This guide is written for Nigerian women who want to be proactive about their health — not just reactive when something goes wrong. It covers what every woman should test at every age, what symptoms to never ignore, and how to use the healthcare system effectively. It is written by a doctor, for real patients, in plain language.
The Symptoms No Nigerian Woman Should Ever Normalise
Go to a doctor immediately for any of these:
- Bleeding after menopause (any bleeding 12+ months after your last period)
- Bleeding after sex (postcoital bleeding) — persistent or recurrent
- Severe pelvic pain that comes on suddenly
- A positive pregnancy test with one-sided pain
- A breast lump that appeared within the last 4–6 weeks
- Vaginal discharge that is green, blood-stained, or has an unusual smell AND is associated with fever or pelvic pain
The Biggest Cultural Health Problems for Nigerian Women
Period pain normalisation
"Period pain is normal — you must endure it." This phrase has caused more suffering and more delayed diagnoses of endometriosis, adenomyosis, and pelvic inflammatory disease than any other cultural norm in Nigerian women's health. Period pain that requires regular medication, causes you to miss school or work, or is worsening over time is not normal. It has a diagnosis. And diagnoses have treatments.
Cervical cancer ignorance
Most Nigerian women do not know what the cervix is, what cervical cancer is, or that it is preventable. The result: Nigeria kills 26,000 women per year from a cancer that a 15-minute clinic procedure can prevent. Every sexually active Nigerian woman from age 21 onwards should have cervical screening (VIA or Pap smear) every 3 years.
Fibroid acceptance
Fibroids affect 1 in 3 Nigerian women. In Lagos clinical practice, it is common to see women with fibroids the size of a 20-week pregnancy who have been told to "just manage it." Fibroids can be monitored when appropriate — but they should always be diagnosed, classified, and managed with a plan rather than ignored until they cause a medical emergency.
What to Test at Every Age
Ages 21–29
- Cervical screening (Pap smear or VIA) — from first sexual activity, or age 21
- STI screening (HIV, syphilis, gonorrhoea, chlamydia) — if sexually active with new or multiple partners
- Blood pressure — baseline
- Premarital screening (genotype, blood group, HIV, hepatitis B) — when considering marriage
Ages 30–39
- All of the above
- Pelvic scan — baseline to check for fibroids, ovarian cysts
- Hormonal assay (AMH, FSH, LH) — if planning pregnancy or experiencing irregular cycles
- Blood sugar (fasting glucose) — particularly if overweight or family history of diabetes
- Thyroid function (TSH) — if fatigue, weight change, or menstrual irregularity
- Breast examination — from age 35, annual breast ultrasound scan
Ages 40–49
- All of the above
- Annual breast ultrasound (perimenopausal breast tissue changes)
- FSH and oestradiol — if perimenopausal symptoms (irregular periods, hot flushes)
- Annual blood pressure monitoring
- Lipid profile — cardiovascular risk increases significantly in perimenopause
- HbA1c — diabetes risk rises with age and hormonal change
Ages 50 and beyond
- Cervical screening continues to age 65
- Annual breast ultrasound
- Menopause management — HRT discussion if indicated
- Bone health — calcium, vitamin D, bone density assessment
- Colonoscopy referral from age 50
- Annual blood pressure, HbA1c, lipid profile
Contraception — A Medical Decision, Not a Pharmacy Decision
Too many Lagos women choose their contraception based on what the pharmacy has available or what a friend is using. Contraception choice should be individualised — based on your medical history (particularly blood pressure, smoking, migraine history), your reproductive plans, your menstrual symptoms, and your preferences about hormones.
The combined pill is not appropriate for women with migraines with aura, uncontrolled hypertension, or heavy smokers over 35. The IUD is not appropriate for women with unexplained abnormal uterine bleeding (until the cause is identified). The Depo injection suppresses fertility for up to 18 months after the last injection — important information for women planning pregnancy soon.
The VIP Warning Signs for Nigerien Women
Based on clinical experience in Lagos, these are the presentations most commonly delayed or missed:
- Vulval itching for more than 3 months: Often assumed to be recurrent thrush and treated with antifungal cream repeatedly. Persistent vulval itching may be lichen sclerosus, a pre-malignant condition requiring diagnosis and steroid treatment.
- Irregular periods since the teenage years: Often labelled "normal" — frequently PCOS, which has lifelong metabolic implications beyond fertility.
- Chronic pelvic pain for more than 3 months: Often told it is "stress." Frequently endometriosis — the 7–10 year average time to diagnosis in Nigeria represents years of unnecessary suffering.
About the author: Dr. Chioma Ezenwachi is a Women's Health Physician at Mascot Healthcare, Akoka, Lagos, specialising in gynaecological primary care, reproductive health, and cervical cancer prevention.