Menstrual Hygiene Day and Why it Matters

Menstrual Hygiene Day 2024 (#MHDay2024) takes place on 28 May. 2024 marks the 10^th celebration of Menstrual Hygiene Day with the theme: Together for a #PeriodFriendlyWorld.

The purpose of the day, much like other global awareness days, is to raise awareness and initiate conversation to effect long-term change at global, national and local levels.

Even though half of the world’s population experiences menstruation, it is a topic that is traditionally taboo. Unfortunately, millions of women and girls around the world are stigmatised, excluded and discriminated against simply because they menstruate.

Menstruation, however, is a perfectly normal fact of life. What’s more, it is the mechanism by which our species reproduces. Without the menstruation cycle, the human race as we know it would cease to exist!

Understanding menstruation: The biology explained 

In the past, people did not talk about menstruation. As a result, some basics of human biology were completely misunderstood or even not known to begin with. To keep things easy to understand, we have broken down the menstrual cycle into four weeks, but please note that everyone has a slightly different cycle and the number of days for each phase will be different for each person. 

Dr Estima in her conversation with Dr Perlmutter notes how ovulation is the central event and the point of the menstrual cycle. We have summarised part of the conversation.³

The follicular phase 

Week 1 – the bleed week
During this week, the endometrial lining is shed. Estrogen, progesterone and most hormones related to the menstrual cycle are low. However, the FSH (follicle-stimulating hormone) designed to stimulate the follicle, drives the development of the follicle with the egg inside it.

Week 2 – the week before ovulation
The first two weeks of the menstrual cycle are called the follicular phase as it is all about driving follicular maturation and producing a viable egg for fertilisation. Estrogen rises during the second week as does testosterone, making people feel outgoing and social.

At the end of this week, LH (luteinising hormone, the hormone responsible for helping the follicle release the egg), rises dramatically to result in ovulation. The egg bursts from the follicle and is viable for fertilisation for about 24 hours.

Terminology

Ovulation: is a phase of the female menstrual cycle that involves the release of an egg (ovum) from one of the ovaries. It generally occurs about two weeks before the start of the menstrual period.⁴

The luteal phase

Week 3 – the week after ovulation
When ovulation occurs, the leftover sac of tissue in the ovary becomes the corpus luteum. The corpus luteum starts to secrete progesterone in anticipation of pregnancy. This causes the endometrial lining to develop into a welcoming environment for a potential baby.

Week 4 – the week before your period
Progesterone peaks on day 21. If there is no pregnancy at this point, the cycle starts again. During this week, there is the biggest drop in serotonin (a happiness hormone). Midway through the week, the corpus luteum stops secreting progesterone if the egg has not been fertilised. This causes a loss of blood and oxygen supply to the endometrium. The blood vessels developing in the endometrium, contract and die. The endometrium shed begins – menstruation starts again.

Menstruation is a vital sign of health and tracking your cycle 

While the point of the menstrual cycle is ovulation, menstruation is also important as a vital sign of female health.

If you are interested in keeping track of your cycle, several different apps⁵ can help you, including the Clue App, Flo App and Ovia Fertility App, amongst many others. By keeping tabs on your cycle, you will soon know your baseline, notice anything out of the ordinary and be able to flag any potential health problems. These apps can also help you to prepare for your menstrual cycle and be proactive about planning your month.⁶

Menstrual fluid

Many religions and cultures have long believed that menstrual blood is impure and contains toxins. This idea has oppressed women for thousands of years. Today, women are still banned from places of worship or from preparing food during menstruation.

Menstrual blood is blood. It is the same as the blood drawn from your arm. It is not dirty or spoiled or polluted blood. Blood flows to the uterus and ends up in tiny blood vessels in the endometrium. The hormonal cascade that triggers menstruation weakens these blood vessels, and they open and bleed, which helps to push off the outer layer of the endometrium. The blood picks up the endometrium that has now separated from the uterus and then heads down through the cervix to the vagina picking up cervical mucus and vaginal discharge. What comes out of you is menstrual fluid – regular blood mixed with endometrial cells, cervical mucus and vaginal discharge.

