Over 90% of women report having some premenstrual symptoms, such as bloating, headaches, and moodiness. [ 35 ]  Premenstrual symptoms generally do not cause substantial disruption, and qualify as PMS in approximately 20% of pre-menopausal women. [ 33 ]   Antidepressants  of the  selective serotonin reuptake inhibitors  (SSRI) class may be used to treat the emotional symptoms of PMS. [ 33 ]


In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle. This includes muscle contractions of the uterus (menstrual cramping) that can precede or accompany menstruation. Many women experience painful cramps, also known as  dysmenorrhea , during menstruation. [ 40 ]  Among adult women, that pain is severe enough to affect daily activity in only 2%–28%. [ 40 ]  Severe symptoms that disrupt daily activities and functioning may be diagnosed as  premenstrual dysphoric disorder . [ 41 ]  These symptoms can be severe enough to affect a person's performance at work, school, and in everyday activities in a small percentage of women. [ 6 ]


When severe pelvic pain and bleeding suddenly occur or worsen during a cycle, this could be due to  ectopic pregnancy  and  spontaneous abortion . This is checked by using a pregnancy test, ideally as soon as unusual pain begins, because ectopic pregnancies can be life‑threatening. [ 42 ]


The most common treatment for  menstrual cramps  are  non-steroidal anti-inflammatory drugs  (NSAIDs). NSAIDs can be used to reduce moderate to severe pain, and all appear similar. [ 43 ]  About 1 in 5 women do not respond to NSAIDs and require alternative therapy, such as simple analgesics or heat pads. [ 44 ]  Other medications for pain management include aspirin or paracetamol and combined oral contraceptives. Although combined oral contraceptives may be used, there is insufficient evidence for the efficacy of intrauterine progestogens. [ 43 ]


One review found tentative evidence that acupuncture may be useful, at least in the short term. [ 45 ]  Another review found insufficient evidence to determine an effect. [ 46 ]


Known interactions between the menstrual cycle and certain health conditions include:


Sexual feelings and behaviors change during the menstrual cycle. Before and during ovulation, high levels of estrogen and  androgens  result in women having a relatively increased interest in sexual activity, and relatively lower interest directly prior to and during menstruation. [ 50 ]  Unlike other mammals, women may show interest in sexual activity across all days of the menstrual cycle, regardless of fertility. [ 51 ]


There is no reliable scientific evidence that would advise against  sexual intercourse  during menstruation based on medical grounds. [ medical citation needed ]


Peak  fertility  (the time with the highest likelihood of pregnancy resulting from sexual intercourse) occurs during just a few days of the cycle: usually two days before and two days after the  ovulation  date. [ 52 ]  This corresponds to the second and the beginning of the third week in a 28-day cycle. This  fertile window  varies from woman to woman, just as the ovulation date often varies from cycle to cycle for the same woman. [ 53 ]  A variety of methods have been developed to help individual women  estimate the relatively fertile  and the relatively infertile days in the cycle; these systems are called  fertility awareness . [ medical citation needed ]


Infrequent or irregular ovulation is called  oligoovulation . [ 54 ]  The absence of ovulation is called  anovulation . Normal menstrual flow can occur without ovulation preceding it: an  anovulatory cycle . In some cycles, follicular development may start but not be completed; nevertheless, estrogens will be formed and stimulate the uterine lining. Anovulatory flow resulting from a very thick endometrium caused by prolonged, continued high estrogen levels is called  estrogen breakthrough bleeding . Anovulatory bleeding triggered by a sudden drop in estrogen levels is called  withdrawal bleeding . [ 55 ]  Anovulatory cycles commonly occur before  menopause  (perimenopause) and in women with  polycystic ovary syndrome . [ 56 ]


Very little flow (less than 10 ml) is called  hypomenorrhea . Regular cycles with intervals of 21 days or fewer are  polymenorrhea ; frequent but  irregular menstruation  is known as  metrorrhagia . Sudden heavy flows or amounts greater than 80 ml are termed  menorrhagia . [ 57 ]  Heavy menstruation that occurs frequently and irregularly is  menometrorrhagia . The term for cycles with intervals exceeding 35 days is  oligomenorrhea . [ 58 ]   Amenorrhea  refers to more than three [ 57 ]  to six [ 58 ]  months without menses (while not being pregnant) during a woman's reproductive years. The term for painful periods is  dysmenorrhea .


There is a wide spectrum of differences in how women experience menstruation. There are several ways that someone's  menstrual cycle  can differ from the norm:


Extreme psychological stress can also result in periods stopping. [ 59 ]  More severe symptoms of anxiety or depression may be signs of  premenstrual dysphoric disorder  (PMDD) which is a depressive disorder. [ 60 ]


Dysfunctional uterine bleeding  is a hormonally caused bleeding abnormality.  Dysfunctional uterine bleeding typically occurs in premenopausal women who do not ovulate normally (i.e. are  anovulatory ). All these bleeding abnormalities need medical attention; they may indicate hormone imbalances, uterine fibroids, or other problems. As pregnant women may bleed, a  pregnancy test  forms part of the evaluation of abnormal bleeding. [ medical citation needed ]


Women who had undergone  female genital mutilation  (particularly type III-  infibulation )  a practice common in parts of  Africa , may experience menstrual problems, such as slow and painful menstruation, that is caused by the near-complete sealing off of the vagina. [ 61 ]


Dysmenorrhea , also known as period pain, painful periods or menstrual cramps, is  pain  during menstruation. [ 62 ] [ 63 ] [ 64 ]  Its usual onset occurs around the time that menstruation begins. [ 65 ]  Symptoms typically last less than three days. [ 65 ]  The pain is usually in the  pelvis  or lower abdomen. [ 65 ]  Other symptoms may include  back pain , diarrhea or nausea. [ 65 ]


Dysmenorrhea can occur without an underlying problem. [ 66 ] [ 67 ]  Underlying issues that can cause dysmenorrhea include  uterine fibroids ,  adenomyosis , and most commonly,  endometriosis . [ 66 ]  It is more common among those with  heavy periods , irregular periods, those whose periods started before twelve years of age and those who have a low body weight. [ 65 ]  A  pelvic exam  and  ultrasound  in individuals who are sexually active may be useful for diagnosis. [ 65 ]  Conditions that should be ruled out include  ectopic pregnancy ,  pelvic inflammatory disease ,  interstitial cystitis  and  chronic pelvic pain . [ 65 ]


Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life. [ 65 ]  Treatment may include the use of a heating pad. [ 66 ]  Medications that may help include  NSAIDs  such as  ibuprofen ,  hormonal birth control  and the  IUD with progestogen . [ 65 ] [ 66 ]  Taking  vitamin B1  or  magnesium  may help. [ 64 ]  Evidence for  yoga ,  acupuncture  and  massage  is insufficient. [ 65 ]  Surgery may be useful if certain underlying problems are present. [ 64 ]


Menstrual products (also called " feminine hygiene " products) are made to absorb or catch menstrual blood. A number of different products are available – some are disposable, some are reusable. Where women can afford it, items used to absorb or catch menses are usually commercially manufactured products. Menstruating women manage menstruation primarily by wearing menstrual products such as tampons, napkins or menstrual cups to catch the menstrual blood.


The main disposable products (commercially manufactured) include:


The main reusable products include:


Due to poverty, some women cannot afford commercial feminine hygiene products. [ 68 ] [ 69 ]  Instead, they use materials found in the environment or other improvised materials. [ 70 ] [ 71 ]  " Period poverty " is a global issue affecting women and girls who do not have access to safe, hygienic sanitary products. [ 72 ]  In addition, solid waste disposal systems in developing countries are often lacking, which means women have no proper place to dispose used products, such as pads. [ 73 ]  Inappropriate disposal of used materials also creates pressures on sanitation systems as menstrual hygiene products can create blockages of toilets, pipes and sewers. [ 68 ]  In the UK research has shown that for women  allotment  growers, access to sanitation for menstrual hygiene management is limited. [ 74 ]


Menstruation can be delayed by the use of  progesterone  or  progestins . For this purpose, oral administration of progesterone or progestin during cycle day 20 has been found to effectively delay menstruation for at least 20 days, with menstruation starting after 2–3 days have passed since discontinuing the regimen. [ 75 ]


Hormonal contraception  affects the frequency, duration, severity, volume, and regularity of menstruation and menstrual symptoms. The most common form of hormonal contraception is the  combined birth control pill , which contains both  estrogen  and  progestogen . Although the primary function of the pill is to prevent pregnancy, it may be used to improve  some menstrual symptoms and syndromes which affect menstruation , such as  polycystic ovary syndrome  (PCOS),  endometriosis ,  adenomyosis ,  amenorrhea ,  menstrual cramps ,  menstrual migraines ,  menorrhagia  (excessive menstrual bleeding), menstruation-related or fibroid-related anemia and  dysmenorrhea  (painful menstruation) by creating regularity in menstrual cycles and reducing overall menstrual flow. [ 76 ] [ 77 ]


Using the  combined birth control pill , it is also possible for a woman to delay or eliminate menstrual periods, a practice called  menstrual suppression . [ 78 ]  Some women do this simply for convenience in the short-term, [ 79 ]  while others prefer to eliminate periods altogether when possible. This can be done either by skipping the placebo pills, or using an  extended cycle combined oral contraceptive pill , which were first marketed in the U.S. in the early 2000s. This continuous administration of active pills without the placebo can lead to the achievement of amenorrhea in 80% of users within 1 year of use. [ 80 ]


Breastfeeding  causes negative feedback to occur on pulse secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH). [ 81 ]  Depending on the strength of the negative feedback, breastfeeding women may experience complete suppression of follicular development, follicular development but no ovulation, or normal menstrual cycles may resume. [ 82 ]  Suppression of ovulation is more likely when suckling occurs more frequently. [ 83 ]  The production of  prolactin  in response to suckling is important to maintaining lactational amenorrhea. [ 84 ]  On average, women who are fully breastfeeding whose infants suckle frequently experience a return of menstruation at fourteen and a half months postpartum. There is a wide range of response among individual breastfeeding women, however, with some experiencing return of menstruation at two months and others remaining amenorrheic for up to 42 months postpartum. [ 85 ]


The word  menstruation  is etymologically related to  moon . The terms  menstruation  and  menses  are derived from the  Latin   mensis   ' month ' , which in turn relates to the  ancient Greek   mene   ' moon '  and to the roots of the English words  month  and  moon . [ 86 ]


