Download Your Body and Menstruation

Your Body and Menstruation
One-Hour Training
www.herproject.org
Trainer’s Tips
Start with the introductory
module:
This training is part of a
broader health training
curriculum. We
recommend starting
with the introductory
module, Our Health Is
Important.
HERproject Toolbuilder:
Use the pictures in the
HERproject Toolbuilder to
develop your own personal
materials focused on your
body and menstruation
http://herproject.org/toolbuild
er
Overview
This is a guide for a one-hour training on menstruation. This training is best used
in groups of between 10 and 40 people. This training has been designed for
women. If men are to be included, they will need a separate and modified
training.
What Is Included?
This packet will help you lead a session on the reproductive system and
menstruation. It includes a proposed training agenda, the materials needed to
conduct the training, key messages to emphasize during the training, and
examples of what to say while training.
What if This Is My First Training on Managing
Menstruation?
While it can be intimidating to give a training for the first time, everyone has
something to offer and something to learn. Preparing for the training by reviewing
the lesson and key messages before the training will help you to feel familiar and
comfortable with the content.
If someone asks a question during the training that you do not know the answer
to, it is important that you say “I do not know” and then follow up with a health
care professional in order to provide accurate information. No one trainer can
have all of the answers—it is okay to say “I don’t know.” Only provide information
that you are certain is accurate.
How Do I Use the Document?
How much time you
need for each
section is indicated
at the beginning of
every section.
Numbered items
show the order of
tasks to be
completed by the
trainer.
Trainer’s Tips provide helpful information about how to
conduct a session. Trainer’s Tips might provide guidance on
how to encourage participation or how to adapt a training to
respond to differences in beliefs or behaviors in different
places or among different groups of people. Trainer’s Tips
have been gathered from training professionals, including
HERproject implementing partners in many countries and
regions.
BSR | HERproject Your Body and Menstruation One-Hour Training
Italics (slanted
letters) provide an
example of what a
trainer could say to
session
participants.
2
Trainer’s Tips
Prepare for the Training
Agenda
Be prepared: Before
starting the training it is
important that you
familiarize yourself with
the training agenda,
review and understand
the key lessons, and
gather materials for the
training.
Familiarize yourself with the agenda of the training. The one-hour training
agenda below provides guidance about how much time you should spend on
each section of the training.
Prepare the location: Think
about where you are going to
have the training. To
encourage participation, it is
important that the place have
enough privacy that no one
outside the training can see
or hear what is being
discussed. It also helps for
the training to be conducted
in a quiet location without
distractions.
Plan the timing: Consider
the best timing for the
training. If possible, it is best
to conduct the training when
the participants are alert.
Having a training after work
or before meals may not be
as effective because the
participants might be too
tired or too hungry.
Time
Topics
5 minutes
Open the Training
15 minutes
Your Anatomy: Body Mapping Activity
10 minutes
Your Menstrual Cycle
10 minutes
Managing Symptoms of Your Monthly Bleeding
10 minutes
How Women Can Stay Clean and Healthy During the Monthly
Bleeding
10 minutes
Close the Training
Understand the Key Messages
Before starting, it is important that you understand and be comfortable explaining
these key messages.
Your Body and Menstruation: Key Messages
The menstrual cycle including monthly bleeding is a part of every woman’s
life; it is natural and not shameful. It is the process of fertility and is part
of being a woman.
If a woman’s egg is fertilized by a man’s sperm, she will become pregnant.
If her egg is not fertilized and she does not become pregnant, she will
have her monthly bleeding to remove the egg from her body.
Some discomfort during monthly bleeding is normal. A woman can try a
number of home medicines or see a doctor to help reduce discomfort.
During menstruation it is important to wash the body, including the genital
area, daily with warm water and mild soap.
Use clean cloths or sanitary napkins regularly and change them during the
day. Always wash your hands before and after handling a sanitary
napkin. If you are using a reusable sanitary pad or cloth, be sure to wash
and dry the pad thoroughly, in the sun if possible.
Gather Information
Gather information about where participants can get sanitary napkins in your
area.
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Gather Materials
The materials listed below will be used during the menstruation training:
1. Large flip chart or large sheets of paper and poster markers. At least one
poster paper should be approximately 4 feet or 1.2 meters long.
2. Large, printed color copy (approximately life size) of female reproductive
organs. (Note: If you laminate your copy, then you can use it for multiple
trainings.)
3. List of regional myths related to menstruation.
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Trainer’s Tips
Introduce the trainer and
participants
When possible, use a fun
and interactive way to
introduce participants. For
example, you might divide
participants into two groups
and ask one person in each
group to identify all of the
people in their group. See
which participant can
remember all of the names
of the participants in their
group.
Ensure confidentiality:
Because the goal is to
enable everyone to speak
openly, explain that the
group must promise not to
talk about who said what or
asked which questions in
the training.
Communicate effectively:
Below are some tips on how
to communicate effectively.
»
»
»
»
During the session, if
someone asks a
question, give him or
her your full attention.
Listen carefully to the
participants and ask
clarifying questions if
you do not understand
the question or
comment.
