The truth about menstruation

Although menstruation periods are meant to be normal, there are many things that make girls during this time very uncomfortable and wish they never had them at all

What you need to know:

On May 28 this year, the World celebrated the second Menstrual Hygiene Day with a focus on breaking the silence and taboo around monthly periods and ensuring that women receive the facilities they need to go through menstruation.

Although menstruation periods are meant to be normal, there are many things that make girls during this time very uncomfortable and wish they never had them at all. The mood swings, cramping, nausea, depression; name it. Irrespective of whether one has had them before or not, the experience never differs.

Science of menstruation
According to Dr Cohen Maliro, a clinical medical officer at Diva Medical Centre in Nansana, “The menstruation cycle is a repeated sequence of biological changes that occur in the uterus of human females. The timing for these periods is controlled by hormones and the changes occur in the ovary and the uterus. The cycle is controlled by normal hormonal changes that can be interfered with by contraceptives.”
Girls usually have their first cycle (menarche) at the age of 12 although in some it can be as early as eight years or as late as 16. If a girl goes beyond 16 years without their periods, there is cause for concern. Gynaecologists advise such a girl to be taken for a pelvic examination.

Maliro says: “There are times when newborn babies have pseudo-menstrual cycles (vaginal bleeding) immediately after birth. However, this goes away after three days without treatment but we prepare the mother psychologically because it makes them worry.”
The normal cycle occurs in fertile females until they reach the age between 45 to 52 years (menopause) and the length of a particular cycle is counted from the first day of menstrual bleeding until you get your next period.

The menstrual cycle
Dr Joseph Nsengiyunva, a gynaecologist at Bethany Women’s Hospital in Luzira ,says, “The menstruation cycle occurs in the innermost uterine lining (endometrium) which result in shading following failure of implantation or fertilisation. During the menstrual cycle, changes occur in the reproductive system as well as the bodily system. In the bodily system, the hormones cause the mood changes, mood swings, and breast tenderness.”

In the body system, the cramping is due to hormones which cause the womb to actively shed the lining that was built up in the previous menstrual cycle.
The menstrual cycle has two major phases as the follicular and luteal phases. When the cycle begins, follicle-stimulating hormone (FSH) and Luteinizing Hormone (LH) are produced by the pituitary gland from the brain.

The FSH is the main hormone involved in stimulating ovaries to release mature eggs and during this phase, development of the ovum is the main event.
“The follicles which are the fluid-filled cavities in the ovaries contain undeveloped eggs. The FSH hormone induces a dominant follicle to release a mature ovary in a process known as ovulation, Nsengiyunva says.
After ovulation, the amount of oestrogen in the body increases to ensure that the lining of the womb is thickening with nutrients and blood. This is because in case fertilisation occurs, the fertilised egg will have enough nutrients to support its growth. This phase is usually a fortnight long and noticeable by a thin, slippery cloudy white discharge.”

“Some women claim to feel cramps when they ovulate, but many do not feel any sensation and there is no other sign that shows that one is ovulating. Once the ovum is released, it moves along the fallopian tube towards the uterus and can stay viable for two days. These are considered to be the most fertile days when a woman is more likely to become pregnant,” says Dr Maliro.
After ovulating, the dominant follicle starts producing progesterone which causes further preparation of the womb for fertilization. Dr Maliro adds, “The empty follicle that released the ovum starts to shrink and produce oestrogen and progesterone. During this time, a woman gets pre-menstrual tension (PMS) such as breast tenderness, bloating, lethargy, depression and irritability.”

If no fertilisation takes place, levels of oestrogen and progesterone responsible to maintain the thickness of the uterus lining decrease. The uterus starts to break down, and the body sheds the lining. This is the start of the period and the beginning of your next menstrual cycle.

Padding etiquette

Females with normal menstruation periods change three times a day on average but there are those with a heavy flow and these can change up to five times.
Most girls in urban areas use water-proof sanitary pads, which are the most recommended sanitary towels. However, in the villages where pads are very expensive, girls use re-usable cotton cloth. Sometimes women use cotton and toilet papers. These however, Dr Joseph Nsengiyunva says are not recommended because they are not waterproof and not effective in holding blood.
“Cotton wool and toilet papers break and enter into the vagina as a foreign body which is a source of bacterial infection and smelly discharge. If they must be used, one is supposed to wrap the cotton wool in gauze before use,” he explains.
For the re-usable cloth, the user must handle the pieces of cloth in a hygienic way as they must be washed with hot water and detergent. Thereafter, they must be dried in direct sunlight in order for the ultra violet rays to kill the bacteria that may
have remained. If possible, one should iron and ensure they are dry before being re-used.

Feeding during menstrual period

According to Jamiru Mpiima, a nutritionist at Victoria University Medical Centre, women should avoid eating gas producing foods such as beans during their menstrual periods because they increase blotting due to hormonal changes that occur during that time.
He also recommends drinking a lot of water, fluids and fibre-containing foods such as vegetables and fruits which suppress the menstrual symptoms.

