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Coping With Pandemic Stress, Mental Health and Menstrual Disorders in 2020

This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.
ReimagineTogether logoEditor’s Note: This article is a part of #ReimagineTogether, a campaign by Youth Ki Awaaz in collaboration with UNICEF India, YuWaah and Generation Unlimited, to spark conversations to create a new norm and better world order in the post-pandemic future. How have you and those around you coped with the pandemic? Join the conversation by telling us your COVID story and together, let's reimagine a safer, better and more equal future for all!

The views expressed in this article are the author’s and are not necessarily the views of the partners.

In the wake of the global COVID-19 pandemic, healthcare systems have faced a pivotal challenge. In India, catering to COVID-19 positive patients and conducting tests consumed the entire system with very little infrastructure, time and expertise allocated for other ailments, illnesses or even medical emergencies. While the battle to tackle the physical effects of COVID-19 are ongoing, the assistance we need to help with mental health has largely been self-prescribed/aided by the media.

Articles on how to manage mental health during lockdown have been aplenty. Multiple circumstances have been explored and experts have shared their two cents. For example, if you are away from your family and home alone, here’s what you can do; if you’re having troubles separating your personal life from work in a WFH situation, this could help etc.

There are two interesting aspects to this. One, all of the articles linked to above are borrowed from international media and our socio-cultural realities do not allow for its easy translation into our lives. Two, a very crucial enabler of declining mental health had been neglected – menstrual cycles.

This, however, is unsurprising considering both mental health and menstruation are taboo subjects – especially in India.

Woman looking away and a sanitary pad
Representational image.

Understanding Menstrual Cycles And Mental Health

“All women are emotional and hormonal” is a sexist trope that has not only attached a double-edged sword to the way we engage with the link between menstrual cycles and mental health but has also ridiculed the effects of it. This pervasive slander and its marriage to the taboo associated with menses has affected the rate at which one can diagnose serious menstrual disorders like PMDD (Premenstrual Dysphoric Disorder), PCOS (Polycystic Ovarian Syndrome) and PME (Premenstrual Exacerbation).

Despite 1 in 20 women attesting to going through unpleasant experiences that affect physical and mental health before their period, PMS remains the most understudied in menstruation. About 90% women live with Premenstrual Syndrome (PMS), however, PMSing is still largely associated with a woman’s personality – “overemotional” – rather than a medical symptom that can get in the way of any menstruating person’s wellbeing.

Openly discussing the symptoms and ascertaining diagnosis is key to debunking this trope. At the moment, getting diagnosed for any of these disorders, especially PMDD is challenging. More than 90% of cases go undiagnosed.

Major Menstrual Disorders

Allopregnanolone, a chemical released by our brain, is said to be one of the main factors that trigger PMS symptoms.

This chemical is released as a response to the spike in the progesterone (hormone that thickens the linings of the ovary) levels in our body post-menstruation. It acts as a sedative. When the progesterone levels plummet pre-menstruation, our brain is suddenly starved of allopregnanolone and “experiences a “come-down” – kind of like an endorphin hangover. This allopregnanolone hangover is what scientists believe contributes to the PMS symptoms of anxiety, irritability and mood disturbances.”

PME and PMDD, on the other hand, are very clearly registered as disorders that can lead to suicidal thoughts. PMDD especially is not just a hormone-related disorder but is listed aside mental health disorders like depression, bipolar and general anxiety. It can result in severe mood swings, anxiety and manifest into physical symptoms like body aches as well. These symptoms usually precede the period by one or two weeks and is passed in the first few days of one’s period. This is how one differentiates PME from PMDD. PME is the premenstrual exacerbation/worsening of the symptoms of another disorder, such as major depressive disorder or generalised anxiety disorder.

PCOS is also a hormone imbalance where LH secretion is high. This contributes to the high levels of androgens (male hormones) that causes infertility, obesity, excessive facial hair in women. The mental wellbeing of people who live with PCOS is severely affected because one “can’t treat PCOS effectively unless we pay close attention to any signs of mental distress”.

woman with her hands in her face, stressed, anxious, worried
Representational image.

Experiences Of People Living With Menstrual Disorders During Lockdown

The COVID-19 lockdown, coupled with mass unemployment, economic indebtedness, domestic violence and alcohol abuse had left India at the brim of a mental breakdown.

