Popular in Professional

Human Rights Law

Human Rights and Corruption: Problems and Potential of Individualising a Systemic Problem

Max Planck Institute Anne Peters

Law

A statistical approach to law school citation rankings

University of Virginia Joshua Fischman

Education

High school change

Boston College Andrew Hargreaves

Constitutional Law

What is constitutional ideology?

University of Oxford Nick Barber

Civil Procedure Law

Politics, Identity, and Class Certification on the U.S. Courts of Appeals

University of Pennsylvania Sean Farhang

Culture and Society

The City as a Growth Machine: Toward a Political Economy of Place

New York University Harvey Moltoch

Education

The Role of Education in Reducing Racial Inequality

University of Southern California Pedro A. Noguera

Menstruation: science and society

View more insights in Professional - Medicine - Obstetrics and Gynaecology

View more figures from University of Edinburgh

View the page of Hilary Critchley

Read the Study

Next in Medicine

Clinician care priorities and practices in the fourth trimester

Sylvia Guendelman | UC Berkeley

Seroprevalence of hepatitis B antibodies among international and domestic university students

Anita Heywood | UNSW Sydney

Women’s health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Hilary Critchley discusses the research gaps and opportunities in menstruation science.

Image courtesy of interviewee. April 4, 2024

Log-in or Sign-up to Faculti
Currently viewing this subject insight as a guest. You have insight(s) remaining for this month. Login to view 8000+ figures on the platform.

Generating Workspace...

Export as PDF

This video video discusses the importance of addressing menstruation as a taboo topic that has often led to the normalization of associated problems in society. It emphasizes the need for education about menstruation starting in schools for both girls and boys, recognizing it as a significant physiological process. The speaker highlights menstruation's impact on absenteeism in schools and workplaces, and the necessity of public resources to understand menstrual health.

Additionally, it details the physiological aspects of menstruation, including the roles of hormones such as estrogen and progesterone, and the complexities of the body's response to these hormones. It addresses the rising prevalence of issues like heavy menstrual bleeding (HMB) and uterine fibroids, which are often overlooked yet common in reproductive-age women.

This video video advocates for a multidimensional approach to menstrual health, framing it as a health and human rights issue rather than merely a hygiene issue. It calls for improving access to menstrual products, education, and healthcare, and stresses that menstrual health should be recognized globally as a priority. The speaker urges a cultural shift towards positive messaging around menstruation to combat stigma and enhance understanding, particularly in low- and middle-income countries, but also in higher-income nations. Ultimately, the text calls for more research into menstrual science to better address these vital issues.

Language:

Export as PDF

X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.185 --> 00:01.125
For far too long.

00:01.205 --> 00:04.485
Menstruation has remained a taboo topic.

00:05.075 --> 00:06.485
That means that the problems

00:06.485 --> 00:09.365
of menstruation are also not talked about.

00:10.115 --> 00:13.205
They are far too often normalized, not just

00:13.225 --> 00:16.125
by the individual, but by families in the workplace

00:16.665 --> 00:17.885
and by society.

00:18.185 --> 00:22.685
So I think it's well overdue that we bring attention

00:22.905 --> 00:25.285
to this really, really important topic.

00:26.025 --> 00:29.805
And we shouldn't forget that menstruation is an amazing

00:30.545 --> 00:32.605
and important physiological process.

00:33.125 --> 00:36.285
Menstruation, problems of menstruation are one

00:36.285 --> 00:39.885
of the reasons why time is lost from school.

00:40.505 --> 00:42.445
If you are a child or an adolescent

00:42.705 --> 00:45.485
or from the workplace, if you are an adult.

00:46.025 --> 00:48.845
And I think it's been recognized that we need

00:48.845 --> 00:51.645
to do a lot more around education.

00:52.025 --> 00:55.125
And this education should start early in schools.

00:55.465 --> 00:58.045
It should be for girls, it should be for boys.

00:58.665 --> 01:02.365
And I think there is a real, appetite,

01:02.545 --> 01:04.925
for the public to also have,

01:05.435 --> 01:07.885
well-informed sites they can go to,

01:08.345 --> 01:10.845
to learn about this natural process

01:11.825 --> 01:15.525
and understand what, drives it

01:16.145 --> 01:19.245
and what might happen when things

01:19.715 --> 01:22.805
with periods don't work out quite as you expect.

