By Maryam Umar
The CBT centre at Usmanu Danfodiyo University Sokoto (UDUS) was crowded and humid when Fatimah Umar(Pseudonym), a 400 level student of the university arrived for her examination. She clutched her stomach trying to stand up straight, despite the sharp, persistent pain radiating through her lower abdomen–the kind that announces itself every month with her menstrual cycle.
It was examination week. Fatimah’s usual relief from dysmenorrhea, the medical term for severely painful menstruation, is medication paired with adequate rest. But rest was not an option ; it would mean sacrificing study time, which would result to bad grades or even total failure. So she had taken nothing.
Fatimah joined the queue, an hour passed, then another. She watched a male student near the front tell a supervisor he was unwell and he was allowed to skip the line.
“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,”
Fatimah took her exam, returned to her hostel and lay on her bed for the rest of the day, not because she had chosen to rest, but because her body had run out of options. She didn’t make complaints, nor ask for accommodation. Fatimah simply did what she had learned to do, she endured.
Fatimah is not alone in this silence. A survey conducted by this Reporter among 100 female students from UDUS shows that 95.8% of the respondents experience painful menstruation. Yet, only 21.9 percent had ever reported it to a lecturer or examination supervisor. Of those who remained silent, 50 percent were not comfortable with complaining due to fear of stigma, 35.7 percent didn’t think it would make a difference and only 12.9 percent reported and got fair responses.
The numbers point to a structural failure that extends well beyond any individual experience. Across Nigerian campuses, menstruation is treated as a private inconvenience rather than a legitimate health concern. For students experiencing severe menstrual pain, that framing carries real academic consequences: missed examinations, unsafe self-medication, declining grades, and significant emotional distress.
A MEDICAL CONDITION, NOT AN INCONVENIENCE
Severe menstrual pain is not a matter of low pain tolerance. It is a recognised gynaecological condition. Dysmenorrhea, characterised by painful uterine cramping before and during menstruation is among the most common complaints among adolescents and young women worldwide.
Dr. Olawale Shittu, a gynaecologist specialising in fertility and reproductive health, in an interview with this reporter said that the condition is widespread in Nigeria. “Dysmenorrhea is a very common gynaecological complaint amongst adolescents and young adults, with more than 70 percent prevalence,” he said.
Dr. Shittu also noted that the menstrual cycle is regulated through the hypothalamus-pituitary-ovarian axis, a hormonal feedback pathway controlled by the brain. Disruptions to this system, including chronic sleep deprivation of the kind that defines examination periods can worsen symptoms, leading to heavier or prolonged bleeding, delayed ovulation, irregular cycles, and increased pain severity.
In other words, the academic pressure that makes students reluctant to rest during exams may itself be making their menstrual symptoms worse.
For Aishat Gazali, a final-year student at Kwara State University Malete, every menstrual cycle is a negotiation with her own body. Her symptoms are severe: intense abdominal cramping, nausea, vomiting, and, when the pain becomes too much, fainting.
During one continuous assessment test, she went to school on an empty stomach, knowing that even water could trigger her nausea. She sat in the classroom and waited for the lecturer. The pain intensified. She bore it. Then, minutes before the test was due to begin, she 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.”
Aishat did not inform the lecturer because she had already seen what happened when a classmate tried. During a previous examination, a fellow student told a supervisor she was in pain. But she 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”
Aishat passed the course, but her grade suffered. In subsequent cycles that fell during exam periods, she began taking medication, despite being warned of the health risks. The grade, it turned out, mattered more than her health.
Oseni Aminah, a final-year Linguistics student at the University of Ilorin, describes the cognitive dimension of the problem. When her cramps are at their peak, she cannot hold information. She reads the same paragraph repeatedly without retaining it. Her memory slows. Her concentration fractures.
“I was sweating, nauseous, and constantly shifting in my seat,”she recalled of one lecture she eventually had to leave. “I felt frustrated because I really wanted to stay and learn, but my body wouldn’t cooperate.”
During examinations, she faces an additional anxiety: the fear of staining. Asking for a bathroom break is a risk she is not willing to take. Not because the rules prohibit it, but because she hates the attention that would draw to her. So instead, she endures.
“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
For Maryam Hassan (pseudonym), also a student at UDUS, the pain has become resistant to standard doses. Her response has been to increase both the frequency and the quantity of the over-the-counter painkillers she takes, a pattern she continues despite knowing the risks, because examinations leave her no other choice.
The consequences have been physical. Her menstrual flow has grown heavier with prolonged drug use. Her pad consumption has increased from roughly ten to fifteen pads per cycle, straining a budget that was already tight.
Dr. Shittu was direct about the dangers. “Constant unsupervised usage of over-the-counter painkillers over a long period can lead to serious complications,” he said, including gastritis, peptic ulcer disease, and gastrointestinal bleeding—all associated with prolonged NSAID use of the kind that ibuprofen, diclofenac, and naproxen represent.
