Meet the ‘space gynecologist’ who is exploring women’s health beyond Earth

Space travel affects an astronaut’s health over both short and long term. Despite following a strict diet and exercise routine, spending so much time in a low gravity environment can result in many health problems, including loss of muscle and bone mass, weight loss, eyesight disorders, and can cause changes in the immune system.

And when women astronauts prepare for this journey, they have an additional challenge—managing their period. Early researches stated that blood might reverse its flow into women’s body—also known as retrograde menstruation.

But Dr Varsha Jain, who is currently pursuing her PhD from University of Edinburgh, tells us that is not the case. She says it is exactly similar to what a woman goes through on Earth.

Also known as a “Space Gynecologist”, Dr Jain specialises in studying how women’s bodies respond in space, and particularly addressing the effects of menstruation in micro gravity and providing solutions for female astronauts who wish to skip their periods.

“According to studies, women can menstruate in space if they choose to do so. Your menstrual cycles are controlled by hormones that are released from the brain and act on the ovaries that then act on the womb, and that pathway is not affected,” she tells HerStory.

Personal choice

While Jain says that women astronauts can menstruate in space, most of them avoid to do so due to various reasons.

She says there are two toilets on the International Space Station, and water waste is recycled many times and is used as drinking water. However, blood is considered a solid matter and therefore water waste mixed with blood has to be dumped and it cannot be recycled.

Additionally, she explains that women astronauts cannot shower in space as water does not flow in a zero-gravity environment. During spacewalk, they will need to wear their equipment for 8 to 10 hours straight without changing their sanitary products.

Women astronauts who wish to suppress their periods usually do so by consuming oral contraceptive pills, she says.

“On Earth, the standard practice involves taking the contraceptive pill for three consecutive weeks, followed by a week-long break for a withdrawal period. However, astronauts who prefer not to menstruate in space need to take these pills continuously, bypassing the usual week of bleeding,” she explains.

In 2013, during a conference, Dr Jain met a researcher who focused on female astronaut health. She was intrigued by her question about the safest pill to minimise the risk of blood clots in female astronauts.

While it is known that use of combined oral contraceptives (COCs) doubles the risk of blood clots, the question of increased risk of clots in space pushed Jain to study more about the topic.

In 2016, she started researching on what is being given to astronauts to drop their periods and found that one of the options is that a woman can have the hormonal pill, which she says is probably “the best way to suppress menstruation.”

But she elucidates there are other options like intra-uterine hormonal device called Mirena.

Dr Jain says, “Mirena stays inside the womb and the hormone on the coil stops the lining of the uterus from growing and reduces the heaviness of bleeding. But in a lot of women, it can stop them from having periods completely,” she explains.

She says there is another alternative called the long-acting reversible contraceptive (LARC), which is a hormonal implant. This is put under the skin of the arm and it slowly releases menstruation-suppressing hormones.

After the initial study, Jain's next research on 48 astronaut flights found no evidence of increased blood clot risk in female astronauts during space travel, even with contraceptive use, contrary to the doubled risk on Earth with oral contraceptives.

While female astronauts can take hormonal contraceptives to stop their period in space, she says they should have options to choose from.

“As women, we should have a choice, and we should be able to make that choice for ourselves. And so, that's what I wanted to achieve through this research. I don't know what female astronauts choose, but I should be able to give them options,” she adds.

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Taking the road less travelled

Jain was 17 years old when she had to choose her career path between astrophyics and medicine. While she loved physics as a subject in school, she was also fascinated by her aunt, who was a gynaecologist in Mumbai.

She recalls that despite her parents not being too comfortable with her choice of astrophysics as a career, especially due to the job prospects, they have been her biggest supporters through her journey.

“It was never like I grew up dreaming to be a doctor. My aunt is the only doctor in my family. I always wanted to pursue astrophysics,” she says.

Before deciding on her career, Jain attended a weekend course of an ophthalmologist who talked about helping people with cataract. It moved her so much that she chose to study medicine at Imperial College, London.

“In that session, I just felt that a medical professional can do so much to change someone’s life. I chose medicine as my will to help people in my job outweighed everything else.”

While she was in the end of her second year of medical school in 2004, Jain got to know about a conference on space medicine. After learning about the field, she did an intercalated bachelor’s degree to train in what the body does or how the body copes in these extreme environments–“everything to do with high altitude space, deep sea diving.”

“From there, I discovered that by studying space medicine, I could amalgamate my passion for astrophysics with medicine,” she adds.

In 2007, she got into a research placement at NASA Johnson Space Center. During this time, she researched about balance control mechanisms in astronauts when they returned from space.

“During the course, I made valuable contacts. It was through networking and expressing my interest that I secured a place at NASA in 2007,” she says.

From 2011 to 2012, she pursued a Master’s degree in space physiology and health at King’s College, London, post which she has been working with the International Space Station and has been practicing as an obstetrics and gynecologist.

Talking more about space travel, she explains there are some minor differences in the way microgravity environment affects female and male bodies. She says that the female body is more likely to experience motion sickness on entering the space environment. However, men are more likely to experience sickness on coming back to Earth.

“Women are usually shorter in stature, and they have more accommodating blood vessels. It's therefore more difficult for them to maintain their blood pressure when they get back to Earth, making them more susceptible to fainting,” she adds.

Another difference is that more men experience vision problems and hearing loss in space than women.

Currently, the space medicine expert is working on ongoing research about heavy bleeding. She explains, that heavy bleeding during periods can put women at a higher risk of iron deficiency and anemia.

“About 1 in 3 women suffer from heavy bleeding. Many of these women also do not respond to treatment options like the aforementioned coil and implant, which could lessen the flow. Because of this, they have to go for hysterectomy,” she adds.

Always for women

Jain recalls that in the past, NASA received only 10 to 15 percent of applications from female astronauts. But now, the number of women researchers and astronauts is steadily increasing. Having said that she acknowledges that there is still a far way to go.

She says, “to get something you have to put yourself out there and women earlier were less likely to do that. However, she says that the role of women in society has changed a lot.”

She underscores that while she was researching on menstruation in space, the present study material suggested a simple conclusion–that women can have periods in space, leaving no need for further inquiry. However, she found this approach insufficient. Her perspective is that when sending women into space or any environment, it is imperative to adopt a thorough approach to their health.

Dr Jain says there is a lot to explore when it comes to female astronaut health and the correct approach is that one needs to ask the right questions and prepare accordingly.

“My intention has been to provide the best preparation or the best options for female astronauts, and by doing so I am simply playing my part,” she signs off.