Informational needs related to menstrual literacy among Dutch women: a focus group study

Abstract

Background

Menstruation remains a taboo topic that is rarely discussed openly, even though nearly half of the world’s population experiences it. Studies have shown that women wish to have more information about menstrual care worldwide. It is therefore crucial to break the taboo and support women in their quest for information. This study aims to investigate informational needs related to menstruation among Dutch women, in order to improve menstrual literacy.

Methods

A qualitative exploratory design with focus group discussions was used. Participants were recruited at the gynaecology outpatient clinic of Máxima MC and through social media posts. A total of 24 Dutch women (aged between 20 and 62 years), who currently menstruate or have menstruated, participated in three focus group discussions. A thematic analysis was used to analyse the data.

Results

Participants indicated that schools or family members had not provided them with sufficient information about menstruation prior to their menarche. This lack of information resulted in shame, taboos, and bullying. Furthermore, difficulties in communicating about menstrual complaints with friends, family and medical professionals were reported, resulting in a lack of information about which complaints are normal and when to seek help. Participants suggested creating an easily accessible online platform, categorized according to life stage (for example, menarche, midlife, towards menopause).

Conclusions

This qualitative study shows that Dutch women perceive information regarding menstruation as inadequate. It is recommended to re-evaluate menstrual education in school and combining information in one practical, patient-oriented website. For clinicians, it is important to realize menstrual knowledge of patients may be minimal and thus to support their patients in accessing reliable sources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-025-03694-3.

Background

Menstrual literacy refers to an individual’s understanding of the menstrual cycle and their ability to acquire, comprehend and apply menstruation-related information when making health-related decisions which is essential for achieving menstrual health [1–3]. Despite its importance, menstrual literacy remains low worldwide, often leading to delayed medical help-seeking behaviour and reduced quality of life [4].

The lack of menstrual literacy, along with stigmatization and taboos, contributes to gender inequality [5]. Open discussions about menstruation with relatives or professionals are often challenging, and secrecy further impedes proper medical diagnosis and treatment [1, 3, 6, 7]. This issue has far-reaching societal implications, such as absenteeism from work or school and a diminished quality of life for women [8–10]. Addressing menstrual literacy is critical to empowering women and reducing the adverse effects of untreated menstrual complaints.

Research on menstrual health literacy across low- and middle-, and high-income countries (LMICs and HICs) has revealed varied findings [5, 8, 11, 12]. In LMICs, menstrual health challenges primarily revolve around adverse effects of inadequate menstrual hygiene management and cultural taboos [12, 13]. While interventions are mostly aimed at improving menstrual hygiene, they rarely address knowledge gaps about menstrual health disorders [14]. A recent study in India shows a positive correlation between hygienic use of menstrual products and educational levels of women, showing that improving education may help to improve menstrual hygiene [15].

In HICs, menstrual health concerns are more frequently associated with pain management, delayed diagnosis of menstrual disorders and the implications for long-term health outcomes [12]. For example, dysmenorrhea, a possible indication of endometriosis, is known to greatly affect quality of life and is frequently accompanied by other distressing symptoms like mood changes and fatigue, resulting in a considerable impact on academic performance for young women [16–18]. Nonetheless, many women normalize pain and are hesitant to look for help. This highlights the need for effective menstrual health information to improve menstrual literacy and facilitate early diagnosis of menstrual disorders.

Recently, educational resources and support groups have shown promise in improving menstrual health awareness among adolescents in HICs [12]. However, these initiatives largely target younger populations, leaving significant gaps in menstrual literacy among adult women [12]. Furthermore, existing interventions tend to provide general health information, rather than addressing the nuanced challenges women face in managing menstrual health, such as identifying when symptoms indicate a medical issue and when to seek professional help. The normalization of menstrual pain across LMICs and HICs often leads to delayed medical consultation and late diagnoses. This gap is evident in The Netherlands where, despite access to healthcare, 75% of women remain unaware that heavy menstrual bleeding is a treatable condition [19]. This suggests that current efforts are insufficient in effectively disseminating relevant menstrual health information, highlighting the need for further investigation.

This study seeks to address the following questions:

• What are the informational needs related to menstruation among Dutch women?

• How can these needs be met to improve menstrual literacy?

By investigating these questions, this study aims to provide actionable insights for improving menstrual literacy. The findings could inform policy-makers and healthcare professionals on more effective menstrual health education, ultimately empowering women to make informed health decisions and enhancing their quality of life [5].