After participants have
answered a question,
paraphrase and clarify
answers so that
everyone in the room
understands.
Reassure the
participants that it is
good to ask
questions.
Use introductory
questions: Introductory
questions help people
participate in a training in an
easy way for the first time.
Your Body and Menstruation One-Hour Training
Open the Training
Time: 5 minutes
TRAINER: Open the training by (1) introducing the trainer and participants
and (2) introducing the subject.
1. Introduce the trainer and participants
Open the training by introducing yourself and the participants. When
possible, use a fun and interactive way to introduce participants.
2. Introduce the topic
Discuss what the training is about. Today we are going to learn about our
bodies, where babies come from, and how we can stay clean and healthy during
our monthly bleeding. As we are all women, we will be sharing some of our
personal stories so that we can learn from each other.
Ask introductory questions. Ask the following introductory questions, and
record the responses on the flip chart of large sheet of paper. You will come back
to these responses at the end of the training.
»
What are activities that you should avoid during your monthly bleeding?
»
What are some actions that make you feel better?
Record responses on a flip chart or large sheet of paper. You can tell
participants: We will come back to these questions at the end of our session.
Your Anatomy: Body-Mapping Activity
Time: 10 minutes
TRAINER: During this time you will explain how a woman’s body works and
looks inside. It is best to frame this discussion around when and how changes
begin to occur in a woman’s body that allow her to have babies.
3. Your Reproductive Organs: Body-Mapping Activity
Have one volunteer lie down on the piece of large poster paper. Have another
volunteer draw an outline around her body with a marker pen, being careful not
to touch her or get ink on her clothes.
Describe women’s reproductive organs and genitals for the group. A woman has
sexual parts both outside (external) and inside (internal) her body. They are
called the reproductive organs or genitals.
The external parts are what you see: your vulva and anus.
The internal parts are where babies are made. Do you know where these are?
Can you point to where they are on the map?
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Trainer’s Tips
Once they have pointed, place the laminated picture of the female reproductive
organs in the correct place on the body outline.
Emphasize that we are all
women and we all
experience monthly
bleeding: Monthly bleeding
or menstruation is a
sensitive issue for many
women. Some women may
feel embarrassed
discussing this issue.
Explain to participants that
monthly bleeding is a
normal part of our lives.
The menstruation cycle is
what prepares our bodies
for pregnancy.
Explain the different organs, pointing to each one as you talk about it.
The internal reproductive parts include the following:
»
»
»
»
Ovaries: The ovaries release one egg into a woman’s Fallopian tubes each
month. When a man’s sperm joins the egg, it can develop into a baby. A
woman has two ovaries, one on each side of the womb. Each ovary is about
the size of an almond or grape.
Cervix: This is the opening or “mouth” of the womb, where it opens into the
vagina. Sperm can enter the womb through the small hole in the cervix.
During childbirth, the cervix opens to let the baby come out.
Womb (uterus): The womb is a hollow muscle. Monthly bleeding comes
from the womb. The baby grows here during pregnancy.
Vagina or birth canal: The vagina leads from the vulva to the womb. The
vagina is made of a special kind of skin that stretches easily during sex and
when giving birth. The vagina makes a fluid or wetness (discharge) that helps
1
it keep itself clean and prevent infection.
Point to where each of these are on the laminated picture.
A girl is not born ready to have a baby. She is born with all of the important body
parts (gesture to the body map), but they do not start working until she reaches
puberty. For most of you, these parts are working properly, and you can have a
baby now. The way that you know you can have a baby is because you have
monthly bleeding.
A girl generally has her first monthly bleeding between the ages of 11 and 17. If a
woman does not have her monthly bleeding by 17, she should see a doctor. A
woman will generally stop having her monthly bleeding completely when she
approaches older age (generally between age 40 and 60).
The menstrual cycle including monthly bleeding is a part of every woman’s life; it
is natural and not shameful. It is the process of fertility and is part of being a
woman. Through the menstrual cycle, a woman’s body provides hormones that
keep her healthy and help prepare her body for pregnancy. Now let’s talk about
your monthly bleeding, how it works, and how you can manage any discomforts it
might bring.
1
“Chapter 4: Understanding Our Bodies: A Woman’s Reproductive System,” Where Women Have No
Doctor, Hesperian,
http://en.hesperian.org/hhg/Where_Women_Have_No_Doctor:A_Woman%E2%80%99s_Reproduc
tive_System.
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Trainer’s Tips
Myths and Misconceptions
about Menstruation: Every
culture has myths and
misconceptions related to
menstruation, such as:
»
False: Women will lose
their hair or become
infertile, or their skin will
turn black if they wash
themselves during
menstruation.
True: Keeping
yourself clean by
washing during
menstruation is
important to keeping
you healthy and
maintaining your
fertility. Nothing bad
will happen.
»
False: Women cannot
touch vegetables
because they will turn
them into pickles.
True: Menstruating
women do not have
any effect on
objects that they
touch or any
magical powers.
Menstruation is a
natural process that
all women
experience every
month.
»
False: Women must
wash themselves in a
separate place or with a
separate source of
water from others.
