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Winner, 2010 Emily Toth Award for Best Book in Women's Studies, Popular Culture Association/American Culture Association The Modern Period examines how and why Americans adopted radically new methods of managing and thinking about menstruation during the twentieth century. In the early twentieth century women typically used homemade cloth \"diapers\" to absorb menstrual blood, avoided chills during their periods to protect their health, and counted themselves lucky if they knew something about menstruation before menarche. New expectations at school, at play, and in the workplace, however, made these menstrual traditions problematic, and middle-class women quickly sought new information and products that would make their monthly periods less disruptive to everyday life. Lara Freidenfelds traces this cultural shift, showing how Americans reframed their thinking about menstruation. She explains how women and men collaborated with sex educators, menstrual product manufacturers, advertisers, physical education teachers, and doctors to create a modern understanding of menstruation. Excerpts from seventy-five interviews—accounts by turns funny and moving—help readers to identify with the experiences of the ordinary people who engineered these changes. The Modern Period ties historical changes in menstrual practices to a much broader argument about American popular modernity in the twentieth century. Freidenfelds explores what it meant to be modern and middle class and how those ideals were reflected in the menstrual practices and beliefs of the time. This accessible study sheds new light on the history of popular modernity, the rise of the middle class, and the relationship of these phenomena to how Americans have cared for and managed their bodies.

The major causes of postpartum hemorrhage are uterine atony, lacerations, retained placenta or clots, and clotting factor deficiency. Uterine massage, oxytocin, and methylergonovine are the main treatments, along with blood transfusion and cardiovascular support.

ObjectivesThat Time of The Month. Aunt Flo. Menstruation. Whatever we feel comfortable calling them, we need to talk about periods. 77% of NHS workforce are female1 and our periods do not stop when we come to work. Women in the NHS face situations everyday where they are disadvantaged, particularly when they are on their periods.2 Long shifts or standing for hours at a time (e.g. ward rounds or surgery) can be difficult with few or no facilities to buy sanitary products.3 4 Doctors may be far away from their office and pockets contain bleeps and mobiles, not tampons and pads.The main objective was to provide free tampons and sanitary pads in staff toilets on paediatric and maternity areas in June 2023.MethodsPartnering with a local charity,5 we placed 20 boxes containing different free period products in staff toilets. A QR code was attached for feedback, and results collected over 4 weeks. Questions included demographics, issues of periods at work, views on this pilot and a free text for comments.ResultsWe received over 100 responses within 3 weeks. All staff agreed with this initiative and suggested all NHS staff toilets have period products going forward. Staff shared their difficulties of having periods at work and examples when they had been embarrassed by bleeding through. Many had to request colleagues or parents for period products as there was nowhere to buy these items during work shifts.ConclusionThis snapshot of 2 areas where staff suffer during their periods in our hospital happens across the NHS. Women have struggled and will continue to do so until this issue is widely talked about and support provided.In Scotland and Wales, health boards have agreed to provide free sanitary products to staff following a doctor-led campaign.6 This demonstrates that change is possible to improve staff conditions at work. Improving access to period products in the workplace will improve staff dignity and wellbeing.Referenceshttps://www.nhsemployers.org/articles/gender-nhs-infographic NHS employers. May 2019.https://www.bma.org.uk/news-and-opinion/dignity-at-work Jennifer Trueland. Jul 2022.Abi Rimmer. BMJ 2021;375:2617. Nov 2021.https://www.survivinginscrubs.co.uk/about/. Surviving in Scrubs. Aug 2023.https://www.girlpack.org/ Girl pack. Jun 2023.https://www.nhsgrampian.org/about-us/equality-and-diversity/staff-equalities-network/gender/free-sanitary-products-for-staff-patients-and-visitors-in-nhs- grampian/NHS Grampian. Aug 2023.

