Ciężkie krwawienia miesiączkowe

Ciężkie krwawienia miesiączkowe
Epidemiologia

Ciężkie krwawienia miesiączkowe (HMB), definiowane jako utrata krwi przekraczająca 80 ml na cykl, stanowią istotny problem zdrowotny dotykający 9-52% kobiet w wieku rozrodczym, w zależności od metody oceny i regionu. Epidemiologia wskazuje na wzrost częstości HMB z wiekiem, szczególnie u kobiet w wieku 30-49 lat, a także u nastolatek i w okresie okołomenopauzalnym. Czynniki ryzyka obejmują zaburzenia krzepnięcia (występujące u około 20% pacjentek z HMB, szczególnie u nastolatek), otyłość (BMI ≥ 30 powiązane z nasileniem krwawień), anowulację, zmiany strukturalne macicy (mięśniaki, polipy, adenomioza) oraz czynniki hormonalne. HMB jest często niedodiagnozowane, gdyż 59% kobiet uważa je za normalny element miesiączkowania, a tylko około 5% kobiet w wieku 30-49 lat zgłasza się do lekarza z tym problemem. Wśród kobiet z HMB często występuje niedokrwistość z niedoboru żelaza (64,6% w badaniu chińskim), co prowadzi do zmęczenia, osłabienia i zwiększa ryzyko powikłań okołoporodowych. HMB znacząco obniża jakość życia (HRQoL) i powoduje absencję w pracy lub szkole, co dodatkowo pogłębia nierówności społeczne i zdrowotne.

Epidemiologia ciężkich krwawień miesiączkowych

Częstotliwość występowania na świecie
Odsetek kobiet poszukujących pomocy medycznej
Wpływ na jakość życia

Czynniki ryzyka i przyczyny ciężkich krwawień miesiączkowych

Wiek i inne czynniki demograficzne
Zaburzenia krzepnięcia i ich związek z HMB
Otyłość i inne czynniki związane ze stylem życia
Czynniki reprodukcyjne i hormonalne
Schorzenia organiczne i strukturalne

Grupy szczególnego ryzyka

Nastolatki i młode kobiety
Kobiety z wrodzonymi zaburzeniami krzepnięcia
Kobiety z zespołami hipermobilności

Konsekwencje zdrowotne i społeczne

Niedokrwistość i niedobór żelaza
Wpływ na jakość życia i funkcjonowanie społeczne
Koszty dla systemów opieki zdrowotnej

Aktualne trendy i wyzwania w nadzorze epidemiologicznym

Wyzwania w monitorowaniu i badaniach
Nowoczesne podejścia do nadzoru i badania ciężkich krwawień miesiączkowych
Znaczenie danych raportowanych przez pacjentki

Międzynarodowe różnice w występowaniu i profilaktyce

Różnice geograficzne w występowaniu ciężkich krwawień miesiączkowych
Dostęp do diagnostyki i leczenia
Wyzwania w krajach o niskim i średnim dochodzie
Kolejne rozdziały

Epidemiologia ciężkich krwawień miesiączkowych

Ciężkie krwawienia miesiączkowe (ang. heavy menstrual bleeding, HMB), dawniej określane jako menorrhagia, stanowią istotny problem zdrowotny dotykający znaczną część kobiet w wieku rozrodczym. Jest to stan definiowany jako nadmierne krwawienie miesiączkowe, które negatywnie wpływa na fizyczną, społeczną, emocjonalną lub materialną jakość życia kobiety.¹ Obiektywnie definiuje się je jako utratę krwi przekraczającą 80 ml podczas jednego cyklu miesiączkowego, choć subiektywna ocena pacjentki dotycząca wpływu na jakość życia jest równie ważna w diagnostyce.²³

Częstotliwość występowania na świecie

Roczna częstość występowania nieprawidłowych krwawień macicznych (AUB), których ciężkie krwawienia miesiączkowe są głównym objawem, wynosi 53 na 1000 kobiet.⁴ W zależności od sposobu oceny i populacji badanej, częstość występowania ciężkich krwawień miesiączkowych w różnych regionach świata waha się znacząco:

W badaniach stosujących obiektywne pomiary utraty krwi miesiączkowej, częstość występowania menorrhagii wynosi 9-14%⁵
W badaniach opartych na subiektywnej ocenie, odsetek jest znacznie wyższy i waha się między 20-52%⁶
W badaniu przeprowadzonym w Brazylii, częstość występowania ciężkich krwawień miesiączkowych wynosiła 35,3% (95% CI 32,1-38,6%)⁷
W badaniu wśród kobiet w wieku 40-45 lat w krajach rozwiniętych, 32% zgłaszało doświadczanie ciężkich krwawień miesiączkowych⁸
W badaniu przeprowadzonym w Pekinie wśród kobiet w wieku 18-50 lat, częstość występowania HMB wynosiła 18,2%⁹
Badanie australijskie wykazało wzrost częstości występowania ciężkich krwawień miesiączkowych z wiekiem – od 17,6% w wieku 22 lat do 32,1% w wieku 48 lat¹⁰
Według CDC, około 20% amerykańskich kobiet doświadcza ciężkich okresów¹¹
Międzynarodowe badanie przeprowadzone w Azji Południowej i Afryce Subsaharyjskiej wskazuje, że ciężkie krwawienia miesiączkowe dotykają 47% kobiet w tych regionach¹²

Szacuje się, że jedna na trzy kobiety w ciągu swojego życia doświadczy ciężkich krwawień miesiączkowych, co czyni ten problem bardzo powszechnym.¹³¹⁴

Odsetek kobiet poszukujących pomocy medycznej

Pomimo wysokiej częstości występowania, wiele kobiet nie szuka pomocy medycznej w związku z ciężkimi krwawieniami miesiączkowymi:

Około 1 na 20 kobiet w wieku 30-49 lat konsultuje się z lekarzem pierwszego kontaktu z powodu ciężkich krwawień miesiączkowych¹⁵¹⁶
W Wielkiej Brytanii około 800 000 kobiet rocznie szuka pomocy z powodu nieprawidłowych krwawień macicznych¹⁷
Ciężkie krwawienia miesiączkowe są odpowiedzialne za 12% wszystkich skierowań ginekologicznych rocznie¹⁸¹⁹
Zaburzenia miesiączkowania są drugą najczęstszą przyczyną skierowań na oddział ginekologiczny²⁰

Istotnym problemem jest niska świadomość dotycząca ciężkich krwawień miesiączkowych jako stanu medycznego. Badania wskazują, że 59% kobiet dotkniętych tym problemem uważa swój stan za normalną część miesiączkowania, a 63,2% pacjentek w badaniu chińskim nie miało żadnej wiedzy na temat HMB jako stanu medycznego.²¹²²

Wpływ na jakość życia

Ciężkie krwawienia miesiączkowe mają znaczący negatywny wpływ na jakość życia kobiet:

Kobiety doświadczające ciężkich krwawień miesiączkowych mają znacząco gorszą jakość życia związaną ze zdrowiem (HRQoL) w porównaniu z kobietami z normalnymi krwawieniami miesiączkowymi we wszystkich domenach kwestionariusza SF-36²³
Ciężkie krwawienia miesiączkowe mogą prowadzić do niedoboru żelaza i niedokrwistości z niedoboru żelaza, co powoduje zmęczenie, osłabienie i inne objawy²⁴
W badaniu chińskim 64,6% pacjentek z grupy HMB cierpiało na anemię²⁵
Ciężkie krwawienia miesiączkowe są związane z absencją w pracy, szkole lub podczas aktywności społecznych, co dodatkowo pogłębia nierówności płciowe²⁶

Czynniki ryzyka i przyczyny ciężkich krwawień miesiączkowych

Istnieje wiele czynników zwiększających ryzyko wystąpienia ciężkich krwawień miesiączkowych oraz różnorodne przyczyny tego stanu.²⁷

Wiek i inne czynniki demograficzne

Wiek jest istotnym czynnikiem ryzyka ciężkich krwawień miesiączkowych:

Częstość występowania menorrhagii wzrasta z wiekiem, osiągając szczyt u kobiet w wieku 30-49 lat²⁸
Ciężkie krwawienia miesiączkowe są najczęstsze w okresie dojrzewania oraz w okresie okołomenopauzalnym²⁹
W okresie okołomenopauzalnym około 25% kobiet doświadczy przynajmniej jednego epizodu obfitego krwawienia³⁰
Badanie australijskie wykazało, że odsetek kobiet zgłaszających częste doświadczanie ciężkich krwawień miesiączkowych wzrósł z 6,1% w wieku 22 lat do 12,1% w wieku 48 lat³¹

Niski poziom wykształcenia również został powiązany ze zwiększonym ryzykiem ciężkich krwawień miesiączkowych w niektórych badaniach.³²

Zaburzenia krzepnięcia i ich związek z HMB

Zaburzenia krzepnięcia są istotną przyczyną ciężkich krwawień miesiączkowych, szczególnie u nastolatek:

Częstość występowania zaburzeń krzepnięcia w populacji ogólnej wynosi około 12%, ale wzrasta do około 20% wśród nastolatek, które zgłaszają się z powodu ciężkich krwawień miesiączkowych³³
Wśród nastolatek hospitalizowanych z powodu ciężkich krwawień miesiączkowych, zaburzenia krzepnięcia stwierdza się u 33%³⁴
Około 20% pacjentek z ciężkimi krwawieniami miesiączkowymi ma zaburzenia krzepnięcia, a częstość ich występowania u nastolatek cierpiących na ciężkie krwawienia jest jeszcze wyższa³⁵
Szacuje się, że 10-62% nastolatek z ciężkimi krwawieniami miesiączkowymi może mieć podstawową wrodzoną skazę krwotoczną³⁶

Najczęstszym wrodzonym zaburzeniem u kobiet z objawami menorrhagii jest choroba von Willebranda.³⁷ Ciężkie krwawienia miesiączkowe są najczęściej zgłaszanym objawem wśród kobiet w wieku rozrodczym z chorobą von Willebranda.³⁸

Otyłość i inne czynniki związane ze stylem życia

Otyłość została powiązana z ciężkimi krwawieniami miesiączkowymi w kilku badaniach:

Badanie australijskie wykazało, że wyższy wskaźnik masy ciała (BMI) jest związany z ciężkimi krwawieniami miesiączkowymi³⁹
W brytyjskim badaniu eksperymentalnym stwierdzono, że otyłość była związana ze zwiększoną utratą krwi miesiączkowej u kobiet⁴⁰
W tym samym badaniu 63% uczestniczek miało ciężkie krwawienia miesiączkowe (PBAC score ≥ 80 ml), a 25% wszystkich uczestniczek miało otyłość (BMI ≥ 30)⁴¹
Myszy na diecie wysokotłuszczowej miały znacząco opóźnioną regenerację endometrium w porównaniu z tymi na normalnej diecie⁴²

Badacze sugerują, że otyłość powoduje bardziej prozapalne lokalne środowisko endometrium podczas miesiączki, co może opóźniać regenerację endometrium i zwiększać utratę krwi miesiączkowej.⁴³

Czynniki reprodukcyjne i hormonalne

Różne czynniki związane z reprodukcją i hormonami wpływają na ryzyko ciężkich krwawień miesiączkowych:

Brak owulacji (anovulacja) jest jedną z najczęstszych przyczyn nadmiernego krwawienia miesiączkowego⁴⁴
Wielokrotne aborcje (≥3) zostały powiązane ze zwiększonym ryzykiem HMB, podczas gdy nie stwierdzono wzrostu ryzyka u kobiet z mniejszą liczbą aborcji⁴⁵
Stosowanie hormonalnej antykoncepcji ma działanie ochronne przed ciężkimi krwawieniami miesiączkowymi⁴⁶⁴⁷
Zastosowanie miedzianej wkładki wewnątrzmacicznej może być przyczyną menorrhagii⁴⁸

W przypadku okresu okołomenopauzalnego i dojrzewania, ciężkie krwawienia miesiączkowe często występują w okresach życia, gdy ekspozycja na estrogeny przewyższa i jest niezbilansowana w stosunku do ilości produkowanego progesteronu.⁴⁹

Schorzenia organiczne i strukturalne

Nieprawidłowości strukturalne macicy są częstą przyczyną ciężkich krwawień miesiączkowych:

Nieprawidłowe tkanki w macicy, takie jak polipy, mięśniaki lub adenomioza⁵⁰
Po okresie dojrzewania, menorrhagia najczęściej wynika ze zmian strukturalnych, takich jak mięśniaki, polipy, a także cykli bezowulacyjnych i hiperplazji endometrium⁵¹
Około 50% przypadków zgłaszających się do lekarza nie ma zidentyfikowanej przyczyny i są diagnozowane jako czynnościowe krwawienia maciczne (DUB), które są rozpoznaniem z wykluczenia⁵²

Grupy szczególnego ryzyka

Niektóre grupy kobiet są szczególnie narażone na wystąpienie ciężkich krwawień miesiączkowych i/lub ich konsekwencje.

