NASA has to talk about periods in space if we ever want to go to Mars

In 1983, NASA astronaut Sally Ride became the first American woman to fly in space.

Before launch, a group of NASA engineers came to Ride, asking if 100 tampons would be sufficient for her needs on a six-day space shuttle mission. Ride responded that “you can cut that in half with no problem at all,” according to anoral history produced in 2002.

That interaction best encapsulates NASA's wariness about dealing with women's health, both within the agency and to the outside world when Ride flew decades ago. 

But even today, the space agency rarely, if ever, comments on managing women's reproductive health. NASA will be forced to confront the unique aspects of being a woman in space, at least internally, as the agency pushes to send humans to Mars in the coming years.

In her 2010 oral history, former astronaut Margaret Seddon said:

We were asked, “What do we do about this [menstruation in space]?” We said, “How about we just consider it a non-problem until it becomes a problem? If anybody gets sick in space you can bring us home. Then we’ll deal with it as a problem, but let’s consider it a non-problem.” They did. I’m not totally sure who had the first period in space, but they came back and said, “Period in space, just like period on the ground. Don’t worry about it.”

These may seem like humorous anecdotes, but they illustrate an important point: Menstruation has historically been a fraught issue for NASA and the women that fly to space with the agency.

Today, years after Ride’s first flight, far more women have flown to space with NASA, producing a relatively welcoming space agency culture for female astronauts. 

However, the agency is now grappling with issues unique to women flying long-duration space missions, as it gears up for a trip to Mars. NASA doesn’t appear to be talking publicly about this, however. Mashable contacted the space agency and was told they were looking into the inquiry, but they had not responded as of press time.

Unique challenges

Women are just as capable as men when it comes to spaceflight, performing their duties as well as and alongside their male counterparts, but there are some challenges posed by being a woman in space.

One of those is the question of what to do about your period.

Through the years, many female astronauts have used the contraceptive pill to stop their periods during long-duration spaceflights, but that kind of medically-induced amenorrhea may not be practical on a three-year round-trip mission to Mars, according to a new review study published in the journal npj Microgravity on April 21.

In spaceflight, everything down to the smallest items are taken into consideration before flight. Every ounce of material needs to be counted exactly in order to know precisely how much fuel is needed to get a spacecraft to its destination.

For a three-year Mars trip, an astronaut would need 1,100 birth control pills and the packaging to contain them, plus those pills expire after a set amount of time.

“Thinking about what you would need to do differently on a three-year-long Mars mission, that’s exactly the exercise that a lot of folks at NASA are engaged in right now.

“If you think about supplying someone with a pill to take every day on a three-year-long mission, suddenly that’s not negligible; that’s kind of a big package of stuff.”

Whatever amenorrhea-inducing method used by women on a trip to Mars will also need to sustain high g-loads and be effective in the weightless environment of space. 

Also, if a woman choses to have her period while in space — which is a perfectly reasonable and safe decision — it would require a fair number of supplies like tampons and sanitary pads. 

Plus, a space toilet is not necessarily the most robust tool around. The International Space Station's toilet isn't designed with menstrual blood in mind, according to the new study.

Ultimately, the decision to menstruate or not menstruate in space is up to the woman alone, but if a female astronaut does decide to induce amenorrhea medically on a trip to Mars, there are some things to keep in mind.

The best method for each woman

The review study looked at the advantages and disadvantages of using birth control options like hormone-containing intrauterine devices and subdermal implants, which fall into the category of long-acting reversible contraceptives (LARCs).

According to the study, these LARCs have not been “extensively used by female astronauts” yet, but they could be promising.

For instance, an intrauterine device is effective for five years without any daily maintenance, while a subdermal implant is good for three or five years depending on dosing. And neither of those devices require packaging.

Those two types of LARCs are theoretically safe for use during the high-g loads experienced during landing and launch, but more research needs to be done before that can be confirmed.

It’s also possible that a sub-dermal implant could catch on equipment or a suit, the study says, and there could also be unknown side-effects of long-term use of hormones in the space environment.

“Because loss of bone mineral density is known to occur on spaceflight missions, we need more data regarding health effects, including bone health, with long-term use of hormone treatments not just for contraception (as most women use them), but also for the less-common use to suppress menses," Wotring said in a statement.

Studies on female astronauts are somewhat limited by the small number of female astronauts and cosmonauts. For example, globally, only 59 women have flown in space, a very small sample size for anyone hoping to learn more about the efficacy of any specific kinds of medically-induced amenorrhea in spaceflight.

Women who choose to menstruate normally before and during flight will need to deal with the headaches, cramping and fatigue that sometimes go along with that time of the month, and that may be challenging for a woman keeping abnormal hours training for a mission to space.

Many women in the military, for instance, do choose to suppress menstruation during missions, according to the study.

“Studies of women in the military have shown that many would like to suppress their menstrual flow during deployment, but only a proportion of them use the pill to do so; the majority of women surveyed also wanted more advice from the military to help them make the right choice,” co-author Varsha Jain said in the statement.

Why NASA should care

If the military's trend holds for female astronauts, they may look to NASA to provide some information on the best forms of menstruation-suppressing contraception.

And if the most recent class of astronauts is any indication, women will be a big part of NASA’s journey to Mars: Four of the eight chosen astronaut candidates in 2013 were women, marking the first time an astronaut class had an equal number of women as men.

It’s important that women “have the most up-to-date information on reliable contraception and means of menstrual suppression,” Jain added.

NASA doesn't usually comment publically on the health needs of their astronauts because of privacy concerns, but hopefully, at least internally, discussions surrounding menstruation in space are ongoing.

This isn't the only health issue that NASA stays mum on. The space agency is also exceedingly tight-lipped when it comes to reproduction and sex in space.

NASA has historically denied that any of the agency's astronauts have had sex while in space, but if we are eventually going to settle on Mars, NASA may need to start thinking about what reproduction in space could entail.

If humans are really going to live permanently on multiple planets, then sex is going to be part of that, so figuring out exactly what happens to the body during reproduction and gestation in space and on other planets is an important next step.

And it could be just the thing to push us into the final frontier.