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A combination of social, economic, and political factors have resulted in an inadequate diagnostic process to differentiate between the symptoms of various female-prevalent health issues, and those triggered, worsened, or caused by the menstrual cycle (and/ or hormonal medication).
For example, female people of reproductive age are known to be disproportionately affected (at least 2:1) by chronic health issues that share many of the same symptoms as PMS (Premenstrual Syndrome) ;
However, menstruating patients are not typically asked to track their symptoms over time (at least 2 cycles), to enable a fully-informed differential diagnosis.
In fact, several factors have combined to effectively obscure the role of the menstrual cycle in triggering, worsening, or causing such symptoms;
“I don’t consult [a doctor]… I haven’t bothered again- I don’t feel they understand the problem and it’s so hard to explain.”- Research participant from menstrual symptoms help-seeking behaviour study .
“We have evidence that over half of our patients have to see three clinicians before somebody takes them seriously.” -Lawrence Nelson, a gynaecologist at the US National Institute of Health (NIH) .
So, patients may be misdiagnosed with a chronic health issue (or left without a diagnosis), when, in fact, their symptoms are triggered by their (healthy) menstrual cycle.
The misdiagnosis, or a lack of diagnosis, of cyclical symptoms can have a serious impact on patients and the healthcare sector; especially in terms of costs, health outcomes, patient well-being, and societal perceptions of female-prevalent conditions.
Misdiagnosis can have a serious impact on patients :
For the healthcare sector, this can result in ;
What’s more, cyclical symptoms are often quite simple to treat, without necessarily requiring prescription medication. Plus, there is a big psychological difference between a diagnosis of a chronic ill-health condition, and one of ‘cyclical symptoms’, especially in terms of long term patient health and well-being…
Finally, by ignoring the physiological causes of symptoms, female-prevalent conditions will continue to be dismissed as somehow entirely ‘psychological in origin’ i.e. the “it’s all in her head” mentality. Studies show that female-prevalent health issues (such as IBS, anxiety, depression, migraine, chronic fatigue syndrome, fibromyalgia, and auto-immune conditions) are more likely to be dismissed as ‘not real’ or thought to be ‘exaggerated’ by sufferers [4- 6], even if the patient is male…
The social and political factors described above have also resulted in a strange paradoxical situation. Many clinical guidelines and research articles unintentionally reinforce the sexist idea that the menstrual cycle is somehow pathological in itself. They may do this by vastly exaggerating the prevalence of a menstrual health issue, or by implying that such extreme symptoms are merely the severe end of a ‘normal curve’ of menstrual experiences, rather than due to an underlying health issue in that individual .
At the same time, people who do experience severe symptoms are often positioned in a way to suggest that they are exaggerating, or are simply less able to handle the natural and healthy changes associated with the menstrual cycle, even though they typically have some sort of underlying condition in need of medical treatment [4-6].
These twin assumptions are incredibly pervasive and so it is only with careful and critical evidence-based research that we can unpick and redefine menstrual health in a way that does not unintentionally reinforce problematic gender stereotypes. This is why the social and natural sciences are combined in the Menstrual Matters research approach and blogs.
Recent years have seen significant growth in alternative therapies and mystical descriptions of menstrual health. While some are harmless and can provide useful alternative cultural perspectives and treatment options, others are simply selling products and services that are ineffective at best, or very harmful at their worst . Beyond the financial and physical threats such practices pose, the accompanying narratives around menstrual health typically reproduce sexist beliefs that position people who menstruate as ‘other’, or ‘inferior’ types of humans . Again, it is only with careful and critical social and biological scientific research that we can effectively counter such narratives.
At the same time, there has been a rise in gender discrimination against transgender and non-binary people. Sadly, such discrimination has also gained traction within supposedly human rights-based political movements, including feminism(s). Misinformed and exclusionary beliefs based on pseudo-scientific premises underpin much of the debates surrounding sex/ gender. For example, people often confuse the terms sex/ gender, female/woman, feminist/ female supremacist.
My own deep political belief in equal human rights (regardless of sex or gender identity, or any other intersecting social identity) provides further motivation to help counter this disturbing trend with evidence-based and inclusive research approaches and content. I am very proud of the why we say ‘people who menstruate’ blog, even though the backlash it unleashed was, and remains, deeply upsetting. At least I have the support of the wider menstrual health and rights movement. Menstrual health matters, language matters and fighting social and political discrimination also matters.
References are at the bottom of this page…
Please contact us if you’d like any more information, or to let us know your thoughts.
The people behind this project…
Sally King- Director and Founder
In 2013, Sally started researching the role of the menstrual cycle in ill health after experiencing unexplained nausea and vomiting, and then developing asthma after taking hormonal medication to deal with this issue. The difficulty she faced in trying to find evidence-based and unbiased information on this ‘taboo’ topic led to the creation of Menstrual Matters. Her popular blog looks at how menstrual taboos and gender myths directly contribute to ‘bad science’, inadequate medical knowledge and training, and wider social inequalities.
Before specialising in menstrual health research, Sally spent nearly a decade reviewing and evaluating human rights interventions and policies, for Oxfam GB, Care International and Amnesty International. Sally has a Master’s degree in Research Methods (qualitative & quantitative) and is a big fan of evidence-based critical thinking. She is currently also doing a PhD in Medical Sociology at King’s College London.
Dr Catriona Murray- Medical Adviser
Catriona works as a Family Planning doctor. In her clinical work she directly observes how the menstrual cycle and contraceptive medications have a huge impact on many aspects of health and well-being. Catriona has always had a strong interest in female reproductive health. She worked as a junior doctor in Obstetrics and Gynaecology and currently works in New Zealand as a specialist in Family Planning and Reproductive Health. She has a Master’s degree in Natural Sciences from the University of Cambridge, and a medical degree from the University of Oxford.