The word “menstruation” itself is derived from Greek and Latin words meaning month and moon. Menstruation should rather be celebrated and should be seen as a gift, an element of the divine feminine that deserved appreciation and recognition. It’s a beautiful form of detoxification which only women get to enjoy and this process allows them to give birth a life, a miracle that can only be made possible through menstruation.
Every month, millions of adolescent girls around the world face a miserable cycle of pain, discomfort, shame, anxiety, and isolation when their menstrual period arrives. In many low-income and middle-income countries, access to sanitary products such as pads, tampons, or cups is limited and girls often resort to using proxy materials such as mud, leaves, or animal skins to try to absorb the menstrual flow. Appropriate and hygienic infrastructure including waste disposal mechanisms, soap, and water for washing and safe private and accessible toilets is rarely available or sustainable. This absence of facilities, coupled with the shame and fear of exposing their menstruation, mean that many adolescent girls are forced to miss school during their period; consequently, in many rural resource-poor settings, adolescent girls who are already disadvantaged by social norms miss a quarter of their educational opportunities.
Menstruation is a phenomenon unique to girls. However, it has always been surrounded by taboos and myths that exclude women from many aspects of socio-cultural life. In India, the topic has been taboo until date. Such taboos about menstruation present in many societies impact on girls’ and women's emotional state, mentality and lifestyle, and most importantly, health. The challenge, of addressing the socio-cultural taboos and beliefs in menstruation, is further compounded by the low girls’ knowledge levels and understandings of puberty, menstruation, and reproductive health. Thus, there is a need to follow a strategic approach to combating these issues.
UNICEF study showed that one in three girls in south Asia had no knowledge of menstruation before their first period and 48% of girls in Iran thought that menstruation was a disease. Often considered a shameful, dirty, female weakness, the secrecy surrounding menstruation has permeated every aspect of society nurturing superstitions and taboos that are passed on between generations. In many communities, menstruating girls and women are still banned from kitchens, crop fields, or places of worship. One might say, so what? What is the need for them to know if their mothers and grandmothers never did? It is, in fact, crucial for girls to learn about the menstrual cycle.
The lack of awareness around her first period can put a young girl, sometimes as young as 10, through mental trauma and fear over what is happening to her, combined with is a sense of shame because of the age-old stigma around a menstruating woman. A girl often has to hide the fact from family members, friends, teachers, and others. For most girls, management of menstrual pain is a key concern, yet little sympathy or attention is given to those facing this regular pain, let alone management of irregular or pathological periods.
Menstruation is a normal and regular event in every healthy adolescent girl's life. Yet drastic changes are needed to encourage positive social norms and ultimately enact behavioral change. Global Menstrual Hygiene Day on May 28, led by WASH United and supported by more than 400 organizations globally, aims to achieve that.
What is menstruation?
Menstruation is defined as “periodic discharge of blood from the uterus occurring more or less at regular monthly intervals throughout the active reproductive life of a female”. A period, or menstruation, is the shedding of the lining of the womb. Menstruation is also known as menses. Menses are part of normal sexual health for women during their reproductive years. Menstruation that includes bleeding from the vagina is found mainly among humans and similar animals, such as primates. The endometrial tissue is shed from the womb and is released through the vagina. Women have a period approximately every 28 days; however, there is some variation in this cycle, ranging from a 24-day to a 35-day cycle.
A period is part of the woman’s menstrual cycle. It is a sign that the body is working normally. Menstruation marks the beginning of a woman’s reproductive years. From the time when she has her first period, or a few days before, she can become pregnant.A young woman will notice her first period because blood will come from her vagina. A woman has two ovaries, each of which contains a number of eggs. Every month during the reproductive years an egg will be released. Also, every month, the womb prepares a lining in case the egg should become fertilized. If the egg does not become fertilized, the lining is not needed and, together with the egg, it will be shed. We see this shedding as blood. This is what we call a period. If the egg is fertilized, the womb will need the lining, and it will not be shed. This is why periods stop when pregnancy begins.
Menarche and Menopause
Menarche is the start of periods. It will occur when all the parts that make up a girl’s reproductive system are mature and working together. A girl’s periods generally begin between the ages of 12 and 14 years, but this can vary from 8 to 16 years. Menstruation is a major stage in a girl’s puberty. It is one of several physical signs that a girl is becoming a woman. Around 6 months before getting her first period, a girl may detect more clear vaginal discharge. Unless the discharge has a strong odor or causes itchiness, this is normal and nothing to worry about. The periods will occur regularly until the woman reaches her menopause. Menstruation will end with menopause, usually between the ages of 45 and 55 years.
