Adolescence, the age group of 10-19 years as defined by WHO and a period of transition from childhood to adulthood [1]. Menstruation is the process of shedding of endometrial layer of the uterus through the vagina under the influence of hormones. The onset of menstruation, an important milestone and a natural phenomenon unique to females, is one of the most critical changes is termed menarche [2]. Until now, menstruation has been regarded as unclean or dirty in rural and uneducated parts of Indian society.[3]. There are various myths, misconceptions and restrictions related to menstruation, because of which adolescent girls develop a negative attitude towards this natural physiological phenomenon [4,5]. Although Adolescence is a healthy period of life, the bitter truth is that despite sex and health education in the school curriculum, many adolescents are less informed, experienced & not comfortable in accessing reproductive health information & services compared to adults [6,7,8]. In many rural parts of the developing countries, a culture of silence surrounds the topic of menstruation & related issues as a result of which many young adolescent girls lack appropriate & sufficient information regarding menstrual hygiene and develop a negative attitude towards this physiology, the impact of which may result in incorrect & unhealthy behaviour and practices during their menstrual period leading to acquiring various reproductive tract infections like PID and STI of which infertility may be the worst consequence[9]. This is a common scenario in rural areas as many uneducated mothers/informants themselves lack correct information & skills to communicate about menstrual hygiene, which they pass on as unscientific knowledge to their children leading to false attitudes, beliefs & practices in this regard. Therefore interventional studies are needed to break the silence, as there are very few studies done in Madhya Pradesh regarding this issue of menstruation and its hygiene.

Study Design: Cross-sectional & Prospective interventional study

Study Period: March 2018 - August 2019

Study Area: Govt. Schools of Jabalpur

Inclusion Criteria:

Fallowing tables depict results.

Table 1: Socio-demographic characteristics of adolescent school girls of government schools of Jabalpur

Table 1shows that the majority of girls interviewed are of age group 11-13 years are the residence of rural area and of lower socioeconomic status with mothers having education up to primary school in 70.5% cases and most of them had family income 2000-4000 per month.

Table No 2: Knowledge about menstruation physiology

Table 2 shows that most girls have known that menstruation is a physiological process 72.8% in the pretest, but their count increases to 76% further after health education. They have poor knowledge about the source and type of blood, only 24.8% of girls knew that source of blood is the uterus, and 29.5% of girls knew that bleed coming is pure, both of which increased significantly after

Table 4 shows that the most prevalent myth is not to visit the temple during menstruation is 78.5% which decreased to 68.55 % in the post-test. When talking about diet and exercise, mixed views came,31% said yes to exercise whereas 31.3% don't know what to do precisely whereas most of the girls were confused about for balanced and light diet, these misconceptions were cleared after training. Similarly for diet also there were mixed views,47% were on a soft diet, and 46.3% were on a balanced diet, this notion about diet was also corrected after health education.

In my study, in the pretest, only 24.8% knew that uterus was the source of blood; 73.8% of the girls started understanding that the uterus is the primary source of blood after education was imparted to them. This study is similar to a survey done by DipaliNemade, Seema Anjenaya in Navi Mumbai in 2009, Organ from where the blood comes correctly was reported as uterus by 33.64% [4]. In a study conducted by Adhikari P et al., 25.3% of girls reported the uterus as an organ of bleeding [6].In a study done by SP Singh et al. among adolescent girls of Varanasi, 43.5% said the uterus is an organ for menstruation[7]. A more significant proportion (72.8%) of respondents knew that menstruation is a normal body phenomenon.

Several other restrictions are also followed, like in Studies done by Ray Sudeshna and Dasgupta, Aparajita in rural secondary schools of West Bengal restricting sour food 80% & not visiting temple have been most common restriction observed by girls[13]. And in some countries, myths are of different types. In a study done in Alexandria, Egypt, about 25% of girls avoided bathing during menstruation because cold shower causes retention of blood & hot shower leads to an increase in bleeding.

While the supposedly civilized, educated and progressive urban India is still debating the topic of menstruation and the associated stigma, breaking the mould in rural and urban underprivileged areas is far more challenging. This resistance has to be braked by providing health education regarding menstrual physiology and hygienic practices in adolescent school girls. The policymakers and stakeholders should include it in the school curriculum.

Education about menstrual hygiene through audiovisual aids, when imparted in school going adolescent girls, has shown significant improvement in knowledge.