It was late night, and most people had gone to bed. Lydia Ansong, 16, was supposed to be sleeping. But, she was dozing intermittently as she watched her favourite telenovela. She could not sleep until she had performed the late-night ritual she had been directed to follow religiously.
The directive required her to collect urine from the entire family; her mother, father, two siblings and herself. The urine was supposed to be early morning urine and kept overnight. Lydia was to rinse herself with this urine every night before bed.
It was a horrid challenge to overcome, but that was the extent she was willing to go to ensure she had her menstrual flow.
After two nights, she could not keep up with it due to the stench that emanated from the urine, and, in tears, informed her mother of her inability to continue.
That ritual was supposed to be a solution to her predicament—the missing blood—a condition that had sent her mother roaming several pastors, herbalists, and doctors in desperation.
When Lydia turned 14, she noticed that most of her colleagues her age had started menstruating. She, however, waited for months and years without the sight of blood through her reproductive system.
Menstruation was not supposed to be pleasurable, considering the pains she saw some of her friends experience. It was her inability to experience the pleasure of being regarded as a fully-fledged woman that made her desire that kind of pain.
“Why am I not beginning to see signs that would make me feel like a woman?” she asked herself.
Lydia had developed breasts—firm and rounded. Just like any growing teenager, her curvy body was beginning to take shape. Yet the one thing she felt could make her carry a baby in her arms in the future was missing.
She was not only scared of being unable to bear a child. Rumours had it that the blood could clot and become fibroid or she could develop cancer.
The search for a remedy began with her parents. Then individuals recommended drugs which were supposed to help her menstruate, but there was not even a drop of blood.
During visits to the hospital, she was diagnosed of several conditions she cannot (and does not) want to recall because she does not want to relive that period of her life.
However, there was one moment in her life where she never forgets. The evening rituals she had to perform for six days. The ritual was a directive received from a pastor during one of her mother’s numerous visits to spiritualists to find answers to her condition.
As difficult as it may have been for her mother, she gladly accepted the outcome and allowed her daughter to have that freedom.
Lydia falls in love
The urine experience was supposed to end her search for a solution, but it did not. Lydia started having butterflies in her stomach when she met her better-half. The butterflies of love could not survive for long because desperation and worry subdued whatever feelings she had for her lover.
“What if I could not have a baby?” she thought.
Lydia did not have a menstrual cycle. She could not determine her safe period or follow the natural birth control method. She was not even sure she could conceive. That’s why the first year of her relationship surprised her.
“I got pregnant the very year I met my husband. Despite the fact that it was an unplanned pregnancy, I was not worried,” Lydia said.
After the baby was born, she only experienced a dark bloody discharge that very day. She was hopeful that her menstruation was going to take a different turn after childbirth; things remained the same.
With the support of her partner (they were not married at the time), she started visiting doctors again for answers. The visits all proved futile.
She was told on several occasions that the medications she was taking could make her flow, but it became a mirage. She kept trying until a particular doctor told her it could be genetic. This surprised her because her mother and grandmother had no such condition.
“My mum was not like that and I have two female siblings who are also not like that,” she recalled.
These notwithstanding, the fight to menstruate persisted.
In her desperate search for a solution, she took a herbal concoction purported to be a cure for her condition. She bled profusely and became unconscious. That situation broke the camel’s back, and Lydia accepted her fate.
In her last experience, a gynaecologist advised her against the use of any medication.
Twelve years after having her first child and two others through uncomplicated vaginal birth, she enrolled on family planning in early 2018.
Her first child, a girl, has already started menstruating. It ceased after the first month but continued flowing after about three months later. It has since been regular.
As a teacher, Lydia’s experience inspires her to educate young girls on reproductive healthcare.
Around the world, roughly half of the female population about 26 per cent are of reproductive age and are expected to menstruate each month from at least two to seven days. Menstruation is usually a sign of a healthy and possibly fertile woman, but Lydia Ansong’s condition has challenged that status quo.
“Menstruation” through the nose, mouth and palms
When Fedelia Oduro claimed she menstruated from her palm, she received a backlash from a section of the women in an all-female Facebook group. They accused her of peddling falsehood, reminding her of what she had had to deal with growing up.
She was just a young girl, frustrated by puberty, embarrassed by her awkwardness. She kept to herself.
Fedelia had been ‘shipped’ to live with her auntie and could not share her thoughts with her.
Then, one morning, while enjoying the cold splash of water trickling down her skin, she saw blood dripping down her legs. Naive and innocent, she shuddered.
Her younger sister, upon seeing blood, screamed and drew the attention of her guardian. It was then that it dawned on Fedelia that she had “become a woman”.
But that was for a month. She did not experience her flow again. She was gripped with fear, thinking she was pregnant because she was sexually active at the time.
The third month passed without any sign of blood or pregnancy. Instead, her palms reddened during that time of the month. If that was the only anomaly, she could have endured it without much apprehension. But there was more.
“There were times that I could actually see blood in my mouth and blood from my nostrils, and it was terrifying,” she told The Fourth Estate.
At age 21, Fedelia became pregnant, but she was still in the second year of senior high school. For six months, she hid the pregnancy from the stern and glaring eyes of her guardian, her Auntie. She was plump and could, under the guise of her size, mask the pregnancy which would become her blessing.
