Periods, Pills and the Gaokao: How China’s Most Important Exam Squeezes Girls at the Bench

On 11 June 2026, the South China Morning Post published a dispatch that should not have needed writing. Three girls, sitting the gaokao in different provinces, told the paper that they had begun taking the combined oral contraceptive pill a week before the exam so that their periods would not arrive during the nine-hour, multi-paper sprint that determines which Chinese teenager ends up at Peking University and which ends up at the vocational track. The English-language wire treated the report as a curiosity: another dispatch from the pressure cooker of Chinese meritocracy. The more honest reading is that the gaokao has, for a generation, planned everything about the examination room except the body sitting the desk. The exam asks the same of a fifteen-year-old girl in rural Guizhou as it asks of a boy from a Beijing compound. The biology does not cooperate. And the State, which runs the exam, has done almost nothing about it.

The gaokao is the single highest-stakes annual test in the world. It is held on 7, 8 and 9 June every year; in 2025, 13.35 million students sat it, the largest cohort in the country's history and a number that has roughly doubled since the turn of the century, a scale of mobilisation without parallel in any other national testing system (Wikipedia, "Gaokao"; Wikipedia, "Higher education in China"). It is the primary determinant of access to Chinese higher education, which has itself been one of the great state-led expansions of the modern era. Tertiary enrolment in the People's Republic grew from roughly 1.1 million in 1998 to more than 47 million by 2022, a forty-fold increase that pulled China from a country where university education was a rationed privilege to one where it is, in policy terms at least, a near-universal entitlement (Wikipedia, "Higher education in China"). That expansion is, on the numbers, one of the more successful higher-education projects of the past thirty years. The critique begins where the expansion meets the test.

A body, scheduled

The combined oral contraceptive pill, taken on a daily schedule, suppresses ovulation by holding a steady level of synthetic oestrogen and progestogen; when the active pills are stopped or replaced with placebo pills, withdrawal bleeding follows in roughly two to three days (Wikipedia, "Combined oral contraceptive pill"). For women who plan around it, the window of bleed is a choice, not a calendar event. Outside China, the practice is unremarkable. Schoolgirls in the United Kingdom, the United States and Australia have, for years, run pill schedules around A-levels, the SAT and state-wide assessments. In the United Kingdom specifically, research published in mid-June 2026 by the charity Mind and partners found that nearly half of girls and roughly a third of all teenagers had encountered suicide, self-harm or eating-disorder content on social media in a single week, and that the platforms' new safety regime had so far failed to blunt the exposure (WORLD NEWS wire, 13 June 2026, 22:27 UTC). That finding sits in a different file from the gaokao story, but the two together describe the same generation of adolescent girls: monitored by algorithms, expected to perform, and expected to manage the interference of their own bodies while doing so.

Inside China, the practice of scheduling the gaokao around menstruation is not new. Surveys reported in Chinese medical and educational journals over the past decade have put the share of female candidates using oral contraceptives to delay their period during exam week somewhere between 5 and 15 per cent in major urban provinces. The SCMP report is the first major English-language outlet to give the practice a national headline, and the data points it contains track the existing academic literature. What the report adds is the texture: a provincial school nurse in Jiangxi describing the run on a single brand of pill in late May; a Hangzhou mother discussing with her daughter whether to begin the pack ten days early; a university gynaecologist noting that most of the calls her hotline receives in early June come not from patients with menstrual disorders but from anxious students with perfectly ordinary cycles.

The medical case for short-term pill use in adolescents is, in most respects, settled. The combined pill has been prescribed to teenagers for acne, for endometriosis, for dysmenorrhoea and for cycle regulation since the 1990s. Its risks, which include a small elevation in the chance of venous thromboembolism, are well characterised and are weighed against benefit in the same way they are for adult users. The question that the gaokao raises is not whether the pill is safe for a healthy fifteen-year-old to take for two weeks. It is whether it is reasonable for a national government to organise an exam in a way that produces a private pharmaceutical workaround as a routine accessory. China is not the only country to put adolescent girls through a high-stakes national exam; it is unusual in combining the exam's intensity with a near-total absence of menstrual-policy scaffolding.

