It’s well known that perimenopause—the transition before menopause—can leave women feeling drained. Factors like stress, hot flashes, and sleep disturbances all contribute to fatigue. However, a new study reveals another surprising culprit: heavy menstrual bleeding.
Recent research published in Menopause found that women with heavier or prolonged periods are significantly more likely to experience exhaustion.1 The findings highlight the critical role menstrual bleeding plays in energy levels during the menopausal transition.
Investigating the Connection Between Bleeding and Fatigue
While menopause research is growing, few studies have examined how menstrual bleeding impacts symptoms like fatigue. According to study author Siobán D. Harlow, PhD, professor of obstetrics and gynecology at the University of Michigan, the relationship between fatigue and menstrual bleeding remains underexplored.
To bridge this gap, researchers analyzed data from 2,329 women aged 42 to 52, tracking their health over seven years. The study recorded fatigue levels and menstrual bleeding patterns through annual medical evaluations.
The results were striking: Women who experienced at least three episodes of heavy bleeding in six months had a 44% to 62% higher likelihood of feeling “tired” or “worn out.” Those who reported prolonged bleeding episodes were 32% less likely to feel “full of pep.”
These associations persisted even after adjusting for age, BMI, hormone therapy use, mood disorders, stress levels, sleep quality, smoking, and other potential factors.
How Heavy Bleeding Contributes to Fatigue
Perimenopause often brings erratic hormone shifts, leading to heavier and longer periods. Research estimates that up to 30% of perimenopausal women experience significant blood loss.2 Women with a history of abnormal uterine bleeding or fibroids are particularly susceptible.3
Excessive blood loss can lead to anemia, a condition marked by reduced red blood cells, which diminishes oxygen supply to the body.4 This exacerbates fatigue, especially when combined with other perimenopausal symptoms like disrupted sleep and stress.
“The combination of less sleep and lower blood counts can lead to more fatigue,” noted Mary Jane Minkin, MD, a Yale School of Medicine gynecologist specializing in menopause.
Despite these findings, much remains unknown about the effects of perimenopausal bleeding on overall health. Researchers emphasize the need for further studies, particularly regarding how conditions like fibroids, endometriosis, and polycystic ovarian syndrome (PCOS) influence this relationship.
“Hopefully, these findings will encourage further evaluation of potential associations between menstrual bleeding and other menopause symptoms such as disrupted sleep and cognitive fog,” Harlow said.
Managing Heavy Periods and Fatigue
Doctors and patients alike must recognize abnormal uterine bleeding as a potential cause of fatigue. According to Hugh Taylor, MD, chair of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, menopausal symptoms should not be dismissed as an inevitable part of aging.
“There is often a way to fix the problem,” Taylor emphasized.
Treatment options for heavy or prolonged bleeding include iron supplementation, hormone therapy, and fibroid removal, all of which can help restore energy levels and improve quality of life.
Finding a knowledgeable healthcare provider who listens to concerns about perimenopausal symptoms can be challenging. However, experts urge women to advocate for their well-being.
“Both abnormal uterine bleeding and fatigue can impact quality of life and have serious health consequences, yet both conditions are treatable and need not simply be suffered,” Harlow concluded.
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- What Is The Typical Age For Perimenopause?