Methods

Study aim and design

To explore informational needs concerning menstrual literacy among Dutch women, a qualitative exploratory design with focus group discussions (FGD) was used. This approach was chosen for this study, as FGDs allow for in-depth exploration of informational needs through dynamic discussions and interaction between participants, enabling them to build on each other’s experiences. Additionally, FGDs can reveal social and cultural influences that shape menstrual literacy, which might not emerge in other qualitative research methods such as one-on-one interviews. We used the Consolidated Criteria for Reporting Qualitative health research (COREQ) [20]. This study is part of the research project “Menstrual Narratives”.

Participants

To recruit a population that is as diverse and representative as possible, all women menstruating or those that have menstruated were eligible to participate. Inclusion criteria were age ≥ 16 years at the time of enrolment and ability to speak and understand Dutch. To ensure a range of perspectives, efforts were made to include participants from various age groups and socio-economic backgrounds, as these factors may influence menstrual literacy and access to health information. Convenience sampling was used. Gynaecologists, medical students and nurses at Máxima MC recruited patients, all eligible patients were asked to participate. Additionally, social media platforms (Facebook, WhatsApp and LinkedIn) of the researchers, gynaecologists and two menstruation-awareness organizations were used to recruit women. Information sheets were disseminated to potential participants, followed by telephone consultations led by a researcher (EL, female medical student) to inquire interest in participation. To collect a variety of experiences and opinions, three FGDs were organized with each six to eleven participants [21]. Allocation occurred in chronological order and based on the availability of the participants.

Data collection

Prior to the FGD, participants completed an online questionnaire to collect baseline characteristics (for example education level, symptoms of menstruation, ethnic background).

A discussion guide was drafted to facilitate conversation (see Additional file 1). A literature review combined with input from the research team based on their intuition and clinical experience, shaped the themes and questions included in the discussion guide. The discussion guide was structured according to three main topics: (1) initial information regarding menstruation; (2) current utilization of menstrual health information and preferences; (3) evaluation of five examples of Dutch online informational sources. For the last topic, five Dutch websites related to menstruation were presented: an informational website (https://sense.info/nl/je-lichaam/meisjeslichaam/menstruatie), two medical websites (https://www.mmc.nl/gynaecologie/aandoeningen-en-behandelingen/hevige-menstruatieand https://www.thuisarts.nl/ongesteld-en-veel-bloedverlies) and two websites with personal experiences https://www.hevigbloedverlies.nl/ervaringen/ and https://www.menstruatiemeisjes.nl/).

The FGDs were hosted online (Zoom) between January and April 2023 and varied from 1 to 1.5 h. Video- and audiotaping was used to record the discussions. EL moderated the discussion, ensuring structure, participant engagement, and time management. A second researcher (LZ, female PhD student) assisted in note-taking and capturing the tone of the discussion according to the methodology for the conduct of FGD [21]. Together they aimed to create a secure environment, adopting an impartial and receptive stance. To ensure comfort and openness among participants, clear ground rules were established regarding confidentiality, respect, and non-judgment. A safe environment was fostered by building trust early in the process and promoting open dialogue. Both researchers had no relationship or connection with the participants.

Data analysis

After the third FGD, recordings were transcribed verbatim (EL). A thematic analysis was used. Analyses followed an iterative process, where data collection and analysis alternated. ATLAS.ti Mac (Version 23.1.0) software was used for the analyses [22]. Transcripts were coded and analysed using the six steps of thematic analyses described by Braun & Clarke [23]. These steps are: familiarization with the data, generating initial codes, searching for themes, revising themes by creating a code tree, defining themes and transforming the results into a report [23].

Rigor

To enhance credibility, dependability and confirmability two researches coded the transcripts independently (EL, LZ) and subsequently compared and discussed their coding. The transcripts were re-reviewed several times by both researchers (EL, LZ), making sure all themes were defined. Quotes were used to support the themes. These were translated from Dutch to English by the researchers (EL, LZ) and checked by a native English speaker. A Dutch summary of the findings was sent to the participants as member check [24].

Ethical considerations

All participants participated voluntarily and informed consent was obtained digitally prior to the FGD. Restricted access to the data and de-identification of transcripts was ensured to assure confidentiality. The Medical Ethical committee of Máxima MC has reviewed the research protocol (reference no. N22.041, June 17th, 2022) and confirmed that the Medical Research involving Human Subjects Act (WMO) does not apply to our study.

