Bleeding patterns during the menopausal transition in the multi‐ethnic Study of Women's Health Across the Nation (SWAN): a prospective cohort study

Abstract

Objective Prior studies describing menses duration and heaviness of flow during the menopausal transition (MT) have been short in duration and limited to white women. We estimated the frequency of and risk factors for prolonged bleeding, spotting, and heavy bleeding during the MT in an ethnically diverse population. Design Prospective community–based cohort study. Setting United States: Southeastern Michigan, Northern California, and Los Angeles, California. Population 1320 midlife women who participated in the Study of Women’s Health Across the Nation (SWAN) Menstrual Calendar Substudy. Participants included African-American, white, Chinese, and Japanese women. Methods Women completed daily menstrual calendars from 1996–2006, and provided information on hormone therapy, smoking and physical activity. Annual measures included height and weight. Kaplan-Meier survival analysis and multivariable regression were used to analyze the data. Main Outcome Measures Menses of 10+ days, spotting of 6+ days, heavy bleeding of 3+ days. Results At least three occurrences of menses 10+ days was reported by 77.7% (95%CI: 56.7, 93.2), of 6+ days of spotting by 66.8% (95%CI: 55.2, 78.0) and of 3+ days of heavy bleeding by 34.5% (95%CI: 30.2, 39.2) of women. Menses of 10+ days, 6+ days of spotting, and 3+ days of heavy bleeding were associated with MT stage, uterine fibroids, hormone use, and ethnicity. BMI was associated with 3+ days of heavy bleeding. Conclusions These data provide clinicians and women with important information about the expected frequency of prolonged and heavy bleeding and spotting during the menopausal transition that may facilitate clinical decision making.

Anti-Müllerian hormone, follicle stimulating hormone, antral follicle count, and risk of menopause within 5 years

“…Such symptoms include menorrhagia, which in the Study of Women’s Health Across the Nation affected almost one-third of late reproductive-stage women [25] and which lowers quality of life [26]. The choice of therapy for such symptoms, including intrauterine device insertion, endometrial ablation, hysterectomy, and systemic hormone and anti-platelet therapy, are informed by expected length of time with symptoms, i.e.…”

Menstruation: science and society

“…Generation of standard terminologies related to norms for uterine bleeding among adult women represents significant progress in the field of menstrual health, and there has been significant progress especially in describing symptom expectations in the later reproductive life stages and during the menopausal transition. 24 , 25 , 26 , 27 To ensure that menstrual bleeding norms represent bleeding patterns and other menstrual health symptoms across a racially and ethnically diverse and contemporary population (relative to comorbid conditions and body mass index) of women of all ages, further research is needed. 28 Prospective longitudinal cohort data on menstrual bleeding, menstrual symptoms, and reproductive health diagnoses could fill this critical gap.…”

Management of the Perimenopause

“…In the early menopause transition, short cycle intervals (fewer than 21 days) are more common, while long cycle intervals (more than 36 days) occur later in the transition 48 . During the menopausal transition, women were more likely to experience an increased number of days of bleeding, with 77% reporting at least 3 episodes of 10+ days of bleeding 49 .…”