Researching the Researchers: The Impact of Menstrual Stigma on the Study of Menstruation

Menstruation has been historically stigmatised through a variety of strategies cross-culturally, including silencing and marginalisation. Such stigmatisation has affected the inclusion of menstruation as a topic of research across disciplines, reproducing stigma through a lack of research and new knowledge. I set out to discover more about the perceived nature and impact of such stigmatisation on the professional experience of menstrual researchers. The research cohort was a group of nine scholars from humanities and social science disciplines, living and working in the UK, USA and Russia, who came together in 2020 for a two year project to research menstrual history, activism, politics, education and culture in order to better understand the Scottish context of legislation to 'end period poverty'. I was also a member of this group and this paper is structured through an autoethnographic enquiry. My qualitative research was interview-based using online video meetings. My data shows that the perceived impact of menstrual stigma on academic research has altered, with older researchers experiencing more barriers in the early stages of their careers than younger ones do now. However, menstrual researchers still experience challenges they consider to be stigma-related in publishing menstrual research, in obtaining permanent positions centred on their specialisation, and in attracting long-term and large-scale funding. This research shows how entrenched stigma can lead to a feedback loop of victimisation that is difficult to escape from, and suggests that academics working on stigmatised topics may need specific types of institutional support in order to progress, publish and flourish.

LITERATURE REVIEW: ANALYSIS OF FACTORS AFFECTING PREMENSTRUAL SYNDROME IN GIRLS ADOLESCENT

Introduction: Premenstrual syndrome in adolescent girls is very disturbing daily activities. Changes such as feeling sensitive or irritable, lack of confidence, difficulty concentrating, crying easily, restlessness and anxiety. Premenstrual syndrome in adolescents causes anxiety so that it can result in decreased interest in activities. The purpose of this study is to explain the factors that influence premenstrual syndrome in adolescent girls based on empirical studies in the last five years.Method: The literature review article search was conducted in five databases (Scopus, Proquest, Pubmed, Science Direct and Google Scholar), the search was conducted from July to August 2020. A prism checklist was used to guide this review. Analyzed and tabulated data on articles. Title, abstract, full text and methodology were assessed to determine the feasibility of the study.Result: There were 10 studies that matched the research inclusion criteria, the studies were divided into two themes, namely the influencing factors of premenstrual syndrome (n= 8) and the impact of premenstrual syndrome (n= 2).Conclusion: Factors that affect premenstrual syndrome include: physiological factors include (age, education, length of menstruation, menstrual cycle, menstrual history, physical activity), nutritional factors include (diet, coffee consumption), psychological factors include (stress, feeling uncomfortable). , feelings of insecurity) and the external factor is the use of the internet. Premenstrual syndrome can physically show in the form of headache, breast tenderness, swelling of the extremities, abdominal and heartburn pain and psychologically shows anxiety, withdrawal, confusion, depression and irritability.

Caesarean scar endometriosis

Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. The symptoms are nonspecific, typically involving abdominal wall pain at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of scar the diseased tissue. A case report of 34 year old female patient presenting with scar endometriosis 7 years after her last LSCS (lower segment caesarean section). The patient came with the complaint of supra pubic swelling since 6 months, which was growing slowly. Her menstrual history was regular, but she had lower abdominal pain during menstruation. On clinical history, examination and USG finding the swelling was diagnosed as scar endometriosis.

Relationship between menstrual abnormalities, anemia and hematological parameters among university students

