In the light of the recent social media campaigns encouraging women to get more comfortable with and talk about menstruation, we decided to talk to Dr. Tripti Sharan about some common issues.
Dr. Tripti is a practicing gynaecologist at BLK Superspeciality Hospital, New Delhi and a writer in her quiet moments of introspection. As she strives to empower women by promoting health and awareness, her biggest challenge has been getting past the stereotypes and overcoming the misogyny prevalent in the society. In her recent book, ‘Chronicles of a Gynaecologist’ published by Bloomsbury India and based on real life experiences, she tries to decipher the conundrum of a woman’s life at every step. She also has an anthology of poems, ‘The Dewdrops – a Journey begins’. An active blogger she contributes poems and stories to many anthologies and publications.
Here she answers some common questions women often ask about menstruation.
Q. What are some of the basic menstrual hygiene rules every woman should follow?
Tripti: Before I elaborate on ‘hygiene’ let me stress upon that there is nothing unhygienic about menstruation. It’s just a ‘physiology’ and not pathology. The only thing that needs to be taken care of is that you stay clean and don’t soil your clothes.
The body has an excellent defense mechanism and one is protected even during menses. But keeping infected, dirty or soiled clothes very intimately with your body for a long time can cause some unwanted reactions. The most common is bad odour. This can put one in a tight spot especially when in close proximity with other people or for example if one happens to be a young girl at school.
An unclean or a dried out pad, worn over a long period of time can cause a lot of localized allergic reactions, leading to irritation, itching and uneasiness. So the best thing would be to change the pads frequently. We can’t fix a number but it’s good to change 3 to 4 times per day. One needn’t wait for the pads to get all soggy and then change. Some accumulated body secretions, even if not blood can cause discomfort.
Proper disposal of used pads should be taught to all, because it’s not a very good sight to watch these pads being devoured by dogs on the streets. Infected pads can sometimes carry serious infection like STIs (sexually transmitted infections, e.g. HIV) and in such cases need to be disposed-off properly.
Some women still use old clothes as pads. Though the practice should discontinue we must remember that we live in a country with a great economical divide. For some women though, it is not about money as much as it is about tradition. They have always followed it and do not want to change. The point to remember is that though it’s preferable to use the sanitary pads available in the market but if at all a cloth has to be used make sure that its clean , and not one that’s damp, or infected in any way.
In villages, some people still wash these clothes and reuse them. It might sound a little disturbing to some. But life is not fair to many and we must remember that to some people every penny and yes, every pad counts. Though I do not at all advocate pads being reused, the only option to these women would be too wash these clothes well and dry them up in sunshine.
A good perennial hygiene goes without saying and is what one should follow at all times. In women any infection gets easily transmitted to the urinary tract and hence hygiene is always important to them. We have good vaginal washes these days which keep your body clean and these should be used regularly
Always remember that it’s just a physiology and unless you are not bleeding a lot, your body would take good care of you. Add on lots of fluids, and spike up your diet with proteins and iron all days of the year. Treat menstruation as normal and not as those days marked in red. Carry on with your life, the usual way.
If ever you feel there is any abnormal shift in your cycle, do not hesitate to contact your doctor.
Q. Where do most women go wrong as far as menstrual hygiene and care is concerned?
Tripti: It’s just that they feel they have to behave a little differently. Right from the beginning, women are indoctrinated with special care they have to take during this period and that something abnormal is happening. At a young age the changing body dynamics can be a little alarming to the immature mind but this is where the parents and even the schools need to step in. The ‘feeling of being impure’ is a tag which has to be removed. A little discomfort, a little pain has to be taken in stride. Women don’t need to take the day off during this period. We live in a competitive world and we shall be always be tested for our grit and determination. Periods as a ‘feminine’ excuse stands to be ridiculed.
Majority of women do not want to spend on themselves and are complete misers when it comes to buying napkins. But an uncomfortable cloth keeps them irritated and they get bogged down by the heaviness that such usage generally gives them. Sanitary pads are more comfortable and user friendly, easier to dispose off too and women should understand this.
Q. What are some of the areas related to their period cycle that women are unaware of, but should?
Tripti : Though I stress upon taking periods as normal but apart from taking the measures that we spoke about earlier it is very important to be aware of any deviation. Any change in the periodicity, the amount of bleeding and the character of pain can be suggestive of something going wrong inside. From something like pregnancy, infections like tuberculosis and cancers can produce obvious effects on the menstrual pattern. An excessive bleeding can lead to anemia. Abnormal bleeding can also happen because of stress and some hormonal disorders like thyroid problems.
