Menstruation, also known as a "period," is the monthly shedding of the uterine tissue lining. Girls have their periods at various ages, usually from 10 to 15, while some start as early as 9 or as late as 15. Despite its universality, menstruation is often associated with shame, misunderstanding, and discomfort. Many African women suffer greatly as a result of a lack of information and misconceptions about menstruation and menstrual hygiene. This article aims to provide an introduction to menstruation and period pain. 

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The Menstrual Cycle

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Menstruation normally begins at adolescence (around the age of 10-15) and is controlled by hormones released by the brain and the ovaries. Menstruation continues until menopause, which normally occurs between the ages of 45 and 55.

‍The menstrual cycle is a crucial part of normal reproductive function and prepares the body for a potential pregnancy. It’s divided into 4 phases:

1. Menstrual Phase:  This starts from day 1 of the period and marks the beginning of the menstrual cycle. It involves the shedding of the endometrium which is the inner lining of the womb (Fig. 1). Menstrual blood, made up of blood and tissue from the shedding lining, is expelled through the vagina. This phase typically lasts around 3 to 7 days.

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Figure 1: The Uterus. The uterus (womb) has 3 layers. The innermost layer, the endometrium sheds during menstruation. Made with BioRender

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2. Follicular Phase:  During this phase, the follicle-stimulating hormone (FSH) released by the brain stimulates the growth of fluid-filles sacs in the ovaries called follicles, each containing an immature egg. Oestrogen levels also rise, causing the endometrium to thicken in preparation for potential implantation of a fertilized egg.

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3. Ovulation:  Halfway through the menstrual cycle, usually around day 14 in a 28-day cycle, a surge in another hormone, the luteinizing hormone (LH) causes the follicle to rupture and release a now mature egg from the ovary. The egg travels into the nearest fallopian tube, and then into the uterus. Over the several days, the endometrium continues to grow thicker. This phase is known as ovulation and represents the peak of fertility.

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4. Luteal Phase:  After ovulation, the ruptured follicle that released the mature egg transforms into a structure called the corpus luteum, which releases oestrogen and a lot of progesterone. This hormone helps maintain the thickened uterine lining to support a potential pregnancy. If fertilization happens, the fertilized egg will move into the uterus and attach to the thickened endometrium. If fertilization does not happen, oestrogen and progesterone levels decline, leading to the shedding of the uterine lining and the onset of menstruation.

Figure 2: The Menstrual Cycle. The length of the cycle varies between individuals and can be affected by several factors including stress. Adapted from Always.co.uk (2024)

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Also Read: Best Advice on Family Planning for Nigerian Women

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Menstrual Hygiene Products

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There are different menstrual hygiene products available, including eco-friendly alternatives. Each product has its pros and cons, and while some prefer to stick to one, others may want to explore various options to figure out what works best for them.

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Figure 3: Types of Period Products. There is now a variety of period products to choose from, including reusable alternatives. Adapted from LiveHealthily.com (2022)

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Many African women, including Nigerians, tend to use sanitary pads for several reasons including accessibility, convenience, and cultural taboos. However, while some women are unaware of all the options available, some use other tools like tissues, or cloths usually due to poverty. 

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Related:

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Painful Menstruation in Nigeria and How to Solve It

How Nigerian Girls Can Practice Good Menstrual Hygiene

African Women: How to Talk to Your Girl Child About Menstrual Health

How African Women Can Manage Menstrual Discomfort with Yoga and Meditation

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Painful periods (Dysmenorrhea)

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Menstruation comes with its share of challenges and for a large percentage of African women, this includes pain, which  is referred to as period pain or menstrual cramps. 

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While period pain is normal for most women, excruciating periods may be caused by an underlying medical condition, for which it is advisable to see a doctor.  Dysmenorrhea can also cause nausea, vomiting or diarrhoea in some women, as well as headaches or general discomfort.

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Dysmenorrhea is a common but often misunderstood occurrence. For example, a study of the prevalence of Dysmenorrhea in Nigeria showed that 69.8% of the respondents experienced severe menstrual pain intense enough to hinder normal daily activities and social life. Therefore, understanding and managing period pain is crucial for improving the quality of life for women who experience discomfort during menstruation. If period pain becomes severe or disrupts daily life, it's important to consult a doctor for further evaluation and guidance.

