KUALA LUMPUR, August 14 – The lack of menstrual health training for health care professionals is a contributing factor to period poverty, according to a recently released report by the Human Rights Commission of Malaysia (Suhakam) titled Towards Dignified Menstruation For All: A Human Rights Imperative.
The report cited a Malaysian study that assessed the level of knowledge, attitudes, perceptions, and practices among pharmacists regarding menstrual health. It found that menstrual health problems are not prioritised as much as other health concerns like diabetes or heart disease.
Suhakam’s report attributes this to the absence of clinical practice guidelines from the Ministry of Health (MOH). The lack of formal guidance creates a knowledge gap for health care professionals, including pharmacists.
According to the study cited in the report, pharmacists also require additional training on non pharmacological recommendations and culturally sensitive communication. This includes a stronger commitment to addressing menstrual health with the same urgency as other chronic conditions.
Treatment provided must be individualised and there is a need for affordable and accessible pain management solutions to ensure broader accessibility.
Pharmacists reported that analgesics commonly used for menstrual pain are in high demand, which highlights the need to improve access to timely, non-discriminatory medical care for women experiencing menstrual pain, ensuring they receive appropriate support without stigma or prejudice.
Emotional And Psychological Dimensions Of Menstrual Health
Suhakam’s report also delved into the emotional and psychological dimensions of menstrual health, noting that it was not only limited to physical well-being, but is also closely intertwined with mental and emotional health. However, these dimensions are often neglected or undermined leaving menstruators without adequate support systems.
This widespread dismissal of women’s pain and other health issues can be traced back to medical patriarchy, a system in which medical knowledge, decision-making, and authority have historically been male-dominated.
For centuries, medical discourse pathologised women’s reproductive systems (e.g. hysteria) and denied the legitimacy of their lived experiences. This legacy continues today in more subtle forms: longer wait times for diagnosis, lack of investment in menstrual and reproductive health research, and health professionals dismissing pain complaints as stress or anxiety, noted the report.
It also noted that societal expectations surrounding gender roles can significantly influence health outcomes, particularly in how women experience and recover from medical procedures. The report cited a 2003 study published in the Journal of the American College of Cardiology, which found that women did not recover as well as men from open heart surgery.
This disparity was not attributed to anatomical differences, but rather to socio-cultural factors. Men often received better post-operative care and support, while women were more likely to return quickly to domestic responsibilities such as housework, hampering their recovery.
Clearly, the implications of the gender pain gap extend beyond clinical oversight as it permeates many facets of women’s life including education, employment, mental health, and overall well-being.
Menstrual Health Provision For The Entire Life Cycle
When it comes to women’s health, attention should be given to their entire life cycle, said Dr Hannah Nazri academic clinical fellow in Obstetrics and Gynaecology at the National Institute for Health and Care Research (NIHR) in the UK. “I mean, we shouldn’t just be focussing on one era of a woman’s life. Women are not just here to have babies, but women go through different stages of life, from menstruating to having children and to menopause as well.
“A healthy menstrual health provision would involve knowledge, accurate timely age appropriate information about the menstrual cycle, the accommodation of facilities, and also health services and resources that are able to accommodate other menstrual issues like endometriosis or fibroids or PCOS (polycystic ovary syndrome),” she said during the online launch of the report last August 1.
Dr Hannah added that an inclusive, positive and respectful environment free from stigma and psychological distress where women feel free to talk about their issues during all phases of the menstrual cycle is also crucial in the provision of menstrual health.
Enduring Endometriosis
In Malaysia, in 2022, it is believed that up to approximately 350,000 women are affected by endometriosis, although doctors believe the figure to be higher due to under diagnosis, according to the report. Additionally, menstrual pain and related conditions like endometriosis, dysmenorrhea, premenstrual syndrome (PMS), and menorrhagia are often trivialised by society and health care providers.
Specifically, while endometriosis has been recognised as a medical condition since 1932, to this day, there is still no universally accessible or non-invasive method for definitive diagnosis.
Endometriosis is characterised by tissue that is similar to the ones lining the uterus, also growing outside of it, which can cause inflammation and the formation of scar tissues. It can result in severe pain during menstruation, sex, urination, and defecation, as well as result in infertility.
“There are no tests or clinically usable biomarkers for us to test for endometriosis aside from doing a diagnostic laparoscopy, although recent guidelines have shown that you can do an MRI,” said Dr Hannah, who is also the founding director of Malaysian Doctors for Women & Children.
