What Children Saying About Mental Health Workshop

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Negative Impact of Taboos on Mental Health

Negative Impact of Taboos on Mental Health

By Saniya Islam 

Walking into your house at the ripe age of eight throwing the shiny new ball your friend had just bought you, enamored with how it bounced and tossed up in the air until - Crack! The mirror reflects back at you in its shattered pieces, your mother close behind yelling, “You better wish away the 7 years of bad luck you’ve doomed to yourself,” unleashing anxiety across your body for the next three weeks. 

This is the effect of baseless taboos and superstitions; the issue, however, extends beyond shattered mirrors and knocking on wood. Superstitions are most harmful in the space of periods, an area in which many women and impressionable girls are uneducated. But why? 

Despite their seemingly harmless intention, period taboos are often the only true advice or education that women in underdeveloped countries - like India - receive to guide them through menstrual cycles. This unproven folklore, however, creates fear mongering around periods. 

There are a myriad of superstitions passed around the world that create unnecessary rules for women. In India, for example, there is a superstition that whilst on your period one cannot enter a kitchen or cook for anyone else according to Hello Clue. The consequence of this rumor is that women are taught that they are dirty and disgusting for their period - furthering menstrual health into an unmentionable and disgraceful topic. 

Consequently, the confidence of women is tattered by period myths as is that of young girls. Period superstitions establish a stigma around periods and those who have them. When on one’s period, girls feel ashamed to be in their own bodies because societal taboos tell them to ‘wash your hair’ or ‘not pray’, as though it is an infectious disease rather than a normal bodily function. 

Once disgusted by periods, girls are thereby told to be disgusted with themselves and the body that contributes to such a process. Through low self-esteem comes low-confidence, growing into many mental health issues in the process. 

Women deserve to be reminded that their period is a normal process and one that should not be frowned upon or that they should be judged for. They deserve more than unsupported rumors and hostility toward their bodily functions. Girls deserve not to fear that if they are on their period without a matchbox in their pocket, evil will come to them. They deserve to be educated, to be heard, and to be met with information about their menstrual cycle that will help them manage it and continue with their lives rather than living in isolation and fear constantly. 

By educating women and abolishing these superstitions from their mind, they can live with knowledge and comfort whilst on their period. These are the standards that we should hold menstrual education toward. This is the standard that HEEALS NGO holds itself to when educating young girls on their periods in order to protect them from period anxiety and allow them to reestablish their confidence. By getting rid of period myths, we allow women to accept themselves and their womanhood. To contribute to the cause of revoking rumors and replacing them with facts, donate to HEEALS today. 

 

Sources: 

https://helloclue.com/articles/culture/36-superstitions-about-periods-from-around-world

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Girls Dropout Because Of Menstrual Hygiene

Many Girls Dropout From Their School Just Because Of Periods .

Taboos related to menstrual hygiene is a major player in Girls dropout from schools. Together we can bring back the Girls in school. Join Our Menstrual Hygiene Project . Whats app : +91-- 7982316660

Mental Health And Sensitization On Peer Pressure Workshop

Todays! mental health workshop was all about how peer pressure is an important factor in determining healthy and unhealthy choices in adolescents .

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We Request To All The People To Help and Support Our Work .

Please Donate / Support Us In Anyway You Can. Spread Share Support #HEEALS Donation Details Are Below:

DONATORS LOCATED IN INDIA 

Account Number: 002101200566 Bank: ICICI Address: ICICI, Gurgaon Branch Sco-18 & 19 Sector -14, Huda Shopping Center. Gurgaon -122001 RTGS/NEFT IFSC CODE: ICIC0000021

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Dropout because of child marriage in India

 

Dropout because of child marriage in India!

Of the over 21,800 girls who had dropped out of school before the 2019-20 school year, just over 13% girls did so as they were required for house work and almost 7% did so as they were married off even though child marriage is illegal

Early marriages and chores at home are key reasons why girls drop out of school, The National Family Health Survey-5 (2019-21) indicates. Of the over 21,800 girls who had dropped out of school before the 2019-20 school year, just over 13% girls did so as they were required for house work and a lmost 7% did so as they were married off even though child marriage is illegal. When it comes to paid work, the percentage of boys who dropped out for work is higher when compared to girls. A total of 21,851 girls and 20,084 boys had dropped out of school before the 2019- 20 school year.

How does child marriage affect education in India?

Child marriage ends childhood.  It negatively influences children’s rights to education, health and protection. These consequences impact not just the girl directly, but also her family and community.

