Training Module for

Menstrual Hygiene Management for

Adolescent Girls
 Contents
Note: ....................................................................................................................................................... 3
Session1. What is Menstruation? ........................................................................................................... 4
Session2. Challenges: Menstruation not easy? ...................................................................................... 6
Session3. Menstrual Hygiene Practices ................................................................................................ 10
Session4. Absorbents. What do I use? .................................................................................................. 12
Session5: Bust the Myth ....................................................................................................................... 16
Session6: Me, the Advisor..................................................................................................................... 18

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 Note:

Purpose:

 To instil apropriate information related to menstruation, physiological and psychological

changes experienced

 To develop and strengthen behaviour and attitude to approptiately deal with challenges
related to menstruation and handle socio-cultural taboos which make it difficult for girls
and women to openly discuss issues related to menstruation.

 To release the girls from the sense of shame and embarassment they feel due to
menstruation and to emrace menstruation as a process that is natural and healthy.

Usage:

This training manual can be used by teachers, wardens and trainers of NGOs, frontline workers,
vounteers in order to facilitate effective sessions on MHM with school going (6th – 10th Standard) and
out of school adolescent girls (around 13 years to 16 years)

Output:

 Basic knowledge on menstruation and menstrual cycle

 Simple and appropriate ways to manage menstruation
 Initiate attitudinal change towards menstruation and managing it with confidence

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 Session 1- What is Menstruation?

Objectives:

 Understand the process of menstruation

 Embed the fact in the hearts and minds of the girls that menstruation is a normal
process

Duration: 45 minutes

Materials required: chart papers and markers

Process:

Group Activity 1: Science behind Menstruation

Divide the participants into groups. They are given the following question to discuss and
come up with presentations.

 Ask the participants to write down a word that comes to mind when one says
menstruation (it can be positive or negative)

 Ask them to list the changes that take place in the body once a girl starts
menstruating (See annexure)

Once they complete this activity asks each group to present and note down the
important points to summarize.

Next put up the chart that depicts the menstrual cycle. (The facilitator to keep the chart
ready for use; can be drawn in color by hand or printed). Using the chart explain how
menstruation occurs, the changes that take place inside the female body. Encourage the
participants to try and answer the questions.

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  Science behind menstruation - Females are born with a uterus. This gives them the
special ability to produce children. The Ovaries produce eggs that start their journey
through the fallopian tubes to reach the uterus, where they will meet the man’s
sperm to produce a baby. During this time the lining of the uterus increases in
thickness making a place for the egg to connect with the mother, to grow. If the egg
does not fertilise, it does not attach to the wall of the uterus. When this happens,
the uterus sheds the extra tissue lining. The blood, tissue, and unfertilised egg leave
the uterus, going through the vagina on the way out of the body. The first
menstruation – menarche – occurs between 9 and 16 years.
 Fight back the taboo. Menstruation is a natural process and the taboos like not
touching food, not taking bath, not going to temples etc needs to be addressed. Try
to encourage the participant to find thought behind the superstition and demystify
the misperception through scientific knowledge.

Group Activity 2: Make a jingle/song/poem

Divide the participants into groups of 6-8. The groups are to be instructed to prepare and
develop a jingle/song on MENSTRUATION. They will be required to select a theme (can be
on the scientific awareness or to fight the taboos and myths) related to the topic and
present it before the remaining groups. The groups will be given 20 mins for discussion and
preparation.

Closing activity:
The participants stands in a circle and take a pledges to break the shame and silence around
menstruation.

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 Session 2- Challenges: Menstruation not easy?

Objective:
Participants will be able to understand the challenges related to menstruation and the
management of these challenges.

Duration: 45 min

Materials required: Chart papers and markers

Process:

Group Activity 1: Pairing Solutions

 Ask the group to list the possible questions that young girls may have regarding
challenges and problems faced menstruation. Make a list of their questions on a
chart.

 The facilitator prepares a chart that depicts all the solutions to challenges faced
during menstruation.

 In addition, the facilitator makes various chits consisting of one challenge faced
during menstruation.

 These chits are distributed to the participants. Preferably the group to consist of
around 8 participants so that everyone participates and engages effectively in the
discussion.

 Each girls gets a turn to open her chit, read out the challenge and match it to the
remedy/solutions written on the chart paper. The content can be done vice versa
(challenges on the chart paper and solutions on chits. In whatever order, each
matched solution and challenge to be discussed with the bigger group in detail once
all the chits are matched.