Nastolatki i młode kobiety

Nastolatki stanowią grupę szczególnego ryzyka ciężkich krwawień miesiączkowych i ich powikłań:

Ciężkie krwawienie miesiączkowe przy pierwszej miesiączce i w okresie dojrzewania może być ważnym sygnałem wskazującym na podstawowe zaburzenie krzepnięcia⁵³
Proporcjonalnie nastolatki częściej niż dorosłe kobiety mają zaburzenia krzepnięcia jako przyczynę ciężkich krwawień miesiączkowych⁵⁴
Najczęstszą przyczyną ciężkich krwawień miesiączkowych u nastolatek jest uporczywa anovulacja, ale inne częste etiologie obejmują koagulopatie i ciążę⁵⁵
HMB może być szczególnie niebezpieczne przy pierwszej miesiączce ze względu na przedłużone cykle bezowulacyjne, które zwiększają ryzyko krwawienia podczas pierwszych miesiączek⁵⁶

Nastolatki i młode kobiety są narażone na najwyższe ryzyko absencji związanej z miesiączką, co identyfikuje tę populację jako kluczowy priorytet dla przyszłych programów zdrowia menstruacyjnego i badań.⁵⁷

Kobiety z wrodzonymi zaburzeniami krzepnięcia

Kobiety z wrodzonymi zaburzeniami krzepnięcia doświadczają szczególnych problemów związanych z krwawieniami miesiączkowymi:

Wrodzone zaburzenia krzepnięcia są szczególnie problematyczne dla dziewcząt i kobiet ze względu na comiesięczne występowanie miesiączek i wpływ na zdrowie reprodukcyjne⁵⁸
Choć ciężkie krwawienie miesiączkowe jest najczęstszym objawem (78,3% kobiet z wrodzonymi zaburzeniami krzepnięcia), 49,2% uczestniczek badania UDC zgłosiło więcej niż cztery różne objawy krwawienia⁵⁹
Częstość występowania HMB wśród kobiet z małopłytkowością immunologiczną (ITP) wahała się od 6% do 55% w ośmiu badaniach uwzględnionych w przeglądzie⁶⁰
Według przeglądu systematycznego, który uwzględniał dane z 4 badań kohortowych, ogółem 25% kobiet z zespołem Bernarda-Souliera miało obecny lub przeszły epizod HMB⁶¹

Female UDC (nadzór nad kobietami z wrodzonymi zaburzeniami krzepnięcia) to pierwszy prospektywny, długoterminowy nadzór w USA koncentrujący się na kobietach z wrodzonymi zaburzeniami krzepnięcia, który może dalej identyfikować powikłania i zmniejszać niekorzystne wyniki w tej populacji.⁶²

Kobiety z zespołami hipermobilności

Kobiety z zaburzeniami tkanki łącznej, takimi jak zespoły hipermobilności, również często doświadczają ciężkich krwawień miesiączkowych:

W badaniu kohortowym obejmującym 386 kobiet z zespołem Ehlersa-Danlosa typu hipermobilnego, 76% z nich miało historię menorrhagii/HMB⁶³
W innym badaniu, obejmującym 82 kobiety po okresie dojrzewania z hipermobilnym zespołem Ehlersa-Danlosa (hEDS), 53,7% miało nieprawidłowe krwawienia maciczne⁶⁴
HMB związane z zaburzeniami spektrum hipermobilności nie tylko wydaje się być powszechne, ale także często negatywnie wpływa na jakość życia lub staje się zagrożeniem dla życia⁶⁵

Konsekwencje zdrowotne i społeczne

Ciężkie krwawienia miesiączkowe prowadzą do różnych konsekwencji zdrowotnych i społecznych, które mają wpływ zarówno na jednostki, jak i na systemy opieki zdrowotnej.

Niedokrwistość i niedobór żelaza

Jedną z najważniejszych konsekwencji zdrowotnych ciężkich krwawień miesiączkowych jest niedokrwistość i niedobór żelaza:

80% kobiet krwawiących obficie (>80 ml na cykl) będzie miało co najmniej jeden dowód laboratoryjny niedoboru żelaza⁶⁶
Występuje wysoka częstość niedoboru żelaza i niedokrwistości z niedoboru żelaza u osób z nieprawidłowymi krwawieniami macicznymi w skali globalnej, a problem ten jest często niedostatecznie rozpoznawany i zgłaszany⁶⁷
Ciężkie krwawienia miesiączkowe mogą prowadzić do niskich zasobów żelaza i niedokrwistości z niedoboru żelaza, co może powodować zmęczenie, osłabienie i inne objawy⁶⁸

Co więcej, istnieje związek między ciężkimi krwawieniami miesiączkowymi, niedokrwistością i zwiększonym ryzykiem zgonu w trakcie porodu. Obfite krwawienia miesiączkowe powodują niedokrwistość u młodych kobiet, niedokrwistość zwiększa ryzyko ciężkiego krwawienia po porodzie, a krwawienie to jest główną przyczyną śmierci matek na całym świecie.⁶⁹ Każdego roku 14 milionów kobiet na całym świecie doświadcza krwotoku poporodowego, a ponad 50 000 z nich umiera.⁷⁰

Wpływ na jakość życia i funkcjonowanie społeczne

Ciężkie krwawienia miesiączkowe znacząco wpływają na jakość życia kobiet i ich funkcjonowanie społeczne:

Badanie SF-36 wykazało, że kobiety doświadczające ciężkich krwawień miesiączkowych miały znacząco gorszą jakość życia związaną ze zdrowiem w porównaniu z kobietami z normalnymi krwawieniami miesiączkowymi we wszystkich domenach⁷¹
Nieprawidłowe krwawienia maciczne negatywnie wpływają na jakość życia i są związane ze stratami finansowymi, zmniejszoną produktywnością, złym stanem zdrowia i zwiększonym wykorzystaniem zasobów opieki zdrowotnej⁷²
W badaniu wpływu menstruacji, 38% uczestniczek stwierdziło, że opuszcza aktywności domowe, a 31% stwierdziło, że bierze zwolnienie lekarskie z powodu dolegliwości menstruacyjnych⁷³

Krwawienia związane z miesiączką powodują absencję w pracy, szkole lub podczas aktywności społecznych, co dodatkowo pogłębia nierówności płciowe. Ogólna światowa częstość występowania absencji związanej z miesiączką wynosi 15% wśród kobiet i dziewcząt w wieku 15-49 lat, a najczęściej występuje w Azji Południowej i częściach Afryki Subsaharyjskiej.⁷⁴

Koszty dla systemów opieki zdrowotnej

Ciężkie krwawienia miesiączkowe generują znaczne koszty dla systemów opieki zdrowotnej:

W ambulatoryjnej opiece zdrowotnej, nieprawidłowe krwawienia maciczne są jedną z głównych przyczyn wizyt ginekologicznych, z 20-30% kobiet zgłaszających tę dolegliwość rocznie⁷⁵
Co najmniej 30% histerektomii wykonywanych w USA jest z powodu ciężkich krwawień miesiączkowych⁷⁶
Podczas wczesnych lat 90-tych, około 60% kobiet zgłaszających się z ciężkimi krwawieniami miesiączkowymi poddawano histerektomii (często jako leczenie pierwszego rzutu) w celu rozwiązania problemu⁷⁷
Około 40-50% kobiet w Ameryce Północnej przeszło histerektomię z powodów niezłośliwych, rzekomo z powodu mięśniaków lub menorrhagii⁷⁸

Terapie chirurgiczne są rzadko konieczne w przypadku menorrhagii i nigdy nie powinny być pierwszym podejściem do leczenia.⁷⁹ Jednakże, jedna trzecia pacjentek decyduje się na histerektomię w celu rozwiązania objawów, co podkreśla klinicznie niezaspokojone zapotrzebowanie na bardziej ukierunkowane i spersonalizowane metody leczenia.⁸⁰

Aktualne trendy i wyzwania w nadzorze epidemiologicznym

Monitorowanie i nadzór nad ciężkimi krwawieniami miesiączkowymi napotyka różne wyzwania, a nasze rozumienie ich epidemiologii ewoluuje.

Wyzwania w monitorowaniu i badaniach

Nadzór epidemiologiczny nad ciężkimi krwawieniami miesiączkowymi napotyka szereg wyzwań:

Zróżnicowane definicje i metody oceny ciężkich krwawień miesiączkowych utrudniają porównania między badaniami – częstość występowania waha się od 9-14% w badaniach obiektywnych do 20-52% w badaniach subiektywnych⁸¹
Zaburzenia miesiączkowania, podobnie jak inne aspekty zdrowia seksualnego i reprodukcyjnego, nie są uwzględniane w globalnych szacunkach obciążenia chorobami⁸²
Wkład ciężkich krwawień miesiączkowych w rozwój niedokrwistości, a następnie krwotoku poporodowego, jest niedostatecznie rozpoznawany przez pracowników ochrony zdrowia⁸³
Raport WHO z 2020 roku na temat globalnych wysiłków na rzecz zapobiegania niedokrwistości u kobiet w wieku rozrodczym całkowicie pomijał ciężkie krwawienia miesiączkowe⁸⁴

Chociaż badania pokazują, że zasoby żelaza u kobiety zależą bardziej od utraty krwi miesiączkowej niż od spożycia żelaza w diecie, globalne wysiłki na rzecz zapobiegania niedokrwistości koncentrują się głównie na odżywianiu i suplementacji.⁸⁵

Nowoczesne podejścia do nadzoru i badania ciężkich krwawień miesiączkowych

Pojawiają się nowe podejścia do lepszego zrozumienia i monitorowania ciężkich krwawień miesiączkowych:

Projekt MenstruLife łączy dane z kilku długoterminowych badań kohortowych, aby odpowiedzieć na ważne pytania dotyczące wpływu ciężkich krwawień miesiączkowych i bólu menstruacyjnego na zdrowie psychiczne osób miesiączkujących⁸⁶
Female UDC to pierwszy prospektywny, długoterminowy nadzór w USA koncentrujący się na kobietach z wrodzonymi zaburzeniami krzepnięcia⁸⁷
Badanie WOMAN-2 aktualnie sprawdza, czy podawanie kwasu traneksamowego może zapobiec krwotokowi poporodowemu i innym ciężkim powikłaniom u kobiet z umiarkowaną i ciężką niedokrwistością⁸⁸

Terminologia i definicje do diagnozowania przyczyn nieprawidłowych krwawień macicznych są obecnie znormalizowane w Systemach 1 i 2 Międzynarodowej Federacji Ginekologii i Położnictwa i powinny być stosowane dla ułatwienia synchronizacji klinicznej i badawczej.⁸⁹

Znaczenie danych raportowanych przez pacjentki

Dane raportowane przez pacjentki stają się coraz ważniejszym źródłem informacji w nadzorze nad ciężkimi krwawieniami miesiączkowymi:

Podczas kampanii szczepień przeciwko COVID-19, ponad 34 000 zgłoszeń ciężkich krwawień miesiączkowych po podaniu szczepionek przeciwko COVID-19 pochodzących z Europejskiego Obszaru Gospodarczego zostało złożonych do EudraVigilance, unijnej bazy danych podejrzewanych działań niepożądanych leków⁹⁰
Raportowanie konsumenckie do europejskiego systemu gromadzenia danych spontanicznych, EudraVigilance, było bardzo wartościowe dla regulacyjnych przeglądów bezpieczeństwa, chociaż zachowania raportujące nie były wolne od wpływu mediów⁹¹
W następstwie zakończenia procedury sygnałowej 27 października 2022 r., PRAC doszedł do wniosku, że istnieje uzasadniona możliwość przyczynowego związku ciężkich krwawień miesiączkowych ze szczepionkami przeciwko COVID-19 opartymi na mRNA⁹²

Duża liczba zgłoszeń była kluczowa dla zainicjowania przeglądów bezpieczeństwa dotyczących ciężkich krwawień miesiączkowych, choć zwiększona liczba spontanicznych zgłoszeń sama w sobie nie może określić, czy występuje rzeczywisty wzrost częstości występowania zdarzenia.⁹³⁹⁴

Międzynarodowe różnice w występowaniu i profilaktyce

Częstość występowania i podejście do ciężkich krwawień miesiączkowych różni się znacząco między regionami świata i poziomami rozwoju gospodarczego.