A girl who is married as a child is more likely to be out of school and not earn money and contribute to the community. She is more likely to experience domestic violence and become infected with HIV/AIDS. She is more likely to have children when she is still a child. There are more chances of her dying due to complications during pregnancy and childbirth. Estimates suggest that each year, at least 1.5 million girls under 18 get married in India. Nearly 16 per cent adolescent girls aged 15-19 are currently married.

While the prevalence of girls getting married before age 18 has declined from 47 per cent to 27 per cent between 2005-2006 and 2015-2016 it is still too high.

The significant progress in the reduction of child marriages in India has contributed to a large extent to the global decrease in the prevalence of the practice. The decline may be the result of multiple factors such as increased literacy of mothers, better access to education for girls, strong legislation and migration from rural areas to urban centres.  Increased rates of girls’ education, proactive government investments in adolescent girls, and strong public messaging around the illegality of child marriage and the harm it causes are also among the reasons for the shift.

How does child marriage affect health?

A girl who marries early is more likely to give birth before her body is ready, presenting complications that will jeopardize her health for the rest of her life.

Impact of child marriage on Indian economy

Due to dropouts because of child marriage  many students lose opportunity to earn money and raise economy of India. Child marriage negatively affects the Indian economy and can lead to an intergenerational cycle of poverty. Girls and boys married as children more likely lack the skills, knowledge and job prospects needed to lift their families out of poverty and contribute to their country’s social and economic growth. Early marriage leads girls to have children earlier and more children over their lifetime, increasing economic burden on the household.

Child marriage is estimated to cost economies at least 1.7 percent of their GDP. It increases total fertility of women by 17 percent, which hurts developing countries battling high population growth. As per IRCW study, the welfare benefit in ending child marriage is estimated to be $22.1 billion globally in the first year (2015). This number increases to $566 billion annually by 2030, for a cumulative welfare benefit of more than $4 trillion. Considering how one out of three such marriages happen in India, this impact is huge on India. Decreased household sizes would lead to an increased availability of funds which then could be used to pay for food, education, health care and other expenses for other members of the household.

Child marriage and mental health

Five of the studies included in our review estimated the effect of child marriage on various aspects of mental health. These studies relied on cross-sectional data collected from Ghana, Iran, Ethiopia, Niger and the United States. Women in the United States who married before the age of 18 were more likely to report experiencing a wide range of mood, anxiety, and other psychiatric disorders in adulthood when compared to those who married at later ages .The authors of a small study from a single county in Iran found that women who married as children reported more depressive symptoms than those who married at the age of 18 or older .John, Edmeades, and Murithi examined the relationship between child marriage and multiple domains of psychological well-being in Niger and Ethiopia . The authors found that marriage before the age of 16 was correlated with poorer overall psychological well-being, but no evidence that marriage between the ages of 16 and 17 was associated with poorer outcomes when compared to women who married at the age of 18 or later . In Ghana, child marriage seemed to protect against measures of stress. The Ghanaian study also found no indication of differences in levels of social support between women who married before the age of 18 and those who married after their 18th birthdays, though these odds ratio estimates were very imprecise

How to stop it ?

Contact a women cell of local police. ...

File for Domestic Violence under PWDW Act. ...

Contact National commission for women. ...

Contact a lawyer. ...

Suit for annulment of marriage in district court or family court.

What to do if you do not live in India?

If you want to help kids in India and stop child marriage you can donate to our organization and we will do everything we can to stop child marriage in India

HEEALS organization

We believe that by starting small and working with one community at a time, we can begin to make changes that will spread gradually throughout India, all the while working hard to create and maintain a self-sustaining society. We aim to facilitate the fulfilment of the millennium development goals, set out by the United Nations, by ensuring that every household in India has unimpeded access to proper WASH facilities.

Heeals was built by a core team of committed executive committee, the member and staff member, who collectively have extensive experience in rural, urban and social development in India. Most of the founding staff is working voluntarily or semi-voluntary.

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Written by Kenenbaeva Janyl

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Used resources:

https://timesofindia.indiatimes.com/india/girls-drop-out-of-schools-due-to-early-marriage-house-work/articleshow/92195487.cms

https://www.vowforgirls.org/aboutchildmarriage?gclid=Cj0KCQjwi7GnBhDXARIsAFLvH4lQXFqdBIWjUXs4wcnUnnKC3TWbL4I9EuP7is6CX3SoOpYH5bKARhkaAv84EALw_wcB

https://www.insightsonindia.com/social-justice/issues-related-to-children/child-marriage/impact-of-child-marriage-on-indian-economy/

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12707-x#:~:text=Women%20in%20the%20United%20States,at%20later%20ages%20%5B21%5D.

