigma, lack of education and awareness, through increasing access to and availability of services and supports, however this is primarily focused on only one cause of menstrual pain – endometriosis. This new focus on endometriosis is a crucial and welcome addition to women’s health policy in Ireland, given unmet needs for care in this underserved population. We strongly encourage more efforts to address the burden of endometriosis in Ireland but also seek greater representation in policy for menstrual pain in general. This includes acknowledging that pain without an underlying cause may also warrant care, as well as pain due to lesser addressed conditions, such as adenomyosis and PMOS.
other causes of menstrual pain that remain unnamed in the Women’s Health Action Plan.
Whilst the Women’s Health Action Plan is a welcome step forward in improving standards for women’s health in Ireland, it’s narrow focus is leaving many Irish women behind. Changes for the next iteration of the Women’s Health Action Plan will benefit from:
- creating educational initiatives that equip individuals before the age of their first period onwards with the necessary knowledge and skills to understand (i.e. to be able to separate conventional views that ‘all periods are meant to hurt’ and their lived experiences of being incapacitated) and manage these symptoms,
- ensuring that menstrual health is not treated as a specialist issue for primary care physicians, but that all are primary care providers are equipped to engage with concerns about painful periods beyond endometriosis,
- expanding funding and care provisions for cases beyond endometriosis or co-occurring with endometriosis.
*This article uses the term womanhood/woman in describing parts of the menstrual experience. We would like to recognize that transgender men, intersex, and non-binary people also experience menstruation and painful periods. “
Acknowledgements
This work was supported by the Scottish Graduate School of Social Sciences under ESRC Grant number: ES/P000681/1.
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