Różnice geograficzne w występowaniu ciężkich krwawień miesiączkowych

Dane epidemiologiczne wskazują na różnice regionalne w występowaniu ciężkich krwawień miesiączkowych i związanych z nimi absencji:

Zbiorcza globalna częstość występowania absencji związanej z miesiączką wynosi 15% [95% CI: 12,7-17,3], z najwyższą częstością występowania w Azji Południowej (19,7% [11,6-27,8]) i Afryce Zachodniej i Środkowej (18,5% [13,5-23,5])⁹⁵
Większość zgonów z powodu krwotoku poporodowego, do którego przyczyniają się ciężkie krwawienia miesiączkowe przez niedokrwistość, występuje w krajach o niskim i średnim dochodzie, gdzie częstość występowania niedokrwistości jest najwyższa, a wiele kobiet nie ma dostępu do opieki zdrowotnej i ratującego życie leczenia⁹⁶
W badaniu przeprowadzonym w Nepalu (96 uczennic w wieku 11-17 lat), menorrhagię stwierdzono u 6,2% dziewcząt⁹⁷
W Turcji nieprawidłowe krwawienia maciczne były trzecim najczęściej zgłaszanym objawem ginekologicznym i czwartą najczęściej diagnozowaną chorobą ginekologiczną wśród dorosłych kobiet⁹⁸

Wśród chińskiej populacji badania na temat HMB były bardzo ograniczone, a wyniki badania przeprowadzonego w Pekinie wykazały, że częstość występowania HMB wśród chińskich kobiet w wieku 18-50 lat wynosi 18,2%, co było zgodne z samodzielnie zgłaszaną częstością występowania 8-27% w innych krajach rozwijających się.⁹⁹

Dostęp do diagnostyki i leczenia

Dostęp do diagnostyki i leczenia ciężkich krwawień miesiączkowych różni się znacząco między regionami:

W krajach o wysokim dochodzie, śmiertelność z powodu krwotoku poporodowego (do którego przyczyniają się ciężkie krwawienia miesiączkowe) jest wyższa wśród czarnoskórych kobiet i kobiet kolorowych, co wskazuje na głębokie nierówności zdrowotne i społeczne¹⁰⁰
Problemy zdrowotne związane z miesiączkowaniem są w dużej mierze zaniedbanym priorytetem w dziedzinie zdrowia seksualnego i reprodukcyjnego w większości krajów o niskim dochodzie¹⁰¹
Wyniki badań wskazują na potrzebę zapewnienia usług opieki zdrowotnej w zakresie menstruacji na poziomie podstawowym¹⁰²

Biorąc pod uwagę obciążenie tą chorobą, ważne jest, aby australijskie kobiety były świadome i miały dostęp do skutecznej opieki w przypadku ciężkich krwawień miesiączkowych – wnioski te można ekstrapolować na inne kraje rozwinięte.¹⁰³

Wyzwania w krajach o niskim i średnim dochodzie

Kraje o niskim i średnim dochodzie (LMIC) stoją przed szczególnymi wyzwaniami związanymi z ciężkimi krwawieniami miesiączkowymi:

Absencja związana z miesiączką jest powszechna, szczególnie w Azji i Afryce, a zwłaszcza wśród nastolatek¹⁰⁴
Ochronny wpływ antykoncepcji hormonalnej, niezależny od wieku, sugeruje, że objawy takie jak ciężkie krwawienia miesiączkowe lub ból powodują absencję¹⁰⁵
Dane dotyczące charakteru i częstości występowania zaburzeń miesiączkowania oraz ich wpływu na stan zdrowia młodych kobiet, jakość życia i integrację społeczną sugerują, że leczenie tych zaburzeń powinno otrzymać większą uwagę w ramach dostępnych programów opieki zdrowotnej w zakresie zdrowia reprodukcyjnego¹⁰⁶

Niedobór informacji i brak programów edukacji zdrowotnej pilnie potrzebne są, aby zwiększyć świadomość konsekwencji HMB, zachęcić kobiety do szukania pomocy medycznej i w ten sposób poprawić ich jakość życia.¹⁰⁷