 There will be challenges that will have multiple solutions/remedies to it, that would
needed to be pointed out by the facilitator.

Facilitators Note: Ensure that all the following points are covered during the activity and/or
discussion in this session:

Some of the challenges and the solutions that needs to be shared with the participants are,

 Fill a plastic bottle with hot water, wrap it in a towel and place it on the abdomen
massage the abdomen
 Local remedies such as ginger or any herbal teas can be taken eating a diet that is
low in salt
 Eat foods high in calcium like diary products
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 Eat foods like leafy green vegetables and fruits, which are high in fibre
 Do not skip meals
 Take a brisk walk
 Mild exercises or yoga
 A warm water bath would for some relief to the aches and pains
 Immersing feet in warm water for pain relief
 Breathing exercises and meditation could also help in pain management

 The pelvic bone needs calcium and iron to get stronger. Intake of black gram dhal,
red rice, gingerly oil, eggs and drumstick leaves is recommended for young girls
when they attain puberty.

Anxiety about unexpected onset of periods

Knowing when your period will arrive will enable you to be prepared so it’s not a
surprise. Keep a calendar and mark the first day of your period. A normal period
cycle is 28-33 days, but in your first few years, it is normal for the menstrual cycle to
be more unpredictable.
Be prepared for it. Keep a sanitary napkin with you in your bag especially around the
time when your periods are due.

Stomach ache
Hot fomentation can be used if the pain is unbearable. Take rest. Try meditation,
yoga and breathing exercises.

Cramps
Some girls have cramps during their periods. Cramps are actually uterus’
contractions. The uterus, which is like a pear-shaped muscle, helps get rid of the
endometrium, or lining of the uterus. These contractions that sometimes feel like
cramps are the body’s way of shedding, or getting rid the lining of the uterus,
through the vagina, and out of the body, as the lining is no longer needed that cycle.

Excess flow and fatigue

Follow a balanced nutritious diet, drink plenty of water. Have bath with lukewarm
water

Itching in the genitals

Wash and keep your genitals clean. Change the sanitary napkin or cloth 5-6 times a
day.

Irritation and blisters in the thighs

Apply coconut oil or spray talcum powder. Use cotton inner garments of correct size.

Blood flows in clots

Mild exercise will regulate the flow.

Feeling fat
Just before and during the period, the body may tend to retain water. This added
fluid might make you feel fat or make your breasts feel tender. Actually, it is normal
to gain a couple of kgs during this time of the month – and lose them right after your
period. If one feels bloated, she may feel better wearing loose comfortable clothing.
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 immediately before and during the period less amount of salt to be consumed
because salt intake increases water retention.

Sometimes emotional changes are experienced like short temper, aggression,

anger, anxiety or panic, confusion, lack of concentration, irritability, nervous
tension, fatigue, or depression around the time of her period. Not everyone has
these feelings – some do not feel anything.

NUTRITIONAL NEEDS

A balanced diet is essential for proper growth, development and functioning of the body
and this remains true even during the years of menstruation. A balanced diet containing lots
of fresh fruits and vegetables should be taken.

Consuming a diet rich in Iron is extremely

important. Iron is required by the body to
make haemoglobin, an important
component of blood. During the years of
menstruation, body's requirement for iron
increases as it needs to create more blood
to make up for the loss of blood during
menstruation. A deficiency of iron in the
body can cause anaemia. Some of the food
products rich in iron are: lean red meat,
dark poultry, lentils, spinach, almonds and
iron fortified cereals. Citrus fruits or
vegetables should be consumed before
taking iron rich food.

EXERCISES

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 WHEN IS IT IMPORTANT TO SEE THE DOCTOR?

 When the period continues beyond seven days

 When one is unable to deal with the pain with the help of home
remedies
 Bleeding in between two periods
 Excessive bleeding (the girls has to change the cloth/pad after every
one-two hours)
 No sign of menstruation for more than three months post menarche
 Irregular periods after one has already had regular periods earlier
 If the girl is not getting her periods after 2-3 years of breast
development or even once she has reached the age of 15-16 years
 Abnormal white vaginal discharge

VAGINAL DISCHARGE

Vaginal discharge may be thin and clear, thick and mucous-like, or long and stringy. A
discharge that appears cloudy white and/or yellowish when dry on clothing is normal. The
discharge will usually change appearance at different times during the menstrual cycle, and
for a variety of other reasons, including emotional or sexual arousal, pregnancy and use of
oral contraceptive pills.

