The landscape of menstrual fluid research — ASN Events
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The landscape of menstrual fluid research (#526)

Emily M Brennan 1 , Kirstin Tindal 1 , Natalie Holowko 1 , Srikar Vallabhapurapu 1 , Dinasha H Wimalasiri 1 , Fiona L Cousins 1 , Beverley Vollenhoven 2 , Caroline E Gargett 1 , Stacey Ellery 1 , Adrienne Gordon 3 , Miranda Davies-Tuck 1
  1. Hudson Institute of Medical Research/Monash University, Clayton South, Victoria, Australia
  2. Obstetrics & Gynaecology, Monash University, Clayton, Victoria, Australia
  3. University of Sydney, Sydney, New South Wales, Australia

Background
Menstrual fluid (MF) is an understudied waste product gaining popularity as a non-invasive alternative for studying the endometrium for general, obstetric and gynaecological health. This review aimed to understand the context, methodology and scope of MF research to characterise the current landscape and identify areas for improvement.

Methods
A scoping review was conducted by compiling search results for “menstrual fluid”, “menstruation” and “collection” or “survey” from four databases. Screening was completed in Covidence. All reviews, forensics and animal studies were excluded. Fields extracted included characteristics of the studies, methods of menstrual fluid collection, transport and storage and outcomes measured. Experiences of women participating in MF research were also extracted from qualitative studies.

Results
136 MF studies were conducted across 32 countries. We identified 9 focus areas: abnormal menstruation (n=50;37%), general menstruation (n=25;18%), regenerative medicine (n=15;11%), technical development (n=11,8%), medical diagnoses (n=9;7%), menstrual hygiene management (n=8;6%), product preference (n=7;5%), and opinions of MF research (n=2;1%). Nine main components of interest were measured: volume (n=84), stromal cells (n=48), immune cells (n=39), proteins (n=32), hormones (n=16), prostaglandins (n=11), epithelial cells (n=10), clots/viscosity (n=8) and DNA (n=8). We noted significant variability in methods used to collect, transport and store MF. We also assessed study reporting sufficiency against 7 criteria: hormone use, cycle length, collection method, day, and interval, media use, transport temperature and storage conditions, of which only 23% (n=28) satisfied all criteria.

Conclusion
MF has gained exponential interest over the past 2 decades, being applied to broader contexts and exploring a broader range of components. Alongside this growth we identified variable reporting and a lack of standardised approaches to collection, transport and storage of MF. This inconsistent reporting limits the ability to compare and generalise MF studies and identifies need to standardise MF methodology and define minimum publication criteria.