Frequently asked questions (FAQ) - Menstruation and menstrual hygiene management

Seetha Gopalakrishnan
Tuesday, May 26, 2015 - 14:00

In the world’s second most populous country with nearly 355 million menstruating women, 23% of adolescent girls drop out of school after their first period. Only 12% of females in the country use sanitary pads. 10% of girls in India believe that menstruation is a disease [1]!

While ‘faeces’ and ‘urine’ have become mainstream, the topic of menstruation still remains taboo. So, what is menstruation? Why do females have to go through this monthly ritual for decades?

Here are answers to some of the more pertinent questions on adolescence and menstruation.

1. What is adolescence and puberty?

2. What is menarche?

3. Why do females menstruate?

4. What is a menstrual cycle?

5. How long does a period usually last?

6. How much blood does a woman lose during every menstrual cycle?

7. Are periods painful?

8. What is Pre-Menstrual Syndrome or PMS?

9. Popular myths and existing realities

10. Why is menstrual hygiene important?

11. What are the sanitary products available for menstruating females?

12. How to dispose of these sanitary products?

13. What to do in case a sanitary pad is not available?

14. How can Menstrual Hygiene be promoted?

15. Where can I get a sanitary pad from?

16. What government programmes are in operation relating to menstrual hygiene in India?

What is adolescence and puberty?

Adolescence refers to that transitional phase between childhood and adulthood in a person’s life. This period is characterized by a plethora of physical, psychological and emotional changes.

A combination of physical changes such as height and weight gain, development of sexual organs and characteristics that ensure the maturation of a child into an adult is termed as puberty. It is during this period that adolescents reach sexual maturity and become capable of procreating.

What is menarche?

At the onset of puberty, girls usually have their first vaginal bleeding, which over time becomes a regular occurrence. The onset of this regular cycle is termed as menarche. Girls start menstruating somewhere between the ages of 9 and 16 and continue to do so till their early 50’s.

Why do females menstruate?

Women have hundreds of eggs in their ovaries at any given time. Every month, in response to reproductive hormones – mainly oestrogen and progesterone – a woman's womb gets ready for pregnancy [2].  

Once every 21-40 days, an egg is released by the ovary, travels through the fallopian tubes and reaches the uterus. The inner lining of the uterus, called the endometrium forms a soft, cushiony layer made up of several minute blood vessels in anticipation of an embryo in case the egg is fertilized by a sperm.

If fertilization does not occur, there is no need to retain the uterine cushion as there is no embryo to nourish and protect. Dropping progesterone levels serve as a cue and the uterus sheds the cushiony blood vessel lining which flows out of the vagina as the menstrual flow.

What is a menstrual cycle?

The time between the first day of a menstrual period and the beginning of the next one is referred to as a menstrual cycle. Usually a typical cycle lasts for 28 days. However, this differs from person to person and can last anywhere between 22 and 45 days.

How long does a period usually last?

On average, a menstrual period lasts somewhere between 3 and 7 days. This varies from person to person.

How much blood does a woman lose during every menstrual cycle?

Scientific studies reveal that on an average, a woman can lose anywhere between 30 and 90 ml of fluid which constitutes both of blood and mucosal tissue over 3-7 days of menstruation.

Are periods painful?

Slight abdominal pain and cramping during periods is normal. The intensity and duration varies from person to person. This is due to the release of hormone-like compounds called prostaglandins which stimulate contractions of smooth muscles of which the uterus is one [3].

Unless the pain is completely debilitating, in which case visiting a doctor would be recommended, most symptoms can be cured using home-made remedies such as hot water compresses and abdominal massage.

What is PMS?

Women usually experience one or a combination of physical and emotional symptoms just before they start their monthly periods. Some of the symptoms include temporary weight gain or feelings of heaviness, tenderness of the breasts, headaches, cramps and general irritability. All these together constitute what is known as Pre-Menstrual Syndrome (PMS).

PMS usually sets in a week or so before menses starts and goes away before the bleeding starts.

Popular myths and existing realities

The topic of menstruation is shrouded by a heavy veil of taboo. For centuries, communities across the world have associated menstruation with all things dark and evil. Menstrual blood is considered impure and menstruating women are often forbidden from entering places of worship, kitchens and farmlands due to fear of ‘polluting’ these spaces. 

Over the years, these perceptions have been proven wrong and science has helped confirm that menstruation is a perfectly normal, healthy, biological function.

Click here for interesting facts about the history of menstrual taboo.

Why is menstrual hygiene important?

Majority of females have very limited or no knowledge about menstruation and the importance of personal hygiene while menstruating. Maintaining adequate hygiene during menses is necessary to stay away from infections as well as for general comfort and easy mobility.

