Maya Galinsky
Blood, Sweat, and Tears: The Heavy Burden of Heavy Menstrual Bleeding on African American Menstruators' Health
Heavy menstrual Bleeding (HMB) is a common gynecological disorder that affects women of reproductive age. It is estimated that one in five women experiences HMB at some point in their life, which can significantly impact a woman's quality of life. Despite its prevalence, HMB has received little attention in the medical community and society as a whole.
There are many potential factors that can contribute to the development of HMB. These factors can include underlying medical conditions, such as fibroids or adenomyosis, as well as genetic factors, hormonal imbalances, and lifestyle factors, such as low body mass index, high stress, and dieting (Harlow & Campbell, 1996). HMB can significantly impact a woman's quality of life, including reduced productivity, social isolation, and anxiety. Therefore, women must have access to accurate information about HMB, including the signs and symptoms, available treatments, and the importance of early intervention.
Where ethnicity/race comes in
Studies have found that African American and Hispanic women experience HMB disproportionately compared to non-Hispanic white women (Marsh et al., 2014). According to Marsh et al. (2014), this may be mainly attributable to the increased prevalence of uterine fibroids among African American women and the potential biological differences in their hormonal milieu. Uterine fibroids are non-cancerous growths that develop in the uterus, and they can cause HMB and other symptoms, such as prolonged menstrual periods, pelvic pressure or pain, and frequent need to urinate (Healthline, n.d.).
Bleeding disorder contributions
Moreover, many black women and girls are at high risk for von Willebrand's disease (a genetic bleeding disorder), whose only symptom might be heavy periods or childbirth hemorrhage. Unfortunately, the actual bleeding patterns in this population have never been accurately determined, nor has the menstrual biome.
The current time to diagnose menstruators with bleeding disorders after menarche is, on average, six years (James et al., 2011). This highlights the need for increased research to understand the causes and effects of HMB among ethnic minorities and develop new and effective treatments.
The high prevalence of HMB among African American women is a significant public health issue that deserves attention. According to a study by Marsh et al. (2014), African American women lack a fundamental understanding of the disorder despite its high prevalence. They often attend the emergency department seeking treatment rather than obtaining preventative care in outpatient health clinics. The patterns of ambulatory care use for HMB differ across the racial spectrum, with African American women twice as likely as non-Hispanic white women to frequent the emergency department or hospital outpatient department (Gilliam et al., 2013). This highlights the need for increased education and outreach efforts to promote preventative care and reduce reliance on emergency department visits.
Implications for mental health
Moreover, the negative impact of HMB among ethnic minorities goes beyond physical health effects. Studies have shown that HMB can lead to depression, anxiety, and reduced quality of life (Marsh et al., 2014). The lack of understanding and proper care for HMB among ethnic minorities can exacerbate these mental health issues. Cultural taboos and stigmas can further prevent ethnic minorities from seeking help for HMB. In some cultures, menstruation is considered taboo, and discussing menstrual issues is considered shameful. This can lead to women suffering in silence and not seeking the care they need, leading to further complications.
Action
Addressing the issue of HMB among ethnic minorities requires a multifaceted approach that includes increasing knowledge and awareness, promoting preventative care and regular check-ups, addressing systemic healthcare disparities, and fostering cultural competency among healthcare providers. By doing so, we can ensure that all women have access to the care and information they need to manage their menstrual health and improve their overall quality of life.
Efforts must be made to increase health literacy and knowledge about HMB among ethnic minorities to promote preventative care and reduce reliance on emergency department visits. This includes educating women about the causes of HMB and its relationship to other health issues, such as uterine fibroids and bleeding disorders. One way to improve awareness and education is through community-based studies. Marsh et al. (2014) conducted a study to assess the self-reported prevalence, knowledge, and health literacy regarding HMB among African-American women. The study found that the prevalence of HMB in the study population was higher than the national prevalence, and there was a significant gap in HMB knowledge among the women surveyed. The study highlights the need for increased education and outreach efforts to promote preventative care and reduce reliance on emergency department visits.
In addition, advocacy and public health campaigns can effectively increase knowledge and awareness of HMB among ethnic minorities. For instance, the National Institute of Child Health and Human Development launched the "Know Your Flow" campaign to educate women about menstrual Bleeding and promote conversations about menstrual health. The campaign aims to increase awareness of HMB and encourage women to seek the care they need.
Telemedicine, the use of technology to provide healthcare services to individuals from remote locations, can be another potential solution to address the issue of HMB among ethnic minorities. This can be particularly useful for individuals who face barriers to accessing healthcare services, such as those living in rural or underserved areas. Telemedicine can provide a way for individuals to access healthcare services, including consultations with healthcare providers, without traveling long distances or incurring high costs.
Finally, increasing public funding for research on HMB among ethnic minorities can also help improve the situation. Public funding can be used to support research studies that focus on understanding the causes and effects of HMB among ethnic minorities and developing new and effective treatments. This can help fill the gap in knowledge and awareness of HMB among ethnic minorities and ultimately lead to better outcomes for these populations.
In conclusion, heavy menstrual Bleeding is a significant health issue affecting women of all ethnicities, but ethnic minorities are particularly affected. Addressing the issue of HMB among ethnic minorities requires a comprehensive approach that includes increasing knowledge and awareness, promoting preventative care, addressing systemic healthcare disparities, and fostering cultural competency among healthcare providers. By doing so, we can ensure that all women have access to the care and information they need to manage their menstrual health and improve their overall quality of life.
References:
Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding in a Multicenter prospective US cohort. (n.d.). Retrieved March 8, 2021, from https://www.hematology.org/Thehematologist/Diffusion/10288.aspx
Gilliam, M., Davis, S. D., Kozhimannil, K. B., & Attanasio, L. B. (2013). Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012–2015. Obstetrics & Gynecology, 132(3), 1158-1166. https://doi.org/10.1097/aog.0000000000002906
Harlow, S. D., & Campbell, O. M. (1996). Ethnic differences in the duration and amount of menstrual Bleeding during the postmenarcheal period. American Journal of Obstetrics and Gynecology, 175(6), 1256-1261. https://doi.org/10.1016/S0002-9378(96)70032-8
Healthline. (n.d.). Black Women and Fibroids: Facts, Stats, and More. Retrieved March 8, 2021, from https://www.healthline.com/health/womens-health/black-women-and-heavy-periods
James, A. H., Kouides, P. A., Abdul-Kadir, R., Dietrich, J. E., Edlund, M., Federici, A. B., ... & Philipp, C. S. (2011). Von Willebrand disease and other Bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. American Journal of Obstetrics and Gynecology, 205(1), 1-11. https://doi.org/10.1016/j.ajog.2011.02.047
Marsh, E. E., Brocks, M. E., Ghant, M. S., Recht, H. S., & Simon, M. (2014). Prevalence and knowledge of heavy menstrual Bleeding among African American women. International Journal of Gynecology & Obstetrics, 125(1), 56-59. https://doi.org/10.1016/j.ijgo.2013.10.001
Stewart, E. A., Nicholson, W. K., Bradley, L., Borah, B. J., (2013). The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women's Health, 22(10), 807-816. https://doi.org/10.1089/jwh.2013.4344
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