https://www.legalserviceindia.com/legal/article-3584-family-pressure-of-marriage-on-daughter-and-indian-laws-.html

Menstrual Health and Its Profound Impact on Mental Well-being

Menstrual Health and Its Profound Impact on Mental Well-being By: Bhavana Jala Nerella (Volunteer at HEEALS)

Menstrual hygiene management and practices among adolescent females in low and middle income countries pose significant challenges for girls, parents, society, and policymakers. The prevalence of menstrual-related problems among adolescent girls in India is a concerning issue, indicating socio-cultural and regional variations. These menstrual abnormalities and disorders have wide-ranging effects on physical, mental, social, psychological, and reproductive aspects, profoundly impacting the daily lives of adolescents and their families. In this article, we explore the intricate relationship between menstrual health and mental well-being, shedding light on the critical need for awareness, education, and access to menstrual hygiene products. 

Here are some examples of unhygienic menstrual practices:

1. Using cloth or rags instead of sanitary pads or tampons: This can lead to inadequate absorption, prolonged moisture exposure, and an increased risk of infection.

2. Reusing menstrual materials without proper cleaning: Repeated use without proper washing and disinfection can introduce harmful bacteria and increase the chances of infection.

3. Improper hand hygiene: Failing to wash hands before and after changing menstrual materials can introduce harmful bacteria and increase the risk of contamination.

4. Lack of proper disposal: Improper disposal of used menstrual materials, such as flushing them down the toilet or throwing them in open areas, can lead to environmental pollution and hygiene concerns.

5. Insufficient personal hygiene during menstruation: Neglecting personal hygiene practices, such as not washing the genital area or changing menstrual materials frequently, can increase the risk of infections and discomfort.

6. Using unsanitary materials for insertion or absorption: Inserting non-sterile objects, such as sticks or leaves, for absorption or makeshift tampons can introduce harmful bacteria and cause infections.

7. Belief in harmful myths and cultural practices: Some cultural practices, such as avoiding bathing or certain foods during menstruation, can contribute to unhygienic conditions and perpetuate harmful myths surrounding menstruation. 

A study conducted with a sample size of 471 college attending women revealed that period poverty, experienced by 14.2% of women, significantly correlated with depression. The findings showed a gradient effect, with higher rates of moderate to severe depression among women facing regular period poverty. Those experiencing monthly period poverty had a higher likelihood of reporting depressive symptoms (68.1%) compared to those who had any period poverty (61.2%) or no period poverty (43.4%).

Another study involving over 12,000 adolescent girls aged 10-19 in Uttar Pradesh and Bihar found a strong association between depressive symptoms and menstrual irregularities. Girls with mild, moderate, or severe depressive symptoms were more likely to experience menstrual irregularities compared to those with minimal depressive symptoms. The study also highlighted that the use of inadequate materials, such as cloth or other materials instead of sanitary napkins, further increased the likelihood of menstrual irregularities. Thus, poor menstrual hygiene practices contribute to both mental health issues and menstrual problems. Insufficient access to affordable menstrual products has detrimental effects on the mental wellbeing of young women. Globally, an estimated 500 million women and girls lack access to adequate facilities for menstrual hygiene management. In regions such as Bangladesh, over 80% of menstruating women resort to inadequate materials like old cloth instead of hygienic products like pads or tampons. This unmet need for menstrual products adversely impacts educational outcomes, contributing to school absenteeism or dropout rates. Efforts to combat period poverty and improve mental health should include increased access to affordable menstrual products. For example, the project led by BJP called Jan Aushadi Kendra has brought about a way to provide pads for 1 rupee which has benefitted lakhs of women across India. However, much more still needs to be done as many are unaware of this, access is difficult, and the quality is sacrificed at the expense of cost. 

Additionally, the stigma surrounding menstruation must be addressed through comprehensive education and awareness campaigns. Proper education and knowledge regarding good hygiene practices are crucial for both adolescent girls and their mothers, fostering a supportive environment and breaking the barriers surrounding menstrual health. The intertwined relationship between menstrual health and mental well-being necessitates action. Bridging the gap in access to menstrual hygiene products, promoting awareness, and providing education on menstrual hygiene practices are vital steps towards empowering young women. By addressing these issues, we can enhance the mental well-being and overall quality of life for countless individuals, ensuring that no one's potential is limited by their menstrual health challenges.