The irony is that proper management of dysmenorrhea is possible. “The ideal way to manage menstrual pain,” Dr. Shittu explained, “is to seek medical help, where proper evaluation would be carried out to ascertain the cause and appropriate pain management put in place.”
But seeking medical help requires time, money, and an institutional culture that treats menstrual pain as a legitimate reason to miss class or defer an examination. On most Nigerian campuses, none of those conditions reliably exist.
Maryam’s situation also illustrates a dimension of the problem that extends beyond pain management. She cannot always afford adequate sanitary products. And even when she can, the campus infrastructure she depends on to manage her period safely has largely collapsed.
Maryam has changed her pad behind a building on campus because the nearest restroom was unusable, despite being worried that someone might walk past.
This reporter conducted a firsthand assessment of the restroom facilities available to students across the UDUS main campus. Eleven restrooms were identified at the school mini mart, Faculty of Arts and Islamic Studies, Faculty of Law, Academic mosque, and STB Hall. Three were permanently locked. Of the eight that were accessible, none were functional or 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 place where students visits the most during school hours was padlocked precisely when students are present in the greatest numbers and most likely to need it.
The World Health Organisation defines period poverty as the inability to afford and access menstrual products. It affects an estimated 800 million women and girls globally each month, predominantly in developing countries. What the unavailability of usable restrooms in key areas on UDUS campus makes clear is that in the Nigerian campus context, period poverty is not only about cost —it is also about the absence of the most basic physical infrastructure required to manage menstruation with dignity.
THE INSTITUTIONAL RESPONSE
When these findings was put to the Dean of Students Affairs at UDUS, Prof. Umar Aliyu, he acknowledged that the receptiveness of menstrual health complaints varies depending on which lecturer or supervisor is on duty. He, however, encouraged female students to notify the Students Affairs Division if pain during examinations becomes unbearable. “We will make sure to provide medical care and reschedule the examination for such a student,” he promised.
That offer, however well-intentioned, runs into a fundamental obstacle: 91 percent of students surveyed said they were unaware that any formal channel existed through which to report menstrual health emergencies to the Students Affairs Division.
The Student Union Caretaker Committee Welfare Director, Fatimah Zarah Muhammad, acknowledged the state of the campus restrooms. She said she could not promise the construction of new facilities but that efforts would be made to maintain the existing ones.
Karo Omu, founder of Sanitary Aid Nigeria — an organisation working to address period poverty across the country in an interview with Campus Reporter locates the problem at the level of institutional design. Examination schedules and attendance policies in Nigerian universities are built around what she calls a “neutral” student model: one that implicitly assumes a male physiology and makes no provision for conditions like dysmenorrhea, endometriosis, or anemia.
“Menstrual health is viewed as a private inconvenience rather than a public health and educational concern that directly impacts learning outcomes,” she said. “This gap reflects a broader issue.”
The effects, she argues, are cumulative and largely invisible. A student who attends class in pain but cannot concentrate does not appear in any dataset. She does not generate a formal complaint. She simply falls behind, in grades, in confidence, in academic progression, and the institution records nothing.
Dr. Hameed Adediran, Senior Programme Manager and Team Lead of Menstrual Health Initiatives at PSI Nigeria, frames the scale of the problem in precise terms. “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,” he said. “Menstrual stigma doesn’t just affect health. It affects education, mental well-being, and economic opportunities.”
Omu is careful to distinguish between what is ideal and what is workable. She is not advocating for expensive infrastructure overhauls. She is describing adjustments to existing systems.
Institutions could, she suggests, integrate menstrual health into existing medical excuse frameworks — allowing students to self-declare a limited number of days per term for menstrual-related absence, supported by campus health services rather than requiring a doctor’s certificate for a condition that rarely requires clinical confirmation. Flexible assessment options, alternative test dates, attendance waivers within defined limits could follow.
For any of this to work, she argues, three things must be in place. First, institutions must explicitly acknowledge in policy language, staff training, and student orientation that menstruation is a normal biological process that can, for some students, be debilitating.
Second, clear and confidential reporting pathways must exist and, critically, be communicated to students since the current situation, in which nearly all students are unaware such channels exist even at institutions where they nominally do, is as limiting as having no channel at all.
Third, partnerships with civil society organisations working on menstrual health education can help shift the cultural norms that underlie the stigma.
“When an institution is ready to pay attention to this, they can co-produce a solution with their student and staff body,” she said. “Addressing menstrual health is central to equity. 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 Umar eventually reached the front of the queue. She took her examination. The pain did not stop while she was writing. It did not stop on the walk back to the hostel. She spent the remainder of the day in bed.
She did not report what she had experienced. She did not even know there was a channel to do so. Fatimah did not believe, based on everything she had seen and heard, that it would have made a difference if she had spoken out.
What happened to Fatimah that day was not unusual. It was not exceptional. It was entirely ordinary. And that, more than any single case, is the point.