Adolescent Perceptions of Menstruation on Twitter: Opportunities for Advocacy and Education

While some adolescents celebrate menstruation as a rite of passage, others seek discretion due to stigma. Many youth have used Twitter to combat stigma and raise awareness about other culturally taboo topics, but previous work has not explored youth conversations regarding menstruation. This study aims to assess whether Twitter can provide useful insights into how youth perceive menstruation.The team searched 162,316,839 tweets of 71,443 users of the age range 13-25 years in the Health Language Processing Twitter Youth Cohort for tweets that matched menstruation-related keywords: a pad, my pad, my period, her period, your period, tampon, diva cup, menstruate, that time of the month. Twelve codes emerged using a grounded theory approach and were sorted into three themes.Analysis was conducted on 10,000 tweets. Three themes emerged, including menstrual health, menstrual stigma, and menstrual positivity. Tweets related to menstrual health included physical complications, sexual/reproductive health, health education, and LGBTQ health. Tweets that addressed menstrual stigma included inconvenience/limitations, shame/stereotypes, religion/alternate perceptions, access/affordability, and self-depreciation/harm. Tweets related to menstrual positivity included awareness/community, strength/resilience, and environment/sustainability.This study provides insights into youth perceptions about menstruation. There was overwhelming emphasis placed on the negative expectations and shame around menstruation. A significant minority of tweets were directly or indirectly related to advocacy or education, which supports the potential use of Twitter as a platform to improve public health messaging, transform health outcomes, and promote equity among youth who menstruate.