Dealing with Problem Menstrual Bleeding in School

Have you noticed that we don’t usually get squicked out by the sight of a spot of blood on a man’s collar because he’s cut himself shaving? I can also testify if you cut your hand during a dissection because you are inept and out of practice most pupils are enthralled rather than horrified.

Even allowing for the fact that pupils from some cultures might be less comfortable with blood than others, the fact remains that we treat menstrual blood differently. And we treat it differently because it comes from our vaginas and we don’t necessarily want to remind the world, at that point that we have a vagina. Nonetheless, as I am fond of saying, we take our vaginas to work.

All this means that we have a very specific fear of menstrual blood leaking through onto our trousers or skirt, or of staining furniture, or of (and I promise this does happen) it trickling down our legs.

It’s not just perimenopausal women that suffer with unpredictable and heavy periods. It can be an issues for younger women for all sorts of other known and unknown reasons — but it does happen more in peri-menopause, and that’s all to do with our friend the corpus luteum.

If we have enough oestrogen to build up a womb lining (and remember it’s sputtering) and not enough to cause ovulation, then there’s no left over egg capsule to turn into a corpus luteum. And the job of the corpus luteum is to produce progesterone which manages the womb lining.

And at the same time we are probably experiencing intermittently high levels of oestrogen which are building up the womb lining.

You see the problem. The womb lining’s not being managed very well. The signalling that causes menstruation is breaking down. So what it happens it often happens with a vengeance.

It’s always tricky to distinguish between what’s normal and what’s abnormal, because to an extent it’s about what’s normal for you. But as a rule of thumb if you are changing sanitary protection more than every couple of hours, or your bleeding goes on for a couple of weeks you should see a doctor. But equally if it’s either totally weird for you, or it’s messing up your life — see a doctor.

There are two reasons for that — and one of them isn’t that it’ll be better than teaching Year 9 on a Friday afternoon, because it probably won’t be.

Firstly you do need to be sure that nothing nasty is happening. That might be fibroids, or a bit later on in the menopausal transition, polyps. Both need attention.

And they might just be able to help It might be that you consider a coil or even an endometrial ablation where the lining of the womb is removed. It might be that tranexamic acid is an option. Painkillers such as mefenamic acid can also slow bleeding as well as help with pain.

It can take a while to get to the bottom of unpredictable menstrual bleeding. It can take a few goes of trying different things to find the one that works. If investigations mean that some very nasty things such as uterine cancers have to be ruled out, it’s an extremely anxious time for the teacher concerned.

Delaying those appointments is likely to make working difficult, or even impossible for the teacher concerned. This is one of those times when we need the school management to be understanding about medical appointments. It’s a stitch in time thing — the sooner its sorted the sooner we’re back doing our jobs to the best of our ability. And that’s what we all want!

In the meantime schools also need to consider how to make it possible for staff to leave the classroom and sort themselves out in case of an emergency. We might also need to review how long our breaks are and consider how far away from the toilets some classrooms are. It’s also incredibly useful to have spare sanitary supplies in the loos — or to give staff a safe place to keep an emergency change of clothes near the loo.

When I work with schools I help them find ways of managing these problems — and that keeps committed and valuable staff in their jobs and helps prevent the heartbreak of someone bouncing out of a profession they love because they can’t cope with menopause in school.