Prof Hilary Critchley: Periods are an amazing natural physiological event - let's talk about them

When I started medical school in 1975, periods were taboo and understudied. It is deeply concerning that this remains the case four decades later - we must break the continuing shame and embarrassment.

Research is ongoing in Scotland to better understand better the cause of heavy periods - but we must speak more about what women go through every month, says Professor Hilary Critchley.

A recent study into hidden reproductive health problems reported that many women described heavy menstrual bleeding (HMB) as a source of embarrassment, affecting relationships, mental health and work. HMB impacts as many as one in three women.

This debilitating symptom imposes amassive impact on women’s quality of life but the underlying cause is often not diagnosed.

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HMB may not be life threatening, but it is life altering.

If menstrual blood loss exceeds iron intake, iron deficiency and then anaemia develops. HMB is a leading cause of anaemia globally and a real hazard to public health. Despite being such a common complaint, HMB is still under reported, largely due to the fact that it has been “normalised” by our society, family, and health care providers.

Optimisation of care for heavy periods requires a deeper understanding of menstruation itself: an amazing natural physiological event which is a wound that completely and repeatedly repairs each month. A crucial component of our laboratory research is to address the gaps in our knowledge of menstruation and gain insights into the biology of the endometrium (lining of the womb) that is shed during a period.

My clinical research team seeks to better understand the problem of HMB, and benefit those suffering with heavy periods. Our studies at the MRC Centre for Reproductive Health are enhancing our understanding of the biology of the endometrium - particularly, the cellular and molecular changes that cause heavy periods. Unbelievably there have been no new medications developed for heavy periods for over 25 years, and we hope to change this.

Our research has revealed that some women with heavy periods have altered oxygen levels in the endometrium. This can impact processes that ensure repair after the lining is shed, so periods last longer. We have also identified a possible lack of a hormone in the endometrium of those with HMB.

This hormone helps tiny blood vessels mature and may reduce menstrual blood flow. We need to understand better the pivotal role of progesterone in menstrual bleeding.

Big questions remain, and we are working hard to find the answers. How do structural features in the womb muscle (myometrium), such as fibroids (areas of thickening of womb muscle), result in heavy periods? Does the endometrium behave differently as it ages? Are menstrual bleeding problems associated with later health problems? To answer these questions, we have to work across-disciplines and embrace new exciting technologies. We need new therapeutic approaches, including delivery routes. Such approaches will make precision medicine for menstrual bleeding problems a closer reality.

Tribute must be paid to the many, many patients who have, and continue to, participate in our studies exploring the process of menstruation and heavy periods; as without their contribution, advances in menstrual health research would not be possible.

Hilary Critchley is a Fellow of the Royal Society of Edinburgh; Professor of Reproductive Medicine at the University of Edinburgh, and Co-Deputy Director at the MRC Centre for Reproductive

Health, Edinburgh. The RSE is Scotland’s National Academy, which brings great minds together to

contribute to the social, cultural and economic wellbeing of Scotland.

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