Abstract Epistaxis, commonly known as nosebleeds, is a frequent occurrence that places significant strain on public health systems worldwide. Traditional methods for managing epistaxis, such as nasal packing, can be uncomfortable and may result in complications, such as adhesions and mucosal trauma. In response to this, the use of carboxymethylcellulose (CMC), chitosan (CS), and citric acid (CA) as green crosslinkers for nasal packing in epistaxis management was studied. These biomaterials were chosen for their hemostatic properties and biocompatibility. This study aimed to assess the effectiveness of these natural materials in improving patient comfort and treatment outcomes compared with conventional packing materials when used as nasal packs for epistaxis. This study compared CA-crosslinked and freeze-dried sponges with two nasal packs commonly used in clinical practice: cotton gauze and a commercial hemostatic sponge. The goal was to optimize the crosslinking process using CA to refine the formulation parameters of the nasal packing materials and enhance their hemostatic efficacy, biocompatibility, antibacterial properties, and mechanical properties. The CS-CMC2 sponge exhibited exceptional morphological, hydrophilic, and mechanical properties, including the ability to partially degrade in an incubated aqueous medium. It has hemocompatible properties in vitro, confirming its safety in the blood contact material. In comparison to cotton gauze and the commercial sponge, it exhibited increased blood clotting capacity and the ability to adhere to red blood cells and platelets owing to its CS content. CS-CMC2 demonstrated potent antibacterial properties against Staphylococcus aureus, which could be prescribed to the presence of CS. These antibacterial properties may facilitate nasal mucosal repair. In summary, CS-CMC2 exhibits outstanding blood clotting, balanced swelling, and mechanical properties, which can support nasal hemostasis and mucosal repair, making it a promising therapy for epistaxis and valuable instrument for monitoring bleeding. Resumo A epistaxe, comumente conhecida como sangramento nasal, é uma ocorrência frequente que impõe uma pressão significativa aos sistemas de saúde pública em todo o mundo. Os métodos tradicionais para controle da epistaxe, como o tamponamento nasal, podem ser desconfortáveis e resultar em complicações, como aderências e trauma da mucosa. Em resposta a isso, foi estudado o uso de carboximetilcelulose (CMC), quitosana (QS) e ácido cítrico (AC) como reticulantes verdes para tamponamento nasal no contole da epistaxe. Esses biomateriais foram escolhidos por suas propriedades hemostáticas e biocompatibilidade. Este estudo teve como objetivo avaliar a eficácia desses materiais naturais na melhoria do conforto do paciente e dos resultados do tratamento, em comparação com materiais de tamponamento convencionais, quando usados como tampões nasais para epistaxe. Este estudo comparou esponjas reticuladas com AC e liofilizadas com dois tampões nasais comumente utilizados na prática clínica: gaze de algodão e uma esponja hemostática comercial. O objetivo foi otimizar o processo de reticulação utilizando AC para refinar os parâmetros de formulação dos materiais de tamponamento nasal e aprimorar sua eficácia hemostática, biocompatibilidade, propriedades antibacterianas e propriedades mecânicas. A esponja QS-CMC2 apresentou propriedades morfológicas, hidrofílicas e mecânicas excepcionais, incluindo a capacidade de se degradar parcialmente em meio aquoso incubado. Ela possui propriedades hemocompatíveis in vitro, confirmando sua segurança no material de contato com sangue. Em comparação com gaze de algodão e a esponja comercial, ela apresentou maior capacidade de coagulação sanguínea e capacidade de aderir a hemácias e plaquetas devido ao seu teor de QS. A CS-CMC2 demonstrou potentes propriedades antibacterianas contra Staphylococcus aureus, o que pode ser atribuído à presença de QS. Essas propriedades antibacterianas podem facilitar o reparo da mucosa nasal. Em resumo, a QS-CMC2 apresenta excelentes propriedades de coagulação sanguínea, equilíbrio do edema e propriedades mecânicas, que podem auxiliar na hemostasia nasal e no reparo da mucosa, tornando-a uma terapia promissora para epistaxe e um instrumento valioso para o monitoramento de sangramentos.

Why did you do this work?Endometriosis, menopause and stress are some factors leading to unpredictable menstrual cycles.1 Add to this challenging on-call shifts, winter pressures, clinical emergencies and the cost-of-living crisis,2 and you’ve got a recipe for gender inequality disaster. Evidence shows that 70% of people have been ‘caught short’ at work,3 leading to discomfort and stress.The objective was to explore the impact of free period products for staff, funding options and suggestions on how this could be applied to other trusts across the NHS.What did you do?This initiative involved supplying unlimited tampons and sanitary towels to staff within the paediatric and maternity department. Across multiple staff toilets, free access to period products was provided. Staff were surveyed and responses were anonymously collected. After the initial pilot, funding options were explored including using charity funds and staff- funded options. To implement this initiative, three proposals were discussed at an executive board meeting. The proposals ranged from doing nothing to using staff-funded products, to spending tens of thousands of pounds.What did you find?Over 130 members of staff responded to the survey over a 6-month timeframe. Shame. Embarrassment. Guilt. These are just some of the emotions women disclosed they felt when surveyed about struggles of managing menstrual cycles within the NHS. 100% of respondents agreed that the initiative was an excellent idea, and expressed they wanted ongoing support regarding female health at work. Furthermore, they disclosed some of difficulties and challenges they faced during times when they couldn’t access products. After much discussion, a cost-effective proposal agreement was decided upon. A budget of just £3,000 per annum was calculated to provide free period products at work. Part of the proposal included the use of women’s health ‘champions’ and establishing a women’s health network within the trust. Furthermore, the results can be shared across other DGHs, allowing this project to be easily accessible to all.What does it mean?Gender inequality is still rife within the NHS. Women are discriminated against, and this initiative showed unanimous support for access to free period products at work.Improving access to period products benefits NHS staff and patients. It improves productivity, staff satisfaction and retention. NHS staff treated with care, compassion and respect leads to empowering staff to deliver high-quality healthcare to patients.ReferencesBae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause. BMC Womens Health. 2018;18(1):36. Published 2018 Feb 6. doi:10.1186/s12905-018-0528-xDean E. Surgeons and periods. R. Coll. Surg. Engl. 2023;105(6):294 – 297.Actionaid. Cost of living: UK period poverty has risen from 12% to 21% in a year [online]. 2023. [Accessed 2 Oct 2023]. Available from: https://www.actionaid.org.uk/blog/2023/05/26/cost-living-uk-period-poverty-risen

