News: Menstruation science moonshot: MIT’s bold quest to revolutionize women’s health

Linda Griffith: "We want to create an international movement that helps us bring a lot of great sience and engineering into the study of menstruation."

Veronika Moroz and Kosha Upadhyah | The Tech

When Professor of Biological Engineering Linda Griffith began working at MIT in 1991, organizational miscommunication left her looking for lab space — only to end up with a room too small for her team. 

“There was a ladies room with a huge lounge with sofas in it next to that lab space. And I went to the provost and said, ‘Can I have this lounge?’” Griffith recalls. “And the provost said, ‘no-no-no-no-no. Women need to lie down every month. We can’t give up those lounge spaces ‘cause women need to lie down.’”

Now the director for the MIT Center of Gynepathology, Griffith remembers smiling and responding, “Women need to lie down? They should go to the doctor and get treated so that they don’t need to lie down.” 

It’s been 24 years since then, but treatments for menstruation pain remain unavailable for many. Griffith’s estimates reveal that, at MIT, about 20 to 25% of people who menstruate miss school or work every month because of menstrual problems.

This problem is the motivation behind menstruation science, a field launched by Griffith and other leading minds in reproductive biology. On Wednesday, April 9, the Center of Gynepathology held a symposium titled “Menstruation Science: Unlocking the Secrets of the Hormone-Immunity Nexus” to gather together people innovating for menstruation health.

An extremely prevalent problem

A quarter of the global population menstruates, yet many lack proper access to menstrual health resources.

“It's quite shocking that one-fourth of the world's population of women and adolescent girls of reproductive age — that's nearly 500 million — say they do not have everything they need to manage their menstruation,” said Dr. Hilary Critchley, a professor of Reproductive Medicine at the University of Edinburgh and the keynote speaker for the event. “And this evidence comes not just from low- and middle-resource countries, but also from high-resource countries such as where we are today.”

Due to the stigma around menstruation, many don’t feel empowered to speak about their experiences and seek help, leading to late diagnosis and inadequate care. This results in a perpetual cycle of medical neglect where individuals’ needs go unmet until it is too late.

“Why is it that, when a young girl seeks health care for pain and bleeding, she's told to go away, told, often by her family and friends, that this is normal?” Critchley questioned.

Menstrual conditions such as endometriosis and polycystic ovary syndrome (PCOS) often go misdiagnosed and underdiagnosed. Menstrual pain may be ignored because people don’t know how much pain is a sign of pathology, causing them to suffer for years before they receive a diagnosis.

Critchley’s talk outlined the health risks faced by people who menstruate around the world. These included abnormal uterine bleeding, which affects one in three women of reproductive age, and anemia, which impacts a third of non-pregnant women.

“When you menstruate, and particularly if your periods are heavy, you lose iron from the body,” Critchley explained. “And what is appallingly under-recognized is that not only are women anemic, but they are also iron deficient.” Studies from Critchley’s lab have found that iron deficiency due to abnormal uterine bleeding can be as debilitating as chronic depression, congestive heart failure, or kidney failure.

Anemia and iron deficiency can also impact pregnancy outcomes by increasing risk of death from postpartum haemorrhage and even impacting the neurodevelopment of the infant. 

Growing the field

Thanks to the work of people like Lisa Halvorson, the first chief of the Gynecologic Health and Disease Branch Chief of the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), menstruation research is receiving more attention and funding.

Halvorson, now the Chief of Service of the Reproductive Endocrinology and Infertility branch of the NHCD, assumed this role with the creation of the Gynecologic Health and Disease Branch in 2012. At that time, “there were essentially no NIH funding grants in the last ten plus years” that had gone to gynecology research, Halvorson recalls. The only exception was one or two grants for studying implantation biology. 

Part of the issue is that menstrual health has historically been difficult to study, due to the “complex tissue” and “heterogenous presentations” of disorders, Halvorson said.

