Gynecologic and Reproductive Considerations

  • Richard T. Jennings
  • Ellen S. Baker


Despite the delay in admitting women to the US space program, being female actually offers some advantages. The weightlessness that is part of life in microgravity negates some of the male advantages of size and strength. The closed environmental systems that are found on all spacecraft—with limited amounts of oxygen (O2), water, and food and with the need to process solid, liquid, and exhaled waste products—favor smaller individuals. Since the general implications for women participating in high-performance aircraft and in spacecraft have been reviewed elsewhere, they will not be addressed here in great detail. Suffice it to say that, although men and women differ in their ability to withstand extremes of hypoxia, decompression, temperature, acceleration, isolation, stress, and impact, these differences are generally small and often depend more on acclimation and individual variation than on sex. While incidence of many of the medical conditions noted in space flight such as space motion sickness is similar between women and men, some conditions are more common in men or women. For instance, spaceflight-associated neuro-ocular syndrome (SANS) findings are more common in men, but postflight orthostasis is more common in women. These differences will be noted in other chapters in the text.

Regardless of the relative assets and liabilities of flying men or women in future space crews, these crews will include both sexes. It is therefore prudent that we examine the reproductive and gynecologic issues associated with selecting, training, and assigning female crewmembers to space missions. This chapter addresses gynecologic medical standards and female astronaut selection, reproductive and operational gynecologic considerations during training and space flight, pregnancy after space flight, and gynecologic considerations for long-duration space flights.


Gynecologic considerations for long-duration space flights Menstruation during space flight Gynecologic standards for female astronauts Pregnancy after space flight Female astronaut selections 


  1. 1.
    Lyons TJ. Women in the fast jet cockpit: aeromedical considerations. Aviat Space Environ Med. 1992;63:809–18.PubMedGoogle Scholar
  2. 2.
    Lyons TJ. Women in the military cockpit. Brooks Air Force Base, TX. Armstrong Laboratory Technical Report AL-TR-1991-0068.Google Scholar
  3. 3.
    Santy PA. Women in space: a medical perspective. J Am Med Womens Assoc. 1984;39:13–7.Google Scholar
  4. 4.
    Rock JA, Fortney SM. Medical and surgical considerations for women in space flight. Obstet Gynecol Surv. 1984;39:525–35.Google Scholar
  5. 5.
    Nicogossian AE, Pool SL, Uri JJ. Historical perspectives. In: Nicogossian AE, Huntoon CL, Pool SL, editors. Space physiology and medicine. 3rd ed. Philadelphia: Lea and Febiger; 1993. p. 5–16.Google Scholar
  6. 6.
    National Council on Radiation Protection and Measurements. Guidance on Radiation Received in Space Flight. NCRP Report No. 98, 1989.Google Scholar
  7. 7.
    Merrill JA. Endometrial induction of endometriosis across Millipore filters. Am J Obstet Gynecol. 1966;94:780–90.PubMedGoogle Scholar
  8. 8.
    Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927;14:422.Google Scholar
  9. 9.
    Scott RB, Te Linde RW, Wharton LR. Further studies on experimental endometriosis. Am J Obstet Gynecol. 1953;66:1082.PubMedGoogle Scholar
  10. 10.
    Te Linde RW, Scott RB. Experimental endometriosis. Am J Obstet Gynecol. 1950;60:1147–66.Google Scholar
  11. 11.
    Fanton JW, Golden JG. Radiation-induced endometriosis in Macaca mulatta. Radiat Res. 1991;126:141–6.PubMedGoogle Scholar
  12. 12.
    McClure HM, Ridley JH, Graham CE. Disseminated endometriosis in a rhesus monkey. Histogenesis and possible relationship to irradiation exposure. J Med Assoc Ga. 1971;60:11–3.PubMedGoogle Scholar
  13. 13.
    Splitter GA, Kirk JH, Mac Kenzie WF, Rawlings CA. Endometriosis in four irradiated monkeys. Vet Pathol. 1972;9:249–62.PubMedGoogle Scholar
  14. 14.