On a personal note growing up as a South Indian girl living in the duality of western values with a unique blend of orthodox values at home menstruation has posed a great impact on my life as a whole. Being ousted amongst family members and set in isolation during what I would consider the most vulnerable period of time for any women even more so as a growing adolescent. The further impact that has had on my mental health may seem small in a bird’s eye view however has had enormous impact on the way I’ve perceived the world. This time for is a very personal and tender time to be treated with some kindness, empathy, and consideration. I not only hope but deeply pray with a heavy heart that we as an entire country start to see a more sensible manner not for ourselves but for the happiness of all our daughters.

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References

https://pubmed.ncbi.nlm.nih.gov/30633137

https://www.worldbank.org/en/news/feature/2018/05/25/menstrual-hygiene-management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229495/

https://www.ircwash.org/sites/default/files/bnhbs.pdf

https://pubmed.ncbi.nlm.nih.gov/35422014/

MENSTRUATION: NOT ONLY A HEALTH ISSUE, BUT A HUMAN RIGHT DUTY

 

MENSTRUATION: NOT ONLY A HEALTH ISSUE, BUT A HUMAN RIGHT DUTY

- Carlotta Pagan

 

What better day than May 28 to break taboos? On this date, Menstrual Hygiene Day is celebrated, an occasion that began initially as a social media awareness campaign by a german non-profit organization and some social entrepreneurs with an attempt to make their message of peace go viral and ended up becoming one of the most important fulcrums for menstrual hygiene management awareness worldwide today.

 

 

Picture 1: School girls holding motivationalmotposterssaying “There are lot more to shame than periods” and “Menstruation is my power and pride”  for the Menstrual Hygiene Day event

 

Celebrated with street demonstrations, eccentric outfits, and bursts of color, it is an important reminder of how important it actually is for women around the world to be assured of functioning toilets, proper privacy, and the correct hygienic means to contain menstrual flow, and to realize how far we still have to go, in many countries, to achieve this basic rights.

 

The street demonstrations are often followed by public speeches, performances, art exhibitions, and movie screenings, all of which demonstrates how unity among people can be strength for a real change and those who can contribute with a small amount, are always welcome.

 

The choice of this date is certainly no coincidence: the month of May, the fifth month of the year, was chosen to represent the normal average length of menstruation, while the 28th of the month was thought to indicate the average length of a menstrual cycle.

 

 

Picture 2:Painting on newspaper sheet depicting menstrual pain and cramps in women without access to primary health care services made by Kurdish activist Zehra Dogan, Santa Giulia Museum, Brescia, Italy

 

As the posters for the 2023 occasion announce, the aim for this year is to“Build a world where no one is held back because they menstruate, by 2030”. A hope, perhaps, rather than a goal, if we consider the conditions in which most South-East Asian countries still find themselves today.

It is a dramatic situation. Another placard, which a young activist waves in her hands amid thousands of protesters in a Pakistan city, says “solidarity is needed”.

And it is true. Action is needed,as soon as possible, and above all, everyone's contribution is necessary. These are countries where there is a shortage of water, where primary resources are accessible to few, and where there are no adequate educational plans: most adolescent girls experience severe physical and psychological conditions during their menstrual cycle, triggered by premenstrual syndrome and other symptoms, and many of them, feeling uncomfortable compared to their male classmates due to lack of access to adequate infrastructure, are forced to drop out of school in a very early age.

In India, many taboos and popular beliefs related to the menstrual cycle and its alleged impurity do not give due vent to an unmanageable situation and they do not do justice to all efforts made for a healthy awareness. This makes not possible to celebrate such an important day, so animatedly, for the people.

 

 

Picture 3: Indian activist holding a picket sign against shortage of hygiene products and facilities in Kolkata, Indiaduring 2019 Menstrual Hygiene Day Celebration

 

 

 

 

The aim for the Menstrual Hygiene Day remains the same and there is a wide agreement on what people need for good menstrual health: safe private spaces where to change often sanitary products, good facilities with access to running water to wash themselves and clean their hands as well as appropriate garbage bins where to throw sanitary pads and materials once used.

The purpose is also to ensure that schools and public places will be capable to guarantee those services, so that adolescent girls will be more likely to attend classes during their menstrual period with more comfort and dignity and with less worries.

During Menstrual Hygiene Day, many global and national development polices also take action to provide investments, in order to prioritize menstrual health and, so, to eliminate period poverty, that is, a condition in which low-income women struggle to get hygienical products as well as a fair access to running sanitized water and sanitation services.

 

 

Picture 4: A school with no water and toilets in Delhi, India, 2016

 

Considering that menstruation is a physiological process and that menstrual health is a basic and fundamental right which deals with the ability for women and girls to take care of their body in autonomy, comfort and dignity, we at HEEALS can do nothing but fully support this day and the efforts of all the people who mobilizee very year to build a self-sustainable society, as well as express our immense gratitude to them, as we believe that even the smallest effort can ultimately bring about great change

In the meanwhile, we continue to strive for reach the people from marginalized communities and women in need through education and through the donation of dignity kits containing essential products, as hand- cleaning soaps, hygienical and sanitary products products and supplies.