Girls and women need effective, safe, and affordable menstrual products. Single-use menstrual pads and tampons are regularly provided by agencies among resource-poor populations. Reusable menstrual pads (RMPs: fabric layers sewn together by an enterprise for manufacture of menstrual products) may be an effective alternative. For this review (PROSPERO CRD42020179545) we searched databases (inception to November 1, 2020) for quantitative and qualitative studies that reported on leakage, acceptability, or safety of RMPs. Findings were summarised or combined using forest plots (random-effects meta-analysis). Potential costs and environmental savings associated with RMPs were estimated. A total of 44 studies were eligible (~14,800 participants). Most were conducted in low- and middle-income countries (LMIC, 78%), and 20% in refugee settings. The overall quality of studies was low. RMP uptake in cohort studies ranged from 22-100% (12 studies). One Ugandan trial among schoolgirls found leakage with RMPs was lower (44.4%, n = 72) compared to cloths (78%, n = 111, p<0.001). Self-reported skin-irritation was 23.8% after 3 months among RMP-users in a Ugandan cohort in a refugee setting (n = 267), compared to 72.8% at baseline with disposable pad use. There were no objective reports on infection. Challenges with washing and changing RMP were reported in LMIC studies, due to lack of water, privacy, soap, buckets, and sanitation/drying facilities. Among 69 brands, the average price for an RMP was $8.95 (standard deviation [sd] $5.08; LMIC $2.06, n = 10, high-income countries [HIC] $10.11), with a mean estimated lifetime of 4.3 years (sd 2.3; LMIC 2.9, n = 11; HIC 4.9 years, n = 23). In 5-year cost-estimates, in LMICs, 4-25 RMPs per period would be cheaper (170-417 US$) than 9-25 single-use pads, with waste-savings of ~600-1600 single-use pads. In HICs, 4-25 RMPs would be cheaper (33-245 US$) compared to 20 single-use tampons per period, with waste-savings of ~1300 tampons. RMPs are used internationally and are an effective, safe, cheaper, and environmentally friendly option for menstrual product provision by programmes. Good quality studies in this field are needed.

Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects. A prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used. A total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used. Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.

The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use. A systematic review of the literature was performed using standardised methodology. Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs. Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.

Concerns regarding the effects of non-tampon menstrual products on reproductive and urogenital health, particularly the risk of infections, is an area of ongoing investigation. We conducted an updated systematic review to assess the methodological quality of current evidence assessing associations between menstrual product use and reproductive and urogenital tract infections (RUTIs), and offer recommendations for future research. Three databases (PubMed, Web of Science, United States Food and Drug Administration Manufacturer User Facility Device Experience) were searched for relevant published studies or product safety reports up to October 13, 2024. We included studies on menstruators of any age and geography assessing for any reusable/disposable menstrual pads, menstrual cups, or homemade alternatives worn only for menstrual absorbency compared to other menstrual products or no product use, with outcomes centered on RUTIs. Protocols, reviews, and studies assessing only tampons or non-menstrual absorbents were excluded. Results were evaluated and synthesized using tabular methods according to measures of association, and assessed across four criteria categories 1) product definition, 2) comparator definition, 3) outcome definition, and 4) confounder consideration. Thirty-one studies were included in this review. Most studies clearly defined outcomes and considered necessary confounders. In contrast, studies with well-defined products (6.5%) and comparator products (9.7%) were uncommon. Just 3.2% and 9.7% of studies fully defined products and comparators, respectively. Ten studies (32.2%) reported some data on four or more confounders, and seventeen (54.8%) defined their infectious outcomes and included laboratory confirmation. A meta-analysis was not possible due to data heterogeneity across product, comparator, and outcome definitions. Overall, associations between menstrual products and RUTIs are inconclusive. Future studies should 1) clearly define product and comparator type, material, frequency of change, and washing, drying, and storage practices for reusable products, 2) prioritize laboratory or clinician-confirmed outcomes over self-reported symptoms, and 3) adjust for relevant confounders.