I. GENERAL INTRODUCTION ABOUT TOPIC
(1) Definition of puberty
v It is defined as the sequence of events by which in individual is transformed into a young adult by a series of biological changes, and it is a period of development of secondary sex (according to UNICEF)
v It starts from 11 – 14 yrs in girls & 13 – 14 years in boys.
v It is a period of an onset of menarche.
(2) Common order of puberty changes in girls
v Accelerated growth in weight and height gain.
v Breast changes like
Ø Pigmentation of areola
Ø Enlargement of breast tissue and nipple.
v Increase in pelvic girth mainly the transverse diameter
v Appearance of pubic hair
v Changes in vaginal secretion
v Activation of axillary sweat glands
v Appearance of axillary hair
Psychological changes
v Feeling overly sensitive
v Looking for an identity
v Feeling uncertain
v Peer pressure
v Conflicting thoughts
v Mood swings
v Feeling conscious about self
v Gelting sexual feelings
(3) Purpose of selection of puberty girls
v Schools have a central role in puberty education
v Teaching puberty in schools can help learners better understand themselves and deal with the changes they are experiencing, and hence gain the self esteem to overcome daily challenges they may face with teachers and peers in school.
v Girl became more conscious of socially constructed myths and taboos built around puberty.
v A better understanding of puberty and life skills helps young people to make independent decisions and better cope with pressure from peers, family, community and media messages.
(4) Definition of menarche
v The first menstruate bleeding is known as “menarche”(According to Dutta pediatric nsg)
v Age of menarche
Ø It begins at different times for young girls.
v Reason for start menarche
Ø Due to biological changes and hormonal changes
v Symptoms onset of menarche
Ø Breast growth like elevation of nipple breast budding
Ø Armpit hair appears
Ø White vaginal discharge
Ø It starts by giving gap 3 – 6 months from after mature
(5) Menstruation
v It is bleeding from the vagina which starts when girl is around 13yrs of age because of hormonal changes can last for 3 – 6 days and the amount varies from one girl to another.
v Mostly a healthy girl can get by an early age of life like 11 – 16 years also. If the who have a not proper physical development and unhealthy, they can get lately by after 16yrs of age also.
v Menstruation occurs due to hormonal changes due to stimulation of pitutary gland bypothialaness.
v In some girls there is choice to failure of menstruation due to hormonal dysfunction any reproductive problems.
(6) cycle
v This menstrual cycle is taken to be 28 days long and which re-occurs regularly from puberty to menopause except during pregnancy intervenes.
v There are main 4 phases includes in this menstrual cycle. Those are:
Ø Menstrual phase
Ø Proliferative phase
Ø Secretary phase
Ø Menopause
v Menstrual phase
Ø This phase characterized by vaginal bleeding lasts for 3–5 days, in this phase endometrium layer is shed down along with blood from capillaries and with the unfeuilie ovum.
v Proliferative phase
Ø This follows menstruation lasts until ovulation during this period endometrium is re-forming and it also described as “generative phase”
v Secretary phase
Ø The secretary activity of the endometrial glands which began to secrete glycogen. So, this period termed as “secretary phase”
Ø In this phase preparatory changes peak about one week after ovulation. At the time a fertilized ovum might arrive in the uterus.
v Menopause
Ø Experienced by women as usually aged 45 – 55 yrs is when menstruation.
(7) Changes during menstruation
v During menstruation there is some changes we will observe. Those are:
Ø Swollen and sore breasts and tenderness
Ø Bloating
Ø Joint and muscle pain
Ø Headache
Ø Skin changes
Ø Pelvic area cramps
Ø Backache
Ø Mild
v Swollen and sore breasts and tenderness
Ø Due to ovaries release progesterone. Progesterone causes the milk ducts in breast to expand which equals swollen and sore breasts.
v Bloating
Ø It is feeling like fullness. It occurs due to the fluctuation of estrogen and progesterone causes fluid retention around the waist area.
Ø This is the only reasons why we gain weight is the days leading up to our period. But it is water weight only. Not fat.
v Joint and muscle pain
Ø Our brains activate the neurons for muscle movement. So, when progesterone deureases as your period begins, it throws the muscle movements out of whack.