    Wood DH. Long-term mortality and cancer risk in irradiated rhesus monkeys. Radiat Res. 1991;126:132–40.PubMedGoogle Scholar
  15. 15.
    Wood DH, Yochmowth MG, Salmon YL, Eason RL, Boster RA. Proton irradiation and endometriosis. Aviat Space Environ Med. 1983;54:718–24.PubMedGoogle Scholar
  16. 16.
    Braun DP, Dmowski WP. Endometriosis: abnormal endometrium and dysfunctional immune response. Curr Opin Obstet Gynecol. 1998;10:365–9.PubMedGoogle Scholar
  17. 17.
    Dmowski WP. Immunological aspects of endometriosis. Int J Gynaecol Obstet. 1995;50:S3–S10.PubMedGoogle Scholar
  18. 18.
    Taylor GR, Konstantinova I, Sonnenfeld G, Jennings RT. Changes in the immune system during and after space flight. In: Bonting SL, editor. Advances in space biology and medicine, vol. 6: JAI Press Inc., Greenwich, Conn. 1997. p. 1–32.Google Scholar
  19. 19.
    Bogomolov VV, Castrucci F, Comtois JM, et al. International space station medical standards and certification for space flight participants. Aviat Space Environ Med. 2007;78:1162–9.Google Scholar
  20. 20.
    Taylor MB. Women in diving. In: Bove AA, editor. Bove and Davis’ diving medicine. 4th ed. Philadelphia: WB Saunders; 2004. p. 399–403.Google Scholar
  21. 21.
    Minard CG, de Carvalho MF, Iyengar MS. Optimizing medical resources for space flight using the integrated medical model. Aviat Space Environ Med. 2011;82(9):890–4.Google Scholar
  22. 22.
    Andrews WC. What’s new in preventing and treating osteoporosis. Postgrad Med. 1998;104:89–97.PubMedGoogle Scholar
  23. 23.
    Kohrt WM, Snead DB, Slatopolsky E, Birge SJ. Additive effect of weight-bearing exercise and estrogen on bone mineral density in older women. J Bone Miner Res. 1995;9:1303–11.Google Scholar
  24. 24.
    Naessen T, Persson I, Adami HO, et al. Hormone replacement therapy and the risk for first hip fracture. Ann Intern Med. 1990;113:95–103.PubMedGoogle Scholar
  25. 25.
    Notelovitz M. Estrogen therapy and osteoporosis: principles and practice. Am J Med Sci. 1997;313:2–12.PubMedGoogle Scholar
  26. 26.
    Prince RL, Smith M, Dick IM, et al. Prevention of postmenopausal osteoporosis. N Engl J Med. 1991;325:1189–95.PubMedGoogle Scholar
  27. 27.
    Cann CE, Martin MC, Genant HK, et al. Decreased spinal mineral content in amenorrheic women. JAMA. 1984;251:626–9.PubMedGoogle Scholar
  28. 28.
    Drinkwater BL, Nilson K, Chesnut CH, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984;311:277–81.PubMedGoogle Scholar
  29. 29.
    Jones KP, Ravnikar VA, Tulchinsky D, et al. Comparison of bone density in amenorrheic women due to athletics, weight loss and premature menopause. Obstet Gynecol. 1985;66:5–8.PubMedGoogle Scholar
  30. 30.
    Lane N, Bloch DA, Jones HH, et al. Long distance running, bone density, and osteoarthritis. JAMA. 1986;255:1147–51.PubMedGoogle Scholar
  31. 31.
    Lindberg JS. Exercise induced amenorrhea and bone density. Ann Intern Med. 1984;101:647–8.PubMedGoogle Scholar
  32. 32.
    Lloyd T, Myers C, Buchanan JR, et al. Collegiate women athletes with irregular menses during adolescence have decreased bone mineral density. Obstet Gynecol. 1988;72:639–42.PubMedGoogle Scholar
  33. 33.
