It’s that time of the month. Your uterus twists, warning that your period is coming. You’re at school and have no tampons or pads. You’re afraid to ask a classmate, so you run to the bathroom. It’s out of toilet paper and there are no stall doors or hand soap.

These are the struggles facing some people who menstruate on the island of Puerto Rico. In many public schools, teachers say, students come up against a horde of troubles when managing their periods. Along with poor public school bathroom conditions, they say, is a lack of comprehensive menstrual education and access to menstrual products. There is also the stigma — having your period is still seen as a mark of weakness and impurity.

But these issues often fly under the radar, as there is little data on menstrual injustices on the island. While studies have focused on such issues as period poverty in developing countries and in the United States, there is a lack of research on menstruation in Puerto Rico from a political and social perspective.

[ 1 in 10 college women face period poverty, a study shows. Here’s what that means.]

A national study published in January in the journal BMC Women’s Health found 14.2 percent of college-aged women in the United States experienced period poverty in the previous year. Before the pandemic, another study published in Obstetrics and Gynecology reported that 64 percent of low-income women surveyed in St. Louis were unable to afford menstrual products in the previous year.

In Puerto Rico, though, there’s little quantified documentation of the effects of period poverty — but there is anecdotal research. Diana Betancur Toro is a doctoral student at the department of psychology at the University of Puerto Rico in Río Piedras, a neighborhood in San Juan. Her research focuses on menstruation from a biopsychosocial perspective.

Betancur Toro said she has worked with individuals who use rags to manage their periods because they cannot afford to buy menstrual products. They also use the same pad or tampon for extended periods of time to minimize the number of products they use, which can cause infections, she added.

The affordability of menstrual products is an issue for many menstruators in Puerto Rico, where the median household income is $20,539 and 43.5 percent of people live in poverty, according to U.S. census data. But only focusing on “period poverty” ignores the other injustices that menstruating individuals experience, and how those are tied to social and economic inequality, according to Betancur Toro.

In particular, Puerto Rican students may suffer from the effects of menstrual injustice, according to advocates.

Health teacher and sexual therapist Sylvia Rivera Lugo teaches at República de Colombia High School in Río Piedras. There, bathrooms lack electricity, have stall doors that won’t lock or no doors at all, are inundated with water, have clogged sinks or have no toilet paper, she said. Some students have family members pick them up at midday to use the bathroom at home or at a mall, Rivero Lugo said. She added that students have told her they feel unsafe in school bathrooms because they are far from classrooms and lack privacy.

[ In the depths of a coronavirus crisis, period poverty is worsening in India]

Vanessa López, director of República de Colombia, confirmed the bathrooms don’t have electricity but did not address the other allegations.

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According to Lourdes Torres Santos, a history teacher at Escuela Dr. Facundo Bueso in San Juan, many public school bathrooms “are not a space in which the basic necessities are satisfactorily met.”

Both educators said they believe schools in more rural or poor areas receive less maintenance. The Puerto Rico Department of Education has not responded to requests for comment.

Torres Santos also said the topic is not addressed enough in elementary school, which is concerning, she added, because some individuals start their menstruation as early as the age of 8. Rivera Lugo always keeps menstrual products in the classroom, she said, and students have asked her if they can take home extra pads because they don’t have any.

Activists on the island are taking matters into their own hands, wielding social media, education and their community connections to try to effect change. L’Orangelis Thomas Negrón is an activist based in San Juan who runs an Instagram account called Matrilíneo, which raises awareness about menstrual and reproductive justice. For Thomas Negrón, options like a reusable menstrual cup were too expensive, she said, so she bought cheaper disposable products until someone gifted her a menstrual cup. Through Matrilíneo, she is now distributing more than 1,000 menstrual cups on the island in partnership with the Black Women’s Health Imperative Positive Period program, she said.

Thomas Negrón faced the menstrual education gap in the early 2000s. She was born with HIV and remembers worrying about how to dispose of pads safely, she said.

“Beyond the embarrassment of menstruation, there is also a worry that my blood could be dangerous,” Thomas Negrón said.

Johana Karis Molina Ortíz, an activist and menstrual educator from Aguas Buenas, runs Todas Jevas, an Instagram account dedicated to nonbinary menstrual education. Molina Ortíz said her activism started after she attended various “menstrual circles,” safe spaces where attendees share their experiences with their periods.

In the first groups Molina Ortíz attended, she noticed they lacked racial and socioeconomic diversity and required attendees to pay a fee. Now, Molina Ortíz goes to the menstrual circles run by Thomas Negrón because they are inclusive, intergenerational and free, she said.

Thomas Negrón started hosting virtual menstrual circles in February 2020. The most recent were held at the workshop house of En El Callejón, an organization based in the Las Monjas community of Hato Rey. The circles facilitate conversations about blood color, odor and texture, which can help menstruators monitor their reproductive health, as well as their feelings related to menstruation.

In September, Thomas Negrón organized the second edition of “Cíclica: Exhibición de Sangrado Libre,” which ran for almost three weeks, at En El Callejón. The event included workshops for children and adults, a menstrual art exhibition, a market and performances. Betancur Toro and Molina Ortiz taught a workshop on menstruation to about 30 individuals of all ages, races, gender identities and backgrounds, they said. Both women explained the process of menstruation, debunked stereotypes associated with it and talked about how women’s body parts were named after White men.

There was an air of comfort at the event, according to Thomas Negrón; at “Cíclica,” menstruation was not a taboo subject. The menstrual art exhibition, where individuals shared paintings made with their menstrual blood, was one of the many ways Thomas Negrón sought to normalize menstruation at the event.

“Transforming our menstrual blood into art is not only a revolutionary act, but also an emancipating act for all,” she wrote in a post on Instagram.

The opening night drew 300 people, Thomas Negrón said. Attendees included newbies and veterans of the menstrual justice movement on the island, who gathered in this vulnerable space to come to terms with what bleeding monthly means to them.

These activists believe educational events like “Cíclica” can change people’s perspectives of that time of the month.

Reporting for this story was supported by the Pulitzer Center.