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MENSTRUAL HYGIENE MENTAL HEALTH AND GENDER EQUALITY FOR BOY AND GIRLS

HEEALS organizes workshops on Menstrual Hygiene , Mental Health And Gender Equality For Boys and Girls in Gurgaon and NCR schools. In our Menstrual Hygiene and Adolescence lessons we included Boys and Girls . It is important for both to know about adolescence and physical changings that happen in their body during the period of puberty but also for the boys to be aware of changing that happens in the girls body, during adolescence, in particular about menstrual flow. It is part of the personal culture, to be conscious and not to tease. In the end of the workshop we distributed sanitary pads , menstrual hygiene and wash booklets and stationary items to children. With your constant supply of sanitary pads, soap bars and stationary items many children will access to basic hygiene and education materials.

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Menstruation Is Not A Problem , Poor Menstrual Hygiene Is...

A Global non-profit social advisory form FSG released a report that revealed 70% of the cases of reproductive diseases in India are due to poor menstrual hygiene. Women in rural areas often use dirty rags as a replacement for sanitary pads. 88% of women in India use alternatives like rags, ash, hay, or sand.  

Info -graphic by : Dr Nissy 

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Why Girls Dropout From School !

Helping Hands Are Better Than Praying Lips.

Did you know? Around 23 % of girls drop out of school every year in India due to lack of menstrual hygiene facilities including toilets or adequate disposal units for sanitary pads. Organizing Menstrual Hygiene Workshops and Giving Sanitary Pads To Girls and Women. Keep Supporting Our Work . We are Looking For CSR/Foundatins And Individual Philanthropists To Support Our PADS4GIRLS Project. Donors Please Contact Us +91- 7982316660 Email: communications@heeals.org Thank you

Why HEEALS Skill Development Center Is Important ?

Our Skill Development Center is for people in need: young girls. children and people from marginalized communities from our slums, in India. 

We are aware of the fact that socio-economical conditions of these people make their life miserable and entangled in poverty, especially because of the fact that they, lacking in basic skills, do not have access to skill-based jobs. 

We are trying to give our best contribute to give resources for these people and clarity in their thoughts, in order to help them build their future. 

 "Through Our Skill Development Center We Are Making The Present Of These Communities Better Than Their Past" -Gaurav Kashyap 

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Who We Are & What We Are Doing !

HEEALS Working in health education environment and livelihood projects in India. Being a grassroot NGO, we need Companies /CSR and Foundations support to make children and communities self empowered and aware.

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MENSTRUAL HYGIENE AND BALANCED DIET IN ADOLESCENT GIRLS IN UTTAR PRADESH, INDIA

MENSTRUAL HYGIENE AND BALANCED DIET IN ADOLESCENT GIRLS IN UTTAR PRADESH, INDIA - By Carlotta 

Menstruation is a periodic and cyclical shedding of progestational endometrium accompanied by loss of blood (1) and characterized by rise and fall of hormones. It is a normal physiological process that begins during the phase of the adolescence between the age of 11 and 14 years old. Normal menstrual cycle occurs every 28-35 days (with a physiological variation of 2-3 days) with an average loss of 30mL-80mL of blood. However, it may be associated with various symptoms occurring before or during the menstrual flow (2). This leads to an abnormal menstrual cycle and to several diseases connected to it. 

In India, the prevalence of menstrual diseases has been recorded as high as 85%-93% in total female population and it has been seen to be a disorder that mainly involves adolescents. In most cases, this affects the normal lifestyle of an adolescent, leading to a decrease of the quality of her life, to the loss of productivity and to innumerable psychological, physical and relational problems that may result to be debilitating. Before or during a period, girls often experience a general weakness and a deep sense of discomfort and feel so uneasy that they may not feel comfortable to go to school.

In general, health conditions, socioeconomic and nutritional factors play an important role in the duration and in the appearence of menstrual diseases. In this article we propose to take in consideration the role of a balanced diet in avoiding the main disases caused by menstrual flow.

A school-based descriptive study made on a population of 320 adolescent girls aged 14-17 years in Aligarh city (Uttar Pradesh) in the academic year 2017/2018 showed that main menstrual disorders prevailing in young girls are menstrual irregularities and pre-menstrual syndrome (PMS).

The prevalence of menstrual disorders was obtained through a menstrual questionnaire.

