When a woman’s body discards the lining of the uterus, it’s called menstruation, menstrual cycle or period. It is a monthly biological occurrence among girls and women usually aged between 10 and 51 years, although in some cases menstruation can start earlier and menopause - the natural cessation of periods - can happen before or after 51.
If menstruation is as straightforward as this, why is there hesitation still to speak about it openly and educate adolescent girls about menstrual hygiene management, which is crucial for women’s reproductive health?
In the past decade, several studies and research have been conducted in many parts of the world to spread awareness about menstrual hygiene management, which is still considered a taboo topic in many cultures and households. Findings from a 2014 study indicated that 71 per cent of girls in India were unaware of the concept of menstruation until their first period or menarche. This number stood at 66 per cent in Sri Lanka in 2015 and 49 per cent in Pakistan as per a poll conducted by Unicef (the United Nations International Children's Emergency Fund) in 2017.
71 %
of girls in India were unaware of the concept of menstruation until their first period or menarche, according to a 2014 UNICEF study.
A more recent survey conducted in the US this year found that 54 per cent of people aged between 18 and 70 years agree that talking openly about menstruation is important, but only 36 per cent do it. Meanwhile, 13 surveys conducted in the UK between 2015 and 2020 show that one in three young girls feel unprepared for their first period.
Recalling her experience, 19-year-old Nayantika Nandy, an erstwhile UAE resident who recently moved back to India said, “Even though I got my first period at the age of 12, my mother had broached the topic much earlier when I was 10 to ensure preparedness. We had multiple conversations about how menstruation is a normal, biological occurrence that girls must not feel embarrassed about.”
I remember two incidents from my early teens that made me realise how period-related conversations need more normalising. Back in the days a friend in school was curious to know more about menstruation, and I shared as much information with her as I could without feeling awkward. The next day her mother sternly told me that I should not talk about such issues openly. I was quite confused because my parents had taught me otherwise.
Nandy also said that while most of her tweenager girlfriends in school knew about periods, initially there was some awkwardness. “As we gained more knowledge about menstruation and its crucial role in reproductive health, there was far less awkwardness.”
She also stressed on the importance of raising awareness about menstruation. “I remember two incidents from my early teens that made me realise how period-related conversations need more normalising. Back in the days a friend in school was curious to know more about menstruation, and I shared as much information with her as I could without feeling awkward. The next day her mother sternly told me that I should not talk about such issues openly. I was quite confused because my parents had taught me otherwise.
“A lot of changes are happening, but more conscious efforts have to be made to not make a big deal of a normal biological phenomenon like menstruation.”
Let's talk about it
Education, awareness and acceptability are crucial to normalising period-related conversations, says Dr Purvi Gupta, Specialist Gynaecology and Medical Director, Mediclinic Ibn Battuta. “That girls and women of certain age menstruate is science and there is nothing to be ashamed of. It is not a conversation to shy away from either.”
Today there are several platforms and forums dedicated to raising awareness about menstrual hygiene management. That wasn’t the case even two decades ago.
That girls and women of certain age menstruate is science and there is nothing to be ashamed of. It is not a conversation to shy away from either.
Addressing questions and sharing as much information as possible are some ways to normalise conversations about menstrual health. “Conversations and awareness are very important to help young girls understand the concept of menstrual cycle. With more knowledge and understanding, fears, anxieties and apprehensions are alleviated. Some young girls start their menstrual cycles earlier than others and there could also be occasional incidents of bullying, so it is advisable to educate them about puberty and related biological changes to ensure preparedness. Sometimes, it can be more distressing than painful to see blood coming out of your body. There could be associated aches, pains and mood swings too, which should be empathetically addressed,” said Shalaka Paradkar, a Dubai-based Indian expatriate and a mother of two.
“Nowadays, schools also hold sessions on menstrual health and hygiene with teachers taking a commonsense approach. This helps youngsters to better understand the importance of menstrual health and be sensitive instead of being embarrassed.”
Based on her experience of discussing period and menstrual hygiene management with her 17-year-old daughter, Paradkar added, “When my daughter started her menstrual cycle at the age of 12-13, she was already aware of the biological changes through the many conversations that we had. Sometimes, we may not have all the answers and in such cases, it is always possible to look for information and pick up the conversation later instead of shrouding anything in secrecy.”
“I have noticed significant changes in the way period related conversations are broached and handled by parents nowadays,” Dr Gupta confirmed. “Earlier, even mothers would shy away from period-related conversations, which can cause apprehension among young girls. Normalisation has certainly happened over the years, but more awareness and knowledge about periods, symptoms, bodily changes and menstrual hygiene management are crucial.”
