Menstruation: science and society
Por:
Critchley H, Babayev E, Bulun S, Clark S, Garcia-Grau I, Gregersen P, Kilcoyne A, Kim J, Lavender M, Marsh E, Matteson K, Maybin J, Metz C, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor H, Wagner G, Griffith L
Publicada:
1 nov 2020
Ahead of Print:
21 jul 2020
Resumen:
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
Filiaciones:
Critchley H:
Univ Edinburgh, Med Res Council Ctr Reprod Hlth, Edinburgh, Midlothian, Scotland
Babayev E:
Northwestern Univ, Dept Obstet & Gynecol, Feinberg Sch Med, Chicago, IL 60611 USA
Bulun S:
Northwestern Univ, Dept Obstet & Gynecol, Feinberg Sch Med, Chicago, IL 60611 USA
Clark S:
Days Girls, Mt Vernon, WA USA
Garcia-Grau I:
Igenomix Fdn Inst Invest Sanitaria Hosp Clin, INCLIVA, Valencia, Spain
Univ Valencia, Sch Med, Dept Pediat Obstet & Gynecol, Valencia, Spain
Gregersen P:
Northwell Hlth, Feinstein Inst Med Res, Manhasset, NY USA
Kilcoyne A:
Massachusetts Gen Hosp, Boston, MA 02114 USA
Kim J:
Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
Lavender M:
Your Belt Hlth, Chicago, IL USA
Marsh E:
Univ Michigan, Dept Obstet & Gynecol, Div Reprod Endocrinol & Infertil, Sch Med, Ann Arbor, MI 48109 USA
Matteson K:
Brown Univ, Women & Infants Hosp, Div Res, Dept Obstet & Gynecol,Warren Alpert Med Sch, Providence, RI USA
Maybin J:
Univ Edinburgh, Med Res Council Ctr Reprod Hlth, Edinburgh, Midlothian, Scotland
Metz C:
Northwell Hlth, Feinstein Inst Med Res, Manhasset, NY USA
Moreno I:
Igenomix Fdn Inst Invest Sanitaria Hosp Clin, INCLIVA, Valencia, Spain
Silk K:
Univ Delaware, Dept Commun, Newark, DE USA
Sommer M:
Columbia Univ, Dept Sociomed Sci, Mailman Sch Publ Hlth, New York, NY USA
Simon C:
Igenomix Fdn Inst Invest Sanitaria Hosp Clin, INCLIVA, Valencia, Spain
Univ Valencia, Sch Med, Dept Pediat Obstet & Gynecol, Valencia, Spain
Harvard Univ, Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
Baylor Coll Med, Dept Obstet & Gynecol, Houston, TX 77030 USA
Tariyal R:
NextGen Jane, Oakland, CA USA
Taylor H:
Yale Sch Med, Dept Obstet Gynecol & Reprod Sci, New Haven, CT USA
Wagner G:
Yale Univ, Dept Obstet Gynecol & Reprod Sci, Syst Biol Inst, Dept Ecol & Evolutionary Biol, New Haven, CT USA
Wayne State Univ, Dept Obstet & Gynecol, Detroit, MI USA
Griffith L:
MIT, Ctr Gynepathol Res, 77 Massachusetts Ave, Cambridge, MA 02139 USA
hybrid, Green Published
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