https://padlet.com/brent78/ntcz6ni7h67eub8y Medieval Perceptions of Menstruation and the Continued Stigmatization of Menstrual Health Today en-us 2022-06-04 04:17:09 UTC 2025-09-24 03:39:10 UTC hello@padlet.com brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218186830 Before diving into the lesson, I wanted to provide you all with some background information on the state of medical thinking and science in the medieval ages. Keep these ideas in mind while completing the rest of the lesson, as they provide context to help you better understand the views and beliefs on menstruation in the medieval ages.

First off, women were viewed as inferior to men in all aspects of life in the medieval ages. They were expected to be subservient to men in all social, religious, economical, and political settings. It was the predominant belief by doctors, scientists, and philosophers that the male body was the normal, natural state and the female body was a deformed male. Medicine reflected this, and we will see that scholars sometimes struggled to develop both negative and positive explanations for conditions women faced and why.

Second, the majority of diseases that medieval scientists and physicians were talking about and treating are diseases that we still talk about and treat today. The conditions related to menstruation like abnormal cycles, pain symptoms,  and varying levels of blood flow that people in the medieval ages were discussing are still conditions that we discuss today. What is different about medieval medicine and what we have to keep in mind is the scientific understanding and explanations of these conditions are not at the level we have today. The ways in which medicine was used to control people's bodies in the medieval ages is also not the same as it is today.

Third, medieval medicine and science was dominated by fear. There was hardly any understanding of diseases such as the plague that were killing massive amounts of people, and they had limited understanding of how and why women's bodies differed from men's. Scientists, physicians, and philosophers from the medieval ages turned to texts written thousands of years ago by Greek and Roman scholars who also had very limited understanding and proposed crazy theories on how the body worked. Medieval medicine focused on the function of the body and its parts rather than the actual structure and form of the body to explain medicine, and the most important function of the body to medieval scholars was procreation. Virtually all discussions of medicine in the medieval ages for both men and women always came back to reproduction. The health of an individual was intricately related to how they could produce healthy offspring.

For the purpose of this lesson we will be looking more closely at 3 of the Greek and Roman scholars who wrote texts on their theories and beliefs of medicine that heavily influenced medieval theologies. These 3 scholars are Hippocrates, Aristotle, and Galen.

Photo]]> 2022-06-11 15:22:07 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218186830 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218226408 Around 500 years after Hippocrates and Aristotle, from 129-216 C.E lived Galen, a Greek doctor whose translated works would later have a significant impact on medicine in the medieval ages. Galen was influenced by both Aristotle and Hippocrates theories on elements and humors. He developed the one-sex model, believing that the reproductive organs were the same in both men and women but due to a women's lack of heat, her reproductive organs were inverted and stayed inside the body. Men carried enough heat to push their reproductive organs outside.

Photo]]> 2022-06-11 17:00:46 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218226408 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218228474 Hippocrates was a Greek doctor who lived from 460-370 B.C.E and is considered the father of medicine. He is credited with developing the humoral theory. Hippocrates believed that the body contained 4 humors; blood, phlegm, black bile, and yellow (or red) bile. To be healthy all of these humors must be in balance. Any disease or condition outside of the norm was caused by an imbalance of the humors. The humoral theory and Hippocrates texts heavily influenced scholars of medicine for years to come, and as we shall see had a significant impact on how women and menstruation were viewed.

Photo CC BY-SA 2.5]]> 2022-06-11 17:06:55 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218228474 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218241696 Aristotle lived from 384 B.C.E to 322 B.C.E, just after Hippocrates' time. He was a Greek philosopher whose writings influenced medicine in the later medieval ages. Of note, his elemental theories had a significant impact on the beliefs surrounding women's health. Aristotle believed that all matter was made up of the 4 elements; earth, water, air, and fire. Each element coincided with 2 of 4 qualities; cold, hot, wet, and dry. In Aristotle's view, the superior male form was hot and dry while the inferior female form was cold and wet. He also believed that women were deformed, failed men and because of this they faced many conditions and their bodies were like that of monsters.