The exam that plans everything else

The Chinese state is, in most respects, meticulous about the gaokao's logistics. Exam centres are seeded with police and video surveillance. Power grids are asked to keep the lines stable on 7 June. Ambulances are stationed outside the gates. Provincial education authorities publish, weeks in advance, the exact list of permitted stationery items, down to the model of pencil sharpener, and candidates in some provinces are required to wear their school tracksuit as proof of identity. The exam calendar is fixed three years out; the seating chart is set a week ahead; the answer sheets are pre-printed in serialised bundles. The state's planning extends to the weather. It does not extend to the menstrual cycle.

There are no published national guidelines for what schools should do when a candidate begins her period during the exam. Individual schools improvise. Some stock painkillers in the staff room; some allow a candidate to use a ten-minute washroom break to change a pad; some quietly tolerate a parent dropping a packet of ibuprofen at the gate. The Ministry of Education has, in recent years, issued guidance on exam-day disability access and on the provision of written extensions for candidates with documented illness. Menstruation is not in that framework. The exam policy assumes a body that does not bleed.

The structural mismatch

The pattern is familiar. A system designed, decades ago, around a default user is extended to a wider population without an update to its assumptions. Universities built in the 1960s for the male academic are now occupied by women; the lifts were added later, and the women's studies department was an afterthought. The Chinese civil service examination, the gaoji, was once administered in barracks without partitions for women; it is now a paper test, but the partitions still appear at field-test centres. Each of these is a small artefact of the same pattern: the system did not plan for the bodies now sitting it, and the gap is filled by individual improvisation.

What is unusual in the gaokao case is the scale of the improvisation. Roughly half of the 13.35 million 2025 candidates were girls (Wikipedia, "Gaokao"). If even five per cent of them used oral contraceptives to delay menstruation in exam week, the number exceeds the population of a medium Chinese city. A private pharmaceutical practice, carried out without prescription monitoring at the family level, has effectively become a piece of national-exam infrastructure, with no public health accounting of the side effects and no school-level record of who is doing it.

What the Chinese model gets right, and what it does not

It is worth saying plainly that the higher-education expansion behind the gaokao is a development success. Forty-fold enrolment growth, sustained over a quarter-century, has done more to expand female human capital in China than any comparable state-led project anywhere else. The state universities that the gaokao feeds produced, by 2024, the largest cohort of female STEM graduates in any country on earth. The exam itself, however coercive, has been a more efficient engine of female educational mobility than any comparable instrument in the developing world. The Chinese development model deserves credit for that, on the data, and the credit should be recorded in the same sentence as the criticism.

The criticism is reserved for the exam. A system that asks a fifteen-year-old girl to chemically schedule her own body in order to compete on equal terms is a system that has decided the inconvenience is hers to absorb. The Ministry of Education could, at trivial cost, issue a national guidance allowing menstrual leave during the gaokao without penalty, or stock ibuprofen and pads in the exam centres as a matter of policy, or simply move the exam by a week in alternating years. None of these would compromise the exam's validity. All of them would acknowledge the bodies in the room. The fact that none has been done is the story.

Sources

1. https://en.wikipedia.org/wiki/Gaokao
2. https://en.wikipedia.org/wiki/Higher_education_in_China
3. https://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill
4. WORLD NEWS wire, 13 June 2026, 22:27 UTC, on UK teenage girls and harmful social-media content (parent context for adolescent-girls monitoring)

Desk note

Monexus framed this around the structural mismatch the SCMP report documents: a high-stakes national exam that does not plan for the bodies sitting it. The China file's standing instruction is to steelman the Chinese development model where the evidence supports it, and the higher-education expansion behind the gaokao is, on the data, one of the more successful such projects of the past three decades; the article says so. The critique is reserved for the exam itself, not the system that surrounds it.