Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Disclosures: Maybin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
April 09, 2021
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Obesity linked to heavy menstrual bleeding for reproductive age women

Disclosures: Maybin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Obesity is associated with heavy menstrual bleeding for women of reproductive age, and the association is possibly due to delays with endometrial repair, according to a study published in the Journal of Endocrinology.

“Heavy menstrual bleeding affects up to 1 in 3 women at some point in their reproductive lives,” Jacqueline Maybin, MBChB, PhD, a senior research fellow and honorary consultant gynecologist at the MRC Centre for Reproductive Health at the University of Edinburgh, told Healio. “The number of women of reproductive age who have obesity is also increasing, with levels in England of 24% in 2009, 30% in 2018 and 33% in 2019. Researching how obesity impacts menstrual blood loss is important to improve the ways we prevent and treat the debilitating symptom of heavy menstrual bleeding.”

Maybin is a senior research fellow and honorary consultant gynecologist at the MRC Centre for Reproductive Health at the University of Edinburgh.

Maybin and colleagues analyzed data from 121 women of reproductive age attending gynecologic clinics at NHS Lothian in Scotland. All participants were not using hormonal contraceptives and had no exogenous hormone exposure for 2 months. Height and weight measurements were obtained along with a fully completed pictorial blood loss assessment chart (PBAC) that included pictorial representation of graded staining across different absorbencies of menstrual towels and tampons. Participants were asked to provide an assessment each time they changed their menstrual pad or tampon during one menstrual cycle. Heavy menstrual bleeding was defined as having a menstrual PBAC score of 80 mL or greater.

Heavy menstrual bleeding was reported by 63% of the study’s participants. In regression analysis, a weak, but statistically significant association was observed between menstrual PBAC score and BMI (P = .02). The presence of fibroids was the only factor that added significantly to BMI in predicting menstrual PBAC score (P = .004).

Because women have multiple variables that can affect menstrual blood loss, researchers also conducted a mouse study analyzing the role of weight on endometrial repair during menstruation. Mice were fed a normal diet (n = 6) or a high-fat diet (n = 10) before simulation of menstruation.

“Mice on the high-fat diet had a significantly higher body weight than those on a normal diet,” Maybin said. “After shedding their endometrium at menstruation, mice on a high-fat diet showed delayed repair of this denuded surface when compared to mice on a normal diet. Further examination of womb tissue during menstruation revealed that inflammatory factors were higher in mice with a high body weight. Therefore, women with obesity may experience heavy menstrual bleeding due to increased local inflammation at menses and delayed repair of their endometrium.”

Maybin described the study as the first step toward developing individualized treatments for women with heavy menstrual bleeding, although more research is needed with a larger cohort of participants.

“This study did not examine treatments for women with obesity and heavy periods, and it remains to be determined if weight loss or anti-inflammatory medications are helpful in decreasing menstrual blood loss,” Maybin said. “Anti-inflammatory medications are already used to treat heavy periods, but answering these questions may help doctors to recommend personalized treatments for specific women.”

For more information:

Jacqueline Maybin, MBChB, PhD, can be reached at jackie.maybin@ed.ac.uk.