Photo]]> 2022-06-11 17:45:44 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218241696 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218250230 Blood was considered one of the most important humors and was crucial to medieval medical thinking. Bodily fluids, like semen, sweat, and menstrual blood were believed to be the humor blood at various stages of digestion. The most predominant theory on menstruation in the medieval ages was that because women were cold they could not cook the excess humor of blood like men could. Men cooked their excess humor to make semen, women could not. Therefore, the monthly purging of this excess, uncooked blood humor was menstruation. When a woman was pregnant and would no longer menstruate it was believed that the excess humor of blood was being used to nourish the baby in the womb, and then in the later stages of pregnancy it was being transported up to the breasts and cooked to be made into milk. When menstruation stopped in older women (menopause) or a woman skipped her period that month it was seen as incredibly dangerous and referred to as menstrual retention. In this situation, it was believed that because the excess blood humor could not be purged it was building up in to toxic levels in a woman's body. As we will see and discuss later on, varying opinions and beliefs from scholars existed as to why this happened, the consequences of menstrual retention, and the cures for it. 

Photo CC0]]> 2022-06-11 18:11:13 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218250230 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218266707 These scholars and practitioners of medicine at the Salerno Medical School then went on to write their own treatises and texts on medicine influenced by Galen's theories and ideologies. Their texts were distributed throughout medieval Europe to serve as instructional material for readers on how to treat and cure diseases as well as maintain a healthy body. Medical texts at the time generally had 2 parts; one concerning theory (the explanations of what diseases were and how they came to be) and the other concerning practice (how to treat and cure these conditions in real life). The texts were very philosophical, based on the humors and elements and how those caused diseases. Natural science as we know it today involving observational and experimental evidence was not prominent in these texts. There was no separation between religion and science and theory dominated most scientific practices.

One of the most influential of these texts to come out of Salerno concerning women's health and conditions was the Trotula.

Photo]]> 2022-06-11 19:04:08 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218266707 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218267532 The majority of the Trotula is alleged to be written by a mysterious female professor of medicine who lived in Salerno around 1000-1100 C.E. It is a collection of 3 separate texts joined together after many layers of editorial improvements. For the purposes of this lesson, we will be focusing on 2 of the 3 books of the Trotula; Book on Conditions of Women and Treatments for Women.

This first section of the Trotula, Book on Conditions of Women, is the authors attempt to assimilate the newly translated Galen medical texts into the pre-existing medical theories of the time. This text carries forward humoral and elemental ideas from Galen, discussing women as cold, wet, and not able to cook their excess humors which then must be purged by menstruation. Of note, this chapter discusses menstruation in almost a positive light. Incorporating Galenic ideas, menstruation is viewed as a natural, purgation process essential to a women's health. There is no blame on a women for menstruation, rather the author discusses these unique conditions women face with pity and sympathy. There is a heavy focus throughout this text on reproductive health and maintaining a normal menstrual cycle as like previously discussed retention of the menses was thought to cause horrible illness. The chapter provides an extensive amount of remedies and treatments for the retention of menstruation, paucity of menstruation, and excessive blood flow. Treatments for Women includes similar views and treatments for menstrual conditions but is believed to be more representative of the practices actually occurring locally in every day life. Book on Conditions of Women discusses more theory and would be used more so for educational purposes.

The view on menstruation presented in the Trotula is a good representation of the overall view on menstruation and women's health at the time. While they believed in the purgation of excessive blood humor through menstruation and women were still seen as weaker and inferior to men, it was thought of as a normal process that was a women's problem to deal with and had no effect on others. With a heavy focus on reproduction, it was seen that maintaining a normal menstrual cycle was the key to fertility and part of a women's burden from God to create life.

The theories presented by the Trotula were not the only influential material on menstruation and women's health in the medieval ages. As we shall see going into the later medieval ages, a much more negative outlook on menstruation was starting to make its way around Europe as well.