01:23.025 --> 01:25.725
And also to recognize what is normal

01:26.025 --> 01:29.565
and what may be out with the boundaries of normal.

01:29.865 --> 01:33.285
So huge amount more needed to be done on education

01:33.625 --> 01:35.325
and inflammation provision.

01:35.945 --> 01:38.965
It is the endometrium, the lining of the womb.

01:39.195 --> 01:40.645
That is what is bleeding.

01:40.745 --> 01:43.125
It is not the muscle of the uterus that is bleeding.

01:43.225 --> 01:45.485
It is the lining of the womb, the endometrium.

01:46.025 --> 01:49.325
And that is a site in the body that responds to two female

01:49.885 --> 01:54.245
hormones produced by the ovary, estrogen, and progesterone.

01:54.825 --> 01:56.525
So estrogen is the hormone

01:57.125 --> 01:58.965
dominant in the first half of the cycle.

01:59.985 --> 02:02.485
And progesterone, along with estrogen,

02:02.545 --> 02:04.125
but particularly progesterone,

02:04.225 --> 02:07.445
is the dominant hormone in the second half of the cycle.

02:07.865 --> 02:11.365
And that, hormone progesterone is the one

02:11.365 --> 02:13.965
that is important for the establishment

02:13.985 --> 02:15.525
and maintenance of pregnancy.

02:16.145 --> 02:20.085
Now, when you are not pregnant, the structure in the ovary

02:20.085 --> 02:23.325
that makes progesterone, that we call the corpus lutetium,

02:24.205 --> 02:27.765
declines it di it, you know, it, dies effectively.

02:27.945 --> 02:32.405
But in doing so, it means the levels

02:32.505 --> 02:36.965
of hormone, of progesterone circulating in the body fall.

02:37.585 --> 02:41.485
And it is that critical fall, the hormone progesterone,

02:42.095 --> 02:45.845
which is what triggers bleeding from the endometrium.

02:45.845 --> 02:49.485
Menstruation. And that will happen

02:50.245 --> 02:53.325
whenever you take hormone away from the lining of the womb.

02:53.505 --> 02:55.925
So when you're on the combined pill for three weeks

02:55.985 --> 02:58.525
and you stop it, you have a withdrawal bleed.

02:58.845 --> 03:00.365
'cause, 'cause you've taken hormone away.

03:00.985 --> 03:04.245
If you are on progestin based pills, perhaps

03:04.385 --> 03:05.765
to manage your periods

03:05.905 --> 03:09.045
and you forget one hormone is taken away

03:09.185 --> 03:12.725
and you can expect an unscheduled spotting a few days later.

03:13.345 --> 03:17.325
So it's really important that we understand that the lining

03:17.465 --> 03:21.685
of the womb has this really carefully coordinated exposure

03:21.785 --> 03:23.365
to estrogen, then estrogen

03:23.365 --> 03:25.765
and progesterone, progesterone withdrawal.

03:26.185 --> 03:29.645
And when that withdrawal happens, you trigger,

03:29.865 --> 03:31.085
in effect a wound.

03:31.505 --> 03:32.605
So the lining

03:32.605 --> 03:36.325
of the womb is an amazing physiological example

03:38.055 --> 03:42.315
of a wound that repeatedly injures and repairs each month,

03:42.895 --> 03:44.955
but incredibly without scarring.

03:46.215 --> 03:50.075
And I always use the analogy that if as a child

03:50.135 --> 03:53.035
or your own children, you fell on a gravel path

03:53.095 --> 03:54.275
and grazed your knee

03:54.275 --> 03:58.715
and you got a red raw surface on your kneecap, that's

03:58.715 --> 04:00.275
what the inside of the lining

04:00.275 --> 04:02.795
of the womb looks like when you menstruate.

04:02.815 --> 04:05.755
So it's got all the same features of an injured wound.

04:06.215 --> 04:10.115
You have white cells come in, you have inflammatory markers,

04:10.735 --> 04:14.915
sorry, mediators and products like prostaglandins.

