Menstrual Hygiene
Part of Sanitation and Hygiene
Menstrual hygiene is public health infrastructure. Without it, half your population faces monthly risk of infection, social exclusion, and reduced productivity. This guide covers reusable cloth pad construction, washing and disinfection protocols, alternative materials, privacy solutions, and cycle tracking for health monitoring.
Why This Is Public Health, Not Personal
In many historical and present-day societies, menstruation has been surrounded by taboo, leading to secrecy, shame, and — critically — poor hygiene practices born from ignorance. The consequences are medical, not moral:
- Infection — using unclean materials against broken or irritated skin introduces bacteria. Vaginal and urinary tract infections follow. Without antibiotics, these can become systemic.
- Skin breakdown — prolonged contact with moisture and friction causes rashes, sores, and secondary infections.
- Social exclusion — if menstruating individuals cannot manage hygiene effectively, they withdraw from communal work, food preparation, and social life. A community loses productive capacity every month.
- Reproductive health — chronic infections affect fertility, pregnancy outcomes, and maternal survival.
Treating menstrual hygiene as essential infrastructure — with the same seriousness as latrine building or water purification — prevents all of these outcomes.
Reusable Cloth Pad Construction
Cloth pads are the most practical, sustainable solution. They require only fabric, basic sewing skills, and a washing routine.
Materials
| Layer | Material | Purpose | Alternatives |
|---|---|---|---|
| Top layer (skin contact) | Soft cotton, linen, or flannel | Comfort, wicking moisture away from skin | Soft wool (lanolin is naturally antimicrobial) |
| Absorbent core (middle) | 3-4 layers of cotton, terry cloth, or wool | Absorbs and holds menstrual fluid | Moss (sphagnum), cattail fluff, soft dried grass |
| Bottom layer (outer) | Tightly woven fabric or oiled cloth | Leak prevention | Leather (thin, flexible), waxed cloth |
Construction Steps
Step 1 — Cut the shape. Cut a rectangular pad approximately 20-25 cm long and 8-10 cm wide from your top-layer fabric. Cut the same shape from your bottom layer. Cut 3-4 rectangles of absorbent material slightly smaller than the outer pieces (about 18 x 7 cm) so they sit inside without bunching at the edges.
Step 2 — Layer. Stack: bottom layer (leak-proof side down), absorbent layers in the middle, top layer (skin-contact side up).
Step 3 — Sew. Stitch all layers together around the edges. If you have a needle and thread, use a simple whip stitch or running stitch. Leave no raw edges exposed on the skin-contact side — fold the top layer over the edges and stitch flat. If sewing is not possible, tightly fold the layers and secure with a safety pin or tie.
Step 4 — Add wings (optional but recommended). Cut two rectangular flaps (about 8 x 4 cm) extending from each side of the pad at the center point. These wrap around underwear or a belt and fasten with a button, tie, or snap to hold the pad in place.
Step 5 — Make a set. Each person needs 4-6 pads for rotation during a period, plus 1-2 extras for heavy days. This allows washing and drying time between uses.
Fastening Without Modern Underwear
If elastic-waist underwear is not available:
- Cloth belt — a strip of fabric tied around the waist with loops or ties at front and back. The pad threads through the loops and is held in place by the belt.
- Tied undergarment — a simple cloth diaper-style wrap secured with ties at the hips
- Pinned in place — thorns, bone pins, or carved wooden toggles can secure a pad to a garment
Sizing for Different Flows
Make pads in two sizes: regular (20 x 8 cm, 3 absorbent layers) for normal flow, and heavy (25 x 10 cm, 5 absorbent layers) for the first 1-2 days when flow is heaviest. Nighttime pads should be longer (28-30 cm) to prevent leakage while lying down.
Washing and Disinfection Protocol
Proper washing is as important as proper construction. A poorly washed pad carries bacteria directly to vulnerable tissue.
Step-by-Step Washing
Step 1 — Cold soak. Immediately after use, soak the pad in cold water for 15-30 minutes. Cold water dissolves blood. Hot water sets blood proteins into the fabric permanently (the same reason you rinse a blood stain with cold water first).
Step 2 — Scrub. After soaking, scrub the pad by hand with soap (see Saponification) or wood ash water. Focus on the absorbent core. Squeeze and wring repeatedly until the rinse water runs clear.
Step 3 — Hot wash. After scrubbing, wash the pad in hot water (as hot as your hands can tolerate, or boil for 5 minutes if possible). Hot water kills bacteria that cold washing cannot. Add soap or ash to the hot wash.
Step 4 — Rinse. Rinse in clean water until no soap residue remains. Soap residue against skin causes irritation.
Step 5 — Sun dry. Hang pads in direct sunlight for complete drying. UV radiation from sunlight is a powerful disinfectant — 6 hours of direct sun kills virtually all bacteria and fungi on fabric. This is not optional in a pre-antibiotic setting. Sun-dried pads are safer than shade-dried pads.
Step 6 — Inspect before reuse. Check for: persistent staining (cosmetic, not a problem), fabric thinning or tearing (replace the pad), musty smell even after drying (re-wash with hot water and more sun exposure).
Washing Frequency
| Situation | Protocol |
|---|---|
| During menstruation | Change pad every 4-6 hours (more frequently on heavy days). Soak used pads immediately. |
| End of period | Wash all pads thoroughly. Sun-dry completely before storing. |
| Storage between periods | Store clean, dry pads in a clean cloth bag or container, away from moisture and insects. |
Never Reuse Without Washing
A used pad left to dry without washing harbors dangerous bacterial growth. Even if time is short, at minimum rinse in cold water and hang to dry. Full wash protocol should happen within 24 hours of use.
