Bleeding Out Loud: Breaking the Silence on Heavy Menstrual Bleeding

The Hidden Health Crisis Affecting Millions

Let's talk periods.

We know, we know, it's an uncomfortable topic. But here's the situation: every minute, somewhere in the US, a woman requires a blood transfusion because of her menstruation. Heavy menstrual bleeding (HMB) often involves blood loss so significant that if it were associated with an injury, it would result in a call for an ambulance or a trip to the emergency room.

In fact, 1 in 3 women of reproductive age report heavy menstrual bleeding, and 950 million menstruating women globally are iron deficient as a direct result. That's more common than asthma or diabetes in reproductive-aged women. Aren’t these numbers staggering? We think so. Let’s discuss…

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The Medical Reality

Chronic HMB, medically referred to as menorrhagia, poses significant health risks if left undiagnosed and untreated. According to the CDC, heavy menstrual bleeding is one of the most common problems women report to their healthcare providers. It affects more than 10 million American women each year — about 1 of every 5 women.

How do you know if you have heavy menstrual bleeding? The CDC defines it as:

• Needing to change your tampon or pad after less than 2 hours

• Having a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row

• Needing to double up on pads to control your menstrual flow

• Needing to change pads or tampons during the night

• Having menstrual periods lasting more than 7 days

• Having a menstrual flow with blood clots the size of a quarter or larger

• Having a heavy menstrual flow that keeps you from doing the things you would do normally

Excessive blood loss over time can lead to iron-deficiency anemia, characterized by reduced hemoglobin levels and diminished oxygen-carrying capacity of the blood. This results in symptoms like fatigue, tachycardia, and shortness of breath, and may progress to cardiovascular strain in severe cases.

HMB may also signal serious underlying health conditions such as:

• Uterine fibroids

• Polyps

• Hormonal imbalances

• Coagulopathies such as von Willebrand disease

• Certain cancers

This type of chronic blood loss disrupts homeostasis and can impair immune function, healing, and overall quality of life, increasing the risk for physical, cognitive, and emotional complications, including anxiety and depression rates 3 times higher than those seen in the general population.

Beyond Health: Education and Economic Impact

Suffice it to say that heavy menstrual bleeding is a pretty serious health concern, but it's also a significant barrier to education and productivity for women worldwide.

In the UK, girls miss an average of 9 school days each year due to abnormally heavy menstruation - even more than common illnesses like colds (7.8 days) - equating to a loss of 11 academic weeks across formative educational years. In the US, menstrual-related absences from school are estimated to total over 100 million school days annually.

For those impacted by chronic menstrual bleeding, the consequences are even more severe:

• They're about one-third less likely to meet the academic benchmarks required for apprenticeships or continued education compared to their peers

• Upon entering the workforce, women with HMB lose an average of 3.6 work weeks each year

• This contributes to an economic burden exceeding $94 billion annually in the US alone

Increased Health Risks

Recent research has revealed even more concerning health implications. A 2024 study published in BMC Medicine found that heavy menstrual bleeding is significantly associated with increased cardiovascular disease risk, particularly in women under 40 years of age. The study of over 2.4 million hospitalizations found that women with HMB had:

• 61% higher odds of major adverse cardiovascular events

• 72% higher odds of coronary heart disease

• 95% higher odds of stroke

• 53% higher odds of heart failure

• 84% higher odds of atrial fibrillation or arrhythmia

This suggests that HMB is not just a reproductive health issue but a potential early warning sign for serious cardiovascular problems.

The Silent Suffering

Despite its remarkably high frequency and prevalence, not to mention the physical, emotional, and financial burden, women with HMB go an average of 5 years before receiving proper medical treatment.

Imagine going 5 years before getting diagnosed and treated for diabetes. Or asthma. Or high blood pressure.

This delay is potentially due to several factors:

• Taboos surrounding menstruation that result in HMB being normalized by women and society

• The pervasive stigma that discourages open discussion with healthcare providers

• Many women are taught from an early age that menstrual pain and heavy bleeding are simply part of being a woman, leading them to dismiss their symptoms regardless of severity

• Many healthcare providers also downplay complaints or fail to ask the right questions (84% of women who seek help feel dismissed)

• Self-perception of menstrual blood loss has sensitivity and specificity values of only 60-70%, making it difficult for women to accurately assess their condition

According to CDC data, despite its prevalence, only 8% of women who suffer from HMB can access the tests and treatments required to alleviate it. This cycle of silence and normalization not only prolongs suffering but also increases the risk of serious health complications, including anemia, reproductive issues, mental health disorders, and potentially cardiovascular disease.

The Situation Isn’t Improving

It's worth noting that this issue affects more women for longer than ever before. A few centuries ago, women experienced just over 100 menstrual cycles in their lifetimes. On average, they had 5 children and lactated for 12 months with each child.

Today, women living in high-resource settings can expect to menstruate over 400 times due to a combination of extended reproductive lifespan and reduced pregnancy and lactation. Menstruation always was an important sign, but it's more relevant to women's lives today than ever before.

The Path Forward: Treating Menstruation as a Vital Sign

Look, we need better solutions. This isn't just about inconvenient bathroom breaks or needing to change your tampon, pad, cup, or whatever period product you use more frequently. We're talking about a very real medical issue that affects millions of women's ability to participate fully in education, work, and daily life – and may even put them at risk for serious cardiovascular problems down the road.

Breaking the cycle of silence starts with changing how we talk about periods. Not as something embarrassing or just an inconvenience to be endured, but as important health information. The medical community needs to catch up here, too.

The goal of The Missed Vital Sign program is to get healthcare providers to start treating menstruation the same way they treat blood pressure or heart rate – as a vital sign that offers a unique window into women's overall health. These indicators are critical for identifying, diagnosing, and treating HMB before it leads to years of unnecessary suffering.

To meaningfully reduce the 5-year diagnostic delay, we need to move past viewing menstruation as a taboo topic and recognize it as the powerful diagnostic tool it is– period. The program aims to demonstrate that routine recording, quantifiable measurement, and better treatment options can reduce the time a woman experiences heavy menstrual bleeding from 5 years to 5 months, without increasing unwanted surgical intervention or menstrual cycle suppression.

Want to learn more? Tune in to our podcast episode "Heavy Menstruation: A Bloody Big Problem" wherever you listen to podcasts or watch on YouTube. We speak with gynecologist Dr. Jackie Maybin, MD, PhD, who leads a specialist menstrual disorders service and chairs the National Menstrual Clinical Network for the Scottish Government.

(P.S. Nope, this isn’t sponsored. We just wanted to shine a light on this important issue and a research initiative that aims to address it!)

Stay Curious,

Unbiased Science

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