OPINION: Menstrual health matters - Why it deserves more than products and silence

We never forget the day we had our first period. We remember not just what happened to our bodies, but how the world around us reacted. Or didn’t.

Some of us were given vague instructions while others were told not to speak about it. If you were lucky, you got a bit of guidance, but honestly it seems most of us learned through trial and error. The lasting message was that menstruation was something to hide. That silence hasn’t gone away.

Yes, there is more public discussion than before. But most of it still focuses on one thing: access to products. This definitely matters. Pads and tampons should be available and affordable. No one should miss school or work because they don’t have what they need. But menstrual health is about more than what we use to manage the physical flow of blood.

It’s about how we feel, and whether we are taken seriously when something is wrong. Many people live with menstrual disorders they’ve never heard of. Heavy bleeding, extreme pain, mood changes, and infertility are often dismissed as “just part of being a woman.” Conditions like fibroids, endometriosis, and Premenstrual Dysphoric Disorder are common, yet are rarely diagnosed early. The saddest part is that some never get a diagnosis at all.

In low-resource settings, the silence is even deeper. We’ve met girls who miss class each month and fall behind. Women who keep working through pain because they can’t afford to stop, and therefore are not working at 100%.

Health workers who don’t know what to look for or what to say are in fact encouraged to dismiss what women are experiencing as 'normal'. The result of this approach to women’s health is not just discomfort. Women and girls experience missed opportunities, financial implications, and poor quality of life with some experiencing significant negative mental and physical health impacts.

In the workplace, menstruation can be the hidden reason a woman is absent or underperforming. A survey in Rwanda found nearly 23% of employed women had missed work due to a lack of menstrual product. Women in informal jobs who have to take a day off lose income they can’t afford.

Some women stop applying for permanent jobs because they worry about managing heavy flow in public or the missed days due to debilitating pain. Some students drop out because they fall too far behind, and many of us go years without understanding that their pain is not normal. This is what happens when menstrual health is left out of the health agenda.

In Kenya, Uganda and other African countries, reusable pads and menstrual cups are being distributed through schools and women’s groups. Schools are also starting to train teachers to talk openly about periods.

The East African Community has taken early steps to set shared standards for menstrual products and countries like Rwanda and South Africa have removed taxes on pads. These are small but important steps because the trickle from the tap has started. But we’re still far from where we need to be, because there’s barely any public health investment in menstrual health, and most health workers aren't trained to recognize menstrual disorders. We need to move to the next step and open the tap fully.

So, what still needs to happen?

• Funding menstrual health as part of sexual and reproductive health, not just under education or WASH. We need to address menstrual disorders such as endometriosis and recognise their debilitating effects on quality of life.
• Train health workers to not only identify but correctly manage menstrual disorders with the same urgency as other conditions.
• Support policies that give people flexibility during their period, including menstrual leave where needed and developing workplace policies.
• Bring men and boys into the conversation, not as bystanders, but as supporters and leaders.

 And ask better questions.

What would your school or clinic look like if menstrual pain was treated seriously?

What would change if periods were no longer whispered about, but addressed with the same clarity as any other health issue?

Each of us can help by talking about periods without discomfort. Share correct information. Listen when someone says they are in pain. Small actions like these build trust and shift how we see menstrual health. You don’t need to be a health expert to make a difference. You just need to care enough to stop pretending this doesn’t matter.

Menstrual health belongs in every conversation about health and is part of public health. It’s time we treated it that way.

The Writer is an obstetrician-gynaecologist and global health specialist