By Agbonkhese Oboh
When managing dysmenorrhoea couldn’t stop a girl from having 3 degrees, you get Enitan Sophie Oluwa
Enitan (call me Ennie) has come to terms with the fact that her handbags are mobile pharmacies. She moves around so much her friends call her The Nomad. However, her regular companion a few know about is dysmenorrhoea— painful menstruation. So any handbag she has with her is a drugstore because her periods are as unpredictable as her flight tickets, and restless mind and legs.
“For some,” she says, “it’s not just dysmenorrhea. They battle endometriosis. That is the menstrual pains resulting from tissues normally lining the uterus growing in other areas such as the ovary or fallopian tubes. And there are neither specialists for these conditions nor cure. Gynaecologists just help us manage the pains. However, when the pains hit, they fold me up like a foetus.”
Ennie is one of the millions of women and girls dealing with this condition. But she is one of the few that have access to the right information and health facilities. Besides the stigma, myths and taboos that come with menstruation for some, dealing with painful periods is an additional nightmare. A 2012 research published in the Journal of Pain (“Prevalence of menstrual pain in young women: what is dysmenorrhea?”), 84.1% (344) of 408 Italian women experience menstrual pains. Of this figure, 43.1% had pain during every period, while the rest (41%) experienced pains during some periods (ResearchGate 2014).
Another ResearchGate publication is “Prevalence and correlates of dysmenorrhea among Nigerian college women,” by Olabisi M. Loto, Tomi Adewunmi and Abiodun Adewuya (2008). In studying 409 first-year students of a Nigerian university, they found that 53.3% suffer dysmenorrhea. Common with both researches are that the subjects experienced pain at the onset of menses, experience longer days of menstrual flow and younger age at menarche. So it is obvious that dysmenorrhea is common and has certain indicators. But the last index is not for Ennie. She started menses late (16 years) and dysmenorrhea came with the first period. And for 16 years, she has been managing the pains of womanhood. It is not surprising that she has come to terms with it and now an authority in describing the pains and an advocate for the goodness in being a woman in spite of the pains and stigma.
The pains, the symptoms and advocacy
Ennie said: “When it started at 16 with menarche, I had no knowledge of what it was. So it was a case of ‘no be you start to dey get period’. It took about 10 years for it to be diagnosed after I had done so many scans and tests: ovarian, pelvic, TB and others I don’t know what they were about. Before then I used agbo. But it wasn’t really working. Now some say it will go when I start having babies. For now, as long as there is period, there are pains. At times, just ovulation can trigger it. In my case, the first 48 hours and the last 48 hours are cruel. I coil up in bed, looking for a cold surface to rest on.
“But the pains are indescribable and the symptoms vary each time. It can feel like bowel movement, pains in my back or legs. It’s confusing. I just fold up like a foetus. At other times, the pain could spread you out, with one leg in Sokoto and the other Calabar. And heat in the stomach. It can begin with my legs swelling up or I can just start having a terrible cough. Now, thank God for gynaecologist, the University of Lagos, UNILAG, that help with drugs and the privileges God has given me. Together we manage dysmenorrhoea. But when the drugs are out of stock I either look for money to buy the drugs elsewhere or just bear the pains when there’s no money.
“However, there are still many out there who don’t know what is happening to them. Others can’t access the appropriate healthcare and many more are suffering so much because many ignorant people feel we are not normal and that dysmenorrhoea leads to infertility and painful pregnancy. This is Africa. Period pain is not an issue worth discussing for many. So I seize every opportunity and platform to reach out to teenage girls, share my experience and tell those in my shoes they are normal. I use social media and one-on-one talks with people I know have this challenge. I volunteer with different NGOs to do reproductive health advocacy. In fact, I am Lagos State Coordinator for International Youth Alliance for Family Planning. I am also Head of Public Relations & Partnerships at Wellvis Health.”
Healthcare accessibility and the dangers of self-help
That millions of women live with dysmenorrhoea is no news. The poignant reality is that the majority of those millions do not have the healthcare opportunity or access to information Ennie is privileged with. Many more resort to self-help. A study by Statista on how women treat dysmenorrhoea in the United States puts the issue in perspective. Published in August 2019, it shows that 21.76 million women used non-prescription products.
According to Statista, “this statistic shows the kinds of products used to relieve menstrual pain in the United States in 2019.” It added that the data was calculated by Statista based on the United Nations data and Simmons National Consumer Survey, NHCS. The table (below) shows the gap between those who sought professional help (prescription) and self-help (non-prescription).