“But what I’m trying to point out is for the last decades or so, if you want to diagnose someone with endometriosis, you have to do a very invasive surgery for the surgeon to visualise lesions, and this causes a huge gap – like six to 12 years before women are being diagnosed with endometriosis.
“In the meantime, they suffer from heavy and painful periods, and this has a huge impact not only on themselves, but on their family life and on their work life as well.”
Suhakam’s report cited a study that suggests that endometriosis can be indicated by moderate to severe dysmenorrhea that causes absenteeism from school or work. However, the cause of endometriosis is still a mystery and a cure remains elusive even as women continue to suffer as medications used to suppress the symptoms of the disease are not always effective.
Furthermore, while there are ongoing efforts to study the genetics and diagnosis of endometriosis, research that focuses on Southeast Asian women and their specific experiences and challenges are wanting and urgently needed.
Different Stages Of Menstrual Health
The report also called for attention to be given to awareness about the mental health of menstruators during premenstrual syndrome (PMS). According to a study conducted in Sibu, Sarawak in 2017, 44.3 per cent of women experienced PMS, marked by common symptoms like mood swings and irritability.
Apart from PMS, it is just as vital to acknowledge the mental and emotional challenges associated with perimenopause and menopause, which occur later in life, noted the report. These transitional stages are often accompanied by hormonal fluctuations that may result in anxiety, depression, brain fog and mood disturbances.
Despite their prevalence, these experiences are rarely discussed in public discourse or health education, leaving many women to navigate them without adequate support or information.
The report cited a 2024 survey of 2,000 American women, which revealed that many feel they are overly targeted with information about pregnancy and childbirth. When it comes to perimenopause and menopause though, they felt that information and resources were insufficient.
According to another survey in the US cited in the report, many women feel “scared” at the prospect of menopause because of the dearth of discussion and education about it, and this perpetuates the taboo associated with this life stage.
As Malaysia is set to be an aging country by 2040, it is crucial to acknowledge that the rate of mature women’s participation in the paid workforce will increase. This shift underscores the significance of understanding and addressing the health challenges faced by women as they age, noted the report.
A study presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2021 found that women who entered menopause by the age of 40 had a 40 per cent increased risk of developing coronary heart disease over their lifetime compared to women who did not undergo early menopause.
The report also cited neuroscientist Lisa Mosconi, who studied menopausal women’s brains using fMRI scans for her book The Menopause Brain. According to the book’s website, it reveals “how menopause doesn’t just impact the ovaries — it’s a hormonal show in which the brain takes center stage.
“The decline of the hormone estrogen during menopause influences everything from body temperature to mood to memory, potentially paving the way for cognitive decline later in life.”
Policies For A Comprehensive And Gender Responsive Health System
In order to work towards a comprehensive and gender responsive system, women’s health must be prioritised through the life course approach, Dr Hannah said. The life course approach aims to ensure people’s well-being at all ages by addressing their needs, ensuring access to health services, and safeguarding the human right to health throughout their lifetime.
“We can think about maybe endometriosis friendly employer and menopause friendly employer schemes. Aside from just thinking about free menstrual products in schools and educational institutions, we can talk about menstrual leave,” she continued.
“But what about pregnancy loss leave and those undergoing fertility treatments? Perhaps much more controversially, offer state subsidised egg freezing to eligible women. For example, women undergoing chemotherapy.”
She added that it was also crucial to invest in infrastructures, training of medical professionals and world class research in Malaysia.
Economic Costs Of Neglecting Women’s Health
Furthermore, Dr Hannah said studies have shown that initial investments to address inequalities are modest compared to the long-term costs of neglecting women’s health.
“The Royal College of Obstetricians and Gynaecologists have released a survey alongside 48 other women’s health organisations. What they found is that the under-investment in women’s health is not just happening in Malaysia, it happens across the world.
“And just to give you an example here, the economic benefit of investing in women’s health includes that every £1 (RM5.70) spent on women’s health hubs yields an estimated £5 (RM28.50) in benefits.
“The NHS Confederation analysis has also established that every additional £1 (RM5.70) invested in obstetrics and gynaecology services per woman could deliver £11 (RM62.71) in return amounting to £319 million (RM1.82 billion) in economic value.”
In a nutshell, the price to pay for disregarding women’s health is significant.
In its report, Suhakam said that addressing this issue requires restructuring medical training, investing in gender specific health research, and creating a health care environment that validates, listens to, and believes women.
