Screening Teens, Clinicians Discover a Tampon Access Crisis

Asking teenage girls about their access to menstruation products can help pediatricians gain a better understanding of the resources their patients need, whether it be more education or pads and tampons, according to a new study published in Pediatrics.

An academic pediatric clinic in North Carolina implemented a three-question screener inquiring if teens had problems acquiring products to manage their periods, such as pads and tampons. Researchers found 1 in 10 of 73 girls had these issues.

Some girls reported they resorted to using toilet paper as menstrual pads or missed school because they were worried about bleeding through their clothing.

Clinicians who screened the teens reported that patient responses were sometimes surprising and opened dialogue for broader conversations about menstrual health.

“I was surprised: I feel like, 30%…of my teens have screened positive, and sometimes even just the period poverty screener itself makes me probe a little bit more on questions,” said one clinician involved in the study. “And even if they’re not positive on the screener, sometimes they’ll realize they really actually don’t have the things that they need.”

The study took place in 2022 during well visits at Atrium Health Wake Forest Baptist’s Downtown Health Plaza Pediatric Clinic in Winston-Salem, North Carolina, with a patient population with mostly Medicaid coverage. Teens were also asked if they had ever missed school (7%) or experienced anxiety because of their period (10%).

Girls who answered yes to any of the questions received a bag of menstrual supplies and information about where to obtain additional free products. The clinic partnered with a local chapter of The Period Project, a nonprofit aimed at eliminating menstrual poverty.

The North American Society for Pediatric and Adolescent Gynecology in 2022 called for clinicians to ask their patients about access to menstrual products, educate them about menstruation, and speak openly with girls about their periods.

A recent study found that 1 in 3 girls who visited an emergency department in Washington, DC, said they were unable to afford supplies or had to use cloth, toilet paper, tissues, or rags as alternatives.

Girls who struggle to afford supplies may “resort to using products beyond their recommended use,” which increases their risk for toxic shock syndrome, said Tambu Kudze, MD, a pediatric and adolescent gynecologist at Harborview Medical Center in Seattle, who was not associated with the study.

The use of items like cloth or toilet paper can also increase the risk for vulvar irritation, poor hygiene, and infection, Kudze said.

However, asking questions about access to menstrual products is not a widespread clinical practice, said Callie Brown, MD, an associate professor of pediatrics at Wake Forest University School of Medicine in Winston-Salem, North Carolina, and senior author of the study.

“I would say honestly that some of these teens lack understanding for their menstrual cycles in general, and not understanding that it can be irregular, and how much they need to use pads and tampons,” said one clinician. “Sometimes, they’re using them inappropriately, so the education part has been an issue for some kids.”

Kudze said that written questionnaires could easily be integrated into clinical practice and might help patients disclose their struggles.

“One of my biggest takeaways from the study is we can ask these questions, but it’s important to then have the resources,” Kudze said. “You can’t just say ‘I’m sorry that you don’t have pads’ and then leave it there.”

Kudze and Brown reported having no disclosures. The study was independently funded.

Brittany Vargas is a journalist covering medicine, mental health, and wellness.