Ann Arbor Times

Fatigue and lack of energy are common symptoms during menopause, alongside hot flashes, sleep disturbances, and mood swings. However, the role of abnormal or heavy menstrual bleeding in contributing to these symptoms is often overlooked. The Menopause Rating Scale, widely used in research to assess menopause symptoms, does not include questions about menstrual bleeding.

A new study from the University of Michigan investigates the connection between heavy and prolonged menstrual bleeding and fatigue as women approach menopause. Published in the journal Menopause, this research follows 2,329 midlife women who documented their menstrual cycles and completed annual surveys from 1996 to 2005.

Lead author Sioban Harlow explained that while previous studies have noted fatigue during menopause, few have explored changes in menstrual flow or duration. "This study is unique in that we have prospectively recorded monthly menstrual calendars and gathered information on symptoms of fatigue over a period of 10 years as women transitioned through the menopause," she stated.

The research aims to determine if abnormal bleeding could be a biological cause for menopausal fatigue. As Harlow noted: "For up to one-third of women, menstrual bleeding can be excessive—lasting longer than eight days or having very heavy flow... When we lose blood, we are also losing iron, and heavy menstrual bleeding can lead to iron deficiency."

Harlow pointed out that discussions about menstruation remain stigmatized despite its significant health implications. She emphasized that both abnormal uterine bleeding and related fatigue impact quality of life but are treatable conditions.

Primary care providers often receive limited training on menstruation and menopause. Harlow stressed the importance for providers to recognize the potential health consequences of increased abnormal uterine bleeding during menopause transition: "When evaluating fatigue, providers should include a menstrual history."

Future research is needed to better understand how abnormal uterine bleeding relates to other menopausal symptoms like sleep disturbances and cognitive issues. Co-authors of this study include Michelle Hood, Alain Mukwege, John Randolph from U-M; Gail Greendale from UCLA; and Ellen Gold from UC Davis.