62.8% of Malaysian Schoolgirls Think Their Period Blood Is “Dirty.” A Doctor Who Built Malaysia’s First Children’s Gynaecology Unit Says That’s Exactly Backwards.

Episode 1 of the Sumberpakar podcast, with Dr Nik Sumayyah Nik Mhd Nor, Paediatric and Adolescent Gynaecologist, Hospital Tunku Azizah.

When Dr Nik Sumayyah surveyed 341 Malaysian schoolgirls at a menstrual health seminar in 2023, the numbers she brought back should worry every parent in the country. 62.8% of the girls believed menstrual blood is “darah kotor,” dirty blood. Only 8.8% could tell you what a normal cycle length actually is. Most of them learned what they know about periods from their mothers, who often pass the same myths down without meaning to.

Dr Sumayyah is not a random voice on this. She built the first Paediatric and Adolescent Gynaecology (PAG) unit in Malaysia, at Hospital Tunku Azizah, opened in July 2025. Her job, every single day, is to sit across from girls and their mothers and untangle what is actually happening in their bodies from what they have been told is normal. And what she sees in that clinic is that the silence around periods is not just uncomfortable. It is dangerous.

The case that set her on this path

Four years ago, on call at Hospital Sultanah Nur Zahirah in Terengganu, an 11-year-old girl was brought in rolling on the floor in pain, unable to urinate. She had never had a period. A scan found the reason: a collection of blood, 10 to 11 centimetres, trapped behind a blocked vaginal canal. Her body had been producing menstrual blood every month with nowhere for it to go.

It was an emergency. Dr Sumayyah’s consultant, Dr Roziana, walked her through the surgery hand over hand that same night, the first surgery Dr Sumayyah ever performed. When she came out to tell the mother her daughter was stable, the mother broke down in her arms and said she had been praying to Allah for a doctor who could help her child.

“I felt the gap,” Dr Sumayyah says of the years before that moment, treating cases she knew she didn’t have the training to handle well. That case is why the gap got filled.

What period blood actually is

Here is the myth-bust, stated as directly as she says it on camera: period blood is not dirty. It is one of the clearest signs your body is healthy.

Blood in general carries oxygen to your brain, your lungs, your heart, every cell in your body. Menstrual blood is the uterine lining shedding after the body prepares itself, every month, for a pregnancy that did not happen this time. “Bila kita period bukan bermakna kita ni kotor,” she says. “Bila kita period bermakna kita ni sihat.” When you have your period, it doesn’t mean you’re dirty. It means you’re healthy. It means your brain, your ovaries, your uterus, every part of the system, is working exactly as it should.

She walks through the actual mechanism on screen: the brain signals the ovaries, the ovaries release estrogen, the estrogen thickens the uterine lining, and if no pregnancy happens after ovulation, that lining sheds as your period. It is not a tap that turns on. It is a wall that thickens and thins, thickens and thins, every month, in balance.

What “normal” actually looks like, in numbers

Most Malaysian girls, and their mothers, have never been given a ruler to measure against. Dr Sumayyah gives one:

• A period should come roughly every month, because ovulation happens roughly every month.
• It should last about 5 to 10 days, occasionally up to 10.
• Pad changes: around 2 to 3 times a day. Leaking is possible but should not be constant, not every night, not every school day.
• Passing large clots regularly is not normal.
• Bleeding that runs 15, 16, 17 days, or stretches past a month without stopping, is not normal.
• Pain for a day or two that you can still function through, go to school, go to work, is normal. Pain that puts you on the floor for a whole week, that keeps a child out of school entirely, is not.

The line she draws matters more than any single number: a period should not stop you from living your normal life. If it does, on any front, that is the signal to see a doctor.

Why period pain actually hurts

Asked to describe period pain to someone who will never feel it, Dr Sumayyah reached for an analogy from her professor in Melbourne, Sonia Grover: it is like peeling the skin off a potato. The uterine lining thins and sheds, and shedding tissue causes inflammation. Then the uterus contracts to push that blood out through a narrow opening at the cervix, and that contraction is what produces the cramping pain, the same mechanism, she says, as squeezing air out of a balloon through a narrow neck, except what’s being pushed out isn’t air, it’s clotted blood.

Left untreated for years, especially when flow is heavy, that pain and inflammation can progress into endometriosis, a chronic condition where the pain no longer stops when the period ends.

The silence has a body count

Two cases from her clinic show what happens when heavy bleeding gets dismissed as normal.

A 12-year-old girl fainted at school after playing sports and climbing a flight of stairs. Her haemoglobin, the protein in red blood cells that carries oxygen, was 5. A healthy level for a girl her age is 12 and above. At 5, her body simply could not get enough oxygen to her brain.