04:15.175 --> 04:17.955
And that's why for four decades we've used

04:18.955 --> 04:23.475
nonsteroidal anti-inflammatories, which are prostaglandin

04:24.345 --> 04:28.435
syntase inhibitors to treat menstrual periods just

04:28.435 --> 04:30.155
for a few days at the time

04:30.215 --> 04:33.195
of menstruation can reduce menstrual blood loss.

04:33.815 --> 04:37.675
So it is a structure that has this,

04:37.945 --> 04:40.355
well coordinated both in space

04:40.415 --> 04:44.115
and time production of, if you like, a jigsaw

04:44.135 --> 04:46.155
of actions which have to come together.

04:46.815 --> 04:50.835
And if they come together correctly, your period will stop

04:51.175 --> 04:55.715
and it will last an expected, length of time.

04:56.335 --> 05:00.665
So it's when those pieces of the jigsaw become disordered

05:00.685 --> 05:05.195
or in their wrong places that we see prolongation

05:05.195 --> 05:07.475
of bleeding, excessive bleeding.

05:07.745 --> 05:09.875
Because if you're gonna stop your periods,

05:10.215 --> 05:11.315
you have to have three things.

05:11.495 --> 05:14.595
You have to constrict the blood vessels that are bleeding.

05:15.135 --> 05:17.875
You have to have a stoppage of bleeding,

05:18.415 --> 05:22.395
and you have to repair that injured surface of the wound.

05:22.935 --> 05:26.915
So I think this is where we have to say a huge thank you,

05:27.045 --> 05:28.275
first of all, faculty

05:28.615 --> 05:30.955
for recognizing the importance of the topic.

05:31.695 --> 05:33.795
But this topic would not have been written,

05:33.795 --> 05:36.355
written about in the article,

05:36.355 --> 05:40.235
highlighted if it hadn't been for the foresight

05:40.535 --> 05:44.955
of colleagues in 2018, in the autumn of 2018,

05:46.055 --> 05:48.195
in the gynecologic health

05:48.255 --> 05:51.515
and disease branch of the Eunice Kennedy Shriver,

05:52.275 --> 05:55.355
national Institute of Child Health and Human Development.

05:55.655 --> 05:59.085
So I needed to say a huge thank you to the colleagues there

05:59.105 --> 06:03.125
for convening this two two day meeting on Menstruation

06:03.125 --> 06:04.485
Science and Society.

06:05.305 --> 06:08.485
And what it aimed to do was identify gaps

06:08.665 --> 06:11.205
and opportunities in menstruation science

06:11.985 --> 06:14.045
and raise awareness of the need

06:14.065 --> 06:15.885
for more research in this field.

06:16.585 --> 06:19.925
So the, group of colleagues

06:20.225 --> 06:22.965
and a huge thank you to every single one of them

06:23.505 --> 06:27.365
who co-authored with me the article, menstruation Science

06:27.425 --> 06:31.005
and Society, later published in the American Journal

06:31.025 --> 06:32.885
of Obstetrics and Gynecology,

06:33.315 --> 06:35.765
because they ranged from those

06:35.945 --> 06:40.165
who studied the evolutionary role of menstruation to basic

06:40.805 --> 06:42.885
scientists working on the endometrium,

06:44.285 --> 06:47.235
those working in translational medicine

06:47.735 --> 06:52.275
and the broader societal cha challenges, those from,

06:53.055 --> 06:54.955
non-governmental organizations.

06:55.735 --> 07:00.395
So it was an incredible multi-discipline group coming

07:00.715 --> 07:04.955
together to talk about the same challenges, as I say,

07:04.975 --> 07:06.275
to identify the gaps

07:06.855 --> 07:09.275
and think about how we could move the field forward.

07:10.045 --> 07:14.515
We've also, arrived at a time, in,

07:14.975 --> 07:18.955
you know, history when if we looked at the experiences

07:19.295 --> 07:20.635
of our grandmothers

07:20.815 --> 07:22.315
or their predecessors,

07:22.705 --> 07:26.675
then menstruation was not such a common event 40 times a

07:26.675 --> 07:30.955
year because now, there are

07:32.835 --> 07:35.245
abilities to choose family size

07:35.425 --> 07:39.725
and couples are having fewer children, breastfeeding,

07:40.305 --> 07:43.125
will still be encouraged very much so,

07:43.225 --> 07:45.085
but may not be for quite so long.

