Excerpt: The Invisible Crisis That Puts Black Women at Risk Every Month

In her new book, "A Terrible Strength," Dr. Kemi Doll weaves memoir, story and science to shine a spotlight on the full scope of Black maternal health.

(Courtesy of Harmony Books)

While we have heard much about Black maternal mortality and the dismal disparity that Black women are more likely to die in childbirth than all other groups in this country, I ask you to consider that this fact is just one thread to pull on the full picture of what is happening with Black women and the womb.

In this country, Black women’s bodies were the site of major discoveries in gynecology, but we are the last in line to receive the benefit of gynecologic care. As a double-board certified gynecologic oncologist and uterine cancer scientist, I wrote a book to change this: A Terrible Strength: The Hidden Crisis of the Black Womb & Your Survival Guide to Healing. Each chapter weaves memoir, story and science to bring into relief the full scope of this crisis.

Below is an excerpt from Chapter 4, HEAVY MENSTRUAL BLEEDING: The Suffering Womb, from the book, “A Terrible Strength: The Hidden Crisis of the Black Womb and Your Survival Guide to Healing.” Harmony Books, a division of Penguin Random House, 2026.

Dr. Whitney Ragan Robinson has been my friend and scientific collaborator for over ten years. We met when I was starting my research training, after completing my OB-GYN residency and the first half of my gynecologic oncology fellowship. I had just enrolled in graduate school, and she was an early-career assistant professor in the Department of Epidemiology at the University of North Carolina at Chapel Hill. Her educational pedigree was beyond impressive. Coming out of public schools in Memphis, Tennessee, she earned admission to Harvard University, graduating with a degree in biochemical sciences and going on to complete her Ph.D. in epidemiology.

Whitney is wearing a new Kamala T-shirt and sitting with a familiar backdrop—a room in her house where I can hear the sounds of her young boys playing (and sometimes screaming) in the background. She has natural hair in a braided style that makes me imagine a young Black girl, between her mother’s knees, getting a swoop of cornrows that end in a side fall of soft, short twists. Whitney’s family is Black American, with deep roots in the U.S. South. Many generations back, her maternal ancestors settled in Alabama, where her grandmother and then her mother were raised. I have always felt a gravity in Whitney’s presence, and today, I wonder if it’s because she embodies the unbroken line of Black women who survived the unimaginable—kidnapping, being carried like cargo across an ocean, enslavement, rape, and unending psychological violence—and are still here. What are the epigenetic signatures she carries with her right alongside the powerful cultural legacy?

Whitney describes her mother as being extremely hardworking and entirely practical. She had a strong sense of right and wrong and was unafraid to share it. Her mother also had a perfectionist streak, and one of the things she wanted to do perfectly was parent. Although Whitney’s softer and more sensitive take on the world could clash painfully with her mother’s directness, I can tell she clearly respects and appreciates all that her mother imparted to her. This gratitude includes that deep practicality (and minimal emotion) with which she approached teaching her only daughter about how to care for herself when she started her periods.

Whitney’s first period occurred when she was 10 years old. She had been in bed sleeping with her mom, because her father was out of town and it was still a practice that brought Whitney comfort. She woke up to go to the bathroom and discovered blood in her underwear. “My mother must have told me something about it before, because I remember I was not shocked. I just came back to tell her what happened and ask her what to do.” Her mother was matter-of-fact in teaching her about using pads and keeping a monthly calendar. Her mother tracked her own cycles on a big wall calendar that was used to organize all family activities. There was a P for the day her mother’s cycle was expected, and it would then be struck through with an X the day it arrived. It was out in the open, next to any assortment of kids’ appointments, work meetings, and family trips. And there was no shame. When Whitney entered this arena with her first cycle, a WP was added to the calendar. She started carrying a small purse to school to hold her maxi pads, using the calendar to prepare, and following the directions she was taught to keep herself tidy. Her periods were not a problem.

Except for the bleeding.

