Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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Volume 1 | Issue 1 April 12, 2018 Menstruation & Menstrual Hygiene
Menstruation is a bodily function which is natural and important for women’s health and reproduction.
Menstruation is also called as menses and is a word derived from the Latin language which means monthly. Monthly bleeding from the genital tract is called menstruation. This bleeding comes from the womb which is situated in the lower part of the woman’s body. This bleeding contains blood and pieces of tissues which lines the womb. This tissue is meant for shedding that is it is deciduous and has a specific function of embryo implantation. The blood which flows through the track is non-clotting blood and different from the blood one gets when hurt. This blood is actually broken down by some enzymes inside the womb so that it can flow easily through the womb into the vagina and outside the body. The first menstruation of life is called as Menarche. It marks the beginning of the menstrual cycle. It also is a sign that the reproductive function of the body is getting ready to eventually prepare for childbearing. The menarche usually is experienced between 13 -14 years. Some girls may get it earlier than this while some may not have menarche by the age of 16 years and need to be checked for the cause of menses not beginning. Sometimes there can be some hormonal abnormalities, structural abnormalities or infections which may prevent the start of menses
Let’s, therefore, know more about our body and menses
One of the important functions of a woman’s body is to bear children. Menarche marks the beginning of this change over from girlhood to womanhood. Throughout this transition which is called as the adolescence or ‘teens’, there is gradual maturation of the hormonal system, emotional and psychological makeup and physical capability needed for childbearing and rearing
Menarche ensues by 13 -15 years of age. Bleeding is cyclical with the duration of cycles between 22-32 days and bleeding phase of 3-7 days. There is minimal discomfort and sometimes the menstruation may be without any pain. The bleeding is more on the first 2-3 days and gradually reduces and stops and is self-limiting.
Excessive bleeding, irregular cycles, painful periods or no periods need to be consulted for as can have an underlying cause which may need some therapy. How do I manage my menstruation?. Menstrual management encompasses the following:
1. Menstrual hygiene
2. Personal hygiene
3. Nutrition and hydration
4. Pain management
5. Signs needing medical attention
6. Personal warnings
Let us tackle each one of them serially
1. Menstrual hygiene: the blood that flows out of one’s body during this phase needs to be managed so that it does not soil one’s clothes and surroundings and the privacy of menses is maintained. Traditionally cotton clean cloth was the norm and today over the time this has been identified as the best approach towards menstrual management. These are cheap, easy to manage and are biodegradable. These are easy to make. a semisoft cotton material can be bought, and two squares of 1.5 by 1.5 feet are made. one is folded into a rectangular pad and wound in the other fold like a roll which develops long ends which can be used to tie to secure it to the string around the waist. Other option is to create a pad and place it in the snuggly fitting underwear. The cloth should be soft, absorbent and of cotton. It should be washed and clean. The cloth can be washed before the first use and dried in bright sunlight thoroughly before storing for use. The pad should be changed every 4-5 hours as longer keep pads can cause bacterial growth and infection in the very delicate genitalia. When changing the pad should be thoroughly rinsed and soaked in warm soaped water with bleach solution added. It is then scrubbed and thoroughly washed. This is then dried thoroughly and stored in a closed ventilated space for further use. The cloth can eventually be discarded if torn or tattered by burning. There are commercially available synthetic pads which are convenient to use but are not amenable to biodegradation. Currently, menstrual cups are proposed for this use and are being used. However, they can be expensive for some and unacceptable too as it has to inserted inside the vagina which an unmarried woman or an adolescent may find difficult to use. In any case, utmost hygiene is necessary. One must wash hands every four hours and keep them clean. Touch your own body parts only with clean hands. Change the pad every 4-5 hours and also the menstrual cup should be emptied every 4-6 hours to avoid bacterial growth and infection.
