Heavy menstrual bleeding may contribute to fatigue in midlife women

Multiple menopause symptoms can make women feel fatigued. Hot flashes, sleep problems, pain, and depression are just a few. A new study suggests that heavy or prolonged menstrual bleeding may increase fatigue, which helps to explain why midlife women are two-to-four times more likely to experience debilitating forms of syndromic fatigue. Results of the study are published online today in Menopause, the 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 Nation (SWAN) revealed that one in three women transitioning through menopause had episodes of AUB.

Despite the high occurrence of AUB, only a few prior studies have focused on the problem, and no known studies have attempted to link AUB during the menopause transition with fatigue or an overall decreased quality of life. Heavy menstrual bleeding, in particular, is linked to iron deficiency anemia, a well-recognized cause of fatigue.

In this new large-scale study, daily menstrual calendar data from more than 2,300 midlife women were assessed to determine whether HMB or PMB recorded during the 6 months before a follow-up visit were associated with the reporting of four specific symptoms of fatigue (feeling worn out, feeling tired, not feeling full of pep, or not having energy). Based on the results, the researchers concluded that HMB and PMB during the menopause transition were associated with an increased risk of fatigue, even after adjusting for other causes. They suggest that greater clinical awareness is required of bleeding changes during this life stage, especially when fatigue is also reported.

Because iron deficiency and related anemia can be readily treated, an early assessment and remediation in women with these symptoms would be helpful. To date, however, limited attention has been paid to bleeding problems during the menopause transition-in research, the lay press, and social media.

Survey results are published in the article "Abnormal uterine bleeding is associated with fatigue during the menopause transition."

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

Dr. Stephanie Faubion, medical director, The Menopause Society