Intense or prolonged menstrual bleeding is a common experience for about 33% of people who are in transition to menopause. Excessive flow episodes often meet abnormal uterine bleeding criteria, a medical condition defined by vaginal bleeding within a period of six months that is excessive in quantity, duration or frequency during or between menstrual periods.
Despite the prevalence of excessive bleeding and its impact on quality of life, there is little research on whether this bleeding is also associated with other typical menopause symptoms, according to the authors of a new study published on Wednesday (12) in Menopause magazine.
Having tried three or more episodes of intense or prolonged menstrual bleeding within a period of six months is associated with fatigue symptoms, according to the report.
According to the authors, the study is the first to evaluate over time the association between intense and prolonged menstrual bleeding between women in premenopausal and perimenopausal and their reports of fatigue or vitality.
“Menstruation remains a silence involved in silence and associated with taboos, even in scientific research,” says the study’s lead author Siobán Harlow, Emerite Professor of Epidemiology and Obstetrics and Gynecology at the University of Michigan, by email.
“The lack of dialogue about menstruation, particularly about changes in bleeding standards as women approach menopause, leads to women’s lack of knowledge about what is normal. We hope these findings encourage an additional assessment of possible associations between menstrual bleeding and other menopause symptoms such as disturbed sleep and cognitive mist, ”adds Harlow.
Perimenopause usually occurs about three to 10 years before menopause, a day that marks a year without menstruation and signals the end of a woman’s reproductive life. The transition period is caused when ovaries gradually stop working, according to Johns Hopkins Medicine.
During this period, estrogen and progesterone hormone levels can float, leading to mood swings, irregular menstrual cycles and other conditions such as depression.
The authors reviewed the health data of 2,329 women who were an average of 47 years when they enrolled in the study of women’s health through the nation in 1996 or 1997. At the beginning and each annual follow -up visit for up to 10 years, women responded to their gynecological, menstrual and medical historical.
Participants also maintained a monthly menstrual calendar in which they noted their menstrual bleeding up to two years after their final menstrual period or up to 10 years. Reporting “very intense bleeding” meant that they had to exchange a sanitary product every hour or two for more than four hours during the day.
The authors defined prolonged menstrual bleeding as bleeding that lasted more than eight days, while intense menstrual bleeding meant very intense bleeding for three or more days, according to the study.
In the first six visits and eighth visit, the team has evaluated the participants’ sense of vitality or fatigue asking four questions from the Rand 36 health questionnaire: Over the past four weeks, how long did they feel full of energy, with disposition, worn or tired?
Women who experienced at least three episodes of intense menstrual bleeding in the previous six months were 62% more likely to feel tired and 44% more likely to feel worn out, according to the study. Having reported three or more cases of prolonged bleeding in the last six months has been associated with 32% less likely to feel available.
“It seems intuitive that intense menstrual bleeding is associated with fatigue symptoms,” says Stephanie Fabion, medical director of The Menopause Society, who has not participated in the study. “What is surprising is that we never really look at it before, and I agree with (the authors) in the end, where they say one of our most commonly used menopause questionnaires don’t even ask about bleeding.”
“Menopausal questionnaires are not designed to cover perimenopause because, by definition, if you are in menopause, you no longer bleed,” says Faubion, who is also director Penny and Bill George at Mayo Clinic’s Women’s Health Center. “Perimenopausal is a little studied and little described.”
With half of the world’s population experiencing menopause if you live until middle age, much more studies are needed on this phase, according to Leana Wen, emergency medical and Associate Professor of Emergency Medicine at George Washington University in Washington, DC.
The relationship between fatigue and abnormal bleeding
The association between intense and prolonged menstrual bleeding and fatigue may be due to iron deficiency and blood loss caused by blood loss, which are well -established causes of fatigue in general and are known complications of abnormal uterine bleeding, according to the authors – an idea supported by a one Small study of August 2016 with black women.
Anemia is a condition of not having sufficient red blood cells or hemoglobin (an iron -rich protein within oxygen -bound blood cells) to transport oxygen throughout the body. Several common causes include iron deficiency, deficiency of other vitamins necessary for red blood cell production, and when bleeding causes loss of red blood cells and hemoglobin faster than they can be replaced.
However, the authors had no measures of participants’ blood iron, which would have helped establish a stronger connection.
Consequently, Faubion is not sure if anemia is the only potential culprit, especially “because it takes a lot of bleeding to become anemic.”
“This is an easy explanation, but is it also related to the fact that people are not sleeping so well because they are getting up to go to the bathroom and are bleeding a lot?” states Faubion. “Another thing is that if you have an iron deficiency – and people may have iron deficiency without being anemic – you can develop restless leg syndrome that can disturb your sleep.”
Harlow, the main author of the study, agrees, but adds that the team has controlled the reported sleep problems. The study also suggests that when evaluating patients’ complaints about fatigue, health professionals should question them about abnormal menstrual bleeding and downwards iron and anemia, the authors wrote.
Initial screening for prolonged and intense menstrual bleeding during menopause transition, even before possible fatigue reports, should also be considered, according to Wen.
“Those who are undergoing menopause should document the duration of the cycle, menstrual bleeding duration and whether it is perceived as more intense than before,” he says.
Treating fatigue by the root
If anemia is what is causing the fatigue of someone’s menopause, health professionals need to stop bleeding and replace iron, typically starting with oral prescription iron, says Faubion. Increasing iron levels is what helps someone produce more red blood cells and rebuild their blood supply.
Common treatments for excessive menstrual bleeding include non-steroid anti-inflammatory drugs, or NSAIDs such as naproxen or ibuprofen, and contraceptive pills, which can reduce bleeding by about 30%, adds Faubion. Hormonal intrauterine devices can reduce bleeding between 79% and 98%.
Restless leg syndrome can also be treated, often correcting an iron deficiency, according to Faubion.
“Abnormal uterine bleeding should never be without evaluation,” says Fabion, “and needs someone to investigate it. Because what we risk losing is not only anemia, which can cause fatigue, but it can also be a sign of early cancer alert. ”
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This content was originally published in researchers find out what can cause tiredness in menopause; Understand on CNN Brazil.
Source: CNN Brasil
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