Hormonal health
Inadequate heavy bleeding care costs NHS millions a year, analysis finds
Mismanaged heavy bleeding care is costing the NHS millions each year, a new analysis suggests.
Experts say thousands of patients could be treated earlier in the community rather than in hospital.
Heavy periods, affecting at least one in three women, are defined as blood loss that disrupts daily life.
Symptoms can be linked to conditions such as fibroids, endometriosis or adenomyosis.
Treatment options include hormonal contraception or tranexamic acid, a medicine that helps blood to clot and reduce bleeding.
Severe blood loss can lead to anaemia, a lack of red blood cells, sometimes requiring transfusion.
Janet Lindsay, chief executive at Wellbeing of Women, said: “This study shows that we cannot afford to dismiss heavy menstrual bleeding as just a period. The impact of heavy menstrual bleeding on women’s lives is real and it can be debilitating.”
Researchers at Anglia Ruskin University analysed 1,332 hospital visits from 98 NHS gynaecology units between January and June 2024, during which 3,025 units of red blood cells were used.
The mean cost per admission was £2,972, with post-discharge care averaging £1,735. Scaled across a year, this equates to a little over £13m.
The average hospital stay was two days, and one in five patients were discharged while still anaemic.
Dr Bassel Wattar, associate professor of reproductive medicine at Anglia Ruskin University, said: “This is a silent crisis in women’s health.
“We are seeing thousands of women admitted to hospital for a condition that could often be managed earlier and more effectively in the community.”
Dr Sue Mann, national clinical director in women’s health at NHS England, added: “It’s vital that women experiencing heavy bleeding seek help from the NHS before it leads to serious conditions such as chronic anaemia, so please do come forward for support.”
Supermarket loyalty card data suggests more than a quarter of women buying menstrual products also buy pain relief at the same time.
The findings also suggest women in lower-income areas are significantly less likely to do so, pointing to disparities in access to over-the-counter pain relief across England.
The study was led by Dr Victoria Sivill of the University of Bristol and colleagues.
The authors said: “The study highlights the need for greater awareness and policy interventions to address the high prevalence of menstrual pain as well as socioeconomic dimensions of menstrual pain.
“Public health initiatives should incorporate menstrual pain relief as part of broader efforts to improve health equity.”
Researchers analysed anonymised loyalty card data from a major UK health and beauty retailer, covering 211m transactions by 3.4m people between 2006 and 2015.
The study examined how often shoppers bought menstrual products and pain relief in the same transaction, and compared this with a customer’s usual rate of buying pain relief.
It found that 26.7 per cent of customers who bought menstrual products also bought pain relief at the same time.
These customers were nearly four times more likely to buy pain relief when buying menstrual products than on other shopping trips.
As a check on the approach, researchers found the most common interval between consecutive menstrual product purchases was exactly 28 days, consistent with the average menstrual cycle.
Menstrual pain is common and can affect daily activities, including school and work attendance.
Regional income was the strongest predictor of menstrual pain purchases.
Customers in the lowest-income areas were 32 per cent less likely to buy pain relief at the same time as menstrual products than those in the highest-income areas.
The authors said lower rates of pain relief purchases in deprived areas are likely to reflect an inability to afford over-the-counter medication rather than lower rates of menstrual pain itself.
Co-author Dr James Goulding said: “It is wonderful that smart data research in the UK is able to bring issues which may have once been overlooked in scientific settings, such as the sheer scale and impact of menstrual pain, to light. This is well overdue.
Co-author Dr Anya Skatova said: “Like many women, I was aware of how common menstrual pain is, but the scale of painkiller purchases alongside menstrual products was still striking.
“Using shopping data, we can see just how widespread the need for pain relief really is. This kind of evidence helps make menstrual pain visible at a population level and provides a strong foundation for systemic change in how it is recognised, treated, and prioritised in public health.”
Wearable technology could revolutionise how women understand and manage their menstrual and hormonal health, according to a major new review that assessed dozens of studies involving data from millions of participants.
The review, which examined 40 studies with cohorts ranging from small pilot groups to nearly 19 million participants, found that devices such as the Oura Ring, Apple Watch, Fitbit, WHOOP band and Garmin watches are capable of detecting meaningful physiological changes across the menstrual cycle – and could one day help identify conditions far sooner than current methods allow.
The findings come as growing attention is being paid to the economic and personal toll of menstrual health problems.
Up to 90 per cent of women report cycle-related symptoms including pain, bloating and mood swings, while up to 40 per cent suffer from premenstrual syndrome.
A more severe condition, premenstrual dysphoric disorder, affects up to 8 per cent of women. In economic terms alone, menstrual and perimenopausal symptoms are estimated to cost the United States more than US$26 billion a year.
Researchers found that wearables were able to reproduce well-established hormonal patterns in real-world settings.
Skin temperature was found to be lower in the first half of the cycle before ovulation, and higher afterwards, consistent with known effects of progesterone.
Resting heart rate rose by around two to four beats per minute from the pre-ovulation phase to the days following it.