07:45.505 --> 07:47.045
And so as a consequence,

07:47.385 --> 07:50.405
we have more periods than we did in the past.

07:51.305 --> 07:55.085
So instead of 40, maybe 400 a year.

07:55.305 --> 07:57.925
So if you're having more periods, that gives you more time

07:58.625 --> 08:00.925
to have more period problems.

08:01.785 --> 08:06.085
And we don't understand why certain associated,

08:06.585 --> 08:09.515
conditions,

08:09.935 --> 08:12.515
but also an even more common condition.

08:12.875 --> 08:16.955
Uterine fibroids may be present in 70%

08:17.015 --> 08:20.755
of reproductive age, women

08:21.495 --> 08:23.315
by the age of 50.

08:24.535 --> 08:29.235
That's a large percentage, again, under recognized.

08:29.295 --> 08:31.235
But both of adenomyosis

08:31.255 --> 08:35.435
and fibroids are commonly associated with the problems

08:35.435 --> 08:36.715
of heavy menstrual bleeding.

08:37.375 --> 08:38.755
We call it HMB

08:38.775 --> 08:42.315
or abnormal uterine bleeding that we refer to as a UB.

08:42.735 --> 08:47.115
And we will be seeing these perhaps more often or maybe

08:47.345 --> 08:50.635
because of the developments in, medical imaging,

08:51.215 --> 08:54.515
we are detecting them more often. And so

08:54.955 --> 08:56.525
Another gap is

08:57.635 --> 09:01.485
what we don't understand is if you have fibroids

09:01.665 --> 09:03.125
or adenomyosis

09:03.345 --> 09:07.365
or both, is the presence of a fibroid in the womb

09:07.465 --> 09:12.085
or adenomyosis in the womb exacerbating the problem

09:12.145 --> 09:16.285
of heavy bleeding or was the problem there all along?

09:16.705 --> 09:20.085
So that, that's perhaps a bit more subtle gap,

09:20.585 --> 09:22.445
but it's a very important gap.

09:23.285 --> 09:25.085
I think a third gap I'd like

09:25.085 --> 09:27.725
to raise is the under recognition

09:28.385 --> 09:31.245
and indeed the whole field is I could I,

09:31.385 --> 09:35.165
the three u's under recognized, under researched,

09:35.335 --> 09:38.685
under recognized is that if you lose a lot of blood,

09:40.055 --> 09:43.795
you will also lose a lot of iron and iron deficiency.

09:44.375 --> 09:48.715
And the then later iron deficiency anemia are

09:49.875 --> 09:51.335
hugely impactful.

09:52.205 --> 09:55.735
They're really, represented in low

09:55.735 --> 09:57.655
and middle income countries as well

09:57.655 --> 09:58.975
as high income countries.

09:59.635 --> 10:04.055
But what we aren't recognizing sufficiently is the links to,

10:04.915 --> 10:06.535
poorer pregnancy outcomes

10:07.355 --> 10:10.735
and perhaps even impacts on the infant and the neonate.

10:11.155 --> 10:13.215
So, you know, these are big gaps.

10:13.415 --> 10:16.335
I mean, that's maybe a extension of the brief

10:16.355 --> 10:17.655
of the discussion today,

10:17.715 --> 10:19.455
but since heavy menstrual bleeding

10:20.035 --> 10:21.575
is such an important cause

10:21.575 --> 10:23.975
of iron deficiency on iron deficiency anemia,

10:24.495 --> 10:27.855
I do feel we have to call that out as a gap.

10:28.915 --> 10:32.735
If we have these structural features in the womb

10:32.885 --> 10:37.455
that may be, causing an exaggerated inflammation

10:37.675 --> 10:39.895
or an inadequate hemostasis

10:40.435 --> 10:42.815
or an inadequate vasoconstriction,

10:43.245 --> 10:47.455
then these are areas we need to research and to help this,

10:48.115 --> 10:50.295
and again, I I really want to raise this

10:50.355 --> 10:54.135
for the community listening is how incredibly important,

10:54.225 --> 10:58.095
especially as we develop these huge data resources

10:58.095 --> 11:00.735
with all the omic studies, is that

11:00.795 --> 11:05.735
to understand their power, we have to have good phenotyping

11:06.635 --> 11:09.415
of the individuals, the patients that we study.