Ø As study conducted by res university of north Carolina.
v Headache
Ø Estrogen levels drop before period, while progesterone is released and can trigger headache.
Ø It will leads to menstrual migraines also in some women’s.
Ø It’s causes includes
· Being as hormonal birth control
· Irregular sleep patterns
· Poor nutrition habits
· Consistent stress.
v Skin changes
Ø Due to before our periods oil glands become overactive. The combination of low estrogen and high androgen levels puts our bodies oil production at an all-time high, which blocks our pores.
(8) Basic facts of menstruation
v Menstruation is the monthly shedding of the uterus lining in females of reproductive age.
v Periods occur on average every 28 days.
v Bleeding during periods usually lasts for 5 – 7 days, but can be more/ less than this.
v The average blood loss during menstruation is 35 Mls.
v Excessive blood loss of 80 Ml more is known as menorrhagia.
v Severe menstrual pain is called as dysmenorrhoea.
v 1 in 10 women experience dysmenorrhoea especially those under the age of 30.
II. MENSTRUAL HYGIENE
(a) Hygiene
v It refers as to conditions and practices that helps to maintain health and prevent the spread of diseases.
(b) Definition of menstrual hygiene
v The hygiene which we will practice during the menstruation time is called as menstrual hygiene.
(1) Maintenance of menstrual hygiene
1. Choose your method of sanitation.
v There are a number of ways including the use of sanitary
Ø Napkins
Ø Tampons
Ø Menstrual cups
Ø Pads to stay clean
v The best tip here is to try and use one brand for one type of protection for a while to know if it helps you to needs.
v Frequent switching between brands can make you uncomfortable since brands are unique they suit everyone differently.
2. Change regularly
v Menstrual blood once it has left the body it gets contaminated with the body’s innate organisms.
v Organisms from vagina, sweat from genitals will most contact with pad.
v Organisms remain in a most place for a long time they tend to multiply and can lead to conditions like:
Ø Urinary tract infections
Ø Vaginal infections
Ø Skin rashes
v The standard time to change a sanitary pad is once every six hours.
v While for a tampon is once every 2 hrs.
v While some girls might have a heavy flow and would need to change more often, others will need to change less frequently.
v In the case of tampons it is very important because, if left inserted into the vagina for long periods of time it can cause a condition called TSS/ Toxic shock syndrome.
3. Wash yourself regularly
v During menstruate the blood tends to enter tinny spaces like
v The skin between labia crust around the opening of the vagina should always wash this excess blood away.
v Wash well genital area before change a new pad.
v Hand wash before and after changing.
4. Don’t use soaps vaginal hygiene products
v The genital area has it’s own cleaning mechanism, that works in a very fine balance of bad bacteria.
v Washing it with soap can kill the good bacteria making way for infections. But use soap on the external parts only. But do not use it inside area.
v Use warm water. (Not too hot and too cool)
5. Use the right washing technique
v Always clean the area in a motion that is from the vaginal to the anus.
v Never wash in the opposite direction. Washing in the opposite direction can cause bacteria from the Anus to lodge in the vaginal and urethral opening. It leading to infections.
6. Discard sanitary product properly
v It is essential to discard used napkins/ tampons properly because they are capable of spreading infections will smell very foul.
v It is advised not to flush the pad/ tampon down the toilet to back up.
v Hands should wash must well after discard used napkin.
7. Beware of a pad rash
v A pad rash is something that girls might experience during a period of heavy flow.
v It usually occurs when the pad has been wet for a long time. And rubs the thighs causing irritate.
v To prevent this try to stay dry during periods.
v If rash, change the pads regularly and apply an antiseptic ointment, after a bath and before bed
8. Use only one method of sanitation at a time
v Some girls who have heavy flow during their periods, they tend to use either:
· Two sanitary pads
· A tampon and sanitary pad
· Sanitary pad along with piece of cloth
v They thought that it is good option. But actually it is not good to reproductive health.
v There is choice to the whole 2 pad structure is extremely uncomfortable and can leave a bad rash and an even worse temper.
