“But Your Reports Came Back Normal”: Implementing Menstrual Justice into Reproductive Healthcare

by

Menstrual Rights Global

Authored by Fatima Hayat Malik, Menstrual Rights Global, Pakistan

Global menstrual health advocacy continues to challenge stigma, expand knowledge,  and transform the conversation around women’s health. Women, girls, and people who menstruate are encouraged to speak openly about their experiences, advocate for themselves, and seek help when something does not feel right. But across South Asia, seeking help may not always mean that appropriate care is accessible.

Efforts to advocate for bodily autonomy, self-determination, and the right to access equitable menstrual resources regardless of age, gender, geographic location, or socioeconomic status also continue. And this progress matters. But advocacy alone can only take us so far. Financial barriers, unequal access to specialist services, and poor clinical infrastructure can delay diagnosis and treatment in South Asian countries.

Not everyone experiences these barriers equally either. Gender, disability, geography, and other aspects of identity can shape healthcare experiences. A study on barriers to women’s healthcare in rural Pakistan, for instance, identified limited financial autonomy, lengthy travel to access services, and gendered norms preventing independent decision-making. A menstrual justice approach, therefore, would work to reduce these barriers at community and systems levels. 

For many people with conditions such as adenomyosis, PMOS (formerly PCOS), endometriosis, fibroids, and pre-menstrual dysphoric disorder (PMDD), the journey to a diagnosis may take years. In the U.K, endometriosis has an average diagnosis time of around nine years, showing how delayed diagnosis is not limited to South Asia. But dispersed services, fewer specialists, especially in rural areas, and systems that do not cater to individual needs can also delay diagnosis. Unexplained symptoms can impact education, careers, relationships, and everyday life while missing out on timely interventions. 

Too often, individuals seeking help receive unsatisfactory care, such as dismissive attitudes towards reported symptoms, fragmented referrals, and long wait-lists due to limited healthcare resources.

This can help understand why many share experiences of having heard: “Don’t worry, your reports came back normal.” But initial testing with “normal” results may not necessarily mean nothing is wrong. The issue is not in the use of diagnostic testing or clinical guidelines, but in treating standard investigations as conclusive when persistent symptoms suggest further assessment is needed. Conditions also do not share similar diagnostic pathways. Endometriosis often remains unconfirmed through initial blood tests or standard ultrasounds, while diagnosis of PMDD focuses on noting cyclical symptoms rather than a specific imaging or blood test. Similarly, despite common co-occurrence, adenomyosis and uterine fibroids maintain distinct diagnostic considerations. 

These differences matter because reproductive conditions can overlap with chronic pain, mental health difficulties, hormonal changes, and fertility concerns. Our understanding of disorders such as PMOS (previously PCOS) continues to evolve to include metabolic and psychological aspects in addition to the previously understood reproductive dimensions. A single clinician cannot be expected to tackle every aspect of this experience alone. Multidisciplinary care should therefore be the standard rather than an exception.

Living with chronic pain while navigating repeated dismissal and uncertainty can impact mental health as well. For disorders like PMDD, the relationship between reproductive and mental health is especially important. A study among university students in Bangladesh found that PMDD was associated with suicidal ideation and behaviours when it co-occurred with depressive and anxious symptoms. While these findings alone do not establish causation, they do reinforce that reproductive and mental health care cannot continue to be treated as separate conversations.

A menstrual justice framework can meaningfully add to the current reproductive health landscape. Menstrual justice places dignity, bodily autonomy, informed decision-making, and equitable access to services at the forefront of healthcare, regardless of gender, sexuality, religion, or ethnicity. Traditional reproductive healthcare becomes a menstrual justice issue when it influences whose pain is heard, whose symptoms are prioritised, whether patients are meaningfully included in healthcare decisions, and how diagnostic and treatment inequalities are tackled. This approach recognises how menstrual health is embedded within the rest of an individual’s life.

South Asia is also not starting from scratch. Grassroots organisations, community health workers, adolescent health programmes, and menstrual health advocates already build trust and awareness within communities. However, these efforts can be amplified when properly connected to health systems. Researchers have also called for context-specific priorities for menstrual justice rather than solely relying on a Western-centric framework. For example, researchers in India and Sri Lanka highlighted priorities for improved healthcare, including better diagnostic tools, comprehensive care models, and regional research collaborations. This strengthens the need for reproductive healthcare to be informed by evidence that reflects local contexts. 

As menstrual health advocates in South Asia, our next step is to ensure menstrual justice and reproductive healthcare are no longer tackled separately. Implementation could focus on: strengthening clinical education, streamlining referrals, equitable access through culturally sensitive services, and accountability at the systems level. 

Clinical guidelines should recognise that a “one-size-fits-all” approach is inadequate. Clinicians should be trained to recognise persistent symptoms and understand how initial assessments may be insufficient to form a complete diagnostic picture. Organised referral networks can also save patients from managing disconnected services. Care should connect to gynaecology, endocrinology, pain management, and mental health where appropriate.

These services must also recognise how intersecting identities shape healthcare experiences. Migrants, transgender and non-binary people, religious minorities, people with disabilities and marginalised communities may face additional barriers related to cost, discrimination, language restrictions, and geography. A systematic review based in rural Pakistan suggested support and training for local healthcare workers to counter limited specialist care.

Implementing menstrual justice requires accountability at all levels. Services could monitor patients’ experiences of misdiagnosis and repeated consultations to identify where people continue to fall between the gaps. The aim is to strengthen existing systems rather than replacing them. These priorities are consistent with recommendations from the Asia-Pacific Endometriosis Expert Panel, which pressed for earlier symptom recognition, improved medical training, and greater focus on region-specific research. The challenge, however, is to translate these recommendations into actionable, culturally sensitive changes that reflect the realities of local contexts across South Asia and beyond. 

Menstrual justice was never limited to breaking stigma or improving access to menstrual products. It is also about maintaining reproductive autonomy, having our experiences understood with respect, and receiving appropriate care as a basic human right. And perhaps most importantly, it stands for ensuring that when someone feels empowered to ask for help, there is a healthcare system ready to listen and respond.

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