Privacy Solutions for Drying
In communal living situations, drying menstrual pads openly may create social discomfort. Practical solutions that preserve both hygiene and dignity:
- Dedicated drying line — a clothesline in a partially screened area (behind a privacy screen, inside a shelter, on a building’s non-public side) that still receives direct sunlight
- Drying rack with cover cloth — hang pads on a rack and drape a thin, light-colored cloth over the top. The cover provides visual privacy while still allowing UV light through
- Indoor drying near a fire — in wet climates where sun-drying is unreliable, dry pads near (not on) a fire. Heat kills bacteria, but ensure the fabric does not scorch
- Community norm-setting — the most effective solution is normalizing menstrual pad drying alongside other laundry. This requires leadership and education but eliminates the problem entirely
Alternative Materials
When cloth is scarce, other absorbent materials work:
Natural Absorbents
| Material | Absorbency | Comfort | Availability | Notes |
|---|---|---|---|---|
| Sphagnum moss | Excellent (20x its weight) | Good | Wetlands, bogs | Naturally antimicrobial. Used as wound dressing in WWI/WWII |
| Cattail fluff | Very good | Good | Marshes, pond edges | Soft, lightweight, abundant in season |
| Dried grass (soft species) | Moderate | Fair | Everywhere | Must be changed frequently. Sun-dry before use |
| Softened bark fiber (cedar, lime) | Moderate | Fair | Forests | Pound bark until fibers separate. Soft and absorbent |
| Wool (raw or felted) | Very good | Excellent | Where sheep are kept | Lanolin is antimicrobial. Felted wool does not fray |
| Animal hide (thin, soft-tanned) | Low (barrier only) | Fair | Where hunting occurs | Use as leak-proof bottom layer only |
Moss as Emergency Supply
Sphagnum moss is the best emergency menstrual absorbent. It holds up to 20 times its dry weight in fluid, is naturally antimicrobial (low pH inhibits bacteria), and is widely available in temperate and boreal climates. Collect, sun-dry, and store for use. Wrap in a thin cloth layer for comfort.
Menstrual Cup Alternatives
If pottery or metalworking skills are available, a simple menstrual cup can be fashioned:
- Silicone or rubber — if salvaged from pre-collapse supplies, these are ideal
- Fired pottery — a small, smooth, bell-shaped ceramic cup (very thin walls, well-glazed interior). Must be perfectly smooth to prevent tissue damage. Boil before and after each use.
- Carved wood — theoretically possible but difficult to make smooth and safe enough. Not recommended unless the surface can be sealed with beeswax or resin.
In practice, cloth pads are more reliable and safer than improvised cups until high-quality materials become available.
Cycle Tracking for Health Monitoring
Tracking menstrual cycles provides valuable health information without any modern technology.
What to Track
- Cycle length — count from the first day of bleeding to the first day of the next period. Normal range: 21-35 days. Track with knots in a cord, notches on a stick, or marks on a calendar.
- Duration of bleeding — normal: 3-7 days
- Flow heaviness — note changes from cycle to cycle
- Pain levels — mild cramping is normal. Severe, debilitating pain may indicate a medical issue.
- Cycle regularity — regular cycles suggest normal reproductive health. Sudden changes may indicate pregnancy, nutritional deficiency, extreme stress, or illness.
Health Indicators from Cycle Data
| Observation | Possible Meaning | Action |
|---|---|---|
| Missed period | Pregnancy (most common), malnutrition, extreme stress | Assess pregnancy possibility first |
| Very heavy bleeding (soaking a pad in <2 hours) | Uterine issue, nutritional deficiency (iron) | Increase iron-rich foods (liver, red meat, dark greens). Monitor for anemia signs (fatigue, pallor) |
| Cycles shorter than 21 days | Hormonal irregularity, perimenopause | Track for pattern. No immediate treatment needed unless bleeding is heavy |
| Severe pain with fever | Possible infection | Medical emergency. Isolate pain source. Treat infection aggressively |
| Bleeding between periods | Various causes from benign to serious | Track frequency. If persistent, investigate |
Disposal of Worn-Out Materials
Cloth pads last 6-12 months with proper care before fabric breakdown makes them ineffective.
- Worn cloth — burn if fabric is heavily stained and cannot be re-purposed. Otherwise, compost or bury (menstrual blood is organic waste and decomposes rapidly).
- Natural materials (moss, grass, cattail) — compost directly or bury in a waste pit. Do not dispose of near water sources.
- Never dispose of menstrual materials in or near drinking water sources, food storage, or communal living spaces.
Key Takeaways
Menstrual Hygiene Essentials
- Menstrual hygiene is public health infrastructure — treat it with the same seriousness as sanitation and water purification.
- Build cloth pads with three layers: soft top, absorbent core (3-5 layers), leak-proof bottom. Each person needs 4-6 pads.
- Wash protocol is critical: cold soak first, scrub with soap, hot wash, thorough rinse, sun-dry for UV disinfection.
- Sun-drying is non-negotiable in a pre-antibiotic setting. 6 hours of direct sunlight kills bacteria and fungi on fabric.
- Sphagnum moss is the best natural emergency absorbent — 20x its weight, naturally antimicrobial.
- Track cycles with knots, notches, or marks. Changes in cycle length, flow, or pain are early warning signs for health issues.
- Normalize menstrual hygiene management in your community. Secrecy and taboo lead to poor practices, infections, and lost productivity.
- Replace pads every 6-12 months as fabric breaks down. Burn or compost worn materials away from water sources.