Due to this lack of knowledge, many women follow very unsafe practices such as using coir and unsanitary cloth pads during their menses.

What are the sanitary products available for menstruating females?

It is important to use an absorbent material to soak up menstrual blood in order to prevent bacterial and fungal infections. It is a known fact that many women use traditional cloth napkins during their period. While this may not be totally sanitary, it is not completely unsanitary either. If cleansed well and dried properly under the sun, these pads can be re-used a few times. But in most cases, this does not happen. In order to avoid the ‘shameful’ exhibition of these cloth napkins, women hide them in nooks and reuse the unsterile pads leading to infections and complications.

Sanitary napkin – The most widely used sanitary product is the disposable ‘sanitary napkin’. Most napkins have an absorbent core and a leak-proof barrier that holds the napkin together [4]. These use and throw napkins are available in a variety of sizes and are by far the most popular female hygiene product in India.

Tampons – Unlike the sanitary napkin which is placed outside the vulva, tampons are miniature cylinders of absorbent material that can be inserted into the vagina.

Menstrual cups – These silicone cups can be placed inside the vagina to collect the menstrual flow. Unlike the sanitary pad or the tampon, menstrual cups can be sterilized and re-used.

How to dispose of these sanitary products?

One time use sanitary products should be disposed of with care. Sanitary pads should not be thrown out in the open as it may turn into a breeding ground for bacteria. They should not be flushed down the toilets either as the plastic can choke up drains.

 They should be wrapped in newspaper and thrown out along with the garbage. If your village or town does not have daily garbage collection facility, it is better to burn them instead of letting them lie around.

What to do in case a sanitary pad is not available?

While opting for a sanitary solution is best, in case a sanitary napkin or a tampon is not available, a clean cotton cloth can be used to soak up the menstrual flow. The cloth should be changed periodically depending on the flow.

In case you plan to use the same piece of cloth again, make sure it is washed thoroughly, dried under the sun and stored in a clean and dry place.

How can Menstrual Hygiene be promoted?

Talking openly about puberty and menstruation at home and school are probably the best options. The government, as part of its efforts to reach out to adolescent girls between the ages of 10 and 18, has involved ASHAs to spread the word about menstrual hygiene.

As part of this, ASHAs are encouraged to hold monthly meetings in Anganwadis or Panchayat Bhavans to talk about general health and menstruation issues. ASHAs are also required to make home visits for the benefit of those girls who do not attend the monthly meetings.

Where can I get a sanitary pad from?

Sanitary pads are available in most pharmacies and general stores across towns and cities. For rural areas lacking these facilities, the Union Health and Family Welfare Ministry in 2010 introduced a scheme through which subsidized sanitary pads were made available to adolescent girls. Initially 150 districts were identified.

SHG manufactured napkins ‘Freedays’ can be procured from Accredited Social Health Activists (ASHA) during monthly meetings or from schools at Rs. 6 for a pack of six [5].

What government programmes are in operation relating to menstrual hygiene in India?

The Adolescent Reproductive and Sexual Health (ARSH) and the Adolescence Education Programme (AEP) are core components of national health programmes that address adolescent health.

SABLA – The centrally sponsored Rajiv Gandhi Scheme for Empowerment of Adolescent Girl aims to empower adolescent girls by promoting awareness about hygiene as well as adolescent reproductive and sexual health. Girls between the ages of 11 and 18 are given a ‘Kishori card’ with information relating to body weight, BMI, nutrient supplement and any referral services [6].

Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India – Under this, sanitary pads are made available at subsidized rates to girls in rural areas.

You can also download the FAQ listed as an attachment below in portable document format .

References:

1. Celebrating womanhood: Menstrual hygiene Management - Water Supply and Sanitation Collaborative Council (WSSCC) http://www.wsscc.org/sites/default/files/publications/final_wsscc_mhm_handout_4pp_2.pdf_eng_23082013.pdf

2. Why do women have periods when most animals don’t - http://www.bbc.com/earth/story/20150420-why-do-women-have-periods

3. Menstrual pain and how to relieve it - http://www.motherearthnews.com/natural-health/menstrual-pain-zmaz81ndzraw.aspx?PageId=1

4. Sanitary napkin – Wikipedia - http://en.wikipedia.org/wiki/Sanitary_napkin

5. Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India - http://nrhm.gov.in/nrhm-components/rmnch-a/adolescent-health/menstrual-hygiene-scheme-mhs/schemes.html

6. Sabla scheme for adolescent girls - http://timesofindia.indiatimes.com/city/patna/SABLA-scheme-for-adolescent-girls/articleshow/7927855.cms?referral=PM

Lead image courtesy: Training module for ASHA on menstrual hygiene

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