Results

In total, 54 women received information about the study (Fig. 1). 24 Dutch women agreed to participate in the three focus group discussions (n = 11, n = 6, n = 7). Demographic characteristics of the participants are presented in Table 1, below. All participants were female with a mean age of 33 years (SD = 12.02).

Fig. 1.

Recruitment process

Table 1.

Baseline characteristics of participants

Participant	Age	Country of birth	Level of education [25]	Self-reported complaints during menstruation (scale 1–5)*	Visited doctor for menstruation (complaints)
1	24	NL**	High	5	Yes
2	20	NL	High	4	Yes
3	21	NL	Medium	3	No
4	24	Unknown	High	2	No
5	28	NL	Medium	3	No
6	56	Unknown	Medium	5	No
7	37	NL	High	4	Yes
8	38	Other European country	Medium	3	Yes
9	43	NL	High	3	Yes
10	34	NL	High	3	Yes
11	52	NL	Medium	4	Yes
12	48	NL	High	4	Yes
13	43	NL	High	3	Yes
14	24	NL	High	2	No
15	24	NL	High	4	Yes
16	22	NL	High	5	Yes
17	21	NL	Medium	2	No
18	37	NL	High	3	Yes
19	25	NL	High	5	Yes
20	22	NL	High	3	Yes
21	33	NL	High	3	No
22	62	NL	Medium	3	No
23	41	NL	Medium	2	Yes
24	24	NL	High	3	No

* Scale: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always; ** NL = The Netherlands

Based on the thematic analysis, four main themes were derived: “initial information is not sufficient”, “lack of information upholds the taboo”, “need for recognizable and practical information” and “preference for one online platform”. These themes will be described in the following sections and illustrated with quotations from the focus group discussions.

Theme 1: Initial information is not sufficient

Most participants initially received information about menstruation solely from female family members, in particular from mothers or sisters. However, satisfaction with this information diverged. Some women described this source of knowledge as sufficient, and valued being able to recognize their experience in the stories of family members. Others, mentioned the information was too subjective.

“Because I did have my mother and sister, of course, but they also only have their own experiences and how things went for them and what symptoms they had.” (participant 9).

Moreover, some participants received information at school. None of them described this information as sufficient, partly due to wrong timing and unsatisfactory content. Information was often provided after girls had their menarche or the ‘standard biological story’ about hormones in the menstrual cycle was discussed. Participants missed information about practical tools and differences between individuals in symptom presentation. However, all participants found it important that information is provided at schools. It was noted that factors like cultural background, openness in communication and family structure strongly influence the quality of information received at home. Information at school could ensure everyone receives the same basic information.

“I think that school is truly very important. Also for individuals with difficult home situations. For example, those with only a father. And I also noticed with my own mother that she had very little information herself, or at least too little. And I think that school is a very important factor in those cases, particularly in providing that information.” (participant 15).

Theme 2: Lack of information upholds the taboo

Lack of sufficient information results in shame and taboo according to many participants. Participants described that – especially at younger age - the lack of information provoked bullying.

“I also remember from primary school that one girl was the first to have her period. She was kind of teased about it, because no one really knew what it was. This made everyone act like they considered it gross and strange.” (participant 14).

Most participants particularly experience a knowledge gap between women and men, mainly due to ignorance and a lack of interest from men. They noted that as a result it is difficult for men to understand what it is like to have your period. Some women experienced difficulties in social settings or at work because of this lack of compassion. As a result many participants indicated that discussing menstruation was easier with other women than with men. Nevertheless, participants still expressed having difficulties discussing menstrual complaints with others. They still face challenges in understanding which complaints are regarded normal. As a consequence of this lack of openness, several participants waited long before visiting a medical doctor.

“Yes, what I especially missed is also hearing from others how burdensome it can be. I myself often struggled with it in the past, and I happened to be in a group of friends where that wasn’t the case. And only later did I realize that its quite burdensome for many others.” (participant 24).

Theme 3: Need for recognizable and practical information

In all FGDs, participants mentioned having difficulties finding adequate information, due to the extensive quantity of available information. Participants agreed that this leads to more questions and insecurities, rather than that answering their questions.

“You come across a lot of information, and one thing contradicts the other. And of course, that’s often the case on the internet, so as a result, you can’t really draw a solid conclusion from it yourself.” (participant 20).