The following can be a sign of abnormal discharge and could indicate a health problem:
 Discharge accompanied by itching, rash or soreness.
 Persistent increased discharge
 White, lumpy discharge (like curds)
 Grey/white or yellow/green discharge accompanying a bad smell

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 Session 3- Menstrual Hygiene Practices

Objective: To ensure that participants will gain understanding regarding appropriate

menstrual hygiene management

Duration: 45 min

Materials Required: chart paper, markers

Process:

Group Activity:

Ask participants to work in their groups on the following questions:

 How they think hygiene should be maintained by young girls (including genital
hygiene).
 Health risks if appropriate hygiene is not maintained during menstruation?
 Possible barriers that they may face to adapt and maintain appropriate hygiene
practices and what could be done about it.
 How can the adolescent girls push for change that would eliminate these barriers at
the home, village, and school levels?

Once the group finishes their group work ask them to present their chart.

Facilitators Note: List of hygienen pactices to be covered while conducting activity and
discussion

 Bathe at least once daily.

 Ensure that undergarments and sweat drenched clothes are changed regularly.
 Cotton panties are preferable to synthetic ones as the latter hold in moisture and
heat making it a breeding ground for bacteria.
 Change napkins and cloth periodically at least 3 to 4 times per day (preferable, after
every 6 hours). Most importantly, once wet, the napkin/cloth should be changed
immediately.
 Cloths should not be shared with others.
 Wash the genital area after each use of the toilet, also after urinating. Cleaning of
genitals and wiping from front to back after using toilet and after urinating
 Keep the area between the legs dry otherwise soreness and chaffing may develop.
 Some amount of body odour is natural but regular bathing, washing and changing of
cloths/napkins will ensure that it is not noticeable.

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  During menstruation, the outer genitals should be washed from time-to-time to
remove any blood that is left.
 Girls should wash their hands every time they change the napkin.
 If the underwear is soiled, it must be changed. Otherwise this makes bacteria to
grow and cause infection.
 Use of toilets is very essential.
 If a girl’s panties or clothes get stained with blood, she can soak them in cool, mildly
salty water before washing. Hot water will cause the blood to set and remain as a
permanent stain.

Discussing health impact of unhygienic practices is mandatory to create linkages to health.

To be simplified while explaining.

Hygiene Practice Health Risk

Unclean sanitary pads/cloths
Changing pads
Insertion of unclean material into the
vagina
Wiping from back to front following
urination or defecation
Lack of hand washing with soap after
changing an absorbent
Bacteria may cause local infections or
travel up the vagina and enter the uterine
cavity
Wet pads can cause skin irritation which
can then become infected if the skin
becomes broken
Bacteria potentially have easier access to
the cervix and the uterine cavity
Makes the introduction of bacteria from
the bowel into the vagina (or urethra)
more likely
Can facilitate the spread of infections such
as Hepatitis B or Thrush

Closing activity:

Make individual chits of each hygiene practice. Make sure all hygiene practise are included
and nothing is left out. Mix the chits and put it in a big bowl.

Make the participants sit in a circle. The box is passed around slowly from one participant to
the other when the music is on. The participant that has the box in her hand when the music
stops (the facilitator to stop the music at random while the box is being passsed around) will
be required to pull out a chit from the box and read it aloud for all to hear. The participant
rejoins the game and the game continues in a similar fashion till all the chits are read out.
The participants are expected to keep the chits with them till the end of the game. The
group is then brought together and the facilitator asks the girls to again read out the chits
they have received

In case a participant has got more than one chit with her then she shares the chit with any
participant who may not have got a chance to read out any of the chits during the game.

Each hygiene practice is discussed in detail in an interactive manner one by one and the
chits are placed / stuck one by one on a chat paper on floor / wall.

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 Session 4- Absorbents: What do I use?

Objective:
• Learning to deal with menstrual bleeding using cloth/cloth pad as well as
sanitary napkin/pad
• Learning about the use and safe disposal of cloth and disposal sanitary
napkin/pad

Duration: 60 minutes

Materials Required: Samples of the sanitary napkin, cloth; chart papers; marker pens;
sketch pens

Process:

Group Activity 1
Divide the participants into 2 groups. One group will discuss in detail on DISPOSAL SANITARY
NAPKIN/PAD and the other on CLOTH/CLOTH PAD

The discussion points to include use, handling, storage, disposal, accessibility, dos and
don’ts, etc in relation to the particular absorbent.

The teams are given 15-20 minutes to discuss and prepare a presentation.

