Managing menstruation woes

This year, on January 19, Kerala’s Chief Minister Pinarayi Vijayan announced menstrual leave for female students in all state universities under the Department of Higher Education, meaning that:

* A girl aged 18 years or above is eligible to avail 60 days of menstrual leave in a year.

* With this, the attendance percentage of girl students is sealed at 73 per cent, against the usual 75 per cent.

While some are rejoicing and welcoming this move, others are debating about the repercussions and discrimination. With menstrual health still being a taboo in our society, let us understand the menstrual cycle, women’s mental health and PMS.

It is not the first time that a menstrual leave has been announced in our country. In 1992, Bihar introduced period leave for working women, and in 2017, Menstruation Benefit Bill was introduced, only to be later withdrawn from the Parliament due to the topic being too “unholy”.

Many countries like South Korea, Taiwan, Japan and Indonesia already have a period leave set in place. And closer home, in the private sector, Swiggy, Zomato, and Byju’s are some of the Indian companies that provide their employees with paid period leaves.

What is menstruation (aka period)?

It is a natural and normal biological process that occurs in a biological female’s reproductive system. The average length is 25 to 35 days and periods last between three to seven days. Menarche is the onset of puberty (the average age is around 12 years but may range from nine to 16 years of age) and menopause is the end of a woman’s menstrual cycle forever (the average age is around 45 to 50 years).

This process needs to occur as it prepares the uterus to hold a fertilised egg.

Day 1-5: Menstrual period occurs; the woman bleeds due to the shedding of the lining of the uterus. This happens when pregnancy does not occur.

Day 6-14: Hormones begin to thicken up the lining of the uterus. An egg is released during ovulation (around day 14), which travels down the fallopian tube.

Day 15-28: If the egg is not fertilised with a sperm, the hormone levels begin to drop, and the uterus lining begins to shed, leading to the start of a new menstrual cycle. If the egg is fertilised, then it gets implanted in the uterus leading to a pregnancy.

The various products used by women can range from sanitary pads to menstrual cups and tampons. In India, the availability of hygienic options is still a widespread issue. Many women in India still use washable cloth, while in some rare cases, there are reports of grass, ash, leaves, mud and soil being used.

What are some popular terms used by women to refer to their periods?

Chums, aunt flow, red days, the curse, shark week, and even the great crimson wave

Why do women require menstrual or period leave?

Menstrual leave is one of the most contested topics around the world. It is a kind of leave where women, while they are menstruating, can opt for leave if they are unable to go to work.

This is often due to dysmenorrhea, meaning heavy and painful cramps, and stomach-ache, nausea, bloating, mood swings with discomfort.

What is PMS?

PMS is a short form of premenstrual syndrome. This comprises a group of physical and emotional symptoms in the days leading to the menstrual period. Few symptoms can occur commonly in women, but nearly three to eight per cent of women have a clinically significant PMS picture.

Bodily symptoms: Pain (breast tenderness, backache, joint pain, muscular pain, abdominal pain); overall fatigue; gastrointestinal changes like constipation, diarrhoea, nausea, flatulence, water retention and soreness

Emotional and Behavioral symptoms: Mood changes (irritability, heightened rejection sensitivity, tearfulness) changes in appetite and sleep.

They occur because of changes in hormones estrogen, progesterone, LH (luteinising hormone) and FSH (follicle stimulating hormone). The other neurochemical involved is serotonin.

One can try to manage their PMS by:

An active lifestyle, reducing vices (like smoking and drinking), massages, hot water bags, medications like NSAIDs (pain killers) and oral contraceptive pills have shown benefits in conjunction with therapy.

What is PMDD? Are PMS and PMDD different? How does one get diagnosed?

PMDD stands for premenstrual dysphoric disorder and is a much more severe form of PMS. PMDD affects roughly two to four per cent of women. The symptoms are like PMS, but in severity, they are enough to disrupt work, school and relationships. One requires five or more symptoms in the week before menstruation and improves within a few days of menstruation starting.

Mood symptoms can go on to encompass depression, anxiety, irritability, menstrual mood swings and rage.

Treatment is similar to PMS but may require a medical line of approach.

What can a partner do to support you during your PMS?

Rather than lightly commenting and using the term PMS in a derogatory manner, try to listen and understand your partner. Show empathy by helping with chores and respecting her boundaries. You can also give company in exercising, eating healthy or being available to cuddle and show support.

Why do we need period leave?

Menstrual leave is being promoted to help acknowledge and address the often-debilitating pain and discomfort that many women go through and, hence, are unable to be a hundred per cent at work. These leaves help make accommodations for those who experience distress. The cramps can in some women be as painful as a heart attack, according to research at University College London.

Is there a downside to providing period leave?

First and foremost, not all women experience the same amount of distress during their periods. Secondly, while the leave seems great on paper, there has been a decline in the number of women availing them across various countries where it was

already available. Most cite the social stigma against menstruation as the reason. Another group of advocates also cite that this causes medicalising a normal monthly biological process that can further strengthen the biases against women’s working capacity. Employees can

even be reluctant to hire more women staff due to mandatory period leaves.

Menstrual equity and menstrual knowledge

It encompasses making menstrual products affordable and accessible to all, alongside imparting education about reproductive care. As per a 2022 National Family Health Survey report, in our country, about 50 per cent of women aged 15-24 years still use cloth for menstrual protection. Making sanitary napkins and other hygienic options affordable and accessible is a country-wide drive.

Recommended movies: ‘Pad man’, based on Arunachalam Muruganantham, an activist for menstrual health in India.

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