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.

Developing a codebook of definitions and exemplars of significant text segments and applying it to the collected data revealed several themes. For example, mothers, friends, teachers, the Internet, and social media are among the most common sources of information about menstrual hygiene and health. Yet, women reported that those sources of information often echoed stigmatized ideas about menstruation, eliciting feelings of shame and fear. That poor quality of information was instrumental to women’s abilities to detect and report abnormal menstrual bleeding.

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.

Endometriosis is a medical condition that involves abnormal growths of tissue resembling the endometrium, which is the tissue that lines the inside of the uterus. Those growths, called endometrial lesions, typically form outside the uterus, but can spread to other reproductive organs such as ovaries and fallopian tubes. Endometrial lesions swell and bleed during menstruation, which can cause painful and heavy menstruation, as well as infertility. As of 2021, there is no cure for endometriosis, although medical therapies such as birth control pills and GnRH analogues can treat the painful symptoms of endometriosis. More than eleven percent of women between the ages fifteen and forty-four in the US have endometriosis, which can often decrease a woman’s quality of life due to painful symptoms and impair her reproductive potential.

Amenorrhea is considered a type of abnormal menstrual bleeding characterized by the unexpected absence of menstrual bleeding, lasting three months or longer. Menstrual bleeding typically happens approximately once a month when blood and endometrial tissue, or tissue lining the inside of the uterus, sheds from the uterus through the vagina. Menstruation is expected to stop with pregnancy, breastfeeding, and menopause, or the natural cessation of the menstrual cycle at an older age. However, women may also experience amenorrhea because of an underlying health condition, including low body weight or polycystic ovarian syndrome, that may complicate fertility and contribute to decreased quality of life. According to the American College of Obstetricians and Gynecologists, one in twenty-five women experience amenorrhea as a menstrual disorder within their lives at times.

In 1953, Raymond Greene and Katharina Dalton, who were doctors in the UK, published The Premenstrual Syndrome in the British Medical Journal. In their article, Dalton and Greene established the term premenstrual syndrome (PMS). The authors defined PMS as a cluster of symptoms that include bloating, breast pain, migraine-headache, fatigue, anxiety, depression, and irritability. The article states that the symptoms begin one to two weeks before menstruation during the luteal phase of the menstrual cycle, and they disappear upon the onset of the menstrual period. Menstruation is the monthly series of changes a woman's body undergoes in preparation for the possibility of pregnancy. Dalton and Greene described how progesterone affected women during different phases of their menstrual cycles. The paper convinced many about the phenomenon of PMS, and docotors and scientists adopted Dalton's and Green's term. The paper furthered research about the role of hormones in physiology and of conditions linked to the reproductive system.