Menstrual History

What is Menstruation?

Menstruation is a natural body function. This is one of the processes, which prepares a girl’s body to conceive a baby in the future. Menstruation is a sign that her reproductive system is functioning healthy and well.

Understanding Menstruation and Problems during menstruation

Menarche

The onset of puberty, when the girl has her first period is known as Menarche. Menarche may take place between 9-16 years of age. During this period, most girls observe bleeding for the first me from the vagina. This bleeding becomes a periodic occurrence in a girl’s life with the cycle of bleeding observed in a gap of 28-40 days.

Menstrual Cycle

Why does menstruation occur?

Girls have thousands of eggs in their ovaries when they are born. Every month, or about once in 21-40 days, one of the eggs leaves one of the ovaries, and travels through a fallopian tube. When the egg leaves the ovary, this is called ovulation. As the egg travels in the fallopian tube, a so spongy lining gets formed within the uterus. This lining is mostly made of tiny blood vessels.In case an egg and sperm meet to form an embryo, or a baby, that begins to grow in the uterus and the lining will provide the nutrition. If the egg is not joined by a sperm, the lining of the uterus begins to break. The blood that is released from the broken lining, flows out of the vagina. This bleeding is the menstrual period. This whole cycle is called menstruation.

A menstrual cycle lasts from the first day of one period to the first day of the next. The typical cycle of an adult female is 28 days, although some are as short as 22 days and as long as 45 days. Periods usually last about 3-7 days, which can vary too. During a period, a woman passes about 2-4 tablespoons (30-59 millilitres) of menstrual blood.

The period (Days 1-7) is considered the beginning of the menstrual cycle. A period normally lasts for around five days, but can be as short as two days or as long as seven. There is usually around 2-6 tablespoons of blood lost during each period, depending on the heaviness of the flow. A period occurs because the uterus will shed its lining if an egg (ovum) is not fertilised.

(Days 8-14) One of the ovaries releases an egg and the uterus begins to rebuild its lining. Only one egg is released in each cycle. The egg slowly travels down the fallopian tube from the ovaries towards the uterus. If the egg is fertilised by a sperm before it arrives the uterus, the girl becomes pregnant.

(Days 15-28) If the egg is not fertilised, the uterus wall con nues to thicken until there is a sudden drop in hormone levels. The lining breaks down, and the next period begins.

Problems that a Girl may Encounter During Menstruation

The difficulties that girls may experience during menstruation are:

1. Irregular Periods
2. Painful periods
3. Heavy periods

Irregular Periods : For the first few years of menstruation, cycles are often irregular. They may be shorter (3 weeks) or longer (6 weeks). A young girl may even have only three or four periods a year. A girl’s cycles will usually become regular within two to three years after menarche.

Heavy periods : A heavy period is one which lasts longer than eight days, saturates the napkin within an hour or includes large clots of blood in the menstrual flow. This is common in adolescents because of slight imbalance in chemical hormones secreted by the body. However, if this happens regularly, it leaves the girl feeling exhausted; which means that the body is losing more blood than it is producing. The girl should then consult a doctor immediately.

Painful period : Slight pain during periods is quite normal. This is due to the secre ons of a chemical called prostaglandins in larger quantity than normal. This leads to nausea, headaches, diarrhoea and severe cramps. Usually, this lasts only for a day or two. To get relief from these symptoms, a girl should try the following methods:

• Fill a plastic bottle with hot water, wrap it in a towel and place it on the abdomen,
• Massage the abdomen
• Local remedies such as ginger tea can be taken

Premenstrual Syndrome (PMS) : This refers to a combination of physical and emotional symptoms experienced by all women during the menstrual cycle, usually just before bleeding begins. These symptoms include:

• Temporary weight gain and a feeling of heaviness due to accumulation of water in the body
• Headaches and cramps
• Painful or heavy feeling in the breasts
• Feelings of irritability

These symptoms begin five to seven days before the period starts and disappear before the bleeding begins. This can be managed with remedies for pain described above and eating a diet that is low in salt, and includes foods like leafy green vegetable and raw fruits and vegetables, which are low in sugar and high in fibre.

• Menstruation is part of every woman’s life and there should be no shame or embarrassment around this.
• There is no impurity or pollution associated with menstruation.
• Menstruation should not be seen as an obstacle to daily activities
• Practices such as seclusion or staying away from school must be discouraged.

Importance of Menstrual Hygiene?

Good menstrual hygiene is essential for the health and dignity of girls and women. Discussions on menstrual hygiene are important for adolescent girls to clarify existing myths and misconceptions around menstruation. Improving menstrual hygiene is important from the point of view of personal comfort and increased mobility. It also reduces the likelihood of infections resulting from poor hygiene practices during menstruation. Providing girls with knowledge and skills on maintaining menstrual hygiene improves school attendance among girls, who otherwise may not a end school during those days or even drop out of school altogether.

How to promote Menstrual Hygiene?

Promoting menstrual hygiene is achieved through:

• Provision of health education to girls and women on menstruation and menstrual hygiene
• Increasing community action to improve access to clean toilets with water, both at home and in schools
• Promoting the availability and use of sanitary products
• Enabling safe disposal of sanitary products

Who can promote Menstrual Hygiene?

Menstrual Hygiene can be promoted in the community and in schools. It is best to start with adolescent girls; although, other women in the reproduc ve age group would also benefi t from the informa on and access to sanitary products. ASHA, the Anganwadi Workers (AWWs), and the members of women’s Self Help Groups (SHGs) can make a substantial difference to menstrual hygiene practices in the community.

As an ASHA, you already have the advantage of being in close contact with women in the community. This will be helpful in providing information on menstrual hygiene and sanitary products contained in this booklet to adolescent girls and women in the community. As a member of the Village Health and Sanitation Committee (VHSC) and in working with members of the Panchayat, you can promote toilets in homes, and ensure separate toilets for girls in local schools. Members of women’s SHGs can support and assist you in encouraging menstrual hygiene and promoting the use of sanitary napkins in the community. Sanitary napkins can be made locally by SHGs using a simple technology. You can encourage the groups in your village to take up this activity. Further information is available in the offices of the District Health Society and the District Collector.

Things to remember about menstrual hygiene

• Once wet, the napkin should be changed immediately. If not it can cause irritation on the inside of the thighs and can lead to infections.
• Sanitary napkins should be kept in a clean and dry place.
• It is essential to wash the body and private parts daily.
• During menstruation, the outer genitals should be washed from time-to-time to remove any blood that is left. Girls should wash their hands every time they change the napkin.
• If the underwear is soiled, it must be changed. Otherwise this makes bacteria to grow and cause infection.
• If sanitary napkins are not available, a clean cloth pad should be used.

Sources :

1. Rashtriya Kishor Swasthya Karyakram - Resource Book by Ministry of Health and Family Welfare
2. Menstrual Hygiene, Reading Material for ASHA - By National Rural Health Mission