Menstruation can increase feelings of gender dysphoria for nonbinary people due to the traditional link between menstruation and femininity, which may not align with their gender identity. For a nonbinary person who menstruates, the experience of having their body discussed in gendered terms by friends, family, or healthcare providers can compound the difficulty of an already complex experience.
People’s questions are based on assumptions. Menstruation-related questions that imply menstruation is a feminine experience, or one that is unexpected or should be explained, can make already challenging conversations even more challenging. Questions beginning with curiosity, care and respect for the person’s own language have the opposite effect.
This guide includes questions to ask, how to ask them and why the framing is important for health care providers, for partners and family members, and for friends who want to be supportive.
Key Takeaways
- Not every nonbinary person will menstruate, and not everybody who menstruates is a woman. The first step to asking good questions is to let go of that assumption.
- The first question to ask is what language a nonbinary person would like when discussing their cycle and every following conversation should be based on that.
- Gender dysphoria can be brought on or exacerbated by menstruation for nonbinary individuals. Supportive questions recognize the physical experience without reinforcing gendered notions of menstruation.
- Clinicians, in healthcare settings, should request permission to raise menstruation, explain its relevance and employ the patient’s language.
- Supportive questions include: What are you feeling physically? What are you feeling emotionally? What do you need? Are you being met where you are?
- Questions to avoid are those that assume the person is a woman, that assume the person is only a woman, that assume the person is a woman because they didn’t say so, or that show surprise that a nonbinary person menstruates.
- A 2022 study in Transgender Health found that nonbinary patients had significantly more positive experiences with healthcare providers who ask about their preferred name, pronouns, and preferred terminology at the beginning of each appointment.
Understanding Nonbinary identity and menstruation
What Nonbinary Means
Nonbinary: Gender identity that is not binary (man/woman). While some trans men and trans women may also identify as nonbinary, nonbinary identities are different from binary transgender identities. Gender nonbinary has been represented by participants as nonbinary, genderqueer, transgender, gender nonconforming, transgender male, transmasculine, agender, demi-boy, and neutrois gender.
Nonbinary is an umbrella term that represents a variety of gender identities. Some nonbinary people only use they and them as pronouns. Some use she/they or he/they combinations. Some use neopronouns. Not every nonbinary person has one set of experiences, presentations or medical histories.
Who Menstruates
A trans masculine person who decides not to take hormones and who has a functioning uterus will probably have a period, not because of their gender identity. If they have not received hormone therapy, surgery or other procedures that impact the menstrual cycle, nonbinary individuals with these organs may menstruate. There are some nonbinary individuals who use hormones to control or end their periods. Others do not.
The real-life application is that the key to good questions is not to presume. A nonbinary person can have periods or not, may or may not want to talk about them, and may or may not connect with the clinical or cultural language around periods.
Questions that Open the Conversation
Start With Language
Before talking to a non-binary person about menstruation, the one most helpful question is:
What words do you like to use when discussing your cycle?
Ask patients what kind of words they would like to hear: “I use standard clinical terminology such as ‘menstruation’, ‘bleeding’ and ‘menstrual cycle’, do you prefer these terms, or would you prefer to hear them in a different way that feels more comfortable for you?”
This question serves several purposes. It indicates that you will not make the assumption that the person speaks the same language as everyone else. It affords them a degree of control over a conversation that has been traditionally dominated by others. And it provides you with correct details on what to do.
Examples of inclusive language include: period or menstruation products instead of “feminine hygiene” products, and when referring to people who get periods: menstruators, those with uteruses, people who have a period, person on their period. Some nonbinary people prefer to use regular terms, rather than a euphemism, to refer to menstruation, or a period. Others like “cycle”, “bleeding” or words that refer to their experience. There is no right or wrong answer that’s what makes it worth asking.
Request permission to bring up the subject
If someone mentions menstruation, in particular in a healthcare context, it should be done with acknowledgment.
There are many reasons for this, such as trauma, gender dysphoria, and more, which is why talking about the menstrual cycle can be triggering for many transgender and gender non-conforming patients. Explain why you want to broach the topic and ask for permission before you proceed: “The menstrual cycle can provide important clues about overall health for anyone with ovaries. As part of this appointment, I was planning on asking you some questions about menstruation. Would that be all right with you?”
It is a way of communicating relevance and seeking consent which respects the person’s autonomy whilst also enabling the clinician to obtain relevant health information. It also conveys, without a lengthy explanation, that the clinician is aware that menstruation is not something that all patients are comfortable discussing.
Supportive Questions for Friends, Partners, and Family
If you are not a health care provider but someone who cares for a nonbinary person who menstruates, the questions that will help most are the ones that provide practical support without assumptions.
Questions that are focused on physical experience
- So how are you feeling at this moment? Open and non-gendered. It asks the person if they want to disclose as much or as little as they can.