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] The frequency of bleeding disorders in the general population is approximately 12%, but bleeding disorders are found in approximately 20% of adolescent girls who present for evaluation of heavy menstrual bleeding and in 33% of adolescent girls hospitalized for heavy menstrual bleeding. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder.
#2 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
Most menstrual cycles (periods) occur every 24 to 38 days (as measured from the first day of one bleeding episode to the first day of the next); the average is every 28 days. In a normal menstrual cycle, a person loses an average of 2 to 3 tablespoons (35 to 40 milliliters) of blood over four to eight days. However, some people lose a lot more blood or bleed for a longer duration (prolonged periods). Doctors define „heavy” periods as bleeding so much that it affects your physical health, emotional health, or quality of life. […] Heavy periods (which doctors sometimes call „menorrhagia”) can lead to low iron stores and iron deficiency anemia (low red blood cell count caused by ongoing excessive blood loss), which can cause fatigue, weakness, and other symptoms. […] Several treatments for heavy bleeding are available.
#3 How much period blood is normal?
https://helloclue.com/articles/cycle-a-z/what’s-normal-period-volume-and-heaviness
Heavy menstrual bleeding is excessive menstrual blood loss that interferes with a persons quality of life. […] Heavy menstrual bleeding is a set of symptoms collectively known as abnormal uterine bleeding. Healthcare professionals and researchers have previously defined HMB as the loss of more than 80 mL of blood in one menstrual period. […] If you’re repeatedly soaking through a tampon or pad every one to two hours, this is considered heavy menstrual bleeding and should be brought to your healthcare provider’s attention. […] In essence, heavy menstrual bleeding is not defined by a healthcare provider but by you, if the volume of your periods adversely impacts the activities and quality of your daily life. […] Excessive menstrual bleeding can impact a person’s quality of life and can cause iron deficiency anemia. […] Heavy menstrual bleeding can have many potential causes including fibroids, adenomyosis, bleeding disorders, uterine polyps, and (rarely) tumors.
#4 Menorrhagia(Archived) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK536910/
Abnormal uterine bleeding, or menorrhagia as previously classified, is a predominant complication among women in the United States that is related to the major impacts of women’s quality of life, productivity, and healthcare cost. Reports are that the annual prevalence rate is 53 per 1000 women. In the outpatient setting, AUB is one of the leading causes of outpatient gynecological visits with 20-30% of women presenting with this complaint annually. […] At least 30% of hysterectomies performed in the USA are for heavy menstrual bleeding.
#5 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#6 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#7 Menstrual bleeding patterns: A community-based cross-sectional study among women aged 18-45 years in Southern Brazil | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-11-26
Population variation in the duration and amount of menstrual bleeding has received little attention in the literature. […] Prevalence of heavy menstrual flow was 35.3% (95% CI 32.1-38.6%). […] Heavy menstrual bleeding is highly prevalent at the community level, and is associated with socio-demographic and anthropometric women’s characteristics, as well as with duration of menstruation, extra-bleeding and presence of clots. […] The main new findings of this study relate to the high prevalence of heavy menstrual bleeding in this population and to the increased prevalence in women with little formal education. […] The reported prevalence of extra-menstrual bleeding (9%) is similar to findings from other studies conducted in developing countries (1-11% of women report spotting or inter-menstrual bleeding).
#8 Heavy menstrual bleeding significantly affects quality of life – PubMed
https://pubmed.ncbi.nlm.nih.gov/24266506/
Objective: To investigate the prevalence of women subjectively experiencing heavy menstrual bleeding in the general population and their health-related quality of life (HRQoL) compared with women experiencing normal menstrual blood loss. […] We found that 32% of women experienced heavy menstrual bleeding, 39% normal menstrual blood loss, 15% light menstrual blood loss and 14% no menstruation. […] The SF-36 showed that women experiencing heavy menstrual bleeding had significantly worse HRQoL compared with women with normal menstrual bleeding in all domains. […] Of women 40-45 years old, 32% experience heavy menstrual bleeding. These women have significantly worse HRQoL compared with women with normal menstruation patterns.
#9 Heavy menstrual bleeding among women aged 18â50Â years living in Beijing, China: prevalence, risk factors, and impact on daily life | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0726-1
Heavy menstrual bleeding (HMB) has been shown to have a profound negative impact on womens quality of life and lead to increases in health care costs; however, data on HMB among Chinese population is still rather limited. […] Overall, 429 women experienced HMB, giving a prevalence of 18.2%. […] HMB was highly prevalent among Chinese women and those reporting heavy periods suffered from greater menstrual interference with daily lives. More information and health education programs are urgently needed to raise awareness of the consequences of HMB, encourage women to seek medical assistance and thus improve their quality of life. […] About 1 in 20 women aged 3049 years consult their general practitioner each year for HMB, which is the second highest-ranked reason for a hospital referral and accounts for 12% of all gynecologic referrals.
#10 Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000â2021: a longitudinal cohort survey study | The Medical Journal of Australia
https://www.mja.com.au/journal/2025/222/4/women-who-experience-heavy-menstrual-bleeding-prevalence-and-characteristics
Objectives: To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22-48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life. […] The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years; the proportion who reported often experiencing the condition increased from 6.1% to 12.1%. […] Heavy menstrual bleeding was reported by large minorities of women of reproductive age, and the proportion increased with age. Many women experience symptoms that have a substantial impact on their physical and mental health-related quality of life. […] The prevalence of heavy menstrual bleeding among women of reproductive age in Australia, and its change across the reproductive lifespan, are uncertain.
#11 Global Issue in Review: Heavy Menstrual Bleeding | Rollins School of Public Health | Emory University | Atlanta GA
https://sph.emory.edu/news/news-release/2023/10/global-issue-heavy-menstrual-bleeding.html
Heavy menstrual bleeding (heavy periods) is an understudied global health challenge. […] Sinharoy and Caruso’s multinational study showed heavy periods affected 47% of women across 10 settings in South Asia and sub-Saharan Africa. The CDC estimates that 20% of American women are impacted by heavy periods. […] This work shines a light on heavy periods and hopefully brings it out of the shadows. […] More research on the topic, education for the general public, and training for health care providers would help reduce stigma and allow people who menstruate to self-advocate and seek out the help they need.
#12 Global Issue in Review: Heavy Menstrual Bleeding | Rollins School of Public Health | Emory University | Atlanta GA
https://sph.emory.edu/news/news-release/2023/10/global-issue-heavy-menstrual-bleeding.html
Heavy menstrual bleeding (heavy periods) is an understudied global health challenge. […] Sinharoy and Caruso’s multinational study showed heavy periods affected 47% of women across 10 settings in South Asia and sub-Saharan Africa. The CDC estimates that 20% of American women are impacted by heavy periods. […] This work shines a light on heavy periods and hopefully brings it out of the shadows. […] More research on the topic, education for the general public, and training for health care providers would help reduce stigma and allow people who menstruate to self-advocate and seek out the help they need.
#13 Heavy Menstrual Bleeding | Pharmaceuticals | Bayer
https://www.bayer.com/en/pharma/heavy-menstrual-bleeding
Many women are unaware that heavy menstrual bleeding (HMB) is a medical condition and affecting womanâs quality of life. […] Heavy Menstrual Bleeding (HMB) is a medical condition in which excessive menstrual bleeding interferes with a womanâs quality of life. The condition can occur alone or in combination with other symptoms. […] On average, HMB affects one in three women at some point in their life and for the majority of women, there is no identifiable cause of HMB. […] Despite its effect and high incidence, many women are unaware that HMB is a medical condition. Almost 59% of the women affected believe that their condition is a normal part of having a period. […] Symptoms of HMB include: heavy and prolonged menstrual periods, symptoms of anemia such as tiredness, fatigue, shortness of breath, lower abdominal and pelvic pain. […] There are different contraceptive methods approved for the treatment of HMB, including products from Bayer. It is important for doctors and patients to discuss all available treatment options to ensure the patient receives the best medication for her.
#14 Prevalence and knowledge of heavy menstrual bleeding among gynecology outpatients by scanning a WeChat QR Code | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229123
The aim of this study was to assess menstrual blood loss (MBL) and knowledge of heavy menstrual bleeding (HMB) among the gynecology outpatients at Peking University Peoples Hospital […] HMB is a common abnormal uterine bleeding and is frequently found among Chinese gynecology outpatients. HMB has major impacts on a woman’s quality of life, affecting both physical and emotional health domains. […] There is a low level of awareness and understanding of HMB amongst women, which often leads to acceptance of the condition, without seeking the medical help. […] According to the HMB knowledge questionnaire, 63.2% (728/1152) of the patients knew nothing about HMB, while 34.5% (397/1152) had limited knowledge of HMB. […] It is estimated that one in three women is affected by HMB, but the prevalence varies according to how HMB is assessed.
#15 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
The most common causes of excessive menstrual bleeding are: Not ovulating every month (called „anovulation”); Having abnormal tissue in the uterus, such as polyps, fibroids, or adenomyosis; Having a condition that increases bleeding throughout the body (for example, a bleeding disorder); Certain medications, like „blood thinners” or the copper intrauterine device (IUD). […] If you have heavy menstrual bleeding, your health care provider will want to perform a physical exam, including a pelvic exam. They might recommend other tests, based on what they find during the exam. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding; Your preferences; Whether you want to prevent pregnancy; Whether you might want to be able to get pregnant in the future.
#16 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#17 Epidemiology of abnormal uterine bleeding â Primary Care Notebook
https://primarycarenotebook.com/pages/gynaecology/abnormal-uterine-bleeding-aub/epidemiology-of-abnormal-uterine-bleeding
Abnormal uterine bleeding and its subgroup, heavy menstrual bleeding (HMB) are common conditions present in 14-25% of women in the reproductive age group (1). […] HMB is the predominant complaint in patients with AUB. […] one in 20 women aged between 30 and 49 years will consult their GP each year with HMB (2). […] Around 800,000 women in the UK seek help annually for AUB. […] it is the fourth most common reason for referral to UK gynaecological services (1).
#18 Epidemiology â Primary Care Notebook
https://primarycarenotebook.com/pages/gynaecology/menorrhagia/epidemiology
menorrhagia is responsible for 12% of all gynaecological referrals annually (1) […] approximately 22% of healthy premenopausal women aged over 35 years are affected (1) […] around 1 in 20 women aged 30 to 49 will consult their GP because of heavy menstrual bleeding (2) […] during the early 1990s, around 60% of women presenting with heavy menstrual bleeding would undergo a hysterectomy (often as first line treatment) in order to resolve the problem (3).
#19 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#20 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#21 Heavy Menstrual Bleeding | Pharmaceuticals | Bayer
https://www.bayer.com/en/pharma/heavy-menstrual-bleeding
Many women are unaware that heavy menstrual bleeding (HMB) is a medical condition and affecting womanâs quality of life. […] Heavy Menstrual Bleeding (HMB) is a medical condition in which excessive menstrual bleeding interferes with a womanâs quality of life. The condition can occur alone or in combination with other symptoms. […] On average, HMB affects one in three women at some point in their life and for the majority of women, there is no identifiable cause of HMB. […] Despite its effect and high incidence, many women are unaware that HMB is a medical condition. Almost 59% of the women affected believe that their condition is a normal part of having a period. […] Symptoms of HMB include: heavy and prolonged menstrual periods, symptoms of anemia such as tiredness, fatigue, shortness of breath, lower abdominal and pelvic pain. […] There are different contraceptive methods approved for the treatment of HMB, including products from Bayer. It is important for doctors and patients to discuss all available treatment options to ensure the patient receives the best medication for her.
#22 Prevalence and knowledge of heavy menstrual bleeding among gynecology outpatients by scanning a WeChat QR Code | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229123
The aim of this study was to assess menstrual blood loss (MBL) and knowledge of heavy menstrual bleeding (HMB) among the gynecology outpatients at Peking University Peoples Hospital […] HMB is a common abnormal uterine bleeding and is frequently found among Chinese gynecology outpatients. HMB has major impacts on a woman’s quality of life, affecting both physical and emotional health domains. […] There is a low level of awareness and understanding of HMB amongst women, which often leads to acceptance of the condition, without seeking the medical help. […] According to the HMB knowledge questionnaire, 63.2% (728/1152) of the patients knew nothing about HMB, while 34.5% (397/1152) had limited knowledge of HMB. […] It is estimated that one in three women is affected by HMB, but the prevalence varies according to how HMB is assessed.
#23 Heavy menstrual bleeding significantly affects quality of life – PubMed
https://pubmed.ncbi.nlm.nih.gov/24266506/
Objective: To investigate the prevalence of women subjectively experiencing heavy menstrual bleeding in the general population and their health-related quality of life (HRQoL) compared with women experiencing normal menstrual blood loss. […] We found that 32% of women experienced heavy menstrual bleeding, 39% normal menstrual blood loss, 15% light menstrual blood loss and 14% no menstruation. […] The SF-36 showed that women experiencing heavy menstrual bleeding had significantly worse HRQoL compared with women with normal menstrual bleeding in all domains. […] Of women 40-45 years old, 32% experience heavy menstrual bleeding. These women have significantly worse HRQoL compared with women with normal menstruation patterns.
#24 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
Most menstrual cycles (periods) occur every 24 to 38 days (as measured from the first day of one bleeding episode to the first day of the next); the average is every 28 days. In a normal menstrual cycle, a person loses an average of 2 to 3 tablespoons (35 to 40 milliliters) of blood over four to eight days. However, some people lose a lot more blood or bleed for a longer duration (prolonged periods). Doctors define „heavy” periods as bleeding so much that it affects your physical health, emotional health, or quality of life. […] Heavy periods (which doctors sometimes call „menorrhagia”) can lead to low iron stores and iron deficiency anemia (low red blood cell count caused by ongoing excessive blood loss), which can cause fatigue, weakness, and other symptoms. […] Several treatments for heavy bleeding are available.
