Do you hate those few days when you are on your period? Does it hurt so badly that your concentration is slightly impaired? As much as these are mutual feelings among girls and women experiencing menstruation across the world, there is absolutely nothing you could do about this process.
Hormones are special chemical messengers in the body that are created by the endocrine glands. These messengers control most major bodily functions from simple basic needs such as hunger to complex systems such as reproduction to controlling emotions and your mood. In the case of menstruation, it is once again a hormonal change where Oestrogen- the female sex hormone causes puberty, prepares the body and uterus for pregnancy and regulates the menstrual cycle. In view of the World Menstrual Hygiene Management Day- which falls on May 28- the Mirror Health Capsule sheds light on the importance of the menstrual process to a girl’s health, why one should maintain her personal hygiene during their period and treating irregularities.
Cultural beliefs 
According to Dr. Sanath Lanerolle, Consultant Obstetrician and Gynaecologist at the Castle Street Hospital, this is a transition period where the girl becomes an adult. “Therefore there are many changes happening to her physical health and mentality as well. There are many cultural beliefs related to menstruation. According to Sri Lankan culture we celebrate with a function the onset of menstruation which is called Menarche. Some cultures have a belief that during menstruation the girl is not clean; hence they are not allowed to enter temples and religious places. Generally a young girl gets the knowledge and education from her elder relations and it could be the mother, sister or grandmother. Therefore there is no formal education on this matter. Reproductive health is included only in certain syllabi and it is doubtful whether these subjects are taught in depth in the national curriculum as well. Even in general health education these topics are not taught in depth,”said Dr. Lanerolle.
“But when you consider the physiology of menstruation there is no truth in these beliefs,” Dr. Lanerolle added. “It is the normal blood that passes with the shedding off of the inner lining of the womb (Endometrium) which gets Hypertrophied (enlarged) so that the fertilized eggs could come and deposit on it. This is known as implantation. When this process doesn’t take place it is called an Aborted Cycle and when there’s no pregnancy it causes the shedding off of the endometrium. This is happening due to hormonal changes regulated by the hypothalamus-pituitary-ovarian axis.”
Personal hygiene
Speaking about the importance of maintaining personal hygiene, Dr. Lanerolle said that in the physiological perspective there is no truth about the girl or woman not ‘being clean’ during their period. “But the blood that passes is good culture media and if you do not maintain personal hygiene, many bacteria and viruses can get nutrition from it and multiply. They can live there if you’re unclean and you will end up with many problems, also known as Endometritis - the inflammation of the inner lining of the womb. As a result there could be many outcomes due to this uncleanliness. It could in turn lead to the formation of abscesses in the pelvis leading up to permanent sterilization. Sanitary napkins need to be changed regularly for a day in order to avoid infections. There are two kinds of sanitary towels - the normal napkin and tampons. Tampons are inserted into the vagina and those wearing sanitary napkins should have a good practice of changing it frequently. But the danger of tampons is that the user might forget to remove it. Therefore if it exists in the vagina, it will lead up to severe infections causing death, also known as Toxic Shock Syndrome. Therefore those using tampons have to be extra cautious about removing them at the correct time.
In Sri Lanka there are certain cases of these kinds of infections. Generally during your period you should have a bath and stay clean. Also one should allow the flow to happen without blocking it. In addition to that, proper practices and disposal of sanitary napkins too should be encouraged,” Dr. Lanerolle said.
Precautions
During your period your mothers would have probably given you a special diet. This may include ‘cooling’ foods such as cucumber, king coconut and the like. Dr. Lanerolle too agrees that there are certain foods which are allergic to women during this period. “Those allergies are known by those people only. Generally foods containing histamines including tuna fish and prawns could cause increased blood loss.”
In addition to that, girls or women also worry about doing heavy work during their period. They may refrain from going to the gym and taking a good rest instead. According to Dr. Lanerolle, if you’re having a lighter period, doing light exercises and general work is alright. “But certain women have a severe pain and a heavy flow. They need to rest. If there’s a pain it should be investigated rather than taking panadol and other painkillers haphazardly in order to ensure that there are no underlying diseases. There are diseases such as endometriosis, pelvic inflammatory diseases, certain tumours such as fibroids and ovarian cysts among others. Taking panadol is not the treatment for these diseases and it is important to treat the disease as and when it’s identified. But having excluded these diseases sometimes people take painkillers and that is not a big issue,”said the doctor.
This is a hormone-regulated cycle and if it doesn’t happen it will lead to a lot of diseases because the inner lining of the womb will become thicker, which could even cause endometrial cancers. In certain parts of Sri Lanka people still use other materials for their sanitary napkins as they cannot afford to buy branded items. According to Dr. Lanerolle using these materials is alright as long as the user is conscious about the cleanliness and hygiene. “Back in the day when sanitary napkins were not available our parents used to wear a cloth. They used clean and dry towels. The absorbing power is different because the modern napkin absorbs the blood and keeps it dry as well. But in the case of normal clothes, they will absorb the blood but it will be wet,” he added.
Irregularities and complications
“Irregular blood flow could happen due to the hypothalamus-pituitary-ovarian axis,” Dr. Lanerolle further said. “They are hormonal causes, but if you’re having fibroid in the womb there will be an irregular flow. In the case of endometriosis also it is the same. Some women using contraceptive methods may also experience irregular blood flow. If there is an excessive blood flow you are losing the amount of blood in the system. Usually it is 80ml of blood per cycle that is lost but if you are losing more than that people will experience symptoms of anaemia from lethargy to mood changes,”said Dr. Lanerolle.
Speaking about treatments, he further said that treatments for these irregularities depend on the cause. “If there is a fibroid it has to be removed. In the case of a hormone irregularity, the hormonal cycle needs to be regulated by regulating external hormones. If it is caused by pelvic inflammatory disease then antibiotics need to be given to cure it,” he said.
In his concluding remarks, Dr. Lanerolle said that menstruation is a physiological event and it shouldn’t hamper education or the number of working hours. “Generally it is found that during this period your power of concentration is a little bit impaired. However, there is medication in the event of heavy blood flow or frequent periods thereby reducing most symptoms by regulating the menstrual cycle. During this period you need to have a high protein diet because you are losing blood. Some people say not to eat meat and other food but scientifically there’s no truth in it. During the period one should know what is normal to have and not. It is also important to maintain the personal hygiene and have a good nutrition as well,” he concluded.
