![]() Additionally, women from this era had their first child at an earlier age (19 years), conceived more children over their lifetime (six children on average) and breastfed for much longer (2–3 years per child) than women living now 5. In contrast to these figures, research estimates that hunter–gatherer women of the Palaeolithic era experienced approximately 160 ovulations per lifetime, due to later average age at menarche (16 years) and earlier menopause (47 years). This estimate is based on the average age at menarche (12.5 years), average age at menopause (50.5 years), age at first birth (29 years), number of children conceived per lifetime (1.8 children per woman) and the average duration of breastfeeding (4 months) 5, 6. ![]() ![]() However, menstrual complaints remain under-reported 4.Ĭurrently, women living in high-income countries, for example, the USA or UK, are estimated to have approximately 400–450 ovulations in their lifetime. Menstrual abnormalities have become increasingly prominent in the latter half of the 20th century, probably due to increased prevalence and recognition 4. However, menstrual abnormalities are estimated to affect up to one third of women globally and can have a debilitating impact on an individual’s quality of life 1, 2, 3. Menstruation is a physiological process that, for most women, is a routine part of life. Menstruation is defined as “a woman’s monthly bleeding from the reproductive (vaginal) tract, as a consequence of cyclical changes in hormonal activity” 1. Treatments for AUB are not specific and a third of patients resort to a hysterectomy for resolution of symptoms, highlighting a clinically unmet need for more targeted and personalized treatments. The terminology and definitions for diagnosing causes of AUB are now standardized in the International Federation of Gynecology and Obstetrics Systems 1 and 2, and should be followed for ease of clinical and research synchrony. There is a high prevalence of iron deficiency and iron deficiency anaemia in those with AUB, on a global scale, and this is often under-recognized and under-reported. The endometrium is a dynamic, multicellular tissue highly responsive to sex steroids subtle variances in the endometrial environment and, therefore, functioning, can lead to abnormal uterine bleeding (AUB).ĪUB is a debilitating symptom that affects up to one third of reproductive-aged women comprehensive knowledge of menstrual cycle physiology is crucial for understanding and progressing endometrial physiology research. Menstruation is a phenomenon of repeated tissue injury and repair that is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. In a field where no new medications have been developed for over 20 years, emerging technologies are paving the way for a deeper understanding of the biology of the endometrium in health and disease, as well as opening up novel diagnostic and management avenues. This standardization will facilitate future research endeavours, diagnosis and clinical management. The International Federation of Gynecology and Obstetrics have produced standardized terminology and a classification system for the causes of AUB. On a global scale, iron deficiency and iron deficiency anaemia are closely linked with AUB, and are often under-reported and under-recognized. Poor menstrual health has a negative impact on a person’s physical, mental, social, emotional and financial well-being. An imbalance in any one of these processes can lead to the abnormal endometrial phenotype of AUB. Menstruation (that is, endometrial shedding) is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. Menstruation is a physiological process that is typically uncomplicated.
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