#25 Prevalence and knowledge of heavy menstrual bleeding among gynecology outpatients by scanning a WeChat QR Code | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229123
Among our patients, 64.6% (62/96) from the HMB group and 3.6% (2/56) from the normal blood loss group suffered from anemia. […] AUB is one of the common diseases encountered in gynecology clinics. In the present study, 60.8% of the patients were diagnosed with AUB, with HMB being the most common clinical manifestation (94.0%). […] This study showed that there is a low level of awareness and understanding of HMB amongst our patients.
#26 Epidemiology of menstrual-related absenteeism in 44 low and middle-income countries | medRxiv
https://www.medrxiv.org/content/10.1101/2024.05.07.24307016v1
Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women and girls daily lives and exacerbates gender inequality. […] The pooled global prevalence of menstrual-related absenteeism was 150% [95% CI: 127-173], with the highest prevalence in South Asia (197% [116-278]) and West and Central Africa (185% [135-235]). […] Menstrual-related absenteeism is prevalent, especially in Asia and Africa, and particularly in adolescent girls. […] Our work identified menstrual-related absenteeism as a common health concern for women and girls in LMICs, particularly in South Asia and parts of sub-Saharan Africa. Adolescents and young women were at the highest risk of menstrual-related absenteeism, hereby identifying this population as a key priority for future menstrual health programs and research.
#27 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
The most common causes of excessive menstrual bleeding are: Not ovulating every month (called „anovulation”); Having abnormal tissue in the uterus, such as polyps, fibroids, or adenomyosis; Having a condition that increases bleeding throughout the body (for example, a bleeding disorder); Certain medications, like „blood thinners” or the copper intrauterine device (IUD). […] If you have heavy menstrual bleeding, your health care provider will want to perform a physical exam, including a pelvic exam. They might recommend other tests, based on what they find during the exam. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding; Your preferences; Whether you want to prevent pregnancy; Whether you might want to be able to get pregnant in the future.
#28 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#29 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#30 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#31 Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000â2021: a longitudinal cohort survey study | The Medical Journal of Australia
https://www.mja.com.au/journal/2025/222/4/women-who-experience-heavy-menstrual-bleeding-prevalence-and-characteristics
Objectives: To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22-48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life. […] The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years; the proportion who reported often experiencing the condition increased from 6.1% to 12.1%. […] Heavy menstrual bleeding was reported by large minorities of women of reproductive age, and the proportion increased with age. Many women experience symptoms that have a substantial impact on their physical and mental health-related quality of life. […] The prevalence of heavy menstrual bleeding among women of reproductive age in Australia, and its change across the reproductive lifespan, are uncertain.
#32 Menstrual bleeding patterns: A community-based cross-sectional study among women aged 18-45 years in Southern Brazil | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-11-26
Population variation in the duration and amount of menstrual bleeding has received little attention in the literature. […] Prevalence of heavy menstrual flow was 35.3% (95% CI 32.1-38.6%). […] Heavy menstrual bleeding is highly prevalent at the community level, and is associated with socio-demographic and anthropometric women’s characteristics, as well as with duration of menstruation, extra-bleeding and presence of clots. […] The main new findings of this study relate to the high prevalence of heavy menstrual bleeding in this population and to the increased prevalence in women with little formal education. […] The reported prevalence of extra-menstrual bleeding (9%) is similar to findings from other studies conducted in developing countries (1-11% of women report spotting or inter-menstrual bleeding).
#33 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] The frequency of bleeding disorders in the general population is approximately 12%, but bleeding disorders are found in approximately 20% of adolescent girls who present for evaluation of heavy menstrual bleeding and in 33% of adolescent girls hospitalized for heavy menstrual bleeding. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder.
#34 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] The frequency of bleeding disorders in the general population is approximately 12%, but bleeding disorders are found in approximately 20% of adolescent girls who present for evaluation of heavy menstrual bleeding and in 33% of adolescent girls hospitalized for heavy menstrual bleeding. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder.
#35 Abnormal Uterine Bleeding in Premenopausal Women | AAFP
https://www.aafp.org/pubs/afp/issues/2019/0401/p435.html
Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age. It negatively affects quality of life and is associated with financial loss, decreased productivity, poor health, and increased use of health care resources. In 2011 the International Federation of Gynecology and Obstetrics convened a working group that produced standardized definitions and classifications for menstrual disorders, which the American College of Obstetricians and Gynecologists subsequently endorsed. The 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is more effective than other medical therapies for reducing heavy menstrual bleeding. Hysterectomy is the most effective treatment for reducing heavy menstrual bleeding. […] The most common causes of abnormal uterine bleeding are described with the acronym PALM-COEIN. The etiologies in the PALM group (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia) are structural and can be imaged or biopsied. The etiologies in the COEIN group (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified) are nonstructural. […] Approximately 20% of patients with heavy menstrual bleeding have a bleeding disorder, and the prevalence in adolescent girls who bleed heavily is even higher.
#36 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
Heavy menstrual bleeding (HMB) is a common clinical condition affecting adolescent and adult women and compromising their quality of life. […] The goal of this study was to create an informative, comprehensive review of the primary hemostasis disorders that have been linked to HMB. This study provides a summary of the basic published information regarding epidemiology, pathophysiology, clinical phenotype, diagnosis, and treatment of HMB in those diseases and serves as a reference guide for further reading. […] It is estimated that 10â62% of adolescents with heavy menstrual bleeding (HMB) may have an underlying inherited bleeding disorderâcoagulopathy. […] Heavy menstrual bleeding is the subcategory of AUB characterized by increased menstrual bleeding and/or prolonged bleeding (over 7 days).
#37 (PDF) Epidemiology of abnormal uterine bleeding
https://www.academia.edu/28195863/Epidemiology_of_abnormal_uterine_bleeding
Menstrual dysfunction is a common cause of referral to the gynaecology clinic, and the problem has a considerable impact on the health status and the quality of life of women. […] The spectrum of abnormal uterine bleeding comprises of menorrhagia (heavy periods; blood loss 80 mL), metrorrhagia (prolonged, irregular periods), polymenorrhoea (frequent periods), oligomenorrhoea (scanty and infrequent periods), amenorrhoea (absent menstrual periods), intermenstrual bleeding and postcoital bleeding. […] In a survey carried out in Nepal (96 school girls with an age range of 11-17 years), menorrhagia was identified in 6.2% of girls. […] The most common inherited disorder in women with symptoms of menorrhagia is von Willebrand disease. […] Abnormal uterine bleeding (AUB) is a common reason for women of all ages to consult their gynecologist and is one of the most common debilitating menstrual problems ending up in hysterectomy in developing countries.
#38 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
HMB is the most commonly reported symptom among women of reproductive age with VWD. […] The clinical picture of patients with VWD varies according to the level of residual VWF activity, the category of disease, as well as age and sex. […] The majority of patients (60 to 80%) experience bleeding following surgery or dental extractions. […] HMB can be especially dangerous at menarche due to the prolonged anovulatory cycles that increase the bleeding risk during the first periods. […] The prevalence of symptomatic VWD is estimated to be around 1 in 1000 (making it a rare diagnosis) it is difficult to conduct large randomized controlled trials with a sufficient number of participants. […] The 2021 ASH Recommendations are in line with the results of the, suggesting either hormonal therapyâCombined Hormonal Contraceptives or LNG-IUSâor tranexamic acid over desmopressin for women with VWD and HMB who do not wish to conceive, and tranexamic acid over desmopressin for those who wish to.
#39 Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000â2021: a longitudinal cohort survey study | The Medical Journal of Australia
https://www.mja.com.au/journal/2025/222/4/women-who-experience-heavy-menstrual-bleeding-prevalence-and-characteristics
Serial surveys of a cohort of Australian women found that at age 22 years 17.6% reported heavy bleeding during the preceding twelve months, rising to 39.3% of women aged 48 years who menstruated. Higher body mass index, iron deficiency, and endometriosis were associated with heavy bleeding. Health-related quality of life was poorer for women who experienced heavy menstrual bleeding. […] Given the burden of the condition, it is important that Australian women are aware of and have access to effective care for heavy menstrual bleeding.
#40 Obesity is associated with heavy menstruation that may be due to delayed endometrial repair in: Journal of Endocrinology Volume 249 Issue 2 (2021)
https://joe.bioscientifica.com/view/journals/joe/249/2/JOE-20-0446.xml
Heavy menstrual bleeding is common and debilitating but the causes remain ill defined. […] Rates of obesity in women are increasing and its impact on menstrual blood loss (MBL) is unknown. […] In conclusion, obesity was associated with increased MBL in women. […] Our results indicate that obesity results in a more pro-inflammatory local endometrial environment at menstruation, which may delay endometrial repair and increase menstrual blood loss. […] Heavy menstrual bleeding (HMB) is one of the most common reasons for referral to gynaecology clinics with greater than 800,000 women seeking treatment per year in the United Kingdom alone. […] Subjectively, HMB is defined as excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.
#41 Obesity is associated with heavy menstruation that may be due to delayed endometrial repair in: Journal of Endocrinology Volume 249 Issue 2 (2021)
https://joe.bioscientifica.com/view/journals/joe/249/2/JOE-20-0446.xml
We hypothesised that a high BMI would result in increased menstrual blood loss and contribute to the symptom of HMB. […] Current evidence indicates that hypoxia is required for efficient endometrial repair in both women and the mouse model of simulated menses and that increased endometrial inflammation is associated with HMB. […] Heavy menstrual bleeding, defined as a PBAC score 80 mL, was present in 63% of participants. […] Women with obesity (BMI 30) constituted 25% of all participants. […] Mice on a high fat diet had significantly delayed endometrial repair vs those on a normal diet. […] The impact of obesity on menstrual blood loss has been scarcely reported in the literature and we believe our results provide new evidence that increased body weight may contribute to heavy menstrual bleeding.
#42 Obesity is associated with heavy menstruation that may be due to delayed endometrial repair in: Journal of Endocrinology Volume 249 Issue 2 (2021)
https://joe.bioscientifica.com/view/journals/joe/249/2/JOE-20-0446.xml
We hypothesised that a high BMI would result in increased menstrual blood loss and contribute to the symptom of HMB. […] Current evidence indicates that hypoxia is required for efficient endometrial repair in both women and the mouse model of simulated menses and that increased endometrial inflammation is associated with HMB. […] Heavy menstrual bleeding, defined as a PBAC score 80 mL, was present in 63% of participants. […] Women with obesity (BMI 30) constituted 25% of all participants. […] Mice on a high fat diet had significantly delayed endometrial repair vs those on a normal diet. […] The impact of obesity on menstrual blood loss has been scarcely reported in the literature and we believe our results provide new evidence that increased body weight may contribute to heavy menstrual bleeding.
#43 Obesity is associated with heavy menstruation that may be due to delayed endometrial repair in: Journal of Endocrinology Volume 249 Issue 2 (2021)
https://joe.bioscientifica.com/view/journals/joe/249/2/JOE-20-0446.xml
Heavy menstrual bleeding is common and debilitating but the causes remain ill defined. […] Rates of obesity in women are increasing and its impact on menstrual blood loss (MBL) is unknown. […] In conclusion, obesity was associated with increased MBL in women. […] Our results indicate that obesity results in a more pro-inflammatory local endometrial environment at menstruation, which may delay endometrial repair and increase menstrual blood loss. […] Heavy menstrual bleeding (HMB) is one of the most common reasons for referral to gynaecology clinics with greater than 800,000 women seeking treatment per year in the United Kingdom alone. […] Subjectively, HMB is defined as excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.
#44 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
The most common causes of excessive menstrual bleeding are: Not ovulating every month (called „anovulation”); Having abnormal tissue in the uterus, such as polyps, fibroids, or adenomyosis; Having a condition that increases bleeding throughout the body (for example, a bleeding disorder); Certain medications, like „blood thinners” or the copper intrauterine device (IUD). […] If you have heavy menstrual bleeding, your health care provider will want to perform a physical exam, including a pelvic exam. They might recommend other tests, based on what they find during the exam. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding; Your preferences; Whether you want to prevent pregnancy; Whether you might want to be able to get pregnant in the future.
#45 Heavy menstrual bleeding among women aged 18â50Â years living in Beijing, China: prevalence, risk factors, and impact on daily life | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0726-1
Our results showed that having multiple abortions (3) was associated with an increased risk of HMB, while no incremental risk was found among women with fewer numbers of abortions. […] HMB and multiple abortions (3) may have shared common etiologies, such as underlying bleeding disorders, which can partly explain the observed correlation between these two conditions. […] To our knowledge, this study is also the first one to examine the perceived impact of HMB on womens daily lives in a Chinese population. […] Our study also has limitations. […] In conclusion, HMB was a highly prevalent gynecological symptom among women of reproductive age living in Beijing, China.
#46 Menstrual bleeding patterns: A community-based cross-sectional study among women aged 18-45 years in Southern Brazil | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-11-26
