Today menstruation is no longer the confining event it was as recently as the early part of this century. Health care professionals encourage menstruating women to continue their daily activities, and menstrual absorbents have been developed that conveniently meet the hygienic demands of menstruation. While these developments have freed women from some of the confining aspects of menstruation, taboos surrounding menstruation are remarkably similar to taboos of the 19th century.

Most menstrual-related research has emanated from a pathological perspective. In order to understand more fully the menstrual experience, it is important to examine menstruation from a non-pathological perspective, a perspective coming from the daily lives of healthy women. The purpose of this research was to discover how women integrate menstrual care practices into their activities of daily living.

Grounded theory methodology was used to approach the research question. The purpose of this qualitative methodology is to generate a substantive theory that conceptualizes how individuals resolve a particular social problem. The methodology has been most productively utilized in studying previously unresearched areas and in gaining a fresh perspective on a familiar situation.

Making sure is the process that enables menstruating women to continue their daily activities and resolves the problem of "having to worry about it." Making sure allows a culturally appropriate response to a physiological process, while minimizing the time and effort directed to menstruation. Thus daily demands of higher priority can be attended to and not suffer neglect resulting from distractions from the continuous menstrual demand.

Making sure consists of three subprocesses--attending, calculating, and juggling. Each of these processes is conditioned by the day of flow and public or private context. For some women, back-up strategies are used to enhance making sure.

Recommendations for clinical practice include educational application in preparing girls for menarche, and assisting women in decreasing their risk for toxic shock syndrome. Additionally, the theory discovered here appears to be an initial step in the development of a theory of managing involuntary eliminative processes.