Ending the taboo on periods and period problems

Abstract

Heavy menstrual bleeding (HMB), reflecting excessive menstrual volume, affects quality of life in up to half of all menstruating girls and women^2,3. The blood loss associated with HMB may induce iron deficiency that, when severe, results in iron deficiency anemia (IDA). Iron deficiency, with or without IDA, can adversely affect physical, cognitive and even cardiac function. In pregnancy, anemia can have an adverse effect on both the mother and her fetus, with increased risks of antepartum hemorrhage, prematurity, stillbirth, neonatal death, post-partum hemorrhage (PPH), and maternal mortality. Furthermore, peri-conceptional and prenatal iron deficiency is linked to impaired fetal neurodevelopment and adverse neuro-behavioral effects for the child that persist into adulthood⁴.

Some 30% of the world’s non-pregnant women are anemic, increasing to over 40% in South Asia, the Eastern Mediterranean and sub-Saharan Africa (WHO Anaemia Action Alliance), with iron deficiency the most common contributory factor. During ‘normal’ periods, approximately 1 mg of iron is lost monthly, but in women with HMB, iron loss may be 5–6 times higher. As a result, independent of culture or geographic location, HMB is the most common cause of iron deficiency and IDA (>50%) in nonpregnant reproductive-aged girls and women. The extent of iron loss associated with HMB can make it impossible for dietary replacement (even with supplementation) before the next period starts, thus establishing a progressive deterioration of iron status.