Obesity as an effect modifier of the association between menstrual abnormalities and hypertension in young adult women: Results from Project ELEFANT

PLoS One. 2018 Nov 28;13(11):e0207929. doi: 10.1371/journal.pone.0207929. eCollection 2018.


Background: The menstrual cycle is regulated by reproductive hormones such as estrogen which has been implicated in the pathogenesis of hypertension and is associated with obesity. However, to date there has scant study of hypertension in relation to menstrual characteristics and abnormalities. We hypothesize that adverse menstrual characteristics are associated with an increase the prevalence of hypertension and that this relationship is exacerbated by obesity.

Methods: Our study leverages 178,205 healthy female participants (mean age = 29) in a population-based cross-sectional study in Tianjin, China. Menstrual characteristics including menstrual cycle length and regularity, menstrual bleeding length, menstrual blood loss and dysmenorrhea were assessed by self-reported questionnaires, and hypertension was diagnosed by physician. Multiple logistic regression models were used to assess the relationships between menstrual characteristics and hypertension.

Results: Normal length menstrual cycle (OR = 1.21, 95% CI: 1.03-1.41), oligomenorrhea (OR = 1.54, 95% CI: 1.12-2.07), irregular cycle (OR = 1.54, 95% CI: 1.22-1.93), and light menstrual blood loss (OR = 1.36, 95% CI: 1.06-1.72) were associated with hypertension among women who are overweight or obese, but not among women who are normal weight. Longer menstrual bleeding duration (OR = 1.44, 95% CI: 1.24-1.67) and dysmenorrhea were associated with increased prevalence of hypertension (OR = 1.20, 95% CI: 1.14-1.41) in all young women.

Conclusions: The prevalence of hypertension is higher among women with menstrual abnormalities, and this association is modified by overweight and obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • China
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Menstruation
  • Menstruation Disturbances / epidemiology*
  • Menstruation Disturbances / physiopathology
  • Obesity / epidemiology*
  • Obesity / physiopathology
  • Prevalence

Grant support

This work was supported in part by National Natural Science Foundation of China (Grant numbers 81602827 to LG and 41601548 to PL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.