'Not all menstruators are women': Why trans and nonbinary folks want to talk about their periods

When it comes to menstruation, calls for action to include trans and nonbinary people in research, literature and overall education — both in the medical field and in society at large — are on the rise.

Earlier this month, Rep. Alexandria Ocasio-Cortez chimed in and was subsequently criticized for using the term “menstruating people” during a CNN interview discussing Texas’s strict anti-abortion law.

"I don't know if he is familiar with a menstruating person's body,” she said of Texas Gov. Greg Abbott. “In fact, I do know that he's not familiar with a woman, with a female, or [with a] menstruating person's body.”

Ocasio-Cortez was later ridiculed by the Daily Mail, which tweeted her quote with the caption: “AOC calls women ‘menstruating people’ while explaining the female body.”

"Not just women!” she replied in a retweet. “Some women also *don’t* menstruate for many reasons, including surviving cancer that required a hysterectomy. GOP mad at this are protecting the patriarchal idea that women are most valuable as uterus holders.”

Ocasio-Cortez isn't the only public face fighting for more trans- and nonbinary-inclusive language. In 2019, the brand Always removed the female symbol on its products to be more inclusive to non-female-identifying customers. Similarly, several trans-affirming period brands have increased their visibility online to raise awareness for non-cisgender menstruators.

But as companies and public servants have debates around ideology and terminologies, folks like A.J. Lowik, a nonbinary activist and researcher at the University of British Columbia, says the erasure of trans and nonbinary folks from the period discussion is having real-life impacts.

“We are dealing with erasure at the level of information,” Lowik (who uses they/them pronouns) tells Yahoo Life. “We know very little about trans and nonbinary people’s menstrual health and menstrual health care needs. Health care providers, educators, parents and trans and nonbinary people alike, among others, are at an informational disadvantage. The result is that trans and nonbinary people are having to make health care decisions, for example, without all the relevant information, and we are having to navigate health care spaces where few people know anything about how we might experience our periods differently from our cis counterparts.”

The central reason for this erasure, Lowik argues, is a “cisnormative worldview” that frames trans and nonbinary people as “abnormal, unnatural, rare and exceptional.”

“It’s baked into everything,” Lowik adds. “From education to architecture, from medicine to law. In brief, we assume and expect everyone to be cisgender, to identify with the gender that is understood as ‘aligning’ with the sex they were assigned at birth. We treat sex and gender as binaries, and we expect that these binaries will — or ought to — align in predictable ways according to dominant sociocultural values. We treat cisgender people as normal, natural and expected. It’s kind of like heteronormativity — where we assume everyone will be straight, and we treat heterosexuality as normal, natural, and expected. It’s that same idea, but as it relates to sex and gender, rather than sexuality.”

Canela López, an activist and journalist who covers trans health for Insider, agrees, adding that because menstruation is viewed only as a “cis woman’s issue,” access to adequate health care is compromised by major health agencies and is left “unaddressed.”

“For somebody who's been on testosterone, menstruation is maybe going to look a little bit different,” López (who uses he/them pronouns) tells Yahoo Life. “Somebody who is looking to get off HRT [hormone replacement therapy] to get pregnant, that's going to look a little bit different than somebody who hasn't been on HRT before. Those are really specific questions that can really only be answered by a doctor, but because there isn't research there, it's really difficult for a lot of trans people who are looking to either get pregnant or just get very basic care.”

“You don't have research facilities that are doing this work,” López continues. “Or you have teams of researchers who want to look into trans-specific menstrual care but can't because they don't have the funding because it's not seen as a broad enough issue by agencies to get out that kind of funding.”

Isabela Rittinger, founder of Bleed the North, a growing student and volunteer-led organization of Canadian youth activists fighting for menstrual equity, explains that the first step toward trans-inclusivity is by “bettering our language.”

“Using terms like ‘menstruators’ and avoiding gendered names” is important, Rittinger believes, though she admits it’s going to be a long time before most people accept the shift in terminologies — and that we have to accept that as "completely OK" for now.

“I remember explaining to my parents why we use the term ‘menstruators’ instead of ‘women’ and they looked confused because it’s not something they grew up with,” Rittinger, a cisgender woman, tells Yahoo Life. “This is something that is new for a lot of people.”

Still, she says it’s not an excuse to be “harmful” in any way to trans and nonbinary communities. “I think it all comes down to the stigma, which is obviously affected by a number of different identities,” she adds, pointing to older generations, especially those also impacted by cultural and religious beliefs, as the main perpetuators of period stigma.

“I come from a family of immigrants,” she explains. “I do think that while menstruation could be a unifier, it’s the way that it's discussed in society in different groups that is very different.”

López says inclusive language extends beyond just period terminologies but also when describing people.

For example, “instead of saying ‘women with vaginas,’ you could say ‘people with vaginas’ or ‘people with vulvas,’” López explains. “Making sure our language is very gender neutral can be a small way to include people and make sure it seems more of a safe space when we're having these conversations that can oftentimes be really triggering for trans folks.”

Tara Costello, a U.K.-based period activist and author of Red Moon Gang, adds that it’s not enough for “brands and celebrities” to make inclusive statements, but that people who menstruate must demand more research and education from all levels of health agencies — something she says can save lives. Especially when one considers that, too often, trans men, nonbinary and intersex folks, “anyone with a cervix, basically,” must often rely on cisgender women to access correct health information, and that there's not enough specific research covering all who menstruate.

“There's not enough funding," Costello acknowledges, "but there are people out there doing the work. I recently spoke to a doctor in South Africa who's doing a study about endometriosis, specifically in trans men. So, there is little stuff being done.”

Due to a growing number of allies on social media, Lowik says more of the public is beginning to understand that “not all menstruators are women,” which they argue is “fundamentally important” not only to trans and nonbinary people but for cis women as well.

“I see [critics] relying on biological essentialism — that a woman is necessarily a person with a uterus, and that uterus-having and everything that comes with it, is 'what makes a woman' — in a way that feels really harmful not only to trans and nonbinary people but also for cis women,” Lowik says. “We can’t rely on trans and nonbinary activists — scholars, researchers, health care providers — alone. We need strong, fierce, and determined allies to mobilize their privilege, to speak up when they see our communities being erased from the discussion, to ensure that we have a place at the table. This is vital, and that it’s happening now is momentous.”

“The violent idea seems to be that if you menstruate, you are therefore a woman,” Lowik adds. “Our very identities become subject of debate in a way that puts us at increased risk of violence and discrimination. Thinking about trans and nonbinary people who menstruate seems to expose some people’s transphobia, their cisnormative, reductive way of understanding sex and gender.”