11:09.995 --> 11:14.255
And so the figo, which is the International Federation

11:14.275 --> 11:16.215
for Gynecology and Obstetrics

11:16.405 --> 11:19.415
through its first menstrual disorders committee,

11:19.475 --> 11:21.095
and then its menstrual disorders

11:22.245 --> 11:26.385
and related health impacts committee of which I will,

11:26.935 --> 11:30.025
declare my conflict that I have had the privilege

11:30.085 --> 11:32.425
of being in for many years

11:32.685 --> 11:35.505
and being the chair of, between 21

11:35.505 --> 11:39.985
and 23, that with my colleagues, Matt Monroe,

11:40.325 --> 11:44.705
definitely the leadership there, our late colleague,

11:45.165 --> 11:49.765
so, much a contributor to the field, Ian Fraser

11:49.765 --> 11:52.645
and myself, we've led this classification system

11:53.785 --> 11:56.845
to really try and help define,

11:57.225 --> 11:59.125
the structures in the uterus

11:59.665 --> 12:03.565
or the, non-structural conditions associated

12:03.675 --> 12:07.325
that you can't see under this figo system too.

12:07.325 --> 12:09.965
It's called the Palm Coin Classification.

12:10.145 --> 12:12.445
So palm with a coin on your hand.

12:12.865 --> 12:17.045
And now in teaching, for the public, for educators,

12:17.185 --> 12:20.285
for doctors in training, for healthcare providers,

12:20.825 --> 12:25.565
by having this important classification, we can begin to,

12:25.785 --> 12:28.605
clearly describe our patients.

12:29.305 --> 12:30.805
And that is the road

12:30.945 --> 12:34.725
or the, the, the, the gateway to being able

12:34.865 --> 12:36.565
to do really good science

12:36.865 --> 12:39.165
or really good epidemiological studies.

12:39.885 --> 12:42.325
'cause we will have described our populations.

12:42.505 --> 12:46.805
And so the gap is actually the education piece

12:46.825 --> 12:50.205
of encouraging researchers, those in industry

12:50.225 --> 12:52.885
who do clinical trials to adopt

12:53.025 --> 12:55.205
and use these classification systems,

12:55.975 --> 12:59.565
which were not just developed by a small group of people,

13:00.105 --> 13:04.365
but involved a process with global stakeholders across most

13:04.365 --> 13:06.205
of the continents of the world.

13:07.185 --> 13:10.845
The advocacy has been hampered by the fact that in

13:10.865 --> 13:12.965
so many societies there is the taboo

13:13.905 --> 13:15.685
as people don't talk about periods.

13:15.905 --> 13:20.685
So there is the education piece needed there also globally,

13:20.785 --> 13:22.245
26 million girls

13:22.265 --> 13:25.565
and women of menstruating age a displaced globally.

13:26.425 --> 13:29.365
And so if we don't tackle this taboo

13:29.705 --> 13:32.085
and break the taboos around menstruation,

13:32.995 --> 13:34.965
educate young people, their parents

13:35.065 --> 13:37.965
and communities, we will not move forward.

13:38.105 --> 13:40.485
And I think a strap line is,

13:42.285 --> 13:45.915
heavy period should be treated as a global health priority.

13:45.985 --> 13:47.995
This was actually used by a colleague

13:47.995 --> 13:51.115
of mine working very much in the field of bleeding

13:51.255 --> 13:54.395
and, problems with postpartum hemorrhage,

13:54.545 --> 13:58.115
exacerbated if women are anemic face in Roberts at the

13:58.115 --> 14:00.195
London School of Hygiene and Tropical Medicine.

14:01.095 --> 14:04.715
But the, recognition

14:05.335 --> 14:08.275
by WHO to call out

14:08.305 --> 14:11.475
that menstrual health should be recognized, framed,

14:11.495 --> 14:12.875
and addressed as a health

14:12.975 --> 14:17.915
and human rights issue, not as a hygiene issue, is one

14:17.915 --> 14:21.475
of the most important things that will help those in low

14:21.555 --> 14:23.155
and middle income countries.