Reported heavy menstrual bleeding is highly prevalent at the community level and is related to older age, low formal education, obesity, higher number of pregnancies, as well as with other features of menstruation, like longer periods, extra-menstrual bleeding, and clots in the flow. On the other hand, hormonal contraception is protective against heavy menses.
#47
#48 Menorrhagia | Study 14697 | Bayer – Clinical Trials Explorer
https://clinicaltrials.bayer.com/study/14697/
The aim of this prospective, non-interventional post-marketing surveillance study is to obtain data on safety and efficacy of Mirena in treatment of prolonged or heavy menstrual bleeding (Menorrhagia) under daily-life treatment conditions. […] Women complaining of heavy menstrual bleeding over several consecutive cycles […] The contraindications and warnings of the respective Summary of Product Characteristics (Mirena, combined oral contraceptives, oral/injectable progestogens, non-steroidal anti-inflammatory drug, or anti-fibrinolytic agent) must be followed. […] Women on anticoagulative therapy or other treatment (including e.g. Copper IUD use) known to cause menorrhagia.
#49 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#50 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
The most common causes of excessive menstrual bleeding are: Not ovulating every month (called „anovulation”); Having abnormal tissue in the uterus, such as polyps, fibroids, or adenomyosis; Having a condition that increases bleeding throughout the body (for example, a bleeding disorder); Certain medications, like „blood thinners” or the copper intrauterine device (IUD). […] If you have heavy menstrual bleeding, your health care provider will want to perform a physical exam, including a pelvic exam. They might recommend other tests, based on what they find during the exam. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding; Your preferences; Whether you want to prevent pregnancy; Whether you might want to be able to get pregnant in the future.
#51 Menorrhagia: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/255540-overview
Menorrhagia remains a leading reason for gynecologic office visits, only 10-20% of all menstruating women experience blood loss severe enough to be defined clinically as menorrhagia. […] Any woman of reproductive age who is menstruating may develop menorrhagia. Most patients with menorrhagia are older than 30 years. The most common cause of heavy menstrual bleeding in adolescents is persistent anovulation, though other common etiologies include coagulopathies and pregnancy. After adolescence, menorrhagia most frequently results from structural lesions, like leiomyomas, polyps, in addition to anovulatory cycles and endometrial hyperplasia.
#52 Menorrhagia – almostadoctor
https://almostadoctor.co.uk/encyclopedia/menorrhagia
Menorrhagia is a common presenting compliant, and a cause is not always found. Endometrial carcinoma should always be considered as a differential. […] Up to 30% of women report having heavy periods, however only about 5% of women will consult their GP for the problem. […] 30% of women report heavy periods […] When measuring menstrual loss, and using a cut-off of 80mls per menses, the prevalence of menorrhagia is between 10-15%. […] About 50% of cases then present medically have no cause identified and as such are diagnosed as Dysfunctional Uterine Bleeding (DUB) a diagnosis of exclusion.
#53 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] The frequency of bleeding disorders in the general population is approximately 12%, but bleeding disorders are found in approximately 20% of adolescent girls who present for evaluation of heavy menstrual bleeding and in 33% of adolescent girls hospitalized for heavy menstrual bleeding. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder.
#54 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding
Adolescents in whom a bleeding disorder has been diagnosed should be reminded that products that prevent platelet adhesion, such as aspirin or nonsteroidal antiinflammatory drugs, should be used only with the recommendation of a hematologist. […] Proportionally, adolescent girls are more likely than women to have an underlying bleeding disorder as a cause of heavy menstrual bleeding. Screening for bleeding disorders and iron deficiency anemia should be included in the initial evaluation of girls with heavy menstrual bleeding.
#55 Menorrhagia: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/255540-overview
Menorrhagia remains a leading reason for gynecologic office visits, only 10-20% of all menstruating women experience blood loss severe enough to be defined clinically as menorrhagia. […] Any woman of reproductive age who is menstruating may develop menorrhagia. Most patients with menorrhagia are older than 30 years. The most common cause of heavy menstrual bleeding in adolescents is persistent anovulation, though other common etiologies include coagulopathies and pregnancy. After adolescence, menorrhagia most frequently results from structural lesions, like leiomyomas, polyps, in addition to anovulatory cycles and endometrial hyperplasia.
#56 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
HMB is the most commonly reported symptom among women of reproductive age with VWD. […] The clinical picture of patients with VWD varies according to the level of residual VWF activity, the category of disease, as well as age and sex. […] The majority of patients (60 to 80%) experience bleeding following surgery or dental extractions. […] HMB can be especially dangerous at menarche due to the prolonged anovulatory cycles that increase the bleeding risk during the first periods. […] The prevalence of symptomatic VWD is estimated to be around 1 in 1000 (making it a rare diagnosis) it is difficult to conduct large randomized controlled trials with a sufficient number of participants. […] The 2021 ASH Recommendations are in line with the results of the, suggesting either hormonal therapyâCombined Hormonal Contraceptives or LNG-IUSâor tranexamic acid over desmopressin for women with VWD and HMB who do not wish to conceive, and tranexamic acid over desmopressin for those who wish to.
#57 Epidemiology of menstrual-related absenteeism in 44 low and middle-income countries | medRxiv
https://www.medrxiv.org/content/10.1101/2024.05.07.24307016v1
Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women and girls daily lives and exacerbates gender inequality. […] The pooled global prevalence of menstrual-related absenteeism was 150% [95% CI: 127-173], with the highest prevalence in South Asia (197% [116-278]) and West and Central Africa (185% [135-235]). […] Menstrual-related absenteeism is prevalent, especially in Asia and Africa, and particularly in adolescent girls. […] Our work identified menstrual-related absenteeism as a common health concern for women and girls in LMICs, particularly in South Asia and parts of sub-Saharan Africa. Adolescents and young women were at the highest risk of menstrual-related absenteeism, hereby identifying this population as a key priority for future menstrual health programs and research.
#58 Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres
https://stacks.cdc.gov/view/cdc/33778
Inherited bleeding disorders are especially problematic for affected girls and women due to the monthly occurrence of menstrual periods and the effects on reproductive health. […] Although heavy menstrual bleeding (HMB) is the most common manifestation, females with inherited bleeding disorders (FBD) experience other bleeding symptoms throughout the lifespan that can lead to increased morbidity and impairment of daily activities. […] HMB was the most common bleeding symptom (198/253; 78.3%); however, 157 (49.2%) participants reported greater than four symptoms. […] The female UDC is the first prospective, longitudinal surveillance in the US focusing on FBD and has the potential to further identify complications and reduce adverse outcomes in this population.
#59 Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres
https://stacks.cdc.gov/view/cdc/33778
Inherited bleeding disorders are especially problematic for affected girls and women due to the monthly occurrence of menstrual periods and the effects on reproductive health. […] Although heavy menstrual bleeding (HMB) is the most common manifestation, females with inherited bleeding disorders (FBD) experience other bleeding symptoms throughout the lifespan that can lead to increased morbidity and impairment of daily activities. […] HMB was the most common bleeding symptom (198/253; 78.3%); however, 157 (49.2%) participants reported greater than four symptoms. […] The female UDC is the first prospective, longitudinal surveillance in the US focusing on FBD and has the potential to further identify complications and reduce adverse outcomes in this population.
#60 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
The frequency of HMB among women with ITP ranged from 6% to 55% among the eight included studies. […] Heavy menstrual bleeding can be an important clinical manifestation in the course of the disease. […] According to a systematic review by Marieke C. Punt et al. that included data from 4 cohort studies, overall, 25% of women with BernardâSoulier syndrome (13/52) have a present or past history of HMB. […] In a cohort study including 386 women with hypermobility type Ehlers-Danlos syndrome, 76% of them had a history of menorrhagia/HMB. […] In another study, including 82 post pubertal women with hEDS, 53.7% had AUB. […] HMB associated with hypermobility spectrum disorders not only seems to be common but also quite often to negatively impact the quality of life or end up being life-threatening.
#61 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
The frequency of HMB among women with ITP ranged from 6% to 55% among the eight included studies. […] Heavy menstrual bleeding can be an important clinical manifestation in the course of the disease. […] According to a systematic review by Marieke C. Punt et al. that included data from 4 cohort studies, overall, 25% of women with BernardâSoulier syndrome (13/52) have a present or past history of HMB. […] In a cohort study including 386 women with hypermobility type Ehlers-Danlos syndrome, 76% of them had a history of menorrhagia/HMB. […] In another study, including 82 post pubertal women with hEDS, 53.7% had AUB. […] HMB associated with hypermobility spectrum disorders not only seems to be common but also quite often to negatively impact the quality of life or end up being life-threatening.
#62 Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres
https://stacks.cdc.gov/view/cdc/33778
Inherited bleeding disorders are especially problematic for affected girls and women due to the monthly occurrence of menstrual periods and the effects on reproductive health. […] Although heavy menstrual bleeding (HMB) is the most common manifestation, females with inherited bleeding disorders (FBD) experience other bleeding symptoms throughout the lifespan that can lead to increased morbidity and impairment of daily activities. […] HMB was the most common bleeding symptom (198/253; 78.3%); however, 157 (49.2%) participants reported greater than four symptoms. […] The female UDC is the first prospective, longitudinal surveillance in the US focusing on FBD and has the potential to further identify complications and reduce adverse outcomes in this population.
#63 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
The frequency of HMB among women with ITP ranged from 6% to 55% among the eight included studies. […] Heavy menstrual bleeding can be an important clinical manifestation in the course of the disease. […] According to a systematic review by Marieke C. Punt et al. that included data from 4 cohort studies, overall, 25% of women with BernardâSoulier syndrome (13/52) have a present or past history of HMB. […] In a cohort study including 386 women with hypermobility type Ehlers-Danlos syndrome, 76% of them had a history of menorrhagia/HMB. […] In another study, including 82 post pubertal women with hEDS, 53.7% had AUB. […] HMB associated with hypermobility spectrum disorders not only seems to be common but also quite often to negatively impact the quality of life or end up being life-threatening.
#64 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
The frequency of HMB among women with ITP ranged from 6% to 55% among the eight included studies. […] Heavy menstrual bleeding can be an important clinical manifestation in the course of the disease. […] According to a systematic review by Marieke C. Punt et al. that included data from 4 cohort studies, overall, 25% of women with BernardâSoulier syndrome (13/52) have a present or past history of HMB. […] In a cohort study including 386 women with hypermobility type Ehlers-Danlos syndrome, 76% of them had a history of menorrhagia/HMB. […] In another study, including 82 post pubertal women with hEDS, 53.7% had AUB. […] HMB associated with hypermobility spectrum disorders not only seems to be common but also quite often to negatively impact the quality of life or end up being life-threatening.
#65 Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age
https://www.mdpi.com/2077-0383/12/17/5702
The frequency of HMB among women with ITP ranged from 6% to 55% among the eight included studies. […] Heavy menstrual bleeding can be an important clinical manifestation in the course of the disease. […] According to a systematic review by Marieke C. Punt et al. that included data from 4 cohort studies, overall, 25% of women with BernardâSoulier syndrome (13/52) have a present or past history of HMB. […] In a cohort study including 386 women with hypermobility type Ehlers-Danlos syndrome, 76% of them had a history of menorrhagia/HMB. […] In another study, including 82 post pubertal women with hEDS, 53.7% had AUB. […] HMB associated with hypermobility spectrum disorders not only seems to be common but also quite often to negatively impact the quality of life or end up being life-threatening.
#66 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#67 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology
https://www.nature.com/articles/s41574-021-00629-4
Menstruation is a physiological process that is typically uncomplicated. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. […] AUB is a debilitating symptom that affects up to one third of reproductive-aged women; comprehensive knowledge of menstrual cycle physiology is crucial for understanding and progressing endometrial physiology research. […] There is a high prevalence of iron deficiency and iron deficiency anaemia in those with AUB, on a global scale, and this is often under-recognized and under-reported. […] The terminology and definitions for diagnosing causes of AUB are now standardized in the International Federation of Gynecology and Obstetrics Systems 1 and 2, and should be followed for ease of clinical and research synchrony.
#68 Patient education: Heavy periods (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/heavy-periods-beyond-the-basics
Most menstrual cycles (periods) occur every 24 to 38 days (as measured from the first day of one bleeding episode to the first day of the next); the average is every 28 days. In a normal menstrual cycle, a person loses an average of 2 to 3 tablespoons (35 to 40 milliliters) of blood over four to eight days. However, some people lose a lot more blood or bleed for a longer duration (prolonged periods). Doctors define „heavy” periods as bleeding so much that it affects your physical health, emotional health, or quality of life. […] Heavy periods (which doctors sometimes call „menorrhagia”) can lead to low iron stores and iron deficiency anemia (low red blood cell count caused by ongoing excessive blood loss), which can cause fatigue, weakness, and other symptoms. […] Several treatments for heavy bleeding are available.
#69 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
Heavy menstrual bleeding is killing women, but it is not being treated as a global health priority. This urgently needs to change. […] There are three steps in this dance to death: heavy periods, anaemia, and death during childbirth. Heavy menstrual bleeding causes anaemia in young women, anaemia increases the risk of severe bleeding after childbirth, and this bleeding is the leading killer of mothers worldwide. […] Each year, 14 million women globally develop postpartum haemorrhage (PPH) or severe bleeding after childbirth and over 50,000 of these women die. Most of these deaths are in low- and middle-income countries where the prevalence of anaemia is highest and many women lack access to healthcare and life-saving treatment. […] Although women in low- and middle-income countries are worst affected, PPH is a problem everywhere and one that exposes deep health and societal inequalities as, in high-income countries, deaths from PPH are higher among black women and women of colour.