Menstrual irregularities are defined as missed, delayed or erratic periods or abnormal bleeding patterns. They include several diseases as infrequent menstrual periods which occur more than 35 days apart (oligomenorrhea); frequent menstrual periods which occur less than 21 days apart (polymenorrhea) and absent menstrual periods for 3 months continuously (amenorrhea).

In the population that was took in consideration by the first study, it was found that 12,8% of girls was affected by oligomenorrhoea, 22,2% of them was affected by polymenorrhoea and 21,3% of them by amenorrhoea.

In a more recent study, it has been recorded that almost 50% of adolescents in India have irregular menstrual cycle.

A persistent menstrual irregularity can increase the risk of incurring conditions such as iron deficiency anemia. Anemia develops when iron stores, which are needed for the production of proteins such as hemoglobin and for the proper functioning of red blood cells in distributing oxygen to tissues and in eliminating carbon dioxide, are reduced or absent. In a normal menstruation, about 3 mg to 30 mg of iron is lost.

As a result, these individuals are often weak, and they experience conditions such as headaches, prolonged migraines, fatigue and extreme exhaustion, hair loss, stress connected to a neurocognitive dysfunction and dizziness.

Premenstrual syndrome (PMS) is a heterogeneous set of physical and psychological changes, which are highly variable depending on the case. Premenstrual syndrome occurs 7-10 days before the arrival of the menstruation and improves or disappears completely a few hours after the onset of it.

The most common symptom is dysmenorrhea, that is defined as an acute and cramping pain which is manifested by spasms in the lower abdomen spreading to the back and thighs. The pain ranges from mild, to unpleasant, to severe and few adolescent girls require medical help (3).

Premenstrual syndrome affects the emotional sphere with mood swings, crying fits and hunger pangs accompanied by decreased concentration, confusion, depression and nervousness and the physical sphere with symptoms such as headache, breast pain and bloating.

Premenstrual discomfort is an important social consecuence that influences adolescent girls’ life in a major way and in numerous aspects, starting from a loss of school days due to a sensation of discomfort to a prolonged bed rest and a period of isolation, to a chronic sleep disturbance and decreased appetite.

Approximately, in 10%-40% of indian girls, this disorder has an impact on their school life and their lifestyle

(4).

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual disease and it causes extreme mood shifts that can disrupt school life and daily life. Main symptoms include extrem depression and a marked anxiety in addition to PMS common symptoms such as bloatting and periods of crying.

As in PMS, the symptoms begin to interfere with girls’ usual social functioning.

In comparison to PMS, it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

Previous indian studies have found a 20% prevalence of premenstrual syndrome in the general population and, among those with PMS, 8% had premenstrual dysphoric disorder associated with severe symptoms (5). Actually, in the menstrual questionnaire targeting a total 320 adolescent girls that we decided to take as a point of reference, the data revealed that premenstrual syndrome is the most common disorder with the majority of girls (71,3%) suffering from.

The causes of premenstrual syndrome are not fully known. Major contributing factors are thought to include low serotonin levels, a deficiency of magnesium and calcium, and hormonal fluctuations in estrogen and progesterone, in addition to alterations in response to these two hormones, which can cause transient water retention, that means an accumulation of fluids in the cavities of the body.

Calcium supplementation has a functional role in the relief of symptoms associated with PMS.

Impaired calcium metabolism leads to magnesium deficiency. Magnesium is a mineral and trace element essential for the maintenance of cellular homeostasis and it is important because it has an effective detensive action on the muscles of the uterus, improving spasm, with the consequence that it helps reduce symptoms related to dysmenorrhea. It also counteracts irritability typical of the premenstrual period and relieves water retention. An intake of magnesium is extremely helpful in the treatment of premenstrual syndrome. Its presence in foods is quite widespread, especially in vegetables.

Serotonin is a neurotransmitter found in the central nervous system and involved in the regulation of mood and behavior. In addition to acting as a mood stabilizer, serotonin allows one to live a balanced life by promoting a restorative sleep routine.

It is a substance responsible for the state of well-being, and its decrease in it in the body can affect women’ susceptibility, especially adolescents’ susceptibility, to PMS symptoms.

During a period, it is therefore recommended to consume foods that contain a generous amount of tryptophan, which is the aminoacid that contributes to the synthesis of serotonin, so as to counter mood disorders such as depression and anxiety.

Foods that keep serotonin levels high include eggs, fresh acid-set paneer, and salmon along with a serving of healthy carbohydrates such as basmati rice, oatmeal, and whole wheat chapati.

Therefore, there is a strict correlation between menstruation and a balanced diet. The more balanced and correct the diet is, the better are the chances of reducing the symptoms connected to the menstrual flow.

