Even in 2020, periods are a somewhat taboo topic. Many people still feel the need to hide their tampons and pads on the way to the bathroom. Menstrual products are still being taxed in 33 US states. But that behaviour — and stigma — may have perpetuated a bias in the medical field, one that resulted in experts missing important insights that could be gleaned from menstrual blood.
There's a small, but increasingly vocal group of experts and advocates who are pushing forward a movement that hopes to legitimise the use of menstrual blood as a diagnostic tool.
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"Menstrual blood is a bio-sample that's being completely ignored every month," says Candace Tingen, PhD, a program officer in NICHD’s Gynecological Health and Disease Branch. "If you need to diagnose a condition like low vitamin D or high cholesterol, you'll go to a clinic get your blood drawn because it's a very informative source of your hormone levels and basic vitamin levels. The truth is that menstrual blood is the same thing... It has similar information in it."
One of the most promising areas of menstrual blood-related research is occurring in the field of endometriosis. This condition occurs when cells similar to that which makes up the uterine lining grow outside the uterus or on nearby organs. It can cause pelvic pain during sex and menstruation, heavy periods, GI problems, cramping, and other issues.
Right now, endometriosis is notoriously difficult to diagnose. In fact, it takes someone with the condition an average of eight years to be diagnosed, according to a 2019 study in the Journal of Obstetrics and Gynaecology.
"The most vexing problem facing women with endometriosis is this long delay in diagnosis," says Christine Metz, PhD, professor at the Feinstein Institutes for Medical Research at Northwell Health.
Part of the reason for this long delay is that to be diagnosed, women typically must undergo an invasive laparoscopic surgery, which can identify abnormal cell growth. But that means years spent suffering with painful symptoms.
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Dr. Metz is the lead researcher for the Researchers OutSmart Endometriosis (ROSE) trial, which aims to reduce the amount of time it takes women with endometriosis to get diagnosed, and to develop less invasive tests as well. And that's where menstrual blood comes in. Dr. Metz refers to it as "a window into the uterus."
"There are many many scientific papers supporting that the lining of the uterus is different in women with and without endometriosis," she explains. And, of course, the lining of your uterus is shed once a month in the form of your period. Dr. Metz, along with her team, hopes to find a way to use menstrual blood as a diagnostic tool. They're currently in the process of gathering samples from people with endometriosis, people without endometriosis, and people who suspect they may have it.
The end goal of this trial is to receive FDA clinical approval for the new menstrual diagnostic test for women nationwide, and to move away from the invasive test we have now. "If we fail, it will still be an amazing screening tool for identifying those women who should undergo the diagnostic," Dr. Metz says. They're also seeking FDA approval for their menstrual collection pad, which can be used to send in samples.
Ultimately, menstrual blood could one day be used to diagnose other conditions as well, including fertility issues, uterine diseases, cancer, and even Alzheimer's.
"When I started researching menstrual blood and why people don’t use it to diagnose disease, I also started seeing all of the discrepancies around women’s health being underrepresented," Anna Villarreal, founder and CEO of LifeStory Health, a bioscience company focused on the female biology, explained to Refinery29. "We’ve definitely proven that it can be a clinical utility — and not medical waste, which is how it’s taught in medical textbooks today still."
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According to their website, LifeStory Health has "affirmed unique protein signatures in menstrual blood that are not found anywhere else in the human body — signatures can be used to screen for and early-detect female prevalent diseases." The company currently has clinical trials in the works that are studying the early detection of breast, lung, and endometrial cancer through the use of menstrual blood samples.
Villarreal's hope is to use menstrual blood to eventually replace the blood draw in your arm.
Some day in the near future, menstrual blood testing may be mainstream, even integrated into period tracking apps, says Dr. Tingen. If someone logged symptoms that might indicate endometriosis or another condition, the app could flag it. "Women would track their symptoms and their app would tell them, 'Hey, it looks like you’re using a lot of tampons' or 'It looks like you’ve recorded a lot of pain — click here to get a tampon collection kit,' or 'Click here to have an address for the lab you can send your tampon to,'" Dr. Tingen says.
But the most important outcome, she notes: "Women wouldn’t suffer in silence."