Haematologists should be prepared to address several key transitions and timepoints during the female reproductive health lifespan to provide safe and equitable care for all patients with haematological disorders. In this Review, we summarise important points for recognition and consideration in the care of patients with lifelong or transient haematological conditions. We include discussions on menarche, pregnancy, menopause, and gender-affirming care, and how these life transitions might impact people with underlying haematological disorders, including an increased risk of iron deficiency with or without anaemia. We focus specifically on the impacts of anticoagulation on menstrual bleeding, thrombosis risk on gender-affirming care, and pregnancy on those with sickle cell disease and inherited bleeding disorders.

Background: Heavy menstrual bleeding (HMB) is a common cause for iron deficiency amongst menstruating patients, yet it is often not discussed as a potential cause of iron deficiency by both patients and providers. This objective of this study is to evaluate documentation and workup of heavy menstrual bleeding in patients with known iron deficiency. Methods: This was a retrospective chart review of female patients (age, 18-50 years) with a ferritin value of less than 50 μg/L between February 1, 2024, and May 1, 2024 and visited a primary care clinic in our academic medical center. The visit was evaluated for documented discussion of menstruation and additional laboratory or imaging workup within a month of ferritin lab result. Results: Among 383 participants, the mean age (SD) was 36.3 (8.6) years, mean BMI was 28.7 (8.7). Our population comprised of 63% non-Hispanic white (NHW), 11% Hispanic, 9% Black, 14% Asian, 3% Native Hawaiian/Pacific Islander. Discussion of menstruation was documented in 46% of NHW participants versus 59% of non-white patients ( P = .015). There was no significant difference in workup ordered. Male providers documented menstruation discussions in 42% of cases. Female providers documented it in 55% ( P = .014). Conclusions: Non-white patients were more likely to be asked about HMB than NHW patients. Only about half of patients are asked about menstruation at the time of diagnosis for iron deficiency. Male providers are significantly less likely to ask about menstruation than female providers. The findings of this study highlight the infrequency of thorough discussion of menses in patients with ID, as this may improve diagnostic clarity, guide further workup, and thus reduce costs for unnecessary tests.

The use of anticoagulation in reproductive-aged females increases the risk of heavy menstrual bleeding (HMB). Excessive blood loss from HMB can lead to iron deficiency (ID), without or with anemia (IDA). We investigated the frequency with which reproductive-aged female patients on anticoagulants undergo screening for and receive a diagnosis of ID/IDA. We conducted a retrospective cohort study using the TriNetX global dataset of females aged 18-55 without a diagnosis of cancer who started anticoagulation therapy. The cohort was divided into sub-groups based upon ferritin testing within 90 days of starting anticoagulation and descriptive statistics were calculated. The initial cohort included 1,463,349 unique female patients across 93 healthcare organizations. Exclusion of those with cancer and those without laboratory values resulted in a final cohort of 783,196. Out of the final cohort, 9.2% had a ferritin level checked within 90 days of starting anticoagulation. Of those, 36.6% had a ferritin level ≤ 50 ng/mL while 25.8% had ferritin levels ≤30 ng/mL. Among individuals with ferritin ≤30 ng/mL, 19.7% (n = 3655) had a hemoglobin ≥12 and 44.0% (n = 8170) had MCV < 80 fL. These findings highlight a significant gap in the evaluation of ID for reproductive-aged females taking anticoagulation and emphasize the importance of using ferritin for the diagnosis of ID with or without anemia. Future studies and interventions are indicated to increase screening and expedite treatment of ID/IDA in reproductive-aged female patients starting anticoagulation.

Polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), is a complex disorder affecting females of reproductive age. Patients with PMOS can develop several comorbidities, including obesity, hyperlipidemia, arterial hypertension, insulin resistance, infertility, and increased risk for endometrial carcinoma. Venous thromboembolism (VTE) is another complication associated with PMOS, thought in part to be related to chronic inflammation leading to prothrombotic hemostatic changes. Hormonal therapy is the mainstay of management, but the presence of other comorbidities and risk factors such as thrombophilia and/or family history of VTE influences the choice of hormonal therapy. Management of this disorder requires multidisciplinary care of its gynecologic, cardiovascular, endocrine, and hemostatic components. In this review, a summary of the diagnosis and management of PMOS is provided with an emphasis on hemostatic considerations. We highlight 1) the diagnostic criteria and general management of PMOS, 2) Hormonal therapy and VTE risk considerations in PMOS management, and 3) Infertility management and the potential risk for thrombosis in patients with PMOS.

The availability of direct oral anticoagulants rapidly changed the landscape of anticoagulation between 2010 and the present. Randomized controlled trials demonstrating efficacy with similar or superior safety compared with warfarin led to the widespread use of direct oral anticoagulants in male and female patients of all ages. Years later, postmarketing data demonstrated a markedly increased rate of heavy menstrual bleeding (HMB) with rivaroxaban that had gone undetected in registry trials. Factor (F)XI inhibitors are currently being investigated as another alternative to available anticoagulation agents. While generally mild, the phenotype of inherited FXI deficiency includes bleeding in tissues with enhanced fibrinolysis, including HMB. Thus, we aimed to perform a systematic review of published studies on FXI inhibitors in order to estimate rates of HMB. However, we found that few studies included menstruating individuals, and even fewer specifically reported on uterine bleeding, highlighting once again a flaw in our approach to conducting trials of new anticoagulants.

Objectives: This study aimed to assess the risk of venous thromboembolism (VTE) among obese and nonobese females aged 10 to 44 years prescribed hormonal therapy (HT) and compare VTE rates between different HT types in a large national database. Methods: A retrospective cohort study was conducted using TriNETX data, which includes electronic health records and pharmaceutical claims from 81 million patients across 56 US tertiary care hospitals. Females prescribed HT between 2000 and 2022 were stratified by body mass index. VTE incidence was identified using International Classification of Diseases, Ninth/Tenth Revision, codes and anticoagulant prescriptions. Propensity score matching controlled for confounders. Results: Of 4,020,467 females, 34% (1,370,481) were obese. VTE incidence was higher in obese HT users (0.99%) than nonobese users (0.51%; P < .01). Obese users of levonorgestrel + ethinyl estradiol (EE) had a VTE rate of 0.55% vs 0.33% in nonobese users (P = .01, relative risk [RR] = 1.63). Similarly, obese users of norethindrone + EE (0.44% vs 0.24%; P < .01; RR = 1.8) and norgestimate + EE (0.44% vs 0.22%; P < .01; RR = 1.97) had higher VTE rates. No significant differences were found for progesterone-only HT users. Conclusion: In this large study comparing rates of VTE among obese and nonobese females on HT, a significantly higher risk of VTE was observed among obese females using certain HTs, particularly EE with levonorgestrel, norethindrone, and norgestimate. These results highlight the importance of considering obesity as a key risk factor when prescribing HT, particularly for females with higher body mass index.

The care of menstruating adolescents and adults requiring anticoagulation is challenging and requires close interdisciplinary collaboration. A number of collaborative clinics have been developed across the United States, and the Foundation for Women and Girls with Blood Disorders has led the effort to designate specific centers of excellence. Here, we describe the role of various team members, including hematologists, gynecologists, adolescent medicine providers, and nurses, in providing comprehensive, interdisciplinary care to menstruating individuals.

Von Willebrand disease (VWD) is the most common inherited bleeding disorder in the world. It is characterized by mucocutaneous bleeding, with heavy menstrual bleeding affecting the vast majority of girls and women with this condition. However, while bleeding episodes are the hallmark of VWD, there are marked psychological and socioeconomic ramifications of this chronic disorder, which may impact patients throughout their lifetimes, as well as additional medical issues, which may affect women with VWD preferentially. In this review, we discuss the evidence in support of nonbleeding complications of VWD and the key importance of providing a holistic approach to patient care.