    Lloyd T, Triantafyllou SJ, Baker ER, et al. Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc. 1986;18:374–9.PubMedGoogle Scholar
  34. 34.
    Marcus R, Cann C, Madvig P, et al. Menstrual function and bone mass in elite women distance runners. Ann Intern Med. 1985;102:158–63.PubMedGoogle Scholar
  35. 35.
    Myburgh KH, Hutchins J, Fataar AB, et al. Low bone density is an etiologic factor in stress fractures in athletes. Ann Intern Med. 1990;113:754–9.PubMedGoogle Scholar
  36. 36.
    Prior JC, Cameron K, Yuen BH, et al. Menstrual cycle changes with marathon training: anovulation and short luteal phase. Can J Appl Sports Sci. 1982;7:173–7.Google Scholar
  37. 37.
    Russell JB, Mitchell D, Musey PI, et al. The relationship of exercise to anovulatory cycles in female athletes: hormonal and physical characteristics. Obstet Gynecol. 1984;63:452–6.PubMedGoogle Scholar
  38. 38.
    Shangold MM, Levine HS. The effect of marathon training upon menstrual function. Am J Obstet Gynecol. 1982;143:862–9.PubMedGoogle Scholar
  39. 39.
    Shangold M, Rebar RW, Wentz AC, et al. Evaluation and management of menstrual dysfunction in athletes. JAMA. 1990;263:1665–9.PubMedGoogle Scholar
  40. 40.
    Corson SL. Oral contraceptives for the prevention of osteoporosis. J Reprod Med. 1993;38:1015–20.PubMedGoogle Scholar
  41. 41.
    Cummings DC. Exercise-associated amenorrhea, low bone density, and estrogen replacement therapy. Arch Intern Med. 1996;156:2193–5.Google Scholar
  42. 42.
    DeCherney A. Bone-sparing properties of oral contraceptives. Am J Obstet Gynecol. 1996;174:15–20.PubMedGoogle Scholar
  43. 43.
    Lohman T, Going S, Pamenter R, et al. Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. J Bone Miner Res. 1995;10:1015–24.PubMedGoogle Scholar
  44. 44.
    Hosking D, Chilvers CED, Christiansen C, et al. Prevention of bone loss with alendronate in postmenopausal women under age 60 years of age. N Engl J Med. 1998;338:485–92.PubMedGoogle Scholar
  45. 45.
    Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997;337:1641–7.PubMedGoogle Scholar
  46. 46.
    Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: preventing breast cancer. Cancer Prev Res. 2010;3(6):696–706.Google Scholar
  47. 47.
    Waters EA, McNeel TS, Stevens WM, Freeman AN. Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat. 2012;134(2):875–80.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2727–41.PubMedGoogle Scholar
  49. 49.
    Davis JR. Medical issues for a Mars mission. Texas Med. 1998;94:47–55.Google Scholar
  50. 50.
    Jennings RT, Santy PA. Reproduction in the space environment: part II. Concerns for human reproduction. Obstet Gynecol Surv. 1989;45:7–17.Google Scholar
  51. 51.
    Santy PA, Jennings RT. Human reproductive issues in space. Adv Space Res. 1992;2:151–5.Google Scholar
  52. 52.
    Warren MP. Effects of space travel on reproduction. Obstet Gynecol Surv. 1989;44:85–8.PubMedGoogle Scholar
  53. 53.
    Ehresmann B, Hassler DM, Zeitlin C, et al. Charged particle spectra measured during the transit to Mars with the Mars Science Laboratory Radiation Assessment Detectors (MSL/RAD). Life Sci Space Res (Amst). 2016;10:29–37.Google Scholar
  54. 54.
    Hassler DM, Zeitlin C, Wimmer-Schweingruber RF, et al. Mars’ surface radiation environment measured with the Mars Science Laboratory’s Curiosity rover. Science. 2014;24(6169):343.Google Scholar
  55. 55.
    National Council on Radiation Protection and Measurement. Limitation of exposure to ionizing radiation. Bethesda: National Research Council; 1993. NCRP Report No 116.Google Scholar
  56. 56.
