Several studies from India show that adolescent girls and women facing menstruation-related concerns and health problems often avoid visiting gynaecologists.

Menstruation is often considered a ‘woman’s topic’, and women hence tend to hide their symptoms and complaints from the male decision-makers in the house, which hampers their reproductive health. Large-scale studies suggest that menstrual disorders and reproductive tract infections among women often go untreated due to their inability to seek treatment on time.

Unhealthy habits lead to menstrual problems

According to the National Family Health Survey –IV, 62% of women in India use cloth as a menstrual absorbent. The problem is that the cloth is often stored in unsanitary conditions and is not washed properly during usage. Unsurprisingly, some areas such as Bihar, Chhattisgarh and Uttar Pradesh have an extremely high proportion of women using unsanitary cloths. The usage of unsanitary cloths is highest among women with no or little education, and among women in the lowest wealth quintile.

Doctors can break the silence

Doctors are uniquely equipped to tackle this topic at their own level, wherein they can build a dialogue with patients about reproductive health. It is indeed essential to discuss what a primary medical contact person (often a family doctor) can do to break the silence over menstruation and reproductive health-related complains. Any health problem associated with taboos needs to be handled with care and empathy by medical professionals.

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Important points highlighted in this article help us think of the possible ways in which Indian family doctors can help women initiate conversation on this sensitive topic and help them seek appropriate care at the right time.

Giving each patient time to open up about their concerns

It is essential to understand that women find it extremely difficult to talk about their menstrual or reproductive health-related complaints to a doctor with the awkwardness being much more if the doctor is male.

Instead of running through a patient's file quickly and hurriedly asking them about their present issues, it is a good idea to ask about their past complaints, present life stressors, and overall health, to break the ice.

Creating an environment of trust

A room crowded with interns (especially, the male interns) writing down notes while a patient is talking about her health might feel like a breach of privacy for the patient. A calm, well lit room with curtains, where a patient will be at ease to talk about her menstrual health is a must for initiating a comfortable dialogue.

It is advisable to take a patient’s verbal consent in case assistants or interns need to be in the room to take a patient’s history. This creates trust in the patient’s mind.

The same rule also applies to the individual accompanying the patient. Doctors may kindly ask the patient if she is okay with talking about her complaints in the presence of the person accompanying her.

Understanding the subtle hints given by patients or their accompanying relatives

Women often avoid using direct words while talking about their menstrual symptoms. They may say it very subtly or may just hint at it. Doctors need to understand the patient’s psyche and language to be able to diagnose them for their real concerns.

Discussing various treatment options rather than enforcing them on patients

It is always advisable to respect a patient’s choices and rights and discuss with them the available treatment options for their concerns. Letting patients know what their symptoms mean is the essential first step.

Instead of jotting down the treatment on the prescription, it is best to discuss it with them and ask them if they have any questions regarding the treatment options. This increases the chances of patients in further seeking treatment.

Discussing side effects of prescribed medicines

Reproductive health complaints many times entails hormonal treatment. Prescribing hormonal pills without discussing their possible side effects may affect a patient’s trust. Patients often receive information from friends or actively search for it on the internet when they know that they are under hormonal treatment. They may get fearful of the information they find or may get into the trap of misinformation that may be harmful for their health. Hence, discussing all possible side effects and giving any possible tips in order to face these effects can be a useful strategy.

Discussing the need of follow ups (in case, advised)

Doctors can do their best to highlight the need of revisiting them, in case, needed. If this is not communicated clearly, patients often skip these essential visits.

Having educational aids at hand

Educational aids such as videos/charts/pictures can help doctors educate patients on sensitive topics such as menstrual or sexual health. This is especially important as health literacy can be poor even among well-educated patients.

Importance of body language while conversing with patients

A doctor’s body language should reflect their respect for the patient, their understanding of the nuances of their culture, their knowledge regarding a topic, and their ease of using appropriate local language words to educate patients better. Doctors should come across as confident, professional, and empathetic while dealing with women having menstrual/reproductive health complaints.

Working as a team

Family physicians do a great deal in educating and treating girls and women having menstrual complaints that can be easily treated. However, it would be highly beneficial to include gynecologists and other specialists in the treatment loop whenever the need arises.

A medical team working together for patient’s health can become trustworthy when all the relevant decisions are communicated to patients well in advance and derived only after receiving a patient’s consent.