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Menstruation in the USA

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Abstract

Purpose of Review

Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces.

Recent Findings

First, menstruation plays many roles in psychology — premenstrual syndrome affects psychological well-being, and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the hypothalamus-pituitary-ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve “menstrual equity,” by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and “impurity” associated with menstruation.

Summary

Overall, this review highlights the universality of menstruation in society. As a “fifth vital sign,” there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.

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Funding

Supported by NICHD Grant 3R01HD094380-04S1.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Malini Ramaiyer & Bethlehem Lulseged

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Rachel Michel

  3. Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA

    Fiza Ali

  4. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jinxiao Liang

  5. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA

    Mostafa A. Borahay

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  1. Malini Ramaiyer
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M.R., B.L., R.M., F.A., and J.L. wrote the sections of the manuscript. M.R. prepared Figs. 1 and 2. M.R. and M.B. authors reviewed the manuscript.

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Correspondence to Mostafa A. Borahay.

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Ramaiyer, M., Lulseged, B., Michel, R. et al. Menstruation in the USA. Curr Epidemiol Rep 10, 186–195 (2023). https://doi.org/10.1007/s40471-023-00333-z

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