- What could make today easier for you? Practical and forward-looking.
- Are you in need of anything? Heat? rest? food? company? Specific alternatives, but not assuming which one is required.
- Do you usually have this cycle, or is it different? When someone appears to be in more trouble than usual, and demonstrates that you are listening.
Questions that Recognize the Emotional Dimension
Some tips for managing gender dysphoria during a cycle are using language that is appropriate to them, such as a preferred term or simply “period”, and using the words that are meaningful to their experience.
- “Is your cycle impacting your body image right now? This question allows the person to speak about gender dysphoria if they have it, but not if they don’t.
- “Is there anything you’d find it helpful for me to avoid saying or doing this week?” Asks them to establish the rules.
- What is your preferred way of being supported during your cycle? Seeks specific instructions instead of taking it for granted what is considered “help.
What Not to Ask
Some questions, even though they are well-intentioned, are harmful due to the assumptions they contain:
- “Doesn’t it make you feel more like a woman?” This equates menstruation with womanhood and is directly opposed to the person’s identity.
- Does this mean you’re not truly nonbinary? Menstruation is a natural phenomenon and not a declaration of gender identity.
- “Does it sound like a bit of a mess to be nonbinary and have a period?” If there is a complication, it is not due to the person’s gender identity, but rather social assumptions about menstruation.
Any question that implies that a nonbinary person can’t menstruate.
Healthcare Providers: Questions
Providers who have nonbinary patients who menstruate must balance the clinical needs of obtaining accurate health history with the ethical duty to avoid adding to the harm many nonbinary patients have faced in health care settings.
Recommendations for the provision of gender affirming health care for nonbinary patients include nonbinary-inclusive intake forms and electronic health records, asking providers to be proactive in asking for preferred names and pronouns, and requiring education for providers and staff at all levels on the provision of nonbinary-inclusive gender affirming health care.
Before Raising Menstruation
Use the patient’s preferred name and pronouns at the beginning of each appointment, not what it says in the chart. Charts are not always accurate and the authority on the person in front of you is YOU.
Ask about pronouns (index=27-1) and mirror patient’s language. Inquire with your patients about their name and pronouns and speak with them in their language with regards to their gender. Practice using gender inclusive pronouns.
The Four Clinical Questions
In a clinical setting, there are four questions to ask about menstrual cycles:
- Are you taking hormones at the time of the interview?
- What is the average length of your period?
- For transgender and gender non-conforming patients: “The menstrual cycle can provide important clues about overall health for anyone with ovaries. As part of this appointment, I was planning on asking you some questions about menstruation. OK?Is that OK?
- “What type of terminology do you prefer when we discuss this?”
Specific Clinical Questions, Patient-Led Language
After the patient has said that they are okay with the conversation and has told you how they like to describe their clinical questions, the clinical questions should reflect how they described them:
- How many times do you bleed / have your period / have your cycle?
- What is the usual flow rate?
- “Do you experience pain? If so, what would you say it is and how does it impact your everyday life?
- “Has anything changed in your [cycle] recently?”
- Do you have anything you are doing now to control or inhibit your [cycle]?
- “Do you feel that your current management strategy is effective, or would you like to consider other management strategies?
This guidance aims to offer guidance for healthcare providers who have patients who discuss menstruation and its management in their scope of practice, and may be transgender or gender non-binary. This includes nurses, physicians, physician’s assistants, and therapists in the fields of endocrinology, primary care, or mental health services.
After the Clinical Conversation
At the end of the conversation, clinicians should say something like: “Thank you for discussing this with me. Don’t hesitate to call if you’re worried about symptoms you’re having.”This closing statement is useful because it is neutral in language, leaves the door open for follow-up, and does not re-introduce any gendered framing that may have been avoided during the appointment.
The Language Framework: A Practical Reference
The following table lists some of the most common terms used and what they mean when discussing menstrual health issues with a non-binary person.
| Standard Term | More Inclusive Alternative | Notes |
| Women’s health | Reproductive health, menstrual health | Removes the gender assumption |
| Feminine hygiene products | Period products, menstrual products | Used by August, Thinx, and most inclusive brands |
| Ladies / girls | People who menstruate, menstruators | Useful in clinical and advocacy writing |
| She / her (assumed) | Ask first; use they/them as default if unsure | Misgendering has documented health impacts |
| Aunt Flo / that time of the month | Period, cycle, bleed | Plain language is easier and more inclusive |
| Female reproductive system | Reproductive anatomy, internal reproductive organs | More precise and less gendered |
To promote care for all people who menstruate, menstrual advocacy should be gender inclusive and gender affirming.
Why These Questions Matter: The Health Impact of Inclusive Care
There is more than politeness to the difference between inclusive and non-inclusive healthcare conversations. The health impacts of treatment of nonbinary patients in clinical contexts have been documented.