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Types of Dysmenorrhea

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• Primary Dysmenorrhea: This is the most common type of period pain and is not associated with any underlying medical condition. It usually begins 1 to 2 days before menstruation and may last from 2 to 4 days.

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• Secondary Dysmenorrhea: Caused by an underlying reproductive health issue like endometriosis or PCOS, secondary dysmenorrhea tends to start earlier in the menstrual cycle and lasts longer than primary dysmenorrhea.

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Causes of Dysmenorrhea

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1. Prostaglandins: During menstruation, the womb lining releases chemicals called prostaglandins, which cause muscle contractions to help shed the lining. Excessive prostaglandins can cause increased pain.

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2. Other Factors: Conditions like endometriosis, fibroids, and pelvic inflammatory disease can contribute to more severe menstrual pain.

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Managing Painful Periods

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1. Lifestyle and Dietary Changes:

Exercise Regularly: Engaging in regular physical activity can help reduce period pain by improving blood flow and reducing stress.

Maintain a Healthy Diet: Incorporate foods like fruits, vegetables, whole grains, and omega-3 fatty acids, while managing caffeine and sugar intake.

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2. Heat Therapy:

Applying heat to the lower abdomen can help relax muscles and reduce menstrual cramps. A hot water bottle can be effective in providing relief.

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3. Over-the-Counter Medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation associated with menstruation. It's however important to follow the recommended dosage and consult with a doctor or pharmacist if needed.

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4. Prescription Medications:

For people with severe period pain or underlying conditions, prescription medications such as hormonal birth control or stronger pain relievers may be recommended. A virtual consultation with a Débbo Doctor is essential to determine the most appropriate treatment, as it varies between people.

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5. Alternative Therapies:

Acupuncture, yoga, and meditation are alternative therapies that some people find helpful in managing period pain. Another therapy is TENS (Transcutaneous electrical nerve stimulation), where small pads are attached to the skin and small electrical impulses are delivered to the area. Although research on their effectiveness is ongoing, many people report relief from these therapies.

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In conclusion, menstruation is a natural and essential aspect of female reproductive health, yet it is often surrounded by stigma and misconceptions. By understanding the biological mechanisms of menstruation, we can work towards destigmatizing this natural process and promoting menstrual health more effectively.

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Also Read: Essential Health Tips Nigerian Women Must Know Before They Clock 40

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Sources

Chéileachair, F.N., McGuire, B.E. and Durand, H. (2022). Coping with dysmenorrhea: a qualitative analysis of period pain management among students who menstruate. BMC Women’s Health, [online] 22(1), pp.1–11. doi:https://doi.org/10.1186/s12905-022-01988-4.

Deborah Tolulope Esan, Sharon Ayobami Ariyo, Elizabeth Folu Akinlolu, Oluwadamilare Akingbade, Oluwaseyi Isaiah Olabisi, David Bamidele Olawade, Theresa Olaitan Bamigboye and Adesola Adenike Ogunfowokan (2024). PREVALENCE OF DYSMENORRHEA AND ITS EFFECT ON THE QUALITY OF LIFE OF FEMALE UNDERGRADUATE STUDENTS IN NIGERIA. Journal of Endometriosis and Uterine Disorders, 5, pp.100059–100059. doi:https://doi.org/10.1016/j.jeud.2024.100059.

Jo, J. and Lee, S.H. (2018). Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific Reports, 8(1). doi:https://doi.org/10.1038/s41598-018-34303-z.

Livehealthily.com. (2022). Period products: What’s Good for You and What’s Good for the environment? [online] Available at: https://www.livehealthily.com/self-care/period-products [Accessed 14 Apr. 2024].

NHS (2022). TENS (transcutaneous Electrical Nerve stimulation). [online] NHS. Available at: https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/.

www.always.co.uk. (2024). Your Menstrual Cycle Phases. [online] Available at: https://www.always.co.uk/en-gb/tips-and-advice-for-girls-and-parents/my-period/menstrual-cycle-phases/.

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