The teams to use samples of absorbents, and use stationary like chart paper, sketch pens,
marker pens, etc. to create pictorial representations or props for presentation. The can also
create role play and other creative items in their presentations. Each team gets 5-7 mins to
present.

Facilitator to discuss in detail about both the absorbents further after the presentations are
over and fill in any gaps or correct any inaccurate information (if any) brought forth in any of
the presentations.

Facilitators Note:

Cloth/Cloth pad – A pad made of cloth is folded and placed within the underwear, or passes
over the private parts by means of a string tied around the waist. This cloth is washed and
reused.

If you use cloth to absorb the bleeding, use a clean soft cotton cloth. Thick or heavy cloth
will cause friction and irritation in the thighs and genitals. The cloth should be washed and
dried properly. If you want to use cotton wool, it should be placed between the folds of the
cloth and not on top in a way that it comes in direct contact with the genitals. The cloth
should be changed at least every 5 hours.
The string used to fasten the cloth should be tied properly around the waist so that the cloth
does not slip out of place. Never use moist cloth as it will make you feel uncomfortable and
increases the chances of infection.

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Wash the used cloth, wrap it in paper and put it in the dustbin. Do not throw it in a river or
pond. Make sure you wash the used cloth even if you are not going to use it again. Never
dispose of the cloth with blood stains on it.
If you are going to reuse the cloth the subsequent month, wash it separately and thoroughly
with water and soap and then it should be dried in the sun. After drying it completely, keep
it in a plastic bag. Use can add some Neem leaves into the bag as Neem is a good antiseptic.
Keep the bag in a safe place. Do not put it on the roof top or in other unclean storage areas,
as it may attract insects leading to infection. Try not to reuse the cloth more than three
times.

Pic: Handling and use of cloth

Images of cloth pads: Same handling as cloth

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Sanitary napkin/pad – These are disposable and should be discarded after being used once.
These are designed to fit the panty area close to the body. . Some sanitary napkins/pads are
made with removable strips of paper that reveal adhesive tape that is made to stick to your
panties. Other pads have wrap-around “wings” that wrap under your panties to keep it from
moving. Some may prefer the belt model where the napkin is held using the belt. Pads have
a plastic lining to minimize the spill of blood. Sanitary napkins manufactured by
multinational companies like Stayfree, Carefree, Whisper, Kotex are available in the market.
In the recent times, SHGs have also started manufacturing sterile, low cost sanitary napkins
which can be purchased locally even at the village level. Women SHG members themselves
sell these products and so adolescents and rural girls may feel comfortable purchasing
them. Some schools have installed sanitary napkin dispensers for easy access. (see
annexure)

Points to keep in mind while choosing a napkin

 Quality of the napkin
 Cost
 Pattern of flow
 Number of menstruation days

Selecting a napkin depends on individual needs and convenience. You may want to try a few
brands and types and choose the one that most suits you.

Menstrual flow differs from individual to individual. For some, the flow is heavy only on the
first day, for others it’s for 2 to 3 days. Similarly for some the flow is heavier during the day
and for some in the night.
Some napkins may absorb blood well and prevent leakage, but cause irritation and itching in
the thighs and genitals. If that’s the case, you may want to change the napkin till you find a
comfortable one. If the problem persists, consult a physician.

How to use a napkin?

Remove a napkin from the pack. Most napkins
are individually wrapped. Do not throw away the
wrapper. You can use it dispose of the napkin.
Peel the sticker on the napkin and place it
correctly in the panty. If the napkins have wings,
spread them, remove the sticker and stick them
on the panty.

Wear the panty. If it’s uncomfortable, remove it

and adjust the napkin accordingly. But you can’t
change the placement too many times, as it will
lose its adhesiveness.

It’s important that the panty you are wearing is of the correct size and comfortable,
especially during menstruation. If the panty is too loose, the napkin wouldn’t stay in place. If
it’s too tight, you will feel uncomfortable.

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The frequency of changing the napkins depends on the flow. If the flow is high, you can
change it once in 3 hours, otherwise you can keep it on for up to 5-6 hours. It’s quite
common for girls to not change the napkins frequently in order to save money. However,
keeping a napkin on for a long time may cause infection or at least irritation. Each time you
urinate and wash your genitals with water, the napkin absorbs the water and eventually it
loses its shape. This may lead to overflow, discomfort and bad odour. Change the napkins
regularly to keep yourself dry and comfortable.