Background Clinical diagnosis of heavy menstrual bleeding (HMB) is dependent on patient report of menstrual product usage of pads and tampons, but it is unknown if newer reusable menstrual products (cup and underwear) are similarly diagnostic.Methods We enrolled 20 regularly menstruating individuals with HMB for two menstrual cycles. Participants completed a retrospective baseline Pictorial Blood loss Assessment Chart (PBAC) at the time of enrolment (eligibility PBAC score >= 100) as well as several different measures with each study cycle. In cycle 1, participants used study-provided disposable pads and tampons. For cycle 2, participants were randomised to menstrual cup or underwear and collected their menstrual fluid on their heaviest 2 days. We compared the two cycles with respect to the weight of menstrual fluid collected and the frequency of product changes and leaks during the heaviest days in cycles 1 and 2, as well as questionnaire responses.Results Overall, the mean rate of product changes per heaviest day were 5.5 disposable product changes (range 1.5-11), 3.6 cup changes (range 1.3-6.2), and 3.5 underwear changes (range 2.7-6.9). Both groups (cup users and underwear users) reported a median 3.5 leaks (range 1-5) per heaviest day in cycle 2, while using the menstrual cup or underwear.Discussion Participants reported fewer daily changes of reusable products compared with disposable ones, but more leaks, suggesting that 'rate of product change' with reusable products may result in missed diagnoses of HMB.

Abstract Introduction: Heavy menstrual bleeding (HMB), traditionally defined as menstrual blood loss of greater than 80 mL per menstrual cycle, is a common complication for individuals with the propensity to menstruate. For those of reproductive age starting on anticoagulation, rates of HMB have been reported in up to 70% of patients. Assessment of HMB on anticoagulation remains challenging as the standardized bleeding assessment tools may not fully capture these specific bleeding events. As a result, patients may develop severe iron deficiency while on anticoagulation. Although other validated assessment tools, such as the pictorial blood loss assessment chart, may have a higher sensitivity and specificity to capture HMB, their usage may be impractical in certain clinical settings or unfamiliar to healthcare providers. Through a survey, we sought to investigate the practice patterns and strategies providers use to assess and treat HMB in patients on anticoagulation. Methods: Our survey was designed through collaboration with Foundation for Women and Girls with Blood Disorders thrombosis subcommittee and included input from Hematologists, Obstetricians/Gynecologists (OBGYN), and Pediatricians. A 25-question survey was distributed through medical professional organizations' email distribution lists and social media (LinkedIn and Twitter/X). Study data were collected and managed using REDCap electronic data capture tools hosted at Massachusetts General Hospital (MGH). The survey was approved through MGH Institutional Review Board. Results: A total of 108 participants completed the survey. Specialties included Hematology (52), OBGYN (36), Emergency Medicine (EM; 5), and Primary Care Providers (PCP; 15), which comprised of Pediatrics (7), Family Medicine (5), and Internal Medicine (3). Most respondents were from United States (87%) and female gender (86%). More providers reported less than 10 years in practice, 57%, compared to 43% who had more than 10 years. When queried about prescribing anticoagulation, 100% of EM providers reported starting anticoagulation compared to 56% Hematologists, 38% PCP and 0% OBGYN. Of the providers who initiated anticoagulation, 93% of Hematologists asked about menstrual history compared to 47% PCP and 20% EM. Most Hematologist (92%) and OBGYN (92%) asked how HMB affected their patients compared to PCP (60%) and EM (0%). Providers who reported using quality of life (QOL) metrics to assess HMB included 8% Hematologists, 6% OGBYN, 6% PCP, and 0% EM. Barriers to asking about HMB were lack of time (33%), lack of experience (7%), or hadn't thought about the topic (14%). Almost half (44%) reported no barriers. When asked whether restarting or continuing hormonal contraceptives increased the risk of recurrent clot while on anticoagulation, 23% Hematologists, 60% EM, 33% PCP, and 31% OBGYN answered affirmatively. Providers who reported pursuing a bleeding diathesis workup for patients with HMB and on anticoagulation included 83% Hematologists, 60% PCP, 50% OBGYN, and 20% EM. More of the providers reported pursuing this work up for patients with HMB and not on anticoagulation (96% Hematologists, 93% of PCP, 83% OBGYN, and 20% of EM). Types of educational resources used by providers to assess and manage HMB varied and included personal clinical experience (87%), professional guidelines (81%), conferences (61%), journals (56%), consultation within specialty (53%), medical school or residency educational curriculum (49%), consultation with OBGYN (40%), consultation with Hematology (37%), institutional guidelines (16%), and social media (2%). Discussion: Our survey demonstrates substantial differences in clinical practice patterns for the evaluation and management of HMB in patients on anticoagulation amongst numerous specialties. There were variations in rates of inquiry about HMB at the initiation of anticoagulation by provider specialty with the majority being Hematologists. Although many of the specialties reported asking how HMB affects their patients, few used QOL metrics. Moreover, many of the providers regardless of specialty felt that restarting hormonal contraceptives increases one's risk of recurrent VTE even if on anticoagulation, which is not supported by current literature. This project highlights the disparities and gaps in the assessment and management of HMB as well as underscores the need for additional research and opportunities for education in this clinical space.

