“I thought it was normal”: Menstrual education, symptom interpretation, and diagnostic delay

Menstrual education shapes how individuals learn to interpret bodily symptoms and decide when to seek care. In the United States, menstrual education often emphasizes hygiene, discretion, and endurance, while providing limited guidance on biological variability or indicators of abnormality. This study examines how these educational narratives influence perceptions of normal menstrual bleeding and contribute to delayed care-seeking and diagnosis.Using a qualitative, multi-method design, we conducted five focus groups with college-aged women (n = 33) and semi-structured interviews with women diagnosed with endometriosis or polycystic ovary syndrome (n = 12). Data were analyzed using reflexive thematic analysis to explore sources and content of menstrual education, normalization of pain and irregularity, and pathways to symptom recognition and diagnosis.Participants described learning about menstruation primarily through family and school-based education that prioritized management and concealment over biological understanding. Pain and irregular bleeding were commonly framed as routine, leading many participants to interpret persistent or severe symptoms as normal variation. For those with diagnosed gynecological conditions, this misrecognition delayed care-seeking and contributed to prolonged diagnostic timelines. Limited menstrual health knowledge also shaped early clinical encounters, reinforcing reassurance and dismissal.These findings highlight menstrual education as an upstream social process that structures symptom interpretation before individuals enter healthcare settings. Reframing menstrual education to emphasize biological variability and symptom legitimacy may support earlier recognition of abnormal symptoms and reduce diagnostic delay.