Embryo Project Encyclopedia

Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.

In their 2014 article “A Comparison of the Menstruation and Education Experiences of Girls in Tanzania, Ghana, Cambodia, and Ethiopia,” hereafter “Comparison of Menstruation,” researchers Marni Sommer, T. Mokoah Nana Ackatia-Armah, Susan Connolly, and Dana Smiles examined various physical and social barriers impacting women’s management of menstrual health across Ghana, Cambodia, and Ethiopia. The authors examined barriers such as misinformation about menstruation and how schools limit girls’ ability to manage their menstrual cycles. They then compared their findings to a previous study led by Sommer on similar experiences shared by girls living in Tanzania. “Comparison of Menstruation” provides insight into the physical and social barriers to managing menstruation in low-resource contexts and serves as a precursor to the creation of educational resources intended to improve menstruation health management for women and girls.

On 5 April 2018, the documentary Period. End of Sentence. premiered at the Cleveland International Film Festival in Cleveland, Ohio. In the documentary, Rayka Zehtabchi, the director of the film, documents the stigma surrounding menstruation in India and follows a group of women in Kathikhera, a rural village in the Hapur district of India, as they manufacture and distribute sanitary pads. A group of high school students at Oakwood High School in Los Angeles, California, raised money to produce the documentary after one student was inspired by her visit to the United Nations Commission on the Status of Women in New York City, New York, which focused on the stigma surrounding menstruation in low-income countries. Period. End of Sentence. draws attention to the obstacles impeding proper menstrual health management in low-income contexts by documenting the women of Kathikhera’s journey to manufacture and sell sanitary pads.

In July 2015, Marni Sommer and colleagues published “Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue,” hereafter “Defining MHM,” in American Journal of Public Health. The authors discuss that growing interest in the gender gap in education raised awareness about girls’ obstacles to managing menstruation, especially in low-income countries. Increased focus on MHM pushed menstruation to be redefined as a public issue rather than a private one. That transition made MHM the responsibility of national governments instead of just the responsibility of young girls, because it became more widely recognized that girls could only appropriately manage menstruation if they had access to the necessary resources through public infrastructure. “Defining MHM” outlines how defining MHM as a public health issue brought much-needed attention to the obstacles to MHM young girls face and emphasizes that other underrepresented public health issues could use similar tactics as the MHM movement to gain global attention and funding.

In October 2017, Columbia University Mailman School of Public Health in New York City, New York, and the International Rescue Committee published A Toolkit for Integrating Menstrual Hygiene Management (MHM) into Humanitarian Response. Researchers Marni Sommer, Margaret Schmitt, and David Clatworthy collaborated on the Toolkit to benefit women and girls in Lebanon, Myanmar, and Tanzania. The Toolkit serves as a guideline for humanitarian organizations to ensure better menstrual hygiene management, or MHM, in low and middle-income countries. MHM includes clean water, private hygiene facilities for women and girls, materials such as sanitary pads, and accurate literature on menstruation. The authors of the Toolkit provide ways in which humanitarian organizations can work in communities to address social and physical barriers to managing menstrual health in low and middle-income countries.

In “Beyond Menstrual Hygiene: Addressing Vaginal Bleeding Throughout the Life Course in LMICs,” hereafter “Beyond Menstrual Hygiene,” Marni Sommer, Penelope A. Phillips-Howard, Therese Mahon, Sasha Zients, Meredith Jones, and Bethany A. Caruso explored the barriers women experience in managing menstruation and other forms of vaginal bleeding in low and middle-income countries, which the researchers abbreviate to LMICs. The medical journal British Medical Journal Global Health published the article on 27 July 2017. As little literature existed at the time concerning the topic of vaginal bleeding for women in LMICs, Sommer and her team state that they were motivated to assess the topic in order to better understand how issues concerning the health of women and girls are managed in limited-resource contexts. In “Beyond Menstrual Hygiene,” the authors assert that females in LMICs need access to better resources, education, and supplies to manage menstruation.

A Treatise on the Theory and Practice of Midwifery is a three volume collection of patient accounts that William Smellie published from 1752 to 1764. Smellie, a physician and instructor in obstetrics in Great Britain, published these compilations to share his expertise in reproductive medicine, while also providing his students and colleagues with a source of reference in their own medical practices. Smellie wrote these books to shift obstetrics from a discipline practiced by midwives with limited medical training to one practiced in a medical context by physicians. Throughout his books, Smellie describes effective and ineffective treatments, tools, and interventions for complications during pregnancy. Due to the popularity of Smellie's writings, access to Smellie's work expanded beyond his students, allowing obstetricians, man-midwives, and physicians to refer to scientific literature and apply Smellie's teachings to their own practice.

Edgar Allen identified and outlined the role of female sex hormones and discovered estrogen in the early 1900s in the US. In 1923, Allen, through his research with mice, isolated the primary ovarian hormone, later renamed estrogen, from ovarian follicles and tested its effect through injections in the uterine tissues of mice. Allen’s work on estrogen, enabled researchers to further study hormones and the endocrine system.

James Young Simpson was one of the first obstetricians to administer anesthesia during childbirth in nineteenth century Scotland. Before his work in the 1800s, physicians had few ways to reduce the pain of childbirth. Simpson experimented with the use of ether and chloroform, both gaseous chemicals, to temporarily relieve pain. He found that those chemicals both successfully inhibited the pain women felt during childbirth and pain during other surgeries. Patients under the influence of chloroform fell asleep and were unaware of the intense pain of childbirth. Simpson’s work was not popular for a variety of reasons, and the major claim against his practice being that pregnant women should not receive a form of pain relief during labor and childbirth. Against common beliefs at the time, Simpson advocated in favor of using anesthetics for pain-free labor, which later became the standard for surgical procedures and childbirth.

Lydia Estes Pinkham invented and sold Lydia Pinkham’s Vegetable Compound, a medicinal tonic used to treat menstrual discomfort and promote female reproductive health in general, in the US during the nineteenth century. Pinkham also founded Mrs. Lydia E. Pinkham Medicine Company, a business that sold natural remedies for women’s health issues. Throughout her life, Pinkham acted as an authority on female wellness, writing medical pamphlets about female anatomy and reproductive processes. In those pamphlets, Pinkham addressed female medical issues that physicians did not frequently discuss with their patients. Pinkham’s advertising techniques and her products helped women learn about their reproductive anatomy and processes and helped ease menstruation.