14:23.215 --> 14:28.075
And if I can just, flag at least a couple of,

14:28.215 --> 14:31.675
the recommendations we need to recognize

14:31.735 --> 14:34.115
and frame menstruation as a health issue,

14:34.135 --> 14:35.355
not a hygiene issue.

14:36.175 --> 14:39.315
And that means addressing physical, psychological

14:39.455 --> 14:40.875
and social dimensions

14:42.055 --> 14:46.355
and to recognize the need for information, education,

14:47.455 --> 14:50.835
access to products, menstrual products

14:50.855 --> 14:54.685
and access to water, sanitation and privacy.

14:55.905 --> 15:00.005
And I think that the, term menstrual health,

15:00.465 --> 15:01.525
is used widely.

15:01.545 --> 15:04.685
And again, stakeholder groups have put together a

15:04.685 --> 15:05.805
very good definition.

15:06.505 --> 15:09.365
And I quote that definition, it's a state

15:09.365 --> 15:12.125
of complete physical, mental and social wellbeing

15:12.705 --> 15:14.885
and not merely the absence of disease

15:14.905 --> 15:17.685
or infirmity in relation to the menstrual cycle.

15:18.585 --> 15:22.805
And this other term which is very, commonly used period,

15:22.805 --> 15:27.645
poverty, again, defined, in the literature,

15:27.645 --> 15:30.765
when there is limited access to affordable, safe,

15:30.825 --> 15:34.005
and appropriate period projects, hygienic

15:34.005 --> 15:38.205
and private spaces to change or dispose of used products.

15:38.505 --> 15:40.525
So these, this is now becoming

15:41.085 --> 15:43.565
a truly societal issue.

15:44.385 --> 15:47.565
And others have said how much we need

15:47.565 --> 15:49.925
to reframe the messaging on menstruation

15:50.585 --> 15:54.605
by recognizing menstruation as a normal biological process

15:55.785 --> 16:00.005
and to recognize the unnecessary burden of menstrual stigma

16:00.945 --> 16:02.845
and work towards a much more

16:03.365 --> 16:05.325
positive messaging on menstruation.

16:05.505 --> 16:08.445
And I think if we can achieve that positive menstruation,

16:09.145 --> 16:13.925
we can enhance education, we will help,

16:14.215 --> 16:17.525
those who live in middle, low and middle income countries.

16:17.785 --> 16:21.005
But this is also needed in those higher income countries

16:21.005 --> 16:25.405
too, because too often still menstruation is normalized

16:25.405 --> 16:28.565
either by the individual or by society.

16:29.105 --> 16:31.005
And this is why we need more research

16:31.945 --> 16:33.325
on menstruation science.

Breaking the Menstruation Taboo Through Education

00:00:00 - For far too long. Menstruation has remained a taboo topic. That means that the problems of menstruation are also not talked about. They are far too often normalized, not just by the individual, but by families in the workplace and by society. So I think it's well overdue that we bring attention to this really, really important topic. And we shouldn't forget that menstruation is an amazing
00:00:33 - Menstruation, problems of menstruation are one of the reasons why time is lost from school. If you are a child or an adolescent or from the workplace, if you are an adult. And I think it's been recognized that we need to do a lot more around education. And this education should start early in schools. It should be for girls, it should be for boys. And I think there is a real, appetite,
00:01:05 - well-informed sites they can go to, to learn about this natural process and understand what, drives it and what might happen when things with periods don't work out quite as you expect. And also to recognize what is normal and what may be out with the boundaries of normal. So huge amount more needed to be done on education
00:01:35 - It is the endometrium, the lining of the womb. That is what is bleeding. It is not the muscle of the uterus that is bleeding. It is the lining of the womb, the endometrium. And that is a site in the body that responds to two female hormones produced by the ovary, estrogen, and progesterone. So estrogen is the hormone dominant in the first half of the cycle. And progesterone, along with estrogen, but particularly progesterone,
00:02:07 - And that, hormone progesterone is the one that is important for the establishment and maintenance of pregnancy. Now, when you are not pregnant, the structure in the ovary that makes progesterone, that we call the corpus lutetium, declines it di it, you know, it, dies effectively. But in doing so, it means the levels of hormone, of progesterone circulating in the body fall.
00:02:42 - which is what triggers bleeding from the endometrium. Menstruation. And that will happen whenever you take hormone away from the lining of the womb. So when you're on the combined pill for three weeks and you stop it, you have a withdrawal bleed. 'cause, 'cause you've taken hormone away. If you are on progestin based pills, perhaps to manage your periods and you forget one hormone is taken away

