Menstruation

Question 1

What is the difference between Menstrual Hygiene Management and Menstrual Health and Hygiene?

Answer 1

The term Menstrual Hygiene Management, or MHM, was first used around 2004-2005, and focuses on ensuring that women and girls have the materials and facilities necessary to manage their menstruation. The term, “Menstrual Health and Hygiene,” or MHH, builds on and expands the original MHM definition to include gender equality, education, and attention from trained health professionals.

Question 2

What is the average percentage increase of menstrual blood loss that has been observed in before-after studies where iron therapy was provided to anemia women?

Answer 2

We observe a 25% increase in menstrual blood loss volume upon anemia remission (estimated calculated based on recalculation of raw data of Hallberg and Jacob)

Question 3

What is the hypothesized mechanism behind an increase of MBL among anemic individuals who underwent iron therapy and are no longer anemic?

Answer 3

The menstrual blood volume increase is thought to be due to a reversal of a compensatory mechanism where the development of iron deficiency anemia results in a reduced blood flow from the endometrium.

Question 4

What does the distribution of menstrual blood loss look like?

Answer 4

It is known to be highly skewed

Question 5

For girls aged 15-18 years, menstrual iron losses constitute …..% of median iron requirements

Answer 5

One-third

Question 6

Among girls who suffer from heavy menstrual bleeding, menstrual iron losses can account up to …..% of median iron requirements

Answer 6

61%

Question 7

Menstrual iron losses variability…

Answer 7

Menstrual blood losses are very constant from month to month for an individual woman but vary markedly from one woman to another. The main part of this variation is genetically controlled by the fibrinolytic activators in the uterine mucosa.

Question 8

How many women suffer from heavy menstrual blood loss?

Answer 8

Up to one-third of women of reproductive age experience heavy menstrual bleeding (HMB).

Question 9

A population-based prevalence study of nearly 1000 healthy female adolescents revealed that ….% had experienced HMB

Answer 9

nearly 40% (this was conducted in Sweden)

Question 10

Give a quick summary of the Alkalkine Hematin method

Answer 10

The AH method is considered the gold standard method for menstrual blood loss determination. It involves the collection of soiled tampons and/or towels collected in Cryovac plastic bags which are then blended with a known volume of 5% NaOH until completely homogenized using a Stomacher Lab-Blender.

Question 11

What does menstrual fluid consist of ?

Answer 11

Menstrual blood is a complex biological fluid composed of:

1. Blood
2. Vaginal secretions
3. Endometrial cells of the uterine wall as they exist immediately prior to menses

Question 12

What do we know on the evolution of iron status markers and other parameters (e.g. hepcidin, sex hormones) over the menstrual cycle?

Answer 12

We know very little. The limited evidence would suggest that hepcidin, serum iron and transferrin saturation change over the menstrual cycle, first dipping during menses, then increasing at mid-cycle before stabilizing during the second part of the cycle.

Question 13

What are the different phases of the menstrual cycle?

Question 14

How do iron parameters behave during the menstrual cycle and why?

Question 15

How do hormones behave during the menstrual cycle and why?

Question 16

How do hormones’ behavior relate to iron status during the menstrual cycle?

Question 17

How would you expect iron absorption to change over the menstrual cycle and why? Based on which findings?

Question 18

What is the average menstrual blood loss among adolescent girls?

Question 19

What is the proportion of adolescent girls who suffer from heavy MBL?

Question 20

What are the determinants of heavy menstrual blood loss?