Photo CC0]]> 2022-06-11 19:06:59 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218267532 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218267819 Much like the 1000-1100's, medicine in the later medieval ages was dominated by theories stemming from the translations of earlier Greek and Roman scholars. While we see the influence of Galen heavily in texts like the Trotula, it was Aristotle's texts that were starting to gain more of an influence in the later 1200's. His views on menstruation were much more negative than Galen's. Later medieval medical writers were also influenced by Isidore of Seville's texts. Isidore lived in Spain around 560-636 C.E. and wrote a 20 volume collection called Etymologies. Included in this collection were discussions on women's anatomy, describing women's bodies as "undisciplined by the mind" and ruled by their internal sexual organs. Around this time we start to see a shift in mentality regarding women's health. While menstruation was still viewed as a purgation of excessive humor, the Galenic views that it was a normal, natural process were being challenged by those following more of Aristotle and Isidore's beliefs. They argued that women were corrupt and evil, and menstruation was more so the act of cleansing. Menstrual blood was extremely dangerous and to come into contact with it or a women who was menstruating could be disastrous.

One of the most influential medical texts to come out of this time period and the one that we will be discussing in this lesson is Albertus Magnus's De Secretis Mulierum.

Photo]]> 2022-06-11 19:07:53 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218267819 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218268123 The Secrets of Women contains many small chapters mostly concerned with reproduction, including conception, the formation of an embryo and fetus, the birthing process, the "generation of imperfect animals", and virginity and chastity. Albertus presents the theory that there are more than one type of menstrual fluid; the type that is used to nourish the embryo (or be transformed into milk), and the type that is impure, excess blood humors. He describes menstruation as following the 4 phases of the moon. The fourth and final phase is when Albertus believes the extremely poisonous, impure menstrual fluid builds up and must be expelled or it will infect the body. Throughout the text, Albertus also strongly discourages men from having sexual relations with women when they were menstruating in this final phase. He discusses how children born from this fluid will have leprosy (a common diseases that at the time had no cure). The men themselves were also at risk of contracting leprosy, cancer, and injury to their penis. To have sex with a woman who was menstruating was basically a death sentence for a man. Albertus described in detail how the corrupt, venomous menstrual blood would infect and weaken them. He even goes as far as accusing some women of knowingly having sex with men in the last phase of the moon to purposely inflict damage and illness, stating that the menstruation occurring at this phase makes women want to commit evil. Prudent and good women know how to keep themselves away from men during their time of menstruation so as not to hurt them in this way.

Albertus also presents strange theories to almost suggest that menstrual blood has supernatural qualities. These ideas stem directly from Isidore's Etymologies where he discussed in great detail how menstrual blood could prevent seeds from germinating, kill herbs, cause trees to shed their fruit, give dogs rabies, and rust iron. Albertus describes how burying the hair of a menstruating woman will result in snakes growing from the ground. He also presents the idea that the excessive humors present in menstrual blood rise through to body as vapors and exit into the air through a woman's eyes. These vapors can go on to posion the eyes of a child or infect the vocal chords to any nearby man, making him hoarse. He suggests that women wear veils while menstruating to help prevent this as well as to hide themselves because they are pale and unattractive while menstruating.

Included in The Secrets of Women are also discussions on what can happen when a women stops menstruating. With no way to expel the excessive poisonous humors, women who are not menstruating are corrupt and dangerous. Albertus states how old women should never look at or kiss babies because they are so full of venom. He believes menstrual defects can cause women to develop sick wombs which could infect their entire body, particularly their mind, making them insane.

Photo]]> 2022-06-11 19:08:52 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218268123 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218310934 From 1000-1100 C.E. in the southern Italian city of Salerno there was an explosion in medical thought and writing commonly referred to as the twelfth-century Renaissance. This city was a hub of science and medical knowledge and was heavily involved in the education of new doctors at the Salerno Medical School as well as the circulation of pharmaceuticals. During this time, medical writings by the earlier Greek and Roman scholars, primarily Galen, were being translated and rediscovered by those at the university.

