Women’s reproductive health

This edition of the Biochemist focuses on the critical area of women’s reproductive health. There are over 4 billion women in the world, making up slightly less than half of the population. Around half of the female population is of reproductive age, defined as when a female first starts to menstruate to when she reaches menopause. The WHO defines the female reproductive age range as between 15–49 years old, although up to 2 million women under 15 are also thought to give birth each year.Good reproductive health contributes to a woman’s overall health and can prevent significant morbidity. It involves complex biological systems essential for well-being and directly impacting fertility, genetics and overall health. A healthy female population is crucial for maintaining economic productivity, and when women have access to reproductive healthcare, they can participate more fully in both society in general and in the workforce.There is an abundance of evidence of the impact of poor female reproductive health on societal well-being and on economic performance. Where women’s health issues are ignored or remain incompletely treated, this impacts not only physical and mental health and relationships but also produces significant economic impacts. Improving women’s reproductive health will have a ripple effect that will improve the health of families and wider communities. Although it is a critical subject, women’s reproductive health remains a relatively poorly studied topic in biological science for many reasons. In this edition, we publish five feature articles on aspects of women’s reproductive health.Two of these deal with aspects of menstruation. Menstruation, or period, is the normal vaginal bleeding that occurs as part of the monthly reproductive cycle. During this cycle, the body prepares for pregnancy, and if no pregnancy occurs, then the lining of the uterus is shed through the vagina as menstrual fluid that is a mixture of blood and endometrial tissue. In the first of these, Hilary Critchley and Varsha Jain provide an overview of the molecular and hormonal basis of the process, highlighting how major barriers to progress in women’s reproductive health lie not only in the lack of understanding of the basic uterine and menstrual physiology underpinning menstruation but also in the societal stigma associated with it that acts as a significant impediment to progress. Douglas Gibson describes the importance of inflammation in the process of menstruation emphasising that the menstrual cycle is a classic (and perhaps the most extreme?) example of how homeostatic inflammatory processes drive tissue repair. This cyclical inflammation and repair process occurs during a woman’s reproductive life and yet results in scar-free replacement of the endometrial tissue that is enabled for pregnancy. The author describes attempts to understand this process by the use of cell-fate mapping to follow inflammatory macrophages during this cycle and how impairment of macrophage function may underpin reproductive health disorders.Two articles focus on the biology of one such disorder, endometriosis. Endometriosis is a condition in which uterine (endometrial) epithelial tissue grows ectopically outside of their normal location. Problems (which can be debilitating) arise from the fact that this tissue remains hormonally responsive, meaning that it acts as it would were it located in the uterus. So, the tissue thickens, breaks down and bleeds with each menstrual cycle, causing pain and potentially fertility problems. This condition affects approximately 10% of menstruating women. In the first article, Erin Greaves gives an informative overview of the potential causes of the condition, which has traditionally been considered to be a result of retrograde transfer of endometrial cells into the pelvic cavity, highlighting new views about its underlying causes. She describes inflammation and immune dysregulation as central drivers of pathology seen in endometriosis and highlights how the immune system may represent a novel target for the development of treatments. She also highlights the need for the development of biomarkers to simplify and speed up formal diagnosis as well as to monitor progression of the condition.Stella Irungu and colleagues provide an overview of how proteomic approaches can be applied for the identification of biomarkers of endometriosis. Non-invasive biomarkers have the capacity to improve early detection of endometriosis and enable better management. The review covers the different technical approaches that can be used and suggests that these may be able to provide information that could differentiate between the different forms of the condition. They also highlight that, to date and perhaps not unexpectedly, no single protein biomarker has been identified. No doubt the search will go on.The final feature focuses on the looming effect that climate change (specifically rising global temperatures) has on premature birth. Premature birth is the leading cause of death in under 5s globally and is most common in parts of the global south. Khondoker Akram and Dilly Anumba review the area and their own data that suggest that elevation in temperature has an effect on placental function and may impact on prematurity delivery. This is a key and yet under-researched area of global public health importance, as rising temperatures are increasingly going to impact the global south disproportionately. Understanding more about how temperature changes influence placental function and premature delivery should directly inform global health policies.This edition also includes a different type of beginners’ guide, that rather than presenting a specific research technique, outlines ways in which scientists can evidence the impact of their research. In a world where justification of research is key to public understanding of science and its value to society, this is an important area. As well as evidencing impact, scientists also need to be able to communicate their research clearly, and we also include contributions relating to the Biochemical Society Further Education Science Communication Prize winners. We also include a number of additional articles on outreach, lifelong learning and education.I really hope you enjoy reading this edition and that the features give you an insight into the importance of women’ reproductive health. As ever, feel free to contact us with any comments on the issue or if you would like to contribute to the magazine in the future.