It was a warm June morning and I had only just managed to get myself out of bed. The pain in my lower abdomen was excruciating and 13-year-old me was still wrapping my head around what was happening to my body. I walked towards the bathroom but just as I was about to shut the door my head began to spin; my vision blurred and I yelled out to my mom as I collapsed. Regaining consciousness, I found myself on the bed with our family doctor on the side. My mother awkwardly narrated to him what had happened. He told her I had suffered low blood pressure due to heavy bleeding. “It’s quite common amongst menstruating girls. Do not worry,” he said casually. I was given a few basic medicines. The matter was never discussed again.
Being brought up in a typical middle-class household in a small town, the taboo around mensuration was my version of normal. Everyone seemed to think that way. “You cannot enter the puja room.” “Do not touch the pickle.” “Speak softly about it, your brother will hear.” Menstrual education seminars in school, too, were only held for girl students. But we could all hear the boys peeping in from the windows, giggling and pestering us later, to tell them what it was all about. When it came to menstrual health problems, however, the saga took a turn for the worse. I hadn’t even known such issues could exist until I moved to a bigger city for higher education, perhaps because my periods were fairly regular and the pain was bearable, so to speak. But I knew my best friend had a problem when she did not turn up for school on particular dates every month and my aunt took my cousin to the gynaecologist frequently because of irregularities in her menstrual cycle. In a way, everyone knew, but no one spoke about it. “It is a ‘personal’ problem,” they said. You aren’t supposed to discuss all this, right? Or are we? Shouldn’t we be?
The answer is a resonating yes and I realised it quite late, only post living in a girls hostel in a bigger city. Here, women did not shy away from complaining about pain and cribbing about experiencing death by uterus, like they did in the confines of their homes. They shared the pain with ease, often joking about it over a tub of ice cream. It helped a lot in reducing mental anxiety. It was during this time that I first heard the terms ‘PCOD’ (Poly cystic Ovary Disorder) and PCOS (Polycystic Ovary Syndrome) and realised the horrors of these diagnoses. I understood that the heavy pain that rendered my best friend immobile for a few days was dysmenorrhea, a condition of severe menstrual cramps and heavy bleeding. My own lack of awareness and ignorance led me to the internet, where I found that Dysmennorhea among adolescent girls in India ranged from 11.35 to 72.6% and was one of the main reasons for school absenteeism among girl students in India. Heavy Menstrual Bleeding or Mennorhagia was found to be between 1% to 23% among Indian girls. Nearly 26 million Indian women between 18 and 40 years suffered from endometriosis. And nearly every woman in the country with a menstrual health problem suffered in silence.
When talking about mensuration itself is an issue in the country, the health issues related to it often go undiagnosed. Most women pop painkillers and comfort themselves with hot water bags even when the pain is intolerable. Most aren’t aware of the kind of problems irregular periods cause as the conversation around it is almost non-existent. The issue is graver in villages where period irregularities and menstruation becomes yet another opportunity for gender discrimination and abuse against women. As most women in rural areas prefer using cloth over sanitary napkins or tampons, the chances of acquiring severe infections are quite high. Anitaben, 34 from Khurgaon village in Gujarat narrates a saddening experience of a girl from her village who was married off at a very young age. After her husband and in-laws discovered that she had irregular periods, they abandoned her saying she wouldn’t be fit enough to carry a baby (read: heir) for the family. “Most girls in the villages do not go to the doctor or share their suffering with anyone as news spreads fast in the villages and it directly affects their chance of finding a suitable groom. Moreover, they shy away from visiting a male doctor” says Anitaben who is undergoing training with Vatsalya foundation to train and aware women about menstrual hygiene. They feel uncomfortable talking about it even with their husbands, in the fear that they would either ignore it or remarry. “Some women say that they do not have the money to buy pads or go to a doctor,” says Shivani Thakore, coordinator at Vatsalya Foundation. “But it’s more about the stigma rather than anything else, really,” she adds.
The situation is only so much better in the urban areas. Arzoo Patankar, a 26 year-old creative producer, now based out of Austria was born in a family of doctors and yet found herself struggling to get a proper diagnosis. “The first two days of my period, I am in hell. I almost pass out. Though the issue isn’t much of a stigma in my house, as it is looked at very medically, I am still often told that the pain would go away after I am ‘married.’ (read: become sexually active). The doctors just gave me some birth control pills to ease the pain. But I didn’t take them because I was too afraid of the side effects. Moreover, it only seemed like a temporary solution,” she says. My own boss, Varsha Patra, 34 told me how she would be hospitalized every month due to an extremely heavy blood flow and excruciating pain. “I would be wearing a thick tampon and a pad and would still bleed through. It felt like someone was stabbing me through my abdomen,” she says, right before narrating another horrifying incident of a young girl who jumped off the building because she just couldn’t take the pain. “I wasn’t officially diagnosed with dysmenorrhea. The doctor just gave me some birth control pills. The situation is better, but the pain is still really bad,” she states.