Photo CC BY-SA 3.0]]> 2022-06-11 21:39:56 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218310934 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218644756 These theories on menstruation and the view of women's bodies presented by Albertus was disastrous on the perceptions of women's health and how women were viewed by society. Helen Rodnite Lemay, the scholar who translated The Secrets of Women, even argues that the beliefs presented in this text heavily influenced later texts written for the prosecution of witches across Europe during the 1400's.

Ideas of women being impure, menstrual blood as a potentially dangerous substance, and menstruation as a taboo subject had always existed prior to texts like The Secrets of Women. The consequences of this text and others like it was now these folktales were being endorsed by influential men and incorporated into real science and practice, affecting how women were treated and viewed by the medical community and society.

Photo]]> 2022-06-12 16:06:22 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218644756 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218646694 Answer these questions by either adding comments to the post or adding a new post in response.]]> 2022-06-12 16:10:58 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218646694 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647135 2022-06-12 16:11:48 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647135 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647203 [student's comments]]]> 2022-06-12 16:11:57 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647203 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647476 2022-06-12 16:12:21 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647476 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647570 [student's comments]]]> 2022-06-12 16:12:33 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647570 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647919 2022-06-12 16:13:22 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218647919 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218648272 [student's comments]]]> 2022-06-12 16:14:06 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218648272 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218648843 2022-06-12 16:15:23 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218648843 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218649182 [student's comments]]]> 2022-06-12 16:16:16 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218649182 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218673077 Before 1000 C.E., a lot of the writings from these 3 Greek and Roman scholars were destroyed, lost, or translated into other languages. During the 1000's and continuing throughout the rest of the medieval ages, they were being rediscovered and translated back into Latin to be distributed to scholars across Europe. Medical practice and belief in the medieval ages was the complex work of scholars trying to incorporate these newly translated medical theories from Hippocrates, Aristotle, and Galen with their own local religious practices and traditions. This was not an easy task, and it created a lot of problems and contradictions within the scientific community.]]> 2022-06-12 17:07:47 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218673077 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218722635 De Secretis Mulierum or The Secrets of Women was believed to be written in the late 1200's or early 1300's either directly by Albertus Magnus or by one of his followers. Albertus was a philosopher, theologian, and scientist who interpreted Aristotle's ideas. The Secrets of Women includes detailed discussions on women, science, and celestial influences or astrology. Albertus's writings were much more philosophical than other medical texts from this time, significantly lacking in the depth of medical knowledge that we know existed. It is still unsure who his audience was but the predominant theory is that The Secrets of Women was intended to be used as an educational text for male monks rather than for physicians. Prevalent themes throughout the text are reproduction and the evil nature of women.

Photo]]> 2022-06-12 19:04:39 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218722635 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218741674 The more sympathetic views on women and menstruation from Galen and the Trotula existed alongside the less sympathetic views of Aristotle, Isidore, and Albertus. These contradicting beliefs of a women's body and its functions as both dangerous and essential for procreation made the perception of women and menstruation confusing for everyone in the medieval ages.]]> 2022-06-12 19:51:26 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218741674 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218800277 Menstruation plays a huge role in how women perceive themselves and their bodies and many scholars argue that menstruation is a form of social stigma for women. Stigma refers to any defect of the body or character that sets people apart from others based on their appearance or identity. 

While we have come far enough in science and medicine to know that having sexual relations with a menstruating woman is not a way to contract leprosy, menstruation still  carries a negative connotation. The feelings of disgust and repulsion that come with discussions on menstruation negatively impact a women's life, and we still have a ways to go to change some of these attitudes founded in the medieval ages. The core beliefs presented throughout the medieval ages that menstruation is dirty, impure, and only important to women's health for reproductive purposes as well as the ideas that women are mysterious, dangerous, and hardly human still cast a shadow over how we view and treat those who menstruate.  ]]> 2022-06-12 22:44:34 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218800277 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218806570 Multiple studies suggest the most significant form of shame and stigmatization that women feel from menstruation is the constant need to hide it from others. This is supported by advertisements, euphemisms, and jokes emphasizing the need to be quiet and discreet about menstruating as well as the embarrassment of any blood leaks. Educational pamphlets in tampon or pad packaging also contribute to this shame. They often do not accurately display female reproductive organs and avoid discussing the menstrual cycle in detail, only focusing more on how to maintain secrecy.  

