Menstrual Exclusions in Nepal: Some Evidence of Transition

There is a long history of menstrual restrictions, stigmas and taboos across nearly all religions, regions and cultures. The origins of myths and misconceptions have often been linked to various religious texts and women were prohibited from participating in normal life while menstruating. Culturally, in many parts of the world, menstruation is still considered ‘dirty’ and ‘impure’, although this is not true. Menstruation is often associated with feelings of shame, horror, danger, disgust, and sin. There have been initiatives to change the perception that menstruating women are not polluted, thus bringing an end to traditional customs such as not being allowed to sleep in their own home or touch male relatives to more extreme forms of isolation such as being confined to the ‘cow shed’. This paper draws on research conducted between 2019 and 2021 under a British Academy-funded Global Challenge Research Fund project entitled ‘Dignity Without Danger’. The study employed qualitative methods, covering 160 qualitative interviews and 16 focus group discussions among different caste and ethnic groups in three different ecological areas (mountain, hill, and tarai) in seven provinces in Nepal. Today, menstruating women have relatively more freedom to discuss this topic due to increased awareness that menstruation is a natural process. However, our study shows there are still differences between cultures, religions, castes and ethnic groups, and regions, and a single narrative does not represent the issues related to menstrual exclusion in Nepal. The study shows that many menstruating girls and women are still restricted in a number of diverse ways, from not offering prayers, entering or worshiping in temples, touching holy books, and participating in religious rituals. In some areas, more extreme practices persist which discriminate against women when menstruating. Our research highlights that education and an interdisciplinary, multisector approach are required if menstrual discrimination is to be addressed. Finally, this paper emphasizes the necessity for providing correct knowledge about menstruation to the entire community including elders, males and religious leaders as well as adolescents and young girls. Such knowledge will help them practice safe and hygienic menstrual practices, challenge and reduce their traditional beliefs, misconceptions and restrictions regarding menstruation that are essential to achieving menstrual dignity.

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

Primary Dysmenorrhea: pathophysiology

The present study was conducted to investigate and analyze the recent and relevant studies about primary dysmenorrhea and its pathophysiology. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, Google Scholar and the Cochrane Library for original articles written in English and in Scielo, Lantidex, Imbiomed-L, Redalyc and Google Scholar for original articles written in Spanish. The searches included the key words (Mesh): menstruation, menstrual period, menstrual cycle, dysmenorrhea, primary dysmenorrhea, inflammatory substance and inflammatory markers. Publications from January 1980 to February 2021 were reviewed. Dysmenorrhea is the most common gynecologic condition experienced by menstruating women. It is characterized by crampy lower abdominal pain that can range widely in severity, and associated to others symptoms. Its overall impact often has significant medical and psychosocial implications. The hallmark of primary dysmenorrhea is painful menses in the absence of any associated macroscopic pathologic process, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism. An excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation have been mentioned as the main cause of primary dysmenorrhea. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings. This narrative review investigated and analyzed the pathophysiology of primary dysmenorrhea and the implications of other chemical substances.

Rectosigmoid endometriosis: diagnostic pitfalls and management – A case report

Endometriosis constitutes a benign condition, occurring in 10-12% of menstruating women. Bowel involvement is estimated to occur in 5-12% with the rectosigmoid region involved in up to 90% of these cases. We present the case of a 45-year-old Caucasian female patient with rectosigmoid endometriosis.

Safety and influence of a novel extract of fenugreek on healthy young women: a randomized, double-blinded, placebo-controlled study

Background Fenugreek (Trigonella foenum-graecum) seed is a popular kitchen spice and medicinal herb with wide applications in Indian folklore. Earlier studies have shown that the hydro-ethanolic extracts of fenugreek are efficient in the management of a number of hormone related disorders in women, including post and peri-menopausal discomforts, sexual dysfunctions, lactation and even in amenorrhea. However, systematic informations on their safety and influence on hormonal balance are limited. Results Forty-eight healthy menstruating women aged 20 to 48 were randomized either to FHE (n = 24) or placebo (n = 24) and supplemented with 250 mg × 2/day for 42 days. FHE did not produce any side effects or adverse events. It offered significant (P < 0.05) beneficial effects to sexual problems (41.6%) and irritability (40%) among the participants who had higher sexual dysfunctions scores (> 1) when monitored by the validated Menopausal Rating Scale (MRS) scale. Further, hormone analysis indicated an enhancement in estradiol (P = 0.040), free testosterone (P = 0.025), and total testosterone (P = 0.012) in FHE group in comparison to placebo. There were no significant changes in progesterone (P = 0.174) and FSH (P = 0.879) upon FHE supplementation. The hematological and biochemical safety parameters were also at par with the safety of the extract. Conclusion Thus, the supplementation of FHE may be considered as a natural alternative for sexual issues in women. Trial registration CTRI/2018/09/015614 dated 05/09/2018.

