Observed globally on May 28, Menstrual Hygiene Day is a call to break the stigma and silence around menstruation. Despite growing awareness and wider access to sanitary products in India, millions of women and girls continue to face poor menstrual hygiene, inadequate education, and untreated health conditions. From adolescent anaemia to infections that threaten fertility, the consequences are wide-ranging and serious. Patriot spoke with Dr Neena Malhotra, Head of the Department of Gynaecology at the All India Institute of Medical Sciences (AIIMS), New Delhi, about the clinical realities, prevailing taboos, and the urgent need for systemic change.
What are the most common menstrual health issues you encounter in your clinical practice at AIIMS?
Out of every 100 OPD patients, around 40 women come with menstrual problems. These issues span all age groups—from adolescents to postmenopausal women—and vary with age.
Among adolescents (13–19 years), irregular periods are common due to the immaturity of the brain-ovary axis. Some face heavy bleeding—about 2–5%—while others have PCOS, which leads to delayed cycles. Obesity, which affects hormonal balance, is another growing factor.
In women in their 20s and 30s, PCOS continues to be common. But we also see conditions like endometriosis and fibroids, which lead to heavy or painful periods and may impact fertility.
Middle-aged women (35–45 years) often present with endometrial hyperplasia and polyps, causing heavy or intermenstrual bleeding.
In women over 40, adenomyosis and fibroids are prevalent, usually causing pain and excessive bleeding. After 50, heavy bleeding becomes a concern for endometrial cancer.
Many women do not initially report menstrual symptoms directly—they complain of fatigue or weakness, and we later discover anaemia caused by menstrual issues.
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How serious is the issue of anaemia among menstruating adolescents, and what role does menstrual health play?
Anaemia in adolescents is a major concern and often stems from unaddressed heavy menstrual bleeding. We tend to focus too much on anaemia during pregnancy and ignore the fact that the problem begins much earlier, in adolescence.
Despite economic progress and better diets, anaemia rates remain unchanged because menstrual blood loss often goes unrecognised. Girls are frequently conditioned to think that pain and heavy bleeding are “normal,” which delays the diagnosis of underlying issues like endometriosis or adenomyosis.
At AIIMS, we are conducting a root cause analysis to understand why women remain anaemic despite improved nutrition, and how unreported menstrual issues contribute to this.
How does poor menstrual hygiene contribute to infections like UTIs, RTIs, or bacterial vaginosis?
Poor menstrual hygiene can lead to ascending infections such as bacterial vaginosis, urinary tract infections, and pelvic inflammatory disease. This is particularly common in under-resourced settings like refugee camps or rural areas, where access to sanitary products is limited. Women in such areas often use unsafe materials, which can cause vaginal infections and long-term complications, including infertility.
Can poor menstrual hygiene lead to long-term complications such as fertility issues or pregnancy risks?
Yes. Poor menstrual hygiene can result in pelvic infections, which may scar reproductive organs and impair fertility. Infections like pelvic inflammatory disease often go undetected until fertility problems surface.
During pregnancy, such infections increase the risk of miscarriage and preterm birth.
Is there a link between menstrual hygiene and long-term conditions like PCOS or endometriosis?
PCOS is not linked to menstrual hygiene. However, there is some weak evidence suggesting that endometriosis could be influenced by menstrual obstruction. For example, if menstrual blood doesn’t flow freely due to the use of improper materials, it could contribute to retrograde menstruation—a possible cause of endometriosis. But we need more robust research to confirm this link.
Do women often delay treatment for menstrual problems due to stigma or lack of awareness?
Absolutely. Social stigma, cultural beliefs, and a lack of awareness prevent many women from seeking timely medical attention. In many cases, they only visit the hospital once the symptoms become severe.
To better understand this, AIIMS is conducting a community-based study to examine the reasons behind delayed care and the influence of socio-economic and cultural factors.
What are some harmful menstrual practices still prevalent in rural or semi-urban areas?
In many such areas, women continue to use unhygienic materials like cloth rags, ashes, or other unsafe alternatives due to lack of access or awareness. These practices significantly increase the risk of infections and reproductive health complications.
In addition, taboos surrounding menstruation continue to restrict women from cooking, attending school, or taking part in daily life, which negatively affects both their mental and physical well-being.
How do you view the adoption of menstrual cups and reusable pads from a hygiene and safety perspective?
Menstrual cups and reusable pads are both safe and sustainable—if used and cleaned properly. They are cost-effective and environmentally friendly. But education is critical. Without proper guidance on hygiene and use, there is a risk of infection. Cultural resistance and low awareness remain barriers, especially in rural areas.
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Is there a gap in menstrual education among adolescent girls, and how can it be addressed?
Yes, there is a significant gap. Many young girls lack even basic information about menstruation before they experience it.
This can be addressed through school-based health education, parental involvement, and community outreach. Teachers must be sensitised, and menstruation should be included in health curricula across schools.
Has AIIMS undertaken any awareness or outreach initiatives in underserved communities?
Yes. We are currently running a community outreach project in areas like Ballabhgarh. The goal is to assess socio-cultural barriers to menstrual health and investigate why women delay care. This research will help us design more effective interventions and policies.
What role do lifestyle factors like obesity, screen time, and stress play in causing menstrual irregularities?
Stress affects hormone levels, and excessive screen time disrupts sleep. Rapid weight gain or loss, especially in teenagers, interferes with the hormonal cycle. These are now major contributors to irregular menstruation among young girls.
Obesity, now common among teenagers, is a major disruptor of hormonal balance. Reducing screen time, encouraging outdoor activity or sports, and addressing emotional stressors are all crucial for maintaining hormonal stability.
Why are so many urban girls today experiencing delayed or irregular periods?
Lifestyle factors play a big role. Obesity, stress, academic pressure, lack of physical activity, and disrupted sleep cycles all impact hormonal regulation.
Urban teenagers often lead sedentary lives and spend excessive time on screens, which disturbs their circadian rhythm and contributes to irregular periods. PCOS is often the underlying cause.
When should a young woman consider a delayed period as a medical concern?
If delayed periods persist for more than two to three months repeatedly—or if accompanied by other symptoms such as excessive weight gain, acne, or facial hair—it’s advisable to consult a doctor.
One or two missed cycles may not be alarming, but consistent irregularities should never be ignored.
What is your key message to the public on the importance of menstrual health?
Menstruation is a natural and essential aspect of a woman’s health across her lifespan—from adolescence to menopause. We must normalise conversations around it, eliminate taboos, and ensure access to hygienic products and timely medical care.
Ignoring menstrual health doesn’t just affect reproduction—it impacts education, work, and overall quality of life. A stigma-free and supportive environment is essential for empowering girls and women to take control of their health.