This shame is not a new concept, in fact we can see it stemming from themes carried throughout the medieval ages. Suggestions of women staying away from men, hiding their faces in veils, and overall disgust and repulsion at the thought or sight of menstrual fluid has carried on to today.  Suggestions that women do whatever they can to hide that they might be menstruating from the world for fear of embarrassment or ridicule still strongly affects how women view themselves and menstruation. ]]> 2022-06-12 23:06:02 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218806570 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218814294 Scholars also suggest there is still a stigma surrounding menstrual blood as a poisonous or magical substance that can inflict harm. Up until the late 1920's and early 1930's, real scientific studies were being conducted to explore the existence of menotoxins. Menotoxins were believed to be poisonous substances released by menstruating women in their blood, saliva, urine, and tears that could kill flowers and prevent jam from setting or bread from rising.

This example represents one of the more shocking themes from the medieval ages that has influenced the perceptions of menstrual fluid centuries later. Clearly, the writings of Albertus and Isidore suggesting that menstrual blood is a toxic and dangerous substance have had continued influence on scientists and researchers as time has progressed. ]]> 2022-06-12 23:26:50 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2218814294 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221030219 Menstruation can be closely linked to objectification theory which is another form of shame and stigma for women. The objectification theory centres around the idea that we live in a society that highly values women based on their attractiveness. This causes women to closely correlate their worth based on how attractive others find them. In cultures that find normal bodily functions like menstruation repulsive and unattractive, this can have significant consequences on how women see themselves and their bodies. 

Experiences of sexual objectification are largely connected to objectification theory and how desirable women are perceived. Something scholars have noted is that the connection between this theory and reproductive functions serves as a reminder of humans "creaturely nature". This is something that has existed for years and was also highly prevalent in the medieval ages. When society reduces a woman's worth down to her attractiveness and her reproductive function, we suggest that she exists only to serve men. Factoring menstruation in to that, we can see the shame and stigma that has persisted for centuries. For medieval women, it was the shame of abnormal menstruation that marked them as possibly unable to reproduce. For modern women, it is the shame of menstruation that might make them unattractive or undesirable to men.  ]]> 2022-06-14 17:14:43 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221030219 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221042673 As we have discussed, the attitudes towards menstruation today that were birthed from the beliefs in the medieval ages still majorly affect how women and menstruation are perceived socially. Something we haven't touched on yet is how these attitudes also impact women's health. In the remainder of the lesson we will focus on how research and the diagnosis and treatment of women suffering from menstrual abnormalities has been impaired due to these attitudes.

Menstruation is defined as cyclical bleeding that occurs from the uterus between menarche (the onset of menstruation, usually early teens) to menopause (the end of menstruation, usually around 50 years of age). 28 days is a rough estimate of the menstrual cycle, but this varies greatly. 30% of women experience alterations in their cycles that can last anywhere from just one month to many years. It is estimated that 1 in 4 women suffer from abnormal menstrual bleeding and 93% of women suffer menstrual pain that impacts how they function. All these facts and numbers are here to highlight for you just how many women face and deal with troubling symptoms of menstruation and/or abnormal menstruation. 

From a scientific perspective, conditions like this affecting this huge of a percentage of the population and how they function should be a massive area of research. The normalization of menstrual pain and the stigmatization of menstruation has instead presented many barriers to research and to women seeking care for abnormal menstruation. ]]> 2022-06-14 17:27:41 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221042673 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221049578 PubMed is an online database containing life sciences and biomedical journals. Doctors, scientists, researchers, and students all use websites like PubMed to access and read scientific journals and apply that research to their practices. If you search on PubMed for articles in the last decade containing the word "menstruation", you will find about 6,000 articles. In comparison, if you search on PubMed for articles containing the word "semen", you will find almost 17,000. This is incredibly concerning. Significant gaps in research still exist when it comes to understanding the complex mechanisms of normal and abnormal menstruation across all life stages. This lack in understanding has also lead to significant gaps in physicians and patients identifying what a normal menstrual cycle looks like and how that compares to an abnormal one. 