The care of menstruating individuals on anticoagulation is complex and often overlooked in current clinical guidelines. Although existing recommendations address anticoagulant use broadly, they provide little guidance on managing menstrual bleeding, contraception, or reproductive transitions in this population. To address these gaps, we developed a practical clinical toolkit focused on anticoagulation stewardship for individuals who menstruate-from adolescence through menopause. This expert-driven resource outlines the best practices for identifying and managing heavy menstrual bleeding, optimizing contraceptive counseling, and coordinating care during high-risk periods such as pregnancy, surgery, and perimenopause. It also offers guidance for special populations, including adolescents, transgender and genderdiverse individuals, and those with limited access to care. Key topics include medication selection, dose adjustment, screening for anemia, and referral to gynecology when appropriate. The toolkit emphasizes the role of multidisciplinary teams- including hematology, gynecology, primary care, and anticoagulation services-in delivering patient-centered, equitable care. It also highlights practical strategies for integrating menstrual health into routine anticoagulation management, promoting shared decision making, and improving quality of life for affected individuals.

Pregnant persons with bleeding disorders (pwBD) have an increased risk of primary and secondary postpartum hemorrhage (PPH). Patients with von Willebrand disease, a bleeding disorder of unknown cause, or qualitative platelet defects (QPDs) and hemophilia carriers (HC) may or may not naturally achieve an adequately hemostatic state due to the hypercoagulable changes of pregnancy. PwBD greatly benefit from receiving care in a multidisciplinary setting including hematologists, obstetricians, anesthesiologists, and clinical geneticists. Factor levels should be obtained, at minimum, prior to conception as baseline as well as at the 34- to 36-week mark for delivery planning. However, target factor levels for delivery remain controversial given that many bleeding phenotypes do not predictably correlate with levels. Hemostatic therapies include antifibrinolytic agents, desmopressin, factor concentrates, and blood components such as cryoprecipitate, plasma, and platelets. Antifibrinolytics such as tranexamic acid have the most robust evidence for PPH management, though factor concentrates are now routinely utilized in certain circumstances. Blood products are an option for pwBD who have QPDs or when factor concentrates are not available. In patients with certain bleeding disorders, such as HCs, mode-of-delivery discussions must include consideration of the risks both to the affected neonate and to the mother. We favor selecting the mode of delivery based upon maternal indications whenever possible. Post partum, therapies may be continued for days or sometimes weeks after delivery, as pwBD are at high risk for delayed PPH.

