12 Chapter 1 GENERAL INTRODUCTION Menstrual health At the 50th session of Human Rights Council panel on menstrual hygiene management, human rights and gender equality discussion (June 2022), the World Health Organisation (WHO) adopted Menstrual Health in the Human Rights Council agenda. WHO calls for three actions. Firstly, to recognize and frame menstruation as a health issue with physical, psychological, and social dimensions, and one that needs to be addressed from before menarche to after menopause. Secondly, to recognize that menstrual health means that people who menstruate, have access to information and education about it; to the menstrual products they need, especially for those who are displaced because of war or natural calamities; water, sanitation, and disposal facilities; to competent and empathic care when needed; to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured. More and more governments are calling for attention and change in menstrual health in recent years. Currently, there is also a discussion in the Netherlands about menstrual leave for those women whose periods are severe. Women with underlying bleeding disorders are one such group. These women are more likely to experience heavy bleeding throughout their lives, anemia, physical or emotional pain, and increased absenteeism from school and work. Despite the increased attention to menstruation as a global health issue, attention to the optimal route to timely detect bleeding disorders in women is lagging. As a result, there will continue to be delays in diagnosis and care for these people in 2024. Strategies to reduce bleeding in women Heavy menstrual bleeding (HMB) is mostly the first symptom of a bleeding tendency and various bleeding disorders (1-4). Von Willebrand disease (VWD) type 1 is one of the most common inherited bleeding disorders with a prevalence ranging from 5%-24% in patients with HMB (2). However, women with a bleeding disorder may also experience various other bleeding symptoms in addition to HMB, with which women may present at the outpatient clinic (5). An overall bleeding history besides an obstetrical-gynecological history is an important factor in reducing the diagnostic delay in bleeding disorders and could be crucial in optimizing gynaecological management (6-10). Awareness is key in screening for bleeding disorders in women with HMB or other gynaecological conditions (1, 11) Interventions such as narrowing knowledge gaps, increasing awareness of female care pathways, and promoting empathetic care are essential to improve the quality of care (2). Lack of progress for women with bleeding disorders Despite the increasing focus on the need to ensure menstrual health worldwide (3-5), women continue to have lengthy delays in referral and diagnosis of underlying bleeding disorders,
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