Safe disposal of used napkins:

The manner in which you dispose the napkins depends on the facilities available. She needs
to do any of the below:

 For disposal one can create a sanitary pit in the backyard. Dig a pit in the backyard,
keep dropping the newspaper wrapped used napkins in the pit. Cover the pit to stop
animals from pulling it outside. Keep dropping ash after use. Once the pit is filled up,
close the pit completely and use another pit.
 Used napkins can be collected and burnt using kerosene oil or cooking oil.
 One can wrap the napkin in an old newspaper/waste paper and drop it in the dust
bin. If there are no bins, then drop it in the general waste bin.
 Some toilets have incinerators that will burn the napkins.

Pic: Handling and disposal of cloth

 Sanitary napkins / cloths should be stored in a clean, safe and

dry place
 Never flush a sanitary or cloth pad down the toilet as they will
cause blockage
 They should not be left in the garbage pile

Closing activity:

Ask the participants to rapid fire some of the points that they have learnt one after the
other.

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 Session 5- Bust the Myth

Objective:

To stress that menstruation is a natural process and bust the myths and taboo

Duration: 60 mins

Materials Required: Papers, Markers, balloons, Cards on Menstruation.

Process:

The following case studies can be done through role plays followed by discussion

Case Study 1

I got tired. And I feel bad of being born as woman. I can’t ride cycle to school during periods. I
was not able to sit during the first menstrual periods. Dress stained with blood even while using
sanitary pads. I was sleeping when I attained puberty. I came out and said that I was bleeding.
My brother saw it first and I felt shy. He informed it to my mother.

Discussion:
 Why do you feel bad of been born as woman during periods?
 Why do you have to feel shy when speaking about menstruation with opposite sex?
 Why menstruation is seen as ‘untouchable’ rather looking it as a growth?

Case Study 2

One day, during periods my mother was sick and was not able to go and buy sanitary pads for
me. When mother asked the father to buy napkins, he refused as he was in a hurry to his office.
Then, with full lot of hesitation, I asked my brother to buy the napkins and he also refused to go.
Finally I sent my younger sister to buy it. The younger sister also felt shy to ask shop keeper,
thinking that shop keeper will think differently and faced comments from the boys around the
pharmacy and she got upset and returned home.

Discussion:
 Why didn’t she ask her father directly to buy napkins?
 Why did his brother refuse to buy napkins?
 Why did her sister returned home without buying napkins?

Content: (See annexure)

Closing activity:

The participants are asked to make chits of various myths and misperceptions reagrding
menstruation and put it inside a balloon. They all blow the balloon and throw it at the
centre of the class. Once the facilitator gives a go, each girl bursts the balloon and takes out
the chit to see what myth they will be busting.
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Sum up!

 Menstruation is part of every girl’s/woman’s life

 This is an absolutely normal process and not an illness.
 Menstruation is an indication of good health
 There is no need to be scared about getting the periods.
 There should be no shame or embarrassment around this.
 It is not risky and dangerous to engage in sports and playing games. It is medically
safe to do anything that you normally do during menstruation.
 There is no reason for a girl/woman to eat separately while having her periods.
 There is no impurity or pollution in the blood associated with menstruation.
 Practices such as seclusion or staying away from school should not be followed.
 Keeping a record of periods should help in preparing one to handle it effectively.
 It is important to communicate. Any doubts can be clarified by discussing with
parents, elder siblings, elderly relatives, teachers and healthcare providers.
 There should be no reason to be embarassed while purchasing sanitary napkin.
Normally, in local shops, the napkin packets are wrapped in newspapers/paper
covers. One can carry non-transparent bags for such purpose. Feeling confident and
relaxed like one makes any other purchase is the way to normalise the practice.

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 Session 6- Me, the Advisor

Objective:

➢ Assessing the girls’ comprehension on menstruation and MHM

➢ Encouraging peer to peer communication

Duration: 45 mins

Material required: papers and pens

Process:

Each girl writes a letter to her younger sister (imaginery or real) who has not yet entered
puberty. (or even a younger friend)

Through the letter the girl is required to explain to her younger sister/friend the kind of
changes she can expect in the coming days/months.

The facilitator is required to read the letters carefully.

Those that have good / intetresting content are to be read out so all can hear

Inaccurate content to be corrected by further discussion or a revision session.

Caution: The facilitator must not reveal the name of the girl

Sum up!

Closing activity:

Ask Participants to create a poster on solutions for a healthy and happy menstruation and
stick it in the ladies toilet block

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ANNEXURE:

WHAT HAPPENS INSIDE THE BODY (PUBERTY)

There are different organs in our bodies.

