Pediatricians Reveal Why Menstrual Health Still Gets Pushed Aside in Kids’ Checkups

Menstruation is supposed to be treated like a vital sign in pediatric care, according to formal recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). Yet a new qualitative study suggests that in real-world clinics across the United States, menstrual health remains one of the most under-addressed topics in routine pediatric visits, pushed aside by time constraints, limited training, and structural barriers that vary dramatically by geography and practice setting.

The study, published in Frontiers in Adolescent Medicine, conducted in-depth interviews with 46 pediatric-facing providers across four geographic regions of the United States, representing 22 states and a mix of urban, suburban, and rural practice contexts. The sample consisted primarily of Medical Doctors (78 percent), but also included Doctors of Osteopathy, Nurse Practitioners, and Physician Assistants. Roughly half of participants practiced in urban centers, with the remainder divided between suburban and rural settings. Researchers from Columbia University’s Mailman School of Public Health, Emory University School of Medicine, Columbia University Irving Medical Center, Yale University School of Medicine, and the Centered Youth Clinic & Consulting in Texas used thematic analysis to identify patterns in how providers engage with menstruation during clinical encounters.

Three central themes emerged from the analysis. First, formal training and experiential learning shape provider engagement with menstrual health. Second, structural and relational factors influence the extent to which menstrual health is integrated into clinical encounters. Third, biological, quality-of-life, and condition-specific menstrual health questions affect clinical care. Together, these themes reveal a complex picture of why menstruation continues to be an under-discussed topic in pediatric settings, despite its critical role in overall health.

Most participants remembered learning little about menstrual health during their clinical education, and what they did learn was primarily focused on biological processes and developmental milestones. Many physicians described their residencies, particularly adolescent medicine rotations, as more influential than didactic clinical education because of hands-on opportunities with complex patients. Mentorship also played a key role, with participants crediting mentors in school or residency with helping them understand how to discuss menstruation in a meaningful way, what questions to ask, and how to create rapport with patients and families around a topic that can create discomfort.

Informal experiential learning through personal and family experiences of menstruation also shaped provider confidence. For participants who menstruated, many described their own heavy or painful periods as a catalyst for including more in-depth menstrual health guidance in their patient encounters. Others used their own experiences to connect with patients, normalize menstrual concerns, and put young people at ease. Male providers described overcoming gender barriers by drawing on the menstruation-related experiences of family members. One male physician at a hospital in the West explained how patients question his knowledge, saying, “What do you know? Come on, you’re a guy,” and he responds by describing his daughters’ experiences.

Structural factors, particularly appointment duration, emerged as the most impactful barrier to integrating menstrual health into routine care. Participants reported that the amount of time allotted for well-child visits ranged from 10 minutes to “as long as I want them to be,” underscoring significant variability in time available to include menstrual health topics. Providers at Federally Qualified Health Centers (FQHCs) highlighted particular challenges due to patient volume, time-related pressures, and the frequent need for interpreter services that effectively halve the usable clinical time. One provider described 15-minute visits regardless of whether they were sick visits, well-child visits, initial appointments, or follow-up appointments, noting that menstruation questions get pushed to the side when competing priorities like vaccines, school forms, and physical exams cannot be skipped.

Referral systems, both formal and informal, were important structural elements in addressing a lack of time or knowledge about menstrual health issues. For some providers, this was as simple as walking the patient down the hall to another clinician or a health educator. For others, particularly in rural locations, referrals were far more challenging. One rural physician in the South described a six-month wait just for a primary OB/GYN appointment, noting that family medicine practitioners who used to provide OB and GYN services “don’t really exist anymore.” Another rural provider emphasized that the nearest children’s hospital was an hour away, creating transportation barriers for patients. Some clinicians suggested telehealth as a possible solution, but noted it was not always available and was complicated by unstable internet in some rural communities.

Participants described varied approaches to obtaining a menstrual history, with no discernible patterns associated by provider type or institutional context aside from the influence of time constraints. This suggests a lack of consistency in both what is included on the topic and when it is asked. Many, but not all, participants shared they provide anticipatory guidance with their patients pre-menarche, focusing on the biological and sometimes social experiences of menstruation. Some described taking a brief menstrual history and only following up when an issue arose. Often this short assessment would include questions about menarche, last menstrual period, regularity, and pain. On occasion, providers who described taking a more detailed menstrual history would explore quality-of-life questions, such as whether patients miss school because of their periods, who they would ask for help, and what they would change about their menstrual experience.

When asked about the ACOG/AAP recommendation to treat the menstrual cycle as a vital sign, most participants were not aware of the position statement, but a variety of views emerged when presented with the concept. Some participants articulated the value of integrating routine menstrual health questions to normalize and standardize the topic, particularly given competing priorities during a pediatric visit. One physician explained that unless it is structured as a vital sign, it will not get done, because once it becomes routine, it is standardized. Other participants were less certain, sharing concerns about how vital signs are defined and measured, noting the broad range of “normal” menstrual cycles, especially in the first few years post-menarche, and the challenge of patient recall compared to objective values like heart rate and blood pressure. Despite hesitation among some clinicians, the general consensus was that regardless of what it is called, asking about menstruation on a regular basis is a critical part of the clinical encounter.

The findings have important implications for clinical practice, policy, and provider training. The researchers propose four categories of recommendations: clinical practice and guidance, including anticipatory guidance before menarche and normalization of menstruation in care; time and workflow management, including longer visits and integration of tools like the MENSES mnemonic into electronic medical records; professional reflection and education, including reflection on personal biases and pursuit of continuing education; and referrals and mentorship networks, including building formal and informal referral pathways and providing mentorship for trainees. The MENSES mnemonic, which addresses both biological and quality-of-life questions on menstruation, could be integrated into provider conversations or pre-screening questionnaires depending on clinic structure and flow, alleviating the time burden on providers while ensuring a framework for collecting menstrual health information. The study’s authors emphasize that integrating menstrual health screening addressing both biological and quality-of-life factors is essential for early diagnosis of menstrual conditions, which can include endometriosis, bleeding disorders, polycystic ovary syndrome, and other conditions, and helps ensure that adolescents feel prepared and confident in managing menstruation as they mature. The researchers also note key limitations, including a predominantly female and urban-suburban sample of providers already attentive to menstrual health, and the absence of patient and family perspectives, which they recommend for future research.

Subject of Research: Menstrual Health

Article Title: Pediatric clinical engagement on menstrual health: a qualitative assessment

Article References: Combs, S., Huliyar, B., Brocato, I., Hill, S., Master, S., Fan, L., Efuribe, C., Bell, D., & Sommer, M. (2026). Pediatric clinical engagement on menstrual health: a qualitative assessment. Frontiers in Adolescent Medicine, 4, Article 1823919. https://doi.org/10.3389/fradm.2026.1823919

Image Credits: AI Generated

DOI: 10.3389/fradm.2026.1823919

Keywords: menstrual health, pediatrics, qualitative research, adolescent medicine, vital sign, healthcare barriers, Pediatric, clinical, engagement, menstrual, health, qualitative