Discussed by Dr Sinchan Das:
India is one of those ancient civilisations where the seeds of education, medicine, science, culture and art were first sown. But this land of glory was eventually submerged under a huge amount of social stigma. India is a country where ‘sex’ still considered a taboo subject. Different concepts regarding sex have prevailed in society for a long time. However, a suspicious atmosphere has been created around sex. This hindrance is one of the principal causes of sexually transmitted diseases (STDs) and the ever-growing rate of sexual violence.
It is a common trait of the human mind to feel interested in matters that are hushed up. Sex does not mean the ‘sexual act’ or ‘sexual performance’ only; rather, sex denotes ‘sexuality’ and ‘sexual identity’ also. Sex is a basic psycho-neuro-endocrine property of all living beings, expressed by the means of different sexual behaviours and actions. So, it is immaterial to consider sex as a ‘sin’ or ‘offence’ and it must not be considered as a subject of hindrance.
In this male-dominated society of India, several customs are superimposed over women. There are several such customs regarding menstruation as well.. Even in this modern era, women – especially those from rural areas – still hesitate to talk about the sexual matters. Hence, they cannot even share their problems regarding menstruation or anything that may involve the reproductive system. As a result of this, gynaecological disorders remain unidentified during the first few stages. Due to this hindrance and ignorance, lots of pathologies remain unnoticed and untreated for a considerable period of time. By the time they are diagnosed, the level of threat has gone way up. So, hindrance and myths may result in compromisation of health and compromisation of expenditure.
Menstruation or menstrual bleeding is a similar physiological phenomenon as digestion, excretion, circulation and others; so, it must not be considered as something different or a matter of hindrance.
Menstruation is the cyclical discharge of blood, mucous, stripped of endometrium, leucocytes and an unfertilized ovum at an regular interval of average 28 days (21-35 days). The duration of a menstrual cycle is about 4-5 days and the amount of blood loss is estimated to be 20-80 ml with an average of 35 ml.
Menstruation must not be a ‘sin’. There is a serious need for sexual education and awareness regarding reproductive physiology, so that a woman can easily come forward and share her usual and unusual experiences from the very first day of her menstrual life (menarche). This may play an important role in the identification of reproductive pathology in an initial stage, through which we can avoid many serious pathologies very easily. On a serious note, menstruation is not solely an endocrinal issue; rather, it is better to say that it is a psycho-neuro-endocrinal issue. For that reason, we have to maintain a healthy atmosphere to maintain healthy reproductive functions.
Let us make a short summary of the different menstrual pathologies commonly occurring during the reproductive life of a woman.
1. Dysmenorrhoea: Dysmenorrhoea means painful menstruation of sufficient magnitude so as to incapacitate day-to-day activities.
2. Mittelschmerz’s Syndrome: In this case, there is an onset of ovular pain in the mid-menstrual period. The pain usually located in the hypogastrium or in either iliac fossa. This pain generally lasts less than 12 hours and it is associated with slight vaginal bleeding and excessive mucoid vaginal discharge.
3. Pelvic Congestion Syndrome: There is a disturbance in the autonomic nervous system which may lead to gross vascular congestion with pelvic varicosities. The patient has a congestive dysmenorrhoea without any demonstrable pathology. The patient complains of vague disorders with a backache and pelvic pain with or without dyspareunia.
4. Premenstrual Syndrome (PMS): PMS is a psycho-neuro-endocrine disorder of unknown Aetiology, often noticed just prior to menstruation.
5. Menorrhagia: It is defined as cyclic bleeding at normal intervals; the bleeding is either excessive in amount or duration. Common causes are – a) DUB; b) Fibroid of uterus; c) Adenomyosis; d) Chronic tubo-ovarian mass.
6. Polymenorrhoea (Epimenorrhoea): It is defined as cyclic bleeding where the cycle is reduced to an arbitrary limit of fewer than 21 days and remains constant at that frequency.
7. Metrorrhagia: Metrorrhagia is defined as irregular, acyclic bleeding from the uterus.
8. Menometrorrhagia: Bleeding is so irregular and excessive that the menses cannot be identified at all.
9. Oligomenorrhoea: Menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency.
10. Dysfunctional Uterine Bleeding (DUB): It is defined as a state of abnormal uterine bleeding without any clinically detectable organic, systemic and iatrogenic cause.
11. Secondary amenorrhoea: Absence of menstruation after minimum a successful menstrual bleeding. These above-mentioned pathologies are the results of different grades of pathologies, which need to excluded carefully. To minimise the rate of reproductive pathologies, infertilities, maternal and child mortality rates, we have to educate ourselves with proper sexual education and erase all hesitations regarding sexual matters from the root.