The menstrual cycle and menstrual hygiene

1A normal part of life

During a morning lesson, Umutoni realises that her period has started unexpectedly. She is not sure what to do, and she worries that someone will notice. Her friend walks with her to the school's girls' room, where there are pads, water and soap, and a female teacher who helps her calmly.

About half of the people in the world will have periods for much of their lives. A period is a sign that the body is healthy and working as it should. So why do periods happen, why do they come roughly once a month, and how can every girl manage them with confidence?

2The cycle, day by day

Days are counted from the first day of a period, which is day 1. In a 28-day cycle:

• Menstruation, $1\le d\le 51\; \backslash le\; d\; \backslash le\; 5$: the thick lining built up in the last cycle is shed.
• Lining rebuilds, $6\le d\le 136\; \backslash le\; d\; \backslash le\; 13$: FSH makes an egg ripen in a follicle in the ovary; the follicle releases oestrogen, which rebuilds the lining.
• Ovulation, $d\approx 14d\; \backslash approx\; 14$: a surge of LH makes the ripest follicle release its egg into the oviduct.
• Lining kept ready, $15\le d\le 2815\; \backslash le\; d\; \backslash le\; 28$: the empty follicle becomes a corpus luteum ("yellow body"), which releases progesterone. Progesterone keeps the lining thick and ready to receive a fertilised egg.
• No pregnancy: the corpus luteum breaks down, progesterone falls, the lining can no longer be kept, and a new period begins: day 1 again.

Figure 1: The menstrual cycle as a circle. Real cycles vary in length, and ovulation does not always fall on day 14.

A 28-day cycle is only an average. Cycles in adults usually last between about 22 and 32 days, and in the first years after menarche they are often irregular. Ovulation usually happens about two weeks before the next period, so it moves when the cycle is longer or shorter.

3Reading the hormones

Figure 2: Oestrogen and progesterone during one cycle (schematic, based on the pattern described by OpenStax).

4Menstrual hygiene

• Use a clean pad, disposable or a washable cloth pad, and change it regularly: about every 4 to 6 hours, or sooner if it is full.
• Wash your hands with soap before and after changing a pad, and bathe every day with clean water.
• Dispose of used disposable pads by wrapping them in paper and putting them in a covered bin. Never flush them down a toilet. Wash reusable pads with soap and water and dry them in the sun.
• Carry a spare pad when a period is due, and wear clean cotton underwear.
• Mild cramps are common. A warm drink, gentle exercise, rest or a painkiller recommended by a health worker can help. See a health worker if the pain stops you doing normal activities, if bleeding is very heavy, or if periods have not started by the age of 15.

5Rwanda: keeping girls in school

If a girl cannot afford pads, or her school has nowhere private to change, she may miss lessons every month. Rwanda has acted in two ways:

• Girls' rooms (icyumba cy'umukobwa): the Ministry of Education's strategy is for every school to have a room where a girl can rest and find pads, water, soap and help. UNFPA Rwanda reported in 2022 that Ministry of Education figures showed 1,691 primary schools, 57.1 percent of the total, had such a room in 2019, and that schools are advised to give free pads to girls who cannot afford them.
• No tax on pads: sanitary pads are exempt from value added tax (VAT), which makes them cheaper. The VAT law (Law Nº 049 of 2023, article 8) lists them among the goods exempted for health reasons.

6Discuss

In groups, list the reasons a girl might miss school during her period. For each reason, suggest one thing the school, the class, or boys and girls themselves could do so that no girl misses a lesson.