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 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 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:

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 its 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/tampon every one to two hours
• Passing blood clots larger than the size of quarters
• Bleeding that lasts more than eight days 
• Feeling faint/dizzy

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.”

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.

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.

There is a significant gap in women’s knowledge and understanding of abnormal uterine bleeding, with almost half of African American women believing that there was nothing they could do about their heavy menstrual bleeding.” Erica E. Marsh, M.D.

For people who are not trying to conceive, birth control pills or an 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.

New research will focus on underserved communities 

Researchers hope to enroll at least 200 participants, half Black and half Latina, 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.

“In that same population, we also showed that there is a significant gap in women’s knowledge and understanding of abnormal uterine bleeding, with almost half of African American women believing that there was nothing they could do about their heavy menstrual bleeding.”

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.

Project 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.”

Funding for the project stems from the National Institutes of Health to fund the Michigan Community Engaged Alliance, or Michigan CEAL, which is a community based research initiative that was created to improve awareness and reduce COVID-19 inequities among underserved communities in the state. The effort has evolved to fund ongoing community engagement projects for other conditions. A portion of the funding will be used to support community based interventions to improve cardiovascular health as well, led by Barbara Israel, M.P.H. and Jennifer Garner, Ph.D., R.D. of the U-M School of Public Health.

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