Heavy menstruation should be considered a global health priority

Ian Roberts of the London School of Hygiene & Tropical Medicine writes: Anemia due to heavy menstrual bleeding can lead to severe bleeding after delivery.

Heavy menstrual bleeding is killing women, but it’s not seen as a global health priority. This needs to be changed urgently.

There are three steps in this dance of death: heavy menstruation, anemiaand died during childbirth. Heavy menstrual bleeding causes anemia in young women, anemia increases the risk of severe bleeding after delivery and this bleeding is the leading killer of mothers worldwide.

Each year, 14 million women globally experience postpartum haemorrhage (PPH) or severe bleeding after childbirth, and more than 50,000 of these women die. Most of these deaths are low and middle income countries where anemia rates are highest and many women lack access to health care and life-saving treatment.

Although women in low- and middle-income countries are hardest hit, reproductive health is a ubiquitous problem and one that exposes profound social and health inequalities. like, in high income countriesmortality from PPH was higher in the group black women and women of color.

This week (March 7-10), the World Health Organization (WHO) will convene the Reproductive Health Summit to bring together stakeholders to prioritize the most urgent actions needed to reduce deaths. by BHSS worldwide.

For the past 20 years, I have worked with Professor Haleema Shakur-Still from the London School of Hygiene & Tropical Medicine and colleagues from around the world, to coordinate a large-scale clinical trial program. about a cheap drug called tranexamic acid (TXA) cuts blood by stopping bleeding blood clots break.

This drug has been around for 50 years, but in 2017 we showed that prompt treatment with TXA reduces PPH deaths by a third. Summit should be a time to step up and coordinate efforts to make this treatment available to women everywhere.

Monthly menstrual blood loss varies widely between women. The average loss is about 40 ml of blood, but some women lose more than this multiple.

Some women who have had excessive bleeding for many years consider their bleeding “normal”. Medical information providers are often refuted.

Researchers estimate that a quarter young woman may bleed profusely. For every cup of blood lost, iron is filtered out of the body and unless it is compensated with dietary iron, women will inevitably become anemic.

Red blood cells are like buses, pick up oxygen molecule in the lungs and transport them to tissues. The passengers breathing oxygen sit on an iron containing a protein called hemoglobin, red seats on the bus.

When the body lacks iron, it cannot produce enough hemoglobin. Anemia occurs when the hemoglobin level in the blood is lower than normal. Frequent cycles of heavy bleeding can drag women below this threshold.

Anemia increases the chances of babies being born small, being born prematurely, and dying soon after birth.

In anemic women, there are not enough red buses to carry oxygen around and so the heart pumps blood around stronger and faster. Her breathing was quick. Her body is working even though she is still in line. And with the exertion of childbirth, her heart may fail. She’s also more likely to bleed after giving birth.

Anemic blood is thinner and bleeds faster. Every 10g drop in a woman’s hemoglobin greatly increases her chances of severe bleeding. And if she bleeds, she’s more likely to die.

The contribution of heavy menstrual bleeding to anemia and subsequently PPH has not been recognized by medical professionals. A 2020 WHO report on global efforts to prevent anemia in women of reproductive age completely ignores heavy menstrual bleeding.

Although research shows that women’s iron stores depend more on blood loss during menstruation than on iron intake, global efforts to prevent anemia have largely focused on nutrition and supplements.

TXA is a commonly prescribed treatment for heavy menstrual bleeding in high-income countries. But in sub-Saharan Africa and South Asia, most women don’t have access to tampons, tampons or menstrual cups, let alone menstrual treatments. Access to TXA can help solve a problem before it becomes a life-or-death problem.

Global health experts tend to attribute cases of PPH to the “unable to contract” uterus. This diagnosis ignores other causes such as anemia due to heavy menstrual bleeding.

The WOMAN-2 trial is currently looking at whether taking TXA can prevent PPH and other serious consequences in women with moderate to severe anemia. 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 is time for us to stop turning a blind eye to the cause and work together to ensure that all women, wherever they are in the world, have access to the right to safe childbirth.

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