When participants sought professional help for their questions, some participants experienced dissatisfaction with the results. For example, several participants expressed feeling like they were sent away with the oral contraceptives to alleviate their symptoms instead of having the cause of their complaints thoroughly investigated.

Many participants expressed that they missed information categorized per life phase. Informational needs for a teenager may differ from those of a middle-aged woman.

“So, it’s quite phase-dependent, because indeed many young people start taking the pill at some point. (…) At that point, you’re looking for different information than when you first start menstruating. I also don’t know if when you approach menopause, does it change again? What can you expect then? There are quite a few milestones where there will be real changes, and when you’re really look for different information. Or at least you have different information needs.” (participant 10).

Furthermore, participants would also like to receive more information about the varying degrees of complaints and its impact on daily life. Since talking about menstruation and its associated complaints can be difficult, it would help if information about varying experiences of menstruation and their impact were easily accessible.

“And also that emphasis is placed on the differences in terms of distressing experiences, as well as the ages at which it starts. So that as a young girl, you already know: okay, if I have more or less discomfort than my friends, or if I start earlier or later, that’s also normal. So that from the beginning, you already know that there are a lot of differences in that.” (participant 19).

Additionally, most participants agreed that it would be appreciated if a clear distinction between normal and abnormal complaints could be easily found.

“Of course, you can find a lot on the internet as well; about what constitutes a normal cycle and more theoretical explanations. But at the end of the video, you’re still left thinking: what should I do with this? So, I believe that the more practical aspects, such as when should I do something about it, could be highlighted a bit more” (participant 14).

Theme 4: Preference for one online platform

While discussing the format in which participants would prefer to receive this information, various ideas were raised. Some participants suggested a yearly gynaecological consultation to ask questions and have a general check-up. Others suggested the provision of a physical kit delivered at home, corresponding to different life phases (such as menarche, child wish, pregnancy, menopause) containing information and tools like tampons and sanitary napkins. However, most participants preferred one general website with all information combined and divided into different life phases. Also, specific information for men and people with different cultural backgrounds should be provided.

“If I had to say, and I were looking for information, whether I was young or now, I would simply appreciate having a platform, let it be a website, where I could find everything and receive information in different ways. For example, I could find an audio file, a short story, or a brief video. A website where all aspects of menstruation would come together, including things you could do about it, possible causes, presented in a light-hearted manner.” (participant 24).

In general, participants wished for a resource that combines medical information with tools to recognize alarming symptoms. The tone of voice was highlighted as an important aspect in mitigating fear of serious conditions. Hence, it is crucial to refrain from employing technical jargon. Participants’ opinions about a website with personal experiences differed. Some women were positive and expressed that personal experiences can elicit feelings of acknowledgement and recognition and show the varying experiences at different life stages. Others indicated the risk of unrealistic stories or incorrect advices being told, raising questions about the reliability of the information.

“I don’t like it. Yeah, no, well, sometimes it even makes you a bit scared because there are people who share stories that might be exaggerated or false. Or they give you strange tips that actually lead you in the wrong direction, so I find it very unreliable.” (participant 22).

“That’s what I feel, that’s what I find most important. That’s what I would be looking for. (…) Because you have general information, but when you happen to deviate slightly, it’s comforting to read about others who deviate as well.” (participant 21).

Of the displayed examples of online informational sources, participants preferred the outlining of the Dutch website of Thuisarts.nl, a trusted health information website, designed by the Dutch college of General Practitioners and Federation of Medical Specialists. Participants valued its clear division into subheadings and its structured appearance. Additionally, participants considered the website as reliable, since it is often recommended by general practitioners.

Discussion

This study describes informational needs related to menstruation among Dutch women in order to improve menstrual literacy. Participants expressed that initial information, received at schools or from family members, had not provided them with adequate information about menstruation prior to their menarche. Although the role of mothers in providing this information is significant, our findings highlight the potential variability in quality and sufficiency of this information. Menstrual education in schools was suggested as a solution to ensure high quality of the initial information. Furthermore, our study underscores that a lack of information can increase shame, taboos, and bullying. Participants expressed their difficulties in addressing the topic of menstruation, leading to difficulties for women in determining the legitimacy of their complaints. Consequently, participants wished for recognizable information about what kind of complaints can be regarded as normal and when to seek medical help. They wished for extensive information such as a better understanding of changes of the menstrual cycle throughout life (for example during menarche, fertility, menopause). Lastly, most participants expressed a desire for a website containing patient-oriented information according to different life stages. Perspectives on the value of personal experiences on this platform varied. The tone of the platform was highlighted as a pivotal factor, especially preventing employing technical jargon.