    Mole RH. Consequences of pre-natal radiation exposure for post-natal development. A review. Int J Radiat Biol Relat Stud Phys Chem Med. 1982;42:1–12.PubMedGoogle Scholar
  57. 57.
    Mole RH. Radiation risks to the individual in utero. Report of a scientific symposium: radiation risks to the developing nervous system. Int J Radiat Biol Relat Stud Phys Chem Med. 1986;49:183–9.PubMedGoogle Scholar
  58. 58.
    Otake M, Schull WJ. In utero exposure to A-bomb radiation and mental retardation; a reassessment. Br J Radiol. 1984;57:409–14.PubMedGoogle Scholar
  59. 59.
    Otake M, Schull WJ, Lee S. Threshold for radiation-related severe mental retardation in prenatally exposed A-bomb survivors: a reanalysis. Int J Radiat Biol. 1996;70:755–63.PubMedGoogle Scholar
  60. 60.
    Reyners H, Gianfelic de Reyners E, Poortmans F, et al. Brain atrophy after foetal exposure to very low doses of ionizing radiation. Int J Radiat Biol. 1992;62:619–26.PubMedGoogle Scholar
  61. 61.
    Devi PU, Baskar R. Influence of gestational age at exposure on the prenatal effects of gamma radiation. Int J Radiat Biol. 1996;70:45–52.PubMedGoogle Scholar
  62. 62.
    Santy PA, Jennings RT, Craigie D. Reproduction in the space environment: part 1. Animal reproductive studies. Obstet Gynecol Surv. 1989;45:1–17.Google Scholar
  63. 63.
    Snetkova E, Chelnaya N, Serova L, et al. Effects of space flight on Xenopus laevis larval development. J Exp Zool. 1995;273:21–32.PubMedGoogle Scholar
  64. 64.
    Suda T. Lessons from the space experiment SL-J/FMPT/L7: the effect of microgravity on chicken embryogenesis and bone formation. Bone. 1998;22:73S–8S.PubMedGoogle Scholar
  65. 65.
    Suda R, Abe E, Shinki T, et al. The role of gravity in chick embryogenesis. FEBS Lett. 1994;340:34–8.PubMedGoogle Scholar
  66. 66.
    Wong AM, DeSantis M. Rat gestation during space flight: outcomes for dams and their offspring born after return to earth. Integr Physiol Behav Sci. 1997;32:322–42.Google Scholar
  67. 67.
    Non-contraceptive Uses of Hormonal Contraceptives. Practice Bulletin of the American College of Obstetrician-Gynecologists. Number 110. January 2010, E-rea 2018.Google Scholar
  68. 68.
    Beral V, Doll R, Hermon C, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008 Jan 26;371:303–14.PubMedGoogle Scholar
  69. 69.
    Roach RE, Helmerhorst FM, Lijfering WM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015;8:CD011054.Google Scholar
  70. 70.
    Lidegard O, Lidegard E, Svendsen AL, Carsten A. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890.Google Scholar
  71. 71.
    Tepper NK, Dragoman MV, Gaffield ME, Curtis KM. Nonoral combined hormonal contraceptives and thromboembolism: a systematic review. Contraception. 2017;95(2):130–9.PubMedGoogle Scholar
  72. 72.
    Dulicek P, Ivanova E, Kostal M, et al. Analysis of risk factors of stroke and venous thromboembolism in females with oral contraceptives use. Clin Appl Thromb Hemost. 2018;24(5):797–802.PubMedGoogle Scholar
  73. 73.
    Dragoman MV, Tepper NK, Fu R, et al. A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception. Int J Gynecol Obstet. 2018;141:287–94.Google Scholar
  74. 74.
    Van Hylckama VA, Helmershorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestin type: results of the MEGA case-control study. BMJ. 2009;339:b2921.Google Scholar
  75. 75.