True: Women who
are menstruating
should wash daily,
and it does not need
to be in a separate
location or with a
different water
source.
»
False: When you start
menstruating again, you
should stop breastfeeding.
True: Keep breastfeeding after you start
menstruating; it is the
best possible food for
your baby. When your
monthly bleeding
returns, however, make
Your Menstrual Cycle
Time: 10 minutes
TRAINER: During this time you will discuss the different parts of the
menstruation cycle. It’s best to frame this discussion around where babies
come from.
4. Discuss the steps of the menstrual cycle
Every month, a woman’s body prepares for the possibility of having a baby. This
is called our menstrual cycle. The menstrual cycle is controlled by chemicals
called hormones produced by a woman’s body. The entire cycle lasts from the
beginning of one period (monthly bleeding) to the day before your next period
(bleeding) starts. Most women bleed every 28 days, but some bleed as often as
every 20 days or as seldom as every 45 days. The cycle is different for each
woman.
PHASE 1
The first day of your monthly bleeding is the first
day of a new cycle. Your monthly bleeding will
normally last around five days but can be as short
as two days or as long as seven. After
menstruation, a woman’s uterus begins to get
ready for pregnancy in case a sperm fertilizes the
egg. About the same time, her hormones start
preparing an egg to be released from the ovary.
PHASE 2
At about the middle of the cycle, ovulation occurs
(an egg is released from the ovary). Over the next
few days, the egg will travel down the Fallopian
tube. If the egg is fertilized, it will attach to the lining
of the uterus where it slowly develops into a baby. It
is during this second phase of a woman’s cycle—
usually days 8 through 19—when a woman is most
likely to become pregnant. During this time of fertility, a man’s sperm can fertilize
the woman’s egg if they have sex without condoms or other contraceptive
methods.
PHASE 3
When a woman’s egg is not fertilized by a man’s
sperm, she does not get pregnant. and will have her
monthly bleeding to remove the egg from her body.
This is the beginning of a new cycle.
MONTHLY BLEEDING IS NORMAL AND HEALTHY
Monthly bleeding happens when a woman is not pregnant. It is just one part of
our menstruation cycle and is normal and healthy! Our menstruation cycle is
what prepares our bodies for pregnancy.
Pay attention to how your body changes each month so that you can understand
your cycle. Once you understand your own body better, you can pay attention to
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changes and any abnormalities that might occur. If you see a significant change
in your monthly cycle, you should see a health worker.
MONTHLY BLEEDING AND FERTILITY
A woman is usually not fertile (does not get pregnant) on the first 7 days of her
cycle and the last 10 to 14 days.
A woman has a good chance of becoming pregnant if she has sex on the fertile
days in the middle of her cycle, days 8 to 19 of her cycle.
MONTHLY BLEEDING AFTER PREGNANCY
When you are pregnant, your monthly bleeding stops because you have a
fertilized egg growing in your uterus. Your body no longer needs to produce eggs
to be fertilized or remove them by bleeding.
After you give birth, your monthly bleeding will not start right away. During that
time, you are not fertile and are unlikely to become pregnant, especially if you are
breast-feeding and giving your baby no other liquid or food.
5. Answer any questions posed by the participants
Encourage participants to ask questions about their menstrual cycles.
Managing the Symptoms of Your Monthly Bleeding
Time: 10 minutes
TRAINER: During this time participants will discuss some of the symptoms
they may have during their monthly bleeding.
6. Engage the participants
Ask the participants the following questions:
How do women you know feel during their monthly bleeding?
What changes do women you know feel during their monthly bleeding?
It can be very difficult for women to talk about their monthly bleeding. Share your
own experience with participants to encourage their participation.
Another technique you can try if women are shy is to give participants green
cards for YES answers and red cards for NO answers. Then you can ask: “How
many of you experience [name a problem] during the time of your monthly
bleeding?” Those who do share this problem can raise their green cards.
List or say the symptoms below that the participants did not mention, or to
prompt responses using the green/red card method.
»
Acne [or locally appropriate term]
»
Swollen or tender breasts
»
Cramps
»
Change in appetite
»
Feeling sad
»
Feeling tired
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Trainer’s Tips
»
Upset stomach
»
Trouble sleeping
Encourage discussion: It
is important to encourage
discussion during this
training. Participants may
feel shy about discussing
such a private issue.
Discussing methods of
managing menstruation will
help women feel more
comfortable speaking with
friends in the future and
sharing solutions.
»
Constipation
»
Joint or muscle pain
»
Headache or backache
»
Diarrhea
»
Bloating
There are two objectives to
Discussion 7:
1) To help the women
learn to speak publicly
about what they may
have thought to be only
a private problem; and,
2) To share solutions and
help each other.
Many women have at least one of these
symptoms each month, and some
women may have all of them. A woman
may have different symptoms from one
month to the next. For many women, the
days before their monthly bleeding starts
are a time of discomfort. But some
women say they feel more creative and
better able to get things done. Let’s look
at ways in which we can manage these
symptoms.
7. Discuss how women can manage these symptoms
Ask the participants: What do you do to relieve symptoms from your monthly
bleeding?
