For decades, Michelle Alston thought she was simply bad at managing her periods. From the age of twelve, she bled through her clothes and sheets, once staining an unforgivingly white chair at a mobile phone shop. She slept off the worst days in the school nurse’s office, battling severe pain while believing what she had been taught — that this was just something women had to endure. It wasn’t until her early forties that a doctor finally identified her heavy menstrual bleeding as a serious medical condition, nearly thirty years after it began. Her story is far from unique, and researchers are only now beginning to grasp how widespread and damaging this neglect has been.
A search of PubMed for “menstrual blood” yields roughly four hundred publications over the last decade, compared with more than fifteen thousand for “semen.” Jackie Maybin, a gynaecologist at the University of Edinburgh who directs The Missed Vital Sign research initiative, puts it bluntly: women are owed years if not decades of research, and the time is now. Part of the problem is that determining how much blood loss qualifies as excessive remains remarkably imprecise. Clinicians sometimes ask patients to compare their flow against charts featuring progressively bloodier pads and tampons, but period products vary widely in absorption. In practice, doctors often fall back on whether bleeding interferes with quality of life — meaning patients must first recognize their experience isn’t normal before anyone intervenes.
Heavy menstrual bleeding is rarely a standalone condition but rather a signal of deeper problems such as fibroids, polyps, endometriosis, blood disorders, or even cancer. Yet scientists still don’t fully understand why these conditions cause excessive blood loss in the first place. Maybin notes that extensive research exists on fibroids themselves, but almost none on why they trigger heavy bleeding. When left untreated, the consequences ripple outward well beyond the menstrual cycle itself. Studies estimate more than forty percent of women with heavy menstrual bleeding also suffer from iron deficiency, which can bring brain fog, dizziness, shortness of breath, hair loss, and extreme cold sensitivity. Alston found herself constantly chilled and craving ice cubes — a peculiar but recognized sign of depleted iron stores. If unaddressed, iron deficiency escalates into anaemia, which can become so severe that blood transfusions are required.
Emily Young, another woman affected by the condition, captures its toll plainly when she says it’s not just an inconvenience but rather having to structure your entire life around your menstrual cycle. Around the world, stigma compounds the problem further. Hemantha Senanayake, emeritus professor at the University of Colombo in Sri Lanka, observes that many women never raise the issue because pain has been normalized and shame runs deep. Even within medicine, gynaecologists may know which questions to ask, but clinicians outside the field frequently miss warning signs entirely. As women today experience up to four hundred lifetime cycles compared with perhaps forty throughout most of human history, addressing this gap becomes ever more urgent.