To identify and treat women suffering from abnormal menstrual patterns, practitioners need to document detailed records of their patients bleeding and cycle histories. Due to the stigmatization and shame surrounding menstruation this is unfortunately not happening. Less than 10% doctors document their patients menstrual history. Women still feel embarrassed to discuss their menstrual patterns with their doctors or come forward with symptoms that may be causing them distress. Only 4 in 10 women will seek care for heavy menstrual bleeding which is often a sign of a more serious condition. Doctors are also still uncomfortable discussing menstruation with their patients and often times ignore any signs or symptoms related to menstruation that could signify a worse condition. ]]> 2022-06-14 17:35:55 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2221049578 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222151379 Haemophilia and Von Willebrand disease are conditions that affect the bloods ability to clot. Normally after receiving a cut, protein clotting factors in your blood will travel to the site of injury and mix with blood cells to form a clot and stop the bleeding so you do not lose too much blood. Those suffering from these conditions have a mutation in their genes that results in them not making enough protein clotting factors to form these clots. Even from minor injuries, this can result in excessive bleeding that could potentially be life threatening.

Photo CC0]]> 2022-06-15 16:27:35 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222151379 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222185940 These disorders are inherited genetically as X-linked recessive traits, meaning that the mutated gene is located on the X chromosome and can be passed down from either mother or father to daughter or son. 

A few of the problems in treating women with bleeding disorders have been the perception that conditions like these only affect men and that the blame is entirely on women for handing down this disorder to their sons. This is because in women, who have XX chromosomes, having the mutation on one of their chromosomes doesn't necessarily mean they will be affected by the disorder. Their other X chromosome with no mutation will still be producing protein clotting factors just fine. When this happens, the woman is known as a carrier of the disorder. Men with this mutation will always be affected by the condition because they will only have the one mutated X chromosome (men have XY chromosomes). As illustrated in the image above on the left, a carrier mother will have a 50/50 chance of producing sons affected by the disorder and a 50/50 chance of producing daughters who will be carriers. Men who have this mutation instead have a 100% chance of passing it onto their daughters and a 0% chance of passing it to their sons (right side of the image above). 

This perception of women as unaffected carriers and bleeding disorders as conditions that only affect men has only recently been proven not entirely true. This is due to X-inactivation. In every cell in a woman's body, one of her X chromosomes will become inactivated. In an ideal world this would occur at a ratio of 50:50, so for every 100 cells 50 would have one of the X chromosomes active and 50 would have the other. As with most things in nature, it does not occur this perfectly. X-inactivation can be incredibly skewed, which is a problem in women carrying a bleeding disorder mutation. If her X-inactivation is skewed more to a ratio of 20:80, with 20 of 100 cells having the non-mutated X chromosome active and 80 having the mutated chromosome active, she will be affected by the mutation. This "carrier" woman will have significantly less protein clotting factors and could be classified as having a bleeding disorder. This is a phenomenon that is estimated to occur in 1/3 of women carriers. ]]> 2022-06-15 17:08:06 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222185940 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222599073 For every man with a bleeding disorder there will be almost 2 women carriers. If 1/3 of women carriers have protein clotting factor levels low enough to be classified as haemophilia or Von Willebrand disease, then statistically 30% of all patients treated for bleeding disorders should be women. Unfortunately, this is far from the truth. Only 3.5% of patients diagnosed are women. What exactly does this mean? Of the 30% of carrier women suffering from bleeding disorders, only 3.5% of them are actually receiving the proper treatment and care. 

To explore the reasons why this is occurring we turn to one crucial component in the presentation of women suffering from bleeding disorders. The most common symptom and earliest sign of a bleeding disorder in women is abnormal, heavy menstrual bleeding. In fact, 90% of women with a bleeding disorder will also experience heavy menstrual bleeding. 

