Heavy periods should be treated as a global health priority

Anemia caused by heavy periods can lead to heavy bleeding after birth, writes Ian Roberts of the London School of Hygiene and Tropical Medicine.

Heavy menstrual bleeding kills women, but is not treated as a global health priority. This urgently needs to change.

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

Each year, 14 million women worldwide develop postpartum hemorrhage (PPH), or heavy bleeding after giving birth, and more than 50,000 of these women die. Most of these deaths are in low- and middle-income countries, where the prevalence of anemia is highest and many women lack access to health care and life-saving treatment.

Although women in low- and middle-income countries are most affected, PPH is a problem everywhere and reveals deep health and societal inequalities, as in high-income countries deaths from PPH are higher among black and women of color.

This week (March 7-10), the World Health Organization (WHO) is convening a PPH Summit to bring together relevant stakeholders to prioritize the most urgent actions needed to reduce PPH deaths worldwide.

For the past 20 years, I have worked with Professor Halema Shakur-Steele of the London School of Hygiene and Tropical Medicine and colleagues from around the world to coordinate a program of large clinical trials of a cheap drug called tranexamic acid (TXA), which reduces bleeding. by stopping the breakdown of blood clots.

The drug has been around for 50 years, but in 2017 we showed that timely treatment with TXA reduced deaths from PPH by a third. The summit should be a moment to mobilize and coordinate efforts to make this treatment available to women everywhere.

Monthly menstrual blood loss varies greatly between women. The average loss is about 40 ml of blood, but some women lose many times that amount.

Some women with excessive bleeding for many years consider their bleeding to be “normal”. Health information providers are often dismissive.

Researchers estimate that a quarter of young women may experience heavy bleeding. Each glass of blood lost leaches iron from the body, and unless compensated by dietary iron intake, women inevitably become anemic.

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

When the body is deficient in iron, it cannot produce enough hemoglobin. Anemia is present when the concentration of hemoglobin in the blood is lower than normal. Repeated cycles of frequent heavy bleeding can push women below this threshold.

Anemia increases the chance that the baby will be born small, early and die soon after birth.

In women with anemia, there are not enough red buses to carry oxygen, so the heart pumps blood harder and faster. Her breathing is rapid. Her body works even when she is still. And with the effort of childbirth, her heart can fail. She is also more likely to bleed after giving birth.

Anemic blood is thinner and bleeds faster. Every 10-gram drop in a woman’s hemoglobin significantly increases the chance of serious bleeding. And if he’s bleeding, he’s more likely to die.

The contribution of heavy menstrual bleeding to anemia and in turn to PPH is not sufficiently recognized by health 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 a woman’s iron stores depend more on her menstrual blood loss than on dietary iron intake, global efforts to prevent anemia have largely focused on nutrition and supplementation.

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 pads, tampons or menstrual cups, let alone treatments for heavy periods. Access to TXA can help address the problem before it becomes a matter of life and death.

Global health professionals tend to attribute cases of PPH to the “inability” of the uterus to contract. This diagnosis ignores other causes such as anemia from heavy menstruation.

The WOMAN-2 study is currently looking at whether giving TXA can prevent PPH and other severe outcomes in women with moderate and severe anemia. The results will be published later this year and will provide the evidence needed to address this critical healthcare gap.

Tens of thousands of women who die from PPH could be saved each year. It is time to stop turning a blind eye to the causes and work together to ensure that all women, wherever they are in the world, have access to their right to a safe birth.

Provided by SciDev.Net