P–600 Ovarian function following intraovarian injection of autologous platelet rich plasma (APRP) in women with low functional ovarian reserve

Study question Does exposure of ovaries to autologous growth factors in platelet rich plasma (APRP) affect the pituitary ovarian axis? Summary answer Within 60 days after injection, growing follicle numbers and estrogen levels increased, though FSH did not change, with effects most pronounced in still menstruating women. What is known already APRP is extracted from a patient’s autologous blood and delivers growth factors. It is widely used in several medical specialties and has in infertility practice been reported to increase folicle/egg numbers if injected into ovaries and improve endometrial thickness/implantation if used for perfusion of the endometrium. Study design, size, duration Prospective observational cohort study of women with low functional ovarian reserve, followed for 60 days after subcortical injection of ovaries. Participants/materials, setting, methods 44 women with prior poor response to ovulation induction, FSH &gt; 12 mIU/mL and AMH &lt; 1.0 ng/mL. APRP was prepared using Regen Lab PRP Kit which is approved by the US-FDA. 1.0–1.5 ml of PRP was injected into the cortex of each ovary divided among 7 to 10 injection sites. Participants were followed every three days with monitoring for estradiol, FSH and follicle growth for the first two weeks after PRP and then weekly. Main results and the role of chance 21/43 patients still regularly menstruated (subgroup A, age 43.9 ± 5.1 years); 23/43 (subgroup B, age 42.6 ± 6.2 years) were amenorrheic for a median of 6 months. In A, AMH, FSH and estradiol were 0.18 ± 0.20 ng/mL, 37.5 ± 47.6 mIU/mL, and 100.2 ± 73.4 pg/mL, while in B they were 0.06 ± 0.11 ng/mL, 73.0 ± 44.8 mIU/mL and 66.7 ± 57.6 pg/mL. Following APRP, A-patients demonstrated increased estradiol to 211 ± 193.7 pg/mL (P = 0.029) while B-patients only demonstrated a trend to 98.1 ± 86.5 (P = 0.09). Among A patients, 14/21 (66.7%) entered IVF cycles and 5/21 (23.8%) reached retrieval. So-far 1 patients established an ongoing clinical pregnancy. Among B patients 8/23 (34.8%) entered IVF cycles and only 2/23 (8.7%) reached retrieval and none achieved pregnancy. Limitations, reasons for caution This observational study was only carried out to estimate possible effects of APRP treatments. Based on these observations, we are now conducting a randomized controlled trial, limited to cycling women under age 45 years [registration # NCT04278313]. Wider implications of the findings: PRP appears to have limited ability to affect ovarian reserve of older, and especially amenorrheic women. It may, however, exert more favorable effects on still menstruating women. Promotion of APRP treatment as “ovarian rejuvenation,” however, appears to be an inappropriate choice of words. Trial registration number N/A

An Overview on Dysmenorrhea

Every month, many women suffer from menstrual cramps, but few know what causes them, which is an issue in and of itself 1. Dysmenorrhea is the leading cause of chronic short-term school absences in teenage girls1,2,3,4,5 and a common issue in reproductive-age women5,6. In reality, it is estimated that each year, over 600 million hours of work are lost due to dysmenorrhea5. Dymenorrhea is a common ailment among women that can cause severe physical and emotional pain as well as life disturbance. Women, on the other hand, do not seek clinical help in order to relieve this condition7. Menstrual pain is referred to as dysmenorrhea. It is the most common menstrual condition among females. More than half of menstruating women experience pain for 1-2 days per month. For women of reproductive age, it is a very common and often disabling disease. In reproductive-age women, the prevalence ranges from 16 to 91 percent8.