Menstruation: Period, Psychological & Cultural Consideration

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Menstruation is the periodic vaginal discharge of blood and mucous from the inner lining of the non-pregnant uterus, which occurs about every 28 days during the reproductive years and is under hormonal control. However, the normal cycles can vary during which time 50 to 60ml of blood are lost without any kind of gynaecological problems.

The cyclic process of menstruation is known as menstrual cycle, which is the preparation for a pregnancy, whenever pregnancy does not occur, the endometrium degenerates and the cycle recommences. Normally, it occurs every 28 to 30 days but sometimes can vary every 21 to 42 days.

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A sanitary pad/ perineal pad or tampons is generally used to absorb the menstrual discharge which solely depends on the use of the ones respective surrounding. In American society, women extensively use tampons whereas in Asian countries, perineal pads are preferred. In  some places around the world women use and reuse old cotton clothes cause they do not have access to clean sanitary pads. There is no significant evidence of untoward effects from the use of tampons, provided that there is no difficulty in inserting them. However, tampons should not be used for more than 4 to 6 hours as well as the perineal pads and superabsorbent tampons should not be used because of their association with toxic shock syndrome.   

we exist, because we bleed”.

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Psychological considerations

Girls who are approaching their first menstruation ( menarche) should be acknowledged about the normal process of the menstrual cycle before it occurs. Psychologically, it is much healthier and appropriate to refer to this event as a “period” rather than “being sick”. With adequate nutrition, rest and exercise most women feel discomfort, although some girls may complain breast tenderness and feeling of fullness 1 or 2 days before menstruation begins. Others report fatigue and some temperament or mood swings. Slight changes from the usual pattern of daily living are considered normal, but excessive changes may require supervision and evaluation. Regular exercise and some healthy diet have found to decrease discomfort for some women. Heating pads, hot water bag, rest and consumption of nutritious diet along with plenty of fluid and water are home remedies for such discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be very effective for cramps. For women with excessive cramping or dysmenorrhoea,  referring to a women’s health care provider or a gynaecologist is appropriate option; following evaluation, practitioners may prescribe oral contraceptive.

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Cultural considerations

Culture refers to knowledge, beliefs, customs, practice and values acquired as the members of a racial, ethnic, religious or society  group. Different types of cultural beliefs and views has been encountered about menstruation on different society as per their practice and cultural aspects. Some women believe that it is detrimental to change pad or tampons too frequently; they think that allowing the discharge to accumulate increases the flow, which is considered desirable. Some women believe they are vulnerable to illness during menstruation. Others believe it is harmful to swim, shower, have their hair permed, have their teeth filled, or eat certain foods during menstruation. They may also avoid using contraception during menstruation.

Religiously and culturally, in some part of the world menstruation is considered as taboo. As the girl  approaches her menarche, she is isolated in different room or cowshed for 5 to 7 days. She is out of the reach of sunlight and no male person is allowed to see her. She is also termed locally or traditionally as “impure”. Instead of providing a safe and healthy environment, nutritious diet, care, love and support. She is isolated from everything and everyone. She can’t even participate in any religious function. Such deep-rooted malpractice still prevails in our society and are the causes of death of young women due to infection and malnutrition. Such superstitious belief must end where women’s health education and public awareness is key to end it or at least minimize at some extent.

Many health concerns of women are related to normal changes or abnormalities of the menstrual cycle and may result from women’s lack of understanding of the menstrual cycle, development changes, and factors that may affect the pattern of the menstrual cycle. Educating women about the menstrual cycle and changes over time is an important aspect of every mother, sister, teachers and health care provider especially nurse’s role in providing quality care of women. Teaching should begin early, so that menstruation and the lifelong changes in the menstrual cycle can be anticipated and accepted as a normal part of life.

Menarche is the first onset of menstruation, which occurs between the ages of 12-15 years. The process of  menstruation continues for about 40-45 years at regular intervals except during pregnancy.

Reproductive age is between 15-49 years at which, in any time the girl can conceive. She produces an ovum in every month. If fused with sperm it became fertilized and if it is not fused with sperm it is shed and become degenerate and menstruation occurs.

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Perimenopause is the period extending from the first signs of menopauses; usually hot flashes, vaginal dryness, or irregular menses, to beyond the complete cessation of menses. It has also been defined as the period around menopause, lasting to 1 year after the last menstrual period. Women often have varied beliefs about aging, and these must be considered when caring for or educating perimenopauses patients. Women in their 40s are often less concerned with menopause and more interested in their health, well-being and appearance. The view taking themselves as one way to look younger  (Beyene, Gillis & lee, 2007).

Menopause is the permanent physiologic cessation of menses associated with decreasing ovarian function; during this time, reproductive function diminishes and ends. Post-menopause is the period beginning from about 1 year after menses cease. Menopause may be associated with some atrophy of breast tissue and genital organs, loss in bone density and vascular changes. It starts gradually and is usually signaled by changes in menstruation. The monthly flow may increase or decrease,  become irregular and finally cease.

Health care for women who are lesbians

Lesbians can generally be defined as women who prefer or have sex with or primary emotional partnership with women, but there is no universally accepted definition; variability exists in relationships and sexual preferences. Lesbians are found in every ethnic group and socioeconomic class. They can be single, celibate, divorced and are seen in all age groups including teenagers and adults. Some experts believe that sexual orientation is not a conscious choice.

Lesbians have often encountered insensitivity in health care encounters as some part of the society cannot accept the fact. When they are asked if they are sexually  active and respond affirmatively, contraception is immediately urged as health care providers may assume in correctly that they practice heterosexual intercourse. Similar to many other marginalized groups of women, they often feel invisible and underuse health care. Whether heterosexual or homosexual every health care provider needs to consider lesbianism within the continuum of human sexual behaviour and need to use gender-neutral questions and terms that are non judgemental and accepting.

Lesbians are at great risk of women health problems.

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  • Teen lesbians are at risk for suicide, smoking, depression  and STDs
  • Many lesbians do participate in heterosexual activity and often have consider themselves at low risk for STDs. Because HPV, herpes infection and organisms implicated in STDs are transmitted by secretions and contact, they may need information on STDs and contraception.
  • They are at risk for cancer, heart disease, depression, and alcohol abuse.
  • They may have higher body mass index, may bear fewer or no children  and often have fewer health preventive screenings than heterosexual women.
  • These factors may increase the risk of colon , endometrial, ovarian, and breast cancer as well  as cardiovascular disease and diabetes.

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