Some organizations have begun to use the term "menstruator" instead of "menstruating women", a term that has been in use since at least 2010. [ 87 ]   Menstruator  is used by activists and scholars in order to "express solidarity with women who do not menstruate,  transgender men  who do, and  intersexual  and  genderqueer  individuals". [ 87 ] : 950   The term can be contentious between different schools of feminist thought; however, the majority of feminist scholars consider the term to correctly reflect the reality that people of different genders menstruate. [ 87 ] : 950   The term "people who menstruate" is also used. [ 88 ]


Many religions have menstruation-related traditions, for example: Islam prohibits sexual contact with women during menstruation in the  2nd chapter of the Quran . [ 89 ]  Some scholars argue that menstruating women are in a state in which they are unable to maintain  wudhu , and are therefore prohibited from touching the Arabic version of the Qur'an. [ 90 ]  In  Judaism , a woman during menstruation is called  Niddah  and may be banned from certain actions. For example, the Jewish  Torah  prohibits sexual intercourse with a menstruating woman. [ 91 ]  In  Hinduism , menstruating women are  traditionally considered ritually impure  and given rules to follow. [ 92 ] [ 93 ]  In Zoroastrianism, if a woman’s menses did not stop after nine days, it was considered the work of the  daēvas . [ 94 ]


Menstruation education is frequently taught in combination with sex education at school in  Western countries , although girls may prefer their mothers to be the primary source of information about menstruation and puberty. [ 95 ]  Information about menstruation is often shared among friends and peers, which may promote a more positive outlook on puberty. [ 96 ]  The quality of menstrual education in a society determines the accuracy of people's understanding of the process. [ 97 ]  In many Western countries where menstruation is a taboo subject, girls tend to conceal the fact that they may be menstruating and struggle to ensure that they give no sign of menstruation. [ 97 ]  Effective educational programs are essential to providing children and adolescents with clear and accurate information about menstruation. Schools can be an appropriate place for menstrual education to take place. [ 98 ]  Programs led by peers or third-party agencies are another option. [ 98 ]  Low-income girls are less likely to receive proper sex education on puberty, leading to a decreased understanding of why menstruation occurs and the associated physiological changes that take place. This has been shown to cause the development of a negative attitude towards menstruation. [ 99 ]


In some cultures, women were isolated during menstruation due to menstrual  taboos . [ 100 ]  This is because they are seen as unclean, dangerous, or bringing bad luck to those who encounter them. These practices are common in parts of South Asia including India. [ 101 ]  A 1983 report found women refraining  from household chore during this period in India. [ 102 ]   Chhaupadi  is a social practice that occurs in the western part of Nepal for  Hindu  women, which prohibits a woman from participating in everyday activities during menstruation. Women are considered  impure  during this time and are kept out of the house and have to live in a shed. Although chhaupadi was outlawed by the  Supreme Court of Nepal  in 2005, the tradition is slow to change. [ 103 ] [ 104 ]  Women and girls in cultures which practice such seclusion are often confined to  menstruation huts , which are places of isolation used by cultures with strong menstrual  taboos . The practice has recently come under fire due to related fatalities. Nepal criminalized the practice in 2017 after deaths were reported after the elongated isolation periods, but "the practice of isolating menstruating women and girls continues." [ 105 ]  Not all cultures villainize menstruation, the Beng people of West Africa consider menstrual blood as sacred and recognize its significance in reproduction. [ 106 ]


Even though the average length of the human  menstrual cycle  is similar to that of the  lunar cycle , in modern humans there is no relation between the two. [ 107 ]  The relationship is believed to be a coincidence. [ 108 ] [ 109 ]  Light exposure does not appear to affect the menstrual cycle in humans. [ 110 ]  A meta-analysis of studies from 1996 showed no correlation between the human menstrual cycle and the lunar cycle, [ 111 ]  nor did data analyzed by period-tracking app Clue, submitted by 1.5   million women, of 7.5   million menstrual cycles; however, the lunar cycle and the average menstrual cycle were found to be basically equal in length. [ 112 ]


Beginning in 1971, some research suggested that menstrual cycles of cohabiting women became synchronized ( menstrual synchrony ). [ 113 ]  Subsequent research has called this hypothesis into question. [ 114 ]  A 2013 review concluded that menstrual synchrony likely does not exist. [ 115 ]


Some countries, mainly in Asia, have  menstrual leave  to provide women with either paid or unpaid leave of absence from their employment while they are menstruating. [ 116 ]  Countries with policies include Japan, Taiwan, Indonesia, and South Korea. [ 117 ] [ 118 ]  The practice is controversial due to concerns that it bolsters the perception of women as weak, inefficient workers, [ 116 ]  as well as concerns that it is unfair to men, [ 119 ] [ 120 ]  and that it furthers gender stereotypes and the medicalization of menstruation. [ 117 ]


Most  female mammals  have an  estrous cycle , but not all have a menstrual cycle that results in menstruation.  Menstruation in mammals  occurs in some close evolutionary relatives such as chimpanzees. [ 121 ]


Menstruation   is the shedding of the uterine lining ( endometrium ).  It occurs on a regular basis in uninseminated [ 1 ]  sexually reproductive-age  females  of certain mammal species.


Although there is some disagreement in definitions between sources, menstruation is generally considered to be limited to  primates . It is common in  simians  ( Old World monkeys ,  New World monkeys , and  apes ), but completely lacking in  strepsirrhine  primates and possibly weakly present in  tarsiers . Beyond primates, it is known only in  bats , the  elephant shrew , and the  spiny mouse  species  Acomys cahirinus . [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ]  Overt menstruation (where there is bleeding from the  uterus  through the  vagina ) is found primarily in humans and close relatives such as  chimpanzees . [ 7 ]


Females of other species of  placental mammals  undergo  estrous cycles , in which the endometrium is completely reabsorbed by the animal (covert menstruation) at the end of its  reproductive cycle . [ 8 ]  Many zoologists regard this as different from a "true" menstrual cycle. Female domestic animals used for breeding—for example dogs, pigs, cattle, or horses—are monitored for physical signs of an  estrous cycle  period, which indicates that the animal is ready for  insemination .


Females of most mammal species advertise fertility to males with visual behavioral cues,  pheromones , or both. [ 9 ]  This period of advertised fertility is known as  oestrus , "estrus" or  heat . [ 9 ]  In species that experience estrus, females are generally only receptive to  copulation  while they are in heat [ 9 ]  ( dolphins  are an exception). [ 10 ]  In the  estrous cycles  of most  placentals , if no fertilization takes place, the uterus reabsorbs the endometrium. This breakdown of the endometrium without  vaginal discharge  is sometimes called  covert menstruation . [ 11 ]  Overt menstruation (where there is blood flow from the vagina) occurs primarily in humans and close evolutionary relatives such as chimpanzees. [ 7 ]  Some species, such as domestic  dogs , experience small amounts of  vaginal bleeding  while approaching heat; [ 12 ]  this discharge has a different physiologic cause than menstruation. [ 13 ]


A few mammals do not experience obvious, visible signs of fertility ( concealed ovulation ). In humans, while women can learn to recognize their own level of fertility ( fertility awareness ), whether men can detect fertility in women is debated; recent studies have given conflicting results. [ 14 ] [ 15 ]


Orangutans  also lack visible signs of impending ovulation. [ 16 ]  Also, it has been said that the extended estrus period of the  bonobo  (reproductive-age females are in heat for 75% of their menstrual cycle) [ 17 ]  has a similar effect to the lack of a "heat" in human females. [ 18 ]


Most  female mammals  have an  estrous cycle , yet only ten primate species, four  bat  species, the  elephant shrew , and one known species of  spiny mouse  have a menstrual cycle. [ 19 ] [ 20 ]  As these groups are not closely related, it is likely that four distinct evolutionary events have caused menstruation to arise. [ 21 ]


There are varying views on evolution of overt menstruation in humans and related species, and the evolutionary advantages in losing blood associated with dismantling the uterine lining rather than absorbing it, as most mammals do. [ 22 ]  The reason is likely related to differences in the ovulation process. [ 21 ]


Most female placentals have a uterine lining that builds up when the animal begins ovulation, and later further increases in thickness and blood flow after a fertilized egg has successfully implanted. This final process of thickening is known as  decidualization , and is usually triggered by hormones released by the embryo. In humans, decidualization happens spontaneously at the beginning of each menstrual cycle, triggered by hormonal signals from the ovaries. For this reason, the human uterine lining becomes fully thickened during each cycle as a defense to  trophoblast  penetration of the  endometrial wall , [ 23 ]  regardless of whether an egg becomes fertilized or successfully implants in the uterus. This produces more unneeded material per cycle than in non-menstruating mammals, which may explain why the extra material is not simply reabsorbed as done by those species. In essence, menstruating animals treat every cycle as a possible pregnancy by thickening the protective layer around the endometrial wall, while non-menstruating placental mammals do not begin the pregnancy process until a fertilized egg has implanted in the uterine wall. [ medical citation needed ]


For this reason, it is speculated that menstruation is a side effect of spontaneous decidualization, which evolved in some placental mammals due to its advantages over non-spontaneous decidualization. Spontaneous decidualization allows for more maternal control in the maternal-fetal conflict by increasing selectivity over the implanted embryo. [ 21 ]  This may be necessary in humans and other primates, due to the abnormally large number of genetic disorders in these species. [ 24 ]  Since most  aneuploidy  events result in stillbirth or miscarriage, there is an evolutionary advantage to ending the pregnancy early, rather than nurturing a fetus that will later miscarry. There is evidence to show that some abnormalities in the developing embryo can be detected by endometrial stromal cells in the uterus, but only upon differentiation into  decidual cells . [ 24 ]  This triggers epigenetic changes that prevent formation of the placenta, which prevents the embryo from implanting and leaves it to be removed in the next menstruation. [ better source needed ] [ 25 ]  This failsafe mode is not possible in species where decidualization is controlled by hormonal triggers from the embryo. This is sometimes referred to as the choosy uterus theory, and it is theorized that this positive outweighs the negative impacts of menstruation in species with high aneuploidy rates and hence a high number of 'doomed' embryos. [ medical citation needed ]


The female will ovulate spontaneously and be receptive to the male to be bred (express estrus) at regular biologically defined intervals. The female is receptive to males only while experiencing estrus.


