Bringing Menstrual Awareness to Occupational Therapy: An interview with Janelle Gullan

One of the best parts of being an occupational therapist is the privilege of hearing the most intimate details of our client’s daily life. For years, I enjoyed getting to know my clients through hearing about the occupations that fill their days, but until I became acquainted with Janelle Gullan’s work, I never asked women in my care about their menstrual cycles. I have interviewed Janelle to share with other occupational therapist the link between occupational therapy and menstrual cycles.

Janelle Gullan BOccTher(Hons) has her own private practice in Melbourne, Australia, where she supports women through mother transitions. She explores feminine rites of passage and the ways they impact roles, relationships, participation, rhythms and joy. Whether mentoring occupational therapists or working directly with mothers, her approach brings together wellbeing for the head, heart and womb. Janelle can be found at her clinic, The Wild Orange Tree.

Janelle, thanks for sharing your knowledge with us today. First off, can you give me an overview of the work that you do?

I help women increase their body awareness so they can move into their new mothering role with confidence, self-love and vitality. I bring together pelvic health, mental health, body wisdom and – of course – menstrual cycles! My approach recognizes that becoming a mother is a blood rite of passage; a transition that comes from our womb space and is heavily influenced by our menstrual cycle.

I incorporate hands-on body work with occupational therapy interventions for preventative and restorative support for mothers. My clients may be trying to conceive, pregnant, postpartum or simply curious about their body and what they can learn from connecting with their womb and inner rhythms.

What made you interested in menstruation specifically?

My own mothering journey led me to search for more holistic approaches to birth recovery and adaptation to mother transitions. I encountered some body work practices that had an enormous impact on my wellbeing, and womb and menstrual cycle wisdom sat at their core. As I trained and then integrated these techniques into my occupational therapy practice, I started to bring menstrual awareness to my pelvic health and mental health interventions.

While my interest in this area came about by accident, the enormous impact that I see from really simple education about our feminine bodies and inner rhythms has convinced me of the value and need for occupational therapy to work in this space. I now have a particular interest in the ways that our relationship with our menstrual cycle influences our early mothering experiences, and how birth and early mothering challenges can imprint back into our menstrual cycle as a mechanism for integrating and honouring these stories.

Can you give us an overview of the inner seasons?

Too often, we think of menstrual cycles as a strange oddity that exist within women’s bodies. However, our menstrual cycle matches perfectly to longer biological rhythms found in nature such as the tides, moon cycles and seasons.

By using the seasons as a guide, we can see the change, purpose and value in the different phases of our menstrual cycle:

Spring: The follicular phase in our cycle (after our bleeding time and before ovulation) correlates to springtime. Just as spring is a time for new growth, this menstrual season usually brings us exploration, new ideas, curiosity, playfulness and higher energy.

Summer: Ovulation matches summertime which holds creative energy, achievement and often more outward social energy.

Fall: Our luteal phase (after ovulation but before our bleeding time) calls us to reflection, honouring, critique and speaking our truth – just as autumn in nature is a shedding of what isn’t needed before winter.

Winter: Our bleeding time then brings us to a winter phase which offers us restoration, a time of nourishment, intuition and surrender.

Our menstrual cycle is a monthly reminder of the need to find balance and rest within our daily lives; a guide for fulfilling our roles and responsibilities feeling sustained rather than burnt out. I love this quote by Lucy Pearce – “When you understand that your body is always changing, but that the rhythm of these changes follows a regular pattern, then you can begin to live within your body's cycles rather than fighting them.”

What do you see as the connection between occupational therapy and menstruation?

At a basic level, there are significant numbers of people who experience challenges with occupational engagement and performance because of their menstrual cycle. This may be due to painful periods and other physical menstrual symptoms, or changes to mental health that match the cycle rhythm. This then plays out as missed work or education, being unable to complete self-care or care giving tasks, reduced participation in leisure or intimate activities, and reduced self-efficacy or meaning and purpose in life. Menstrual cycles are also a gateway to occupations such as conception and mothering, and the transitions that come with menarche and menopause affect our identity, roles and relationships.

Social, cultural and political environments have an enormous impact on our experience and conditioning around menstrual cycles, and these factors fall into the domain of occupational therapy. Occupational justice, another area of occupational therapy practice, likewise needs to be considered when it comes to access to menstrual products and opportunities for women impacted by menstruation on the background of poverty, disability or privilege.

For a profession that is heavily dominated by people with wombs, I believe it is a clear indication of the shame and taboo that still exists around menstrual cycles that this knowledge does not appear within our curriculums and assessment practices.

How can we best use this knowledge to serve our clients?

I like to think of menstrual cycles as buried treasure in our own backyard that we do not realize is there. As occupational therapists, we can help shed light on the impact and wisdom that may be held in a client’s menstrual rhythm.

This might be as simple as asking a client what their menstrual cycle is like and how it impacts them; or wondering if their menstrual cycle is having an influence on any symptoms they report or how recovery progress.

I am still blown away by the difference it makes when I can simply remind a new mother that she is in a winter phase of her life. This same wisdom can be applied to all sorts of recovery, life transitions and the expectations that we place on ourselves.

We can also provide education to normalize a person’s experience of their menstrual cycle; and validate that while so many of the undesirable symptoms of menstrual cycles might be common, they should not be considered normal or expected. There is a lot that occupational therapists can offer to help women adapt to the challenges that arise from their cycle such as poor sleep, pain, fatigue or reduced concentration. However, I would also like to see more occupational therapists work restoratively with menstrual cycles, just as we do in other areas of practice and parts of the body.

How does knowledge of the menstrual cycle impact you as an occupational therapist and business owner?

Menstrual cycle wisdom has impacted me profoundly in my personal life and that is the self that I bring to my work as an occupational therapist. Menstrual cycle wisdom has infiltrated into all of my assessments and service delivery – both as a grounding framework and explicitly in the conversations and interventions that I share with clients. This deeper knowledge of blood rites of passage, and the biological needs of women at these times, has certainly changed my clinical reasoning and client interactions.

I am also aware of how I show up differently for my clients in different phases of my cycle, just as they show up differently to me. This is used as a therapeutic tool rather than an inconvenient variable.

The rhythm and wisdom of my menstrual cycle also allows me to structure my business activities for better productivity, less frustration and greater ease. For example, I try to schedule podcast interviews, discovery calls and my course launches for the spring and summer time phases of my cycle. Editing articles, strategic planning and setting up templates are a perfect match for my autumn inner season. During my winter phase I try to build in extra breaks and am extra aware of my own boundaries. When these alignments are not possible, I can at least bring intention to the activity I need to do and consider the bigger picture of how I am honouring these natural rhythms throughout the month.

How would you like to see our profession move toward integrating knowledge of menstruation into practice?

I would love to see menstruation, menstrual cycles and blood rites of passage being covered by education within our profession at least at a basic level. I believe that these rhythms and transitions impact our occupational performance – both positively and negatively – too much to be missed. With ongoing advocacy, I would like to see occupational therapy become well known as a resource for women seeking adaptive and restorative approaches to their menstrual cycle challenges, as well as a support for the transitions that are linked these biological rhythms.

I really appreciated Janelle taking the time to answer my questions and increase our understanding of the menstrual cycle on our occupations and life transitions. For me, the takeaway learning has been to bring menstrual health into consideration as we assess a women's overall health and occupational engagement. In addition, for those of us who have a menstrual cycle, mindfulness of the inner seasons can help us to be more present and effective with our own occupational performance.

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