Dr Hiroko Sakai's research in women's health exemplifies how mainstream medical conversations simply do not articulate well the important aspects of women's health perspective. For example, the health risks associated with smoking have long been known and exposed to the public. However, the way smoking affects women's bodies in particular has not been fully studied. Over the years, one of Sakai's major projects has been addressing the effects of smoking on menstrual cramps and premenstrual syndrome (PMS). She has also been involved with healthcare education programs in Nepal. "A more inclusive healthcare landscape does not only mean treating solely female aspects of the human body; it means seeing where women have fallen through the cracks in conventional medicine and bringing their perceptions and concerns to the front," highlights Sakai. Sakai recognises that social systems and health are intertwined. "Women's health is affected by their socioeconomic status," she states. A disproportionate number of women of lower socioeconomic status are exposed to psychological, physical and social health risks. On top of this, women pay a high price for motherhood and tend to pay hefty costs by taking care of children, deterring them from continuing work. Japanese women specifically meet many impediments whilst working so they can be economically independent. After childbirth, it becomes difficult for them to return to a typical employment pattern. "Commonly, women wind up working for low pay at irregular hours, and the Japanese tax and benefits system is such that dependent spouses receive financial incentives to limit their earnings," explains Sakai. Thus far, Sakai has carried out a body of research defining the relationship between smoking and the menstrual cycle. She has revealed that for women of reproductive age, between 20 and 50 years old, smoking and second-hand smoke is associated with higher risks to pregnancy-related health outcomes. "Women who smoke are at increased risk for difficulty conceiving, infertility and spontaneous abortion," Sakai explains. The most recent research by this team reveals that smoking is associated with shorter menstrual cycle length and irregular cycles. Additionally, smoking, especially in young adults may substantially increase a women's risk of developing severe, more symptomatic, longer instances of PMS.