Inside the world of pains, pangs of Nigerian women

Since she was 13, Adama Dauda, now 25, has struggled with intense menstrual pain which usually begins five days before her menstrual flow, and peaks three days into it.

To her, each menstrual cycle brings as much difficulty as the last or even worse. But it was hardly ever bearable and the pattern was always the same. First, there’s a throbbing in her abdomen, thighs and waistline; then an unexplained weakness follows, accompanied by dizziness, nausea, and body aches of an unusual intensity.

She said she never spoke of her pain or attempted to seek healthcare because no woman around her ever did.

Ms Dauda was raised in Rafi Zurfi, a remote community in Gwagwalada Local Government Area of Abuja. She said women in the community spoke dismissively of menstrual pain, and that she had been teased a few times for acting too sickly for “mere menstruation.” But she knew her cramps were in some way very different from the others.

“Unlike them, mine hurts too much,” she said.

When she began to use pain relief medication in 2021, it was as an act of desperation, an overwhelming desire to numb the pain that, at the time, was brewing uglier experiences. With an infant son, a husband and a local stall to care for, she could no longer afford to be incapacitated every month by her period.

The pills did not stop the pain, she said, but it brought relief. The cramping began three, instead of five days, before each flow, and ended one or two days into it. The pain, thus, became less tortuous for her.

Ms Dauda was never diagnosed, but based on her account, medical experts said she exhibits some symptoms of secondary dysmenorrhea, a form of menstrual disorder which, according to research, causes severe and frequent period pain. The symptoms can be both physical and emotional, triggering anxiety, mood swings, depression, or irritability in a continuous manner that affects the quality of life.

About menstrual disorder

Many other kinds of menstrual disorders affect women. Some of those with high prevalence are Menorrhagia, which causes heavy bleeding; Amenorrhea, a complete absence of bleeding; polycystic ovary syndrome (PCOS), resulting from hormonal imbalance that affects the reproductive system; and Premenstrual Dysphoric Disorder (PMDD), an acute form of premenstrual syndrome which destabilises physical and emotional state of minds.

Menstrual disorder is any irregularity in the menstrual cycle that affects, among other things, the timing, frequency, duration, or intensity of menstrual periods. The irregularities are often caused by hormonal imbalances, medical conditions, or an underlying health issue.

Some women who spoke with PREMIUM TIMES said they experienced symptoms of dysmenorrhea, PCOS, and PMDD but many of them are undiagnosed – a prevalent phenomenon in Nigeria especially among women with limited access to medical care.

Ashley Lori, founder of Padup Africa, a non-profit advocating for improved menstrual health and hygiene for women in Nigeria, said the culture of silence and shame of menstrual issues continues to deter women from speaking up about their conditions or seeking medical help.

Misconceptions and myths about menstruation have forced women into silence, she said, such that many women are unaware of their conditions, and the few with little insight prefer to keep it a secret.

While data collection across the country is significantly limited, research has shown that there’s a high prevalence of menstrual disorders among women. Local studies have reported rates between 90.4 per cent and 69.4 per cent in studies of women in their reproductive age. The knowledge rate, however, is poor.

“The symptoms and disorders associated with menstrual disorders make women box themselves up from the condemning eyes of society, and with help rarely available, most women have little knowledge of what ails them,” Ms Lori said.

Finding medical care

In 2023, Esther Idorenyin, a 25-year-old residing in Badagry, Lagos State, approached gynaecologists. It was nine years after her first attempt at medical care when she said the doctor diagnosed her with polycystic ovary syndrome (PCOS) but told her parents that her condition was “a minor case of discomfort.”

While PCOS is not a menstrual disorder itself, it is a prominent cause of menstrual irregularities among women, many of whom experience irregular, or prolonged menstrual periods due to hormonal imbalance.

Ms Idorenyi had wondered what could have been the case had the doctor simply told her parents the truth. She said it took the intervention of a distant relative, who worked at the facility, for her to learn of the diagnosis years later.

Her condition, between those years, worsened and her symptoms grew so pronounced that she began to worry about potential complications that could be life-threatening. The memory of her mother’s struggle before she died in 2016 from complications reportedly triggered by PCOS still lingers and contributes to her concern.

Studies show that – although a rare occurrence – menstrual disorders can lead to life-threatening complications such as anaemia from heavy bleeding, undiagnosed ectopic pregnancy, and untreated pelvic inflammatory disease (PID), depending on the condition.

For women with PCOS, endometrial cancer and cardiovascular issues are all potential dangers.