#70 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
Heavy menstrual bleeding is killing women, but it is not being treated as a global health priority. This urgently needs to change. […] There are three steps in this dance to death: heavy periods, anaemia, and death during childbirth. Heavy menstrual bleeding causes anaemia in young women, anaemia increases the risk of severe bleeding after childbirth, and this bleeding is the leading killer of mothers worldwide. […] Each year, 14 million women globally develop postpartum haemorrhage (PPH) or severe bleeding after childbirth and over 50,000 of these women die. Most of these deaths are in low- and middle-income countries where the prevalence of anaemia is highest and many women lack access to healthcare and life-saving treatment. […] Although women in low- and middle-income countries are worst affected, PPH is a problem everywhere and one that exposes deep health and societal inequalities as, in high-income countries, deaths from PPH are higher among black women and women of colour.
#71 Heavy menstrual bleeding significantly affects quality of life – PubMed
https://pubmed.ncbi.nlm.nih.gov/24266506/
Objective: To investigate the prevalence of women subjectively experiencing heavy menstrual bleeding in the general population and their health-related quality of life (HRQoL) compared with women experiencing normal menstrual blood loss. […] We found that 32% of women experienced heavy menstrual bleeding, 39% normal menstrual blood loss, 15% light menstrual blood loss and 14% no menstruation. […] The SF-36 showed that women experiencing heavy menstrual bleeding had significantly worse HRQoL compared with women with normal menstrual bleeding in all domains. […] Of women 40-45 years old, 32% experience heavy menstrual bleeding. These women have significantly worse HRQoL compared with women with normal menstruation patterns.
#72 Abnormal Uterine Bleeding in Premenopausal Women | AAFP
https://www.aafp.org/pubs/afp/issues/2019/0401/p435.html
Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age. It negatively affects quality of life and is associated with financial loss, decreased productivity, poor health, and increased use of health care resources. In 2011 the International Federation of Gynecology and Obstetrics convened a working group that produced standardized definitions and classifications for menstrual disorders, which the American College of Obstetricians and Gynecologists subsequently endorsed. The 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is more effective than other medical therapies for reducing heavy menstrual bleeding. Hysterectomy is the most effective treatment for reducing heavy menstrual bleeding. […] The most common causes of abnormal uterine bleeding are described with the acronym PALM-COEIN. The etiologies in the PALM group (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia) are structural and can be imaged or biopsied. The etiologies in the COEIN group (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified) are nonstructural. […] Approximately 20% of patients with heavy menstrual bleeding have a bleeding disorder, and the prevalence in adolescent girls who bleed heavily is even higher.
#73 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
In Turkey, abnormal uterine bleeding was the third most commonly reported gynecological complaint and the fourth most commonly diagnosed gynecological morbidity among adult women, while among adolescents who consulted a gynecologist menstrual disorders and dysmenorrhea were the most common complaints. […] Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. […] Findings of the study reinforce the need to provide menstrual health care services at the primary level. […] Data on nature and prevalence of menstrual disorders and their effect on young women’s health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. […] The results showed high prevalence of menstrual ailments among participants, the highest prevalence was pre-menstrual syndrome and dysmenorrhea. […] According to the impact, 38% of participants stated that they miss home activities, and 31% stated getting a sick leave due to menstrual ailments.
#74
#75 Menorrhagia(Archived) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK536910/
Abnormal uterine bleeding, or menorrhagia as previously classified, is a predominant complication among women in the United States that is related to the major impacts of women’s quality of life, productivity, and healthcare cost. Reports are that the annual prevalence rate is 53 per 1000 women. In the outpatient setting, AUB is one of the leading causes of outpatient gynecological visits with 20-30% of women presenting with this complaint annually. […] At least 30% of hysterectomies performed in the USA are for heavy menstrual bleeding.
#76 Menorrhagia(Archived) – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK536910/
Abnormal uterine bleeding, or menorrhagia as previously classified, is a predominant complication among women in the United States that is related to the major impacts of women’s quality of life, productivity, and healthcare cost. Reports are that the annual prevalence rate is 53 per 1000 women. In the outpatient setting, AUB is one of the leading causes of outpatient gynecological visits with 20-30% of women presenting with this complaint annually. […] At least 30% of hysterectomies performed in the USA are for heavy menstrual bleeding.
#77 Epidemiology â Primary Care Notebook
https://primarycarenotebook.com/pages/gynaecology/menorrhagia/epidemiology
menorrhagia is responsible for 12% of all gynaecological referrals annually (1) […] approximately 22% of healthy premenopausal women aged over 35 years are affected (1) […] around 1 in 20 women aged 30 to 49 will consult their GP because of heavy menstrual bleeding (2) […] during the early 1990s, around 60% of women presenting with heavy menstrual bleeding would undergo a hysterectomy (often as first line treatment) in order to resolve the problem (3).
#78 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#79 For Healthcare Providers: Managing Menorrhagia Without Surgery – CemCOR
https://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery
Officially, flow of more than 80 ml per menstrual period is considered menorrhagia. 80% of women bleeding this heavily will have one or more laboratory evidences of iron deficiency. However, statistically, the maximum flow should be between 45 and 60 ml per cycle. Menorrhagia is most common in adolescence and in perimenopause, both are times of the lifecycle in which estrogen exposure exceeds and is out of balance with the amount of progesterone produced. Most women with menorrhagia report regular periods and have been shown to have normal estrogen and progesterone levels. In perimenopause, approximately 25% of women will have at least one episode of heavy flow. Very rarely is menorrhagia caused by a primary bleeding disorder. About 40-50% of North American women have had hysterectomy for benign reasons, allegedly for fibroids or menorrhagia. Thus surgical therapies are rarely necessary for menorrhagia and should never be the first approach to treatment. In summary, menorrhagia meaning blood loss of 80 ml or 16 soaked regular sanitary products or more per cycle occurs in 25% of Very Early Perimenopausal or early menopause transition women as well as in fewer adolescents and premenopausal women of any age.
#80 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology
https://www.nature.com/articles/s41574-021-00629-4
Treatments for AUB are not specific and a third of patients resort to a hysterectomy for resolution of symptoms, highlighting a clinically unmet need for more targeted and personalized treatments. […] A detailed review of the key risk factors related to uterine fibroids, highlighting the importance of race in the epidemiology of fibroids.
#81 Menorrhagia (Heavy Periods) | Doctor
https://patient.info/doctor/menorrhagia
Menorrhagia is a very common complaint: […] The prevalence of menorrhagia increases with age, peaking in women aged 30-49 years. 5% of women aged 30-49 years in the UK consult their GP each year due to excessive uterine bleeding. […] The perception of what constitutes 'heavy’ menstrual bleeding is subjective. The prevalence of menorrhagia ranges from 9-14% in studies that assess menstrual blood loss objectively by measuring it, but is much higher (20-52%) in studies which are based on subjective assessment. […] Menstrual disorders are the second most common gynaecological condition to be referred to hospital, accounting for around 12% of all gynaecological referrals.
#82 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
This systematic review examines the prevalence of menstrual disorders among women in developing countries, highlighting a significant lack of attention to this aspect of women’s health within global health priorities. […] Despite the negative impact menstrual disorders have on quality of life and social integration, they are often overlooked in reproductive health programs. […] The paper consolidates data from various studies conducted between 1970 and 2002 to underscore the importance of including the evaluation and treatment of menstrual complaints in primary care programs. […] Menstrual dysfunction, like other aspects of sexual and reproductive health, is not included in the Global Burden of Disease estimates and, even as reproductive health programs expand their focus to address gynecologic morbidity, the utility of evaluating and treating menstrual problems is not generally considered.
#83 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
The contribution of heavy menstrual bleeding to anaemia and in turn to PPH is under-recognised by health professionals. A 2020 WHO report on global efforts to prevent anaemia in women of reproductive age completely overlooked heavy menstrual bleeding. […] Although research shows that a woman’s iron stores depend more on her menstrual blood loss than on her dietary iron intake, global efforts to prevent anaemia largely focus on nutrition and supplementation. […] Global health professionals tend to attribute PPH cases to the failure of the womb to contract. This diagnosis ignores other causes like anaemia from heavy periods. […] The WOMAN-2 Trial is currently looking into whether giving TXA can prevent PPH and other severe outcomes in women with moderate and severe anaemia. The results will be published later this year and will provide the evidence needed to address this critical gap in healthcare. […] Tens of thousands of women who die from PPH could be saved each year. It’s time we stopped turning a blind eye to the causes and work together to make sure all women, wherever they are in the world, have access to their right to a safe childbirth.
#84 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
The contribution of heavy menstrual bleeding to anaemia and in turn to PPH is under-recognised by health professionals. A 2020 WHO report on global efforts to prevent anaemia in women of reproductive age completely overlooked heavy menstrual bleeding. […] Although research shows that a woman’s iron stores depend more on her menstrual blood loss than on her dietary iron intake, global efforts to prevent anaemia largely focus on nutrition and supplementation. […] Global health professionals tend to attribute PPH cases to the failure of the womb to contract. This diagnosis ignores other causes like anaemia from heavy periods. […] The WOMAN-2 Trial is currently looking into whether giving TXA can prevent PPH and other severe outcomes in women with moderate and severe anaemia. The results will be published later this year and will provide the evidence needed to address this critical gap in healthcare. […] Tens of thousands of women who die from PPH could be saved each year. It’s time we stopped turning a blind eye to the causes and work together to make sure all women, wherever they are in the world, have access to their right to a safe childbirth.
#85 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
The contribution of heavy menstrual bleeding to anaemia and in turn to PPH is under-recognised by health professionals. A 2020 WHO report on global efforts to prevent anaemia in women of reproductive age completely overlooked heavy menstrual bleeding. […] Although research shows that a woman’s iron stores depend more on her menstrual blood loss than on her dietary iron intake, global efforts to prevent anaemia largely focus on nutrition and supplementation. […] Global health professionals tend to attribute PPH cases to the failure of the womb to contract. This diagnosis ignores other causes like anaemia from heavy periods. […] The WOMAN-2 Trial is currently looking into whether giving TXA can prevent PPH and other severe outcomes in women with moderate and severe anaemia. The results will be published later this year and will provide the evidence needed to address this critical gap in healthcare. […] Tens of thousands of women who die from PPH could be saved each year. It’s time we stopped turning a blind eye to the causes and work together to make sure all women, wherever they are in the world, have access to their right to a safe childbirth.
#86 Research Fellow in Epidemiology – MenstruLife
https://menstrulife.com/projects/heavy-and-painful-menstrual-periods-and-their-relationship-with-depressive-symptoms-across-the-life-course/research-fellow-in-epidemiology/
We wish to recruit a Postdoctoral Research Fellow (PDRF) to participate in the innovative new MenstruLife project, which combines data from several longitudinal cohort studies to address important questions around the impact of heavy menstrual bleeding and menstrual pain on the mental health of people who menstruate. […] The successful applicant will work with our international team of expert researchers to design analysis plans, conduct systematic reviews, design, code and execute statistical analyses in R, write and submit scientific papers, and deliver oral and poster presentations to international audiences. […] Applicants will: possess a relevant PhD or equivalent qualification/experience in epidemiology, medical statistics or a related field; be able to work collaboratively, supervise the work of others and act as team leader as required; be highly skilled in collaborative working, designing and executing analysis plans, coding in R, and writing scientific papers.
#87 Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres
https://stacks.cdc.gov/view/cdc/33778
Inherited bleeding disorders are especially problematic for affected girls and women due to the monthly occurrence of menstrual periods and the effects on reproductive health. […] Although heavy menstrual bleeding (HMB) is the most common manifestation, females with inherited bleeding disorders (FBD) experience other bleeding symptoms throughout the lifespan that can lead to increased morbidity and impairment of daily activities. […] HMB was the most common bleeding symptom (198/253; 78.3%); however, 157 (49.2%) participants reported greater than four symptoms. […] The female UDC is the first prospective, longitudinal surveillance in the US focusing on FBD and has the potential to further identify complications and reduce adverse outcomes in this population.
#88 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
The contribution of heavy menstrual bleeding to anaemia and in turn to PPH is under-recognised by health professionals. A 2020 WHO report on global efforts to prevent anaemia in women of reproductive age completely overlooked heavy menstrual bleeding. […] Although research shows that a woman’s iron stores depend more on her menstrual blood loss than on her dietary iron intake, global efforts to prevent anaemia largely focus on nutrition and supplementation. […] Global health professionals tend to attribute PPH cases to the failure of the womb to contract. This diagnosis ignores other causes like anaemia from heavy periods. […] The WOMAN-2 Trial is currently looking into whether giving TXA can prevent PPH and other severe outcomes in women with moderate and severe anaemia. The results will be published later this year and will provide the evidence needed to address this critical gap in healthcare. […] Tens of thousands of women who die from PPH could be saved each year. It’s time we stopped turning a blind eye to the causes and work together to make sure all women, wherever they are in the world, have access to their right to a safe childbirth.
