Study decodes why middle-aged women are 4 times more likely to experience fatigue

Besides the commonly known menopause symptoms such as hot flashes, sleep problems, pain, and depression heavy or prolonged menstrual bleeding may increase fatigue

Heavy or prolonged menstrual bleeding during menopause transition may explain why middle-aged women are two-to-four times more likely to experience fatigue, suggests a new study, calling for more attention on tiredness among females. 

Besides the commonly known menopause symptoms such as hot flashes, sleep problems, pain, and depression heavy or prolonged menstrual bleeding may increase fatigue.

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 team led by researchers from the University of Michigan 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, lamented the researchers.

Heavy menstrual bleeding, in particular, is linked to iron deficiency anaemia, a well-recognised cause of fatigue, said the team in the paper, published online in the journal Menopause.

For the study, the team assessed the daily menstrual calendar data from more than 2,300 midlife women 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).

The team found 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 anaemia can be readily treated, an early assessment and remediation in women with these symptoms would be helpful.

“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,” said Dr. Stephanie Faubion, medical director for The Menopause Society.

Faubion urged the need for educating women about the possibility of prolonged or heavy menstrual bleeding during the menopause transition.

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