Empowering girls through education and health initiatives, including effective menstrual hygiene management, is essential for a nation’s development. Addressing the stigma and challenges surrounding menstruation prevents shame and anxiety, ensuring girls can attend school and achieve their full potential, enabling their future participation as equal members of society.
As per a study published in The Lancet Global Health journal, menstruation affects a woman’s quality of life. Startling, isn’t it?
What the study highlighted?
The survey showed that menstruation keeps nearly 20% of women and girls in South Asia away from regular daily activities. The study focuses on menstrual-related absenteeism in 44 low-income and middle-income countries and included 673,380 women and girls aged 15–49 years.
In West and Central Africa, the prevalence was found to be at 18·5% but with 19.7% in South Asia, it was the highest in the latter region. In India, around 31·8% remain absent due to excessive bleeding, whereas 76·3% are absent due to pain or discomfort during menstruation.
According to the study, “After pooling data across surveys, girls aged 15–19 years were found to have a higher prevalence of menstrual-related absenteeism than those in older age groups, with overall pooled prevalence ratios ranging from 0·75 (0·68–0·82) in those aged 35–39 years to 0·92 (0·87–0·97) in those aged 20–24 years relative to the 15–19 years age group, with adjustment for area type (rural or urban).”
Factors associated with absenteeism
Menstruation-related absence in public spaces – schools, colleges, was not associated with household affluence or the use of menstrual products, such as tampons or sanitary pads, according to researchers, including those from the University of Melbourne in Australia.
It turns out that having a private place to wash at home encourages women to not step outside during menstruation. It possibly hints at access to clean and exclusive toilets for women in public spaces.
While contraceptives, especially hormonal methods, reduced absences during menstruation for women of all ages, symptoms such as heavy bleeding or pain could be keeping women away from pursuing daily activities.
Dr Sandhya Mishra, Consultant – Reproductive, Medicine – Obstetrics and Gynecology, Milann Fertility Hospital, Bengaluru, says, “A woman’s body undergoes hormonal changes during the menstrual cycle that can lead to symptoms like cramps, headaches, bloating, mood swings, acne, and fatigue. And these symptoms vary from person to person and can be influenced by other health conditions. Therefore, to keep your periods healthy, maintain good menstrual hygiene, exercise regularly, and eat a nutritious diet rich in vitamins and omega-3 fatty acids. Staying hydrated, getting enough rest, and managing stress can also help reduce discomfort and support overall well-being.”
Effect in resource-constrained societies
Around 63.2% of women and girls are using reusable menstrual materials, whereas only 2.4% of women in Latin America and the Caribbean resort to reusable menstrual materials. However, it hasn’t contributed to the menstrual-related absenteeism. The study shows that there was no evidence of a difference in menstrual-related absenteeism when using reusable menstrual materials compared with using only non-reusable menstrual materials.
As compared to the use of solely non-hormonal or no contraceptives, hormonal contraceptives were revealed to lower the menstrual-related absenteeism after controlling for age, affluence, education level, parity, and region type.
The report goes on to emphasise the vulnerability of this group and suggest an urgent need for adolescent girls to be prioritised in future research and programmes. “Women and girls who use hormonal contraceptives reported less menstrual-related absenteeism, independent of age, wealth, education, area type, and parity, suggesting that menstrual symptoms might contribute to this outcome. Our analysis provides new evidence to inform future menstrual health research and public health interventions.”
The study underlines that hormonal contraception improves many menstrual symptoms, including heavy menstrual bleeding and menstrual pain. “Both symptoms have been shown to contribute to menstrual-related absenteeism in adolescents in countries such as Malawi (47·9% absent due to heavy bleeding, 19·5% absent due to cramps, headache, or pain), India (31·8% absent due to excessive bleeding, 76·3% absent due to pain or discomfort), and Ghana (40·0% absent due to heavy bleeding, 57·3% absent due to pain).”
Vulnerable aspects
Dr Sapna Raina, Gynecology Consultant and Clinical Lead, Narayana Health City, Bengaluru feels intense menstrual cramps, anxiety about leakage and discomfort are primary reasons that keep girls away from public life. “We have seen that many women experience primary dysmenorrhea, which results in severe menstrual cramps during cycles. It can lead to stronger uterine contractions. Also, irregular menstrual cycles and hormonal imbalance during puberty may lead to heavy bleeding, severe cramps and nausea,” she says.
Conditions like PCOD and endometriosis are more prevalent during the early years of life and can lead to pain and discomfort if left untreated. “A teenage girl with intense cramps and bleeding may find it difficult to sit through longer school hours and participate in other physical activities. There is low awareness about treatment and managing this pain so we need to work on that. Many schools lack proper support for menstruating students, which may lead to embarrassment and discomfort. The fear of leakage, bad odour, and teasing by students can make students confined to home. Also, students in the lower socio-economic strata may lack access to tampons and sanitary napkins so there is anxiety about leakage,” adds Dr. Raina.
Dr Shanthala Thuppanna, HOD & Senior Consultant – Gynaecology, Sakra World Hospital, Bengaluru, feels that menstrual-related absenteeism derails gender equality. “Menstrual-related absenteeism from school and work impedes gender equality and empowerment, hindering the ability of women and girls to participate fully in education and the workforce, and posing a barrier to achieving gender equality and empowering all women and girls.”
She underlines that regular interactions with gynaecologists play a crucial role in menstrual health by providing diagnosis, treatment options, and education regarding any menstrual irregularities, pain, heavy bleeding. “Doctors may suggest lifestyle modifications, hormonal therapies, or surgical interventions depending on the underlying cause; they also provide preventative care through regular check-ups and discussions about menstrual health concerns,” concludes Dr. Thuppanna.
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