A balanced diet defeats fluid retention and, thus, it can alleviate or make the main symptoms of PMS disappear.

Diet is to be understood as a true lifestyle, that is, a set of healthy and correct habits, which put into practice on a daily basis, can exert a strong impact on the health both from a preventive and protective point of view (6).

As we mentioned, these elements (iron, calcium, and magnesium) play a key role in the management of symptoms related to PMS and irregular menstrual cycle, consequently they should be introduced in an appropriate amount by following a precise diet.

First of all, the water balance in the body must be rebalanced. In fact, hormonal fluctuations in estrogen and progesterone cause water retention in the lower abdomen, breasts and ankles, which causes a feeling of bloating, that can be aggravated by the other symptoms of PMS.

Since most PMS symptoms occur before menstruation, there are several ways to counteract fluid retention.

It is necessary to drink at least 2 liters of water daily (8 glasses of water a day) to ensure proper daily water intake and to expel salt and toxins from the body. Water is responsible for all the physiological processes that normally occur in the body, such as digestion, absorption of food, and the proper elimination of waste. However, water can also be introduced through other sources, such as fruits and vegetables. Fruits, vegetables, legumes and whole grains contain fiber, which are very important in maintaining bowel function and preventing constipation, which is one of the main consequences of water retention.

For instance, one can eat salad, fruit salad, one small cup of bhindi or kidney beans (rajma) and/or, as a beverage, natural tender coconut water.

Secondly, one needs to increase iron intake before or during a period to replace physiological iron loss during the menstrual flow. Iron is particularly bioavailable in certain foods, such as meat, fish, and legumes. In particular, fish is rich in iron, protein and omega-3 fat acids, so it is an excellent nourishment both to counteract a decrease in iron levels and to balance the ratio between omega-3 and omega-6 in the body.

The ratio of omega-3 to omega-6 in a healthy diet is 4:1, yet in India this ratio varies greatly between rural areas (6:1) and urban areas (38:1 to 50:1), a sign of a diet that is too unbalanced towards omega-6.

High circulating levels of omega-6 from a diet excessively rich in vegetable oils is another major cause of dysmenorrhea.

From a biological point of view, both omega-3 and omega-6 belong to the prostaglandin family; however, they have a antagonistic function, in fact omega-6 has a pro-inflammatory function while omega-3 has an anti-inflammatory function, so omega-3 counteract the action of omega-6 and are related to a reduction in inflammation levels and thus to a decrease in pelvic pain.

Increased omega-3 intake helps decrease menstrual pain and can balance mood and the feeling of sadness and nervousness typical of the days leading up to the arrival of a period.

It is recommended a diet that considers iron-rich foods, such as red meat or meatloaf dishes, as kofta, and fish curry.

Proper magnesium and calcium intake also has a defensive effect against PMS symptoms.

The introduction of calcium into the diet plays a key role in the relief of symptoms associated with premenstrual syndrome. Calcium is also important because it makes bones stay strong.

Among 99% of the human body's calcium is contained in the bones, where it is accumulated and stored. Nevertheless, small amounts of calcium are consistently removed from the bones, so they need to be refilled with calcium rich foods.

A research based on women taking 500 mg of calcium carbonate twice a day for 3 months found they had less fatigue, fewer changes in appetite and less depression than women with PMS who did not take the supplement (7). However, most of the times an appropriate diet is sufficient to promote adequate daily calcium intake in the body.

Most popular foods that provide calcium in the indian diet are dairy products, such as low-fat milk, cheese, paneer and in particular curd, which is one of the best probiotic, Mooli and Fresh fruit raita and Lauki ka raita, green leaf vegetables and sprouted moong beans.

Magnesium directly intervenes in the process of relaxing the smooth muscles of the uterus and reducing the levels of pro-inflammatory prostaglandins that usually stimulate uterine wall contractions and thus cause menstrual pain. It also contributes to the normal functioning of the nervous system, counteracting nervousness and depression, regulating mood and thus also increasing concentration.

Its presence and stability at the level of the body also makes it possible to regulate circadian rhythms, such as the sleep-wake rhythm, and to restore its balance.

The amount of magnesium that should be taken daily should be 240 mg up to 360 mg in an adolescent girl.

To maintain high and stable magnesium levels in the body, it is essential to have a healthy, balanced diet rich in grains, fiber, legumes and dark chocolate.

Magnesium intake during the menstrual cycle becomes most important when symptoms such as pain, headache, and migraine occur.