Menstrual flow: How much is too much? 

The upper limit for normal menstrual blood per cycle is 80 ml. Blood makes up about half of the menstrual fluid, so up to 160 ml of fluid per cycle is within the normal range. Here are some practical ways to better understand if menstrual fluid is excessive:

• Changing pads/tampons more than every 1-2 hours
• Soaking onto clothes or sheets despite using a menstrual product
• Clots > 2 cm
• Sensation of gushing
• Needing to double up on menstrual products (a tampon and a pad)

If you feel your menstruation is abnormally heavy, speak to a healthcare professional.

Navigating online information

Sensitive topics are often shrouded in secrecy and shame, and can leave those seeking answers at risk of exploitation. Dr Jen Gunter MD advises caution when it comes to trusting information posted on social media.

• Question the motives behind those who are posting. Are they trying to sell you something? Do they have an agenda?
• Research their professional background and make sure that they have the appropriate medical qualifications and experience to offer advice.

Suggestions for managing menstrual cramps 

• Ibuprofen: NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen can help alleviate menstrual cramps. Several studies have been done to evaluate the effect of these drugs on the menstrual cycle. They reduce menstrual cramps and also cause a 25-35% reduction in menstrual flow.
• Hot water bottle: applying heat to the lower abdomen can relax muscles and ease cramping. Avoid prolonged exposure to heat to prevent skin damage or irritation.
• TENS unit: transcutaneous electrical nerve stimulation (TENS) units deliver small electrical impulses to the body, which can disrupt pain signals and also provide relief.
• Pressure: applying gentle pressure to the abdomen with a massage, wrap or by using your hands can help relax muscles and alleviate cramping.
• Time spent caring for yourself: self-care activities, such as taking a warm bath, practising relaxation techniques or participating in exercise can help reduce stress and relieve menstrual cramps.
• Herbal remedies: ginger, chamomile, or raspberry leaf tea are believed to have anti-inflammatory and muscle-relaxing properties that may help alleviate menstrual cramps.

Period poverty in South Africa⁷

If you or your class are interested in these statistics and how you can make a positive difference, take a look at the websites below for more information and ways to become involved.

Subz: www.subzpads.co.za

Project Dignity:
www.projectdignity.org.za

Note: We recognise that not everyone who menstruates identifies as a woman and that not all women menstruate.

REFERENCES

1. Menstrual Hygiene Day. [Online], Available: ly/MenstrualHygiene2024[18 Apr 2024].
2. Gunter, J. (2024) Blood, the Science, Medicine and Mythology of Menstruation, [Online], Available: ly/DrGunterMenstruation[18 Apr 2024].
3. Perlmutter, D. (Host). (2024). The Empowering Neurologist EP. 137 [Audio podcast]. Make Your Menstrual Cycle Your Superpower – with Dr. Estima Available: ly/DrEstimaMenstrualCycle[18 Apr 2024].
4. Ovulation and Fertility,  [Online], Available: bit.ly/OvulationFertility[18 Apr 2024].
5. Women’s Health. Best Period Tracker App: 11 Options To Get To Know Your Cycle, According To Ob-Gyns, [Online], Available:ly/PeriodTrackingApps [18 Apr 2024].
6. Brayboy, L. (2022) Cycle tracking puts you in charge, [Online], Available: ly/3QfVKfX[18 Apr 2024].
7. Project dignity. [Online], Available: ly/3QCJE0D[18 Apr 2024].

If you are using the Achieve Careers English LO Programme, the following information and activities are recommended:

• GR 12 CAPS eBook – Module 3 (Democracy and Human Rights): World Press Freedom Day
• GR 10 LO Manual – Module 3 (Skills Development): Cultural Diversity for Dialogue and Development
• GR 7 CAPS eBook – Module 1 (Development of the self in society – Puberty)
• GR 9 CAPS eBook – Module 1 (Development of the self in society)
• Teacher’s Flash Drive – LO Resources – folder on Puberty and Personal Hygiene