“I feel like I was pretty regular from the beginning, and looking back, they were heavy,” Whitney tells me. “But, like, my mom also had heavy periods, so I think that was normalized. It wasn’t a problem; it was more a pain. I can remember visiting my grandmother for Christmas, and I bled through the sheets one night. And my grandmother woke me up, we changed the sheets, you know. … And that was not uncommon that I would bleed into my sheets.”

Her mother taught her to lay towels on her bed to avoid bleeding accidents. And when she bled through those, they used a special spray to get the stains out. They would check her mattress pad to see if the blood had seeped through that layer as well. They always kept an extra set of sheets on hand and knew to expect more laundry some weeks. All of this was normal to Whitney the child, Whitney the young adult in college and graduate school, and even Whitney the wife and mother. It would be a long time before Whitney, the 44-year-old expert in the symptom severity of gynecologic conditions, could see the problem. By this time, she had already had a hysterectomy.

So, what really counts as “heavy bleeding,” as Whitney and so many of us casually say? There is a formal definition, and it may surprise you. I know it surprised me.

Heavy menstrual bleeding—or menorrhagia, as it was called for a long time in gynecology—is defined by the National Institute for Health and Care Excellence as “menstrual blood loss of sufficient volume to adversely affect physical, emotional, social and/or material quality of life.” I think this definition is one of the primary reasons why Black women are so deeply underdiagnosed. Menorrhagia is inherently subjective. It depends on your own assessment of what blood volume loss is acceptable and, most crucially, what quality of life you should expect. Surviving Black womanhood in this country requires strength, and modern gynecology has repeatedly shown a lack of empathy for the Black body. It is entirely rational that Black women would have a markedly different understanding of what constitutes a tolerable quality of life.

When I was in gynecology training, I was taught to screen for heavy menstrual bleeding by asking about bleeding that lasts more than seven days in a single cycle; soaking through more than one heavy pad or tampon an hour for more than three hours; or having more than three days of heavy bleeding within a single cycle. When I would use these questions to screen for abnormal bleeding in Black women patients, they often scoffed at me. To them, these were features of a normal cycle. In the moment, I felt silly creating what then felt like a false alarm. And then they shared stories of having to use adult diapers or Depends garments to manage bleeding because commercially sold heavy pads were woefully inadequate. They told me about lining trash bags under their bedsheets to save the mattress, because even the thickest diaper or pad could not contain the heaviness of their flow. But they were functioning, they were living, and to the definition I had been taught in medicine, they weren’t suffering.

A patient I’ll never forget exemplified this pattern of Black women accommodating the suffering. During a routine Pap smear appointment at the Cook County hospital, when I was in residency training, she told me that her blood flow was so heavy, she went through ten heavy pads a day. I immediately ordered blood work. Her blood level came back as critically and severely anemic—a hemoglobin level of 4 g/dL—which called for immediate hospitalization and blood transfusion. I called her, frantic, but she laughed. “I feel fine. I’m tired sometimes, but who isn’t?” she responded. Plus, her family always had “strong” periods, and she couldn’t miss work. I was stunned. It turned out she was a grocery store stocker. A physically intensive job that she performed with minimal oxygen-carrying capacity in her blood. If she could do this work at her current levels, what could she do at normal levels? Become an Olympian?! I am ashamed now that all I could initially see was her strength. It was several days later that I also thought about how precarious her life was. For example, if she were in a car accident, losing just a small amount of blood could put her into cardiac arrest, killing her before help could arrive. In a case like that, the autopsy report would say that she hemorrhaged to death—a typical occurrence in an accident. There would be no evidence of the medical invisibility that allowed her anemia to go untreated. And even without the bad luck of a terrible accident, her routine next period could be the tipping point, where she loses enough blood to have dangerously low blood pressure, landing her in an emergency department, requiring blood transfusions, time off work, and the cascade of inconveniences that have serious financial and social consequences for anyone not born into wealth. She is not alone. In a study of young Black women from Chicago who were not actively seeking gynecologic care for any reason, over one-third (35 percent) who reported having “heavy periods” were clinically anemic by blood test. One in three.