Objective: To determine the relationship between anemia, menstrual abnormalities and hematological parameters among students, who are studying at Sindh University and are the permanent residents of Hyderabad city. Methodology: This cross-sectional study was carried out at physiology department, university of Sindh Jamshoro. Study duration was one year from August 2018 to July 2019. All participants were the permanent resident of Hyderabad, aged from 18 to 25 years, and willing to contribute in the study. The questionnaire was designed to elicit comprehensive responses from participants regarding hematological parameters and menstrual abnormalities. Menstrual abnormalities such as poly-menorrhea, menorrhagia, oligo-menorrhea, dysmenorrhea, and amenorrhea were determined using the menstrual history. Participants with a hemoglobin level of <12 gm/dl were deemed anemic. SPSS version 20 was used to analyze the data. Results: A total of 300 individuals were randomly selected for this study, and 283 of them agreed to have their blood drawn. The participants' average age was 20.99±1.87 years. Most of the participants had irregular cycle 44.52%, followed by oligomenorrhea 13.43%, Polymenorrhea 11.66% and remaining were normal. Hypomenorrhea was seen in 8.48% of the respondents while hypermenorrhea was seen in 7.42% of the respondents. 14.49% of females reported the duration of menstrual bleeding for fewer than three days, and 34.63% reported normal duration of menstrual bleeding. Longer menstrual bleeding days (>7 days) was 26.85% Anemia in the participants was 45.94%, out of this mild, moderate and severe anemia was 32.51%, 7.42% and 6.01% respectively. RBCs, HCT and WBCs were statistically significant in terms of menstrual abnormalities (P<0.05), whereas other hematological parameters remained statistically insignificant in terms of menstrual abnormalities (p->0.05). Conclusion: Prevalence of menstrual abnormalities and anemia were observed to be frequently high among female students of Sindh University’s permanent residents of Hyderabad. Key words: Menstrual patterns, menstrual abnormalities, Anemia, University students

690Growth in childhood and age at menarche: Insights from individual trajectory modelling

Background The relationship between patterns of weight gain across childhood and the onset of puberty remains unclear. We aimed to derive growth parameters (size, tempo, and velocity) from models of weight across childhood and to estimate their effects on age at menarche. Methods Serial height and weight measurements from birth to age 9.5 years for 557 children who took part in the Generation 1 cohort study were used, along with girls’ menstrual history at age 12-13 years. Shape invariant random effects models were fit to log(weight+1) for all available participants’ data (282 girls, 260 boys), and AIC used to identify the best-fitting model. In time-to-event models subsequently fit to the girls’ data to estimate effects of the growth parameters on menarcheal age, a censoring age of 12 years was used to define early puberty. Results A model with 4df and fixed and random effects for size and tempo and a fixed effect for velocity was preferred. Some 19% of girls began menstruating before age 12 years. Size and tempo were each associated with an increased hazard of earlier menarche; a 0.1 unit gain in size was associated with a hazard ratio of 1.75 (95%CI 1.32–2.33), and a 0.1 unit gain in tempo with a hazard ratio of 7.84 (95%CI 3.41–18.05). Conclusions Using all participants’ data gave more precise growth parameter estimates. Key messages Understanding mechanisms that drive increased size and tempo of childhood growth may help to elucidate the links between obesity and girls’ risk of early puberty.

Estudio Descriptivo: Cumplimiento del estándar de estimación de la edad gestacional en la atención prenatal en un hospital general en Ecuador

BACKGROUND: Gestational dating is an important requirement for decision-making during pregnancy; the World Health Organization recommends making the first ultrasound before week 24. Gestational age can also be estimated based on menstrual history. The aim of this study was to describe the rate of compliance of the standards for estimating gestational age in a general hospital in Machala, Ecuador. METHODS: This is an observational, descriptive, cross-sectional study; the universe was the total of pregnant women who attended for prenatal care to Hospital General Machala, El Oro- Ecuador, between April 2017 and March 2020. The entire universe was studied. We collected data for the variables: age, parity, last menstrual period( LMP), menstrual age, early ultrasound, reliable gestational dating. RESULTS: 47.9% of the sample was 18 to 29 years old. 83.33% (195/234) patients complied with the weeks of amenorrhea registry. 75.21% (176/234) of patients complied with the recommendation of an early ultrasound, at 24 weeks or less. 1.28% did not have any method of gestational dating. 64% (n=149) of the sample underwent the first ultrasound until week 20. Of 140 patients who complied with having both gestational dating by reliable LMP and ultrasound, in 31/140 (22.1%) the gestational age given by LMP could not be confirmed with early ultrasound. CONCLUSION: We concluded that gestational dating obtained by weeks of amenorrhea was registered n 83.33% of the patients, this rate qualifies as regular compliance. An early ultrasound was performed, at ≤ 24 weeks, as recommended by WHO, in 75% of the patients, this rate qualifies as poor compliance.