Next, go through the following symptoms and suggestions for how to alleviate
them. Avoid using words like “you should” and “women should.” Instead say
“symptoms can be reduced by.” Also make sure to include any specific home
remedies used in your culture in your discussion.
Bloating may be relieved by:
»
Eating less salt
»
Avoiding caffeine
»
Drinking clear fluids, such as water
Pain from cramps and tiredness may be reduced by:
» Eating whole grains, peanuts, fresh fish, meat, milk, or other foods that
are high in protein
»
Exercising, such as walking, to help reduce cramping
»
Rubbing your lower belly to help tight, cramping muscles relax
»
Drinking tea made from raspberry leaves, ginger, or chamomile
»
Using a hot compress or hot water bottle
»
Doing your daily work as normal
»
Taking a mild pain medicine if needed
Ask the participants: Have you tried any of these? What has worked well for you?
What has worked less well? Lead a discussion among the women.
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Trainer’s Tips
Discuss How to Stay Clean and Healthy During the
Monthly Bleeding
Demonstration: How
Sanitary Pads Work
Time: 10 minutes
1) Show women an actual
sanitary pad.
TRAINER: During this time participants will discuss proper hygiene during
their monthly bleeding.
2) Unwrap and explain the
proper way to use a
sanitary pad.
3) Take a small amount of
a colored liquid (two to
three tablespoons) and
pour it onto the pad to
show how it absorbs
liquids.
8. Discuss ways to stay healthy and clean during monthly bleeding
During menstruation it is important to wash the body, including the genital area,
daily with warm, clean water and mild soap. Always pat the area dry after
cleaning it.
»
A piece of cloth: It can be very
dangerous to use scraps of cloth, such as
factory waste, that are not clean to absorb
menstrual blood. Cloth carries bacteria
that may cause an infection. Also,
sometimes cloth is treated with chemicals
that can irritate your skin and cause a
rash. If you use cloth for bleeding, it is
important to make sure the cloth has been
washed before you use it and to change the
cloth at least four or five times a day. Always
wash your hands before and after handling
the cloth. If you reuse the cloth, be sure to
wash and dry it thoroughly. It is important to
dry the cloth in sunlight to kill any bacteria.
»
Sanitary pads: Use sanitary napkins
regularly and change them at least four or
five times a day. Always wash hands before
and after handling a sanitary napkin. Make
sure you dispose of the napkin in a trash
container. If you are using a reusable
sanitary pad, be sure to wash and dry the
pad thoroughly in sunlight.
4) Next, demonstrate the
proper disposal of a
sanitary pad by
wrapping it in toilet
paper and disposing of
it in the trash can.
9. Discuss the places that women can buy or receive sanitary pads
Ask participants where it is possible for them to get sanitary napkins. Ask about
the challenges they face in getting sanitary napkins in those places. Try to
address challenges and encourage them to use sanitary napkins to protect their
health.
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Close the Training
Time: 10 minutes
TRAINER: During this time you will ask the group a series of questions to
help them summarize and together reflect on the knowledge they have
gained. You will also provide participants with information about where they
can access services.
10. Revisit the opening exercise
Now that you’ve completed the session, go back to the list you recorded on the
flip chart or large sheet of paper. Go through each item, and have the women tell
you if it’s “true/correct” or “false/misconception” based on their understanding of
their monthly bleeding. Circle the items that are correct, and put an “X” through
the items that are not.
11. Review participants’ knowledge
Ask participants a series of questions to test their knowledge.
QUESTIONS AND ANSWERS
Question: Is it okay to wash yourself during your monthly bleeding?
Answer: Yes. In fact, it’s necessary to keep you healthy and clean.
Question: Is it normal to feel sad during or before your monthly bleeding?
Answer: Yes. This is just the result of changes in your hormones.
Question: What are some of the ways to reduce the discomfort you might feel
during your monthly bleeding?
Answer: Avoid salt and caffeine, do moderate exercise, eat whole grains, drink a
lot of water, and take a mild pain medicine to reduce pain associated with
cramps.
Question: Can you use scraps of cloth during your monthly bleeding?
Answer: Using sanitary napkins that are changed four or five times per day is
the healthiest and cleanest way to continue your normal life during your monthly
bleeding. Using unclean cloths can be very dangerous for women, leading to
rashes, infections, and other problems. If you want to use cloth, you must make
sure to clean it thoroughly and dry it in the sun to prevent infection.
Question: What does it mean when a woman starts her monthly bleeding?
Answer: It means that she is not pregnant.
12. Provide information to participants
Provide information to participants on where they can get sanitary napkins in
your area.
13. Encourage the participants to act
Ask the participants:
»
Now that we have talked about menstruation, who is one person you would
like to share this information with?
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»
What is one thing you have learned today that you will be able to put into
practice?
»
What else would you like to learn about menstruation?
14. Test participants’ knowledge
Administer the Your Body and Menstruation Post Training Quiz immediately or
shortly after the training.
