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Furthering knowledge of menstruation, bleeding disorders

OHSU scientist Bethany Samuelson Bannow, M.D., works to normalize discussions around periods, improve care, quality of life for individuals who menstruate
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Bethany Samuelson Bannow - Research Week 2024 - has short blonde hair, wearing a black top and pink sweater, stands on the lawn at OHSU on a spring morning.

Many women have experienced the effects of menstrual stigma, whether it’s sneaking a tampon into a restroom undetected, feeling embarrassed to ask a provider about unbearable cramping or heavy bleeding, or simply not understanding if a cycle is “normal.”  

Menstruation is a key indicator of overall health and fertility, yet so many individuals who menstruate feel confused or ashamed about the topic, says Bethany Samuelson Bannow, M.D., MCR, associate professor of medicine (hematology/medical oncology), Oregon Health & Science University School of Medicine, and the OHSU Hemostasis and Thrombosis Center.

Her research is working to change that.

Bannow is a classical hematologist, researching, diagnosing and treating blood-related conditions and diseases. In her years conducting research and providing clinical care for patients with bleeding and clotting disorders, Bannow became acutely aware of the significant gaps in women’s health research, even for seemingly basic medical events like menstruation.

“Many people are surprised to learn that women weren’t even required to be included in clinical trials run by the National Institutes of Health until 1993,” Bannow says. “It’s very recent history that we prioritized women in research, let alone pursued research related to women’s health issues specifically.

“I feel we completely missed the mark by not including women for so many years. Advancing women’s health research has now become a passion of mine.”

Recently, Bannow’s research has aimed to advance clinical understanding of menstruation, which is essential to improving reproductive health outcomes and empowering individuals to make educated decisions related to their menstrual health.

Half the adult population has a personal experience with menstruation; in the United States alone, this includes approximately 72 million people. Researchers and clinicians have a critical role in menstrual education, Bannow says, including identifying and assessing potential problems and providing guidance and follow-up care.

“Sadly, menstruation has not been prioritized in medical research or education. The result is that many people don’t have a basic understanding of their cycle or what ‘normal’ menstruation looks like,” Bannow says. “There’s so much to learn and so many opportunities to personalize treatment that can improve health and quality of life for people who menstruate.”

In fall 2023, Bannow received global attention for her study that was the first to use human blood rather than saline to test the capacity of modern menstrual products. The study concluded that understanding the capacity of newer menstrual products could help clinicians better quantify menstrual blood loss and identify patients with heavy bleeding.

“The fact that the research got so much attention around the world speaks to the public’s desire for more information about this topic,” Bannow says. “I had mixed feelings. On the one hand, I was saddened because there was such shock and disappointment that these issues hadn’t been investigated before, but on the other hand, I’m thrilled to see people talking so openly about menstruation. These are the conversations we need to have make periods not so taboo.”

Bannow’s current research focuses on coagulation factors in menstrual blood and the cells that regulate hemostasis, or the biological mechanism that leads to the stopping of bleeding. Bannow and her team are looking at endometrial endothelial cells — the cells that line the walls of blood vessels in the uterine lining — and measuring and analyzing coagulation factor levels in the menstrual blood of people who experience heavy menstrual bleeding. The findings may further experts’ clinical understanding of these conditions and advance treatment options.

Additionally, Bannow is investigating the genetic carriers of hemophilia in hopes of determining why some people experience heavy menstrual periods and other abnormal bleeding and why some don’t — a question that remains unanswered in research.

Bannow hopes this work will continue to bring women’s health issues to the forefront.

“From a research standpoint, in some ways, we know less about menstruation than we do about heart attacks,” she says. “That’s the struggle as a women’s health researcher: There is so much we don’t know and we’re so behind. But it’s gratifying to know our work is helping move things forward.”

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