Sanitation ‘secrets’ and menstrual hygiene management: what can perimenopausal women tell us?

An increasingly ageing population brings a rise in the number of perimenopausal women, who commonly experience changes and irregularities in their menstruation, which they wish to conceal from view and keep ‘secret’. The WASH sector has paid attention to the menstrual hygiene management (MHM) needs of adolescent girls, whilst the MHM needs of perimenopausal women are ignored. Using narratives provided by women in Ghana through oral history interviews, participatory mapping and PhotoVoice, and using a vignette method to engage stakeholders, this paper discusses how MHM during the perimenopause is affected by inadequate sanitation provision. Sanitary materials which fail to provide effective menstrual protection also raise related issues of access to sanitation, toilet and bathing infrastructure design, and the need for good solid waste management. The sanitation needs of menstruating perimenopausal women can be addressed through adapting existing hardware and software solutions.