Imagine spending nearly seven years of your life bleeding. Now, consider this: every woman, barring a medical condition, goes through exactly this.

Here’s the math: on average, a woman menstruates 456 times over 38 years — enduring pain, discomfort, and hormonal fluctuations every single month for four to seven days, sometimes even lasting up to 10 days. That’s seven years, give or take.

Moreover, research shows that three out of four women have experienced premenstrual symptoms including mood swings, irritability, anxiety, depression, fatigue, bloating, headaches, sleep disorders, joint or muscle pains, constipation or diarrhea, and appetite changes. Premenstrual syndrome (PMS) occurs one or two weeks before a woman is about to have her period.

And yet, something so natural — something half the world’s population goes through every month — is wrapped in stigma. We hesitate to admit the pain we’re in, afraid of being dismissed or judged. We’re still handed pads in hushed tones, slipping them into our bags like a secret. Even on television, a harmless ad triggers collective discomfort — everyone fumbles for the remote, flipping channels in a desperate bid to dodge a 10-second glimpse of sanitary pads on screen.

We are conditioned to stay silent. But this silence comes at a cost.

The weight of this stigma, combined with poor menstrual health education and period poverty, affects millions of people globally — especially in countries like Pakistan. Still, we’re expected to endure it quietly, as if menstruation itself is the problem, rather than the shame forced upon it.

It’s time we debunk the myths

Menstruation and puberty remain deeply entrenched taboos in South Asian culture, shrouded in myths that persist because open discussions are discouraged. Schools do not provide adequate education on these topics, leaving young girls uninformed and misguided.

While working on a project in public schools in Lahore, I witnessed firsthand how many mothers hesitate to discuss menstruation with their adolescent daughters — not out of neglect, but because they lack the language and knowledge to do so. Ideally, mothers should be a girl’s first source of guidance, yet most remain silent, forcing girls to seek information elsewhere — often from friends or unreliable sources, unknowingly getting caught in a cycle of misinformation.

The consequences of this misinformation are alarming. One common myth in South Asia discourages girls from showering during menstruation. A study conducted by the Nur Foundation in public schools in Lahore revealed that only 10 per cent of adolescent girls believe they should shower during their periods, and just 28pc actually do so. Now, imagine the risk of bacterial, fungal, and urinary tract infections when someone avoids showering for a week. But hey, let’s keep quiet about menstruation because silence is more important than living a healthy life, right?

Beyond this, period poverty remains a pressing issue in Pakistan. Many girls and women lack access to basic menstrual hygiene facilities at home, school, and work. Financial barriers and limited awareness force many to resort to unsafe alternatives, increasing the risk of infections and other health complications. The taboo surrounding menstruation ends up complicating a natural biological process — when we don’t talk about it, we miss out on the correct information needed for proper menstrual care.

Yes, it gets worse

There’s a more painful side to this — one that goes far beyond stigma. Menstrual disorders don’t just bring discomfort; they can severely impact lives.

Millions of women silently endure conditions like dysmenorrhea (cramps that strike before or during periods), amenorrhea (absence of menstruation for three months or more), and menorrhagia (excessively heavy or prolonged menstrual bleeding). Some battle oligomenorrhea (irregular cycles), Polycystic Ovary Syndrome (PCOS) — hormonal disorder causing irregular periods and ovarian cysts — and endometriosis (tissue similar to the uterine lining grows outside the uterus, causing pain and heavy periods).

Others struggle with PMS or its more severe counterpart, Premenstrual Dysphoric Disorder (PMDD), which deeply impacts mental health. Uterine Fibroids — noncancerous growths in the uterus causing heavy bleeding and pain — add yet another layer of suffering.

The World Health Organisation reports that PCOS affects an estimated 6pc to 13pc of reproductive-aged women. Up to 70pc of affected women remain undiagnosed worldwide. It is a chronic condition that cannot be cured and is one of the leading causes of infertility. In addition to infertility, it can also cause obesity, anxiety, depression, and unwanted hair growth which can lead to more social stigma for women.

Similarly, endometriosis affects approximately one in 10 women globally, yet it often takes years, sometimes up to a decade, of severe chronic pain before being diagnosed, typically through laparoscopy. The pain is described as excruciating, often likened to being repeatedly stabbed with knives.

Despite its high prevalence, the exact cause and a definitive cure remain unknown due to limited research on the condition. As a result, endometriosis is frequently misunderstood. To manage their symptoms and maintain a sense of normalcy, many women turn to frequent surgical procedures, hormonal treatments like birth control pills, as well as lifestyle and dietary changes.

Menstrual conditions and diseases have profound social, public health, and economic implications, in addition to causing pain, fatigue, depression, and anxiety for women. The World Economic Report highlights how “for every one woman diagnosed with a health condition, roughly four go undiagnosed.” The lack of awareness is not limited to women themselves, many medical professionals also lack sufficient knowledge of these conditions due to inadequate research on women’s health.

According to Imperial College London, less than 2pc of medical research funding is allocated to pregnancy, childbirth, and female reproductive health, underscoring a significant gap in healthcare priorities. Despite making up over half of the global population, this representation is not reflected in clinical trials or medical research. Still, we should not talk about menstruation because people around us are offended.

As we mark Endometriosis Awareness Month this March, I refuse to stay silent. I am an endo warrior — one of the millions who have endured years of excruciating pain, nausea, and dismissal by gynaecologists who labelled it as “just cramps”. It took over 15 years and a 10cm ovarian cyst for doctors to finally recognise that something was seriously wrong. But that was only the beginning of my ordeal. I’ve endured agonising stabbing pains in my uterus that no painkiller could remotely fix, undergone two surgeries in four years, faced countless emotional breakdowns, and confronted the devastating reality — there is no cure.

Endometriosis is more than just a ‘bad period’. It’s a chronic, life-altering condition that demands awareness, research, and action.

This March, I pledge to speak openly about menstruation, free from shame. It is time we demand better research, and healthcare policies around menstrual health. The cost of suffering in silence is simply too high.

Header image: created via generative AI