Excessive menstrual bleeding may worsen fatigue during menopause transition

Key takeaways:

• Women reporting abnormal uterine bleeding during the menopause transition were more likely to report feelings of fatigue.
• Clinicians should ask midlife women about their menstrual bleeding history.

Midlife women with repeated episodes of heavy or prolonged menstrual bleeding over 6 months were 40% to 60% more likely to report feeling fatigued, underscoring the clinical importance of menstrual history during the menopause transition.

"Despite the increased scientific and media attention to menopausal symptoms, studies of menopause have rarely examined the health consequences of women's menopausal bleeding experiences, although up to 30% of women experience significant blood loss during menopause transition,” Siobán D. Harlow, PhD, Professor Emerita of Epidemiology and Global Public Health at the University of Michigan, told Healio. “This study provides empirical evidence that midlife women who experience excessive bleeding, both heavy and prolonged, have an increased likelihood of feeling tired or fatigue. Although excessive menstrual bleeding can lead to anemia and most women report feeling tired or fatigued as they approach menopause, to date, the association between these two treatable conditions has received inadequate scientific or clinical attention.”

Researchers analyzed longitudinal daily menstrual calendar data from 2,329 participants in the Study of Women's Health Across the Nation to assess episodes of heavy or prolonged menstrual bleeding. Women responded to questions about feelings of fatigue — described as “worn out,” feeling tired,” full of pep” or “having energy” — at seven annual follow-up visits. Researchers assessed the association between each fatigue variable and prolonged or heavy menstrual bleeding recorded during the 6 months before each follow-up visit.

The findings were published in Menopause.

Researchers found that women who reported three or more episodes of heavy menstrual bleeding during the 6 months before a follow-up visit were 63% more likely to report feeling tired (adjusted OR = 1.62; 95% CI, 1.11-2.38) and 44% more likely to report feeling worn out (aOR = 1.44; 95% CI, 0.98-2.13).

Women with three or more episodes of prolonged menstrual bleeding during the 6 months before a follow-up visit 32% less likely to report feeling full of pep (aOR = 0.68; 95% CI, 0.49-0.95). Results were unchanged after adjusting for race, age, BMI, hormone therapy use, depression and anxiety symptoms, perceived stress, sleep problems or smoking.

“Women should understand that excessive bleeding and accompanying fatigue may occur or worsen during the transition to menopause,” Harlow told Healio. “Women experiencing these symptoms can seek care from a health professional as treatments are available for both excessive bleeding and fatigue.”

Harlow said the data suggest that a menstrual bleeding history is warranted for midlife women presenting with fatigue symptoms. Additionally, clinicians should prioritize providing midlife women with information about the likelihood of excessive menstrual bleeding during the menopause transition and available treatments both for excessive bleeding and related symptoms of fatigue.

“Excessive menstrual bleeding needs to be recognized as a symptom of menopause with important health consequences,” Harlow told Healio. “Future studies of menopause should systematically include assessment of abnormal uterine bleeding and evaluate its potential impact on women's experience of menopause and quality of life, as well as on its association with common menopausal symptoms including fatigue, sleep disruptions and brain fog.”

For more information:

Siobán D. Harlow, PhD, can be reached at harlow@umich.edu; Instagram: @umichsph.