School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
School of Civil Engineering, University of Leeds, Leeds, West Yorkshire, United Kingdom.
PLoS One. 2021 Jul 21;16(7):e0255001. doi: 10.1371/journal.pone.0255001. eCollection 2021.
There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research.
Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts.
We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest.
The review protocol registration is PROSPERO: CRD42019157618.
人们越来越认识到，月经对于实现所有人的健康、教育和性别平等至关重要。高收入国家（HICs）的新政策回应了一些传闻证据，即许多人难以满足其月经健康需求。定性研究探索了在 HICs 中月经的生活体验，这可以为设计干预方法做出贡献。为了为不断增长的政策关注提供支持月经的人群，我们在此审查和综合现有研究。
符合条件的研究是在 HICs 中捕获月经体验的主要定性研究。系统数据库和手动搜索确定了 11485 条记录。使用 EPPI-Centre 清单进行筛选和质量评估后，纳入了 104 项研究（120 篇出版物），详细介绍了来自 16 个国家的 3800 多人的月经经历。我们使用从低和中等收入国家（LMICs）的研究中开发的月经体验综合模型作为起点框架，并通过演绎和归纳方法确定了促成月经体验的因素；月经体验本身及其影响。纳入的研究描述了一致的主题和关系，与 LMIC 综合模型非常吻合，通过我们的分析确定了主题和模型途径的修改。社会文化背景严重影响了月经体验，表现为严格的行为期望，隐瞒月经，并限制了月经材料的供应。资源限制导致了负面体验，对月经实践和管理环境的不满以及如果参与者觉得他们没有以整洁、卫生的方式管理月经，就会感到厌恶。身体的月经因素，如疼痛，通常与负面体验相关，对医疗保健的体验也各不相同。在研究中，参与者描述了他们的月经经历的负面影响，包括增加心理负担和对参与和人际关系的不利影响。很少有积极的体验被报道，尽管有时顺性别女性之间的关系因共同经历月经出血而得到加强。纳入的研究反映了广泛的学科和认识论。许多研究旨在了解月经的构建意义，但很少有研究旨在明确为政策或实践提供信息。很少有研究关注与新政策努力相关的社会经济弱势群体。
我们在 HICs 中开发了一个月经体验综合模型，该模型可用于通过强调积极和消极月经体验表现的途径来为研究、政策和实践决策提供信息。
审查方案注册是 PROSPERO：CRD42019157618。