Research shows that women in parts of sub-Saharan Africa, Nepal and Bangladesh, among many other countries often do not have access to even clean rag cloth.”
She added, “Nowadays, the average age when girls start their menstrual cycle is 10-11 years, while in a few cases it can start earlier. It is important that parents, especially mothers, start broaching the conversation when their daughters turn nine about bodily changes at puberty, period, how to use sanitary pads. Gradually they should also talk about premenstrual syndrome (PMS) to help young girls understand that they could feel certain physical and emotional symptoms just before their menstrual cycle. These days, due to easy access of information young girls themselves are more aware and open about menstruation related discussions.”
Change starts from home
With greater access to technology and information, nowadays adolescent girls are indeed far more aware of their bodily functions. For instance, Paradkar’s daughter uses an app to maintain a track of her menstrual cycles. “I think this is immensely useful since young girls can be in sync with physical changes and understand what to expect.”
While a lot of positive changes have happened, a lot more needs to be done to reject the stigma and taboos associated with menstruation. “And change must start from home,” Paradkar emphasised. “In our household, we have rejected all period-related taboos that were practised by the older generations, even in our families. We have consciously reinforced that menstruation is biological and has nothing to do with beliefs. I think it is crucial not to pass on certain cultural baggage, in this case period taboos, to our children.”
“I have vivid memories of an incident when my classmate had stained her skirt and felt so ashamed about it. For a stain that was not even clearly visible she felt extremely upset and humiliated,” Paradkar recollected. “I wish someone told us at that time that it’s an accident and nothing to be ashamed of. Stigmatising period only harms women’s reproductive health.”
Offering a medical point of view, Dr Gupta said, “Blood is a good medium for bacterial growth. So, hygienically even if there is a trace of blood, a change of underwear and sanitary pad is advisable to avoid possible infection.”
Practical tips to improve menstrual hygiene management
Dr Gupta has shared some practical advice to better understand and thus improve menstrual hygiene management among adolescent girls.
What kind of biological changes happen when girls start menstruating?
Physical and emotional changes happen at least two-three years before adolescent girls start menstruating. These changes include sudden increase in height, hair growth in private parts, slight growth of the breasts that can sometimes be painful. PMS, meanwhile, happens just before periods with symptoms including headache, backache, pain in the lower abdomen, irritability, bloating, breakouts, breast pain and mood swings. Some girls also suffer from nausea and diarrhoea.
What can be done to tackle aches, pains and mood swings?
Again, education and awareness play a big role in helping girls to understand what to expect during menstruation. Healthy diet and regular exercising make a huge difference, too; they are particularly helpful in stress management. Although I think most young girls don’t, we still advise them to avoid drinking coffee as it may increase aches, pains and cause breast tenderness. Some girls could be sensitive to dairy products, which they should then avoid during this time. In addition, for mild pain hot water bags can be used along with an occasional paracetamol tablet. For moderate pain, a slightly stronger painkiller might be prescribed. And in certain extreme cases, girls may have to take injectable painkillers, usually on the first day of menstruation.
Should young girls be watchful of certain symptoms like irregular period and polycystic ovary syndrome (PCOS)?
For the initial two to three years of starting a period, ovaries are usually not very active that could cause irregularities in ovulation and thus menstrual cycles. This should not be a cause of concern. However, if periods don’t happen for three months in a row, a check-up is advisable, especially if accompanied by aches and pains. Also, in case of frequent periods, let’s say twice in a month, with significantly heavy flow, getting a check-up might be a good idea. Period tracker apps can be used to maintain a record. Now in the case of PCOS, a condition where the ovaries produce an abnormal amount of androgens or male hormones, the common symptoms to watch out for are irregular periods, excessive weight gain, acne and hair growth under the chin, among others.
What's your advice on menstrual hygiene management, including use and change of sanitary napkins?
There are several options available such as disposable and reusable sanitary pads, tampons and menstrual cups. While disposable sanitary pads are the most widely used, tampons and menstrual cups have restricted usage due to cultural reasons in certain regions. In case of disposable pads, it is recommended to use the variants with a soft cotton surface. Coming to the frequency of change, in case of moderate flow the sanitary pads should be changed every six to eight hours for hygienic reasons. More frequent change is required in case of heavy flow. Depending on the flow, tampons must be changed every four to eight hours. Menstrual cups should be emptied every 12 hours or earlier in case of leakage, sanitised as per instructions and, importantly, the appropriate size must be chosen. The vaginal area must be washed and cleaned properly during the menstrual cycle. Even underwear must be washed properly and changed frequently.
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