Measures of viability

The interest in the border of viability originated from various sources, including legal requirements, the rejection of technical life support, competition for resources, concerns about handicaps, and proximity to the fetus with its limited rights. Gestational age was determined from menstrual history by Hippocratic writers, who established the tenacious idea that 7-, but not 8-month-old infants could survive. Naegele’s rule, already published by Boerhaave in 1744, was correct when applied to the last day of menstruation. Birthweight and length were not measured until the end of the 18th century. This remarkable disinterest resulted from superstition, grossly inaccurate measurements by the authorities Mauriceau and Smellie, and the conversion chaos of the pre-metric era. A table is provided with historic mass and length units to allow determination of birthweight and body length in the older literature. The idea of viability is a remnant of vitalism, a medical doctrine popularized in 1780 by Brown. Many short-lived statements defined its border, but until now what was meant by viability remained nebulous.

Chronic pelvic pain in children and adolescents

Pelvic pain is a broad term encompassing pain from viscera within the pelvic cavity, and from the bony and myofascial structures of the pelvis. In children and adolescents, pain due to pelvic pathology may be described as abdominal pain, and is frequently overlooked owing to co-occurrence with gastrointestinal symptoms. Dysmenorrhea is highly prevalent among adolescents and associated with central sensitization of pain pathways and other chronic pain syndromes. Dysmenorrhea is also a risk factor for pelvic pathology; two-thirds of adolescents with dysmenorrhea or chronic pelvic pain who undergo laparoscopy are diagnosed with endometriosis. Other overlooked causes of chronic pelvic pain include pelvic myofascial pain, pelvic floor dysfunction, neuralgias, and nerve entrapment. The importance of obtaining a menstrual history, indications for referral to an adolescent gynecologist, and a multidisciplinary approach to pain management are discussed.

NRG Oncology/NSABP B-47 menstrual history study: impact of adjuvant chemotherapy with and without trastuzumab

The NRG Oncology/NSABP B-47 menstrual history (MH) study examined trastuzumab effects on menstrual status and associated circulating reproductive hormones. MH was evaluated by questions related to hysterectomy, oophorectomy, and reported menstrual changes. Pre/perimenopausal women were assessed at entry, 3, 6, 12, 18, 24, 30, and 36 months. Consenting women had estradiol and FSH measurement at entry, 3, 6, 12, 18, and 24 months. Logistic regression determined predictors of amenorrhea and hormone levels at 12, 24, and 36 months. Between 2/8/2011 and 2/10/2015, 3270 women with node-positive/high-risk node-negative HER2-low breast cancer were enrolled. There were 1,458 women enrolled in the MH study; 1231 consented to baseline blood samples. Trastuzumab did not contribute to a higher amenorrhea rate. Amenorrhea predictors were consistent with earlier studies; however, to our knowledge, this is the largest prospective study to include serial reproductive hormone measurements to 24 months and clinical amenorrhea reports to 36 months. These data can help to counsel patients regarding premature menopause risk.

Rate of Prophylaxis Oophorectomy and Associated Factors at the Time of Hysterectomy in Premenopausal Women with Benign Diseases

Objective: To determine the rate of oophorectomy and associated factors at the time of hysterectomy in premenopausal women with benign diseases. Materials and Methods: The medical records of the premenopausal women that underwent hysterectomy with or without oophorectomy due to benign gynecologic conditions between January 1, 2012 and December 31, 2017 at Khon Kaen University Hospital (Thailand) were retrospectively reviewed. The data collected included age, BMI, parity, indication for surgery, family history of carcinoma, route of hysterectomy, procedure, specialization of the surgeon, operative notes, and histopathological reports of the ovaries. Results: Six hundred thirty-eight subjects underwent hysterectomy due to benign gynecologic conditions. Bilateral salpingo-oophorectomy (BSO) was performed in 57.37% (366) of the cases. In 81.97% (300) of these cases, either one or both patient’s ovaries were grossly normal. The rate of prophylactic oophorectomy among all cases was 47.02% (300 in 638). The strongest associated factor with BSO was age (odds ratio 8.421, 95% CI 5.488 to 12.921). Other associated factors were irregular menstrual history, the surgeon being a gynecologic oncologist, and abdominal hysterectomy. No cases of ovarian cancer were found. Conclusion: Nearly half of premenopausal women that underwent hysterectomy due to benign conditions underwent prophylactic oophorectomy. Associated factors were age, irregular menstruation, the surgeon being a gynecologic oncologist, and abdominal hysterectomy. Keywords: Hysterectomy, Premenopausal women, Prophylactic oophorectomy