Big Relief in a Small Pack
Every month in the United States, approximately 1 in 5 menstruating individuals leave school early or miss school entirely because they do not have access to menstrual care products. The cost of these products can create financial strain, particularly for low socioeconomic households who may be forced to choose between buying menstrual products or food. This phenomenon is known as period poverty and is a growing public health crisis.
Children’s Hospital Los Angeles creates hope and builds healthier futures, particularly for underserved children and families. Through the hospital's Hematology-Adolescent Medicine Clinic, our team is helping to address period poverty among our patients and families.
Giving compassion and dignity
Young people experiencing period poverty often use noncustomary items for blood collection or ration the products they have by using them for extended periods of time. Those with heavy periods are especially impacted by the emotional, physical and financial burden of their menstrual cycles.
Jacquelyn Keegan, MSN, RN, CPNP-PC, CPON, Nurse Practitioner in the Hemostasis and Thrombosis Center at CHLA, came up with a solution: distribute a “period pack” to patients seen in the Hematology-Adolescent Medicine Clinic.
“In this particular clinic we hear a lot about our patients’ personal lives,” Keegan says. “Some share a bathroom with 10 other people. Others don’t have access to a working toilet. Imagine having a period on top of that? That is true period poverty. We felt compelled to find ways to help.”
In March 2022, the clinic started distributing period packs to every new and established patient with heavy menstrual bleeding. Each pack contains leak-proof period underwear, sanitary pads or tampons, hand sanitizer, feminine wipes, cramping and pain relief heating patches, and bags to dispose of used products.
Thanks to a $15,000 grant from Bayer Pharmaceuticals, Keegan hopes to provide period packs to 500 clinic patients over the next two years.
Patients who have received them so far have been incredibly grateful.
“One patient shared during her visit that she was feeling really hopeless and depressed,” says Keegan, “and then when our nurse care manager [Erin Cooper, MSN, BSN, CPHON] came in with the period pack, she became so animated and hopeful that she gave Erin a hug. Another said, ‘This pack is all mine? This is all just for me?’ It blew her mind.”
Giving a sense of control
The Hematology-Adolescent Medicine Clinic opened in 2014 and is part of the Cancer and Blood Disease Institute at Children’s Hospital Los Angeles. A partnership with the Division of Adolescent and Young Adult Medicine, this comprehensive clinic brings expertise in hematology and adolescent reproductive health together in one centralized location.
Due to the great need for this multidisciplinary approach, the clinic has grown from one 1/2-day clinic per month to one 1/2-day clinic per week, with an average of eight patients per clinic.
“We primarily serve patients who have heavy menstrual periods,” Keegan says, “and when there is an underlying bleeding disorder, we are able to find it and help manage it.”
Patients are evaluated for both underlying bleeding disorders and hormonal axis abnormalities as a cause for their heavy menstrual period. Studies have shown that approximately 20% of adolescents presenting with heavy menstrual bleeding are found to have an underlying bleeding disorder. In addition, early diagnosis of bleeding disorders is crucial to help prevent complications later in life. The clinic plays a critical role in caring for this vulnerable population who may have otherwise not had an appropriate evaluation into the reason for their heavy periods.
Many of the patients seen in the Hematology-Adolescent Medicine Clinic have inherited or acquired bleeding disorders such as hemophilia, Von Willebrand disease and platelet disorders. Medication and other interventions can be highly effective in treating these conditions.
As Keegan explains, “One of our goals, of course, is to control our patients’ bleeding, help make their periods lighter and shorter. But how can we help them beyond that? They are still going to have a period.”
The answer, she says, is “to help them feel in control of their periods—where they can manage it and they are not fearful at school about having an accident.”
Sharing our expertise
Julie Jaffray, MD, Director of the Thrombosis Program at CHLA, is inspired by the work Keegan is doing with her patients experiencing period poverty and believes it could become a model for other hospitals and clinics.
“The Foundation for Women and Girls with Blood Disorders is a nonprofit group of nurses and doctors in hematology, OB/GYN and adolescent medicine,” Dr. Jaffray says. “The Foundation is made up of about 100 different centers around the U.S., and it’s becoming a pretty powerful group. That’s where we started talking about the period packs, and I’m excited for Jackie [Keegan] to tell everyone what she’s put together at CHLA.”