For breeding livestock, there are a number of advantages to be gained by finding methods to induce ovulation on a planned schedule, and thus synchronize the estrus cycle between many female animals. If animals can be bred on the same schedule, it increases convenience for the livestock owner, since the young animals will be at the same stage of development. Also, if  artificial insemination  (AI) is used for breeding, the AI technician's time can be used more efficiently, by breeding several females at the same time.  In order to induce estrus, a variety of techniques have been tried in recent years, involving both more natural, and more hormonal based methods. [ 28 ]  Different ways of injecting or feeding hormones to livestock are costly, and have variable success rates. [ 29 ]


Average length (days) of estrus and estrous cycles: [ 29 ]


Many beliefs amount menstruation in the early modern period were linked to  humorism , the system of medicine introduced by  Ancient Greek  and Roman physicians. People believed that the human body contained four humours: blood, phlegm, yellow bile, and black bile. [ 1 ]  Illnesses and problems were understood as being caused by  dyscrasia , or an imbalance in the four humours. Treatments for disease had the aim of restoring a balance, curing the patient. The humoral model was a continuity during the early modern period, despite the fact that new medical theories began to arise in the second half of the eighteenth century, because these new ideas which used different treatments involving new chemicals were not as trusted since they were not properly established. [ 2 ]


In this way, medical and popular beliefs about menstrual problems such as irregular menstruation,  amenorrhea  (absence of periods whilst fertile) or  dysmenorrhea  (painful periods) were thought of in relation to the four humours. [ 3 ]  In early modern western Europe, physicians believed that the womb could not be too cold, hot, moist or dry and that an excess in any of these could impact a woman's fertility. [ 4 ]  Significantly, people believed that warmth encouraged sexual pleasure and increased the probability of conceiving a child, meaning that the womb had to be warm during intercourse. If a woman was found to be having problems menstruating which would then impact their fertility, remedies which aimed to alter the humoral state of the body were used. Aphrodisiacs were a common remedy given to women with menstrual problems, since they were believed to have internal heating effects, stimulating menstruation by redressing the constitutional balance of a womb that was too cold. [ 5 ]


The humoral model was not the only way menstruation was understood in the early modern period. The four humours helped guide physicians to give remedies for menstrual problems, but there were different understandings of what menstruation might be caused by. The two main beliefs surrounding menstruation were either that it was necessary to remove an excess of blood, or to purify blood. [ 1 ]  Some believed that women had an excess of blood which the body needed to get rid of in the form of a period. This excess was due to the belief that women's bodies could not use all of the blood in their body unlike men, making them weaker. [ 2 ]  Others believed in the  Aristotelian  model, which purifies women's blood. According to this model, after menstruation a purified substance is left which forms a foetus once mixed with the male seed. [ 4 ]  A further function of menstrual blood was proposed by the  Galen  model. This was the belief that after conception the foetus was nourished in the womb by menstrual blood. [ 5 ]  This shows that in early modern period menstrual blood and conception itself were linked together.


With this in mind, what can be perceived as a classic negative attitude towards menstruation can be re-evaluated. For example, in the Bible (Ezekiel) men are advised to not have sex with a woman who is menstruating. The passage states that "a good man" should "not to lie with a menstruous woman". [ 3 ]  This could be interpreted as an example of the stigmatisation of menstruation, and how menstrual blood was considered to be dirty and not pure. In a translation of a sixteenth-century text on the art of having beautiful children published early in the eighteenth century, the message that no procreation should occur while the woman is menstruating is very clear. This text can be used as an example of the disgust towards menstruation that may have been found at the time:


Press not your Wives, tho height'nd Lust incite The Soul to try the pleasurable Fight, While the Blood monthly rushing from the Veins, The Flowing Womb with foul Pollution stains ... But if by Chance the Seeds concurring fix, And with th'impurer Dross of Nature mix, What a detested, miscreated Thing From such ill-suited Principles must spring? Foul Leprous Spots shall with his Birth begin, Spread o'er his Body, and encrust his Skin; For the same Poison which that Stream contains, Transfer'd affects the forming Infant's Veins, Inbred it fixes deep, and radically reigns. [ 3 ]


However, the conclusion that attitudes towards menstruation were completely negative is not certain. Some historians have argued that the advice followed by many men found in the Bible was not because of a stigma or a hostile attitude towards menstrual blood, but because sex during menstruation was thought to impact healthy conception. [ 6 ]  While it is hard to know exactly which theory is correct, it is important to examine the medical context, because the humoral model emphasised the need for balance between the four humours. This means that blood could be healthy or polluting depending on the humoral context in which blood was discharged and observed, in the same way that menstrual blood was viewed differently depending on certain situations. [ 6 ]


The use of emmenagogues (substances used to promote menstruation) was a key part of sexual health practices associated with fertility and humoral medicine in the early modern period. Aphrodisiacs and hot spices were used to warm up the womb, stimulating menstruation. This was believed to purge the womb of all its contents, including a foetus, as a means of abortion. [ 7 ]  Abortion was not the only function of emmenagogues. They were also used to provoke menstruation which was linked to conception and reproduction. In this way, by purging the womb menstruation would occur and depending on which model people believed in, the menstrual blood helped the formation of the foetus and its healthy growth.


The early modern belief in the humoral model and the need to maintain the balance between blood, phlegm, yellow bile, and black bile means that it has been argued that other forms of bleeding were considered to be similar to menstruation in women. People believed that menstrual blood represented an excess in blood that women had, however it is not completely clear whether menstrual blood was viewed in a different way to normal blood. In this way, a man who had a humoral imbalance may also need to get rid of excess blood. This means that male periodic emissions like nose bleeds, haemorrhoidal flux, blood-letting, and sweating were viewed similarly to menstruation, and were even considered to be a form of vicarious menstruation. As a result the humoral model does not necessarily make a distinction between male bleeding and female menstruation. While bleeding in men represented a re-balancing and for women it had a further role in reproduction, male regularity could also be implicated in reproductive potential because of the belief that the fertile potential of semen fluctuated. Interestingly in 1701 William Musgrave described a case where a man bled from his thumb every month from infancy until the age of 24. This monthly bleeding did not affect his health, however when he chose to sear his thumb with a hot iron to stop the bleeding, this changed. His health worsened and he began to cough up blood. His doctor concluded that this monthly bleeding in a man was similar to a woman's period, being nature's way of keeping bodies balanced. [ 8 ]  This is a very specific example of a rare case of male periodic bleeding, however it does shed light on the way that male blood was viewed in comparison to menstrual blood.


While there were some theories surrounding menstruation that were linked to beliefs in the humoral model in the early modern era, some beliefs were extremely superstitious. There are many tales that can be found in folklore that make a menstruating woman be a sign of good luck. Generally menstruation had a mysterious nature. For centuries people believed that the beginning of a woman's period was controlled by the moon or even by multiples of the number seven. Menstrual blood was believed to be a cure for animal bites or stop fevers. There are stories that recount that if a young menstruating virgin touched the posts of a house it would protect it and there could be no troubles there. [ 3 ]


Menstruation can have a notable impact on mental health , with some individuals experiencing mood disturbances and psychopathological symptoms during their  menstrual cycle . Menstruation involves hormonal fluctuations and physiological changes in the body, which can affect a person's  mood  and psychological state. Many individuals report experiencing  mood swings ,  irritability ,  anxiety , and even  depression  in the days leading up to their menstrual period. This cluster of symptoms is often referred to as  premenstrual syndrome  (PMS). For some individuals, the psychopathological symptoms associated with menstruation can be severe and debilitating, leading to a condition known as  premenstrual dysphoric disorder  (PMDD). PMDD is characterized by intense mood disturbances, cognitive, and somatic symptoms, which occur in a cyclical pattern linked to the menstrual cycle. In addition to PMDD, menstruation can exacerbate existing  mental health conditions . The complex relationship between menstruation and mental well-being has garnered increased attention in both scientific research and public discourse.


The period before menstruation, known as the premenstrual phase, is often linked to emotional  distress . Conditions related to the menstrual cycle encompass premenstrual tension syndrome, premenstrual dysphoric disorder, and the exacerbation of another medical condition during the premenstrual phase. [ 1 ]


Menstruation is linked to a range of psychopathological symptoms, such as lower  self-esteem , increased  anxiety ,  dysphoria , and  feelings of being persecuted . [ 2 ]  Changes in behavior, like decreased social interaction during menstruation, can lead to feelings of loneliness and potentially contribute to the development of depression. [ 3 ]  Several reviews have reported that psychopathological symptoms and mental disorders, such as psychoses,  suicidal tendencies , [ 4 ]   post-traumatic stress disorder , [ 5 ]  and  addictive behaviors , [ 6 ]  tend to worsen during menstruation. [ 7 ] [ 8 ]  Variations in ovarian hormone levels are also linked to the presence of symptoms related to  eating disorders . [ 9 ] [ 10 ] [ 11 ]  Some comprehensive studies have indicated that women might be at a higher risk of  suicide  during menstruation. [ 4 ]  The symptoms occurring during menstruation can have a significant impact on mental health and lead to severe consequences. [ 4 ] [ 12 ]


Premenstrual tension syndrome is a condition marked by particular metabolic, environmental, or behavioral factors that arise during the  luteal phase  of the menstrual cycle. It results in recurring somatic, behavioral, or affective symptoms that disrupt a person's daily life. [ 13 ]  While the quality of studies and their findings in this area can vary, it's common for women to report symptoms like  mood swings ,  depression , tension,  irritability , and  anger  occurring before their period. [ 4 ]


Premenstrual dysphoric disorder  is an affective disorder characterized by emotional, cognitive, and somatic symptoms that consistently occur in the days leading up to menstruation and improve shortly after it begins. These somatic symptoms encompass  joint pain ,  overeating , and  lethargy , while cognitive symptoms involve forgetfulness and difficulty concentrating. Mood-related symptoms consist of  irritability  and  depression . [ 14 ]  Studies evaluating the use of  combined oral contraceptive  pills containing both  progesterone  and  estrogen  have demonstrated their effectiveness in alleviating the symptoms of premenstrual dysphoric disorder. [ 15 ]


Psychotic symptoms tend to worsen when  estrogen  levels drop during the premenstrual period, leading to increased psychiatric admissions for women with  schizophrenia  just before and during their menstrual cycles. [ 16 ]  Another contributing factor to the higher incidence of schizophrenia onset in midlife women may be the reduced estrogen levels associated with  menopause . [ 16 ]  In women with  bipolar disorder , especially  bipolar II disorder , premenstrual syndrome and premenstrual dysphoric disorder are common. [ 16 ]  For those women who experience these premenstrual conditions, bipolar affective symptoms and mood swings may be more severe. [ 16 ]


Menstrual  psychosis  was documented in the mid-19th century and has been extensively discussed in numerous articles. However, it is not widely recognized or diagnosed by modern psychiatrists. The earliest clear clinical descriptions of this condition emerged in French literature around 1850, with most well-documented cases appearing in German literature between 1880 and 1930. [ 17 ]  As per British psychiatrist  Ian Brockington , diagnosing menstrual psychosis requires specific criteria to be met, including symptoms recurring in sync with the menstrual cycle, acute onset against a background of normality, a brief duration followed by complete recovery, and the presence of psychotic features such as  delusions ,  hallucinations ,  confusion ,  mutism ,  stupor , or  manic syndrome . [ 18 ] [ 17 ] [ 19 ]


Menstrupedia comic  is a guide to educate people around the world, particularly in India, on  menstruation . It was started by  Aditi Gupta  and her now husband, Tuhin Paul. [ 1 ] [ 2 ] [ 3 ]  Menstrupedia aims to help people understand the process of puberty in women and men in order to destroy myths around menstruation and normalise the biological process.