Such was the condition of Ms Irondeyin’s mother, who reportedly died of diabetes in 2016.

Meanwhile, Jamila Richifa, a gynaecologist at Abubakar Tafawa Balewa University Teaching Hospital in Bauchi, affirmed that health complications from menstrual disorders can be life-threatening or further decrease the patient’s quality of life.

Mrs Richifa said when menstrual disorders are poorly managed, the health risk can be very dangerous.

“Depending on the type of disorder, women can experience heart failure, difficulty in breathing, general weakness of the body, infertility, and a host of other sicknesses,” she said.

Coping with menstrual sickness

Ms Irondeyin said she later found out that she knew more about her condition than many of the doctors she consulted in 2023.

“Even after I told them that I had been diagnosed a year ago and discussed my symptoms with them, they still argued with me. It is as though they are unaware that the symptoms of PCOS vary among women,” she said.

“Then it became important that I read about my condition because different doctors had different medications to prescribe. I have met doctors who prescribed malaria drugs for my irregular periods in the past.”

Ms Irondeyin said her dropping out of school in 2020 was partly because she felt overwhelmed by her condition. She began suddenly to battle excessive facial hair and weight gain, hair loss, darkening skin, and intense anxiety that weighed too heavily on her.

“It was always as if hell broke loose on me.”

She said as a result of her sudden weight gain and facial hair, she also had to deal with snide comments about her body from friends, classmates and even lecturers.

Women who spoke to PREMIUM TIMES described their disorder as a cause of constant anxiety, frustration, and depression. They also complained that they are often misunderstood and tend to isolate themselves, especially during menstruation.

Mide Olabanji, a 22-year-old with premenstrual dysphoric disorder (PMDD), said her period is always marked by depression and suicidal thoughts. She stays indoors all through the week of her period and skips classes on weekdays until her cycle ends.

“I always have to reassure myself so that I don’t give in to my feelings. I remind myself that an uncontrollable factor is at play and the tension will reduce in about a week,” she told PREMIUM TIMES.

Expert speaks

The gynaecologist, Mrs Richifa, said the impact of menstrual disorders on the health of women causes a reduction in concentration ability, academic disturbance, and changes in normal physical activities.

She said it leads to restriction of activities and absenteeism among them.

She called menstrual disorders one of the most occurring gynaecological issues that affect women of childbearing age, and one of the frequent reasons women consult physicians worldwide.

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“Although menses is a natural phenomenon and an important indicator of women’s health, it could come with traumatic experiences in some women,” she said.

She said poor women with menstrual issues struggle to access health care due to what she described as the lack of attention and the culture of silence on menstrual health.

Herbs for cure

PREMIUM TIMES found that many women with menstrual disorders are quick to opt for traditional treatment in their quest for a cure. But they learn very quickly that the herbs prescribed to them cannot provide the desired result and then quit.

However, for women in poor, disadvantaged communities where medical care is inaccessible, traditional treatment is the only option.

Nafisat Adomu, a petty trader in Checheyi village, Kwali Local Government Area of the Federal Capital Territory, began to visit her traditional healer after her first miscarriage in 2021.

It was her birth attendant, identified as Mama Jude, who told her during one of her first visits that her “period was not good” and without making further findings prescribed “Zarih,” a herbal mixture.

Each day, Mrs Adomu said she had to drink and bathe with the herb because Mama Jude insisted on its judicious use.

The PHC in her community is often locked and the health providers live far away. But even when they are present in the barely functional health centre, the mother of one said, they could hardly provide any useful service.

She said the birth attendant told her that the herb should be prioritised whenever a woman seeks to conceive.

“And you must keep praying that it works for you,” she recalled being told.

Despite multiple calls and efforts for increased awareness on menstrual health by gender advocates, and experts, women across the country are still held back by stigma and an entrenched culture of silence.

In remote communities like Checheyi, the absence of a functional medical facility impedes women’s access to care, thereby allowing the stigmatisation, and the myths about menstrual issues to thrive.

Warning

The Director of the Gender, Adolescent, School Health and Elderly Care Division at the Federal Ministry of Health, John Ovuraye, warned against the use of non-medical treatments for menstrual disorders.

He said the Nigerian government was putting in place policies to address the challenges women face in accessing healthcare.

He said women must, however, make extra efforts to seek medical care and get treatment because the indiscriminate use of herbs could worsen their condition.

Mr Ovuraye also urged women to speak up about their condition and for parents to enlighten their girls about menstruation and reproductive health.