Let us start by defining Menstruation as the periodic discharge of blood and tissue from the uterus, from puberty until menopause. It is a necessary biological function experienced by half of the population. It is similar to other biological functions such as sleeping, breathing, urinating and so on.
Menstruation: Stigma And Taboos
Despite roughly 800 million girls and women living almost 40 years of their lives with menstruation, it is dealt with shame, embarrassment, secrecy, stigma and taboos. Menstruation stigma and taboos are present in almost every society in varying degrees. Here are a few places where menstruating women and girls endure unthinkable oppression and discrimination:
In a country like India, our longstanding history of superstitions, taboos and stigma associated with menstruation continue to manifest in complex and subtle ways. A menstruating woman is often equated with dirty, impure, unclean leading to feelings of shame and fear. As soon as a girl reaches puberty she is taught not to talk about her puberty openly, especially with boys or men. If she needs a pad, she should ask her mother or other women in a hushed tone so that nobody can hear it. Menstruation pads are always hidden under cover. Traditionally in India, women were prohibited from full participation in public and family life; participating or performing religious activities, touching certain food, performing domestic chores, staying in the same room with her husband. Women were forced to remain isolated during menstruation as she is considered dirty, impure and unclean. These customs are still practised at varying degrees in different parts of the country.
The strong taboo associated with menstruation makes people feel period is an uncomfortable, embarrassing and even dangerous topic, leading to the use of slang and code words to refer to menstruation. The scarcity of affordable menstruation hygiene products makes periods even more of a burden and health risk in India. In fact, almost 88percent of women in rural India still rely on clothes, rags, hay, ash, and even leaves to manage their periods. When their menstruation begins, over 23 per cent of girls in India drop out of school. Young girls remain absent on an average of five days of school per month because of their periods. Women’s education can have a major impact on economic growth, which means the menstruation taboo can affect the prosperity of a country.
Women in Nepal face one of the greatest struggles when they begin getting their period because of cultural and religious beliefs. Nepal’s primary religion is Hinduism, where menstruating women are considered impure and polluted. This religious doctrine has led to the practice of chhaupadi for a large portion of western Nepal. Chhaupadi is a word that refers to a custom that requires women to be confined to a menstruation hut during their period. Chhaupadi poses sanitary and safety threats to women. It is reported that women have even died in menstruation huts from smoke inhalation during fires, attacks from wild animals, and serious illnesses like dehydration. Women who observe this practice often spend their menstruation days in a cowshed that doubles as a menstruation hut, which causes humiliation and emotional distress.
Besides Chhaupadi, there are other prejudices against women related to their periods. Women are not allowed to have physical contact with their spouse or male relatives, can’t enter their kitchens, and are prohibited from going to the temples. These discriminatory practices are deeply ingrained in religious and cultural beliefs and are difficult to fight against.
Like India and Nepal, Indonesia share similar kinds of taboos related to menstruation. Unlike India, menstruating women at workplaces in Indonesia are eligible to get leaves but the rural population of Indonesia is not lucky. Here the women are still viewed as dirty, they are prohibited to be touched by their husband as well as other members of the family and here also women perceive menstruation as embarrassing. In Indonesia, tampons are rarely available as it is believed that tampons lose the virginity of girls.
A study by UNICEF has pointed out that half of Africa’s female population are deprived of basic menstruation hygiene, use of menstruation products, and safety. The girls are deprived and discouraged by their mothers to use sanitary pads during their menstruation. Poverty, lack of access to menstruation hygiene, lack of education, superstition, and stigma surrounding menstruation are some of the major barriers faced by girls and women in different African countries.
Most of the girls and women have very little to no access to sanitary tools or products, adequate and hygienic toilet facilities and proper menstrual hygiene mostly in rural areas worldwide, making women’s lives even more difficult.
