Heavy Menstrual Bleeding During Menopause Linked to Fatigue

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Heavy and prolonged menstrual bleeding during menopause is linked to increased fatigue and lower energy levels, according to research published in Menopause. The findings highlight the need for greater clinical attention to menstrual changes and their impact on fatigue and overall well-being in midlife women.

The study examined the link between heavy (HMB) or prolonged menstrual bleeding (PMB) during the menopause transition and fatigue symptoms using longitudinal daily menstrual calendar data from 2,329 participants enrolled in the Study of Women’s Health Across the Nation (SWAN). PMB was defined as episodes of bleeding that lasted more than eight days, and HMB was defined as very heavy bleeding for three or more days.

According to SWAN, one in three women transitioning through menopause experience abnormal uterine bleeding (AUB), characterized by menstrual bleeding within a six-month span that is considered excessive in amount, frequency or duration.

“Although studies are few, available evidence points to adverse effects of AUB on women’s quality of life,” wrote a team of investigators led by Siobán D. Harlow, Ph.D., professor emeritus of obstetrics and gynecology at the University of Michigan. “We hypothesized that AUB during the menopause transition, especially when characterized by HMB, would be related to fatigue symptoms, because HMB is linked to iron deficiency anemia, a well-recognized etiology of fatigue.”

During a seven-year follow-up period, investigators analyzed four symptoms of fatigue and vitality: feeling worn out, feeling tired, having a lot of energy and feeling full of pep. Each participant was asked to assess any connection between each variable and PMB or HMB in the six-month period prior to their annual visit. Response options were “all of the time,” “most of the time,” “a good bit of the time,” “some of the time,” “a little of the time,” and “none of the time.”

Models were adjusted for a variety of factors including age, ethnicity, body mass index (BMI), sleep issues, smoking status, perceived stress, depression and anxiety symptoms, hormone therapy use and discrimination (assessed using the Detroit Area Study Everyday Discrimination Scale).

Most participants (50.5%) were White or Black (23.7%) with a mean age of 47.3 years and a mean BMI of 27.8 kilograms per meter squared. Approximately one out of three women reported sleeping problems at the first follow-up visit and one-quarter experienced depressive symptoms.

In the six months leading up to the first follow-up visit, 20.7% of women recorded one or more episodes of HMB and 24.4% had PMB. Approximately 26.6% said they had felt tired in the past two weeks and 24.2% felt worn out. However, half of the women reported having energy and being full of pep.

After adjustment, women who experienced any episode of HMB in six months had about 30% higher odds of feeling tired and worn out, while those with three or more episodes were 70% more likely to feel fatigued. Similarly, PMB was associated with a lower likelihood of feeling energetic, although it wasn’t linked to any other symptoms of vitality or fatigue.

Limitations of the study included a lack of information to diagnose AUB and no clinical measurements of iron levels. The team suggests that women reporting these symptoms should be tested for anemia and iron stores. Despite these limitations, the study was the first community-based analysis of the connection between PMB and/or HMB during menopause and low energy or fatigue based on menstrual bleeding records. Additionally, the generalizability of the findings was enhanced by the large sample size and broad representation of diverse races and ethnicities.

“Education of women about the likelihood of excessive menstrual bleeding during the menopause transition and its potential health consequences is warranted,” investigators concluded.