Heavy Menstrual Bleeding Is a Global Issue That Goes Beyond the Clinical

Heavy menstrual bleeding is a common but seldom discussed issue affecting about 20% of American women and up to 50% of women globally. It can impact almost every part of someone’s daily life—keeping them from school or work and impacting physical health, mental health, and relationships.

And while certain medical conditions, like endometriosis or uterine fibroids, can cause heavy menstrual bleeding, it also depends heavily on an individual’s experience with and perception of their menstruation.

“The clinical definition of heavy menstrual bleeding is very subjective,” says Sheela Sinharoy, PhD, assistant professor of global health at Emory’s Rollins School of Public Health. “It's a patient-centered definition where if a woman feels that her menstrual blood loss is excessive and interferes with her quality of life, then she has heavy menstrual bleeding.”

Sinharoy and colleagues, including Bethany Caruso, PhD, recently published a correspondence in The Lancet Obstetrics, Gynaecology, & Women’s Health about the need to address the social and structural factors that affect heavy menstrual bleeding.

Heavy Menstrual Bleeding Is More Than Biological

There are many social and cultural norms when it comes to menstruation, and they vary greatly around the world. These can all influence someone’s perception of what they consider normal or heavy. 

“It could be that a woman is losing a volume of blood that would be considered objectively heavy, but she considers it to be normal, or vice versa,” says Sinharoy. 

There are also structural factors that can affect someone’s perception of their menstruation. For example, water, sanitation, and hygiene (WASH) infrastructure—one of Sinharoy’s main research interests—can have an enormous impact on quality of life during menstruation. When facilities to change and dispose of menstrual products as often as needed in privacy are not available, that may make someone perceive that their bleeding is heavier, less manageable, or more impactful on their life. 

The availability and affordability of menstrual products also plays a large role. Someone who cannot access or afford their preferred menstrual products might feel that menstruation negatively impacts their quality of life more so than someone who does have access.

Public Health’s Role

Luckily, public health is particularly good at addressing social and structural factors that impact health.

“Heavy menstrual bleeding is a bit unique in the sense that public health may potentially have a larger role to play than clinical medicine in this condition,” says Sinharoy.

But public health interventions to address heavy menstrual bleeding are highly contextual. Depending on what country, or even the city in the U.S., an intervention is built for, it may need to address different factors. In some places, WASH infrastructure may be the biggest concern. In others, it may be “period poverty,” the inability to afford necessary menstrual products. In others, addressing health literacy or menstruation taboos may be most impactful.

Sinharoy is currently working on a project to bring together researchers working in different disciplines across Emory who work on heavy menstrual bleeding. She received the Convergence Research Seed Award from the university’s Office of the Senior Vice President for Research to kickstart this work.

“Hopefully, through our convergence research project, we can find commonalities and identify research priorities that we all want to work on,” she says. “That could give us some direction for the future for grants that we would want to apply to together.”