Nigeria has one of the highest rates of maternal death in the world, says United Nations Population Fund, UNFPA. The risks are compounded for women and girls living through humanitarian crises, which undermine community support mechanisms and limit access to health facilities (UNFPA, 2017). Now, the results of Statista’s kind of research in a country such as Nigeria would be frightening. In fact, in 2018, Nigeria’s 40 million women of childbearing age (between 15 and 49 years of age) suffer a disproportionally high level of health issues surrounding birth (UNICEF). The responses of some women to Newzandar News inquiries as to how they tackle dysmenorrhoea, one of such reproductive health issues, are incisive.
Others share their experience
“Menstrual pains make me moody. I would vomit, visit the toilet frequently and just feel cranky,” says Mrs Esther Mordi. “One of my most embarrassing moments was when I had an exam and my period came out. I was in secondary school. I was wincing throughout the exam and started vomiting and everyone thought I was pregnant. It felt so shameful. I manage my pains by taking hot tea and staying indoors.”
By the way, Mrs Mordi, who has just put to bed, is the Founder of Impact Her Initiative, IHI, a non-governmental organisation that focuses on girl-child health advocacy.
For Mrs. Ogundare, her family stands still whenever she is having her period. She added that childbirth didn’t reduce menstrual pains, as many presumed. She uses Felvin or any other pain-relieving tablet. But pain relievers caused so many bad side effects for Blessing Ibekwe, who has a fairly regular seven-day period. She now uses a ginger tea recipe she got online: “The first two days are usually very hectic and painful. And sometimes I throw up. The ginger does not completely remove the pains. I just manage it.” Mrs. Olashile Ogabi notes “don’t experience period pains. But I have seen people use blood tonic during their period or a day before or after completing the period to enable the blood flow easily. Again, original coconut oil, I hear, helps a lot to ease the pain.”
The doctors’ say
Two doctors spoke to Newzandar News on managing dysmenorrhoea. Reproductive health analyst who works with UNFPA, Dr. Esther Somefun, said women with painful menstruation should see a physician. She added: “Self-medication for menstrual cramps should be discouraged. Women with dysmenorrhoea should see a physician for proper review and management. Again, most periods last from three to five days. But anywhere from two to seven days is still normal. Above seven days requires a physician’s review.”
Dr. Steven Lemandoro, an obstetrician and gynaecologist, went into details. “There is treatment for managing dysmenorrhoea, but achieving a cure is difficult. There are two types: primary and secondary. For primary dysmenorrhoea, there’s really nothing causing it. It usually starts with the first menstruation and remains throughout a woman’s reproductive life. To manage it, we do give pain relievers around the time of the menstruation so it will not be too unbearable, starting with the simple paracetamol. If that doesn’t work, then we use some group of drugs called non-steroidal anti-inflammatory drugs. In that group, we have Ibuprofen, diclofenac, naproxen and others. Sometimes also, we use combined oral contraceptive pills for young girls with dysmenorrhoea. It tends to make menses lighter and less painful.
“However, secondary dysmenorrhoea usually has an underlying cause. Often it doesn’t start when the woman start menstruating. So if one is able to solve the problem that is causing it, it might be a permanent solution to secondary dysmenorrhoea, besides the pain relievers. If, for instance, it’s fibroid that is causing it, when the fibroid is removed, the pain will stop. But for endometriosis, usually it is not possible to completely remove endometriosis. We can surgically correct some problem associated with that endometriosis to reduce the pains. In the case of pelvic inflammatory disease, when you cure it, dysmenorrhoea may stop. There is also for adenomyosis (endometrial tissues within the muscles of the uterine wall), the solution may be to remove the womb.
“It’s not all cases of endometriosis that needs surgical solutions. For instance, there is a drug the woman can be taking monthly that will reduce the symptoms of endometriosis and also reduce pains. I must state here that dysmenorrhoea is just like any other problem associated with the female reproductive system. So the specialists are the gynaecologists.”
So basically, Ennie’s experience has not only turned her handbags into pharmacies, she is now a ‘specialist’, as Dr. Somefun advice and Dr. Lemadoro’s analysis corroborate her narrative. Equally obvious is that with women and girls there is no single rule when it comes to reproductive health. So even when the pains started at menarche, Enitan Sophie Oluwa has now been diagnosed with endometriosis. But she has NCE, B.A. in English Literature and is rounding off her Bachelor of Laws (LL. B) at UNILAG, “so I can advocate Reproductive Health and Gender Rights.” Meaning she has learned to manage dysmenorrhoea.
“Oboh,” she yells down the phone good-naturedly, “you are as terrible as this thing I have learned to live with, by making me narrate my ordeal. But thank you and your publisher for giving me a voice. I hope my story helps the millions of women and girls out there that have no access to the right information, healthcare and the many others who suffer stigma for something they have no control over. We are normal. The pains and stigma can’t stop us.”
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