Heavy Menstrual Bleeding Linked to Fatigue in Menopausal Women

New research has identified a potential link between heavy or prolonged menstrual bleeding and fatigue in women transitioning to menopause, shedding light on an often-overlooked symptom.

Approximately 33% of women experience heavy or prolonged menstrual bleeding during the transition to menopause. Such episodes can meet the medical definition of abnormal uterine bleeding—excessive in amount, duration, or frequency within a six-month period.

While excessive bleeding is common, research on its connection to other menopausal symptoms has been scarce. However, a new study published in the journal Menopause suggests that frequent heavy bleeding episodes are associated with increased fatigue in menopausal women.

The study, which tracked women over time, is the first to evaluate the relationship between heavy menstrual bleeding and fatigue in premenopausal and perimenopausal women. Lead author Dr. Siobán Harlow, a professor emeritus of epidemiology and obstetrics at the University of Michigan, emphasized the significance of these findings.

“Menstruation remains a subject cloaked in silence and associated with taboos, even within the realm of scientific inquiry,” Harlow stated. “Lack of dialogue about menstruation, particularly about bleeding changes as women approach menopause, leads to a lack of knowledge about what is normal.”

She hopes the findings encourage further research into links between menstrual bleeding, sleep disturbances, and cognitive issues during menopause.

Perimenopause, the phase leading up to menopause, typically lasts three to ten years. It begins when the ovaries gradually reduce hormone production, causing fluctuations in estrogen and progesterone levels. These changes can lead to irregular periods, mood swings, and other symptoms, including depression and fatigue.

The study analyzed data from 2,329 women who were, on average, 47 years old when they joined the Study of Women’s Health Across the Nation in 1996 or 1997. Over a decade, participants provided information about their menstrual and medical histories.

Women documented their menstrual bleeding monthly, noting heavy bleeding as the need to change a sanitary product every hour for over four hours. Prolonged bleeding was defined as lasting more than eight days, while heavy bleeding meant three or more days of very heavy flow.

Researchers assessed participants’ vitality and fatigue levels at multiple visits. They found that:

• Women who had at least three heavy bleeding episodes in six months were 62% more likely to feel tired and 44% more likely to feel worn out.
• Those who had prolonged bleeding were 32% less likely to feel energetic.

Dr. Stephanie Faubion, medical director of The Menopause Society, noted that while the link between heavy menstrual bleeding and fatigue may seem intuitive, it has never been formally studied before. She also pointed out that existing menopause questionnaires do not address bleeding, as menopause is defined by the absence of menstruation.

The fatigue experienced by women with heavy bleeding could stem from iron deficiency or iron deficiency anemia, conditions that result from excessive blood loss. Anemia, caused by low levels of red blood cells or hemoglobin, can lead to fatigue and other health complications.

However, the study did not measure participants’ blood iron levels, making it difficult to confirm iron deficiency as the sole cause. Faubion noted that anemia usually requires significant blood loss to develop. She also suggested other possible explanations, such as:

• Disrupted sleep due to frequent nighttime bleeding, leading to exhaustion.
• Restless leg syndrome, a condition linked to iron deficiency, which can further impair sleep quality.

The study highlights the importance of discussing menstrual irregularities with healthcare providers. Dr. Leana Wen, an emergency physician and adjunct professor at George Washington University, emphasized that women experiencing fatigue should be asked about abnormal menstrual bleeding and tested for iron deficiency.

Women going through menopause are encouraged to track their cycle length, duration of bleeding, and any perceived changes in flow to help identify potential health concerns.

If anemia is the cause of fatigue, treatment involves stopping excessive bleeding and restoring iron levels, often through oral iron supplements. Other treatment options for heavy bleeding include:

• NSAIDs (e.g., ibuprofen, naproxen) – Can reduce bleeding by 30%.
• Birth control pills – Help regulate menstrual cycles and decrease bleeding.
• Hormonal intrauterine devices (IUDs) – Reduce bleeding by up to 98%.

Additionally, restless leg syndrome, if linked to iron deficiency, can be managed by correcting iron levels.

Abnormal uterine bleeding should never go unexamined, as it can lead to significant health issues, including anemia and, in some cases, serve as an early warning sign of cancer. Experts urge medical professionals to include bleeding patterns in their assessment of menopausal symptoms and for more research to be conducted on this critical stage of a woman’s life.

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To come, five things you may not know about testosterone in women, from Harvard-trained board-certified internal medicine physician and chief medical officer at Modern Age Anant Vinjamoori, M.D.:

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Testosterone is quite the misunderstood hormone, probably because there isn’t much education about hormones outside of stereotypes in general. However, we’re here to help change that, just a little bit.

To come, five things you may not know about testosterone in women, from Harvard-trained board-certified internal medicine physician and chief medical officer at Modern Age Anant Vinjamoori, M.D.:

1. It’s not solely a “male hormone”

It’s no secret that many people associate testosterone with male rage and muscle building. However, it’s not just a male hormone, and it has many more functions in the body than you might think.

“In reality, it’s the most abundant hormone in a woman’s body1 and begins to decline in most women by their mid-30s, well before estrogen and progesterone,” Vinjamoori says. However, the latter two hormones are most often discussed in relation to women’s health, leaving testosterone out of the conversation.

2. It doesn’t just impact sex drive and muscle gains
 
This hormone impacts many bodily functions. Below, Vinjamoori explains a few of the most important testosterone functions in women:
 
3. Fact: You can be deficient in testosterone
 
Much of the hormone-balancing conversation in women’s health focuses on estrogen and progesterone, but balance is needed with testosterone as well. In fact, you can even be deficient in testosterone, which Vinjamoori sees quite often in women over 30.
 
4. Birth control can change testosterone function

If you are concerned about testosterone balance, you’ll want to start by making sure any medication you take isn’t impacting your testosterone levels. Or, if it is, make sure you know that your hormone levels may not be able to be accurately measured because of it.

One common medication that can interfere with testosterone measurement (and hormone measurement in general) is oral birth control pills, so make sure you take that into account when looking at results from testosterone tests.

“The suppression of testosterone is often a downstream effect of birth control’s inhibition of gonadotropin-releasing hormone (GnRH) from the hypothalamus and luteinizing hormone (LH) from the pituitary gland, which are hormones crucial for the natural production of testosterone,” Vinjamoori explains.

5. PSA: There are ways to support it naturally

Hormone replacement therapy may be an option for some women who have testosterone deficiency, but that doesn’t have to be the first step when it comes to balancing this hormone. Instead, look to a combination of lifestyle factors.

“To naturally promote healthy testosterone levels, two of the most effective strategies are high-quality sleep and resistance training5,” Vinjamoori says.

You may also look to DHEA supplements. “The body synthesizes DHEA before converting it to testosterone, making it a reasonable choice for supplementation,” Vinjamoori says. However, it’s best to consult your health care provider before starting this supplement to ensure it’s a necessary part of your routine.

The takeaway

Stereotypes aside, testosterone balance is an important part of women’s health. This hormone impacts physical and mental health and may even be an undiagnosed deficiency in women over 30. To support your testosterone levels, prioritize sleep, try resistance training, and consider DHEA supplementation if recommended by your health care provider. Here, more on hormone balancing 101.

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