2. Personal hygiene. one should bathe daily at least ones preferably twice during menstruation to clean the private parts as well as the entire body as menstruation is associated with considerable sweating. Clean loose-fitting garments for easy ventilation should be used. Keep your hands, bowels and private parts clean and dry.3. Healthy and nutritious diet to compensate for the blood loss is essential. Also, pelvic congestion during menses can cause constipation which can be relieved by taking a fiber-rich diet. Women and girls of all ages should consume calcium and protein-rich diet to help compensate for the wear and tear of the body. It is important to take plenty of fluids, especially during this particular period to avoid dehydration as sweating can cause this 4. Pain management: mild analgesics can be taken to combat pain. Light walks are known to relieve pelvic water logging and helps relieve pain. Unbearable pain needs to be treated and one has to consult a doctor 5. Signs needing medical attention: 1. No menses till age of 16. 2. No menses for more than 2 months
3. In case one has had unprotected sexual contact.
3. Excessive bleeding is marked by clots or clumps and heavy flow needing more than 5 pads per day and lasting for longer duration .
4. less bleeding which less than 3 days is and is scarce
5. Painful menses 6. Any premenstrual emotional disturbances, breast pain etc. 6. Personal warning: menstruation means that one has become capable of becoming pregnant if exposed to sexual intercourse. One has to be aware of all the facts and also know how to manage menstruation and indulge into any practices with open eyes. Always consult a doctor or a family member in case things are not right.
More about Pads and tampons woman attains menarche between 10 years – 15 years of age and reaches menopause by 45 to 50 years of age. Thus, she experiences approximately 420 menstrual periods in a lifetime and this needs a scientific and a practical approach. Many possibilities exist to aid menstrual hygiene viz; Sanitary pads: disposable or reusable cotton ones, menstrual cups, diapers. Let us know about each one of them in some details.
1. Disposable sanitary pads :
These are the commonest used menstrual hygiene methods with the perceived advantage of :• Convenience • Thin liners with wings are secure and prevent spillage and staining • Leak proof• Hygienic
But these can also have the following disadvantages :
• Chaffing of the thighs and the genitals• Urinary bladder infection – E-coli (bacteria in our digestive tract) carried from the rectum to the urethra.• Spreading of the Bacterial Vaginosis (vaginal infection)• Contact dermatitis(skin infection)• The malodour associated with periods.• Bulge of the pad is visible under the clothes that we wear• Not all can afford
These are also now identified to be a threat to the environment as non -biodegradable
Cannot Recycle or Reuse Dumped in the landfill and takes hundreds of years to degrade. Serious Environmental & Health Effects Disposing Natural Resources If burnt –produces dioxins and furans
Winged pads Contents : hazards Styrene : tyres
Acetone : chemical in nail polish remover
Chloromethane : petroleum byproduct
Chloroethane : Styrofoam
Worst is many pads get flushed down the toilet. They bloat up due to the superabsorbent gel that they contain and clog the drains which have to be cleaned by cleaners manually which is inhuman.
Do we have solutions? Yes, we have better alternatives
Cloth pads: environmental friendly Secure
Economical cloth pads
Easy to use: 3 hygiene steps for used cloth pads
“Suvidha” pads are launched by the government of India on March 8, 2018. ‘Suvidha’ pads are oxo-biodegradable and will be made available in packs of 4, priced at Rs. 2.50 per pad. They will be found across 586 Indian districts, at Pradhan Mantri Bhartiya Janaushadhicenters.
Menstrual cups (reusable)
They are soft like the baby milk bottle nipples
They are of various sizes so suit all age groups and are leak proof in design.
Method of insertion of menstrual cups is as under
Changing the cup is simple and it has just the right capacity of holding: Normal period –women bleed totally about 50-80 ml.▪ The menstrual cup holds about 15-23 ml.▪ Emptying once in 6- 8-10 hours is more than adequate.▪ Cup can be emptied as per the individual flow pattern of the woman (if the blood flow is heavy, then the cup can be emptied once in 3-4 hours)
Cleaning of the cup is easy. It can be emptied and washed with clean water. Ones done with menstruation, it can be disinfected, dried and stored in a clean paper or cloth container for use the next cycle. The cost is based on brands and ranges from rupees 250 to 600 approximately.
The third option is the baby diapers or adult diapers which are easily degradable
Choices for menstrual hygiene are personal and are determined by the cost, safety and suitability also. This write up is an effort to understand the options we have in order to make the right choices. These choices are important as they also are closely connected with our reproductive health and hygiene
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