In “The Social and Psychological Impact of Endometriosis on Women’s Lives: A Critical Narrative Review,” hereafter “Social and Psychological Impact of Endometriosis,” authors Lorraine Culley, Caroline Law, Nicky Hudson, Elaine Denny, Helene Mitchell, Miriam Baumgarten, and Nicholas Raine-Fenning review the extent at which endometriosis results in a negative quality of life for affected women. Endometriosis is a condition characterized by the growth of cells similar to that of the endometrium, or the tissue that lines the uterus, outside of the uterus, and can cause heavy menstrual periods, pain, and infertility. Such symptoms can impact how women balance romantic or sexual relationships, due to the fact that endometriosis can cause chronic pelvic pain and pain during sexual intercourse. The authors found that women living with endometriosis are more likely to experience depression or anxiety, and conclude that the lack of both overall academic research and factual information given to women at diagnosis results in negative effects on their psychological wellbeing.

In 1987, the World Health Organization, or WHO, took action to improve the quality of maternal health around the world through the declaration of the Safe Motherhood Initiative, or the SMI, at an international conference concerning maternal mortality in Nairobi, Kenya. Initially, the SMI aimed to reduce the prevalence of maternal mortality around the world, as over 500,000 women died during pregnancy and childbirth annually at the time of its inception, while about 98 percent of those deaths occurred in low-income countries. While WHO led the initiative, many organizations in various countries participated in additional programs in order to implement the goals of the SMI. WHO developed the SMI in order to reduce the prevalence of maternal death, developing one of the first proposals that brought attention to maternal health on a global basis at a time when global maternal mortality was high.

Arnaud Fauconnier and Charles Chapron published “Endometriosis and Pelvic Pain: Epidemiological Evidence of the Relationship and Implications,” henceforth “Endometriosis and Pelvic Pain,” in the journal Human Reproduction Update in 2005. In that article, the researchers studied the relationship between pelvic pain and endometriosis. Endometriosis is the growth of endometrium, or tissue that normally lines the inside of the uterus, outside of the uterus. The authors review medical studies in order to determine how much evidence exists that endometriosis causes chronic pelvic pain symptoms. Then, the authors describe specific relationships between different types of endometriotic lesions and pain symptoms. By establishing specific relationships between pain and endometriosis, “Endometriosis and Pelvic Pain” helped healthcare professionals diagnose and treat pelvic pain related to endometriosis.

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.

In 2010, Sophia and Paul Grinvalds founded the organization AFRIpads in Kampala, Uganda, to provide reusable cloth pads to menstruating women and girls throughout the country. At that time, the Grinvalds wanted to help implement better menstrual health and hygiene in Uganda to encourage women and girls to engage in work and school. While living in Kampala, in 2010, they employed Ugandan women to sew cloth pads daily and sell to others living in the local village. In 2018, the United Nations Human Rights Council, or UNHRC, conducted a study in Uganda to test the efficiency of AFRIpads and found that a majority of women and girls studied favored reusable cloth pads. Since then, as of 2021, AFRIpads has expanded to collaborate with other organizations to distribute their reusable cloth pads to women and girls living in African countries. By doing so, AFRIpads has helped introduce a sustainable method for managing menstrual hygiene and teaching menstrual education in low-income countries.

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.

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.

Dysmenorrhea refers to painful menstrual bleeding and often includes symptoms such as cramps in the lower abdominal region, pain radiating down to the thighs, nausea and vomiting, diarrhea, fatigue, and headaches. There are two types of dysmenorrhea, called primary and secondary dysmenorrhea, which develop in different ways. In cases of primary dysmenorrhea, people experience painful cramps before and during most of their menstrual cycles, which does not happen as a result of a different underlying condition and is mostly due to hormone imbalances. On the other hand, secondary dysmenorrhea is a symptom of an underlying condition that cause problems with the reproductive organs such as endometriosis. According to the American College of Obstetricians and Gynecologists, researchers have reported that dysmenorrhea impacts up to fifty to ninety percent of women, remaining one of the most common reasons why women miss days of school and work as of 2021, and contributing to decreased quality of life.