Boys and girls both have the same organs and they function in a similar way.

Only their reproductive organs are different

Boy:

During adolescence and with the onset of puberty, important changes occur in

a boy’s body and he experiences semenarche or his first ejaculation. This is commonly known as a wet
dream.

Puberty is the process of physical changes by which a child’s body matures into an adult body capable of
sexual reproduction. The major landmark of puberty for males is the semenarche, which occurs on
average between the ages of 11-15.

As we grow, our body goes through many changes. These changes occur due to secretions in the body.
These secretions are called ‘hormones’ and are vital for growth and development.

What physical, emotional and social changes occur in a boy’s life, when he is growing up?

Height gain, Weight gain, Acne, Growth of hair on the body including a beard and moustache,
Development of the body, Changes to the voice, Penis development, Semenarche, Development of
an Adam’s Apple (a bulge in the neck)

Ambition, Dreams, Shyness, Strong opinions, Responsibility, Individual desire, Seeking independence and
testing boundaries

Girl:

During adolescence and with the onset of puberty, important changes occur in a girl’s body and she starts
menstruating.

Puberty is the process of physical changes by which a child’s body matures into an adult body capable of
sexual reproduction. The major landmark of puberty for females is menarche, the onset of menstruation,
which occurs on average between ages 9–13.

As we grow, our body goes through inside the body? many changes. These changes occur due to
secretions in the body.

These secretions are called ‘hormones’ and are vital for growth and development.

What physical, emotional and social changes occur in a girl’s life, when she is growing up?
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Height gain, Weight gain, Acne, Growth of hair on the armpits and genitalia, Development of the body,
Changes to the voice, Development of the vagina and breasts, Menstruation

Ambition, Dreams, Shyness, Strong opinions, Responsibility, Individual desire, Seeking independence and
testing boundaries

PHYSIOLOGICAL DIFFICULTIES A GIRL MAY ENCOUNTER

DURING MENSTRUATION

The difficulties that girls may experience during menstrual on are:

1. Irregular periods
2. Heavy periods
3. Painful periods

Irregular Periods: For the first few years of menstruation, cycles are often irregular.
They may be shorter (3 weeks) or longer (6 weeks). A young girl may even have only
three or four periods a year. A girl’s cycles will usually become regular within two to
three years after menarche.

Heavy periods: A heavy period is one which lasts longer than eight days, saturates
the napkin within an hour or includes large clots of blood in the menstrual flow. This is
common in adolescents because of slight imbalance in chemical hormones secreted by
the body. However, if this happens regularly, it leaves the girl feeling exhausted; which
means that the body is losing more blood than it is producing. The girl should then
consult a doctor immediately.

Painful period: Slight pain during periods is quite normal. This is due to the secretions
of a chemical called prostaglandins in larger quantity than normal. This leads to nausea,
headaches, diarrhoea and severe cramps. Usually, this lasts only for a day or two. To get
relief from these symptoms, a girl should try the following methods:
 Fill a plastic bottle with hot water, wrap it in a towel and place it on the
abdomen,
 Massage the abdomen
 Local remedies such as ginger tea can be taken

Premenstrual Syndrome (PMS): This refers to a combination of physical and

emotional symptoms experienced by all women during the menstrual cycle, usually just
before bleeding begins.

These symptoms include:

a. Temporary weight gain and a feeling of heaviness due to accumulation on of
water in the body
b. Headaches and cramps
c. Painful or heavy feeling in the breasts
d. Feelings of irritability

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BELIEFS AND FACTS
1. Belief: Menstrual blood is bad blood

Fact: The blood that is shed during menstruation is not impure blood. This is actually the
shedding of the lining of the endometerium of the uterus which is thickened during the cycle in
anticipation of a fertilized egg. That is why the periods are also referred to as “tears of the
womb”. There is no impurity in the blood associated with menstruation. Cleanliness and
hygiene are related to the management of menstrual flow.

2. Belief: The blood stinks a lot

Fact: If hygienically handled, the bad odour can be contained. It‟s only if you don‟t change the
napkin/cloth regularly that it smells. Good hygiene practices like bathing, washing of genital
areas, periodic change of pads help maintain cleanliness and keep away any odour.

3. Belief: Menstrual bleeding make women weak and unhealthy

Fact: Though they experience fatigue while menstruating, regular menstruation is a sign of good
health.