When Aditi Gupta attained puberty at the age of 12, she found that menstruation is a taboo topic in India. [ 2 ] [ 4 ]  She had to follow Indian traditional customs that implied that a menstruating person was impure, [ 4 ]  and although her family was well-to-do and educated, she had no access to  sanitary napkins  because buying them was considered shameful. [ 3 ]  As she grew up and moved away from her hometown, her perception of menstruation changed. She wished to spread awareness to help girls understand their bodies better and not let society shame them for their biology. [ 2 ] [ 4 ] [ 5 ]


The project started as a computer game, then a board game, [ 1 ]  developed when Gupta and Paul were students at the  National Institute of Design  in  Gandhinagar ; it was originally Gupta's thesis project. [ 5 ]  The project was launched in 2012 as a prototype pamphlet in  Hindi  before becoming printed comic books in 2013 following a crowdfunding campaign. [ 1 ] [ 2 ] [ 3 ]


Menstrupedia explains menstruation by using relatable characters. The book is designed in a culturally sensitive manner with no objectionable drawings. The content of the book is reviewed by gynecologists for medical accuracy. [ 6 ]  In the comic, Priya Didi, a doctor, explains puberty to her younger cousin Pinki and to Pinki's friends Jiya and Mira. When Jiya gets her first period during Pinki's birthday party, Priya Didi uses the opportunity to talk to the girls about menstrual health, hygiene and puberty as they ask her questions. [ 2 ] [ 7 ]


Menstrupedia comic is available in 17 languages and also co-published in 11 countries namely Kenya, UK, Malaysia, Brazil, Egypt, Australia, Maldives, Uruguay, Nepal, Hungary, and Zimbabwe.


The associated blog is a crowd-sourced platform with more than 3000 writers, some as young as 12, and intentionally beautiful illustrations "to flip the narrative". [ 1 ]  The website also contains Q&A and Learn sections. The online content and the comic have both been reviewed by medical professionals for accuracy. [ 1 ] [ 2 ]


Since its launch, Menstrupedia has received appreciation for its fact-based portrayal of menstruation. The comic has been used by over 25,500 schools impacting over 13 millions girls and women across India and the world..


As of March 2019, the comic had been published into 17 languages, such as English, Hindi. Assamese, Bengali, Gujarati, Kannada, Malayalam. Marathi, Odia, Punjabi, Tamil, Telugu, Tibetan, Urdu, including Nepali, Hungarian, and Spanish, and has been incorporated by over 25,500 schools across India.


The initiative further gained recognition through its appearance on Shark Tank India, (the Indian adaptation of the American TV series  Shark Tank ) from the CEO of Emcure Pharmaceuticals and Shark Tank India judge  Namita Thapar .


In 2016 the comic won the Laadli Media Award and Advertising for gender sensitivity, held at the  National Centre for the Performing Arts . [ 8 ]


In 2018, the comic was gifted to more than 525 girls from a school run by Nagar Prathmik Shikshan Samiti in Navsari to educate them about menstruation and hygiene.  [ 9 ]


In 2019 the comic was featured in vogue Japan under the section celebrating the female power in Asia.


In 2020 the Assamese version of the comic was released for a  function held at the conference hall of Deputy Commissioner's office in Dibrugarh as part of Project Sakhi with the aim to foster better menstrual hygiene management for girl students.  [ 10 ]


The same efforts were continued in 2021 on the occasion of International Menstrual Hygiene Day by Deputy Commissioner Mr Sandeep Hans who procured 4000 books under the 'Beti Bachao Beti Padhao' scheme which have been sent to government schools of Moga.  [ 11 ]


Later in 2022, an interactive session on menstruation was conducted by Open Eye Foundation for girl students  in Govt Model Middle School in Chandigarh, followed by distribution of Menstrupedia comics.  [ 12 ]


Metaformic Theory  states that modern-day material culture is rooted in ancient menstruation rituals, called "metaforms". Metaforms are  rituals , rites,  myths , ideas, or stories created to contain emerging knowledge relating to  menstruation . [ 1 ] : 20


Metaformic Theory is founded upon anthropological data and artifacts used in menstruation rites or rituals recorded over the last 400 years. The most common of these are menstrual seclusion rites. Menstrual seclusion rites incorporated three basic restrictions for menstruating women: they must not see light, touch water, or touch the earth. [ 1 ] : 11   Metaformic theorist,  Judy Grahn  uses the theory to examine how these restrictions "constructed our minds externally, not abstractly, but through using physical metaphors—metaforms—that embody a comparison to a menstrually based idea." [ 1 ] : 22


Grahn is referred to as the founder of Metaformic Consciousness. [ 2 ]  Metaforms themselves have roots in early human culture, but the theory truly emerged when Grahn outlined the Metaformic Theory in her book  Blood, Bread, and Roses: How Menstruation Created the World . [ 1 ]  She continues to write and edit the online journal,  Metaformia: A Journal of Menstruation and Culture , which includes many other authors' works on Metaformic Theory and related menstrual topics. [ 3 ]  Metaformic Theory has been linked to the creation of a " post-queer " theory.


Metaformic consciousness developed in a period of Chaos, which in this context is a pre-language consciousness "when our pre-human ancestors could not perceive shape, color, light, depth, distance, as we do, and had no names for them and no fixed sense of their qualities." [ 1 ] : 9–10   For menstruating women the process of menstrual seclusion became a process of learning. The evolution of women's consciousness was due specifically to separation of light and dark. Menstruants were not allowed to look at light in fear of destroying it and sending everyone back into Chaos, creating a way to retain the knowledge gained through these rites as they had not yet discovered language. [ 1 ] : 14   When women emerged from seclusion into the light, generally at dawn, they began to see the difference between light and dark, between day and night. Many menstrual seclusion rights required that the emerging woman be led through nature by other women of the village as though it were the first time she was seeing it. [ 4 ]  Separation from above and below was another common feature of seclusion rites. When in seclusion, the menstruant often was made to lay down or stay up in a tree for the remainder of her cycle, creating a physical separation from above and below. [ 1 ] : 10–11


Ancient cultures used menstrual imagery to explain and connect the events around them. Menstrual rites, once established, also provided ways to organize other aspects of life, including childbirth, illness and death. [ 1 ] : 123   People also used metaforms as a tool to understand cause and effect and nature's patterns. They could then begin to predict events such as rainfall and other natural phenomena. [ 1 ] : 62   By sharing and externalizing metaformic consciousness, our pre-human ancestors left Chaos. [ 1 ] : 13


Penelope Shuttle and Peter Redgrove point out that, "Our words for 'mind' and 'civilization' came from words which mean 'moon experience, ' " referring to the connection between menstruation and the moon. [ 5 ]


Based on content, all metaforms fall into four categories: Wilderness, Cosmetic, Narrative, and Material. [ 1 ] : 22–23


Wilderness metaforms often include creatures, formations, and elements of nature that depict menstrual ideas. [ 1 ] : 22   The most common wilderness metaforms feature a creature attracted to female blood or possessing a suggestively  feminine  shape. [ 1 ] : 51   The theory analyzes the ways in which many ancient cultures used a variety of animals in metaformic  mythology . [ 1 ] : 22


The Wild Dog family, a common  deity  of tribes in  Africa ,  Eurasia , and  North and South America , is commonly used in such mythologies of ancient cultures. [ 1 ] : 51   The wild dogs, attracted to the smell of blood, created a necessity of seclusion for menstruating women during ancient times. This necessity led to women's menstrual seclusion rites, such as huts built in trees or burying the menstruant and her scents waist deep in a pit with a shelter over her. This seclusion may be seen as a sacrifice to keep the tribe safe from predators, as they were attracted to the smell of blood and the farther the menstruant was from her tribe, the safer they were. [ 1 ] : 52–53


Snakes often appear in metaformic mythologies, such as the Wawilak Sisters Snake myth of Australian aboriginal people. [ 1 ] : 57–58   Deities from many different cultures are presented in the form of a snake or serpent. In Central America, the Aztec goddess of creation was a snake and in ancient Greece, Gaia, the earth goddess, was a serpent. [ 1 ] : 62


Cosmetic metaforms use "human body action, artful movement, shape, ornament and decoration, and even ingestion of meaningful foods", to depict methods of organization of the world. [ 1 ] : 22–23   Cosmetic metaforms are the ways in which menstruation rites were made visible upon women's bodies, through various forms of modifications. [ 1 ] : 72   For many cultures, cosmetic expression after the conclusion of menstrual seclusion was a very specific way of displaying a woman's unique knowledge gained through her experience. [ 1 ] : 72   Some metaforms were expressed through temporary modifications like painting or dying, while others were more permanent modifications like tattoos, scarification, and embedded objects. [ 1 ] : 82


Narrative metaforms are based on language, stories, numbers, and sound that "came about as people imagined themselves and their originators to be characters in a life cycle." [ 1 ] : 23   Numbers and measurement are of particular significance in narrative metaforms. Beginning with the earliest examples on lunar calendars, menstruation and the cycles of the moon were intertwined in many cultures. [ 1 ] : 155   Metaformic Theory references many examples of narrative metaforms across cultures. One example is the Hindu goddess, often known as Kali, who possessed many qualities of the narrative metaform. Known also as the goddess of the dark moon, Kali was also tied to the number three, and often possesses an enraged red face. [ 1 ] : 156   Metaformic theorists also discuss how cultures, like the Romans and Gaelic used the same words for menstruation and the keeping of time, while the Mayan calendar was directly influenced by women's menstrual cycles. [ 6 ]


Material metaforms express our current external cultural ideas through crafting goods from earthen materials. [ 1 ] : 23   For example, beads, made from animal bones, were dyed and made into necklaces or used for counting menstrual and lunar cycles among ancient women. [ 7 ] [ 8 ]  Necklaces themselves are metaformic, representing the vagina that has powers of creation and destruction. Ancient women crafted jewelry to contain emerging knowledge relating to menstruation and the way the world was organized, fashioning their ontological worldview. Jewelry functions as an expression of human consciousness, abstract thinking, and enhances powers while being an art form made from natural materials. [ 7 ] : 84


Another material metaform is the rose which is given as a gift to show love and respect, but fundamentally symbolizing the vulva in its blood red form. This plant has been cultivated and crafted through horticulture, made by humans to share and pass on metaformic consciousness. [ 1 ] : 230–231