Nonbinary people who feel misgendered frequently in healthcare environments are more likely to feel uncomfortable and will delay or avoid care as a result.
Delayed care is a quantifiable public health issue. Nonbinary individuals who avoid health care appointments due to discomfort or harm do not receive screening, and do not report symptoms or seek treatment for treatable and detectable conditions if they have them. Menstrual health particularly is clinically important because any irregularities in the cycle can be early signs of various disorders such as PCOS, endometriosis, thyroid disorders, and others that can be treated early.
Nonbinary mental health is also affected by healthcare experiences. Making forms inclusive, including gender-inclusive restrooms, and letting clients know that the clinician recognizes and supports them are all part of a clinical setting that can make it more likely that nonbinary people are able to be honest about their health.
Questions asked, and the assumptions behind them, can have real-life impact on whether a person receives the care they need.
How to Support a Nonbinary Person with Gender Dysphoria Related to Menstruation
For some nonbinary people, gender dysphoria (discomfort with their gender identity and the body they’re experiencing) can become more intense during menstruation. This isn’t the case for everyone who is not a man, but it does matter for those who do.
Some tips for managing gender dysphoria during a cycle are to try to consider birth control or hormone therapy options to either manage or stop the period, and to use language that feels right this could be a specific term they prefer, or simply the word “period” using the words that feel right for them. One of the important messages is that your period isn’t your gender. You are valid, you are seen, you are worthy of love and acceptance just as you are.
Some concrete assistance from friends and family may be:
- To follow the person’s example in language without giving reasons for their choices
- Avoid making personal references to men’s periods, if they don’t use feminine language
- Providing hands-on support without making assumptions about their emotions
- When they ask, he/she will ask only once and clearly, what kind of support they want and then give that support.
The main thing to understand is that the support doesn’t have to be comprehensive. It takes a willingness to ask, a willingness to listen, and a willingness to go with the other person.
Conclusion
The questions people ask about menstruation, expose their assumptions about who menstruates and what it means. For nonbinary folks who are experiencing a physical reality that is consistently presented in a way that doesn’t align with their identity, the kind of questions that friends, family and healthcare providers ask can make a real difference in how safe they feel, how honest they can be, and whether they seek care when they need it.
The structure of this guide is consistent: ask the person what language he prefers, go with his lead, explain why you want to bring it up, and ask questions about his experience, not what you think it should be.
It’s not a complex structure. It simply requires that the person asking the question has the same respect and curiosity shown to them. It’s the beginning of all supportive conversations, on all topics and with all people.
Visit Shani Levni‘s complete library for additional guides on health, communication, identity, and more.
Frequently Asked Questions
How do I ask questions of a nonbinary person who menstruates?
Begin by asking them what language they like to cycle in. Next ask them how they feel, what they need, and if it is a typical experience for them. When discussing the issue with patients in healthcare environments, seek consent to discuss the issue and provide a reason why it is clinically relevant. In personal situations, concentrate on practical help and on going with the flow.
What’s the best way to discuss periods with a nonbinary person without being offensive?
Use the same words as the person uses for their own experience. If you don’t know, ask: “What words would you like us to use when we talk about your cycle?” Do not assume that menstruation makes someone more feminine, be surprised that a nonbinary individual menstruates, or use gendered terms such as “ladies” or “girls” in this context. The first place to begin is typically plain, direct language period, cycle, bleed
Is there something wrong with menstruation if it doesn’t mean that someone is not really nonbinary?
No. Gender identity and reproductive physiology do not go hand-in-hand. Nonbinary individuals can have or not have periods based on their anatomy, hormone therapy use, and other medical conditions. Menstruation is not a sign of or against a gender identity.
How are nonbinary people impacted by menstruation?
For some nonbinary people, menstruation may exacerbate gender dysphoria due to the cultural link between menstruation and femininity. While not everyone who is nonbinary will have dysphoria, for those who do, the interactions and conversations about their cycle can either alleviate or exacerbate that dysphoria.
How to ask nonbinary patients about menstruation?
Use the patient’s preferred name and pronouns in the beginning of the appointment. Before addressing menstruation specifically, make sure to discuss the clinical relevance of the information and obtain consent to proceed. Ask the patient what language he/she prefers and use it all the way. The core clinical questions include the frequency of the cycle, the flow, the level of pain and the current management strategies.
What is a more appropriate term for period products other than “feminine hygiene”?
Use the terms “period products” or “menstrual products. These terms accurately represent the purpose of the product without assigning a gender to the users of the product. This is now the common language of many leading brands of period care.
What are some ways to be supportive to a nonbinary friend during their cycle?
Directly ask them: “Is there something that would make today easier for you? How do you like to be supported? These questions allow them to take control of the conversation and help you to provide the support they need, not what you think they need. Do not speak down to them, do not judge the situation as more complex than it really is, and do not hesitate to offer them help in their language.