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A $5.6 million grant helps launch research to improve screening and treatment for a gynecologic disorder disproportionately impacting Black and Hispanic populations.

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Welcome to Health Lab, your destination for news and stories about the future of healthcare. Today: New research launched to address health disparities in abnormal menstrual bleeding and anemia. A $5.6 million grant helps to launch research to improve screening and treatment for a gynecologic disorder disproportionately impacting Black and Hispanic populations.

For nearly one in five women, periods are so heavy that they interfere with daily life.

When left untreated, this abnormal uterine bleeding can cause anemia, leading to fatigue, weakness and disruptive symptoms.

And the condition affects some more than others, with data showing that Black and Hispanic populations experience heavy menstrual bleeding at a disproportionately higher rate than white individuals.

Now, a $5.6 million dollar federal grant is helping Michigan Medicine researchers launch studies to improve screening and interventions for the condition, particularly among disproportionately impacted groups. 

“Our goal is to improve awareness of abnormal uterine bleeding and its treatment options among community members and primary care providers, and to use interventions that may reduce related anemia in Black and Hispanic women,” said Erica E. Marsh, M.D., professor of obstetrics and gynecology at the University of Michigan Medical School and the chief of the division of reproductive endocrinology and infertility at U-M Health Von Voigtlander Women's Hospital.

Marsh will lead the research with co-investigators Samantha Schon, M.D., a Michigan Medicine reproductive endocrinologist and infertility specialist, and Flint community member Sarah Bailey.

The colleagues explain more about abnormal uterine bleeding and their research:

To start, many people may not know whether their periods are normal.

Abnormal menstrual bleeding is one of the most common gynecologic disorders affecting pre-menopausal women and is estimated to impact between 10-30% of women each year.

But many women just think they have heavy periods, Marsh says, making it important to know the difference between normal and abnormal.

“When a person experiences excessive bleeding that interferes with quality of life or bleeding in between the 21-35 day menstrual cycle, they should speak to their physician,” Marsh said.

“Part of the problem is that many women may have experienced this their entire life and may not realize it's abnormal.”

The average woman loses about two to three tablespoons of blood during a period, she says. Symptoms of heavy menstrual bleeding include:

Needing to change your pad or tampon every one to two hours, passing blood clots larger than the size of quarters, bleeding that lasts more than eight days and feeling faint or dizzy.

Next, underlying conditions may contribute to heavy bleeding.

Some health issues may cause abnormal bleeding. Obesity, thyroid issues, fibroids, polyps, hormone problems and conditions like polycystic ovary syndrome, for example, can interfere with regular ovulation.

Abnormal periods can also signal severe stress or disordered eating, which can lead to women losing their periods.

“We use menstruation as a vital sign of health. Someone’s period tells me a lot about a potential underlying medical disorder and whether there’s a need to investigate certain symptoms further,” Schon said.

“When someone’s menstrual cycle is abnormal, we take steps to further investigate potential underlying causes.”

Third, heavy menstrual bleeding and resulting anemia can cause serious symptoms.

Heavy menstrual bleeding can cause spotting, pain, headaches, and especially fatigue and weakness.

Associated anemia can also lead to shortness of breath, decreased cognitive performance and an increased risk for morbidity and mortality. Iron deficiency, Schon notes, is present in 75% of all anemia cases.

“This is a health issue that can significantly impact a person's physical health, emotional well-being, and overall quality of life for them and their family,” Bailey said.

Finally, treatment options vary significantly based on each case.

People who experience abnormal bleeding may be diagnosed with a pelvic exam, ultrasound, pap test, and sometimes a biopsy.

Treatment options will depend on a person’s age, overall health and personal preferences, Schon says.

For people who are not trying to conceive, birth control pills or an IUD (or intrauterine device) can stop ovulation and/or result in lighter periods.

For others, nonsteroidal anti-inflammatory drugs or hormone treatments may relieve symptoms. In some cases, healthcare providers will recommend people increase iron rich foods in their diet or iron supplements to counter anemia as a result of the heavy loss of blood. 

In the more severe cases, surgical options may be considered, including a hysterectomy to remove the uterus for those not interested in future childbearing.

Moving forward, new research will focus on underserved communities.

Researchers hope to enroll at least 200 participants from Wayne, Genesee and Washtenaw counties.

“We have previously shown that a significant percentage of Black women who reported heavy menstrual bleeding are both iron deficient and anemic,” Marsh said.

Participants will be surveyed on medical history, quality of life, perceived severity and susceptibility of abnormal uterine bleeding, race-based treatment beliefs and reproductive knowledge.

They will also be asked about perceived medical mistrust, unfairness, discrimination and religiosity.

“Our interviews will focus on the meaning and significance of menstruation, abnormal bleeding treatment experiences, perceptions of knowledge, trust, and perceptions of differential care,” Marsh said.

The project is focused on improving education, screening and interventions.

Researchers’ plans to use insights from interviews to guide and test various community based interventions. 

This will include a training toolkit and roadmap for community leaders to facilitate discussions about abnormal menstrual bleeding and anemia in their homes, schools, faith-based organizations, and community centers.

Primary care providers will also be interviewed about their experiences treating patients with abnormal uterine bleeding or anemia and challenges with referrals to other specialists, perceptions of patients’ experiences and barriers to care and treatment satisfaction.

“Experts across the country agree that there’s a large, unmet need for a multi-pronged strategy to both raise awareness of the high prevalence and societal impact of abnormal uterine bleeding and iron-deficient anemia and to improve access to screening and treatment,” Marsh said. 

“We will work closely with community partners to work on ways to improve educational and systemic interventions that can greatly improve health and wellbeing among people affected by this condition.”

For more on this story and for others like it, visit michiganmedicine.org/health-lab. Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can subscribe to Health Lab wherever you listen to podcasts.