This is an example of how the shame and stigmatization of menstruation we have been discussing throughout this lesson has directly impacted health outcomes for women. Postpartum women and those who suffer from heavy menstrual bleeding present with the majority of symptoms for bleeding disorders yet they continually suffer from no  diagnosis or treatment. On average, it takes women 16 years from their first reported symptom until they receive a formal diagnosis for a bleeding disorder. This is due to many factors, including the normalization of pain and menstruation resulting in the dismissal and neglect of symptoms, the uncomfortableness both patient and practitioner still feel in discussing menstrual cycles, and the lack of criteria to categorize what consists of a normal menstrual cycle as well as normal bleeding levels. ]]> 2022-06-16 03:02:46 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222599073 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222734585 Untreated bleeding disorders can and have been fatal. Not recognizing or treating women who may be suffering from bleeding disorders because of the stigmatization of menstruation has and will continue to kill women. This is also only just one example of a condition associated with menstruation patterns. Many others exist, and if we do not work toward changing the attitudes about menstruation that can be traced back to the medieval ages, women's health will continue to suffer.
So where do we go from here? I am hoping from this lesson you take away the bigger, broader picture; that there is so much work still to be done in understanding and breaking the stigma surrounding menstruation to improve the treatment, care, and health outcomes for women. Many organizations exist that are working towards this goal, including Let's Talk Period and the Foundation for Women and Girls With Bleeding Disorders. ]]> 2022-06-16 05:47:45 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222734585 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222770469 In 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development held a meeting to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field". The meeting included the collaboration across many disciplines discussing leading areas of research, resources, and the growing significance in menstruation as an area of scientific study.

This meeting discussed a lot of the points we have already covered including the gaps in research and understanding as well as the continued shame and stigma surrounding menstruation. But, they also explored a future area of research that could completely change the way we think about menstruation for generations to come.

Something we have been discussing this entire lesson that has been prevalent throughout the history is menstruation as a component of strictly reproductive health. Upon surface level, there really doesn't seem to be much more use of menstruation other than for reproductive purposes. New areas of potential research are currently challenging this notion. Something about menstruation that is incredibly astonishing is the ability of the endometrial cells lining the inside of the uterus to rapidly shed, regenerate, and mature without leaving behind a single scar. Studying this tissue in greater detail could have endless possibilities for regenerative medicine, which is focused on the "repair, replacement or regeneration of cells, tissues, or organs to restore impaired function". Endometrial tissue that heals incredibly fast and leaves no mark behind could in the future revolutionize treatment for anyone from burn victims to those requiring complex bone regeneration and remodelling. 

Throughout this lesson we have focused on the shame and stigma surrounding menstruation and how it affects women's health negatively. This new avenue of research discussed at this meeting serves as an example of one of the many amazing and positive aspects of menstruation that could potentially be used in the future to better people's lives.]]> 2022-06-16 06:32:29 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2222770469 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223303873 2022-06-16 18:22:56 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223303873 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223303953 [student's comments]]]> 2022-06-16 18:23:05 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223303953 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223304878 2022-06-16 18:24:34 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223304878 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223304955 [student's comments]]]> 2022-06-16 18:24:42 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223304955 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305286 2022-06-16 18:25:16 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305286 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305537 [student's comments]]]> 2022-06-16 18:25:32 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305537 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305725 2022-06-16 18:25:53 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223305725 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223306695 2022-06-16 18:27:26 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223306695 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223306876 [student's comments]]]> 2022-06-16 18:27:46 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223306876 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223307011 [student's comments]]]> 2022-06-16 18:27:57 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223307011 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223307746 2022-06-16 18:29:01 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223307746 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223308126 [student's comments]]]> 2022-06-16 18:29:39 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223308126 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223594213 2022-06-17 02:20:57 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223594213 brent78 https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223594389 [student's comments]]]> 2022-06-17 02:21:08 UTC https://padlet.com/brent78/ntcz6ni7h67eub8y/wish/2223594389