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Your Body and Menstruation
Health Manual
Contents
Woman’s Reproductive System
p. 2
Menstruation
p. 5
Feminine Hygiene
During Menstruation
p. 8
Reproductive Tract Infections
p. 9
Woman’s Reproductive System
A woman has sexual parts both outside (external) and inside (internal) her
body. They are called the reproductive organs or genitals. The external
parts are what you see: your vulva and anus. The internal parts are where
babies are made. Every woman’s body is different and looks slightly
1
different in size, shape, and color.
External Reproductive Parts2
The external reproductive parts include the following:
» Labia majora (Outer folds): The fatty lips that close up when the legs
are together protect the inner parts.
» Labia minora (Inner folds): These flaps of skin are soft, hairless, and
are sensitive to touch. During sex, the inner lips swell and turn darker.
» Opening of vagina: The opening of the vagina.
» Hymen: The thin piece of skin just inside the vaginal opening. A
hymen may stretch or tear and bleed a little when a woman works
hard, plays sports, participates in other activities, or has sex for the first
time. All hymens are different. Some women do not have a hymen at
all.
» Anus: The opening of the intestine, where waste leaves the body.
» Clitoris: Small and shaped like a flower bud, the clitoris is the part of
the vulva that is most sensitive to touch. Rubbing it and the area
around it can make a woman sexually excited and cause her to climax.
» Opening of urethra: The outer opening of the urethra, which is a short
tube that carries urine from where it is stored in the bladder to the
3
outside of the body.
1
“Chapter 4: Understanding Our Bodies: A Woman’s Reproductive System,” Where Women Have No
Doctor, Hesperian,
http://en.hesperian.org/hhg/Where_Women_Have_No_Doctor:A_Woman%E2%80%99s_Reproduc
tive_System.
2
“Female External Genital Organs” The Merck Manual Home Health Handbook,
http://www.merckmanuals.com/home/womens_health_issues/biology_of_the_female_reproductive_
system/female_external_genital_organs.html
3
Ibid.
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2
Internal Genitalia
The internal reproductive parts include the following:
»
»
»
»
Ovaries: The ovaries release one egg into a woman’s Fallopian tubes
each month. When a man’s sperm joins the egg, it can develop into a
baby. A woman has two ovaries, one on each side of the womb. Each
ovary is about the size of an almond or grape.
Cervix: This is the opening or “mouth” of the womb, where it opens into
the vagina. Sperm can enter the womb through the small hole in the
cervix. During childbirth, the cervix opens to let the baby come out.
Womb (uterus): The womb is a hollow muscle. Monthly bleeding comes
from the womb. The baby grows here during pregnancy.
Vagina or birth canal: The vagina leads from the vulva to the womb.
The vagina is made of a special kind of skin that stretches easily during
sex and when giving birth. The vagina makes a fluid or wetness
4
(discharge) that helps it keep itself clean and prevent infection.
A girl is not born ready to have a baby. She is born with all of the important body
parts, but they do not start working until she reaches puberty. For most of you,
these parts are working properly, and you can have a baby now. The way that
you know you can have a baby is because you have monthly bleeding.
A girl generally has her first monthly bleeding between the ages of 11 and 17. If a
woman does not have her monthly bleeding by 17, she should see a doctor. A
woman will generally stop having her monthly bleeding completely when she
approaches older age (generally between age 40 and 60).
The menstrual cycle, including monthly bleeding is a part of every woman’s life; it
is natural and not shameful. It is the process of fertility and is part of being a
woman. Through the menstrual cycle, a woman’s body provides hormones that
keep her healthy and help prepare her body for pregnancy.
Hormones
Hormones are chemicals the body makes that control how and when the body
grows. During the years when she can have a baby, hormones cause a woman’s
body to prepare for possible pregnancy each month. They also tell her ovaries
when to release an egg (one egg every month). So hormones determine when a
woman can get pregnant. Many family planning methods work to prevent
pregnancy by controlling the hormones in a woman’s body. Hormones also
4
Ibid.
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3
cause changes during pregnancy and breast-feeding. For example, hormones
keep a pregnant woman from having her monthly bleeding, and after childbirth
they also tell the breasts to make milk.
When a woman is near the end of her reproductive years, her body slowly stops
producing estrogen and progesterone. Her ovaries stop releasing eggs, her body
stops preparing for a pregnancy, and her monthly bleeding stops forever. This
change is called menopause.
The amount and kind of hormones produced by a woman’s body can also affect
her moods, sexual feelings, weight, body temperature, hunger, and bone
5
strength.
5
Ibid.
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4
Menstruation
About once each month during her reproductive years, a woman has a few days
when a bloody fluid leaves her womb and passes through her vagina and out of
her body. This is called “monthly bleeding,” a “monthly period” or “menstruation.”
This monthly bleeding happens when a woman is not pregnant. Our
menstruation cycle is what prepares our bodies for pregnancy.
The Steps of a Woman’s Monthly Cycle
Every month, a woman’s body prepares for the possibility of having a baby. This
is called our menstrual cycle. The menstrual cycle is controlled by chemicals
called hormones produced by a woman’s body. The entire cycle lasts from the
beginning of one period (monthly bleeding) to the day before your next period
(bleeding) starts. Most women bleed every 28 days, but some bleed as often as
every 20 days or as seldom as every 45 days. The cycle is different for each
woman.