4. Belief: Periods come once in 28 days for everyone

Fact: The frequency depends on genetic factors as well as food habits. Some may get periods
only once in 2 months.

5. Belief: There is no correlation between nutrition and menstrual cycle

Fact: There is a definite correlation between the two. Nutritious food enables the hormones to
facilitate menstruation.

6. Belief: Girls get pimples when they look at men

Fact: No. The onset of acne and pimples are triggered by the production of hormones called
androgens. The production of androgen usually goes into full force between the ages of 11 to 14
when most young girl and boys go through puberty.

7. Belief: Periods are some kind of disease

Fact: This is absolutely a normal process and not a symptom of any disease. It is medically safe
to do anything that one does normally, during menstruation.

8. Belief: One should eat separately from family members while having periods

Fact: There is no reason for a girl/woman to eat separately while having her periods

9. Belief: Is it risky and dangerous to engage in sports and playing games during
menstruation?

Fact: As already mentioned, it is medically safe to do anything that one normally does, however
some girls may feel tired or get cramps which may restrict such activities. One may want to rest
more than normal during this period, though this varies from person to person.

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 10. Belief: When a used sanitary napkin/cloth is thrown outside the house and if a snake
crawls on it, you will suffer from infertility

Fact: It‟s not true. There is no scientific evidence for this

11. Belief: We should not touch anyone while menstruating

Fact: We can. There is nothing unclean about menstruating. Women and girls should not let
anyone make them feel bad about it. Menstruation is a sign of good health.

12. Belief: We should not go to temples, carry babies, wear flowers on the head, water plants,
touch pickles, or go out in the afternoons as the evil spirits might attack you.

Fact: None of these are true.

13. Belief: If birds fly over a sanitary napkin/cloth, you will be cursed by the bird.

Fact: Not true. This belief was probably promoted to ensure hygiene (so that the cloth does not
come in contact with bird droppings thereby causing infection) and safe disposal of the napkins
or cloth.

OPTIONAL ACTIVITIES:
STORYTELLING-

Problems at school:

Prepare and present an imaginative case history, e.g. "Naina has soaked her sanitary pad/cloth. The boys
in class start laughing and making remarks at her. She goes to the toilet to change, but there is no water,
nowhere to throw the pad, there is no emergency towel to use in the school. In order to avoid further
embarrassment, she disappears from school without telling anybody".

Ask the class to discuss three questions:

 What does Naina feel?

 What does this story tell you about the school?
 What could have helped Naina cope with the situation?

Facilitate the discussion and help the girls to share experiences

Problems at home:

 Also make or invite stories that relate to conditions and problems at home.
 Ask the class to use the case study to build a problem tree. Write the central theme on a slip of
paper or card and sticks this on the wall or places it on the floor: "Inappropriate housing
conditions for the hygiene of adolescents in the family"
 Invite the children to write the related problems and consequences on other slips or cards, giving
one message per slip/card.
 Help the children to work in groups to identify solutions for the identified problems.
 In plenary, help the groups to prepare jointly a final list of possible actions, for example on the
blackboard.

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ROLE PLAY SCENARIOS-

Divide the participants into groups and give each of them one of the following case scenarios:
 A teenage girl who is at school and needs psychological support.
 A teenage girl has her period at school and needs some sanitary material.
 A young girl who is worried about pubertal changes taking place in her body and needs
counselling.

Each group should then perform a role play and share their points of view after identifying the
specific requirement in each case scenario. Emphasis should be placed on the skills that are
relevant for resolving the scenario at play.

FAQs: MHM

At what age does a girl start menstruating?

Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls
may begin to menstruate as early as age nine or 10, and some may not get their first period until a
few years later. Menstruation usually stops in the 40’s and this is known as menopause.

How much blood does a girl normally lose during a period?

It varies a lot. For most women, it’s around four tablespoons, but for some, it’s as much as a cup. (If
you’re bleeding more than that, soaking pad after pad all day long, see your doctor.) Sometimes the
blood is red, sometimes it’s brown, sometimes it’s streaky, and sometimes it’s got some darker bits
in it. This is normal. Every girl is different.

How much flow is there normally?

The menstrual flow – meaning how much blood comes out of the vagina – can vary widely from
person to person. Usually, an entire period consists of a few to several spoonfuls of blood – how
much depends on the individual. The blood often starts off as a rusty color and then gets redder. It
lightens to a rust color again until it stops. The amount of blood can also vary from day to day.

How long should a girl’s period last?