Menstruation affects half the global population for roughly 40 years of life. Up to a third of these individuals will experience heavy or otherwise abnormal uterine bleeding. Among those individuals who require anticoagulation for venous thromboembolism (VTE) or other indications, the rate of heavy menstrual bleeding (HMB) skyrockets to 70% [1Patel J.P. Nzelu O. Roberts L.N. Johns J. Ross J. Arya R. How do anticoagulants impact menstrual bleeding and quality of life? - the PERIOD study.Res Pract Thromb Haemost. 2023; 7100072https://doi.org/10.1016/j.rpth.2023.100072Abstract Full Text Full Text PDF Scopus (7) Google Scholar]. While many treatment options are available for HMB, few have been studied in anticoagulated patients, and prescribers often feel confused about or uncomfortable with these strategies. The MEDEA study [2Hamulyák E.N. Wiegers H.M.G. Hutten B.A. de Lange M.E. Timmermans A. Westerweel P.E. et al.Heavy menstrual bleeding on direct factor Xa inhibitors - the MEDEA randomized clinical trial.Res Pract Thromb Haemost. 2024; 8102448https://doi.org/10.1016/j.rpth.2024.102448Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] was a randomized, open-label, pragmatic clinical trial designed to compare 2 treatment strategies: (1) switch from a factor (F)Xa inhibitor to dabigatran, a direct thrombin inhibitor, and (2) addition of tranexamic acid (TXA), an antifibrinolytic, during menses while continuing the FXa inhibitor to no treatment (control arm) for the management of HMB in the setting of anti-Xa therapy. Each participant was randomized to 1 of these 3 arms with the intent of comparing Pictorial Blood Loss Assessment Chart (PBAC) scores from prior to randomization (T1) with those from the 3 subsequent menstrual cycles on the intervention. Regretfully, the study was terminated early due to low enrollment and thus was not adequately powered to detect the differences it sought to identify. Based upon data collected from the 16 randomized individuals, however, Hamulyák et al. [2Hamulyák E.N. Wiegers H.M.G. Hutten B.A. de Lange M.E. Timmermans A. Westerweel P.E. et al.Heavy menstrual bleeding on direct factor Xa inhibitors - the MEDEA randomized clinical trial.Res Pract Thromb Haemost. 2024; 8102448https://doi.org/10.1016/j.rpth.2024.102448Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] report they were able to detect a statistically significant decrease in PBAC scores before and after initiation of TXA (−199; 95% CI, −343 to −54). The team also identified a nonsignificant decrease in PBAC scores with a switch to dabigatran and a slight, nonsignificant increase in those who continued anti-Xa therapy without intervention. While it is disappointing that the study was forced to close early, the study team must be applauded for recognizing the significant gaps in research for HMB, which affects an alarming proportion of individuals requiring anticoagulation, and for making a commendable effort to ascertain the impact of 2 potential treatment strategies in this unique population. Although underpowered, the findings are meaningful and contribute important work to the growing research field of HMB. In non–anticoagulated patients, effective therapies for HMB include TXA, combined hormonal contraceptives, and progestin-only hormonal therapies, including the levonorgestrel intrauterine device (Figure). Patients who do not experience an adequate response to these therapies or who have additional complications or indications may also be considered for procedural therapies such as endometrial ablation, uterine artery embolization, or hysterectomy. Although available data suggest that therapeutic rivaroxaban (20 mg daily) may be associated with numerically increased menstrual flow duration and intensity compared with prophylactic dosing (10 mg daily), dose reduction has not demonstrated statistically significant differences in menstrual bleeding patterns [3Boonyawat K. Lensing A.W.A. Prins M.H. Beyer-Westendorf J. Prandoni P. Martinelli I. et al.Heavy menstrual bleeding in women on anticoagulant treatment for venous thromboembolism: comparison of high- and low-dose rivaroxaban with aspirin.Res Pract Thromb Haemost. 2021; 5: 308-313Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar]. More importantly, the risk of VTE recurrence can be expected to increase when anticoagulation is withheld or, perhaps, even in the setting of early or inappropriate dose reduction, as supported by evidence of increased risk of VTE recurrence in individuals with HMB on rivaroxaban [4Bryk A.H. Pirog M. Plens K. Undas A. Heavy menstrual bleeding in women treated with rivaroxaban and vitamin K antagonists and the risk of recurrent venous thromboembolism.Vascul Pharmacol. 2016; 87: 242-247Crossref PubMed Scopus (53) Google Scholar]. Thus, it was appropriate that the authors did not include this strategy as an additional arm in MEDEA. While these various strategies can be, and often are, used in the treatment of anticoagulated individuals with HMB, data specifically comparing safety and efficacy of treatments in this population are lacking. Furthermore, despite evidence suggesting safety when used in therapeutically anticoagulated individuals [5Martinelli I. Lensing A.W. Middeldorp S. Levi M. Beyer-Westendorf J. van Bellen B. et al.Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use.Blood. 2016; 127: 1417-1425Crossref PubMed Scopus (165) Google Scholar], discontinuation of combined hormonal contraceptives is often a knee-jerk reaction when a patient is diagnosed with VTE. This can lead to a recurrence of HMB, worsened in the setting of anticoagulation. Due to widespread but demonstrably false assumptions that TXA increases risk of VTE [6Murao S. Nakata H. Roberts I. Yamakawa K. Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis.Crit Care. 2021; 25: 380https://doi.org/10.1186/s13054-021-03799-9Crossref PubMed Scopus (65) Google Scholar], patients may also be denied this essential therapy. Thus, inclusion of this treatment option in the MEDEA study was important and, hopefully, precedent-setting despite the inability to complete enrollment as planned. The rationale for switching from an anti-Xa inhibitor to dabigatran for management of anticoagulant-associated HMB is based upon post hoc analyses of large, randomized controlled trials of direct oral anticoagulants, which included some menstruating individuals. This analysis demonstrated decreased rates (odds ratio, 0.59) of abnormal uterine bleeding in individuals on dabigatran compared with low-molecular-weight heparin/warfarin. It is worth noting, however, that the rates of warfarin-associated HMB were higher in the dabigatran trials than in trials of the Xa inhibitors. This fact, in combination with the potential challenges with real-world anticoagulant switching, such as payor coverage restrictions, suggests that addition of TXA may be the more practical of the 2 interventions investigated in MEDEA. The fact that this first randomized, interventional study of treatment options for an adverse effect impacting up to 70% of reproductive-aged female users of these anticoagulants comes more than 15 years after approval of the first direct oral anticoagulants highlights a major limitation with current data and methodology of anticoagulant studies. Studies of anticoagulants to date have not been designed to detect HMB as an adverse effect and thus the scope of the problem remains underappreciated, and data on direct management are absent. The authors of this study used a PBAC to make the diagnosis of HMB. This is a perfectly reasonable and rather straightforward option that involves participant completion of a form that documenting number of menstrual products used and degree of saturation. This method is much more accessible and less costly than the "gold standard" alkaline hematin method, which involves collection of menstrual products and spectrophotometric quantification of hemoglobin contained therein. Limitations of the PBAC include reliance on disposable pads and tampons and sometimes reliance on participant memory if the form is not filled out contemporaneously. An alternative that may be considered, and which may or may not have resulted in different findings or higher rates of inclusion, is the Menstrual Bleeding Questionnaire (MBQ) [7Matteson K.A. Scott D.M. Raker C.A. Clark M.A. The menstrual bleeding questionnaire: development and validation of a comprehensive patient-reported outcome instrument for heavy menstrual bleeding.BJOG. 2015; 122: 681-689Crossref PubMed Scopus (58) Google Scholar]. In addition to objective data such as frequency of product saturation, the MBQ collects data on the impact of menstruation on quality of life. This is particularly relevant as the most up-to-date definition of HMB includes impact on physical, emotional, social, and material quality of life. In working with individuals with HMB, we have found that retrospective PBAC scores are almost always higher than contemporaneously collected ones, thus suggesting that the experience and impact of HMB are not fully captured by PBACs. Use of metrics such as the MBQ to determine inclusion may result in a lower rate of screen failures in future studies while still capturing essential outcomes. Future studies of HMB in anticoagulated individuals may also benefit from more robust screening and recruitment methods. As described, the MEDEA study depended on identification of individuals with HMB by the treating physician. As pointed out by the authors themselves, many cases of HMB likely go undetected due to clinician and patient hesitancy or failure to bring up the topic. If discussion of menstruation and patient and clinician awareness of HMB were ubiquitous, there is little doubt that a much larger sample size could have been obtained. Critically, early closure of the MEDEA study should not be interpreted as proof that future studies in this area cannot be successful. Despite being late in coming in comparison with the release of Xa inhibitors, the MEDEA study suffered from being ahead of its time in examining interventions for a problem that clinicians are not yet appropriately recognizing and diagnosing. Rather than disappointment over inadequate enrollment, the takeaway message of this study should be a call to action to improve our recognition of this common issue so that future studies may be better powered to provide the answers patients suffering from this condition need. The authors received no funding for this study.