Mathematician  John Kellermeier  posits mathematics as quantitative techniques which humans developed as a survival response. [ 9 ]   Quantitative  thinking is seen as a vital element of culture because of its relevance to society. Kellermeier has found that menstruation played a key role in the development of counting and measuring time through anthropological artifacts. [ 9 ]  Many other scholars also contend that women invented timekeeping through charting their  menses  on various animal bones and beads. [ 7 ]


Lunar calendars  were not only methods for measuring time; they indicated both the phases of the moon and a woman’s menstrual cycle. Lunar markings found on prehistoric bone fragments show how early women tracked their cycles and planned families in correlation with the phases of the moon. [ 7 ]  The earliest form of counting "artifacts are menstrual calendar bones, notched with correct lunar cycles, tabulating pregnancy and menstruation." [ 10 ]  The prehistoric calendar bones include the  Ishango bone , the most well known, which was discovered on the shore of a lake in Zaire, Africa, and represented a six-month lunar calendar. The Isturitz Baton represented both a five- and four-month  lunar calendar . The Blanchard Bone Plaque represented a two-month lunar calendar. [ 9 ]


The invention of using beads to family plan is due to the direct correlation of women's menstrual cycles with the lunar cycle. [ 7 ]  These beads covered in  red ochre , which was used in rituals involving nature and perhaps symbolic of menstrual blood, [ 9 ]  and the animal bones with lunar marking provided the foundations for our elaborate modern mathematic and science systems that took thousands of years for our ancestors to develop. [ 7 ] [ 11 ]


Much of the evidence on lunar calendars are from the  Paleolithic period  and characterized by the development of venus or feminine figurines. These "exact lunar tallies [that] fall within ... a complex storied tradition involving at the center a female creatrix figure and all of her characteristic symbols", according to the anthropologist Alexander Marshack. [ 10 ]  Feminine figures, such as  Venus of Willendorf  and  Venus of Laussel , bear traces of having been covered in red ochre. [ 9 ]


Singer and songwriter  Polly Wood  composed an anthem for metaformia called Bledsung. Wood performed Bledsung live at Kuumbwa Jazz Center in  Santa Cruz, California , for the "Goddesses Sing" show on January 25, 2008. [ 12 ]


The 2011 film,  Poomarem , which means flowering tree, by Vijay Vipan, illustrates many of the core concepts of metaformic theory. Poomarem focuses on the "menstrual origins of sciences and arts, such as geometry, time, painting, and cooking; and also the violence, and the isolation that inevitably accompany the loss of women's rituals within a society." [ 13 ]


Vipan states that this film is "A new relational origin story that women's menstrual rituals are the roots of human culture and that in human evolution women and men have markedly different relationships to blood." This film was shown at the 2011  Rotterdam International Film Festival  held in  Rotterdam , the  Netherlands . [ 14 ]


Milaan Foundation  is a  non-governmental organization  co-founded by Dhirendra Pratap Singh and Sharat Goswami in 2007, headquartered in  Gurgaon , India. The foundation advocated the continuation of  secondary education  and the health of adolescent girls. It also focuses on  preventing child marriage  and  gender-based violence  for adolescent girls from low-socio-economic communities in India. [ 1 ]  It supports education for underprivileged girls and also works to bring awareness about  menstrual health  and hygiene among women in India. [ 2 ] [ 3 ] [ 4 ] [ 5 ]


Milaan Foundation was founded in 2007 by Dhirendra Pratap Singh and Sharat Goswami and two their friends from the  University of Delhi . Its name is derived from two words,  Milan , meaning union, and the Urdu word  Elaan , which means declaration. [ 2 ]  It is a registered 501(c)3 nonprofit organization. [ 6 ]


The foundation's initial purpose was to facilitate quality education for children of rural and socio-economically backward regions. In the same year, they started a makeshift school in Kaintain village of  Sitapur district  in  Uttar Pradesh . In its early years, the team from Milaan Foundation visited the villages to identify girls who dropped out of schools and helped them get admission to the foundation's own school. [ 2 ]  The organization is majorly active in  Uttar Pradesh ,  Madhya Pradesh , and  Karnataka .


Milaan's Swarachna School was launched in 2007 in a remote village called Kaintain in  Sitapur district  of  Uttar Pradesh . It provides secondary education to first-generation learners with a focus on adolescent girls. The school currently educates 500 children up to class 12th. [ 7 ] [ 8 ]


In 2016, the foundation built its first senior-secondary wing on the land donated by the village administration. [ 9 ]


The foundation started its flagship Girl Icon Program in 2015, which is a girl-led leadership program for Indian girls aged between 12 and 18 years that encourages them to speak out, and spread awareness of gender-based issues. [ 2 ]


These girls are called Girl Icons. As of 2020, the program has implemented 953 social action projects and impacted over 10,000 adolescent girls, 375 of whom have become Girl Icons. In 2021, all of the Girl Icons continued their secondary education and 80% pursued higher education. As a result, 95% of girls delayed early marriage. Girl Icons have stopped over 50 child marriages from occurring as of 2020. [ 2 ]


The foundation's flagship program works from a grassroots level upward by activating girl leaders as change agents in their own community. The program begins with leadership and development training and the fellows complete social action projects in their communities. [ 6 ] [ 10 ]


In October 2022, Milaan Foundation partnered with  Sony Music Entertainment , under which the organization received funding from Sony Music's Global Justice Fund, a fund that is a part of  Sony Music Group  that supports  Social justice  and  Anti-racism  initiatives worldwide. The funding will be used in providing education, health, life skill enhancement, community development and agency to work towards gender equality among adolescent girls in  Uttar Pradesh , India. [ 11 ]


Milaan Foundation has also been funded by the  Girls Opportunity Alliance Fund , a program of the  Barack Obama Foundation , headed by  Michelle Obama . [ 12 ]


The  Myna Mahila Foundation  ( MMF ) is an Indian organization which empowers women by encouraging discussion of taboo subjects such as menstruation, and by setting up workshops to produce low-cost sanitary protection to enable girls to stay in school. It was founded by  Suhani Jalota  in 2015 while she was studying at  Duke University . [ 1 ]


The foundation's name comes from the  Myna  bird, famously talkative, and the word "Mahila" for "Woman". [ 2 ]


In 2016  Glamour  magazine listed the foundation's founder Jalota as one of its "College Women of the Year". [ 3 ]


It was one of the seven organisations nominated by  Prince Harry  and  Meghan Markle  to receive donations in lieu of wedding presents when the couple  married on 19 May 2018 . [ 4 ] [ 5 ] [ 6 ]  In 2017 Markle wrote an article about the foundation for  Time  magazine, with the title "How Periods Affect Potential", after a trip to Delhi and Mumbai with  World Vision  where she met and shadowed women involved. [ 2 ]  The same year Markle included the foundation's founder Jalota in a list of "The Ten Women Who Changed My Life" in  Glamour  magazine. [ 7 ]


Apart from encouraging conversations around taboo subjects such as menstruation, the foundation provides stable employment to women dwelling in slums by encouraging them to manufacture low cost sanitary napkins that they can sell back into their communities at a fraction of the cost, thus improving menstrual hygiene of the communities too and empowering the women.  [ 8 ] [ 9 ]


With about 3000 customers, the foundation employs about 35 women, 15 of whom work as manufacturers and the other 20 work as saleswomen for the product. They expect to reach 10000 customers by the end of 2018. [ 9 ]  It also empowers its staff by training them in women's health, English, Math, and life skills such as self-defence. [ 10 ]  On the support received via the royal wedding, founder Jalota said that it would further help them expand their reach into the urban slums in Mumbai. [ 11 ]


This article about an organisation in India is a  stub . You can help Wikipedia by  expanding it .


Ovarian follicle dominance  is the process where one or more follicles are selected per cycle to ovulate.


In  female   mammals , each  ovulatory cycle , or  menstrual cycle  in  humans , a set number of  ovarian follicles  ovulate, each follicle releasing an egg that can be  fertilised . If that female becomes  pregnant , this is the maximum number of  offspring  she could have. The ovulated follicles come from a larger pool of growing follicles  Follicle dominance results from competition between follicles from this growing pool, as only some will be selected for further development. These selected follicles are known as the dominant follicles. In humans, there is usually only one dominant follicle per cycle. [ 1 ]


Understanding this system allows medical practitioners to manipulate this process in women in order to help those who have reduced fertility though  assisted reproductive technologies  (ART). These treatments are able to help women with conditions such as  polycystic ovary syndrome  (PCOS) who have reduced fertility be able to conceive. These techniques can also be used in  animal conservation  and  agriculture .


The  ovary  is a female reproductive organ which produces eggs for reproduction and hormones that are essential for this process. Within the ovary, there are ovarian follicles which contain immature eggs. [ 2 ]


Ovulation  is a process where ovarian follicles rupture, releasing eggs that can be fertilized. Follicle dominance results due to competition between follicles, as only some will be selected for further development, which are known as the dominant follicle(s).


During development some follicles are further ahead in development. The more developed follicles will have more blood vessels in theca of follicle, which means they will have more hormones such as FSH available to cross over the basement membrane into the follicle. They also have more FSH receptors and their mural granulosa cells have started to express LH receptors. Follicles that have these properties become dominant which occurs just as circulating FSH levels are falling. Dominant follicle selection is driven by multiplication of cells (proliferation) and cell death (apoptosis) events. [ 3 ]  Only the largest, most developed follicles are able to withstand the drop in hormones, therefore only the selected follicles survive, the rest go through  atresia  (follicle death). In humans, when follicles mature, usually only one becomes dominant. [ 2 ]  Only the dominant follicle(s) goes through ovulation, so there is usually only a single ovulation during each human menstrual cycle. The more mature follicles that are more sensitive to  FSH , can use it to produce inhibin and estrogen through increasing aromatase activity. When levels of circulating FSH drop in response to estrogen levels rising, only the most sensitive follicles to FSH will be able to survive on these low levels. When levels of FSH fall, it is too low to stimulate the other follicles which then go through atresia [ 4 ]


The  hypothalamic-pituitary-ovary axis  controls female reproduction. [ 5 ]  The fall in FSH occurs through an endocrine loop that the dominant follicle causes.


In polycystic ovarian syndrome (PCOS), the follicle dominance process is disrupted, and a large number follicles continue to develop each menstrual cycle  [ 6 ]


Sometimes follicular dominance is manipulated to allow more follicles to ovulate. This manipulation is known as Assisted Reproductive Technology (ART).  It is a group of scientific techniques used to help infertile couples conceive. [ 7 ]  This happens via  in-vitro fertilization  (IVF).