Understanding the Menstrual Cycle's Physiological Process

00:03:13 - So it's really important that we understand that the lining of the womb has this really carefully coordinated exposure to estrogen, then estrogen and progesterone, progesterone withdrawal. And when that withdrawal happens, you trigger, in effect a wound. So the lining of the womb is an amazing physiological example of a wound that repeatedly injures and repairs each month,
00:03:46 - And I always use the analogy that if as a child or your own children, you fell on a gravel path and grazed your knee and you got a red raw surface on your kneecap, that's what the inside of the lining of the womb looks like when you menstruate. So it's got all the same features of an injured wound. You have white cells come in, you have inflammatory markers, sorry, mediators and products like prostaglandins.
00:04:18 - nonsteroidal anti-inflammatories, which are prostaglandin syntase inhibitors to treat menstrual periods just for a few days at the time of menstruation can reduce menstrual blood loss. So it is a structure that has this, well coordinated both in space and time production of, if you like, a jigsaw of actions which have to come together.
00:04:51 - and it will last an expected, length of time. So it's when those pieces of the jigsaw become disordered or in their wrong places that we see prolongation of bleeding, excessive bleeding. Because if you're gonna stop your periods, you have to have three things. You have to constrict the blood vessels that are bleeding. You have to have a stoppage of bleeding,
00:05:22 - So I think this is where we have to say a huge thank you, first of all, faculty for recognizing the importance of the topic. But this topic would not have been written, written about in the article, highlighted if it hadn't been for the foresight of colleagues in 2018, in the autumn of 2018, in the gynecologic health and disease branch of the Eunice Kennedy Shriver,
00:05:55 - So I needed to say a huge thank you to the colleagues there for convening this two two day meeting on Menstruation Science and Society. And what it aimed to do was identify gaps and opportunities in menstruation science and raise awareness of the need for more research in this field. So the, group of colleagues and a huge thank you to every single one of them

Addressing Menstruation: Research and Societal Gaps

00:06:27 - and Society, later published in the American Journal of Obstetrics and Gynecology, because they ranged from those who studied the evolutionary role of menstruation to basic scientists working on the endometrium, those working in translational medicine and the broader societal cha challenges, those from, non-governmental organizations.
00:07:00 - together to talk about the same challenges, as I say, to identify the gaps and think about how we could move the field forward. We've also, arrived at a time, in, you know, history when if we looked at the experiences of our grandmothers or their predecessors, then menstruation was not such a common event 40 times a
00:07:32 - abilities to choose family size and couples are having fewer children, breastfeeding, will still be encouraged very much so, but may not be for quite so long. And so as a consequence, we have more periods than we did in the past. So instead of 40, maybe 400 a year. So if you're having more periods, that gives you more time
00:08:01 - And we don't understand why certain associated, conditions, but also an even more common condition. Uterine fibroids may be present in 70% of reproductive age, women by the age of 50. That's a large percentage, again, under recognized.
00:08:31 - and fibroids are commonly associated with the problems of heavy menstrual bleeding. We call it HMB or abnormal uterine bleeding that we refer to as a UB. And we will be seeing these perhaps more often or maybe because of the developments in, medical imaging, we are detecting them more often. And so Another gap is what we don't understand is if you have fibroids
00:09:03 - or both, is the presence of a fibroid in the womb or adenomyosis in the womb exacerbating the problem of heavy bleeding or was the problem there all along? So that, that's perhaps a bit more subtle gap, but it's a very important gap. I think a third gap I'd like to raise is the under recognition and indeed the whole field is I could I, the three u's under recognized, under researched,

