Abnormal uterine bleeding is associated with fatigue during the menopause transition

Siobán D Harlow; Ellen B Gold; Michelle M Hood; Alain A Mukwege; John F Randolph; Gail A Greendale

doi:10.1097/GME.0000000000002525

Abnormal uterine bleeding is associated with fatigue during the menopause transition

Menopause. 2025 Mar 11. doi: 10.1097/GME.0000000000002525. Online ahead of print.

Authors

Siobán D Harlow¹, Ellen B Gold², Michelle M Hood¹, Alain A Mukwege¹, John F Randolph³, Gail A Greendale⁴

Affiliations

¹ From the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.
² Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA.
³ Division of Reproductive Endocrinology and Infertility, Michigan Medicine, University of Michigan, Ann Arbor, MI.
⁴ Division of Geriatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.

PMID: 40067756
DOI: 10.1097/GME.0000000000002525

Abstract

Objective: During the menopause transition (MT), abnormal uterine bleeding, characterized by prolonged (PMB) or heavy (HMB) menstrual bleeding, occurs often. We assessed whether PMB or HMB was associated with fatigue.

Methods: We used longitudinal daily menstrual calendar data from 2,329 participants in the Study of Women's Health Across the Nation to identify episodes of HMB and PMB. At seven annual follow-up visits, four symptoms of fatigue were queried (worn out, feeling tired, full of pep, having energy). General linear mixed models with random intercepts for each woman assessed the association between each fatigue variable and PMB or HMB recorded during the 6 months prior to each annual follow-up visit. Models were adjusted for race and ethnicity, age, body mass index, hormone therapy use, depressive and anxiety symptoms, perceived stress, sleep problems, cigarette use, and discrimination.

Results: After adjustment, reporting three or more episodes of HMB in the prior 6 months was positively associated with feeling tired (odds ratio [OR] = 1.62, 95% CI = 1.11 to 2.38) and being worn out (OR = 1.44, 95% CI = 0.98 to 2.13), whereas three or more episodes of PMB in the prior 6-month window was negatively associated with being full of pep (OR = 0.68, 95% CI = 0.49 to 0.95).

Conclusions: HMB and PMB during the MT were associated with increased odds of experiencing three symptoms of fatigue. Greater clinical attention to bleeding changes and associated symptoms, including fatigue and lack of energy, is warranted, as is education of women about potential health consequences of excessive menstrual bleeding during the MT.