Heavy menstrual bleeding is one of the most common conditions affecting women, with detrimental impacts on their physical, emotional, and social well-being. It affects millions of women in the United Kingdom and is one of the most common reasons for gynaecological consultations and GP appointments, but symptoms are frequently dismissed and the condition poorly treated.
Like most women's health issues, women face many barriers to accessing adequate care for heavy bleeding, from low awareness and stigma to not being believed by health care professionals.
Many women experiencing heavy menstrual bleeding (HMB) delay seeking help or do not seek help at all. Evidence suggests that approximately half of women with symptoms of heavy menstrual bleeding do not consult a health care professional. Those that do, often have symptoms for a long time before seeking treatment.
Many factors (PDF) influence this. A lack of education and awareness about what constitutes a “normal period” and when women should seek care often results in women normalising heavy bleeding and severe pain. Taboos and stigma around menstruation, particularly heavy bleeding, remain a challenge and contribute to women's reluctance to seek care. Shame also worsens the negative impacts of symptoms, as women report not wanting to go about daily activities to hide their bleeding.
Taboos and stigma around menstruation, particularly heavy bleeding, remain a challenge and contribute to women's reluctance to seek care.
Variability in the provision and quality of services results in a “postcode lottery” of health care experiences for women. Initiatives to improve access to care have been piloted, including the creation of Women's Health Hubs to offer better access to a range of gynaecological and contraception needs. However, RAND Europe's evaluation of Women's Health Hubs found significant variation in their implementation and the services they offered. Hubs also posed the risk of widening inequalities if they were not made available to all women and not designed to address current barriers in access experienced by women from certain communities and parts of the country. One study found that women living in more deprived areas reported more severe symptoms of heavy menstrual bleeding and poorer quality of life when starting treatment.
When women do seek help, they often do not receive the care they need. In a European survey, of those who did seek help for their HMB, almost half did not receive confirmation of heavy menstrual bleeding from their doctor or get offered treatment. A RAND Europe commentary explored issues relating to gender biases in health care, where women's voices often go unheard; unfortunately heavy menstrual bleeding is affected by similar issues.
Often women's concerns aren't taken seriously by health care professionals. A call for evidence from the Department of Health that collected experiences of over 100,000 people found that most women reported that “their symptoms were immediately dismissed upon first contact with health care professionals.” Many had to push to receive a diagnosis, requiring levels of self-advocacy that are not feasible for all women, and exacerbating inequalities in access to care.
Challenges in the care of HMB stem, in part, from the need for more research on its definition and the best approaches to treatment. NICE defines heavy menstrual bleeding as “excessive menstrual blood loss which interferes with a woman's physical, social, emotional, and/or material quality of life.” While this definition marks significant progress in our understanding of the condition beyond measuring blood volume, the quality of care women receive remains inconsistent.
Practical and accurate methods for measuring blood loss are also lacking. Apps such as Flo, Clue, and Natural Cycles increasingly support women to track their menstrual health, including features to log flow intensity, bleeding duration, and other symptoms. Wearable menstrual products are also emerging, with embedded sensors designed to support identification of a number of women's health conditions and in some cases more accurate measurement of menstrual blood volume. Most of these technologies remain in development but may offer new ways to support identification and monitoring of HMB in the future.
Heavy menstrual bleeding can be debilitating, impacting women's work, social lives, general well-being, and sexual relationships, yet symptoms continue to be downplayed and dismissed.
Heavy menstrual bleeding can be debilitating, impacting women's work, social lives, general well-being, and sexual relationships, yet symptoms continue to be downplayed and dismissed. Little progress (PDF) has been made in tackling these challenges over the past few decades, with delays in diagnosis, inconsistent treatment, and disparities in care continuing to hinder effective management.
The UK government's aims of significant health care reforms present the opportunity for a shift in addressing women's health. An effective approach would include taking a whole-of-life and system-wide perspective, understanding women's interaction with the education and health care system at every stage of life, from improving education and awareness from an early age to ensuring equitable and easy access to care throughout life. It also depends on ongoing investment into research and development to support identification of better tools for diagnosis and management of heavy menstrual bleeding and related conditions. We describe some of these issues and steps forward in depth in our recent RAND Europe Perspective, Women's health at a junction in policy and practice: where next?, which brings together published evidence and stakeholder perspectives to suggest ways to drive progress on women's health in the United Kingdom.
Ultimately, meaningful progress begins with listening to and believing women, recognising that conditions like heavy menstrual bleeding are not just a part of life but require attention, care, research, and investment.