Iron Deficiency and Menstrual Health Gaps

00:09:40 - you will also lose a lot of iron and iron deficiency. And the then later iron deficiency anemia are hugely impactful. They're really, represented in low and middle income countries as well as high income countries. But what we aren't recognizing sufficiently is the links to, poorer pregnancy outcomes
00:10:11 - So, you know, these are big gaps. I mean, that's maybe a extension of the brief of the discussion today, but since heavy menstrual bleeding is such an important cause of iron deficiency on iron deficiency anemia, I do feel we have to call that out as a gap. If we have these structural features in the womb that may be, causing an exaggerated inflammation
00:10:40 - or an inadequate vasoconstriction, then these are areas we need to research and to help this, and again, I I really want to raise this for the community listening is how incredibly important, especially as we develop these huge data resources with all the omic studies, is that to understand their power, we have to have good phenotyping of the individuals, the patients that we study.
00:11:14 - for Gynecology and Obstetrics through its first menstrual disorders committee, and then its menstrual disorders and related health impacts committee of which I will, declare my conflict that I have had the privilege of being in for many years and being the chair of, between 21 and 23, that with my colleagues, Matt Monroe,
00:11:45 - so, much a contributor to the field, Ian Fraser and myself, we've led this classification system to really try and help define, the structures in the uterus or the, non-structural conditions associated that you can't see under this figo system too. It's called the Palm Coin Classification. So palm with a coin on your hand.
00:12:17 - for doctors in training, for healthcare providers, by having this important classification, we can begin to, clearly describe our patients. And that is the road or the, the, the, the gateway to being able to do really good science or really good epidemiological studies. 'cause we will have described our populations. And so the gap is actually the education piece

Breaking Taboos: Menstrual Health Awareness

00:12:50 - who do clinical trials to adopt and use these classification systems, which were not just developed by a small group of people, but involved a process with global stakeholders across most of the continents of the world. The advocacy has been hampered by the fact that in so many societies there is the taboo as people don't talk about periods. So there is the education piece needed there also globally,
00:13:22 - and women of menstruating age a displaced globally. And so if we don't tackle this taboo and break the taboos around menstruation, educate young people, their parents and communities, we will not move forward. And I think a strap line is, heavy period should be treated as a global health priority. This was actually used by a colleague of mine working very much in the field of bleeding
00:13:54 - exacerbated if women are anemic face in Roberts at the London School of Hygiene and Tropical Medicine. But the, recognition by WHO to call out that menstrual health should be recognized, framed, and addressed as a health and human rights issue, not as a hygiene issue, is one of the most important things that will help those in low
00:14:23 - And if I can just, flag at least a couple of, the recommendations we need to recognize and frame menstruation as a health issue, not a hygiene issue. And that means addressing physical, psychological and social dimensions and to recognize the need for information, education, access to products, menstrual products and access to water, sanitation and privacy.
00:15:00 - is used widely. And again, stakeholder groups have put together a very good definition. And I quote that definition, it's a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity in relation to the menstrual cycle. And this other term which is very, commonly used period, poverty, again, defined, in the literature,
00:15:30 - and appropriate period projects, hygienic and private spaces to change or dispose of used products. So these, this is now becoming a truly societal issue. And others have said how much we need to reframe the messaging on menstruation by recognizing menstruation as a normal biological process and to recognize the unnecessary burden of menstrual stigma

Promoting Positive Perceptions of Menstruation

00:16:03 - positive messaging on menstruation. And I think if we can achieve that positive menstruation, we can enhance education, we will help, those who live in middle, low and middle income countries. But this is also needed in those higher income countries too, because too often still menstruation is normalized either by the individual or by society. And this is why we need more research
00:16:31 -

Faculti AI can make mistakes

Faculti

Popular in Professional

Human Rights and Corruption: Problems and Potential of Individualising a Systemic Problem

A statistical approach to law school citation rankings

High school change

What is constitutional ideology?

Politics, Identity, and Class Certification on the U.S. Courts of Appeals

The City as a Growth Machine: Toward a Political Economy of Place

The Role of Education in Reducing Racial Inequality

Menstruation: science and society

Next in Medicine

Guide

Platform and Category Pages

Contact Us

FAQs

What is Faculti?

How do you select interviews?

Interview Process

Page Structure

Popular in Professional

Guide

Platform and Category Pages

Contact Us

FAQs

What is Faculti?

How do you select interviews?

Interview Process

Accessibility Options

Contrast Adjustment

Text Size Adjustment

Text Spacing Adjustment

Line Height Adjustment

Cursor Size Adjustment

Page Structure Options

Page Structure