A pioneering study published recently in Menopause, The Menopause Society's magazine, found a clear association between heavy or prolonged menstrual bleeding (HMB/PMB) and fatigue in midlife women. The findings give new light on why women going through menopause are two to four times more likely to suffer from debilitating syndromic fatigue.

People often overlook changes in menstrual bleeding patterns, despite the well-known menopause symptoms of hot flashes, sleep problems, discomfort, and sadness. Many women going through menopause have irregular menstrual flow, with one in every three reporting episodes of abnormal uterine bleeding (AUB), according to the Study of Women's Health Across the Nation (SWAN).

Despite the prevalence of AUB, few studies have investigated its impact on fatigue, and no previous research has explicitly related heavy or protracted bleeding during the menopause transition to overall quality of life. This new study fills a critical gap by illustrating how menstrual bleeding patterns affect energy levels and daily functioning in midlife women.

One of the study's significant findings is the link between excessive menstrual bleeding and iron deficiency anaemia, a well-known contributor to weariness. Researchers examined daily menstrual calendar data from over 2,300 midlife women, observing bleeding patterns in the six months preceding follow-up evaluations. The study discovered that women who reported HMB or PMB were much more likely to have fatigue symptoms such as exhaustion, poor energy, and persistent tiredness.

Even after accounting for other possible reasons for weariness, the association remained robust, prompting researchers to advocate for more clinical monitoring of bleeding abnormalities after menopause. Because iron deficiency and anaemia are curable illnesses, early detection and intervention could play a critical role in enhancing women's well-being throughout menopause.

Despite the significant prevalence of atypical bleeding in postmenopausal women, it has received little attention in medical study and public conversation. The study's authors emphasise the importance of greater medical attention when women complain about weariness during the menopause transition. Addressing heavy menstrual bleeding and associated iron shortages may be a simple but effective method to reduce fatigue and improve general quality of life.

The authors of the study emphasised that, while iron deficiency and accompanying anaemia are easily treated, early screening and management for women suffering from these symptoms would be extremely advantageous.

As the debate about menopause evolves, this study emphasises the necessity of identifying and treating missed symptoms, such as irregular uterine bleeding. Raising awareness, both in clinical settings and through public health initiatives, could result in earlier diagnosis, improved treatments, and better support for the millions of women going through this transition.