# Menstrual Health in Servicewomen: The Menstrual Cycle, Menstrual Disturbances, and Occupational Consequences

## TL;DR

This review highlights how menstrual health affects the well-being and performance of women in the military, emphasizing the need for better support and research.

## Contribution

The paper introduces the concept of menstrual health in the military context and advocates for tailored policies and research for Servicewomen.

## Key findings

- Menstrual disturbances in the military are linked to multistressor environments like nutrition, physical activity, and psychological stress.
- Current military policies often fail to address the unique physiological challenges faced by Servicewomen.
- There is a bidirectional relationship between military stressors and menstrual health, impacting endocrine function and performance.

## Abstract

Most women serving in the military do so during their reproductive life and enter service at a young gynecological age. This review provides an overview of the menstrual cycle and summarizes the evidence for menstrual cycle disturbances in the military and how these disturbances to the menstrual cycle impact health and performance in the military.

Servicewomen often manage the practical challenges of menstruation and symptoms of the menstrual cycle or menstrual disturbances/dysfunction in an austere environment with no formalized support and/or education, and with unknown stigma and risks. Menstrual health in the military context implies that those who experience a menstrual cycle can access timely information, diagnosis, and support/treatment to achieve “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle.” Herein we describe how menstrual health is impacted in a multistressor environment, including nutrition (energy balance and energy availability, micronutrients, and microbiome), physical activity, and recovery (occupational tasks, sleep, psychological stress, environment), and how menstrual disturbances can affect occupational performance and the lived experience of the female workforce.

We call for action of militaries worldwide to protect the health of Servicewomen to maximize their potential. Low representation, relatively recent full integration of women into the military workforce, and the exclusion of women from military research have led to policies developed from evidence on men, with the potential to impact the health and performance of Servicewomen.

Servicewomen face unique physiological challenges. Often, they must meet sex-neutral physical employment—or fitness—standards to be employed, and manage menstrual health.A bidirectional relationship exists between multistressor military environments and menstrual health, whereby multistressors can influence endocrine function and menstrual health can be an additional stressor.More high-quality research investigating the many aspects of menstrual health on the overall health and performance of Servicewomen is essential.

Servicewomen face unique physiological challenges. Often, they must meet sex-neutral physical employment—or fitness—standards to be employed, and manage menstrual health.

A bidirectional relationship exists between multistressor military environments and menstrual health, whereby multistressors can influence endocrine function and menstrual health can be an additional stressor.

More high-quality research investigating the many aspects of menstrual health on the overall health and performance of Servicewomen is essential.