PHASE 1
The first day of your monthly bleeding is the first
day of a new cycle. Your monthly bleeding will
normally last around five days but can be as short
as two days or as long as seven. After
menstruation, a woman’s uterus begins to get ready
for pregnancy in case a sperm fertilizes the egg.
About the same time, her hormones start preparing
an egg to be released from the ovary.
PHASE 2
At about the middle of the cycle, ovulation occurs
(an egg is released from the ovary). Over the next
few days, the egg will travel down the Fallopian
tube. If the egg is fertilized, it will attach to the lining
of the uterus where it slowly develops into a baby. It
is during this second phase of a woman’s cycle—
usually days 8 through 19—when a woman is most
likely to become pregnant. During this time of fertility,
a man’s sperm can fertilize the woman’s egg if they
have sex without condoms or other contraceptive
methods.
PHASE 3
When a woman’s egg is not fertilized by a man’s
sperm, she does not get pregnant and will have her
monthly bleeding to remove the egg from her body.
This is the beginning of a new cycle.
MONTHLY BLEEDING AND FERTILITY
A woman is usually not fertile (does not get pregnant) on the first 7 days of her
cycle and the last 10 to 14 days. A woman has a good chance of becoming
pregnant if she has sex on the fertile days in the middle of her cycle, days 8 to 19
of her cycle.
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MONTHLY BLEEDING AFTER PREGNANCY
When you are pregnant, your monthly bleeding stops because you have a
fertilized egg growing in your uterus. Your body no longer needs to produce eggs
to be fertilized or remove them by bleeding.
After you give birth, your monthly bleeding will not start right away. During that
time, you are not fertile and are unlikely to become pregnant, especially if you are
breast-feeding and giving your baby no other liquid or food.
Premenstrual Pain and Pain with Monthly Bleeding
PREMENSTRUAL SYNDROME
Some women and girls feel uncomfortable a few days before their monthly
bleeding begins. They may have one or more of a group of signs that are known
as premenstrual syndrome (PMS). Symptoms vary in type and severity from
woman to woman. They may include any of the following:
»
Acne
»
Trouble sleeping
»
Swollen or tender breasts
»
Constipation
»
Trouble with concentration or
memory
»
Joint or muscle pain
»
Change in appetite
»
Headache or backache
»
Feeling tired
»
Diarrhea
»
Upset Stomach
»
Bloating
Many women have at least one of these signs each month, and some women
may have all of them. A woman may have different signs from one month to the
next. For many women, the days before their monthly bleeding starts are a time
of unrest. But some women say they feel more creative and better able to get
things done.
A woman can do a number of things to help reduce her PMS symptoms. Every
woman’s body is different, and so each woman must find what helps her most.
PAIN WITH MONTHLY BLEEDING
During monthly bleeding the womb squeezes in order to push out the lining. The
squeezing can cause pain in the lower belly or lower back, sometimes called
cramps. The pain may begin before bleeding starts or just after it starts.
METHODS FOR REDUCING PAIN
Common ways of reducing the pain and discomfort experienced before and
during your monthly bleeding are the following:
Bloating may be relieved by:
»
Eating less salt
»
Avoiding caffeine
»
Drinking clear fluids, such as water
Pain from cramps and tiredness may be reduced by:
»
Eating whole grains, peanuts, fresh fish, meat and milk or other foods
that are high in protein
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»
Exercising, such as walking, to help reduce cramping
»
Rubbing your lower belly to help tight, cramping muscles relax
»
Drinking tea made from raspberry leaves, ginger, or chamomile
»
Using a hot compress or hot water bottle
»
Doing your daily work as normal
»
Taking a mild pain medicine if needed
Severe Pain during Menstruation6
Dysmenorrhea, also known as painful menstruation, is one of the most common
health care problems in women during their reproductive years. Although some
pain during menstruation is normal, excessive pain is not. Approximately 30 to 50
percent of all women suffer from painful menstruation.
There are a number of ways that a woman can reduce her pain during
menstruation:
»
Apply a warm cloth to your lower belly area, just below the belly button.
»
Lightly massage your lower belly area in a circular motion.
»
»
Eat light but frequent meals.
Follow a diet rich in complex carbohydrates, such as whole grains, fruits,
and vegetables, but low in salt, sugar, alcohol, and caffeine.
Keep your legs raised while lying down, or lie on your side with your
knees bent.
Try vitamin B6, calcium, and magnesium supplements, especially if your
pain is from PMS.
»
»
»
Take warm showers or baths.
»
»
Walk or exercise regularly, including pelvic rocking exercises.
In some situations self-care is not sufficient to reduce the pain. In this
case, it is important to talk to a doctor to take medications. A doctor may
prescribe birth control pills, anti-inflammatory medicines, or pain
relievers.
Irregularity during Menstruation
Sometimes the ovary does not release an egg. When this happens, the body
makes less progesterone, which can cause changes in how often and how much
a woman bleeds. Girls whose monthly bleeding has just begun or women who
have recently stopped breast-feeding may only bleed every few months, or have
very little bleeding, or too much bleeding. Their cycles usually become more
regular with time.