The menstrual cycle is the monthly hormonal cycle a female’s body goes through to prepare for pregnancy. Your menstrual cycle is counted from the first day of your period up to the first day of your next period. Your hormone levels (estrogen and progesterone) usually change throughout the menstrual cycle and can cause menstrual symptoms. Hormones are released by the pituitary gland in the brain to stimulate the ovaries during the reproductive cycle. These hormones cause some of the woman’s eggs, which are stored in the follicles of her ovaries, to start to grow and mature. The follicles start producing a hormone called estrogen. The increased estrogen causes the womb lining to become thicker in preparation for receiving a fertilized egg. If a woman has had sex within several days of the egg being released and sperm is present in her fallopian tube, the egg may become fertilized and she will become pregnant. However, it is important to note that pregnancy is possible with unprotected sex at any time during the menstrual cycle.
If the egg is not fertilized, estrogen and progesterone levels will drop, and the lining of the uterus (endometrium) will start breaking down. This marks the start of the period. The period consists of a small amount of blood and endometrium. The bleeding is caused by the breaking of fine blood vessels within the womb as the lining detaches itself. A period generally lasts about 5 days. Bleeding tends to be heavier during the first 2 days. Even when the blood flow seems heavy, the amount of blood lost is usually around 5 to 12 teaspoons. Some women experience heavier than normal periods, known as menorrhagia. Menorrhagia should be evaluated by a doctor as it can lead to problems such as anemia, because of a low blood count.
The typical menstrual cycle is 28 days long, but each woman is different. Also, a woman’s menstrual cycle length might be different from month-to-month. Your periods are still “regular” if they usually come every 24 to 38 days. This means that the time from the first day of your last period up to the start of your next period is at least 24 days but not more than 38 days. Some women’s periods are so regular that they can predict the day and time that their periods will start. Other women are regular but can only predict the start of their period within a few days.
Premenstrual syndrome
Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle generally just before her menses. PMS is a very common condition. Its symptoms affect more than 90% of menstruating women. It must impair some aspects of your life for your doctor to diagnose you.
PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown. However, many researchers believe that it’s related to a change in both sex hormone and serotonin levels at the beginning of the menstrual cycle Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also modulate activity in parts of your brain associated with premenstrual symptoms. Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your moods, emotions, and thoughts.
Symptoms that may be felt by some women in the days leading up to her period include:
Abdominal bloating
Acne
Headache, including migraine
Irritability
Pain, especially backache
Low mood
Feeling generally emotional or troubled
Insomnia
Lack of concentration
Breast tenderness or swelling
Slight weight gain
Binge eating
The following factors may increase the chances of PMS:
High caffeine consumption
Stress
A history of depression or other mental illness
Smoking and alcohol consumption
A family history of PMS
Low levels of some vitamins and minerals, calcium and B vitamins
Menstrual Hygiene
We have to remember that menstruation is a normal physiological process in females, but poor hygiene can bring serious health issues like urinary and reproductive tract infections. Therefore, females, especially adolescents, must be psychologically prepared about the physical changes that occur during this period. They should be well aware of the menstruation, menstrual hygiene, and menstrual cycle even before their menarche as well as how to maintain hygiene during the cycle. Certain misconceptions regarding menstruation because of poor access to health-related education impact their practices to manage menstruation-related issues. Accurate and reliable knowledge can influence attitudes and practices over time, therefore individuals and organizations involved in women’s health have to intervene and improve awareness among adolescents regarding menstruation-related issues.
Healthcare institutes, schools, local societal settings, and religious centers should be used to disseminate menstruation-related information among adolescents that will facilitate the transfer of quality menstruation-related practices to the next generation. Enormous advances have been made in global child and adolescent health, maternal health, and women's rights. Yet the needs of the 300 million women and girls menstruating on any given day remain buried low on the global health agenda, simply because many are too embarrassed for frank discussions about menstruation. It is time to finally abolish the absurd silence and shame that shroud this natural biological event.
Menstruation, a sign of good health, must be normalized and celebrated. There is a strong need for each of us to openly talk about periods. Let’s talk periods and no longer stay silent.
Prepared By
Malavika A S
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