Serotonin is equally important and mainly affects mood swings. Some adolescent girls, in fact, as we have seen, may have such an intense hormonal imbalance that it can affect their daily lives and social relationships. Serotonin, also known as “the feel-good hormone”, is a neurotransmitter, levels of which can drop dramatically in the body as a result of hormonal changes in estrogen and progesterone that occur during or before the cycle.

Serotonin cannot be taken in through diet, but fortunately it is synthesized from tryptophan, which can be introduced through diet instead.

Serotonin mainly plays an active role in reducing mood disorders, and thus counteracting depression and anxiety, and promoting a restorative sleep routine.

The disappearance of sleep-related symptoms and adequate rest thus again promote increased levels of concentration in the girl.

Foods that are major sources of tryptophan are the yolks of eggs, dark green and leafy vegetables, pumpkin seeds and walnuts. In particular, it has been shown that the indian dish Besan Cheela helps converting food to energy and it helps in the serotonin synthesis which aids in reducing general fatigue.

One cup of tea or coffee per week are also recommended. In particular, coffee is one of the best and the most affordable boosters of serotonin (8). It is an ideal remedy to cure and reduce the feeling of unhappiness.

However, one must be very careful about the amount of coffee one drinks, in fact coffee increases one’s serotonin levels as long as one takes it, but once one stops drinking coffee, the effect will be exactly the opposite (9).

In the table below, we propose an ideal 7-days diet-chart that an adolescent girl with symptoms connected with menstrual irregularities and PMS should follow during and before a period.

Table 2: 7-days diet-chart sample for women suffering from PMS syndrome to follow during menstrual flow.

However, excessive and continuous caffeine intake can lead to overstimulation of the nervous system, resulting in increased mestrual pain, increased irritability and alterated mood, and, thus, having the opposite effect to that desired.

Caffeine is found in many beverages, such as coffee, tea, soft drinks and energy drinks. Therefore, one should decrease the intake of these drinks as much as possible during and before a period.

In general, one should reduce the intake of simple sugars and saturated fats from industrial foods that contain preservatives and have little nutritional quality because they are poor in micronutrients and macronutrients, including carbonated fizzy drinks, as well as snacks, chips, and ice cream.

Junk food, which has poor nutritional quality, can cause glycemic and energy imbalances, while salty foods, such as chips and snacks, worsen water retention, which is the accumulation of fluids in the extracellular environment within the body, resulting in menstrual pain.

In addition, socioeconomic conditions and urbanization may also contribute to the development of menstrual cycle issues, but not only that. A study conducted by Imperial College London (march, 2023) showed that adolescents growing in rural areas are showing a healthier growth trend (10) than those growing up in big cities, and especially, in city slums. This is cause of an improvement in sanitation, in nutrition and in healthcare in the rural areas, resulting in fewer nutrition defencies and malnourishment.

In contrast, in urban areas, the tendency to consume carbonated soft drinks and fast food in spite of fruits, vegetables, legumes, and healthy foods leads to a decrease in growth and an increase in obesity and menstrual cycle-related problems in children and in adolescent girls, respectively.

The risk is even greater if an individual, who previously lived in a rural area, decides to move to a densely populated city center.

Of course, this also varies greatly depending on the socio-economic conditions of a city. The degree of change in obesity and in pre-menstrual diseases, changes considerably between urban and rural areas if we consider middle-income countries rather than low-income countries.

For instance, the nutritional deficiencies of people living in a urban slum, an overcrowded residential area where unemployment rate is very high and equal to 60,61% in women and 21,02% in men (The Indian Express, november 2021), are highly prevalent especially in the children and iron deficiency is the most common among all (11). This is mainly due to the factor that the majority of adolescents living in slums are used to consume junk food and in particular hamburgers, that are in fact more affordable and cheaper than healthy food. As a consequence, it has been estimated that the prevalence of anemia in children aged 1–4 years (pre-schoolers), 5–9 years (school-aged children) and 10–19 years (adolescents) was 41%, 24% and 28%, respectively (12). The present study has established poor nutritional status and anemia to be often associated with common menstrual problems among adolescent girls from slum establishments (13).

In conclusion, we can say that menstruation is a physiological process common to all women, but that factors such as living and health conditions, as well as a nutrient deficiency and a poor and unbalanced diet, can affect its regularity and the occurrence of symptoms associated with menstrual pain.

Therefore, it becomes necessary to follow a diet that is varied in the intake of micronutrients and macronutrients, that aims to exclude carbonated beverages and junk food, and that adheres as closely as possible to that shown in Table 2, at least in the period immediately preceding the onset of menstruation, so as to restore the regularity of the menstrual cycle, to reduce anxiety and irritation, and to avoid abdominal cramps.

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