Michelle Alston spent much of her youth sleeping off the worst days of her menstrual periods in the school nurse's office, battling severe pain and bleeding through products. 'I was taught that this is just normal,' she says. 'This is just something that you have to learn to cope with.' It was not until her early 40s that she learned her periods were unusually heavy—a condition called heavy menstrual bleeding.
Studies estimate that between 10 and 30% of reproductive-aged women experience heavy menstrual bleeding, but due to under-reporting and normalisation, the true figure may be as high as 50%. Heavy bleeding can cause anaemia and signal underlying health problems, yet research into the condition has been neglected. A PubMed search for 'menstrual blood' yielded just 400 publications in the last decade, compared with over 15,000 for 'semen'.
Clinically, heavy menstrual bleeding is defined as blood loss exceeding 80ml per cycle, clots larger than a US quarter, or periods lasting beyond seven days. However, measuring blood loss is imprecise, and diagnosis often depends on whether bleeding interferes with quality of life. Many women, like Alston, blame themselves and suffer in silence.
Gynaecologists recognise the signs, but other clinicians may overlook them. Alston waited nearly 30 years for a correct diagnosis. 'I think there are a lot of people in my part of the world who may not complain about it, and who, maybe because of normalisation [of pain] and stigma, don't actually come to a doctor,' says Professor Hemantha Senanayake.
Researchers are now calling for more attention to heavy menstrual bleeding. 'Women are probably owed years, if not decades, of research,' says Dr Jackie Maybin of the University of Edinburgh. For many UK women, heavy periods control not just their work travel but their entire lives.
