{"paper_id":"6a36421d-1c99-4373-bfd6-49c1a29d1eae","body_text":"nature medicine\n Volume 29 | May 2023 | 1029 | 1029\nhttps://doi.org/10.1038/s41591-023-02386-5\nEditorial\nMenstrual health without stigma\nFrom menarche to menopause, \nmenstrual health is intrinsically \nlinked to general health and must find \nregular attention in clinical practice.\nM\nenstrual Hygiene Day , com -\nmemorated annually on 28 \nMay, aims to end the stigma \nsurrounding menstruation. \nThe day serves to raise aware-\nness of global challenges to accessing men -\nstrual hygiene products and to normalize \nmenstruation as a part of regular life. Menstrual \nhygiene — the ability of women, girls and other \npeople who menstruate (which can include \ntransgender men and non-binary people) to \ncare for their bodies during menstruation — \nis a fundamental prerequisite for menstrual \nhealth, defined as a state of complete physical, \nmental and social well-being throughout the \nmenstrual cycle 1. From menarche to meno -\npause, people’s menstrual health is intricately \nlinked to their general health and must find \nregular attention in clinical practice.\nA menstrual cycle that is medically considered \nin the normal range can last 24–38 days, with up \nto 8 days of bleeding2. There can be a disconnect \nbetween what a person feels is a healthy men-\nstrual cycle for them and what medical guide-\nlines consider to be normal. Part of the problem \nis the lack of discourse and of education of the \npublic and healthcare providers around what to \nexpect from a healthy menstrual cycle. Irregular \ncycles (even those within the medically defined \nnormal range) and heavy periods can negatively \naffect quality of life for many people. The same \nis true for premenstrual syndrome, which up to \n77% of women experience3, with symptoms such \nas menstrual pain and emotional dysregulation4. \nThe discomfort and social embarrassment asso-\nciated with menstrual pain and unpredictable \nbleeding can prevent people from engaging in \ndaily activities4. When it comes to menstrual \nsymptoms that are considered normal, but \nin reality interfere with general health — a fun-\ndamental human right — societal framing and \nthe discourse in medical settings must change.\nWith approximately 400 menstrual cycles \nin a person’s lifetime, the regular experience of \nany of the symptoms noted above can be crip-\npling. For people who struggle with these symp-\ntoms, it can be challenging to recognize their \nhardship and need for help. That is also because \nthe societal attitudes around menstruation are \nloaded with stigma and shame. Moodiness and \nirritability during ‘that time of the month’ is a \ntrope used to devalue women’s contributions \nat home, in the workplace and in other settings, \nand the association of menstruation with being \nunclean culminates in the exclusion of women \nfrom public life in some regions. Having to men-\nstruate in secret because of these constraints is \nnot only disempowering and misogynistic, it is \ndeeply inhumane.\nStigmatization and normalization of uncom-\nfortable menstrual symptoms can also mask \npathological conditions, as well as being bar-\nriers to seeking and receiving proper medical \ncare4. Such is the case for women with endo-\nmetriosis (a chronic systemic disease with \nsymptoms that include severe pelvic pain, \ninfertility and adverse mental health) and \npremenstrual dysphoric disorder (PMDD) (a \nchronic neuroendocrine condition with symp-\ntoms that include severe emotional dysregu-\nlation, depression and anxiety, as well being \nassociated with an increased risk for suicide), \naccording to the UK All Party Parliamentary \nGroup report on endometriosis and a 2018 \nglobal survey of premenstrual disorders. Many \nwomen face unacceptable, decade-long wait-\ning times to achieve accurate diagnoses for \nthese and other serious medical conditions.\nA lack of physician sensitivity toward and \nawareness of these and other related condi -\ntions can lead women to hesitate to seek \nmedical help in the first place and increases \nthe number of appointments needed to \nachieve accurate diagnoses. Although 5–10% \nof women struggle with endometriosis5 and \n5.5% of women struggle with PMDD 6, there \nare no validated screening tools or screening \nprograms for either. Formal diagnoses require \nadditional burdens; for example, surgery for \nendometriosis, and 2–3 months of tracking \nof symptoms for PMDD. Efforts to increase \neducation about menstrual health and related \ndisorders need to be ramped up in the public, \nas well as in medical communities. Ultimately, \nhealthcare providers and patients need to feel \nconfident in acknowledging, discussing and \nrecognizing symptoms that require treatment.\nBeyond hormonal contraception, which \ncan also carry problematic side effects such as \ndepression, there are limited treatment options \nfor people who struggle with potentially \npathological menstrual symptoms. Research \nefforts for effective screening strategies and \nnon-invasive and swift diagnoses, as well as \navailability of effective treatment options, \nmust increase. Making menstrual health checks \nroutine in clinical practice also would help to \nremove the stigma and improve general good \nhealth for people who menstruate.\nMedical interventions can also interfere with \nthe menstrual cycle. Studies have shown that \nmRNA vaccines against COVID-19 can induce \nchanges in menstrual cycle length7. This obser-\nvation was missed initially because potential \nadverse events related to or reflected in the \nmenstrual cycle are generally not recorded \nin clinical trials, which raises questions about \nthe mechanisms for the safeguarding of men-\nstrual health before drugs and biologicals \nenter the market. The lack of consideration of \nmenstrual health in disease etiology and treat-\nment speaks to a disregard of how menstrual \ncycles can fundamentally affect and/or be \nreflective of health for those who menstruate. \nIf menstrual health parameters were routinely \nmeasured in clinical research and practice, \nthese data would ensure increased safety, as \nwell as exposing potential links between the \nmenstrual cycle and disease states.\nPatient-centered, standardized menstrual \nhealth outcomes need to be recorded by \ndefault in clinical work, as well as in research. \nWomen, girls and other people who menstru-\nate need to be involved in design of clinical \nstudies in which they are being asked to partic-\nipate. Open, stigma-free discourse in health-\ncare settings is essential for the generation \nof evidence-based knowledge on menstrual \nhealth and setting the course for a truly com-\nprehensive approach to health.\nPublished online: 15 May 2023\nReferences\n1. Hennegan, J. et al. Sex. Reprod. Health Matters 29,  \n31–38 (2021).\n2. Munro, M. G. et al. Int. J. Gynaecol. Obstet. 143,  \n393–408 (2018).\n3. Schoep, M. E. et al. Am. J. Obstet. Gynecol. 220, 569.\ne1–569.e7 (2019).\n4. Critchley, H. O. D. et al. Am. J. Obstet. Gynecol. 223, \n624–664 (2020).\n5. Taylor, H. S. et al. Lancet 397, 839–852 (2021).\n6. Gehlert, S. et al. Psychol. Med. 39, 129–136 (2009).\n7. Edelman, A. et al. BMJ Med. https://doi.org/10.1136/\nbmjmed-2022-000297? (2022).\n Check for updates","source_license":"CC0","license_restricted":false}