Heart rate variability, a marker of nervous system activity, was highest in the early cycle and lowest in the premenstrual phase, with lower readings linked to symptoms of PMS and PMDD.
The review also challenged some long-held assumptions.
Digital data suggested that ovulation tends to occur later and more variably than previously thought, with the pre-ovulation phase averaging 15 to 17 days rather than the 13 to 14 days typically cited.
Skin temperature was also found to dip most sharply more than five days before ovulation – not immediately before it – a finding the authors said could have practical implications for women using cycle tracking for contraception or conception.
Large datasets revealed that cycle patterns vary considerably between individuals and across a lifetime.
Nearly 20 per cent of women showed significant cycle-to-cycle variability, and both low and high body weight were linked to longer and less predictable cycles.
The data also pointed to racial differences in menstrual characteristics that had previously gone largely undetected in smaller laboratory studies.
On contraception, the review found that combined hormonal contraceptive users showed flatter, inverted heart rate variability patterns across the cycle, while progestin-only methods produced trends closer to natural cycles.
The authors cautioned that most research has been conducted in the United States and Europe, with predominantly white participants, and called for broader, more diverse studies.
They also flagged significant gaps in research on perimenopause, partly because many studies excluded women with irregular cycles.
Despite these limitations, researchers concluded that wearable devices hold genuine promise for helping women monitor their health and enabling earlier identification of conditions that might warrant medical attention – provided privacy safeguards and standardised research methods are put in place.
Hormonal health
Sweden eyes domestic production of oestrogen patches amid menopause treatment shortage
Sweden is exploring domestic production of oestrogen patches as shortages continue to disrupt menopause treatment.
Two government agencies have been asked to examine whether transdermal oestrogen patches could be made in the country.
Transdermal treatments deliver medicine through the skin, most commonly through patches, gels or sprays. They provide a continuous low dose of hormones.
The move follows a long-running shortage of oestrogen treatments that has left women struggling with menopause symptoms and forced pharmacists to look for alternatives.
Hot flushes, mood swings and depression are among the well-documented effects of menopause.
Jakob Forssmed, the health and social affairs minister, has asked the Swedish Medical Products Agency and the Dental and Pharmaceutical Benefits Agency to examine whether the patches could be produced in Sweden.
Speaking to Dagens Nyheter, Forssmed described the assignment as “very urgent”, citing recurring shortages affecting women who “need these medications to lead a functional life”.
The Swedish Medical Products Agency will examine whether a national operator could produce bulk transdermal formulations of oestrogen medicines and, where possible, prepare a process for production.
One possible manufacturer is the state-owned Apotek, Produktion & Laboratorier, which makes medicines tailored to the needs of the Swedish health system.
In 2025, about 205,000 women aged over 45 in Sweden were using systemic oestrogen treatment, according to a report from the Board of Health and Welfare.
That represents 8 per cent of women in the age group.
Transdermal oestrogen has become increasingly popular among menopausal women in Sweden. When patches are unavailable, some women switch to sprays and gels, which can then also run out of stock.
There is no shortage of oestrogen pills. However, experts say they are not a suitable option for everyone because of side effects that patches, sprays and gels do not have.
Angelica Lindén Hirschberg, professor of obstetrics and gynaecology at Karolinska Institutet, told Läkemedelsvärlden: “The pills affect the liver’s production of proteins and increase the risk of blood clots. For many women, the transdermal option, administered through the skin, is the only medically appropriate choice.”
Demand for hormone treatment has risen sharply in Sweden and globally, contributing to shortages.
Manufacturing constraints, supply chain bottlenecks and rising production costs are also said to play a role.
Läkemedelshandlarna, the Swedish association for parallel importers, has said access could be improved by allowing importers to buy hormone patches from other European countries at higher prices.
In response, representatives of the Swedish Medical Products Agency and the Dental and Pharmaceutical Benefits Agency said the causes of shortages needed to be seen “in a more nuanced light”.
They said: “The price level in Sweden is not the only explanation for the shortage of transdermal oestrogens, that is, oestrogen medications administered through the skin, most commonly via patches, gels, or sprays.
“Increased global demand and production issues are also affecting international supply.”
Estradot is among the oestrogen patches affected by shortages.
Some dosage strengths have been removed from Swedish benefit schemes by manufacturer Sandoz after authorities did not approve higher prices.
Under the government’s instruction, the Medical Products Agency will also consider whether access could be secured through EU mechanisms, including public procurement.
The Dental and Pharmaceutical Benefits Agency will examine whether more companies could hold marketing authorisations for transdermal oestrogen medicines, as well as whether parallel trade could be promoted.
The agencies are due to report back to the government by 30 October.
The Board of Health and Welfare report also found disparities in access to hormone patches across areas with different socioeconomic conditions.
In areas facing major socioeconomic challenges, 3.2 per cent of women collected hormone replacement therapy. In areas with very good socioeconomic conditions, the figure was 12.1 per cent.
Maja Österlund, an investigator at the agency, said: “These differences reflect a healthcare system that is currently unequal, and where we also know there is a shortage of certain medicines.”
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