The stigma around menstrual health directly relates to the psyche of young girls, especially those suffering from PCOD/PCOS that doctors say are caused due to lifestyle irregularities. Gaining of weight, increasing hair growth, irregularity of periods and irritability give rise to body image issues and add on to the stress. Dr. Dhawan, 59 a practising gynaecologist from Dehradun with 27 years of experience says, “As high as 90 percent girls have either delayed periods, prolonged cycles or amenorrhoea, i.e. lack of periods leading to PCOD. Lack of physical activity, the rise in fast food intake, minimal consumption of a balanced diet with almost zero intake of fruits and vegetables, disturbed sleep pattern, increased engagement on electronic gadgets like laptops and mobile phones, are all aggravating factors which should be taken care of. PCOD, once developed, is beyond treatment at times.”
More often than not, these conditions lead to infertility which is another factor of worry for young girls who mostly have been brought up in a society that has always nurtured the opinion that the primary job of a woman is that of procreation. Nikhita Gowra, one of the directors of the documentary titled ‘Bad Blood’ that sheds light on the challenges faced by young women diagnosed with PCOD and PCOS, interacted with many young urban women during the course of filming. Narrating an overwhelming incident, she says, “I personally found it very moving and hard-hitting when one of the PCOS patients who features in this documentary says, “I am very young but it does worry me sometimes that I am having to hear things like ‘are you upset or scared about not being able to have kids’... these thoughts do come to mind. It’s not that I want to have kids or don’t want to have kids. It’s just that I want to have that choice.” Another part is when Aishwarya Banerjee, another patient featured in the documentary says, “One of the purposes of a woman is to procreate. And if I can’t even do that, I could begin to feel redundant. It’s not a question that I am asking, but it’s a question that society asks.” These lines which came so naturally to them had so much of an effect on me during the filming just because of how true the feelings and emotions behind them were.”
Even with the taboos around, many women brave society and the stigma and visit the doctor but are faced with more serious decisions once they are diagnosed. In 2010, Sudha Gurlhosur then 38, a senior engineer in a multinational company was diagnosed with having fibroids (frequently seen tumours of the female reproductive system). The two plausible solutions for her were to continue with medication or undergo surgery. The medication provided no guarantee of betterment and the fibroids could lead to cancer. Sudha was faced with a difficult decision. Should she undergo the surgery that would take her uterus away? While her husband was supportive of the surgery, she received flack from society for even considering to give up an organ that was primary to her womanhood. But 7 years later, she does not regret the decision at all. “My job requires long hours and bleeding 8-10 days a month was very uncomfortable and hard. It took me three months and various opinions to come to the decision of getting my uterus removed. Although I have suffered some hormonal imbalance, I am happy with the decision. It has made life easier,” she explains.
As we progress into the new year, we are still regressing when it comes to menstrual health issues in India According to a report in the Indian Express, “a 2014 study by Dasra, an organisation that works for social change, showed that 70 percent of mothers in India consider menstruation dirty. As per a study in BMJ medical journal, ‘Menstrual hygiene management among adolescent girls in India’, only 55 percent of girls saw it as normal”. But change is happening, even if gradually. Last weekend I visited Dehna, a village in the interiors of Maharashtra. Women were washing clothes at the river and the discussion ranged from village gossip to latest Marathi movie, when suddenly one of the ladies asked the other if her periods were regular now. Beating away at the cloth, she responded how a particular doctor in Thane had treated her so well that her periods were not only less painful but also regular. “I told you, we must visit doctors and not take the pain upon ourselves,” the other woman said matter-of-factly.
Dr. Dhawan too says that she finds more women both from urban and rural areas coming to her with their ailments. “Women are quite aware of menstrual hygiene, as compared to what they were 50 years back. They are comfortable getting treatment. Stigmas are related to religion in our country. They are being reduced by conducting Adolescent health education classes, school health programmes. A large no of girls are coming forward and discussing their problems, old taboos,” she explains. Upcoming movies like Padman with iconic heroes too will play a huge role in destigmatizing mensuration and first day period leave policy being adopted by some companies shows that employers are understanding and considerate towards female employees.
But we still have a long way to go and the need of the hour is to not just educate and aware young girls but also the boys so that mensuration is looked at normally and health issues can be addressed more properly. This is exactly the thought Anitaben wants to reiterate. She says, “Educating girls is obviously necessary but boys need to be made aware too because they get their information from not so credible sources which then creates a larger problem.” Sudha Gurlhosur agrees to the same and says, “it’s important for men to understand the hardships we face so that they could be supportive and understanding especially when a woman undergoes menopause.”
Change needs to begin at a grass root level. While it may be too late to change certain mindsets, awareness and education for younger generations should begin now, cohesively. Myths need to be busted and conversations need to be initiated. We need to talk about it until it reaches a point of complete normalcy. Until that time comes, women, please do not suffer in silence.
If you enjoyed reading this article, we suggest you read: