On the second day of her period, Alicia Graham uses a menstrual cup to collect blood that could help researchers unlock the mysteries of pregnancy complications.
After decanting her period blood into a small specimen jar, she carefully packs the sample into a parcel alongside an icepack, and a courier transports it to a laboratory.
“It took me a while to get started because I was a little nervous about using the cup,” said the 39-year-old mother of two from Ferntree Gully in Melbourne’s east.
“But if there’s something that can be identified in the menstrual blood that helps stop recurrent miscarriages and other complications, that would be amazing.”
Graham is among hundreds of women involved in two new studies looking at how menstruation affects a woman’s likelihood of developing complications during pregnancy, including unexplained stillbirths, pre-eclampsia, fetal growth restriction and preterm birth.
While menstrual blood has long been perceived as inconvenient, dirty and taboo, researchers at Monash University and the Hudson Institute of Medical Research are now studying the potential of the long-stigmatised bodily fluid.
“Girls hide their periods from the moment that they get them,” said Associate Professor Miranda Davies-Tuck, the lead researcher of the two studies.
“We don’t talk about our periods at all, and so it’s meant that nobody’s really considered them.”
The researchers believe that menstrual blood, which is made up of uterine lining, blood, tissue and immune cells, sheds important biological clues about women’s reproductive health before they conceive.
For the first study, Davies-Tuck and her colleagues are recruiting 1100 pregnant women in the hope of identifying menstrual characteristics – including first onset, frequency, pain, and whether the flow is heavy or light – that could be used as a risk assessment tool during pregnancy.
Davies-Tuck said early onset of periods, often between the ages of eight and 12, was linked to a higher risk or preeclampsia, a serious pregnancy complication in which women develop high blood pressure.
But she said this was not part of current screening tools for preeclampsia risk, which determines who might benefit from aspirin treatment.
Abnormal uterine bleeding can also point to undiagnosed disorders such as endometriosis which are associated with infertility and adverse pregnancy outcomes.
Davies-Tuck said she was inspired to look into the link between menstruation and pregnancy complications after hearing about her friend’s heavy and painful periods, pregnancy complications and then stillbirth.
“I realised that no one was considering that potentially the menstrual cycle is telling us information about the environment that is associated with complications,” she said.
The second study, which Alicia Graham has signed up to, is looking for 65 Victorian women who have experienced pregnancy loss or other adverse pregnancy outcomes to donate their menstrual blood.
It’s looking at whether there are biomarkers in their menstrual blood that could be used to improve pregnancy planning and care.
Graham jumped at the opportunity to be involved in the research last year after suffering a miscarriage in January 2023. She was 13 weeks’ pregnant when the miscarriage occurred and her prenatal tests were normal.
She wanted answers.
“It was an absolute heartbreaking shock after thinking that everything was still going fine,” she recalled. “It wasn’t until I had my loss that I discovered how many people in my circle of friends had gone through something similar, and it’s just never spoken about.”
She has now sent off five menstrual fluid samples to the researchers, and is eagerly awaiting the study results.
“I found it fascinating,” she said of the study. “I’m now more in tune with the different phases of my cycle.”
PhD candidate Kirsten Tindal’s involvement in the research is deeply personal. In her early 20s, she suffered a stillbirth, giving birth to her daughter Aurora at 22 weeks.
“I wanted to use that experience to help others,” she said. “I saw an advertised opportunity to do a PhD in this area and it really spoke to me.”
She said that for too long, menstrual fluid had been neglected as a biological specimen.
“We just flush [it] down the toilet,” Tindal said. “What a cool idea to pursue: could we use this sample to answer some of these questions about why pregnancy loss happens?”
International guidelines often define abnormal menstruation as heavy, painful and prolonged bleeding that affects a woman’s quality of life.
But Tindal believes short, light and pain-free periods might also warrant scrutiny.
“The quiet hypothesis coming out of the data is that there might be something there,” she said.
“Perhaps a very short or light period means the endometrium isn’t thickening or priming properly for pregnancy. Maybe a tiny bit of discomfort and a bit more blood volume is actually what’s normal.”
Dr Nisha Khot, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said while obstetricians asked patients about their gynaecological history, menstruation questions were limited to the date of their last period and whether their periods were regular.
“That helps us determine the due date,” she said. “If something comes out of this study that provides us with a new way of diagnosing and treating pregnancy risk, then that is a good thing.”
Anyone interested in donating their menstrual fluid to the study can find out more here: https://hudson.org.au/endometrial-origins-of-stillbirth-eos-study/
The Red Nose Grief and Loss Support Line is available 24/7 for anyone affected by the loss of a pregnancy, stillbirth or death of a baby or child on 1300 308 307.
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