Being homeless means it's a daily challenge to get your basic needs met: eating, bathing and using the bathroom. For many women, one extra challenge arises every month when they get their period.

What do you do without access to sanitary products, toilets or a safe place to change your clothes—let alone shower? It’s an often-overlooked issue for homeless women, who are already dealing with the other challenges of being homeless.

Kristen Devlin knows this all too well. She’s hanging out at a homeless encampment under an Interstate 80 overpass in San Francisco. Her arms are covered in cuts and scars and she’s reading a zombie novel. She’s 31 years old and gets a regular period—she even has an app on her phone to track it.

“It sucks—one of the hardest things really has got to be just finding places to change ... that and washing your clothes,” says Devlin. “Hydrogen peroxide can be easily gotten, it's hella cheap at the dollar stores and stuff, but I mean yeah, dude, yeah, and supply.”

For homeless women in San Francisco, supplies like pads and tampons aren’t that hard to come by if you know where to look. Shelters are required to provide feminine hygiene products. For Devlin, her product of choice is the DivaCup, a menstrual cup, because you can leave it in longer than a tampon, and reuse it.

“And it is cheaper than tampons, dude,” she says. “But it’s messy.”

And when you’re homeless, finding a bathroom or safe place to change is tough. So when your period is messy—as they often are—it can feel like a nightmare.

“While there are a lot of really wonderful resources that are both open to men and women, there are a lot of different needs for those populations,” says Kemi Role, who leads street outreach services for San Francisco’s Women’s Community Clinic.

“And if you can imagine a homeless woman who might be struggling with issues of trauma, issues of violence, might be currently using—going into a male-dominated space might not be the safest space for her.”

The street outreach program provides hygiene supplies from toothpaste to tampons to between 90 and 150 homeless women a week. When a homeless woman doesn’t have immediate access to sanitary products, Role says it can look a few different ways.

“From doing things like makeshift supplies such as using toilet paper, even though again, for someone who's under-resourced, having access to something like toilet paper is actually pretty significant, and oftentimes our clients don't have anything, so they may be bleeding in their clothes,” she says.

And having soiled clothes can add to the judgment around the appearance and odor of homeless people, Role says. Not only is it humiliating and damaging to a woman’s self esteem, there’s also a physical health risk. Poor health is closely related to homelessness and improvising with unsanitary products or leaving them in too long can lead to vaginal infections that lower the immune system.

For Anna, who asked that her last name not be used, maintaining her health when she became homeless two years ago was really hard.

“It's not like you have something in the library that gives you a handbook, 'How to be homeless,' or where to find all these resources” she says.

Anna was displaced from her apartment and found herself living on the street. Today, she’s getting a free lunch at Martin de Porres House of Hospitality on Potrero. Lunch today is a big bowl of soup and salad. She says her first six months of homelessness were absolute misery, and even harder because of her period.

“You want to preserve your dignity as a human being and especially as a woman the best that you can,” Anna says. “It is hard especially with nowhere to go to wash, to shower, to change ... there were times when I did have a clean change of outfit with me in my backpack but there was no place where I could safely change.”

Although Anna encountered other homeless women with the same problem, she says she’s never discussed it with them.

“Sometimes it's almost too painful to discuss something like this once you've gone through it,” she says. “A lot of times when a person is just getting into a situation that is really new and difficult in that way you can't really connect with others easily, and you don't know where to go for resources. There is no one centralized place.”

Anna says eventually she figured it out. During the day she would hang around libraries with public restrooms so she had access to a toilet. When her food stamps kicked in she would use them at 24-hour fast food restaurants with restrooms for paying customers.

But even if you are a paying customer, many bathrooms have done away with tampon vending machines. Recently, there’s a growing movement pushing to make tampons and pads as available as toilet paper in all bathrooms.

Nancy Kramer has been interested in the tampon problem since 1982 when she visited Apple headquarters in Cupertino and saw free tampons and pads in a women’s restroom for the first time.

A lot of the Bay Area companies offer that and a lot of more progressive businesses do,” Kramer says. "But it's absent in the airport in San Francisco, it's absent in a lot of restaurants in San Francisco, it's absent in the schools in San Francisco—so there are many places that it absolutely is not the case where those items are accessible to people when they need it.”

Kramer isn’t a homeless advocate. She’s a women’s advocate. She started an organization called Free the Tampons to push for free feminine hygiene products in every bathroom nationwide, at the expense of the business owner.

The organization has also been working to help develop timed tampon dispensers that would prevent abuse of free products. But, she says, if men got periods this wouldn’t even be a conversation.

“We have toilet papers that takes care of the other bodily functions that we use the restroom for, but I think it's a bit of a gender equality issue,” she says.

Internationally, tampon drives, like canned food drives for people in need, are growing in popularity. Last year, a crowd-funding campaign raised over $4000 to distribute period packs with sanitary napkins, tampons, and wipes to homeless women in the Bay Area.

Some people acknowledge that it’s an overlooked basic need. But even if sanitary products become accessible to every woman, homeless women in San Francisco will still struggle to find safe places to use them.

This piece first aired on October 28, 2015.