Interpretation

Over the years, mothers have played a dominant role in providing information about the menstrual cycle, offering practical guidance and being supportive [26, 27]. However, their knowledge is often limited to personal experiences, which may lead to misunderstandings [26–28]. Besides, religious and cultural beliefs, among other factors, may influence what is considered acceptable and appropriate knowledge resulting in variation in information provided at home [29]. Therefore, our study underscores a strong desire for implementing comprehensive school-based menstrual education programs to ensure all children with adequate information [1, 30]. Consistent with a Spanish survey, our findings suggest that menstrual education should not solely focus on biological aspects of the menstrual cycle, but rather on recognizing abnormalities in the menstrual cycle, such as signals of adenomyosis, heavy menstrual bleeding and polycystic ovary syndrome (PCOS), and knowing how to address them [1]. This menstrual health curriculum could use age-appropriate content and interactive teaching methods, such as Q&A sessions and digital tools, on basic menstrual symptom management and warning signs of abnormal menstruation [31]. To support this, educators must be trained to address menstrual health sensitively and competently, reducing stigma in the class room. In order to provide evidence-based menstrual health education, collaboration with medical professionals should be sought.

Cultural norms shape menstrual literacy, influencing both the type of information individuals receive and the degree of stigma they experience. For example, in some cultures menstruation is seen as “unclean”, which results in feelings of shame when menstruating [3, 12, 32]. Additionally, a culture of secrecy also exists surrounding the topic. Menstruation is considered a private matter, which should not be discussed, especially not with men. This concealment can result in negative attitudes towards menstruation, gaps in knowledge about the menstrual cycle and recognizing abnormalities. Additionally, this contributes to a lack of knowledge among boys. Participants in our study indicated this gap of knowledge between men and women as problematic. However, at the same time, participants expressed finding it easier to talk to women about the topic of menstruation. Therefore, tailoring menstrual education to cultural contexts is crucial.

In accordance with our study, panel discussions hosted by the United Nations suggest that widespread changes in norms, knowledge, and practices are necessary to minimize the taboo surrounding menstruation [3]. Historically, men have played a significant role in perpetuating taboos and stigma surrounding menstruation, for instance by showing disdain and lack of understanding [32]. By engaging in open and respectful conversations about menstruation, men can provide support to the women and girls in their lives, thereby aiding in the elimination of the taboo [3].

Our study shows the need for practical information about the menstrual cycle conforming findings from a recent Spanish study by Sanchez Lopez et al. [1] Women wished for information on managing pain and menstrual disorders, seeking alternatives beyond (hormonal) contraceptives as their sole solution. Besides, research, similar to our study, indicates that women often feel alone when experiencing symptoms [8]. They consider issues related to menstruation as a common occurrence and not as a medical problem, which results in hesitation to ask for help [33, 34]. Those who do seek medical assistance typically do so when their symptoms become intolerable [33]. In line with this, our study shows that women are longing for guidance in which symptoms should be considered as normal and which symptoms are a reason to seek professional help.

Ultimately, our participants expressed the wish for an online platform with accessible information. These findings align with the evolving landscape of health-related information access, where online sources have outpaced traditional media like printed information and verbal consultation [35]. Despite the fact that most people acknowledge the potential value of the internet as a tool to find health-related information, some concerns must be mentioned [36]. The internet offers a wide range of knowledge ranging from scientifically based and factual information to subjective information, such as personal experiences [37]. Therefore, efficiently addressing the specific needs of all women in the vast amount of information on those online platforms poses a challenge [36]. Our study reflects this complexity, as participants had varying opinions about including personal experiences in resources. Some valued them for recognisability, while others exprx`essed concerns about their reliability. Sharing personal experiences of menstruation with men, however, could help decrease the knowledge gap, and possibly elicit more compassion. Entwistle et al. have investigated the value of personal experiences in healthcare related decision-making [38]. Their study concluded that personal experiences can assist individuals in making informed decisions. However, the challenge lies in selecting appropriate personal experiences for inclusion in informational resources, as not all personal experiences are applicable to every case [39]. Furthermore, it should be emphasized that personal experiences do not replace the need for factual information. To ensure women, access to unbiased and reliable menstrual health information should be also offered to them. It is therefore recommended that healthcare professionals actively engage and assist patients in finding reliable sources. They could also assist people in making critically informed use of personal experiences by explaining how and why these stories could be helpful, as well as why they may not be suitable for their particular situation. Additionally, they could help patients find patient experiences, that have been gathered using a scientific method and are therefore a reliable source [39]. This may eventually empower patients to improve individual evaluation of (menstrual) health information [40, 41].

