If you have a uterus, you are likely aware that periods can be inconvenient and uncomfortable at times. But for many, they can be debilitatingly painful, difficult to manage, embarrassing, or shameful—in other words, traumatic. “I would define period trauma as any sustained psychological, social, or emotional injury/distress related to or caused by menstruation,” says board-certified OB/GYN Charis Chambers, MD, aka The Period Doctor.

In fact, Cece Jones Davis, an Oklahoma-based activist who works for menstrual equity and criminal justice reform, believes the majority of menstruators do experience period trauma—as a result of a patriarchal system that stigmatizes menstruation, de-prioritizes period care, and otherwise discriminates against those who menstruate.

Still, period trauma affects Black menstruators disproportionately, with significant consequences that emerge early and persist throughout the reproductive years. This needs to change, but it requires efforts on many fronts. Below, an exploration of the factors contributing to period trauma for this demographic—as well as what can be done to ensure healthier, happier menstrual futures.

Why period trauma can be worse for Black menstruators

Why do Black menstruators experience more period trauma? For starters, they may be more prone to certain reproductive health issues than other demographics. It’s a well established fact that they have a higher susceptibility to fibroids—9 in 10 develop them before the age of 50—which cause more painful, heavier periods, says Dr. Chambers. “The fibroids piece, albeit just one specific disorder, is actually a large piece of how Black women interact with and navigate their reproductive years,” she says. Black people with uteruses are just as likely, meanwhile, to have endometriosis as white people with uteruses; however, they are less likely to be diagnosed with it, which has led to the misconception that they are less prone to the condition. As a result, they may suffer for longer periods of time without treatment.

Despite experiencing this potentially more intense pain and heavier bleeding than their peers, Black menstruators may be socialized to under-report period issues, too. To begin with, Dr. Chambers points out that if your mother had fibroids, and her mother had fibroids, you might inherit a skewed perspective of what a “normal” period is. “Maybe the idea has been that periods are just tough, that they’re something to be endured rather than treated and diagnosed,” she says. And while not all Black Americans are descended from slaves, Dr. Chambers notes that those who are may have inherited silence around period pain because such silence may have contributed to survivorship for their ancestors. “We have not been a culture that could afford to be perceived as fragile,” Jones Davis says in agreement.

“We have not been a culture that could afford to be perceived as fragile.” —Cece Jones Davis

In some Black family cultures, Dr. Chambers further notes, menstruation is simply considered a private ordeal that’s not to be discussed, even among family. This can also lead to under-reporting of issues. “The cross-generational lack of discussion is huge,” she says. “Moms don’t necessarily discuss their difficulties with their daughters—not really understanding that they are doing a disservice because their daughters sometimes have to repeat the same experiences.”

Jones Davis circles back to those patriarchal perceptions of menstruation—that it is “dirty” or “unclean”—as a source of trauma, too, and says marginalized groups are impacted by this mindset the most. “Up until now, a lot of our work as African-American women and girls has been to be respectable, and to be as tidy as humanly possible,” she explains. She notes that because period stigma specifically compounds biases against Black women and girls, it can be even more difficult for this demographic to form healthy relationships with menstruation than it is for other women. In other words, periods make Black uterus-owners feel disproportionate shame.

Fear also plays a role. Black menstruators may also avoid seeking treatment for their period pain because of historical malpractice. Our country, for example, has a dark history of forcing sterilization on Black women without their consent. “One of the instances that I can recall is something called the Mississippi appendectomy, which was when women were told initially that they were getting their appendix removed, and they were actually being sterilized,” Dr. Chambers says. “There are a number of scenarios where there are truly medical crimes against black women that equal stolen fertility. So there’s a huge hesitation to address period issues, because a lot of the treatments and surgical options have previously been tied to medical crime.” That distrust in doctors also factors into why some Black people with uteruses opt out of less permanent treatment options for period discomfort, such as the birth control pill. “I need to reassure and reassure again that there are studies that prove [birth control] does not impact future fertility,” Dr. Chambers says.

“When the health-care system discriminates against you from the moment you’re born to the moment you die, every aspect of your life is affected by the fallout.” —Jenn Conti, MD

Even if Black people could forget the dark history of their abuse within Western medicine, they wouldn’t be protected from modern bias. “BIPOC people in this country absolutely receive suboptimal healthcare across the board, not just in women’s health,” says OB/GYN Jenn Conti, MD, co-author of The Vagina Book: An Owner’s Manual for Taking Care of Your Down There. “This is a byproduct of systemic and institutional racism that prioritizes white bodies as the default.”

While this affects the treatment Black people receive in myriad ways, Dr. Chambers points to one in which it can specifically exacerbate the trauma of periods. A well-known study, she says, showed that medical students and trainees consistently believed that Black women felt less pain than white women. “If you believe a group of people is more resilient to pain, you don’t take their pain as seriously,” she says. This phenomenon can then result in delayed diagnosis and treatment.

