By Maryam Umar
“I’d rather suffer in silence than speak up and risk being embarrassed.”
Fatimah Umar*, a 400-level student of Usmanu Danfodiyo University, Sokoto (UDUS), says it plainly, like a rule she has learnt to live by.
The CBT centre was crowded and stuffy when she arrived for her examination. Fatimah clutched her stomach to stand straight despite the pain radiating through her lower abdomen, the kind that comes with every cycle.
It was examination week. Her usual relief for dysmenorrhoea, the medical term for severely painful menstruation, is medication and rest. But rest meant lost study time, and lost study time meant bad grades or even failure. So she took nothing that day.
Fatimah joined the queue. An hour passed, then another. Near the front, a male student told the supervisor he was unwell and was let through.
“I didn’t speak up,” she recalled. “I don’t think menstrual pain would count as an excuse, and I didn’t want to be embarrassed in public.”
She wrote the exam, returned to her hostel and lay in bed for the rest of the day, not because she chose to rest but because her body had run out of options. Fatimah made no complaint and asked for no accommodation. She did what she had learnt to do: she endured.
Fatimah is not alone. In a survey of 100 female UDUS students conducted by this reporter, 95.8% said they experience painful menstruation. Only 21.9% had ever reported it to a lecturer or examination supervisor. Of those who stayed silent, half feared stigma, and 35.7%believed speaking up would change nothing.
Infographics showing the survey. Credit : Maryam Umar
These numbers point to a structural failure. Across Nigerian campuses, menstruation is treated as a private inconvenience rather than a legitimate health concern. For students in severe pain, that framing carries real costs: missed examinations, unsafe self-medication, falling grades and emotional distress.
A MEDICAL CONDITION, NOT AN INCONVENIENCE
Severe menstrual pain is not low pain tolerance. Dysmenorrhoea is a recognised gynaecological condition and one of the most common complaints among adolescents and young women.
“It is a very common gynaecological complaint amongst adolescents and young adults, with more than 70 percent prevalence,” said Dr Olawale Shittu, a gynaecologist specialising in fertility and reproductive health.
He added that disruptions to the hormonal pathway linking the brain and ovaries, including the chronic sleep deprivation typical of exam periods, can worsen symptoms: heavier bleeding, irregular cycles, more intense pain. The pressure that keeps students from resting may itself be making their symptoms worse.
For Aishat Gazali, a final-year student at Kwara State University, Malete, each cycle brings severe cramping, nausea, vomiting and, sometimes, fainting.
Before one continuous assessment test, she went to school on an empty stomach, knowing even water could trigger nausea. As the pain intensified, she held on until minutes before the test, then could not continue.
“I rushed out of the class because I felt like I’d die of suffocation if I didn’t,” she said. “And unfortunately, that test was my only chance to make up for my continuous assessment.”
She did not tell the lecturer because she had seen what happened to a classmate who tried. During an earlier exam, that student told a supervisor she was in pain and was told to stop pretending and submit her paper if she had nothing to write.
“I don’t want to put myself in such a situation,” Aishat said. “So I left the test instead.”
She passed the course, but her grade suffered.
For Oseni Aminah, a final-year Linguistics student at the University of Ilorin, the cost is cognitive. At the peak of her cramps she reads the same paragraph repeatedly without retaining it.
“I was sweating, nauseous, and constantly shifting in my seat,” she recalled of one lecture she eventually had to leave. “I really wanted to stay and learn, but my body wouldn’t cooperate.”
In exams, she fears staining and avoids asking for bathroom breaks. The rules don’t forbid it, she simply dreads the attention.
“Even simple accommodations, like allowing short breaks during exams without stigma, would make a big difference,” she said. “But I doubt that’s going to be possible.”
WHEN MEDICATION BECOMES THE ONLY OPTION
Maryam Hassan*, also a UDUS student, now takes over-the-counter painkillers more often and in larger quantities because the pain no longer yields to standard doses. She continues despite knowing the risks. Examinations, she says, leave her no choice.
