Bleeding barriers: Reimaging menstrual health research through a global and interdisciplinary perspective

Introduction

Menstruation is a biological process that has existed for millions of years. The stigma, shame, and medical misinformation surrounding the periodic shedding of the uterine lining dates back to antiquity with humanity’s earliest physicians and politicians shaping society to reflect their implicit bias as people without the capacity to menstruate. ¹ The long-standing effect is the commonly held beliefs that bodies with the capacity to menstruate were abnormal, and menstruation was a sign of frailty. ² The medical perspective on menstruation has shifted from a sign of illness to something that is often neglected in patient care and medical research. From a socio-cultural lens, the origins of menstrual knowledge also influenced the experiences of menstruation in society. For example, some societies practiced covert menstruation where people who were currently menstruating from the general public during menstruation. ³ Given this historical context, it is understandable that internalized shame concerning menstruation and genital self-image persists for some individuals with the capacity to menstruate. ⁴ It is only in recent years that menstrual health is finally being recognized as a critical issue in public health, gender equity, and human dignity.

The current special collection on menstrual health

Women’s Health has solicited and published articles as part of their special collection Improving Menstrual Health Throughout the Reproductive Life Course. This collection offers a diverse and inclusive collection of articles that captures the complexity of menstrual experiences from an interdisciplinary perspective. This helps bolster our current understanding of the challenges and inequities in access to care and products experienced by people who menstruate. This collection also explores innovative strategies for measurement and policy reform that are critically important for advancing equity for people who menstruate. Importantly, this collection examines menstruation from the life-course approach, recognizing that menstrual health not as a one-time issue affecting only adolescents; rather it is a dynamic and evolving aspect of health and well-being from menarche through menopause and beyond. ⁵ Furthermore, this collection features research from multiple global contexts that embraces an increasingly inclusive and nuanced menstrual health research agenda.

Socio-cultural contexts of menstruation from US-based researchers

Within the socio-cultural context of the United States, studies included in this special collection found access to menstrual supplies were inadequate. Casola et al.’s research in Philadelphia discussed the compounding challenges of menstrual pain, financial insecurity, and social shame—underscoring how menstrual needs intersect with other aspects of daily life and identity.^6,7 The findings from Suleman et al.’s research among college-age menstruators in Chicago reports similar themes of product insecurity, experiences of stigma, and lack adequate campus resources. ⁸ Tapp and Henson explored how menstruators in carceral settings experience coercion, humiliation, and health risks due to restricted access. ⁹

Socio-cultural contexts of menstruation from global researchers

This special collection also includes research from low- and middle-income countries that highlights the themes of product insecurity and stigma. This provides an important socio-cultural nuance to our understanding of the experience menstruation. In these settings, limited menstrual health literacy, inadequate hygiene infrastructure, and socioeconomic disadvantage compound to produce poor menstrual practices and increased health risks. Onubogu et al. examined menstrual health knowledge in rural Anambra, Nigeria and found that nearly half of the girls lacked information before menarche. ¹⁰ Similarly, 38% of adolescents in rural Sindha, Pakistan had satisfactory menstrual knowledge; furthermore, Aziz et al. highlighted how disparity in menstrual health knowledge may be based on urbanicity in Pakistan as 71% of urban menstruators demonstrate satisfactory menstrual knowledge. ¹¹

The divergent experiences among menstruators in developing countries based on urbanicity is explored in more depth in a pair of articles detailing research from Ethiopia and Jordan. These articles examine infrastructure barrier faced by menstruators that contribute to suboptimal menstrual hygiene management. Adane et al. noted that a lack of access to water, sanitation and hygiene stations in Ethiopia contribute to the poor menstrual hygiene among school-aged menstruators. ¹² Karmi et al. examined the impact of lack of access to menstrual health products among menstruators in Jordanian refugee camps. ¹³ Menstruators in this setting note that lack of access to menstrual health products contributed to reuse of these products, thereby doubling the odds of urinary or reproductive tract infections. These articles underscore how improving menstrual health requires comprehensive interventions spanning education, infrastructure, social support, and rights-based policy frameworks.

Community-based solutions for improving access to menstrual health supplies

Though access to menstrual products are a key theme throughout many studies in this special collection, there is research highlighting the profound impact of community-based menstrual supply banks. Massengale et al.’s research finds that access to consistent and free menstrual health products contributes to an improved quality of life and reduction of stress related to having to choose between period supplies and basic necessities like food or rent. ¹⁴ Similarly, Glayzer et al. shed light on the importance of environmental and infrastructural factors related to menstrual equity. ¹⁵ Their observational study explores the use of reusable products and improved facilities, particularly in institutional settings. They argue that sustainability must be considered in tandem with accessibility and dignity to achieve long-term menstrual health outcomes. To round out this special collection, Gouvernet and Brisson offered a conceptual commentary that critiques current menstrual health research fragmentation and calls for more integrative, cross-sectoral approaches and challenges researchers to move beyond biomedical reductionism and embrace cultural, psychological, and policy perspectives of menstruation. ¹⁶ After all, menstruation is not merely a biological experience, not given the long-standing and increasing socio-cultural and econo-political experience of inhabiting a body that has the capacity to menstruate.

Conclusion

This special collection clearly illustrates that advancing menstrual health requires more than isolated interventions. In order to advance mensural health, we must implement sustained, global, and interdisciplinary research, policy, and programs that recognize menstruation as a matter of equity, dignity, and human rights. By bringing together research from diverse contexts, life stages, and methodological approaches, the collection dismantles lingering silos and reframes menstruation as both a biomedical and socio-cultural phenomenon. The takeaway is clear: menstrual health research must move beyond reductionism to embrace intersectionality, sustainability, and inclusivity. As we look to the future, we must not only continue to generate knowledge but also to use this research as the foundation for transformative policy, infrastructure, and community action. In doing so, we can ensure that menstruation is no longer a barrier but a shared catalyst for health, justice, and empowerment worldwide.