9. Have a bath regularly
v A bath is the best thing to body during menstruation.
v It not only cleanses the body but also gives a chance to clean private parts well. And it also helps relieve:
Ø Menstrual cramps
Ø backaches
Ø helps improve mood
Ø makes full feel less bloated
v stand under a shower of warm water that is targeted towards
Ø Backaches
Ø Menstrual cramps
10. Be ready with on the go stuff during periods
v During menstrual period it is important to be ready. Should have:
Ø Extra sanitary pads/ Tampons properly stored in a clean pouch/ paper bag a soft towel/ paper tissues.
Ø Hand sanitizer
Ø A healthy snack
Ø Bottle of drinking water
Ø A tube of antiseptic medication.
(2) Availability of sanitary napkins
v Medical shops
v General stores
v Anganwadis in village levels
(3) Types of sanitaries
v Tampons
v Menstrual cups
v Sanitary pads/ napkins
Ø Whispers
Ø Stayfree
Ø Ultra choice
Ø Day use napkins
Ø Night use napkins
Ø Panty liner
v Emergency sanitary
v Definition of sanitary napkin/ pad
Ø It is a disposable absorbent used (as during menstruation) to absorb the uterine flow.
(According to Merrian Webster).
v Tampons
Ø It refers as which is another way to deal with your period. It is a form of menstrual protection made of cotton/ rayon which is inserted into the vagina to absorb menstrual fluid during period is known as tampons.
v Menstrual cups definition
Ø It is a type of feminine hygiene product which is usually made of flexible medical grade silicone, worn inside the vaginal during menstruation to catch menstrual fluid, which collects more menstrual fluid rather than absorbing it.
(According to Wikipedia)
v Emergency sanitary
Ø It is a disposable absorbent pad which is used to absorb menstrual flow in the absence of sanitary napkins.
(4) Way of using sanitaries
v There is few steps to use sanitaries those are includes 3 methods.
1. Putting it on 1st method.
ð Choose a pad of the appropriate thickness, absorbency shape and style.
2. Get in position
ð It will be easiest if sitting down and it will provide proper arrangement of napkin’s place at genital areas.
3. Remove any wrappers/ boxes from pad
ð Never throw it in the toilet it could flood. Throw it in dust bin.
4. Fold out the Flaps/ Wings
ð Fold out the flaps or wings and take off the long center backing that covers the adhesive on the center. Expose the adhesive on the wings too, disposing these parts in the trash should not wrap them.
5. Stick the adhesive part to your panties
ð Set that pad to be directly beneath the vagina.
ð If that napkin have wings, make sure to fold those around the outside of panties. So, they stick. There is choice to free movements.
v Wearing it comfortably – 2nd method
6. Wear the panties as usual
ð Observe if any skin itching/ irritating. Changes remove it and use a different kind.
ð Should check when you go to wash room if the pad needs to change or not.
7. Option for more comfortable clothes
ð Pad will generally not be visible. It will follow the curve of our body and be well hidden however may feel better wearing loose pants. It’s all about peace of mind.
8. Do a routine check especially on heavy days
ð During heavy flow adequate checks should be needed
9. Don’t use pads for no reason
ð Some persons wear pads all the time because they think it keeps them fresh. There is no result like that. Never follow this method.
10. If it is super uncomfortable, change it.
ð If there is any problems with pad should change.
v Changing – 3rd method
11. After 4 hours change it.
ð If pad hasn’t fulfilled it’s purpose, change it. It will smell better and will feel fresh
12. Stay Hygienic
ð Wash your hands always doubly well when changing pads.
Way of using tampons
1. Wash hands
2. Sit on the toilet
3. Insert the tip of the applicator into genital area.
4. Push the applicator with index finger and then pull it out.
5. Remove the tampon by gently tugging at the string.
6. Change tampon every 4 – 6 hrs.
Should remember this;
Ø Be re-assured that a tampon will never get stuck or lost inside genitalia.
Ø Be aware that you can still go to the bathroom with a tampon in.
Ø Realize there is no minimum age to start using a tampon.
Ø Understand that using tampon doesn’t make you lose the virginity. There is no choice to tear hymen layer due to this tampon only stretch the membrane.