“Foods containing Omega 3 mineral, fish and lean meat are very good. Fatty meat should not be eaten because it increases the hormone that may cause blotting, nausea and other menstrual syndromes since the hormone is a composition of fats and a little protein,” he remarks.
Adolescents who do not get enough feeding or those who are starved are bound to have scanty periods so children should be fed well.

“Some people get cravings during their periods and when they eat what they crave, the symptoms may subside. Caffeinated foods and beverages should be avoided because they cause insomnia. The hormones responsible for the cycle sometimes interfere with sleep so caffeinated beverages worsen this condition.”

Period problems
According to Dr Cohen Maliro, there are various factors affecting the menstrual cycle and these include;
Chronic illnesses such as sickle cells
Psychological factors such as stress may cause one to have scanty periods
Uterine abnormalities such as fibroids, ovarian masses block the passage of blood.

Congenital abnormalities such as imperforate cervix retains menstrual blood in the uterus
Some girls may have an imperforate hymen which does not allow blood to pass through. “In such a case, Dr Nsengiyunva says, menstrual blood does not come out of the vagina but instead stays in the cervix. This requires breaking of the hymen because as blood accumulates, it forms a chocolate paste that can cause infection, pelvic pain, discomfort and bulging of the vagina.”

Some contraceptives such as pills, injectaplan and others interfere with the hormones, leading to very heavy flow or spotty periods.
Surgeries that involve partial or total removal of the uterus (hysterectomy) lead to absence of periods.
diet (caffeinated foods)
When an adolescent girl begins to have her periods, they may not be constant because she may not ovulate as the ovum may not be mature and when a woman is nearing the menopause age, the periods may become scanty and spotty.

First time menstrual experiences

Many girls look forward to their first menstruation with a mixture of fear and excitement. The transition from youth to womanhood is full of myths brought on by the silence of our parents.
Since menstruation is a taboo subject in some cultures, mothers leave the topic to senior woman teachers in primary schools and to late night whispers between little girls.

Pads. Many girls look forward to their first menstruation with a mixture of fear and excitement

Angela Kagaari, Human Resource Officer, Kampala, 28 and a mother of two
“In Primary Six, the science teacher taught us about it but I never really believed it could happen to me. After all, I was a good girl.
Whenever we used to annoy our mother, she would say, “You girls are annoying me but one day you will come to me seeking help because blood will be coming out of you.
I thought it was a curse, so I tried to be on my best behaviour. When I saw blood spots on people’s uniforms, I thought they had been bad or had been bewitched.
When I saw the spots in my pants in my Senior One, I was scared. I tried to remember the things I had done to my mother in the last year.”

Fatuma Mwondha, housewife, Mukono, 23 and a mother of one
It happened in my Primary Seven. We had studied about it but I was not prepared for the actual experience. I had finished bathing and was preparing to go to school when I felt the wetness.
I did not tell anyone. Instead I got all my school socks and folded them together and used them as a pad. I pretended to be sick so that I could dodge school.
By mid-morning, the socks were damp so I took another shower and washed them. After squeezing them, I folded them and used them again. That day, I bathed five times.
My cousins noticed my trips to the bathroom. After bathing for the fifth time, they found blood in the bathroom and confronted me. I was so scared, I started crying.
We talked for a long time, and they comforted me and taught me how to count the days in my cycle.”

Irene Chuumu, Secretary, Entebbe, 36 and a mother of five
My mother never told me about menstruation but I knew that it would happen to me at some point before I reached Senior One.
Most of the girls in my class had already started their periods. You would often find a group of boys surrounding a girl, laughing at her, because there was a red patch on her uniform.
Many girls did not even know how to use pads, so the senior woman teacher was quite busy.
In my P.7 vacation however, I began bleeding without warning. I just woke up on stained bedsheets. I thought I had urinated, but when I realised what it was, I was ashamed. I couldn’t ask the housemaid to wash them, but I told her.
When my mother returned from work, and I informed her, she told me never to get pregnant in her house. That was the last time we talked about menstruation.

Clare Mutesi, student, Bugema University, 20
I used to see my mother’s pads in her bedroom and I would only imagine what they were for. On the day I got my first period, I was too embarrassed to tell my sisters and cousins who were at home.
I sneaked into my parent’s room and stole my mother’s pads. After a few minutes I figured out how to use them but I had no remedy for the cramps and backache.
I forced myself to appear normal as I waited for my mother to come back from work. When she finally did. I rushed to tell her. It was like she had been gone for more than a year.

Sarah Adongo, nurse, Rubaga Hospital, 40 and a mother of four
I first saw the blood when I was in the third term of Senior Two. I was horrified. I still remember the way my heart was beating in the toilet.
I had two sisters in the same school but I never told them. Instead, I told a Senior One student, who had had her periods since Primary Seven.
She told me to take a bath, gave me a pad and taught me how to use it. Then we sat on my bed and she told me never to be close to boys again.”
Additional reporting by Gillian Nantume