6
“Dysmenorrhoea,” Health 24, www.health24.com/medical/Head2Toe/777-778-783,11943.asp.
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Feminine Hygiene during Menstruation
Staying clean and protecting your body from infection is very important during
menstruation. There are a number of things that a woman should do during
menstruation.
During menstruation it is important to wash the body, including the genital area
daily with warm, clean water and mild soap. Always pat the area dry after
cleaning it.
To absorb the monthly bleeding, a woman might use a piece of cloth or a
sanitary pad. These two options are discussed below.
»
A piece of cloth: It can be very
dangerous to use scraps of cloth, such
as factory waste, that are not clean to
absorb menstrual blood. Cloth carries
bacteria that may cause an infection.
Also, sometimes cloth is treated with
chemicals that can irritate your skin
and cause a rash. If you use cloth for
bleeding, it is important to make sure
the cloth has been washed before you
use it and to change the cloth at least
four or five times a day. Always wash
your hands before and after handling the
cloth. If you reuse the cloth, be sure to
wash and dry it thoroughly. It is
important to dry the cloth in sunlight to
kill any bacteria.
»
Sanitary pads: Use sanitary napkins
regularly and change them at least four
or five times a day. Always wash your
hands before and after handling a
sanitary napkin. Make sure you dispose
of the napkin in a trash container. If you
are using a reusable sanitary pad, be
sure to wash and dry the pad thoroughly
in sunlight.
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Reproductive Tract Infections
Reproductive tract infections (RTI) are infections of the genital tract that affect
both women and men. In women, overgrowth of endogenous microorganisms
normally found in the vagina may cause RTIs. Most of the serious health
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problems caused RTIs are preventable.
Pelvic Inflammatory Disease8
Pelvic inflammatory disease (PID) refers to infection of the uterus (womb),
Fallopian tubes (tubes that carry eggs from the ovaries to the uterus), and other
reproductive organs that causes symptoms such as lower abdominal pain. PID
can also occur if a person has certain STDs, especially chlamydia and
gonorrhea. PID can damage the Fallopian tubes and tissues in and near the
uterus and ovaries. It can have serious consequences, including infertility,
ectopic pregnancy (a pregnancy in the Fallopian tube or elsewhere outside of the
womb), abscess formation, and chronic pelvic pain.
Sexually active women in their childbearing years are most at risk of suffering
from PID. Women younger than 25 are more likely to develop PID than those
older than 25, partly because the cervix of teenage girls and young women is not
fully matured, increasing their susceptibility to the STDs that are linked to PID.
The more sex partners a woman has, the greater her risk of developing PID.
Also, a woman whose partner has more than one sex partner is at greater risk of
developing PID.
SYMPTOMS
Symptoms of PID vary from mild to severe. When PID is caused by chlamydial
infection, a woman may be more likely to experience only mild symptoms even
when serious damage is being done to her reproductive organs. Chlamydia can
also cause Fallopian tube infection without any symptoms. Because of its vague
symptoms, PID often goes unrecognized by women and their health care
providers. Some common symptoms include:
»
Lower abdominal pain
»
Fever
»
Unusual vaginal discharge that may have a foul odor
»
Painful intercourse
7
Reproductive Tract Infections: An introductory Overview, Population Council,
http://www.popcouncil.org/pdfs/RTIFacsheetsRev.pdf
8
“Pelvic Inflammatory Disease,” CDC, www.cdc.gov/std/pid/stdfact-pid.htm.
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Painful urination
»
Irregular menstrual bleeding
»
Pain in the upper right abdomen (rare)
TREATMENT AND PREVENTION
PID can be cured with several types of antibiotics. The following help to prevent
PID:
»
Given the link between PID and STD’s, preventing STDs or getting early
treatment for STDs reduces the risk of PID.
»
Use latex male condoms during intercourse.
»
Have sex with one partner who doesn’t have any STDs.
»
Do not douche.
Urinary Tract and Kidney Infections
A urinary tract infection (UTI) is a bacterial infection of the bladder and
occasionally of the higher parts of the urinary tract. It is caused by a variety of
bacteria, but most commonly, the organism responsible is Escherichia coli (E.
coli). E. coli is present in the large intestine of all healthy men and women. Some
women are more susceptible to a UTI than others, and the reason is not always
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apparent.
Certain factors increase the chance of infection. The female urethra (urinary
opening) lies just under the clitoris and is continually rubbed during sexual
intercourse. If intercourse is particularly vigorous or prolonged or if the vagina is
not well lubricated during intercourse, then a woman is more likely to develop a
UTI.
SYMPTOMS
If someone has a UTI, she may experience some or all of the following
symptoms:
She may feel the need to urinate frequently.
Blood may be present in the urine.
Generally, she may feel a painful burning sensation when urinating,
discomfort or pressure in the lower abdomen, or pain in the pelvic area or
back.
The urine often has a strong smell, looks cloudy, or contains blood.
Occasionally, sufferers develop a fever.
