Women’s Health Education in Schools
Blog Post | 113 KY. L. J. ONLINE | April 24, 2025
Women’s Health Education in Schools
By: Leigha Whitridge, Staff Editor, Vol. 113
Most states mandate some form of age-appropriate sex education in schools.[1] The content of sex education curriculums vary greatly across states.[2] The topic of menstruation is generally incorporated into these curriculums,[3] but not all menstruation education curriculums are created equal. Few states mandate menstruation education,[4] while even fewer incorporate education on menstruation management or abnormal menstruation.[5]
Variation between schools makes it difficult to know what students learn across the country.[6] Menstruation is commonly treated as a pregnancy risk, rather than a “normal and healthy biological process.”[7] Women have reported not feeling prepared for menstruation[8] and noted that sex education failed to provide practical information on what a healthy menstrual cycle should look like.[9] Schools should address this lack of knowledge by providing more extensive menstruation education.
The inherent tension between the roles of parents and schools in educating students is one challenge to menstruation education.[10] Many states offer “opt-out” policies that allow parents to shield their child from these curriculums.[11] Leaving discussions of menstruation solely to parents may result in “misinformation.”[12] A parent’s education and personal beliefs can affect the accuracy of information shared with their children.[13] On the other hand, some parents are uncomfortable discussing menstruation and prefer that their child learn about it from school.[14]
Because of challenges posed to menstrual education, sex education may result in misconceptions about what is “normal” and a lack of understanding of one’s own body.[15] Women who experience cramping, headaches, and other symptoms related to menstruation believe their symptoms are normal or are told they are “exaggerating.”[16] Severe pain during menstruation is not normal, but many women are unaware of this.[17] Unfortunately, some women gain an understanding of their menstrual cycle only after facing severe pain or struggling to conceive.[18]
Endometriosis highlights why greater menstruation education is needed. Endometriosis is an inflammatory condition where tissues like the uterus lining grow outside the uterus.[19] Symptoms include severe cramping, back pain, painful bowl movements, fatigue and infertility.[20] On average, it takes four to five doctors and ten years to diagnose.[21] While endometriosis affects one in ten women,[22] it is typically diagnosed with a seven year delay.[23] The normalization of period pain causes this delay since “[m]enstruation pain is the only pain that we as humans accept as normal…the pain of endometriosis is too often underappreciated and underrecognized by” heath care providers, patients and families.[24] Similar concerns follow from other endocrine disorders, like polycystic ovary syndrome (PCOS).[25]
There are clear gaps in understanding menstrual health, some of which are attributable to a lack of menstrual education and normalization of period-related pain.[26] In 2022, D.C. was the first jurisdiction to implement legislation defining specific menstrual health education standards.[27] The curriculum discusses “symptoms of menstruation-related health conditions, including endometriosis, fibroids, premenstrual syndrome and [PCOS].”[28] Importantly, students are taught independent menstrual management and how “family, peers, and healthcare providers might support or hinder” healthy menstrual management.[29]
States should enact similar legislation requiring schools to incorporate comprehensive menstruation health curriculums that discuss symptoms of menstruation-related health concerns. These health concerns impact many women,[30] so schools should prioritize identifying signs of abnormal menstruation and how to seek medical treatment. Women should be equipped to take an active role in their health and to be prepared to seek multiple opinions in search of medical treatment without doubting their pain.
[1] Keerthi Bhoda, Sara Burgoa, Yasmine Zerrouki, Vama Jhumkhawala, Diana Lobaina, Michelle Knect, Panagiota Kitsantas & Lea Sacca, Examining Menstrual Health and Hygiene Educational Initiatives for American Middle and High School Menstruating Students: A Scoping Review, 37 J. Pediatric and Adolescent Gynecology 465, 465 (2024).
[2] See Nat’l Conf. of State Legislatures, State Policies on Sex Education in Schools, https://www.ncsl.org/health/state-policies-on-sex-education-in-schools (Oct. 1, 2020).
[3] See Bhoda, Burgoa, Zerrouki, Jhumkhawala, Lobaina, Knect, Kitsantas & Sacca, supra note 1; Margaret L. Schmitt, Caitlin Gruer, Christine Hagstrom, Nana Ekua Adenu-Mensah, Azure Nowara, Katie Keeley & Marni Sommer, “It Always Gets Pushed Aside:” Qualitative Perspectives on Puberty and Menstruation Education in U.S.A. Schools, Frontiers in Reprod. Health, Oct. 24, 2022, at 1.