Way of using Menstrual cups.
Ø Fold and hold. Always start by washing hands.
Ø Insert and ensure. As with tampons, gently insert the folded cup into vagina, tilting back to the base of spine.
Ø Use it up to 12 hrs.
Ø Remove and empty
Ø Re – insert
Ø Wash the hands
Way of using emergency napkins
Ø This napkin is toilet paper, disinfected cloth. Paper most part can be found in any public restroom.
1. Take the paper or cloth.
2. Tear off minimum 6 – 8 square long.
3. Folding
ð It should be done on a flat, clean surface if it is bathroom should do on the thighs.
ð Fold half, another half by that half it should be wrinkles.
4. Roll it
5. Keep it tight
(5) Way of disposal of sanitaries
v Wrap the soiled napkin in it’s plastic cover or a leak proof bag.
v If unavailable, wrap it in few layers of toilet paper or paper bag.
v Discard in a trash that is out of reach of pets and animals.
v Use trash cans located inside cabinets like.
Ø Under the bathroom sink
Ø Lids
v Do not flush, burn or mix it with wet house hold garbage.
(6) Advantages and Disadvantages of using of sanitaries
v Pads
Ø Advantages/ pros
§ Easier to use than tampon and menstrual cups.
§ This will reduce menstrual cramps.
Ø Dis advantages/ cons
§ Can cause bad odour.
§ Less time to use than tampon, menstrual cup.
§ Less absorbents
v Tampons
Ø Pros
§ No odour during use
§ Less bulk to carry in bag
§ Hold more flow than pads
Ø Cons
§ Uncomfortable to use
§ Difficult to insert
§ Increased risk of vaginal infection
§ Brands contain harmful toxins so, they can lead TSS, high in cost
v Emergency napkin/ cloth
Ø Pros
§ Availability at anywhere is easy
§ Low cost
§ Easy to dispose
§ Choice to re - use
Ø Cons
§ Leads reproductive infections
§ More care is needed
(7) Poor menstrual hygiene consequence
v Increased risk of infection
Ø It is higher than normal during menstruation
v Social educational and economic impacts of menstrual hygiene
Ø Dignity
Ø Education
Ø Loss of economic opportunity
v Should maintenance more hygiene practices.
(8) Some myths
v During menstruation they should not
Ø Bath (they will become infertile)
Ø Do not touch a cow (otherwise they will become infertile)
Ø Should never look at mirror (it will loss it’s brightness)
Ø If they touch a plant (it will die)
(9) When we visit doctor?
v Dysmenorrhea
Ø A painful periods
v Menorrhagia
Ø Excessive uterine bleeding (>5 – 6/ day) prolonged (>7 days)
v If menstruation has don’t started by the age of 16 yrs.
v If periods suddenly stops
(10) Should never do during menstruation
1. Cook
ð Due to smell nausea will occur.
2. Exercise rigorously
ð It will leave you sweaty and exhausted and feeling terrible
3. Should not skip meals
ð They already loss blood so it restore energy
4. Avoid unprotected sex or intercourse
5. Avoid heavy works
6. Avoid using of soaps and vaginal hygiene products
7. Avoid shaving to avoid pain due to estrogen levels. It is very sensitive during period.
8. Avoid saw emotional movies or videos.
9. Avoid use phones. Due to it will changes mood.
(11) Meal during menstruation
v Does not
Ø Avoid consuming dairy products Milk, yogurt, cheese they contain an acid called arachidonic. It cause cramping the lower abdomen.
Ø Avoid light sugar product or calori
Ø Avoid food high in salt it will leads
§ Fluid retention
§ Cramps, Bloating
Ø Avoid thinking that calories don’t count during period. It is choice to few extra pounds.
v Do eat during menstruation
v Carbohydrates 53%
Ø Helps in control sugar level
Ø Sources
§ Whole grains
§ Oatmeal
§ Wheat and multigrain
§ Chapattis, vegetables, legumes, cookies
v Proteins 31%
Ø Helps to maintain existing lean and body mass.
