Period shame and silence: how stigma affects mental health

Maybe you learned about periods from a whisper, not a conversation. Maybe a pad was wrapped in black paper, or you were told to sit apart, skip the pooja room, or not mention it before your father or brothers. Maybe, years later, you were told your mood was 'just hormones' when you tried to explain how bad things felt.

None of this means something is wrong with you. This article looks at what research says about how period stigma can affect mental health, and what can help. It cannot diagnose you. It is written for anyone who has periods, and for the people who love them.

What the data show about periods in India

Stigma sits on top of real practical gaps. In the National Family Health Survey 2019-21 (NFHS-5), about 77% of women aged 15 to 24 reported using a hygienic method of protection during their period (89% in urban areas and 72% in rural areas). In Bihar the figure was about 59%, which national press coverage reported as the lowest of any state. The survey counts locally prepared napkins, sanitary napkins, tampons and menstrual cups as hygienic methods, so a woman who uses cloth is not counted in that figure. In a peer-reviewed analysis of the same survey covering 241,180 women aged 15 to 24, 49.8% used only hygienic methods, 22.7% used only unhygienic methods (cloth, nothing or other) and 27.5% used a mix of both.

A 2016 systematic review in BMJ Open pooled 138 Indian studies with 97,070 adolescent girls. Only about half (48%) were told about periods before their first one. Restrictions were common, especially around religious activity (pooled estimate 77%), and about a quarter (24%) reported missing school during periods. The authors noted that the quality of many studies was limited.

Individual studies give a closer picture. In a study of 1,522 girls aged 13 to 18 in four schools (Indian Journal of Child Health, 2015), 40.1% were not allowed to enter the kitchen and 81.2% did not attend religious functions during their period. In a study of 600 girls in six government schools in Delhi (2018), 40% stayed away from school during periods. Nearly 65% said their day was affected by pain, anxiety, shame, or fear of leaks and stains. Mothers were the main source of information, and the authors urged that mothers be helped to set aside taboos when they talk to their daughters.

These are particular schools and communities, so no single number describes every household. The WHO also asks that menstrual health be treated as a health and human rights issue, not only a hygiene issue, and calls for breaking the silence and stigma around menstruation.

How silence and shame can affect mental health

A 2019 review of 76 qualitative studies from low- and middle-income countries, including 12 from India, found that stigma and gender norms limit knowledge and social support. They also shape what girls feel they must hide. Experiences of shame and distress were linked with harms to psychological health, school and social life.

A 2025 scoping review of 74 studies found that anxiety, distress and depression were prominent outcomes and were related to menstrual stigma, lack of information and limited access to menstrual healthcare. In a survey of 3,841 secondary school girls in Uganda (2024), more mental health difficulties went along with poor knowledge about periods, more unmet menstrual needs and lower confidence in managing periods. That study was in Uganda, not India, and was cross-sectional, so it cannot show which came first.

In plain terms, what may happen is this. If a girl is taught to hide, she may carry worry about stains, smell and being noticed. If no one explains, she may fear that pain or mood changes mean something is wrong. Later, as an adult, she may delay seeking help for painful, heavy or mood-related symptoms because it feels embarrassing, or because it has been dismissed before. UNICEF says stigma, harassment and exclusion restrict girls' mobility and affect school attendance. It adds that people who are transgender or non-binary may face discrimination that blocks access to what they need.

When 'just hormones' is not enough

Hormones are part of the story, but the phrase can be used to end a conversation. Some people have premenstrual symptoms that disrupt work and relationships. The American Academy of Family Physicians, summarising ACOG guidance in 2024, reports that about 5% of women of reproductive age report severe, disabling cyclic mood symptoms, the picture seen in premenstrual dysphoric disorder (PMDD). ACOG also notes that depression and anxiety are the conditions that most often overlap with premenstrual syndrome. A fair response is to take your pattern seriously and look at it together. See our article on PMS, PMDD or depression.

How to talk about it

You do not need a big speech. Start with one person who feels safe, and use a short, plain sentence. Adjust these in your own language and style.

With family

• 'Ma, I do not want to hide this anymore. My period is a normal part of my health. Can we talk about it, even for five minutes?'
• On restrictions: 'I understand why this is done in our family. It makes me feel dirty and upset, though, and I would like us to find a way that I can still be part of the kitchen and the festival.' Some families will change slowly. It is fine to take it one step at a time.
• 'I get very low and short-tempered the week before my period. It is not about you. Please give me some space, or ask me how I am instead of saying it is nothing.'

With a partner

• 'When my period is near, I get more sensitive and tired. I will tell you when it starts, so you can know that it is not about us.'
• 'What helps me is a quiet evening and a warm meal. What I do not need is advice. Can you help with that?'

At work

You do not have to share medical details at work. A line such as 'I have a health condition that flares up once a month. A few flexible hours on those days would help me do my job well' is often enough. If you wish to name the symptoms, you can. If you are a manager, say it is fine to speak up and be flexible when asked.

With a doctor

A symptom record makes your story hard to dismiss. The NHS advises keeping a diary for at least two menstrual cycles and taking it to your appointment. ACOG suggests writing down and rating symptoms each day for two to three months, along with period dates. The ACOG guideline summary says the timing of symptoms is the most important element of diagnosis. A cycle tracker in the Progress tab of Manas can help you build this record.

• 'My symptoms come the week before my period and ease after it starts. Here is my record for the last three months.'
• 'This is affecting my work and my relationships. I would like to understand what is going on and what the options are.'
• 'I have been told it is just hormones. Could we check whether anything else, such as thyroid problems, depression or anxiety, could be adding to this?'
• 'What would you suggest if this were your family member? Can you note my concerns in my file?'

It can help to take someone with you. If you are not satisfied, it is fine to ask for another opinion. Some people feel more at ease with a woman doctor, and that is a reasonable choice.

If you are supporting someone

• Daughters: Explain periods early and calmly, before the first one. In a pooled review of Indian studies, only about half of girls were told before their first period. Make sure she knows pads, cloth or cups are all right to ask about, and that pain or very low mood is worth telling you about.
• Sisters and friends: Ask what would help, and do not joke about mood or smells. Offer to go along to a doctor.
• Partners: Learn the rough pattern, offer practical help and do not use 'is it that time of the month?' as a put-down.
• Colleagues and employees: Treat a request for flexibility as a health need. Keep what you hear private.

Boys and men benefit from learning too. UNICEF notes that stigma, taboos and myths keep both girls and boys from learning about menstruation. Normal talk at home makes the whole house easier.

You can read more in our guide on how to support a friend, and in our article on therapy in India if shame has been weighing on you for a long time.