Heavy menstrual bleeding can contribute to fatigue in midlife women

Heavy menstrual bleeding can contribute to fatigue in midlife women

Several menopause symptoms can make women feel tired. Hot flashes, sleep problems, pain and depression are just a few. A new study suggests that heavy or prolonged menstrual bleeding may increase fatigue, explaining why women in midlife are two to four times more likely to have debilitating forms of syndromic fatigue. The results of the study are published online today inmenopausethe Journal of the Menopause Society.

Most women transitioning through menopause experience changes in the amount and duration of menstrual flow, with many reporting episodes of prolonged (PMB) or heavy (HMB) menstrual bleeding that meet the criteria for abnormal uterine bleeding (AUB). The Study of Women's Health Across the Country (SWAN) found that one in three women going through menopause had episodes of AUB.

Despite the high incidence of AUB, few previous studies have focused on the problem, and no known studies have attempted to link AUB during the menopausal transition to fatigue or an overall reduced quality of life. Heavy menstrual bleeding, in particular, is associated with iron deficiency anemia, a well-recognized cause of fatigue.

This new large-scale study examined daily menstrual calendar data from more than 2,300 midlife women to determine whether HMB or PMB was associated with reporting of four specific symptoms of fatigue (feeling worn out, feeling tired, lacking pep or lacking energy) in the 6 months before a follow-up visit. Based on the results, the researchers concluded that HMB and PMB were associated with an increased risk of fatigue during the menopausal transition, even after adjusting for other causes. They suggest that greater clinical awareness of bleeding is needed at this stage of life, particularly when fatigue is also reported.

Since iron deficiency and related anemia are easily treated, early evaluation and rehabilitation would be helpful in women with these symptoms. However, to date, only limited attention has been paid to bleeding during menopausal transition research, the lay press, and social media.

The survey results are in the article “Abnormal Uterine Bleeding Is Associated with Fatigue During the Menopausal Transition.”

This study highlights the need for better clinical awareness of abnormal uterine bleeding, particularly given its increased frequency during the menopausal transition and its association with low energy or fatigue symptoms. Educating women about the possibility of prolonged or heavy menstrual bleeding during menopause and the potential health consequences is also needed. “

Dr. Stephanie Faubion, medical director of the Menopause Society

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