    Berenson AB, Rahman M, Breitkopf CR, Bi LX. Effects of depot medroxyprogesterone acetate and 20 microgram oral contraceptives on bone mineral density. Obstet Gynecol. 2008;112(4):788–99.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Gambacciani M, Ciaponi M, Cappagli B, et al. Longitudinal evaluation of perimenopausal femoral bone loss: effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism. Osteoporos Int. 2000;11(6):544–8.PubMedGoogle Scholar
  77. 77.
    McCausland AM, McCausland VM. Partial rollerball endometrial ablation: a modification of total ablation to treat menorrhagia without causing complications from intrauterine adhesions. Am J Obstet Gynecol. 1999;180:1512–21.PubMedGoogle Scholar
  78. 78.
    Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2000;2:CD000547. Update in: Cochrane Database Syst Rev. 2001.Google Scholar
  79. 79.
    Taylor HS. Use of Elagolix in Gynaecology. J Obstet Gynaecol Can. 2018;40(7):931–4.PubMedGoogle Scholar
  80. 80.
    Kirkpatrick AW, Campbell MR, Brenneman FD, et al. Trauma laparotomy in space: a discussion of the potential indications, conduct of operation, and technical support for the treatment of abdominal trauma during long-duration space exploration. Presented at the 28th International Conference of Environmental Systems, Danvers, MA, 13–16 July 1998. SAE Technical Paper Series 981601.Google Scholar
  81. 81.
    Kirpatrick AW, Campbell MR, Novinkov OL, et al. Blunt trauma and operative care in microgravity: a review of microgravity physiological and surgical investigations with implications for critical care and operative treatment in space. J Am Coll Surg. 1997;184:441–5.Google Scholar
  82. 82.
    Smith RS, Fry WR, Morabito DJ, et al. Therapeutic laparoscopy in trauma. Am J Surg. 1995;170:632–7.PubMedGoogle Scholar
  83. 83.
    Townsend MC, Flanebaum L, Choban PS, et al. Diagnostic laparoscopy as an adjunct to selective conservative management of solid organ injuries after blunt abdominal trauma. J Trauma. 1993;35:647–51.PubMedGoogle Scholar
  84. 84.
    Campbell MR, Johnston SL. Surgical bleeding in microgravity. Surg Gynecol Obstet. 1993;177:121–5.Google Scholar
  85. 85.
    Campbell MR, Billica RD, Johnston SL. Animal surgery in microgravity. Aviat Space Environ Med. 1993;64:58–62.Google Scholar
  86. 86.
    Campbell MR, Billica RD, Jennings RT, et al. Laparoscopic surgery in weightlessness. Surg Endosc. 1996;10:111–7.PubMedGoogle Scholar
  87. 87.
    Campbell MR, Billica RD. A review of microgravity surgical investigations. Aviat Space Environ Med. 1992;63:524–8.PubMedGoogle Scholar
  88. 88.
    Markham SM, Rock JA. Deploying and testing an expandable surgical chamber in microgravity. Aviat Space Environ Med. 1989;60:76–9.PubMedGoogle Scholar
  89. 89.
    McCuaig K. Aseptic technique in microgravity. Surg Gynecol Obstet. 1992;175:466–76.PubMedGoogle Scholar
  90. 90.
    Rock JA, Hesla JS, Repke JT, et al. A surgical isolation system for gynecological and obstetrical surgery. Am J Gynecol Health. 1989;3:126–9.Google Scholar
  91. 91.
    Mutke HG. Equipment for surgical interventions and childbirth in weightlessness. Acta Astronaut. 1981;1:399–401.Google Scholar
  92. 92.
    Colvard M, Kuo P, Caleel R, et al. Laser surgical procedures in the operational KC-135E aviation environment. Aviat Space Environ Med. 1992;63:619–23.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Richard T. Jennings
    • 1
  • Ellen S. Baker
    • 2
  1. 1.Aerospace Medicine Program, Preventive Medicine and Community HealthUT Medical Branch at GalvestonGalvestonUSA
  2. 2.Gynecologic Oncology and Reproductive MedicineUniversity of Texas, MD Anderson Cancer CenterHoustonUSA

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