Let’s talk about menstruation ... the pride, the pain, the stigma and all

How rocky can the path to womanhood be? Pretty rocky for some, like Savannah* who spent her teenage years wishing she had been born a boy. When I met Savannah, she was a 19-year-old second-year university student. She had been referred by the college nurse to see a gynaecologist.

Savannah spent most of her high school years in the awkward phase where her body couldn’t seem to make up its mind which direction it was headed. She was way taller than her peers, but while they were blossoming into womanhood, she remained rail thin with no sign of feminine features.

Then in her third year of high school everything happened at once. Her bust filled out and her menses showed up. She was finally catching up with the rest. What she had not counted on, however, was the chaos her periods would bring. Menarche arrived with a bang! Her first period lasted 13 days!

FIRST PERIOD

Savannah was an only girl in a family of four. She was also the youngest. By the time she was getting to high school, her brothers, who were way older, had left home for college. Her mother was away in Asia for a year-long work assignment, so Savannah was home alone with her father. She had no idea how she was going to broach the subject.

She had an ample supply of pads from her mother’s closet, but she had no idea what to do about the wretched pain. She locked herself in her room, crawling from the bed to the toilet to throw up and back again. She lay on the cold floor to ease the pain. She could not eat anything and did not want to see anyone.

She could not understand why her pads were filling up so fast and when she sat on the toilet bowl, she thought she was bleeding out her entire circulatory system! By midnight, she thought she was going to die. She woke up the housekeeper who in turn woke up her father. She was rushed to hospital.

The doctor who saw her in the busy emergency room gave her an injection for the pain, prescribed some painkillers and some tranexamic acid to minimise bleeding, and asked her to see a gynaecologist. The injection worked rapidly and when she got home she was able to sleep.

The next day she felt fine and was able to attend school despite the numerous trips to the bathroom to change her pad. Her friend told her it was normal for first-time periods to be extremely uncomfortable, but they would settle with time. This was further reinforced by her mum that evening when they chatted on the phone. However, she still lived in mortal fear of soiling her skirt and having boys giggle behind her back.

She never did visit a gynaecologist until the day she came to my office. She had persevered four years of painful periods. She took iron supplements on and off as she was losing too much blood. She used heavy-duty nightwear pads to catch her very heavy flow and wore jeans and long, dark tops during her periods to camouflage any stains.

NOTHING POSITIVE

She had nothing positive to say about her menstrual experience. She echoes the thoughts of many young women, that a normal physiologic process could cause a woman such indignity. She loses 10 to 12 days every month to what should be natural. She envies her brothers who only had to deal with a breaking voice in teenage, yet women must put up with drastic body shape changes and then menstruation.

As we champion for all girls to access free or affordable sanitary pads, let us also focus on creating awareness around menstruation and its attendant complications. The old wives’ tale that painful periods or heavy periods are normal needs to be done away with. Telling young girls to tough it out until they have babies is not correct. Pregnancy does not cure period complications.

All girls and women need proper gynaecological care when that time of the month is not business as usual. Sometimes the complications are a sign of underlying gynaecological conditions such as polycystic ovarian syndrome or endometriosis or even medical conditions such as thyroid disorders. They must be properly addressed.

In addition to educating women, it is imperative that men and boys get informed too. Men will share lives with women and make families together, so they are better able to provide support when they have an idea of what is going on. They will also be fathers to daughters and should therefore be able to provide correct information when they are called upon. It doesn’t end with buying pads.

Yesterday, the world marked Menstrual Hygiene Day. We hope that this day will continue to destigmatise matters of menstruation and empower girls and women to fully embrace womanhood with pride.