And as mentioned above, bias also leads to the prescription of more radical, irreversible treatments (e.g. hysterectomies) for Black people with uteruses. Dr. Chambers says that doctors may look at certain factors, such as a woman’s lack of insurance or a partner and base their recommendations on those factors, rather than on whether or not the patient wants to have more children in the future. “When the health-care system discriminates against you from the moment you’re born to the moment you die, every aspect of your life is affected by the fallout,” says Dr. Conti. “There is no limit to the trauma this causes.”

On that note, Jones Davis also notes that Black menstruators in America may not have adequate access to the health care needed to treat period trauma due to affordability issues. As of 2018, the uninsured rate for African Americans was nearly double that of white Americans—and this was pre-pandemic, which has disproportionately affected the livelihoods (and therefore, the insurance coverage) of Black workers.

Finally, it’s worth noting that low-income individuals in the United States have reduced access to tampons and pads, and that due to the effects of systemic racism, nearly one-quarter of all Black Americans live in poverty. Not being able to afford to contain your period flow isn’t just uncomfortable, either. According to a Harris Poll commissioned by Thinx and PERIOD, four in five students missed school or knew someone who did due to lack of access to period products alone.

How period trauma affects the lives of Black women

Quality of life is undeniably reduced by ongoing period trauma, which can last decades, but there are other consequences, too. All those missed days of school, for example, add up. “A lot of girls, when they’re missing school, tend to miss about one to two days a month,” says Dr. Chambers. This equates to about 24 days a year, which is no small thing. “It’s a big deal socially, academically, athletically,” she says.  Missing so much school is not just a momentary disadvantage, either. In a race that’s already rigged against them, it can put Black girls even further behind their white peers, says Jones Davis, who notes the significant wage gap between men and women. (There’s a notable wage gap between white women and Black women in America, too.)

Dr. Chambers also points out that period trauma can can make it difficult to have what she terms a “warm” relationship with one’s uterus, which might make people hesitant to call upon their reproductive system in the future. “Understanding that pregnancy is using the same resources and organs as your period, and could likely cause an even bigger trauma—especially as we acknowledge the higher rate of Black maternal mortality—definitely weighs on women,” says Dr. Chambers. “It can lead to depressive feelings, if not overt depression.”

What’s needed to ease the burden of period trauma on Black menstruators 

The issues contributing to period trauma in Black menstruators are complex, and there are no simple solutions or quick fixes. According to Dr. Chambers, however, a critical place to start is with education. “There are so many sources of period stigma, and then there’s just pure ignorance—people just making things up about periods and not having access to the education that [menstruation] is normal,” she says. “A lot of it has to be addressed socially, and also religiously—there’s a lot of religious language about menstrual cleanliness [that can negatively impact girls and women].”

Another way to address the inequity of period trauma is by increasing diversity in the medical establishment. Davis Jones believes that having a Black female doctor would significantly improve the level of care a Black woman or girl receives, but according to Dr. Chambers, Black women only make up two percent of practicing physicians. As a result, this care can be difficult to access, and more Black female doctors aren’t going to surface overnight; however, startups like Health In Her Hue are trying to help those currently practicing connect with patients who look like them.

Getting more Black women into medicine isn’t the only answer.

Getting more Black women into medicine isn’t the only answer, however; as Dr. Chambers adds that the onus shouldn’t be on Black providers like herself to educate non-Black doctors on the needs and struggles of Black patients. “It’s suggested [that] by putting a Black physician in a space, I’m absolving myself of the need to improve cultural competency of the other parties present,” she says. “Everyone needs to do better—the curriculum across the board needs to improve.”

It’s also crucial to improve access to period care products, says Jones Davis. “Making sure girls feel like they have adequate access to pain medication and sanitary products so they can go about their days as positively and normally as possible is a barrier we can challenge and address,” she says, noting that this needs to be achieved through policy. To support this cause, you can throw your weight behind the Menstrual Equity for All Act (H.R. 1882), which was introduced in the House in 2019 and would, if passed into law, improve access to period products for students, inmates, the homeless, and more. You can also support efforts to eliminate tampon taxes, which still exist in 30 states.

Finally, Dr. Chambers notes that Black menstruators need access to another form of health care, too. “I believe period trauma that significantly impacts daily life or impairs daily function should be addressed with a mental health expert or therapist in addition to getting proper care and education from a gynecologist,” she says. Cost remains an issue, though some organizations such as The Loveland Foundation are working to make mental health care more affordable specifically to this demographic.

For people who are suffering from extreme period pain or trauma, Dr. Chambers urges them to seek out the help they need—even if it takes multiple tries. “Get another provider, get a second or third opinion, because you don’t have to suffer through periods,” she says. “You just don’t. Not with the medications and medical innovations that are available.” There is already so much pain in the world. Periods should never be another source of that pain—and it’s on all of us to change that.

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