[4] Bhoda, Burgoa, Zerrouki, Jhumkhawala, Lobaina, Knect, Kitsantas & Sacca, supra note 1, at 475.
[5] Schmitt, Gruer, Hagstrom, Adenu-Mensah, Nowara, Keeley & Sommer, supra note 3, at 2.
[6] See id. at 1.
[7] Id. at 2.
[8] Id.; Sadie Bergen, Erin D. Maughan, Karen E. Johnson, Robin Cogan, Molly Secor & Marni Sommer, The History of US Menstrual Health, School Nurses, and the Future of Menstrual Health Equity, 114 Am. J. Public Health 903, 906 (2024).
[9] Schmitt, Gruer, Hagstrom, Adenu-Mensah, Nowara, Keeley & Sommer, supra note 3, at 7.
[10] Id. at 4.
[11] See Sexuality Information and Education Council of the United States, Opt-In vs. Opt-Out: Sex Ed & Parental Consent, 1 (2018).
[12] Schmitt, Gruer, Hagstrom, Adenu-Mensah, Nowara, Keeley & Sommer, supra note 3, at 5.
[13] Id. at 4–5.
[14] Id.
[15] Dana Alloy, Closing the Female Health Education Gap, The Helm (Sept. 14, 2021), https://thehelm.co/closing-the-female-health-education-gap/; Francesca Rosa, The Systemic Problem with the Lack of Education in Women’s Health and Its Consequences, FemTech (May 19, 2022), https://femtechnology.org/2022/05/19/the-systemic-problem-with-the-lack-of-education-in-womens-health-and-its-consequences/.
[16] Alloy, supra note 15.
[17] Id.
[18] Id.
[19] Isabella Backman, Endometriosis, Yale Med. Mag., https://medicine.yale.edu/news/yale-medicine-magazine/article/endometriosis/ (last visited Apr. 17, 2025).
[20] Id.
[21] Id.
[22] Id.; Rosa, supra note 15.
[23] Rosa, supra note 15.
[24] Backman, supra note 19.
[25] For further discussion on PCOS, see Onchee Yu, Jacob P. Christ, Renate Schulze-Rath, Jennifer Covey, Ann Kelley, Jane Grafton, David Cronkite, Erika Holden, Jan Hilpert, Frank Sacher, Elizabeth Micks & Susan D. Reed, Incidence, Prevalence, and Trends in Polycystic Ovary Syndrome Diagnosis: A United State Population-Based Study from 2006 to 2019, 229 Am. J. Obstetrics and Gynecology 39, 39 (2023); NYU Langone Health, Diagnosing Polycystic Ovary Syndrome, https://nyulangone.org/conditions/polycystic-ovary-syndrome/diagnosis (last visited Apr. 10, 2024); Melanie Gibson-Helm, Helena Teede, Andrea Dunaif & Anuja Dokras, Delayed Diagnosis and a Lack of Information Associated with Dissatisfaction in Women with Polycystic Ovary Syndrome, 102 J. Clinical Endocrinology & Metabolism 604, 608 (2017).
[26] See Schmitt, Gruer, Hagstrom, Adenu-Mensah, Nowara, Keeley & Sommer, supra note 3, at 2; Rosa, supra note 15; Alloy, supra note 15; Backman, supra note 19.
[27] Trinity Klomparens, DC Schools Will Have Specific Menstrual Health Education Standards in the New School Year, WUSA9 (June 21, 2023, 2:18 PM), https://www.wusa9.com/article/news/education/first-jurisdiction-with-menstrual-health-standards/65-f4cab1eb-1e7e-4a3d-ad7f-0f19d298538c.
[28] Off. of the State Superintendent of Educ., DC Menstrual Health Education Standards, 6 (2022).
[29] Id.
[30] See Ghalia M. Attia, Ohood A. Alharbi & Reema M. Aljohani, The Impact of Irregular Menstruation on Health: A Review of the Literature, Cureus, Nov. 20, 2023, at 1.