Ø Sources
§ Dals
§ Tofce
§ Paneer
v Vitamins
Ø Vitamin ‘A’
§ Helps in best vision, good reproduction and increased immune function
§ RDA 700 mg/ day
Ø Sources
§ Milk, carrot, tomatoes, spinach, greens, sweat potato.
Ø Vitamin ‘E’
§ Helps in improve to increase body mass.
§ RDA 15 mg/ day
Ø Sources
§ Cakes, cookies, Breads, donuts, salad dressings, nuts, seeds, tomatoes.
Ø Vitamin ‘C’
§ Helps in connective tissue synthesis.
§ RDA 75 mg/ day
Ø Sources
§ Grapefruit juice, fruit drinks, tomatoes, white potatoes.
Ø Folate
§ Important to integral role in RDA, RNA and protein synthesis.
§ RDA is 400 mg/ day
Ø Sources
§ orange juice
§ bread
v Minerals
Ø calcium
§ It helps in skeleton growth
§ RDA is 1300 mg/ day.
§ Sources
· A glass of Milk, Nuts, Seeds
Ø Iron
§ It helps in transporting O2 in the blood stream to decrease anemia.
§ RDA is 15 mg/ day
§ Sources
· Meat, Fish, Poultry, Grains.
Ø Zinc
§ Helps in protein formation and gene expression
§ RDA is 11 mg/ day
§ Sources
· Red meat, Shell fish, whole grains.
Ø Fats
§ Helps for normal growth and development
§ RDA is <30% less
§ Sources
· Saturated fat exceeds
v Other food components
Ø Fiber
§ Helps to normal bowel pattern, prevention of chronic disease
§ RDA is 5 gr/ day
§ Sources
· Potatoes
· Popcorn, fruits
· Vegetables
· Cholesterol
Ø Cholesterol and Sodium
(12) Importance and benefits of menstrual
hygiene maintenance
v Educating girls about menstruation helps self esteem, maintenance, raise grades and raise wages.
v By learning about menstruation empowers girls to take care of themselves in brand new ways.
v It gives them the freedom to make their own decisions.
v It will gives girls confidence to live their lives normally.
v It allows Girls to be prepared for their first period.
v Understand how sanitary materials work allows girls to explore their bodies in new and important days.
v Proper menstrual hygiene keeps girl in school.
v Access to menstrual hygiene product keeps girls on the same track as their male peers.
v It keeps women at work contributing to economic development.
v It helps confront myths and culture superstitions.
v Debunking myths and taboos can keep girls safe.
v It helps them realize they are not impure and unclean.
v There is choice to clear their doubts
v It will helps to ensure clean liners.
v It can avoid reproductive disease like:
Ø TSS
Ø Cervical cancer
Ø Vaginal infections
v It will keeps away from
Ø Doctor
Ø Plumber
v They can keep animals happy in their natural habitats by reducing pollution
v They manage their psychological changes.
(13) Menstrual hygiene day
v It is also called as MHD in short
v Type international
v First time may 28th 2014
v AIMS
Ø To break taboos surrounding menstruation
Ø Raise awareness of the importance of good
Ø Menstrual hygiene management world wide
v The components other important days of the year in relationship to sanitation and hygiene
Ø 5th October : global hand washing day
Ø 19th November : world toilet day
Ø 28th May : menstrual hygiene day it is symbolism approximate menstruation 5 days and their cycle is 28 days
v Objectives of MHD
Ø To address the challenges and hardship many women and girl face during their menstruation.
Ø To positive (highlight) and innovative solutions being taken to address these changes.
Ø To catalyze a growing, global movement that recognizes and supports girls rights and build partnerships among those partners on national and local level
Ø It creates and occasion for medical work including social media.
(14) National and global targets on MHM
v MHM is a part of all national wish policies by 2025
v Target by 2025
Ø All rural, urban house hold sanitation programmes includes MHM in promotion
§ Innovate latrine design
§ Promotion and linked disposal facilities
Ø 80% of community sanitation programs in urban slums includes
§ Adequate and appropriate MHM facilities in public serialization blocks
Ø All schools includes MHM in hygiene education for girls and boys.
v Targets by 2050
All public facilities, schools, institutions, transport hubs, markets provide latrines with water, soap and disposal facilities for menstrual materials.
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