But that’s also part of the reason menstruation science is so important to study. The endometrium is an “excellent model system,” Halvorson said. Every month, it sheds lining and regenerates, earning it its reputation as the “classic example of scarless healing.” An implanted fetus, which contains foreign material from the biological father, should be rejected, but isn’t. The reason might be the key to understanding immune tolerance for transplants — menstrual blood might even be used as a “tissue source” for doing biopsies or diagnosing diseases.

One of the things that makes menstruation particularly hard to study is the lack of model organisms: mice, a common model organism, are quite unhelpful since they have two uteruses and don’t menstruate naturally. Working on this problem has forced scientists to develop better computational models for studying humans. 

“Now, what we’re headed towards is building a core facility at MIT for these in vitro models,” Griffith explained. “We use mathematical modeling to design these in vitro models and iterate on cycles to really humanize all biomedical models, but starting with gynecology.”

Researching solutions

Although menstrual research has long been overlooked, some of the world’s leading researchers are helping to close the gap.

One example is Alix Wagner, a first-year Harvard-MIT Health Sciences and Technology (HST) Medical Engineering and Medical Physics (MEMP) PhD student in the Roche Lab (the Therapeutic Technology Design & Development, or TTDD lab, run by Ellen Roche, Latham Family Career Development Professor, IMES core faculty member, associate professor mechanical engineering.)

“My view on menstruation science is very much tied to going to the gynecologist for your annual exam,” Wagner said.

Tools used in modern gynecology today, such as the speculum and the tenaculum, have barely changed since they were invented in the late 1800s. During routine procedures, the speculum holds open the patient’s vaginal canal, while the tenaculum grabs into the cervical tissue to stabilize the person’s uterus. 

“Because the cervix is the locus of three different nerves,” Wagner explained, “when you are piercing into that tissue and retracting, you are stimulating those nerves and it's incredibly painful.” Through her project, Wagner hopes to make gynecology feel more accessible by introducing less painful technologies.

“If we can come up with tools that are designed by women for people with a uterus that are much more comfortable, much less emotionally scary, and much more physically comfortable, you’ll be much more comfortable going to talk about your menstrual problems and getting an exam to really figure out the root of the issue,” Wagner said.

Researchers are turning their attention to some of the most persistent mysteries in menstrual health, such as endometriosis, an extremely painful inflammatory condition in which the uterine lining, also called the endometrium, starts growing outside the uterus. Endometriosis is fairly common, but often goes undiagnosed for seven to eight years, according to Critchley’s research. Not much is known about its biological root cause.

Sarah Pertsemlidis at the DALLab is working to change that. Her work investigates a cellular process called decidualization, where uterine cells prepare for pregnancy. The team crafted fluorescent genetic reporters and barcoded tracking systems to monitor multiple signaling pathways simultaneously in live cells. By collecting time-lapse data and applying a machine learning algorithm, Pertsemlidis is uncovering how different hormones affect pathway activity and can even predict hormone output linked to successful decidualization.

Her research is no small feat, and neither is her journey into menstruation science.

“When I was applying to PhD programs, I was like, ‘Oh, I totally want to do [synthetic biology] and reproductive health.’ But by the time I got there, they were like, ‘We unfortunately don't do reproductive health anymore, so you have to do this other program now,’” Pertsemlidis recalled. “I tried to work on it. But it wasn't my passion. I just knew that this was always going to be a lingering idea for me.”

Pertsemlidis described the alienation she felt at MIT in pursuing a career path in menstruation science. “Being at MIT, I felt it was more challenging being a bioengineer because whenever someone in MechE or CS talked about their stuff, everyone just understood that language. I always felt like if I was going to talk about my project, I needed to first give a cell biology lecture for someone to even understand or care,” she said.

Although Pertsemlidis once experienced a cultural sameness at MIT, she now appreciates the institute’s evolving educational landscapes.

“I talked to CS and MechE students and I thought, ‘Wow, these people are actually so excited because they're inspired by reproductive health,’” Pertsemlidis said.