If a UTI goes untreated, it can develop into a kidney infection. Kidney infections
tend to affect the whole body and be more severe. Symptoms of a kidney
infection include the following:
Symptoms of lower UTIs that persist longer than a week
An increased need to urinate at night
Chills and persistent fever (typically lasting more than two days)
9
“Urinary Tract Infection,” Smith College Student Information,
www.smith.edu/health/facturinarytract.html.
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Pain that runs along the back at about waist level
Vomiting and nausea
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TREATMENT
In order to cure a UTI or a kidney infection, it is important to take antibiotics. The
number of days the antibiotics are prescribed depends of the length and severity
of symptoms. It is important to take the medication exactly as prescribed and for
the full number of days prescribed even after you start to feel better. In some
cases a medication can be prescribed to make urinating more comfortable until
the antibiotic begins to work.
PREVENTION
There are a number of ways to reduce the possibility of developing a UTI:
»
Urinate immediately after sexual intercourse.
»
Always urinate when there is an urge to do so.
»
»
Do not wait more than three or four hours between urination.
Wipe from the front to back after urinating or after each bowel
movement.
»
Stay hydrated by drinking water.
»
Do not follow anal intercourse with vaginal intercourse.
»
If necessary, use a water-soluble lubricant during intercourse.
»
Wear clean cotton underwear.
»
»
Avoid feminine hygiene sprays.
Build up resistance to infection by eating healthy foods and getting plenty
of rest.
Yeast Infection
A vaginal yeast infection is irritation of the vagina and the area around it called
the vulva. Yeast infections are caused by overgrowth of the fungus Candida
albicans. Small amounts of yeast are always in the vagina; but when too much
yeast grows, infection becomes possible. Yeast infections are very common.
About 75 percent of women have one during their lives, and almost half of
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women have two or more vaginal yeast infections. There are a number of
factors that raise the risk of developing a yeast infection, such as:
»
Stress
»
Lack of sleep
»
Illness
»
Poor eating habits, including eating extreme amounts of sugary foods
»
Pregnancy
»
Menstruation
»
Diseases such as poorly controlled diabetes and HIV/AIDS
10
National Kidney and Urologic Diseases Clearinghouse, http://kidney.niddk.nih.gov/
“Yeast Infection,” The National Women’s Health Information Center, US Department of Health and
Human Services, http://womenshealth.gov/publications/our-publications/fact-sheet/sexuallytransmitted-infections.cfm
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SYMPTOMS
The most common symptom of a yeast infection is extreme itchiness in and
around the vagina. Other symptoms include:
»
Burning, redness, and swelling of the vagina and the vulva
»
Pain when urinating
»
Pain during sex
»
Soreness
»
A thick, white vaginal discharge
»
A rash on the vagina
TREATMENT
Yeast infections are easily cured through antifungal medicines. One home
solution is to mix three tablespoons of vinegar with one liter (quart) of boiled and
cooled water. Soak a piece of clean cotton in the mixture, and insert it into the
vagina every night for three nights. Remove the cotton each morning.
PREVENTION
Yeast infections can be prevented by wearing loose clothing and underclothing
made of cotton, rather than polyester or nylon. These let air flow around the
genitals. Other ways of preventing yeast infections include:
»
Avoid douches.
»
Change sanitary napkins often during your period.
»
Change out of wet swimsuits and exercise clothes as soon as possible.
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Your Body and Menstruation Post Training Quiz
1. Why do women have a menstrual cycle?
a. It’s how your body prepares to have a baby.
b. Your body is trying to get rid of bad stuff inside of it.
c. There is no medical explanation.
d. Don’t know
2. Very painful cramps during menstruation is normal for all women.
a. True
b. False
c. Don’t know
3. Very heavy bleeding during menstruation is normal for all women.
a. True
b. False
c. Don’t know
4. What should you use during your menstrual cycles?
a. Sanitary pads
b. Cloths
c. Others
5. How often should sanitary pads be changed during menstruation?
a. Twice a day
b. Every four to six hours
c. Once a day
6. Where should you dispose of a sanitary pad?
a. In the toilet
b. Trash bin with lid
c. Pad should not be disposed of.
d. Don’t know.
7. If you use a cloth when menstruating, what is the best way the dry the cloth after washing it?
a. In the sunlight
b. In the dirt
c. Inside the house
d. In a cool, shady place
8. Should you take a bath or shower or wash your body during your menstrual cycle?
a. Yes
b. No
9. What are normal symptoms that you could experience from menstruation?
a. Acne
b. Swollen or tender breasts
c. Trouble with concentration or
memory
d. Change in appetite
e. Feeling sad
f. Feeling tired
g. Upset stomach or bloated
h. Constipation or diarrhea
i. None of the above
10. What are some ways that you can manage symptoms from menstruation? Check all that apply.
a. Eat less salt.
b. Avoid caffeine.
c. Drink clear fluids, such as water.
d. Rub your lower belly.
e. Do moderate exercise.
11. What does it mean when a woman starts her monthly bleeding?
a. She is pregnant.
b. She is not pregnant.
c. Don’t know