The consequences are physical and financial. Her flow has grown heavier, and her pad use has risen from about ten to fifteen per cycle, straining an already tight budget.
Dr Shittu warned that prolonged, unsupervised use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac and naproxen can cause gastritis, peptic ulcer disease and gastrointestinal bleeding.
“The ideal way to manage menstrual pain is to seek medical help, where proper evaluation would be carried out to ascertain the cause,” he said.
But medical help demands time, money and an institution that accepts menstrual pain as a reason to miss class or defer an exam. On most Nigerian campuses, those conditions rarely exist.
A CAMPUS NOT BUILT FOR THEM
Maryam once had to change her pad behind a building during an exam because the nearest restroom was unusable, worried that someone might walk past.
This reporter assessed restrooms across the UDUS main campus. Of eleven identified at the school mini mart, Faculty of Arts and Islamic Studies, Faculty of Law, the academic mosque and STB Hall, three were permanently locked. Of the eight accessible, none was usable in any meaningful sense.
The Faculty of Arts and Islamic Studies restroom had broken doors and no running water.
The ones at the school mini mart were dirty, with no clean water or soap.
The academic mosque restroom, the one students use most during school hours, was padlocked at the very time they need it.
The World Health Organisation defines period poverty as the inability to afford and access menstrual products, affecting an estimated 800 million women and girls globally. At UDUS, it is also the absence of the basic infrastructure needed to manage a period with dignity.
THE INSTITUTIONAL RESPONSE
The Dean of Student Affairs, Prof. Umar Aliyu, acknowledged that how menstrual health complaints are received depends on which lecturer or supervisor is on duty. He urged students in unbearable pain to notify the Student Affairs Division.
“We will make sure to provide medical care and reschedule the examination for such a student,” he said.
But 91 per cent of students surveyed did not know any formal channel existed for reporting menstrual health emergencies to that division.
The Student Union Caretaker Committee Welfare Director, Fatimah Zarah Muhammad, acknowledged the state of the restrooms. She could not promise new facilities, only that efforts would be made to maintain existing ones.
Karo Omu, founder of Sanitary Aid Nigeria, in an interview with Pen Press UDUS locates the problem in institutional design. Exam schedules and attendance policies, she said, are built around a “neutral” student that implicitly assumes male physiology and makes no provision for dysmenorrhoea, endometriosis or anaemia.
“Menstrual health is viewed as a private inconvenience rather than a public health and educational concern that directly impacts learning outcomes,” she said.
The damage is cumulative and invisible. A student who sits in class in pain but cannot concentrate appears in no dataset and files no complaint. She simply falls behind, and the institution records nothing.
Dr Hameed Adediran, Senior Programme Manager and Team Lead of Menstrual Health Initiatives at PSI Nigeria, put the scale plainly: “If a girl misses school five days a month due to menstruation, that’s 60 days in a year. It’s enough to set her back academically.”
WHAT COULD CHANGE
Omu is not asking for expensive overhauls. She proposes adjustments to existing systems: folding menstrual health into medical excuse policies, letting students self-declare a limited number of days per term, supported by campus health services rather than a doctor’s certificate, and offering flexible assessment dates and attendance waivers within defined limits.
For this to work, she said, institutions must first acknowledge in policy, staff training and orientation that menstruation is normal but can be debilitating. Second, they must create confidential reporting channels and actually tell students about them, because an unknown channel is as limiting as none. Third, they should partner with civil society groups to shift the norms that sustain stigma.
“Addressing menstrual health is central to equity,” she said. “When female students are expected to endure physical pain as the cost of participation, it creates a structural disadvantage that reinforces gender disparities in academic outcomes.”
Fatimah eventually reached the front of the queue and took her exam. The pain did not stop while she wrote, or on the walk back to her hostel. She did not report what happened. She did not know there was a channel, and nothing she had seen suggested speaking up would help.
What happened to her that day was not exceptional. It was entirely ordinary. And that, more than any single case, is the point.
Editor’s note : Names of the interviewees have been changed to avoid stigmatization.