The natural biological occurrence of menstruation occurs among half of the world’s population, yet the experience of those who menstruate is not commonly discussed. Challenges related to menstruation include stigma and shame around menstruation, access to menstrual health services, the invisibility of menstrual pain, management of menstrual flow, lack of menstrual education, the menstrual experiences of trans and non-binary people, period poverty, and early menopause among other issues. Current conversations and education around menstruation are inadequate and do not address the root cause of menstrual marginalization: shame and stigma that is deeply ingrained in our shared cultural experience from myriad sources. This Special Collection seeks to address this entrenched stigma by highlighting research conducted in a variety of disciplines, among diverse groups in a variety of cultural traditions, and throughout the reproductive life course. Improving Menstrual Health throughout the Reproductive Life Course This talk will provide an introduction to the speakers on the panel and their research in the areas of menstrual product absorbency among people with bleeding disorders, menstruation in carceral settings, and the menstrual health needs of people in the post partum setting. While each of these is talks differs in setting for menstrual health research what they have in common is the lack of visibility for menstruation among these communities. Navigating Carcerality and Menstrual Health: A Feminist Critique Menstruators experiencing incarceration face unique challenges when accessing menstrual health and managing their menses. While research has identified healthcare shortcomings in the carceral setting, period poverty behind bars has remained largely absent from the criminal legal discourse. This research uses qualitative methods to explore the novel concept of menstrual victimization, defined as the physical, emotional, and financial victimization that results from period poverty perpetuated through carceral control. Guided by a radical feminist framework, findings shed light on the unique structural harms menstruators who are incarcerated face and reveal the dearth of needed empirical research on period poverty in carceral spaces. Potential outcomes associated with understanding menstrual victimization in the carceral setting are discussed, including reducing menstrual stigma, disseminating health education, minimizing health disparities, increasing social bonds with children, and ultimately reducing recidivism by enhancing the reentry process. Postpartum Menstrual Equity Despite the universal nature of postpartum vaginal bleeding after childbirth and the importance of managing vaginal bleeding in the postpartum period to monitor health status, little is known about the information or products that birthing individuals are provided. Following IRB approval and in coordination with clinicians at a tertiary hospital in the southeastern United States, data were collected with 15 families from August through December 2020. A multidisciplinary team coded video and audio data from each family from 12 hours before hospital discharge. This analysis evaluates patterns of vaginal bleeding counseling timing, content, and language concordance and thematic content of this communication. Findings suggest that there are opportunities to strengthen clinical practices for more consistent, proactive, and language concordant vaginal bleeding and subsequent menstrual care postpartum. Investigating current practices may offer insights to enacting more supportive and equitable postpartum care and ensuring postpartum menstrual equity.

The topic of this review is venous thromboembolism (VTE) during pregnancy and postpartum. The following topics will be addressed: epidemiology and pathophysiology of VTE in pregnancy and postpartum, diagnostic considerations for VTE in pregnancy, indications for prophylactic and therapeutic anticoagulation in pregnancy and postpartum, choice of anticoagulation in pregnancy and breastfeeding, anticoagulation management during labor and delivery, and anticoagulation considerations for assisted reproductive technology.