Illustration by Emma Günther
The many meanings of ‘heavy’ periods
Heavy menstrual bleeding is often under-recognized—but can apps like Clue help change that?
Heavy menstrual bleeding (HMB) is estimated to impact around 30% of women (1), but it is often under-recognized and difficult to diagnose. One person’s understanding of ‘heavy’ menstrual flow can be very different to another’s, and can be impacted by cultural and personal bias around what is considered ‘normal’.
Healthcare professionals and researchers have previously defined HMB as the loss of more than 80 mL of blood in one menstrual period (2). However, this is difficult to measure (3). Additionally, one study found only 26% of those who describe their period as ‘heavy’ had blood loss higher than the clinical norm (4). This and similar findings suggest that people’s perceptions and experiences of period heaviness are multi-faceted, and go beyond just flow alone (5,6).
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Clue recently partnered with the Bill and Melinda Gates Foundation on the first study of its kind to look at the ways self-tracked data, via menstrual tracking apps like Clue, can help support more accurate diagnosis and individualized healthcare support for heavy menstrual bleeding.
Our study compared the de-identified real-time tracked data of over 6500 consenting Clue users, to their responses to an online questionnaire which asked them about their last period. We compared aspects such as tracked period duration, daily flow volume, and quality of life indicators (such as pain and disruption of daily activities) to the users’ self-assessments of how heavy their period was.
More than blood
We found that for people who reported having a heavy or very heavy period in the questionnaire, actual flow heaviness was not always the most influential factor. Period 'heaviness' was associated with increased app-tracked period length and number of days with heavy flow, along with increased pain and other physical symptoms such as fatigue and digestive issues. Those who reported heavy periods also reported a greater disruption of daily activities such as the ability to participate in sexual activity, social and leisure activities, and school or work.
About 18% of respondents who stated that they had heavy or very heavy periods had not tracked any days of heavy flow in the Clue app. However, their period length and quality of life indicators (such as experienced pain and disruptions to daily life) were similar to those who had tracked heavy flow.
These findings support the recent shift away from blood volume measurements alone in the diagnosis of HMB, towards a greater focus on quality of life. Many clinical organizations now define HMB as: excessive menstrual blood loss that interferes with a person’s physical, social, emotional, or material quality of life (7,8). This prioritization of individual experiences and perceptions can help people with cycles get the tools and support they need to have the highest quality of life, whatever that may mean for them.
No one-size-fits-all approach
Apps like Clue give users the opportunity to track a wide range of cycle-associated experiences in real-time. Instead of trying to recall previous experiences (which can be subject to personal bias and difficult to remember accurately), users have access to data that provides a more reliable and detailed view of bleeding patterns and experiences.
There is no one-size-fits-all approach to reproductive health. This research highlights the potential for menstrual tracking apps to provide valuable data for holistic menstrual health diagnostics that are sensitive to the wide range of individual experiences.
This can help people become more aware of their own unique patterns and changes, as well as assist healthcare providers in better understanding their patients’ experiences and, where needed, help to guide more individualized treatment.
If you feel you have consistently heavy, long periods or any other symptoms that are disrupting your life, we recommend tracking your cycle with Clue and discussing your cycle history and patterns with your healthcare provider.
We want to extend a big thank you to all Clue users who participated in this research and in so doing, have helped to advance this area of female health research. The full research article is available here.