IVF is the process of fertilizing an egg with sperm outside of the body in a laboratory which will then be planted into the mother's or a surrogate's womb. There are several steps involved in IVF. The first is oocyte collection. This is done by hyperstimulation of the ovary to produce multiple ovarian follicles that will release oocytes into the fallopian tubes. These oocytes are then collected via  transvaginal oocyte retrieval . The oocytes are then combined with spermatozoa and fertilized. Sometimes the sperm may need to be directly injected into the oocyte via  intracytoplasmic sperm injection . The embryos are the grown in the laboratory for 2–5 days before being implanted into the uterus  [ 8 ]


The  Period Products (Free Provision) (Scotland) Act 2021  was a  Private member's bill   in the Scottish Parliament  which received  Royal assent  on 12 January 2021. It is the world's first legislation to make it mandatory for all public institutions to provide free  sanitary products  for  menstruation  including  tampons  and  pads . [ 3 ] [ 4 ] [ 5 ]


The act followed a campaign coordinated by  Monica Lennon , MSP, the spokesperson on health for the  Scottish Labour  party, and obtained all-party support in the  Scottish Parliament . The provision will cost an estimated £8.7 million annually. [ 4 ]


In 2017 the Scottish First Minister had announced that period products would be free in Scotland's schools. It has been noted that other public toilets have followed the lead offering free products or free with an "honesty box".  The Scottish government had originally proposed that free products should be available on a means tested basis but changed its proposals in February given the wide support in the Scottish parliament. [ 6 ]


Similar schemes for schools have been promised for Ireland in 2020.


The legislation came into force on 15 August 2022, making Scotland the first country to make such a provision. [ 7 ]


In 2022, the Northern Ireland Assembly passed the similar  Period Products (Free Provision) Act (Northern Ireland) 2022 .


This article related to  law  in  Scotland  is a  stub . You can help Wikipedia by  expanding it .


The  Period Products (Free Provision) (Northern Ireland) Act 2022  received  Royal assent  on 12 May 2022 and requires all public bodies to provide provision of free period products.


In 2021, the Scottish Parliament passed the  Period Products (Free Provision) (Scotland) Act 2021 . Following that, the assembly passed Pat Catney's   private members' bill  in the Northern Ireland Assembly to provide similar provision in the Northern Ireland.


Period product became available free of charge on 13 May 2024. [ 3 ] [ 4 ]


In May 2023, the money allocated to providing free period products was cut by 40% due to funding cuts in the budget from the  Northern Ireland Office . [ 5 ]


Premenstrual syndrome  ( PMS ) is a disruptive set of  emotional  and physical  symptoms  that regularly occur in the one to two weeks before the start of each  menstrual period . [ 4 ] [ 5 ]  Symptoms resolve around the time  menstrual bleeding  begins. [ 4 ]  Symptoms vary, [ 6 ]  though commonly include one or more physical, emotional, or behavioral symptoms, that resolve with menses. [ 7 ]  The range of symptoms is wide, and most commonly are  breast tenderness ,  bloating ,  headache ,  mood swings ,  depression ,  anxiety ,  anger , and  irritability . To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording. [ 7 ]  PMS-related symptoms are often present for about six days. [ 2 ]  An individual's pattern of symptoms may change over time. [ 2 ]  PMS does not produce symptoms during  pregnancy  or following  menopause . [ 1 ]


Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after  ovulation  and before  menstruation  to a degree that interferes with normal life. [ 3 ]  Emotional symptoms must not be present during the initial part of the  menstrual cycle . [ 3 ]  A daily list of symptoms over a few months may help in diagnosis. [ 2 ]  Other disorders that cause similar symptoms need to be excluded before a diagnosis is made. [ 2 ]


The cause of PMS is unknown, but the underlying mechanism is believed to involve changes in hormone levels during the course of the whole menstrual cycle. [ 1 ]  Reducing salt, alcohol, caffeine, and  stress , along with increasing exercise is typically all that is recommended for the management of mild symptoms. [ 1 ]   Calcium  and  vitamin D  supplementation may be useful in some. [ 2 ]  Anti-inflammatory drugs such as ibuprofen or  naproxen  may help with physical symptoms. [ 1 ]  In those with more significant symptoms,  birth control pills  or the  diuretic   spironolactone  may be useful. [ 1 ] [ 2 ]


Over 90% of women report having some  premenstrual symptoms , such as bloating, headaches, and moodiness. [ 6 ]  Premenstrual symptoms generally do not cause substantial disruption, and qualify as PMS in approximately 20% of pre-menopausal women. [ 4 ]   Antidepressants  of the  selective serotonin reuptake inhibitors  (SSRI) class may be used to treat the emotional symptoms of PMS. [ 4 ]


Premenstrual dysphoric disorder  (PMDD) is a more severe condition that has greater psychological symptoms. [ 2 ] [ 1 ]  PMDD affects about 3% of women of child-bearing age. [ 4 ]


Any disruptive, cyclical symptom could be a symptom of PMS, and some sources have suggested that the number of claimed symptoms could exceed even 200. [ 8 ]  However, some symptoms are relatively common in PMS. Common emotional and  non-specific symptoms  include  stress ,  anxiety ,  difficulty with sleep ,  headache ,  feeling tired ,  mood swings , increased emotional sensitivity, and changes in  interest in sex . [ 9 ]  Problems with concentration and memory may occur. [ 1 ]  There may also be  depression  or  anxiety . [ 1 ]


Common physical symptoms include  bloating , bilateral  breast tenderness , and  headache . [ 7 ]


The exact symptoms and their intensity vary significantly from person to person, and even somewhat from cycle to cycle and over time. [ 2 ]  Most people with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern. [ 10 ]  Additionally, which symptoms are accepted as evidence of PMS varies by culture. [ 8 ]  For example, women in China report feeling cold but do not report  negative affect  as part of PMS, while women in the US report negative affect but not feeling cold as part of PMS. [ 8 ]


The exclusion of certain symptoms associated with the menstrual cycle can pose a challenge for researchers. For example,  period pain , which is common, is excluded, as it does not usually appear until menstruation, but some experience period pain prior. However, any kind of pain can contribute to stress, difficulty with sleep, fatigue, irritability, and other symptoms that do count towards a PMS diagnosis. [ 8 ]


While PMS is linked to the  luteal phase , the causes of PMS are not clear, but several factors may be involved. Changes in  hormones  during the menstrual cycle seem to be an important factor, with changing hormone levels affecting some more than others. [ 4 ]  PMS occurs more often in those who are in their late 20s and early 40s, have at least one child, have a family history of depression, and have a past medical history of either postpartum depression or a mood disorder. [ 11 ]


No laboratory tests or unique physical findings exist to verify a PMS diagnosis. However, the three key features are noted: [ 3 ]


The  National Institute of Mental Health  research definition compares the intensity of symptoms from cycle days 5 to 10 to the six-day interval before the onset of the menstrual period. [ 3 ]  To qualify as PMS, symptom intensity must increase at least 30% in the six days before menstruation. Additionally, this pattern must be documented for at least two consecutive cycles. [ citation needed ]  In 2016, the  Royal College of Obstetricians and Gynaecologists  argued that the definition of PMS should be changed to no longer require the presence of a psychological symptom. [ 8 ]


To document a pattern, potentially affected individuals may keep a prospective record of their symptoms on a calendar for at least two menstrual cycles. [ 8 ]  This will help to establish if the symptoms are limited to the premenstrual time, predictably recurring, and disruptive to normal functioning. A number of standardized instruments have been developed to describe PMS, including the Calendar of Premenstrual syndrome Experiences (COPE), the Prospective Record of the Impact and Severity of Menstruation (PRISM), and the Visual Analogue Scales (VAS). [ 3 ]


Additionally, other conditions that may better explain symptoms must be excluded, [ 3 ]  as a number of pre-existing medical conditions  may be made worse  at menstruation. [ 12 ]  This is known as menstrual exacerbation or premenstrual magnification. [ 13 ]  These conditions may lead individuals who do not have PMS to incorrectly believe they have PMS when they have another underlying disorder, such as  anemia ,  hypothyroidism ,  eating disorders  and  substance abuse . [ 3 ]  A key feature is that these conditions may also be present outside of the luteal phase. Conditions that can be magnified perimenstrually include  depression  or other  affective disorders ,  migraine ,  seizure disorders ,  fatigue ,  irritable bowel syndrome ,  asthma , and allergies. [ 3 ]


Further, problems with other aspects of the  female reproductive system  must be excluded, including  dysmenorrhea  (period pain during menstruation, rather than before it), [ 8 ]   endometriosis ,  perimenopause , and adverse effects produced by  oral contraceptive pills . [ 3 ]


Severe symptoms may qualify as  PMDD . [ 14 ]


Many treatments have been tried in PMS. [ 15 ]  Typical recommendations for those with mild symptoms include:


When self-care is not adequate, then medical management may be appropriate. [ 17 ]


Anti-inflammatory drugs  such as  naproxen  may help with some physical symptoms, such as pain. [ 1 ]


Spironolactone  is effective as a  diuretic  when  water retention  cannot be addressed through self-care alone; [ 15 ]  however,  thiazide diuretics  are ineffective. [ 17 ]


In those with more significant symptoms  birth control pills  may be useful. [ 3 ]   Hormonal contraception  is commonly used; common forms include the  combined oral contraceptive pill  and the  contraceptive patch . [ 17 ]  This class of medication may cause PMS-related symptoms in some and may reduce physical symptoms in others. [ 3 ]  They do not relieve emotional symptoms. [ 3 ] [ 17 ]


Gonadotropin-releasing hormone agonists  can be useful in severe forms of PMS but have their own set of significant potential side effects, such as bone loss. [ 17 ]


Progesterone  support was used for many years – in the 1950s, a deficiency of progesterone was believed to be the cause of PMS [ 8 ]  – but it does not provide any benefit. [ 17 ] [ 18 ]


Antidepressants , particularly  SSRIs  and  venlafaxine , are used as the first-line treatment of severe emotional symptoms of PMS, and also in treating PMDD. [ 17 ]  Those with PMS may be able to take medication only on the days when symptoms are expected to occur, because relief often appears within a few days, rather than the longer timespan expected for depression or other common psychiatric conditions. [ 17 ]  Additionally, the minimum dose is often lower than for treatment of depression. [ 17 ]  Although intermittent therapy might be effective and acceptable to some, it might be less effective than continuous regimens for others, especially if they are also experiencing symptoms unrelated to the menstrual cycle. [ 17 ]  Side effects such as nausea and weakness are however relatively common. [ 19 ]


Calcium ,  magnesium ,  vitamin E ,  vitamin B6 ,  chasteberry , and  black cohosh  may help some. [ 17 ]   St. John's wort  is discouraged because it causes many  drug–drug interactions . [ 17 ]  Although St John's wort may help some with PMS, it is ineffective for PMDD. [ 15 ]   Evening primrose oil  does not help. [ 17 ]


PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years. [ 20 ]  Treatment for specific symptoms is usually effective. Unsuccessful medical management of severe symptoms frequently indicates  misdiagnosis . [ 17 ]


Perimenstrual breast pain is associated with  fibrocystic breast changes . [ 21 ]


Even without treatment, symptoms tend to decrease in  perimenopausal  women, [ 22 ]  and  induction of menopause  through  surgical removal of the ovaries  is a treatment of last resort. [ 17 ]  However, those who experience PMS or PMDD are more likely to have significant symptoms associated with  menopause , such as  hot flashes . [ 2 ]


Over 90% of women report having some premenstrual symptoms, such as bloating, headaches, and moodiness. Mostly the symptoms are mild. [ 6 ]


Globally, about 20% of women of reproductive age have PMS that disrupts their everyday lives. [ 4 ]  Additionally, about 30% of women have mild or moderate symptoms related to their menstrual cycles that do not disrupt their everyday lives. [ 4 ]


PMS was originally seen as an imagined disease. Women who reported its symptoms were often told it was "all in their head". [ 23 ]  Woman's reproductive organs were thought to control them. Women were warned not to divert needed energy away from the uterus and ovaries. This view of limited energy very quickly ran up against a reality in 19th-century America that young girls worked extremely long and hard hours in factories; newspapers in the 19th century were peppered with remedies to help in the "tyrannous processes" of the menstrual cycle. In 1873 Edward Clarke published an influential book titled  Sex in Education . Clarke came to the conclusion that female operatives suffer less than schoolgirls because they "work their brain less". This suggested that they have stronger bodies and a reproductive "apparatus more normally constructed". Feminists later took opposition to Clarke's argument that women should not leave the private sphere by showing that women could function in the world outside the home in spite of natural body functions. [ 24 ] [ 25 ]


The first formal description of what is now called PMS as a medical problem, rather than a normal and natural variation, goes back to 1931, in a paper presented at the  New York Academy of Medicine  by Robert T. Frank titled "Hormonal Causes of Premenstrual Tension". [ 8 ]  He incorrectly attributed premenstrual symptoms to an excess of the newly discovered sex hormone, estrogen. [ 8 ]


The specific name  premenstrual syndrome  first appeared in the  medical literature  in 1953. [ 8 ] [ 26 ]  At that time, medical researchers incorrectly thought that PMS was caused by a deficiency in progesterone. [ 8 ]


Since at least the 1990s, when PMDD became accepted, the definitions of PMS have focused on psychological symptoms. [ 8 ]  Throughout the history of PMS, many of the symptoms associated with it have been stereotypical feminine behaviors, such as expressing emotions or " nagging ". [ 8 ]


Since then, PMS has been a continuous presence in popular culture, occupying a place that is larger than the research attention accorded it as a medical diagnosis. Some have argued that women are partially responsible for the medicalization of PMS. [ 27 ]  They claim that women are partially responsible for legitimizing this disorder and have thus contributed to the  social construction  of PMS as an illness. [ 27 ]  The public debate over PMS and PMDD may have been affected by organizations who had a stake in the outcome including feminists, the  American Psychiatric Association , physicians and scientists. [ 28 ]


Some supporters of PMS as a social construct believe PMDD and PMS to be unrelated issues: according to them, PMDD is a product of brain chemistry, and PMS is a product of culture, i.e. a  culture-bound syndrome . Women are socially conditioned to expect PMS, or to at least know of its existence, and they therefore report their symptoms accordingly. [ 29 ] [ 8 ]  Becoming educated about PMS narrows their interpretation of their experiences by teaching them that certain symptoms are accepted as part of PMS, and that other symptoms are not, even though an accepted symptom might be unrelated to PMS for that woman (who might have a different medical condition), and an excluded symptom might be part of PMS, but not mentioned because they did not think it was relevant. [ 8 ]  Social psychologist  Carol Tavris  also says that PMS is blamed as an explanation for rage or sadness. [ 29 ]


The identification of PMS as a medical disorder has been criticized as inappropriate  medicalization . [ 8 ]  These critics are concerned that society is pathologizing the menstrual cycle itself, even when the signs and symptoms are non-disruptive. [ 8 ]


The view of PMS as primarily a psychological situation, rather than primarily a biologically driven, medical condition dominated by physical symptoms, has also been criticized. [ 8 ]  This view makes it harder to address psychosocial factors, such as external stress and a lack of social support, that exacerbate premenstrual symptoms. [ 8 ]  Treating PMS as a psychological situation also makes it difficult to address menstrual exacerbation of other conditions, including  catamenial epilepsy ,  menstrual migraine , and cyclical asthma. [ 8 ]


The limitation of PMS to premenstrual symptoms, rather than having a diagnosis that covers all symptoms associated with the menstrual cycle, has also been criticized. [ 8 ]  Critics of this limitation think that excluding common physical symptoms that appear during the menstrual phase, such as period pain, fatigue, and back pain, is an arbitrary distinction that tends to reinforce the view of PMS as primarily an emotional problem, rather than a biological one. [ 8 ]  They propose a focus on perimenstrual symptoms instead of strictly pre-menstrual ones. [ 8 ]


Open research questions related to treatment include how to predict who will respond to SSRIs, which non-drug treatments are effective, and how to manage people who have PMS in addition to other medical conditions. [ 30 ]


Researchers are also working towards a single, uniform set of  diagnostic criteria  and to identify any objective characteristics that could be useful for diagnosis, such as any possible  genetic predisposition . [ 30 ]


Premenstrual water retention  (or  premenstrual fluid retention ) is the buildup of additional water or fluid in the body. This phenomenon can be seen in various forms like increasing weight gain and swollen belly, legs, or ankles.  Water retention  is a symptom felt by some women of all backgrounds before their  menstruation  onset and was listed as one of the most common premenstrual symptoms in addition to cramping and back pain. [ 1 ]  There is a study that mentions the age effect being potentially linked to the intensity of symptoms, where the maximum symptom intensity was seen around age 35. [ 1 ]  This symptom, among others, have been connected to  premenstrual syndrome  (PMS), which is experienced by women days before their  menstrual cycle  begins. [ 2 ] [ 3 ]   However, water retention itself can cause symptoms similar to those of PMS like body aches, headaches, and nausea. The actual duration of how long symptoms can last varies in length, from a few days to two weeks. [ 3 ]


Premenstrual water retention could be passed off as little weight gain before the start of a menstruation cycle, but should be carefully watched if weight is gained quickly within days. Water retention can cause serious consequences in people who have a kidney or cardiovascular disease and should take extra caution when experiencing this symptom. [ 4 ] [ 5 ]


As of now, the actual cause of water retention remains unclear. It was noted that there is no correlation to serum levels of progesterone or estradiol according to actual data, [ 6 ]  but it is thought to be caused by hormone changes during the menstrual cycle through high levels of circulating  progesterone ,  estrogen , and  prolactin , which stimulate  secretory cells  in the body. [ 7 ] [ 8 ] [ 9 ]  It is also thought that diet may play a role in increased water retention, such as salt and magnesium consumption, and fluid intake. [ 10 ]


Although the cause is still unclear, there are ways to relieve or manage water retention and symptoms caused by it. These methods include both medication (like water pills) and non-medication (diet control) management.


Both girls and women have reported water retention symptoms days prior to their menstrual cycle. The symptoms can appear up to two weeks before the menstrual cycle (before the luteal phase) and can present as physical symptoms such as breast tenderness, weight gain, and bloating. [ 11 ] [ needs update ]   [ 12 ]
The Penn Daily Symptom Rating Form was used in multiple studies that demonstrated these symptoms as core symptoms of the premenstrual cycle. [ 13 ]


Water retention during the premenstrual cycle can be linked to the use of conventional oral contraceptives. This is due to them containing estrogen and progestin. [ 14 ]  Synthetic progestin lacks the ability to antagonize mineralocorticoid receptors, leading to more sodium and water retention and subsequently, temporary weight gain. [ 15 ]  In addition, estrogen is known to interfere with the renin-angiotensin-aldosterone system (RAAS), since high concentrations of estrogen causes the release of more angiotensin II and aldosterone. [ 15 ]


There are pharmacological and  non-pharmacological  treatment options in alleviating symptoms and providing relief during the phase of premenstrual fluid retention. Currently, pharmacological agents that are often used to treat premenstrual water retention in removing or limiting the fluid that is present. [ 10 ]  Non-pharmacological considerations to reduce the effects of the condition is focused on an individual's diet and activity levels such as exercise [ 10 ]


Hormonal treatments such as  oral contraceptives  or  intrauterine devices (IUDS)   alters the menstrual cycle and lessen the amount of fluid retention. [ 16 ]   Within the four phases of the menstrual cycle, water retention occurs during the Luteal phase due to the production of the hormone progesterone and estrogen. [ 17 ]   The increase of these hormones results in an increase in water retention. Hormonal treatments are then used to reduce the amount of progesterone and estrogen that are produces and therefore, leading to a reduce amount of fluid. [ citation needed ] [ medical citation needed ]


In the setting of increased fluid retention, the use of Diuretics is for the removal of fluid in the body. Diuretics are known as one of the main therapies for volume overload and includes several classes whose mechanisms of actions, and pharmacokinetics are involved in the principles of nephrology. [ 18 ]  The therapy consists of drugs that pharmacologically adjusts the renal fluid regulation in favor of excreting water and electrolytes. [ 19 ]  This class of drugs works to achieve the objective of fluid removal through the increase in production and volume of urine. [ 19 ]


A popular pharmacologic over-the-counter treatment on the market to alleviate symptoms associated with menstrual cycles in the USA is  Midol [ clarification needed ] . More specifically, many Midol products contain a mild diuretic in their active ingredients to help with bloating. [ 20 ]  Pamabrom helps relief premenstrual and menstrual symptoms of water retention. It is a xanthine derivative that acts as a mild, short-acting diuretic that eliminates sodium and chloride and sometimes potassium. [ 20 ]  Although the exact mechanism of how this works is still unclear, it is speculated to be due to increasing the GFR (glomerular filtration rate) and decreasing sodium reabsorption in the proximal tubule. [ 20 ]  Some Midol products also contain caffeine as a diuretic. Caffeine increases the GFR by inhibiting adenosine receptors, thus preventing vasoconstriction of the afferent arteriole in the renal system. [ 21 ]


Studies shows that minimizing of the use of the medication class non-steroidal anti inflammatory drugs ( NSAIDs ) such as Naproxen and Ibuprofen will reduce premenstrual fluid retention. NSAIDs mechanism of action consists of the inhibition of  cyclooxygenase  (COX) which further inhibits the production of prostaglandins and resulting in the reduction of renal water and sodium excretion in the kidneys. [ 22 ]