#89 Uterine bleeding: how understanding endometrial physiology underpins menstrual health | Nature Reviews Endocrinology
https://www.nature.com/articles/s41574-021-00629-4
Menstruation is a physiological process that is typically uncomplicated. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. […] AUB is a debilitating symptom that affects up to one third of reproductive-aged women; comprehensive knowledge of menstrual cycle physiology is crucial for understanding and progressing endometrial physiology research. […] There is a high prevalence of iron deficiency and iron deficiency anaemia in those with AUB, on a global scale, and this is often under-recognized and under-reported. […] The terminology and definitions for diagnosing causes of AUB are now standardized in the International Federation of Gynecology and Obstetrics Systems 1 and 2, and should be followed for ease of clinical and research synchrony.
#90
https://link.springer.com/article/10.1007/s40264-024-01426-4
During the COVID-19 vaccination campaign, over 34,000 reports of heavy menstrual bleeding following the administration of COVID-19 vaccines originating in the Economic European Area were submitted to EudraVigilance, the European Union database of suspected adverse drug reactions. […] We investigated the impact of media attention on the reporting trends of heavy menstrual bleeding to EudraVigilance. […] The analysis suggests that the spikes in reporting of heavy menstrual bleeding were to some extent influenced by media coverage in some countries. […] Consumer reporting to the European Union spontaneous data collection system, EudraVigilance, was of high value for regulatory safety reviews, albeit the reporting behaviours were not free of the influence of the media. […] The European Union (EU) regulatory network reviewed the spontaneous reports of menstrual disorders with COVID-19 vaccines received in EV. Reports of amenorrhoea and heavy menstrual bleeding were reviewed as part of the post-authorisation surveillance of COVID-19 vaccines; regular updates on these assessments were communicated by the European Medicines Agency (EMA) to the public via regular vaccine safety updates and press briefings.
#91
https://link.springer.com/article/10.1007/s40264-024-01426-4
During the COVID-19 vaccination campaign, over 34,000 reports of heavy menstrual bleeding following the administration of COVID-19 vaccines originating in the Economic European Area were submitted to EudraVigilance, the European Union database of suspected adverse drug reactions. […] We investigated the impact of media attention on the reporting trends of heavy menstrual bleeding to EudraVigilance. […] The analysis suggests that the spikes in reporting of heavy menstrual bleeding were to some extent influenced by media coverage in some countries. […] Consumer reporting to the European Union spontaneous data collection system, EudraVigilance, was of high value for regulatory safety reviews, albeit the reporting behaviours were not free of the influence of the media. […] The European Union (EU) regulatory network reviewed the spontaneous reports of menstrual disorders with COVID-19 vaccines received in EV. Reports of amenorrhoea and heavy menstrual bleeding were reviewed as part of the post-authorisation surveillance of COVID-19 vaccines; regular updates on these assessments were communicated by the European Medicines Agency (EMA) to the public via regular vaccine safety updates and press briefings.
#92
https://link.springer.com/article/10.1007/s40264-024-01426-4
An increased number of spontaneous reports alone cannot determine whether there is an actual increased rate of an event. […] In February 2022, prompted by an observational study from the Norwegian Institute of Public Health, a signal procedure dedicated to assessing all data available on heavy menstrual bleeding after COVID-19 vaccination with messenger (mRNA)-based vaccines was initiated by the EMAs Pharmacovigilance Risk Assessment Committee (PRAC). […] Following the finalisation of the signal procedure on 27 October, 2022, PRAC concluded that there is a reasonable possibility that heavy menstrual bleeding is causally associated with mRNA-based COVID-19 vaccines and therefore recommended that it should be included as a listed side effect for both Comirnaty and Spikevax. […] The publication of safety updates from regulatory authorities were often followed by media releases, which in turn led to increased reporting of the respective safety concern in some countries.
#93
https://link.springer.com/article/10.1007/s40264-024-01426-4
An increased number of spontaneous reports alone cannot determine whether there is an actual increased rate of an event. […] In February 2022, prompted by an observational study from the Norwegian Institute of Public Health, a signal procedure dedicated to assessing all data available on heavy menstrual bleeding after COVID-19 vaccination with messenger (mRNA)-based vaccines was initiated by the EMAs Pharmacovigilance Risk Assessment Committee (PRAC). […] Following the finalisation of the signal procedure on 27 October, 2022, PRAC concluded that there is a reasonable possibility that heavy menstrual bleeding is causally associated with mRNA-based COVID-19 vaccines and therefore recommended that it should be included as a listed side effect for both Comirnaty and Spikevax. […] The publication of safety updates from regulatory authorities were often followed by media releases, which in turn led to increased reporting of the respective safety concern in some countries.
#94
https://link.springer.com/article/10.1007/s40264-024-01426-4
We found that the median reporting time for Comirnaty Original before the first spike of media outlets ranged between 10 and 25 days, in line with a previous study showing that the median time to report an adverse drug reaction in the EU is approximately 30 days for spontaneous reports, regardless of whether it was reported by consumers or healthcare professionals. […] The high volume of reports was crucial to prompt safety reviews of heavy menstrual bleeding.
#95
#96 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
Heavy menstrual bleeding is killing women, but it is not being treated as a global health priority. This urgently needs to change. […] There are three steps in this dance to death: heavy periods, anaemia, and death during childbirth. Heavy menstrual bleeding causes anaemia in young women, anaemia increases the risk of severe bleeding after childbirth, and this bleeding is the leading killer of mothers worldwide. […] Each year, 14 million women globally develop postpartum haemorrhage (PPH) or severe bleeding after childbirth and over 50,000 of these women die. Most of these deaths are in low- and middle-income countries where the prevalence of anaemia is highest and many women lack access to healthcare and life-saving treatment. […] Although women in low- and middle-income countries are worst affected, PPH is a problem everywhere and one that exposes deep health and societal inequalities as, in high-income countries, deaths from PPH are higher among black women and women of colour.
#97 (PDF) Epidemiology of abnormal uterine bleeding
https://www.academia.edu/28195863/Epidemiology_of_abnormal_uterine_bleeding
Menstrual dysfunction is a common cause of referral to the gynaecology clinic, and the problem has a considerable impact on the health status and the quality of life of women. […] The spectrum of abnormal uterine bleeding comprises of menorrhagia (heavy periods; blood loss 80 mL), metrorrhagia (prolonged, irregular periods), polymenorrhoea (frequent periods), oligomenorrhoea (scanty and infrequent periods), amenorrhoea (absent menstrual periods), intermenstrual bleeding and postcoital bleeding. […] In a survey carried out in Nepal (96 school girls with an age range of 11-17 years), menorrhagia was identified in 6.2% of girls. […] The most common inherited disorder in women with symptoms of menorrhagia is von Willebrand disease. […] Abnormal uterine bleeding (AUB) is a common reason for women of all ages to consult their gynecologist and is one of the most common debilitating menstrual problems ending up in hysterectomy in developing countries.
#98 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
In Turkey, abnormal uterine bleeding was the third most commonly reported gynecological complaint and the fourth most commonly diagnosed gynecological morbidity among adult women, while among adolescents who consulted a gynecologist menstrual disorders and dysmenorrhea were the most common complaints. […] Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. […] Findings of the study reinforce the need to provide menstrual health care services at the primary level. […] Data on nature and prevalence of menstrual disorders and their effect on young women’s health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. […] The results showed high prevalence of menstrual ailments among participants, the highest prevalence was pre-menstrual syndrome and dysmenorrhea. […] According to the impact, 38% of participants stated that they miss home activities, and 31% stated getting a sick leave due to menstrual ailments.
#99 Heavy menstrual bleeding among women aged 18â50Â years living in Beijing, China: prevalence, risk factors, and impact on daily life | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0726-1
Overall, 838.9% of women experience HMB based on subjective assessments, and this condition has been linked to a lower quality of life and increased health care expenses. […] Among Chinese population, research on HMB has been very limited. […] The results of our study showed that the prevalence of experienced HMB among Chinese women aged 1850 years living in Beijing was 18.2%, which was consistent with the self-reported prevalence of 827% in other developing countries, but notably lower than the prevalence of 36% reported by Zhao et al. based on subjective assessments from 1021 Chinese women of reproductive age. […] While HMB may occur in the presence of uterine pathology and other disorders, a broader view of this condition has shown that its potential risk factors also include age, lifestyle factors, and reproductive history.
#100 Heavy periods should be treated as a global health priority
https://www.scidev.net/global/opinions/heavy-periods-should-be-treated-as-a-global-health-priority/
Heavy menstrual bleeding is killing women, but it is not being treated as a global health priority. This urgently needs to change. […] There are three steps in this dance to death: heavy periods, anaemia, and death during childbirth. Heavy menstrual bleeding causes anaemia in young women, anaemia increases the risk of severe bleeding after childbirth, and this bleeding is the leading killer of mothers worldwide. […] Each year, 14 million women globally develop postpartum haemorrhage (PPH) or severe bleeding after childbirth and over 50,000 of these women die. Most of these deaths are in low- and middle-income countries where the prevalence of anaemia is highest and many women lack access to healthcare and life-saving treatment. […] Although women in low- and middle-income countries are worst affected, PPH is a problem everywhere and one that exposes deep health and societal inequalities as, in high-income countries, deaths from PPH are higher among black women and women of colour.
#101 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
In Turkey, abnormal uterine bleeding was the third most commonly reported gynecological complaint and the fourth most commonly diagnosed gynecological morbidity among adult women, while among adolescents who consulted a gynecologist menstrual disorders and dysmenorrhea were the most common complaints. […] Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. […] Findings of the study reinforce the need to provide menstrual health care services at the primary level. […] Data on nature and prevalence of menstrual disorders and their effect on young women’s health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. […] The results showed high prevalence of menstrual ailments among participants, the highest prevalence was pre-menstrual syndrome and dysmenorrhea. […] According to the impact, 38% of participants stated that they miss home activities, and 31% stated getting a sick leave due to menstrual ailments.
#102 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
In Turkey, abnormal uterine bleeding was the third most commonly reported gynecological complaint and the fourth most commonly diagnosed gynecological morbidity among adult women, while among adolescents who consulted a gynecologist menstrual disorders and dysmenorrhea were the most common complaints. […] Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. […] Findings of the study reinforce the need to provide menstrual health care services at the primary level. […] Data on nature and prevalence of menstrual disorders and their effect on young women’s health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. […] The results showed high prevalence of menstrual ailments among participants, the highest prevalence was pre-menstrual syndrome and dysmenorrhea. […] According to the impact, 38% of participants stated that they miss home activities, and 31% stated getting a sick leave due to menstrual ailments.
#103 Women who experience heavy menstrual bleeding: prevalence and characteristics from young adulthood to midlife, Australia, 2000â2021: a longitudinal cohort survey study | The Medical Journal of Australia
https://www.mja.com.au/journal/2025/222/4/women-who-experience-heavy-menstrual-bleeding-prevalence-and-characteristics
Serial surveys of a cohort of Australian women found that at age 22 years 17.6% reported heavy bleeding during the preceding twelve months, rising to 39.3% of women aged 48 years who menstruated. Higher body mass index, iron deficiency, and endometriosis were associated with heavy bleeding. Health-related quality of life was poorer for women who experienced heavy menstrual bleeding. […] Given the burden of the condition, it is important that Australian women are aware of and have access to effective care for heavy menstrual bleeding.
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#105
#106 (PDF) Epidemiology of menstrual disorders in developing countries: a systematic review
https://www.academia.edu/12465445/Epidemiology_of_menstrual_disorders_in_developing_countries_a_systematic_review
In Turkey, abnormal uterine bleeding was the third most commonly reported gynecological complaint and the fourth most commonly diagnosed gynecological morbidity among adult women, while among adolescents who consulted a gynecologist menstrual disorders and dysmenorrhea were the most common complaints. […] Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. […] Findings of the study reinforce the need to provide menstrual health care services at the primary level. […] Data on nature and prevalence of menstrual disorders and their effect on young women’s health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. […] The results showed high prevalence of menstrual ailments among participants, the highest prevalence was pre-menstrual syndrome and dysmenorrhea. […] According to the impact, 38% of participants stated that they miss home activities, and 31% stated getting a sick leave due to menstrual ailments.
#107 Heavy menstrual bleeding among women aged 18â50Â years living in Beijing, China: prevalence, risk factors, and impact on daily life | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0726-1
Heavy menstrual bleeding (HMB) has been shown to have a profound negative impact on womens quality of life and lead to increases in health care costs; however, data on HMB among Chinese population is still rather limited. […] Overall, 429 women experienced HMB, giving a prevalence of 18.2%. […] HMB was highly prevalent among Chinese women and those reporting heavy periods suffered from greater menstrual interference with daily lives. More information and health education programs are urgently needed to raise awareness of the consequences of HMB, encourage women to seek medical assistance and thus improve their quality of life. […] About 1 in 20 women aged 3049 years consult their general practitioner each year for HMB, which is the second highest-ranked reason for a hospital referral and accounts for 12% of all gynecologic referrals.