Because all girls are different, menstrual periods can vary from girl to girl. One girl might have a 3-
day period and another girl might have a 7-day period. It might take several months/years for a girl’s
period to become regular. One month the period might last 4 days, whereas the next month it might
be 6 days. Number of days that normally a girl’s period should last is anything from 3 to 7 days.

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What if a girl’s period never starts?

Periods will start sooner or later. However, if a girl reaches age 16 and has not yet had her first
period, she should visit a health provider/doctor.

What is the length of the menstrual cycle?

The length of the menstrual cycle (the time between first day of one period and the first day of the
next) varies for each girl. For some, the cycle is as short as 21 (or even fewer) days. For others, it is as
long as 35 days or more. Irregular periods are common in girls who are just beginning to menstruate.
It may take the body a while to adjust to all the changes taking place. For example, a girl may have
the same length cycle for two months, then miss a month, or have two periods with fewer days in
between them. Sometimes she might have some spotting of blood for a day or two in the middle of
her cycle. This is usually nothing to worry about, till the cycle regularizes.

What defines normal menstruation?

While most menstrual cycles are between 28 and 30 days long, periods that come anywhere from 21
to 35 days apart are considered normal in most situations. The amount of menstrual fluid lost during
your period averages from 4 to 12 teaspoons for the majority of women; however there are many
variations of normal among women. Most periods last from 3 to 5 days, however it’s not abnormal
for a period to last for 7 days.

Why are periods irregular?

Once a girl starts getting her period; it will probably take several months to a year for the menstrual
cycle to settle into a regular pattern. During this time, hormone levels change and ovulation does
not necessarily occur on a regular basis. So, the interval between periods, the amount of menstrual
flow, and the duration of the period are likely to vary considerably from cycle to cycle. Girls may be
concerned about differences between their cycle and that of their friends. They may worry if, after
their first period, they do not menstruate again for two to three months, but these are normal
variations.

Are girls unclean or impure during their periods?

The blood that is shed during menstruation is not impure blood. This is actually the shedding of the
lining of the endometerium of the uterus which is thickened during the cycle in anticipation of a
fertilized egg. That is why the periods are also referred to as “tears of the womb”. There is no
impurity in the blood associated with menstruation. Cleanliness and hygiene are related to the
management of menstrual flow. Good hygiene practices like bathing, washing of genital areas,
periodic change of pads help maintain cleanliness and keep away any odour.

What if a girl suddenly bleeds through her clothes?

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Well, it happens to almost all of us at one time or another. Just tie a sweater or jacket around your
waist to cover any possible stain. (If you don’t have a sweater on you, ask a friend to borrow hers.
This is what sisterhood is all about!) Then get yourself a napkin/pad, head to the bathroom, do what
you have to do and scrub out any noticeable spot. For future reference, you might want to take an
extra pair of underwear and pad in your bag and wear dark clothes on days when you’re expecting
your period or when your flow is at its heaviest.

How often should napkins or cloth pads be changed?

Menstruation as a regular process needs hygienic management. Girls need to change their napkins
regularly during the period of menstruation especially in the first three days. This can help prevent
infections. During the heaviest days of your period, you may need to change them every 3-4 hours.

Why does a girl feel fat during her periods?

Just before and during your period, your body may tend to retain water. This added fluid might make
you feel fat or make your breasts feel tender. Actually, it’s normal to gain a couple of pounds during
this time of the month -- and lose them right after your period. If you feel bloated, you may feel
better wearing loose, comfortable clothing. Consume less salt immediately before and during your
period because salt increases water retention.

What causes period pain?

During a period, the uterus contracts, tightening and relaxing so that the menstrual flow empties
from the body. This process for some is painful. Some girls get cramps that are more severe than
others. Pain relievers, exercise, a hot bath, or a heat compress can help this.

How does a girl manage if she gets her periods while in school?

Being prepared is the first step in managing your periods. If you know your menstrual cycles, you
would know the probable dates. Do carry a sanitary napkin or an alternative. Feel free to ask your
teacher for a break to go to the girls’ toilet and keep the pad in place. If you avoid the
embarrassment of getting your uniform stained, then you will feel confident about staying in school.

Do girls have to take leave or absent themselves to manage their periods?

There is no need to take leave from school during these periods. After all these are monthly
features. Every month taking leave during this time may result in missing school and your academic
performance may suffer. If you are able to gauge the amount of menstrual flow and plan for periodic
change using the school toilet, then there is no reason for embarrassment. Once handling the flow is
taken care of, attending school should not be a problem at all.

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