Awards

Joyce Were of the Kenya Medical Research Institute in Kenya will develop a screening tool for assessing heavy menstrual bleeding that is adapted for use in Kenya by integrating two globally used questionnaires, adding material to incorporate the impact on women in the Kenyan context, and translating it into the locally spoken languages Swahili and Luo. Through consultations with experts, the tool will combine the Menstrual Bleeding Questionnaire (MBQ) with the Screening Assessment and Measurement of Atypical and Normal Menstrual Patterns Tool for Adolescents and Adults (SAMANTA), and it will incorporate new questions. The tool will be iteratively modified through small pilot tests. It will then be administered to adolescent girls and young women in Western Kenya as part of the Health and Demographic Surveillance System (HDSS) of the Kenya Medical Research Institute (KEMRI), with 70,000 participants surveyed with either the new tool or the MBQ or SAMANTA tools for comparison.

Jennifer Anyanti of the Society for Family Health with Clara Ejembi from Ahmadu Bello University, both in Nigeria, will evaluate patient experiences and treatment outcomes in women with heavy menstrual bleeding in Nigeria, with a focus on increasing the effectiveness, acceptability, and accessibility of hormonal contraceptives as treatment. Clinical data will be collected for a cohort of women receiving care for the condition in Kaduna state in Nigeria, together with qualitative data from interviews with patients, care providers, and supply chain managers. This information will be used to design and pilot targeted interventions to increase access to acceptable and effective treatment, such as community health education, supply chain improvements, and treatment programs. Such interventions can be iteratively improved with the original evaluation framework, generating a sustainable data management system to guide improvements in patient-centered care for heavy menstrual bleeding.

Sara Khalid of the University of Oxford in the United Kingdom will use large data sets from Kenya, Pakistan, and the United Kingdom to better understand the health impact and treatment challenges associated with heavy menstrual bleeding in low-resource settings. The project is a collaboration between Oxford University, Aga Khan University Kenya, and Aga Khan University Hospital Pakistan, with analysis of existing data sets in these three countries covering over twenty years of data for women diagnosed with heavy menstrual bleeding. For Kenya and Pakistan, analysis will encompass disease burden and epidemiology; patterns in treatment access, adherence, and effectiveness; and risk factors, with a risk prediction tool generated for heavy menstrual bleeding and its adverse outcomes. Equivalent analysis will be performed with data from the United Kingdom stratified by ethnic group to identify unique and shared features of the condition across settings.

Nadia Diamond-Smith of the University of California San Francisco in the U.S. will characterize the prevalence and impact of heavy menstrual bleeding as well as treatment preferences in a cohort of women in the state of Rajasthan in India. Building on an ongoing survey, new data will be acquired from 1,500 women in Rajasthan, including newly married women and their mothers-in-law. The prevalence of heavy menstrual bleeding will be determined, and the data will be modeled for its impact on women's physical and mental health. Twenty-five in-depth interviews will be performed, with the information used to design and launch a discrete choice experiment through a survey of 300 women from the cohort with heavy menstrual bleeding. This survey will uncover women's preferences across treatment options for the condition, including their willingness to pay for them, setting the stage for designing treatment programs based on the local context.

Irene Njuguna of Emory University in the U.S. will determine the prevalence and impact of heavy menstrual bleeding in adolescent girls and young women in a variety of community settings in Kenya, as well as the barriers to treatment delivery and uptake. Two thousand adolescent girls and young women aged 10-24 across rural and urban communities in Kenya will be surveyed to determine heavy menstrual bleeding prevalence, and their hemoglobin levels will be measured to assess for anemia as a consequence. Interviews and focus group discussions with participants as well as with care providers will be performed to assess the available options for care and treatment of the condition, including patient referral pathways, and to identify barriers hindering patients from seeking care and providers from delivering it.

Maneesha Inamdar of the Institute for Stem Cell Biology and Regenerative Medicine in India will develop a standardized organoid model of the human endometrium, together with a reproducible and scalable process for generating these organoids. Protocols for deriving endometrial organoids from established human pluripotent stem cell lines will be optimized. This includes generating fluorescent reporter cell lines as visible readouts of secreted products to monitor development and differentiation of the input cells, as well as determining the assays for comparing organoid function with that of human endometrial tissue. The resulting model system will enable automated analysis with equipment for routine cell culture and without the need for human clinical samples, and it will facilitate human endometrial biology research to identify therapeutic targets and treatments for heavy menstrual bleeding.

Sweta Kanavaje of the Myna Mahila Foundation in India will evaluate the effectiveness of the Myna Bolo chatbot in providing confidential, culturally sensitive, and medically accurate guidance on heavy menstrual bleeding to women in poor urban communities in Mumbai. The chatbot incorporates Large Language Models and currently provides tailored sexual and reproductive health information through multiple platforms in local languages. The chatbot will be evaluated specifically for advice on heavy menstrual bleeding through a randomized controlled trial with 400 women from Mumbai, comparing the chatbot to standard in-person counseling and to telehealth counseling. Primary outcomes of the trial, assessed through questionnaires and focus groups, include diagnostic accuracy compared to clinical assessments, reduction in time to seek and begin treatment, and improved understanding of menstrual health.

Rohini Nair of Gujarat Biotechnology University in India will explore the cellular heterogeneity and molecular pathways associated with heavy menstrual bleeding to better understand the condition, using single-cell transcriptional profiling of the endometrium in patients. In collaboration with Rohina Aggarwal of the Institute of Kidney Diseases and Research Centre in India, 60 premenopausal women with self-identified heavy menstrual bleeding will be recruited: one subgroup with irregular menstrual cycles (half with uterine fibroids and half with adenomyosis) and one subgroup with regular menstrual cycles and no discernible pelvic pathology. A control group of women without clinical symptoms will also be recruited. Single-cell RNA sequencing will be performed on endometrial samples taken during participants' menstrual period to reveal potential biological mechanisms shared and unique across patients with the condition.

Susan Ontiri of the International Centre for Reproductive Health Kenya in Kenya will explore AI-enabled ultrasound for diagnosis of structural causes in the uterus of heavy menstrual bleeding, as well as exploring multiple treatment options for the condition. A cohort of 120 women with heavy menstrual bleeding will be recruited at the Coast General Teaching and Referral Hospital in Kenya. Participants will receive the standard clinical assessment together with an ultrasound evaluation. The accuracy and feasibility of the two diagnostic methods will be compared, and the ultrasound images will be annotated by experts and used to develop an AI-based model to enhance diagnosis by ultrasound. A pilot treatment trial will also be performed. Treatments including hormonal therapy, tranexamic acid, and non-steroidal anti-inflammatory drugs (NSAIDs) will be assessed, comparing feasibility, acceptability, adherence, and effectiveness.

Gina Ogilvie of the BC Women's Health Foundation in Canada, with Carolyn Nakisige and Priscilla Naguti of the Uganda Cancer Institute in Uganda, will use community outreach to determine the prevalence and impact of heavy menstrual bleeding in women in rural Uganda, with a focus on better understanding the condition for perimenopausal women. Outreach will build on an existing mobile health program in Uganda for cervical cancer prevention and reproductive health. Village health teams will recruit 5,000 women, aged 30-49, across 15 villages. They will use a set of questionnaires to survey this age group, which includes women's transition to menopause (perimenopause) for which less is known about heavy menstrual bleeding. The survey will include assessment of the health, social, and economic impacts on women and their children; menstrual hygiene and product use; quality of life; and treatment availability and acceptability.