Her younger sister, once again, suspicious of Fedelia’s state due to their close-knitted relationship, confided in her mother miles away.
The secret was now blown, but Fedelia was ready to face the world. She carried her baby to term at the expense of her education.
Fedelia’s Menstrual Condition after Birth
The longest Fedelia has ever gone without menstruating was eight months. Even when she menstruates, it does not last more than two days.
“The blood is usually pink or darker than usual. I just want to be like any ordinary woman,” she bemoaned.
Her loneliness over the years heightened due to her condition. She became more reserved and wanted the world to be silent on her ordeal even though she wanted to be heard. She wanted a solution to it.
Several visits to herbalists, who gave her gallons of herbal medications for a solution, were to no avail.
“Herbalists just keep taking my money, but in actual sense they have no solution to my dilemma and the last one I visited proved me right. He kept saying one thing after another and took GH₵80 on each visit I made,” she recounted.
Eighteen years later, the child Fedelia had in senior high school remains her only child. At 39, she continues to hold on to her faith, hoping fate would someday smile on her and gift her another child.
Diagnosis and Management
Fedelia’s story comes as no surprise to Dr. Titus Beyuo, an obstetrician gynaecologist at the Korle-Bu Teaching Hospital.
“There is a phenomenon that can explain that,” he said, adding that endometriosis makes it possible for such an occurrence.
According to him, some women end up menstruating through their stomach or their lungs even though there may not be blood coming out of the vagina. In such situations, he indicated, blood is usually drained from these parts as a solution each month.
No known cause has been attributed to endometriosis, but retrograde menstruation has been diagnosed as a common factor in about 90% of women worldwide, according to research by the National Institute of Health under the US National Library of Medicine.
The retrograde menstruation is when blood flows back through the fallopian tubes into the pelvic cavity instead of the vagina. This blood flow, through other parts of the body apart from the vagina, could be described as endometriosis, Dr. Beyuo said.
Dr. Beyuo said the total absence of menstruation by a female is possible but rare. When such a situation occurs, there is the need to ascertain whether the person is genetically a woman. He explained that one may be genetically a man but may have female external appearance. He said, in cases where a woman has undergone hysterectomy (the removal of the womb) there would be no sign of menstruation.
Interestingly, Lydia’s case does not fall under any of these possible causes. Her three kids are proof of her fertility despite the absence of menstruation.
Dr. Beyuo, who is the Executive Secretary of the Ghana Medical Association, said he had never come across such a condition in his profession, but there was a possibility of such an occurrence. He was, however, hesitant in stating the exact cause without further examination of the individuals involved.
Meanwhile, a fertility specialist and consultant gynaecologist at the Medifem Specialist Hospital and Fertility Centre, Dr. Nana Henaku Larbi, has explained that blood from any other part of the body other than the vagina during the expected period of menstruation, can be termed as bleeding, and not necessarily menstruation. This, he said, maybe due to a pathological problem (the reduction of a person’s functional abilities below the usual).
He emphasized, “It means the cells which are found inside the womb are being found in distant places such as the nostrils, lungs and even in the brain so it’s a pathological problem which can happen.
“It is abnormal sometimes, but it can be explained. It is known as ectopic endometrial tissue” (When the hormones which control the menstruation are found in different parts of the body and are affected by the hormones causing bleeding).
Dr Larbi attributed some of these conditions to the delay in pregnancy by some women, which are mainly due to career options and advised against it.
“It is very common in people who delay their pregnancy for whatever reason. The system has been structured to produce babies every two years and once that reproductive system is not active, all sorts of diseases invade it.”
In such situations, he said, a biopsy is done and tested to find out if it’s superficial and medications are given to manage the condition. It is usually done to suppress the bleeding from the other parts of the body.
He said the problem is usually managed and, when pregnancy occurs, conception every two years could correct the problem. Most of these issues, he noted, are normally corrected during the menopausal stage.
“If there is a continuing pregnancy, there is a possibility that the hormones would be restored and the problem resolved,” Dr. Larbi said.
Having encountered a few situations like that of Lydia’s who has never menstruated, Dr Larbi said polycystic ovarian syndrome (PCOS), an inhibition of the egg produced by a female due to genetic factors, could be one of the major causes.
Even though PCOS is one of the commonest causes of infertility, the frequent visits to hospitals and interventions could have caused Lydia to ovulate, enabling her to become pregnant in the process, he said.
“She might have ovulated and gotten pregnant just before her menstruation,” he explained the only possible reason he could give for the three kids birthed by Lydia.
According to Dr. Henaku Larbi, there is always a medical explanation for these conditions and must not be termed as myths.
He cited an instance where a patient who had never menstruated was eventually diagnosed with premature ovaries after a series of tests.
In that situation, an IVF was done using the eggs of a donor to fertilize sperms from the husband of this patient. The couple is currently nursing triplets from this exercise.
He, however, cautioned persons with PCOS to seek medical attention since the disorder could lead to other complications and diseases such as diabetes in their old age.
After eighteen years of trying to get a child, Fedelia has eventually taken a seed.