Too much of television, computer and mobiles, leads to sedentary habits. Lack of exercise, faulty lifestyle, and improper diet leads to menstrual irregularities. These can have long term consequences on the body.
So the important message here is to put on your running shoes, leave the stress behind and be happy.
Q. What are the problems women can suffer from due to poor menstrual care and hygiene?
Tripti: We have discussed most of them above. I only need to add that you must visit your doctor whenever you feel that you have missed a period, have had a prolonged period, or you keep bleeding intermittently. Remember, these could be masking a cancer. Cancer of the cervix is the most common cancer in women in India. Pregnancy is another thing and one should remember report to a doctor immediately. We should never ignore it as just another changing phase of life. You can talk to your friendly aunty as much as you want but take a medical advice only from an expert. A pregnancy can be complicated especially when it happens at extremes of age and if unplanned. Even if it’s a planned one, start caring for it immediately.
Q. Do you agree with the government’s move to not reduce tax on sanitary napkins while making bindis and bangles tax free?
Tripti: Governments unfortunately have a mind of their own and they for reasons best known to themselves do populist reforms more than the ones that would go a long way in promoting health and hygiene. It is the insides that matter not the outsides. Sounds like a cliché but is true. Bindis and Bangles are just about appearances, and being a woman is not about looking beautiful but feeling beautiful. But there are a lot of misogynistic notions prevalent in our society. A woman may not need a bindi and bangles any day of her life but it’s almost impossible to do away with the napkins. At a time when we should teach our women to think beyond bindis and bangles and feel confident even in those days, our governments has shown total disregard for something so pertinent to a woman. May be it use of proper sanitary napkins should be made a part of Swacch Bharat Abhiyaan.
Q. What are some of the myths related to menstruation- can’t go into temples, etc? And what’s the reasoning or belief behind it?
Tripti: You rightly said it’s a myth. It’s not that our culture is wrong, but the faulty interpretation of our culture that has created the social bigotry that exists now. The custodians of our culture, in older times decided that any one dealing with body fluids are impure. So they were treated like untouchables. Those who cleaned the toilets and menstruating women came under this category. This was ‘ritual impurity’. Now since they were not pure they were not allowed in the temples. This has been taken up by many women groups and recently there has been much debate over it too. But again it’s an issue that may not garner many votes so other than some activists or NGOs one can hardly see any politician taking this up.
The fall back of this ritual impurity is that apart from barring them from doing any puja even during festivals in many communities, women have to sleep in separate rooms, are not allowed in the kitchen. They are not allowed to touch many kinds of food that includes pickles. They are not allowed to wear new clothes. And at the end of menses they need to wash their hair. These are just myths and need to be busted.
Since it becomes inconvenient to families, these days many women resort to a hysterectomy (uterus removal), once they have completed their family just to get rid of this monthly nuisance. But an unnecessary surgery can have a fall out on their health too and has to be strongly condemned if done for this reason solely.
Q. Tampons v/s pads- which would you recommend and why? Also, what alternatives do women in rural areas use? How safe is that?
Tripti: Tampons are not very user friendly. It has to be inserted and if not done with clean hands and in a clean surrounding has a potential to cause infections. Some women tend to forget tampons inside which can get disastrous. Blood is a good culture medium, and in a warm and moist climate, and in unclean surroundings favours growth of microbes. Because it is a little difficult to use it never became a popular choice and does not go down well with the cultural temperament of majority Indians. So presently pads are a more viable option and must be promoted in this country.
For those who cannot buy pads, either they are made available to them through a government initiative else they have to wash and use clean clothes and dispose them off properly.
Q. What are the side effects of birth control pills or any other medication taken to control the menstrual cycle? How do these medications work?
Tripti: Birth control pills work by preventing ovulation. They have an added effect on making the endometrium or the lining of the uterus less receptive to any embryo. They change our hormonal milieu and hence they reduce the amount of bleeding. This can be a desirable affect for those having an excessive bleeding. In our country where iron deficiency anemia is much prevalent, this is an added advantage. But in some women who already have decreased amount of bleeding, it further reduces and becomes a matter of concern. For some, menstrual blood is an impure blood that needs to get removed every month and hence they become worried. They just need to be counseled and reassured that this is just normal.
People need to understand that women who gain weight develop hormonal disturbances and start skipping periods and later have reduced bleeding. Women tend to take it otherwise and believe they are getting fat because of not bleeding. Again this myth needs to be busted and women need to exercise and eat healthy. It is sedentary lifestyle and improper diet that causes most menstrual problems.
Thank you Dr. Tripti for taking out the time to provide us with these much needed answers.