Her father mentioned, almost as an aside, that she had been chewing ice non-stop for a month, and that he was buying two overnight packs of pads a month for her, more than double what’s typical. Both were signs he had noticed but never connected. Chewing ice, or in adults sometimes rice or ice cubes, is a recognised symptom called pica, the body’s confused attempt to compensate for severe iron deficiency. Neither sign, on its own, seemed alarming. Together, they were a girl bleeding out slowly enough that nobody caught it until she collapsed.

Dr Sumayyah’s own daughter showed a milder version of the same pattern: getting out of breath climbing the school stairs, avoiding PJK because running made her tired, not because she disliked sport. These are the everyday signs of anaemia that get chalked up to “budak-budak memang macam tu,” kids are just like that: constant tiredness, breathlessness on stairs, a racing heart with no clear cause, dizziness, pale fingertips instead of pink ones.

Her advice to parents is simple and immediate: look at your child’s fingertips. If they’ve gone pale instead of pink, and your daughter is going through pads fast, get a haemoglobin check done at any government clinic or GP. It is a basic blood test, available across Malaysia.

Istihadhah: when bleeding stops being a period and becomes something to treat

One of the clearest points in the episode, and one most families never hear explained clearly, concerns the religious side of prolonged bleeding. In fiqh, the maximum duration counted as haid (menstruation) is 15 days. Bleeding that continues past that point is classified as istihadhah, literally a medical disorder, not menstruation, and a girl in that state must resume praying, performing wudhu fresh for each prayer time.

In Dr Sumayyah’s clinic, this gets missed constantly, not because families don’t care, but because nobody connects the dots. A religious teacher flags that a student keeps missing recitation class week after week. The mother assumes it’s still just a long period. Nobody counts the days. Dr Sumayyah now gives every patient a physical period calendar to track exactly when bleeding starts and stops, because, as she put it, a girl bleeding for 21 days straight without treatment isn’t just uncomfortable. Left unaddressed, she may also be missing prayers she was never told she needed to make up, or missing prayers she didn’t need to skip at all.

Medically, the fix is often straightforward: hormone treatment or medication to control the bleeding, so a girl’s body and her prayers are no longer in conflict.

The reframe: what’s the wisdom behind it

Asked what the hikmah, the wisdom or purpose, behind menstruation is, Dr Sumayyah didn’t hesitate. For her personally, it’s rest. A built-in pause where she can step back from her prayer obligations and use that time differently, cook, exercise, catch a breath in a schedule that otherwise never stops.

“So I’m so happy to have period,” she says. It is also, she points out, a monthly sign of fertility, evidence the whole reproductive system is functioning. Her point isn’t that everyone has to feel that way. It’s that the negative framing, dirty, shameful, something to hide, is a choice, not a medical fact. “Sebenarnya bergantung pada diri kita untuk melihat sesuatu itu negatif atau positif,” she says. Whether we see it as negative or positive is really up to us.

What to actually do about period pain

Her advice is unglamorous and practical: rest when you need to rest, sleep when you need to sleep, take Panadol, it’s not shameful to need it. Beyond that, she points to inflammation as the root of most period pain, and to daily habits as the lever that moves it: a proper breakfast every day (an empty stomach changes your body’s pain threshold), fruit on the table at dinner, plain water, a balanced diet, and regular physical activity, whatever form that takes for you.

She’s direct about the stakes of ignoring this over the long term too. Body weight and reproductive health are closely linked; obesity disrupts hormones, worsens period problems, harms fertility, and is a major risk factor for conditions she is now seeing show up decades earlier than they used to. She has treated uterine cancer in a 26-year-old. A 30-year-old with a two-year-old child.

The bigger picture she’s watching

Toward the end of the conversation, Dr Sumayyah flagged a problem she says needs its own episode entirely: teenage pregnancy in Malaysia, which she puts at roughly 60,000 cases a year, alongside a rise in sexually transmitted infections among teenagers, driven in part by early exposure to pornography that most families are too uncomfortable to talk about directly. That conversation is coming in a future episode.

The one thing to take from this

If there’s a single line to leave a parent, or a girl, with from this episode, it’s this: a period is not something to be ashamed of. It is one of the clearest signals your body sends that it’s working. What deserves attention isn’t the period itself, it’s the signs that quietly say something is off: bleeding that won’t stop, pain that stops a normal life, fatigue that never lifts, fingertips that have gone pale. Those are the signs silence has been hiding. They’re worth a conversation, and if needed, a doctor.

Full episode available on the Sumberpakar podcast. Follow @sumberpakar for the rest of this week’s content from this conversation with Dr Nik Sumayyah.