What happens when a woman gets her period in space?

"Do you weep when things go wrong on the job?" another one wanted to know. "Will your reproductive organs be permanently damaged?" "Don't you want to have kids?"

America had a barrage of questions for its first female astronaut in the days before her first venture into space, many of them pretty absurd. "It's too bad this is such a big deal," she responded. "It's too bad our society isn't further along."

But one of those questions – "How will you deal with menstruation in space?" – is still being worked out, although NASA has certainly gotten better at dealing with the issue since Ride's first flight. (Engineers once asked her if 100 tampons was enough for a week-long stint in space, she recalled in a 2002 interview. "No, that would not be the right number," was her straight-faced reply.)

According to an analysis published Thursday in the journal npj Microgravity by space gynecologist Varsha Jain and space pharmacologist Virginia Wotring (let's pause and take a moment to appreciate that those jobs exist), there's a lot to consider. Although periods 250 miles above the Earth aren't so different from ones on the ground, female astronauts still need up-to-date information about the options available to them, Jain and Wotring write – just as women on Earth do.

Fifty years ago, NASA dealt with the issue of menstruation in space by avoiding it. In 1964, a paper written by Johnnie Betson Jr. and Robert Secrest warned of the dangers of putting "a temperamental psychophysiologic human" – i.e., a woman on her period – in charge of a "complicated machine." (lol)

Others cautioned that zero gravity might induce retrograde menstruation, when blood flows backward up the fallopian tubes and into the abdomen. Doctors didn't have evidence for any of these claims, but they still helped shut down the Lovelace Women in Space Program in the early '60s. No American woman would journey into space until Ride's flight two decades later.

"We were asked, 'What do we do about this?' " Rhea Seddon, a member of Ride's astronaut class, said in 2010. Her suggestion: "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."

"I'm not totally sure who had the first period in space," she continued, "but they came back and said, 'Period in space, just like period on the ground. Don't worry about it.' "

According to Jain and Wotring's study, most female astronauts take daily contraceptive pills before and during space flight. Although most prescriptions include 21 days of contraceptive pills and seven days of a placebo (during which the woman usually has her period), the pills can be taken continuously to suppress menstruation.

It's a fine strategy for short-term space travel, but a long journey – like a roughly three-year mission to Mars – would require each female astronaut to bring 1,100 pills with her. That's a lot to pack on a trip where every ounce of added weight counts. Additionally, the authors write, no one has tested the effect of three years of space flight on the stability of those pills. It's possible that the medication would degrade over time.

A better option might be long acting reversible contraceptives, such as hormonal IUDs, injections of progestin and implants that go beneath the skin. Progestin injections last three months, making them seem like an attractive alternative to the pill, but they can also cause bone density loss – compounding a problem that already plagues people living in zero gravity.

Hormonal IUDs and subdermal implants, which last up to five years and three years, respectively, both seem like better options, Jain and Wotring conclude. They still need to be studied further, for the obvious reason that you don't want to send a woman into space for three years and then find out that her implant snags on her spacesuit, or that the lack of gravity causes her IUD to malfunction or become painful.