Menarche, Menstruation, Menopause and Mental Health (4M): a consortium facilitating interdisciplinary research at the intersection of menstrual and mental health

To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity. Multicenter cross-sectional study with prospective recruitment. Sixteen clinical centers in ten countries. A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized. None. Diagnostic delay, HRQoL, and work productivity. There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy. Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Background Attention to women’s and girls’ menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. Methods and findings We undertook systematic searching to identify qualitative studies of women’s and girls’ experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [n = 7], Uganda [n = 6], and Ethiopia [n = 5]), 21 from South Asia (including India [n = 12] and Nepal [n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women’s and girls’ lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas. Conclusions Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women’s and girls’ health and well-being. Review protocol registration The review protocol registration is PROSPERO: CRD42018089581.

The term “menstrual health” has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition. Le terme de « santé menstruelle » est de plus en plus utilisé dans le plaidoyer, la programmation, les politiques et la recherche, mais il lui manque une définition cohérente et indépendante. Ce domaine de recherche et de pratique enregistrant une croissance rapide nécessite une définition complète pour 1) garantir la priorisation de la santé menstruelle comme objectif unifié dans les cadres de la santé mondiale, du développement, des politiques nationales et du financement, 2) préciser l'étendue de la santé menstruelle, même lorsque différents besoins peuvent faire l'objet de priorités dans différents secteurs, et 3) faciliter un vocabulaire commun avec lequel les parties prenantes peuvent communiquer au-delà des cloisonnements pour partager l'apprentissage. Pour parvenir à ces objectifs, nous présentons une définition de la santé menstruelle préparée par le groupe d'action sur la terminologie du collectif mondial sur les menstruations (Global Menstrual Collective). Nous décrivons le processus d'élaboration de la définition, fondé sur la terminologie et les recherches existantes, les définitions apparentées de la santé, et des consultations avec un large éventail de parties prenantes. De plus, nous fournissons des justifications, sur la base des données actuelles, à l'appui de l'interprétation de la définition. El uso del término “salud menstrual” ha aumentado en las áreas de promoción y defensa, programas, políticas e investigación, pero se carece de una definición sistemática y autocontenida. En un campo de investigación y práctica que continúa creciendo rápidamente, se necesita una definición integral para (1) garantizar que la salud menstrual sea priorizada como objetivo unificado en los marcos de salud mundial, desarrollo, políticas nacionales y financiamiento, (2) dilucidar la amplitud de la salud menstrual, aun cuando diferentes necesidades sean priorizadas en diferentes sectores, y (3) facilitar un vocabulario común con el cual las partes interesadas puedan comunicarse entre silos para intercambiar conocimientos. Para lograr estos objetivos, presentamos una definición de salud menstrual formulada por el Grupo de Acción en Terminología de la Colectiva Menstrual Mundial. Describimos el proceso de formulación de la definición, basándonos en investigaciones y terminología existentes, en definiciones de salud relacionadas y en consulta con una gran variedad de partes interesadas. Además, proporcionamos elaboración, basada en la evidencia actual, para apoyar la interpretación de la definición.