The Historical Painting of the "Bleeding Woman": Its Relevance for Today and the Future

Heavy menstrual bleeding (HMB) is a common yet underrecognized manifestation in girls and women with bleeding disorders and in those receiving antithrombotic therapy. HMB remains poorly defined and insufficiently explored and managed in clinical encounters. We explore HMB using the Limbourg Brothers' miniature as a historical and visual point to examine how menstrual bleeding has long remained visible yet unspoken. We argue that the burden of recognition still falls too heavily on the individual, particularly when clinicians fail to ask the right questions or when symptoms are normalized within families and society. We further propose that menstrual health should be treated as a core quality indicator in thrombosis and hemostasis clinics. We call for more recognition, standardized assessment, and proactive management so that women and girls are no longer left to seek help from the margins.