There is ongoing research regarding the efficacy of magnesium supplement in improving premenstrual symptoms and effectively reducing water retention. They may increase fluid output which can reduce premenstrual fluid retention and alleviate symptoms. [ 23 ]


In several studies, it was shown that people experiencing PMS symptoms had a decrease in water retention and breast tenderness when they exercised regularly compared to those who did not. [ 24 ] [ 25 ]


Studies have shown a positive correlation between PMS symptoms and foods that are high in calories, fat, salt, and sugar. [ 26 ]  Instead, individuals should focus on incorporating more fruits and vegetables that are high in fiber and anti-oxidant properties to reduce PMS symptoms. [ 27 ]  Consuming smaller meals or limiting the amount of food can help minimize the occurrence of symptoms since more food consumed causes more volume in the body. [ 28 ]


In  Traditional Chinese Medicine ,  PMS  is seen to be caused by the  qi  in the liver being blocked which leads to an accumulation of blood flow in the lower half of the body. Additionally, the spleen and the stomach have an impact on water retention due to their role in digestion and nutrient breakdown. To open up the  qi , people can be treated with herbs, acupuncture, diet therapy, and deep breathing exercises. [ 29 ]  PMS symptoms are also tied to changes in yin and yang that happen throughout the menstrual cycle. [ 30 ]


Acupuncture has been traditionally used as a Chinese medical treatment for over 2000 years in Asian countries to relieve PMS symptoms. It has been speculated to work by altering blood flow, inflammatory markers, and prostaglandin levels. Especially because inflammatory markers is the main pathway in decreasing premenstrual physical symptoms such as breast tenderness and water retention. [ 31 ]  The acupoints that are most commonly used to relieve PMS symptoms due to hormone regulating properties and regulation of the nervous system include SP6, LR3, and RN4. [ 30 ]


Qigong is another practice that consists of meditation, breathing-exercises, dance-like movements, and relaxation that has been shown to reduce PMS symptoms when compared to placebo results. [ 32 ]  Practitioners of qigong can redirect or emit their qi to heal themselves or others, helping to improve symptoms of negative feelings, water retention, etc. [ 32 ]


Drinking green tea, which is one of the most consumed beverages, is also encouraged to reduce water retention due to its diuretic properties. Green tea contains caffeine and catechins which are anti-oxidants. [ medical citation needed ] [ 33 ] [ 34 ]


Many studies regarding the symptoms of  PMS  were based on populations in the Western or Far Eastern countries. However, the prevalence of PMS is just as dominant in Middle Eastern countries like Saudi Arabia and Palestine. These studies looked into many risk factors that could be correlated with symptom onsets but interestingly have shown that neither smoking or medical history (like  chronic illnesses  or medications) were related to an increase in symptoms. [ 35 ] [ 36 ]  The frequency these symptoms were mainly associated with people who have family history of PMS symptoms [ 36 ]  and dietary habits. [ 35 ] [ 36 ]  These studies observed the effects certain types of drinks (caffeinated) may have on the severity and frequency of symptoms but noted that the amount of fluid intake was not taken into account. [ 35 ] [ 36 ]


The Story of Menstruation  is a 1946 American  animated   short film  produced by  Walt Disney Productions . [ 3 ]  It was commissioned by the International Cello-Cotton Company (now  Kimberly-Clark ) [ 4 ]  and was shown in a non-theatrical release to approximately 105 million American students in health education classes. [ 2 ]  In 2015, the United States  Library of Congress  selected the film for preservation in the  National Film Registry , finding it "culturally, historically, or aesthetically significant". [ 5 ]


The Story of Menstruation  was part of a series of films that Disney produced for American schools between 1945 and 1951. [ 6 ]  Gynecologist Mason Hohn was hired as a consultant to ensure that the film was scientifically accurate and to increase the likelihood that school doctors and nurses would allow the film to be shown. [ 4 ]  Hohn's involvement led to a stronger emphasis on biology than other marketing by ICCC. [ 4 ]   The Story of Menstruation' s reputation was increased when it received the  Good Housekeeping Seal of Approval . [ 2 ]


It was one of the first commercially sponsored films to be distributed to high schools. [ 4 ]  It was distributed with a booklet for teachers and students called  Very Personally Yours  that featured advertising of the  Kotex  brand of products, and discouraged the use of  tampons , when the market was dominated by the  Tampax  brand of tampons from Tampax Inc. [ 7 ]


The film uses animated diagrams to detail the  menstrual cycle . [ 6 ]  The film's narrator, who is not identified in the credits, informs the viewer that "there is nothing strange or mysterious about menstruation", and it shows women engaged in activities such as bathing, riding a horse, and dancing during their menstrual cycles. The film's narration by actress  Gloria Blondell  also provides advice to avoid constipation and depression, and to always keep up a fine outward appearance. [ 3 ]


The Story of Menstruation  is believed to be the first film to use the word " vagina " in its screenplay. [ 3 ]  Sexuality is not mentioned in the film, and an emphasis on sanitation makes it, as Disney historian Jim Korkis has suggested, "a hygienic crisis rather than a maturational event". [ 8 ]  The menstrual flow was depicted as snow white instead of blood red. [ 6 ]


The film's copyright was renewed by Walt Disney Productions on December 3, 1973. [ 9 ]


The  Whitten effect  is  stimulation, by male pheromones, of synchronous  estrus  in a female population. [ 1 ]


Social signals, or social stimuli, have an effect on  reproduction in all mammals .  For certain female mice, the  pheromones  contained in the urine of male mice can  be such stimuli, inducing  synchronous   estrus . [ 2 ]


When the pheromones contained in the urine of male mice stimulate synchronous estrus in a population of female mice, it is known as the Whitten effect. This is a phenomenon observed by  Wesley K. Whitten  (1956, 1966, 1968),  whereby male mouse pheromone-laden urine synchronizes the estrus cycle "among unisexually grouped females," and is an example of male-to-female pheromonal effects in mice, similar to the  Bruce effect . [ 3 ]


The Whitten effect occurs when a group of female mice are exposed to the urine produced by a male mouse. The male’s urine contains certain volatile, or airborne, pheromones that affect the hormonal processes of the females that control their reproductive status. [ 3 ]  A sexually mature and viable male must produce the urine,  as the pheromones that produce the Whitten effect are dependent on male sex hormones such as testosterone. [ 2 ]


The female mice do not require direct contact with the male’s urine to produce the Whitten effect, as the pheromone contained in the urine is airborne and therefore is taken up by the females through their olfactory system. [ 4 ]  The reproductive cycle of female mice in isolation is approximately 4 to 5 days, and the reproductive cycles of grouped females are often longer and more irregular. [ 5 ]   However, when grouped female mice are exposed to the pheromones contained in a male’s urine, the Whitten effect occurs, and the majority of the female mice will enter a new estrus cycle by the third day of exposure. [ 5 ]  However, there is little evidence for a similarly functioning vomeronasal, or olfactory, system (thought to be the sensory organ that initiates the Bruce, Vandenbergh, and Whitten effects) in humans.  These differences, in putative stimulus and neural pathway (as well as species observed), stringently distinguishes the Whitten and McClintock effect, as the latter does not posit a role for male pheromones.


In  Islam , the  Woman prayer  ( Arabic :  صلاة المرأة ) represents the peculiarities, specificities and characteristics of the  Islamic   prayer  ( salat ) that is performed by a  woman . [ 1 ]


The prayer that a woman performs in  Islam  to draw close to  God  is considered equal to the prayer a man performs. [ 2 ]


The American-Canadian sexologist  Ray Blanchard  proposed a  psychological typology  of  gender dysphoria ,  transsexualism , and  fetishistic transvestism  in a series of academic papers through the 1980s and 1990s. Building on the work of earlier researchers, including his colleague  Kurt Freund , Blanchard categorized  trans women  into two groups:  homosexual transsexuals  who are attracted exclusively to men and are feminine in both behavior and appearance; and  autogynephilic transsexuals  who experience sexual arousal at the idea of having a female body ( autogynephilia ). Blanchard and his supporters argue that the typology explains differences between the two groups in childhood  gender nonconformity , sexual orientation, history of  sexual fetishism , and age of transition.


Blanchard's typology has attracted significant controversy, especially following the 2003 publication of  J. Michael Bailey 's book  The Man Who Would Be Queen , which presented the typology to a general audience. Scientific criticisms commonly made against Blanchard's research include that the typology is  unfalsifiable  because Blanchard and other supporters regularly dismiss or ignore data that challenges the theory, that it failed to properly control against  cisgender  women rather than against cisgender men in rating levels of autogynephilia, and that when such studies are performed they show that cisgender women have similar levels of autogynephilic responses to transgender women.


The American Psychiatric Association includes  with autogynephilia  as a specifier to a diagnosis of  transvestic disorder  in the fifth edition of the  Diagnostic and Statistical Manual of Mental Disorders  (2013); this addition was objected to by the  World Professional Association for Transgender Health  (WPATH), who argued that there was a lack of scientific consensus on and empirical evidence for the concept of autogynephilia.


Beginning in the 1950s, clinicians and researchers developed a variety of classifications of transsexualism. These were variously based on sexual orientation, age of onset, and fetishism. [ 1 ]  Prior to Blanchard, these classifications generally divided transgender women into two groups: "homosexual transsexuals" if sexually attracted to men and "heterosexual fetishistic transvestites" if sexually attracted to women. [ 2 ]  These labels carried a  social stigma  of mere sexual fetishism, and contradicted trans women's self-identification as "heterosexual" or "homosexual", respectively. [ 2 ]


In 1982,  Kurt Freund  and colleagues argued there were two distinct types of trans women, each with distinct causes: one type associated with childhood femininity and  androphilia  (sexual attraction to men), and another associated with fetishism and  gynephilia  (sexual attraction to women). [ 1 ] : 533  [ 3 ] : 443   Freund stated that the sexual arousal in this latter type could be associated, not only with crossdressing, but also with other feminine-typical behaviors, such as applying make-up or shaving the legs. [ 4 ]


Freund, four of his colleagues, and two other sexologists had previously published papers on "feminine gender identity in homosexual males" and "Male Transsexualism" in 1974. [ 5 ] [ 6 ]  They occasionally also used the term  homosexual transsexual  to describe transgender men attracted to women. [ 7 ]  Blanchard credited Freund with being the first author to distinguish between erotic arousal due to dressing as a woman ( transvestic fetishism ) and erotic arousal due to fantasizing about being female (which Freund called  cross-gender fetishism ). [ 3 ] : 443