Strengths & limitations

A strength of our study is its national scope, which underscores the importance of context-specific research in understanding menstrual health information needs. Preferences and needs related to menstrual health are influenced by cultural, educational, healthcare, and social factors unique to each country. By focusing on a specific national context, our study provides insights that can be adapted and applied to other settings in high-income countries, highlighting the value of tailored approaches across different populations. This contextualized approach can inform the development of targeted resources and interventions, that are responsive to unique needs.

Furthermore, using a qualitative design allowed us to gain a profound and nuanced insight into a complex topic. Dependability was assured as the analyses followed an iterative process and data saturation was achieved. Two researchers independently coded the transcripts, ensuring confirmability of the process. Also, member checking of the results improved the quality of the study by enhancing the credibility.

However, some limitations should be mentioned as well. Twenty-four Dutch women participated in three focus groups. At least twice as many women were invited; however, many women refrained from participating. The willingness of participants to participate may have biased the results, as they are likely to perceive the topic of menstruation as relevant or important. Additionally, with the exception of one, all participants were born in The Netherlands and had medium to high educational levels. Cultural background and educational level will influence one’s menstrual literacy and information needs. Therefore, results of this study cannot be transferred to all Dutch women, without taking this bias into consideration. Regardless, this study enhances our understanding of the informational needs to improve menstrual health literacy.

Implications for practice and policy

For clinicians, it is important to recognize that patients may have limited menstrual knowledge, which can impact their ability to seek timely medical care. Individualizing care by paying sufficient attention to warning signs, and actively guiding them toward reliable sources of information can improve patient outcomes. Additionally, incorporating routine discussions about menstrual health into consultations may help normalize the topic within health care settings and reducing patient hesitation in bringing up concerns.

On policy levels, it is recommended to launch national campaigns to normalize conversations about menstruation and dismantle menstrual stigma, featuring diverse voices including men to challenge existing taboos. Furthermore, menstrual health education should be re-evaluated to ensure it goes beyond biological explanations and includes practical guidance on recognizing symptoms of menstrual disorders, seeking medical support and addressing common misconceptions. This measure could reduce gender-related health disparities by ensuring that all individuals have equitable access to menstrual health knowledge and care.

Conclusion

This qualitative study highlights that Dutch women perceive menstruation-related information as insufficient, reinforcing the ongoing stigma surrounding the topic. Women expressed difficulties in addressing the topic of menstruation leading to difficulties in determining the legitimacy of their complaints. Re-evaluating menstrual education in schools and the development of a comprehensive and patient-centred website on menstrual complaints is essential to improve overall menstrual literacy.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

HMB

Heavy menstrual bleeding

FGD

Focus group discussion

COREQ

Consolidated criteria for reporting qualitative health research

PCOS

Polycystic ovary syndrome

Author contributions

LZ and EL shared first authorship. LZ coordinated the study. EL helped to design the study, recruited the women and moderated the focus groups. LZ and EL analysed the data. EL wrote the initial draft of the paper. EL and LZ revised the paper and finalized the manuscript. EL, LZ wrote the paper. LZ, MB and PG initiated the project, developed the idea and coordinated the writing process. EL, LZ, MA, JL, MB and PG wrote the paper and critically reviewed the content.

Funding

This study was part of ‘Menstrual Narratives projects’ funded two Dutch funds: Fonds Alledaagse Ziekten and Commissie Onderzoek en Innovatie of Máxima MC.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available because focus group data can potentially be traced back to individual participants. However, they are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

All participants participated voluntarily and informed consent was obtained digitally prior to the focus group discussion. The Medical Ethical committee of Máxima MC has reviewed the research protocol (reference no. N22.041, June 17th, 2022) and confirmed that the Medical Research involving Human Subjects Act (WMO) does not apply to our study. Our study was conducted according to the Research Code by Maastricht University and in accordance with the Declaration of Helsinki.

Consent for publication

All participants participated voluntarily and informed consent, including for publication, was obtained digitally prior to the focus group discussion.

Competing interests

The authors declare no competing interests.