Misconceptions and shame shroud menstruation in many societies. Even when menarche’s arrival is celebrated, girls are taught to hide and manage menstruation discreetly.
A “culture of silence” around vaginal bleeding, from puberty through to menopause, is failing the needs of women and girls and means many are unable to tell the difference between what is healthy and what is not.
Menstrual bleeding, researchers at Columbia University’s Mailman School of Public Health (MSPH), considered as a “neglected topic” in low and middle-income countries and a critical gap that researchers need to target.
In many low and middle-income countries, girls and women are faced with limited access to clean water and sanitation facilities. This is aside the challenges girls and women face in conducting daily activities while managing vaginal bleeding, including participating in school or work, going to the market or fetching water.
Menstruation still shrouded in secrecy
In fact, the management of menstruation in most societies is handled covertly, something girls are often instructed about at menarche. Menstruation doesn’t really have anything to do with s3xuality, yet the management of any vaginal bleeding is often similarly discreet.
Researchers in the journal BMJ Global Health suggests that the “culture of silence” around vaginal bleeding, from puberty through to menopause, is failing the needs of women and girls and means many are unable to tell the difference between what is healthy and what is not.
Girls and women experience numerous types of vaginal bleeding. This, according to Dr Chris Aimakhu, a consultant obstetric and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State, include healthy reproductive processes that are normal, such as menstruation and bleeding after childbirth.
Reasons for vaginal bleeding
Some vaginal bleeding have been said to be abnormal and may be related to health conditions such as fibroids, endometriosis, polycystic ovaries and cancers.
This according to him includes “cases of vaginal bleeding in between menses and a menstrual flow that is more than 10 days. Menses which last more than 10 days may be due to an infection, fibroid, cancers, are abnormal. Also, bleeding after intercourse is common with cancers of the cervix, endometriosis and the womb.”
He added, “There is a condition called polycystic ovaries where the ovaries have a lot of fluid in them; they have hormonal imbalance. Women with this condition could menstruate twice in a year. They are unlike other women with regular menstrual cycle that know when it is safe to have s3xual intercourse and not get pregnant.”
Moreover, he pointed out that some cases of vaginal bleeding due to endometriosis occur if a woman has had a caesarean surgery.
Endometriosis is a condition in which tissue similar to the lining of the endometrium (womb), grows outside of the womb. It can grow on the ovaries, bowel, and in some rare cases has even been found outside of the pelvis such as the urinary bladder.
He added, “The most common reason why a woman could have endometriosis is if she has had a caesarean surgery. When closing up the womb during the surgery, they could have mistakenly implanted some of the cells lining the womb outside of it.”
These cells when present in other places in the body also proliferate and so are shed from time to time, resulting in bleeding. If these cells are in places such as the fallopian tube, the bleeding comes out with the normal menstruation.
Dangers of severe vaginal bleeding
Moreover, physically, frequent or prolonged bleeds add to girls and women’s risk of anaemia, particularly for those who are nutritionally compromised, or having other diseases such as HIV. The attendant weakness, fatigue and other symptoms also affect their ability to complete the heavy burden of chores.
What is normal menses?
According to Dr Aimakhu, “On the average, a woman should menstruate between 21 and 35 days. This is a normal cycle. In terms of length of time, a normal menstrual flow is between three and seven days.
“If it is less than three days, we say the woman has a poor menstruation. If it occurs more than seven days, it is a prolonged menstruation. In terms of volume, the amount of bleeding should be between 30mls and 80mls. About two pads a day is okay.
“Of course, it is not expected to smell and it should be bright red in colour initially. But after some days because the bleeding had occurred hours before and it takes time before it flows out through the cervix, it appears darkish in colour.
“But when the smell of the menstrual flow is offensive, it is suggestive of an infection in the genital tract. The vagina is an open space and it can get contaminated easily.”
Ongoing secrecy around vaginal bleeding
Unfortunately, cultural taboos frequently hinder open discussion around vaginal bleeding, restricting information and early access to healthcare, creates a situation that endangers women’s health.
In some societies, girls and women during their period are not kept away, some are not allowed to share rooms with men and even cook for them because they are perceived as unclean.
This has also affected the possibility of women and girls managing these bleeding experiences with dignity and without discomfort or fear.
Menstrual period is a normal phenomenon
Ironically, menstrual period is a normal phenomenon throughout a woman’s reproductive life, except in women on some contraceptive methods or whose wombs have been removed. Howbeit, “people do not like talking about menstruation. They see it as messy,” said Dr Aimakhu.
Women perceive and go through their menstrual cycle in different ways; some experience lot of pain; some feel embarrassed when others know that they are menstruating. It is completely debilitating for others.
Majority of women experience some cramping for one to two days during their period, and this is normal. It occurs as blood products are expelled through the uterine body and out of the cervix before it makes it way out the vagina.
Teenage girls are also more likely to suffer from painful periods compared to adult women, particularly adult women who have had children.
But, the fact is “a woman who is been managed for infertility, would not want to see her menses because it is a sign of a reproductive failure and that she did not get pregnant,” he declared.
Breaking silence around menstrual flow is important
Menstrual bleeding is normal, and as such no reason for girls and women to be stigmatised or shrouded in secrecy. But, he declared, “in a case, where the bleeding is excessive or bleeding occurs between periods, comes with pain, other symptoms that makes the woman feel bad or irregular, such require health intervention.”
Certainly, breaking the silence around girls and women’s vaginal bleeding and their related social, physical and clinical management needs across the life course require attention in research, practice and policy, including improved education, training and communication.