“At-risk populations include the 150 million with pre-existing mental health issues, COVID-19 survivors, frontline medical workers, young people, differently-abled people, women, workers in the unorganised sector, and the elderly,” says Nelson Vinod Moses, a leading suicide prevention advocate in India.

Women and menstruating individuals in our country were not prepared to respond to the storm caused by the socio-economic failures of the state which collided with the pre-existing symptoms of menstrual disorders. It is deeply concerning to think about the state of mind of individuals living with chronic stress, depression, anxiety and other symptoms of menstrual disorders but are yet to be diagnosed.

Even if the menstruators are prepared to seek help, India’s formal mental health system has merely 9,000 counsellors and therapists available for 1.3 billion people. Large volunteer-based organisations like Let’s Talk, with over 300 volunteers, are also “acutely aware that it is impossible to provide long-term support to the community.” Shekar Saxena, former director of the WHO’s Mental Health Division, says“Mental health systems have always been very scanty in India and during this time, the gap between what is needed and what is available has widened markedly.”

Irrespective of the age, occupation or socio-economic backgrounds, the stories of people living with menstrual disorders during the lockdown have mostly been one of distress. “My shift at the hospital changes every day, so my sleep schedule is completely messed up. The fact that I am always scared and worried about risking myself while putting my whole family in danger creates a lot of stress and anxiety. As a result, my periods in the last few months have always been delayed. My mood swings have started fluctuating a great deal owing to the PMS of a delayed period,” says, Rushali*, a young doctor interning at a hospital in Moradabad, Uttar Pradesh.

“As a person living by themselves with two hormonal disorders – PCOS and PMDD, I rely heavily on my support system to get through life. Lockdown created dissonance and exacerbated the existing dysphoria these conditions subject me to. There were days of heightened depression and all my coping mechanisms to regulate hormones organically (endorphins and oxytocin) – running, swimming, physical support were unavailable. Getting psychiatric medicine (antidepressants and mood stabilisers) on e-prescriptions was not easy and further complicated the situation. The lockdown was undoubtedly the toughest episode of my poor mental health, and the first when I thought about ending my life,” says Sonal Jain, co-founder of Boondh.

“Going out used to be an escape from the toxic environment of my house. Now that I am stuck in the house I have to work a lot. It has majorly affected my mental health and period cycle. PCOS, already used to create a lot of problems but in the last couple of months my period stays for more than a week, are often delayed and are excruciatingly painful,” says  Eshitaa Mudgal, a 22-year-old from Delhi who lives with PCOS.

However, some are using the lockdown to try and navigate a better way to deal with the effects of living with these disorders. “I was heavily dependent on birth-control pills for a year and a half but taking note of how adversely it was affecting my physical and emotional well-being, I stopped. Until college, I was not eating healthy, doing any form of physical activity or controlling the intake of external stimulants which were only worsening the problem. After coming home, I decided to make things better, a good diet, exercise and maintaining a healthy lifestyle are the only ways to treat PCOS so the sooner one adapts the change, the better it will be,” says a fresh graduate, Ishani Vats.

According to an article in The PrintRashtriya Kishor Swasthya Karyakram (National Adolescent Health programme) has made significant changes in its interventions since February this year. The scheme has included counsellors, facility-based counselling, and the concept of social and behavioural change. However, there is limited evidence on the roll-out and implementation of these initiatives. Biological processes that include the life cycle of a menstruating body from menarche to menopause needs to be considered while designing such schemes. This must be in sync with the American College of Obstetrics and Gynecologists Recommendation that recommends menstrual health as the sixth vital sign for assessing health, programmes and interventions, especially on mental health also need to take cognisance of the same.

It is time the government and civil society addressed the mental well being of the people in our country by taking an intersectional approach to helping frontline workers, underserved communities, women, LGBTQIA+ community. This is paramount at a time where socio-cultural and economic realities have a close relationship with the mental health individuals. It is not only important to explore and openly discuss the need for psychoanalysis, it is necessary to acknowledge that the key towards a healthy lifestyle is in destigmatising taboo topics that have linkages to mental health, like menstruation.

With inputs from Bharti Kannan
Boondh is a social enterprise working in the space of menstrual health, literacy, policy advocacy, and sustainable products. COVID X Menstruation is a series of articles that explores menstrual health and hygiene along multiple intersections like menstrual programming, product supply, government policies, civil society interventions, mental health, and more. You can follow them on TwitterFacebook and Instagram.
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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