Menstrual Cycle and Nursing Role: Introduction
The menstrual cycle is a unique physiological process with significant implications for women’s health and well-being. As a gender-specific process, the menstrual cycle impacts women’s lives in various ways and is integral to their reproductive health. Nurses play a crucial role in understanding, researching, and managing menstrual health across different life stages, from menarche to menopause. This article explores the physiological background of the menstrual cycle, the unique contributions of nursing research, the role of nurses in women’s health concerns, and multidisciplinary efforts in advancing menstrual cycle research.
What is the Menstrual Cycle?
The menstrual cycle is a natural biological rhythm unique to women, governed by a complex sequence of physiological events. These events are coordinated by the hypothalamus in conjunction with the pituitary glands, ovaries, and uterus, along with the adrenal and thyroid systems, adapting to environmental changes. The term “menstrual cycle” derives from the Latin “mensis,” meaning month. It involves the shedding of the uterine lining, known as menstruation or a menstrual “period.”
Menstruation typically begins at the age of 11 or 12 (menarche) and ends around 51 years of age (menopause). With a few interruptions, such as pregnancy or use of hormonal contraceptives, women experience approximately 400 menstrual periods in their lifetime. The term “menstrual period” refers specifically to the days of bleeding, while “menstrual cycle” refers to the time from the start of one period to the start of the next. The average cycle length is 29 days, although it can range from 21 to 35 days.
Physiological Background
The menstrual cycle involves cyclical changes in hormonal levels and reproductive organs. The neuroendocrine mechanisms controlling the cycle are complex and not fully understood. Much research has focused on ovarian hormones, particularly estrogen and progesterone, and their influence on the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. However, menstruation is more than a physiological process; it is closely associated with feminine role development, health, well-being, and is embedded in the sociocultural context of women’s experiences.
Nursing Studies on the Menstrual Cycle
Nursing scholarship and science related to menstrual cycle phenomena can be traced back to the early 20th century. Key figures like Lillian Wald, Margaret Sanger, and Mary Breckenridge provided care and support to women, focusing on aspects of fertility, maternity care, and menstrual health. Since the late 1970s, nursing research has uniquely contributed to understanding menstrual cycle events (menarche, menstruation, menopause) as normative experiences rather than diseases. Nursing research has introduced new conceptual models, advanced research methods, and interventions that link therapeutics with advocacy.
Unique Nursing Contributions
Nurses have made significant contributions to understanding menstrual health through research that goes beyond the biomedical model. While traditional medical research often views menstruation and menopause as problems or risk factors for disease, nursing research has explored psychosocial, behavioral, cultural, and health factors influencing menstrual experiences. Nursing studies have developed diagnostic categories for conditions such as dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD), and have explored therapies for menstrual-related issues.
Phenomenon Beliefs, Attitudes, and Menstrual Cycle
Nurse investigators have explored various phenomena related to beliefs and attitudes about menstruation among different groups of women, including those with unique menstrual experiences such as athletes, shift workers, women with disabilities, and those exposed to toxic substances. These studies complement biomedical research by describing physiological patterns across the menstrual cycle and developing diagnostic criteria for menstrual disorders. Nurses have also contributed to defining therapies for problems related to menstruation and menopause.
Nursing and Women’s Health Concerns
Nurses concerned with women’s health have historically incorporated feminist approaches into both clinical practice and research. Scholars like Angela McBride have embraced feminist theory as a research paradigm, advocating for a broader understanding of gynecological diseases within the context of a woman’s everyday life. Nursing literature reflects a definition of health grounded in everyday experiences rather than just clinical definitions of health. This perspective has shifted focus towards biopsychosocial response patterns, normative transitions, functional status, role performance, adaptation to environmental demands, and high-level wellness.
Nursing research has highlighted women’s developmental transitions (menarche and menopause) as normal rather than deficiencies requiring medical treatment. This shift has allowed for more woman-centered therapeutics, where interventions are designed “for” women rather than merely “about” them.
Multidisciplinary Efforts
In recent decades, multidisciplinary efforts have advanced research on women’s health, with nursing playing a significant role. The Society for Menstrual Cycle Research (SMCR) is an example of a multidisciplinary organization with strong nursing leadership. Since 1977, the Society has published research that promotes a comprehensive approach to studying women’s health beyond a reductionist perspective focused solely on sex hormones. The SMCR defines the menstrual cycle within the context of other human biorhythms and sociocultural networks of meanings, providing new insights into how the endocrine system interacts with other bodily functions.
Menstrual Cycle and Nursing Research
Nursing research has been at the forefront of studying normative experiences related to menstrual cycle events. Menarche provides a unique opportunity for nurses to address reproductive and sexual health issues in school-age girls. Nursing researchers have explored various aspects of menstrual health, including attitudes, symptoms, and the impact of early menstrual experiences on adult health. Recent studies have focused on cultural and ethnic differences in menarcheal experiences and programs for menarcheal preparation.
Nurses have also been instrumental in translating research into practice through the development of menstrual health advocacy groups and internet-based education platforms, such as the Red Web Foundation and Red Spot.
Past Events and Menstrual Experiences
Efforts to understand menstruation as a normative experience include studies of community-based populations. For instance, the Tremin Trust Database provides valuable data on women’s menstrual cycles across generations, offering insights into menstrual cyclicity, cycle length, bleeding patterns, and estimates of menopause. This database has been pivotal in understanding how menstrual experiences evolve from menarche to menopause.
Nursing Research and Menstrual Experiences
Since the 1980s, nurse researchers have expanded the scope of menstrual cycle research, exploring how symptoms associated with the menstrual cycle are influenced by social class, education, race, marital status, self-esteem, occupation, and menstrual attitudes. These studies have documented the dynamic nature of symptom formation in response to changing social environments and contributed to developing improved designs and methods for the biobehavioral assessment of menstrual phenomena.
Nursing Research on Menopause
Nursing research on menopause has focused on normative experiences, providing rich descriptions of symptoms like hot flashes, sleep disturbances, and depression. Nurses have explored the meanings and social context of menopause, emphasizing that menopause should be viewed as a normal developmental transition rather than a condition requiring medical treatment. Recent studies have also addressed decision-making processes related to hormone therapy and the development of non-hormonal symptom management strategies.
Nursing Research and Community Efforts
Nursing research has encompassed studies involving both clinical and community-based populations. This research highlights the importance of incorporating the menstrual cycle as the “fifth vital sign” in women’s health assessments. Nurses are increasingly focusing on health education interventions, non-pharmacological treatment options, and culturally appropriate approaches to symptom management for conditions like hot flashes and sleep disturbances.
Conclusion
Nurses play a critical role in understanding and managing menstrual health across a woman’s lifespan. Their research has expanded our knowledge of menstrual phenomena, developed new therapeutic approaches, and fostered a more holistic view of women’s health. By integrating a multidisciplinary approach and focusing on normative experiences, nursing research continues to advance the field of women’s health, offering insights and interventions that empower women to manage their menstrual health more effectively.