Fighting the taboo

From ‘Aunt Flow’ to ‘Shark Week’ to ‘Surfing the Crimson Tide’, the taboo around periods has led to a lot of euphemisms. But it’s also led to a lack of accessibility of accurate, factual information about menstruation. 

Pia Wahi-Singh, a medical student at the University of Edinburgh mentored by Professor Critchley, is focused on taking the pulse on this information landscape.

“When we’re talking about intervening and educating people about menstruation, it’s important to reach people where they’re at already,” Wahi-Singh told The Tech. That’s why Wahi-Singh’s project focuses on surveying students at her university to “understand their experiences and perceptions about menstruation.”

Through this survey, Wahi-Singh seeks to collect both quantitative and qualitative data on her classmates’ experiences with menstruation. “How many people in our demographic actually have abnormal bleeding?” she wondered. “I suspect it will be a lot. What’s the impact on their quality of life? What are things that affect them day-to-day as a student? Also, what are their treatment preferences, and where do they get the knowledge from?”

The industry potential

The event also included a panel on how menstruation science can bring more money to the women’s health industry. The panel included individuals working in the health industry such as Dr. Pearl Huang ’80, CEO of Dunad Therapeutics; Dr. Steve Palmer, CSO of CelMatix; Susan Whitehead of the MIT Corporation; Dr. Megan Greenfield, a partner at McKinsey & Co.; Divya Mathur PhD ’08 of Third Rock Ventures; Dr. Hugo Arellano-Santoyo of RA Ventures; and Luba Greenwood, J.D., the CEO of Gallop Oncology.

“A lot of these conditions, like endometriosis, are healthspan conditions, not lifespan conditions,” Greensfield said. “Historically, we have focused on things that kill you versus things that make you miserable. And I think that's a really big difference.”

Greenfield likens the potential industry boom of an endometriosis treatment to today’s market for weight-loss drugs such as Ozempic. “Not too long ago, we didn't think obesity was a condition. We thought it was a moral failure. There's not a specialized person that actually treats obesity, right? So if you looked at a market, you'd think treating it would be a bad idea,” Greensfield summarized. “And it's not even one of the biggest successes we've had.”

One in ten women have endometriosis, Greenfield pointed out. However, “there isn't a non-invasive diagnostic. There is no good therapeutic.” The potential market is huge — for anyone who can figure out how to develop a drug that taps into it. 

From an employer side, treating endometriosis also boosts employee productivity. With more and more women working, Greenfield added, we need to “support them so they can fully participate in the workforce.”

Fostering collaboration

Elizabeth LaCroix, a Chemistry PhD student at MIT who is co-advised by Griffith and Dr. Jeremiah Johnson, says that helping people with menstrual pain is “one of [her] life’s purposes,” which is why she’s working in multiple labs to study menstrual science. LaCroix got her first period when she was 13. “I spent the majority of my teen years, just every month, in an extreme amount of pain,” LaCroix recalled. “I just wanted to know if my pain was normal or not.” 

Despite the stigma around menstruation, “people are so much more receptive than I ever thought they would be,” LaCroix exclaimed. “My advisor, Jeremiah, is a really good example of that. When I first told him that I wanted to do menstrual health work, he was really excited about that, saying, ‘I don’t know how we’ll do that, but I want to support you.’ I think a lot of PIs at MIT are like that.”

Despite being a first-year PhD student, she’s already launched a student group for menstruation science research through the Center for Gynepathology Research at MIT.

The work of people such as LaCroix paves the way for future scientists and engineers passionate about menstruation science to craft new technologies to better menstrual health. For example, high school students from Milton Academy traveled to MIT to attend the event, representing their student-run organization Free Period Talk. Through Free Period Talk, the founders aim to advocate for menstrual equality by discussing menstruation at a larger level and providing products for those in need.

“Knowing that more people think the same as us motivates us as a team to know that we can do these challenging things and actually make a difference,” said Rhia Patel, a co-founder of Free Period Talk.

*Originally published in The Tech.