Menstruation And Mental Health Issues – A Tangled Story
Menstruation is not a new or emerging health condition but it has always been ignored owing to our preoccupation associated with it. Physical discomforts related to menstruation are still talked about, but mental health issues associated with menstruation are totally ignored due to the prevailing stigma and taboo related to both mental illness as well as menstruation. Unfortunately, for many girls and young women, the shame, stigma, and pain attached to menstruation have put their mental health silently at risk.
There are several factors that can affect the mental health of women during menstruation:
GENETIC PREDISPOSITION plays a vital role in the physical aspect of menstruation such as pain and flow; it also has an impact on the onset of menstruation and menopause. The perception and outlook towards menstruation are also impacted as the genes impact the personality.
HORMONES play an obvious role in the menstruation cycle. As the hormones fluctuate, women’s feelings also get fluctuated like a swing as in the middle of the cycle women has a general feeling of well being but as time progresses and with the onset of menstruation, the feeling of anxiety, irritability and low mood progresses. The fluctuations in hormones lead to disruption of brain chemicals called neurotransmitters, the most common of them during menstruation are Serotonin and Dopamine. These two neurotransmitters are also known as “Happy Hormones”.
Serotonin regulates mood, anxiety, and emotion, Dopamine plays a role in how we feel pleasure and focus on things. Low levels of these two hormones result in not just food cravings but also unhappiness, anxiety, and overall irritability. Mood alterations or commonly mood changes during menstruation are so subtle that they are not even cared for. The changing levels of hormones in the menstrual cycle are responsible for the emotional ride but sometimes the severity of mental conditions can be alarming and they may reflect a mental disorder.
SOCIAL FACTORS also contribute to a greater extent in mental as well as physical well-being. Conditions such as financial issues, religious and cultural values, and family support also impact the mental health of women during menstruation. This becomes a double whammy as in most societies menstruation and mental illness both are stigmatized leading to a life full of emotional turbulence.
The two most powerful outcomes of menstruation leading to disturbances in Mental Health are Premenstrual Syndrome (PMS) and Premenstrual Dysmorphic Disorder(PMDD)
PMS and PMDD are the main disorders linked to menstruation. While PMS involves mild symptoms and is more prevalent, PMDD is more severe and is noted in 3-7 percent of women. Symptoms of PMDD are altered mood, behavioural and physical symptoms. The diagnostic criteria for PMDD include accumulation of symptoms but the most important criterion is the duration in which the symptoms are noted. PMDD symptoms are present in the final week before the onset of menstruation and they start to improve after the onset. Symptoms are minimal or absent in the week after menstruation is over. Some of the major symptoms of PMDD include mood swings, tearfulness and increased sensitivity to rejection; marked irritability or increased interpersonal conflicts; increased anxiety or tension; lethargy; apathy; marked change in appetite; hypersomnia or insomnia, etc.
Both PMS and PMDD should be dealt with and treated with medical supervision and the treatment should be under the guidance of a gynecologist, Psychiatrist and Psychologist as well. While medications can reduce your symptoms, consultation with a Psychologist will help a woman to handle and deal with her emotions, mood, interpersonal conflicts, etc in a more rational way, thus a comprehensive treatment is adopted.
While 100 percent of the world population has mental health – good or bad, and half of this population menstruates, the link between mental health and menstruation is of utmost importance. It is the priority of the time to bridge the issues of menstruation and mental health. We need to make every effort to destigmatize mental health taboos and menstruation stigma to save women from greater risk of poor physical as well as mental health and menstruation struggles- a war for both genders to win and not one to lose.
Key Points To Remember:
- There is nothing impure about menstruation except our mind.
- Girls and women in low-income countries face greater struggles.
- Putting an end to discriminatory social practices, educating and creating awareness among men and women equally will provide women with improvement in menstrual hygiene leading to better mental health and advancements in human rights in many countries around the globe.
- The hope is that education and awareness talk will help children of both genders.
- The aim must be to spread awareness and remove the stigma associated with mental health and menstruation and to help individuals irrespective of gender to embrace emotional wellness and menstruation struggles efficiently.