Irregular Menstruation & Heart Disease Risk

The association between heavy menstrual bleeding (HMB) or menorrhagia and cardiovascular disease (CVD) in the presence and absence of irregular menstruation (IM) among females hospitalized in the United States (US) was shown in a recent study published in the journal BMC Medicine.

Worldwide, cardiovascular disease is the leading cause of death. Finding modifiable contributing risk factors is critical for the prevention of cardiovascular disease in the female population, especially in light of gender inequities and the increased incidence of metabolic syndrome (MS) and cardiovascular disease, especially in females. Menorrhagia is described as excessive blood loss throughout the menstrual cycle or clinically significant menstrual bleeding that negatively impacts a woman’s social, emotional, physical, and overall quality of life. Menorrhagia causes substantial financial hardship for those who are affected in terms of lost wages and medical costs. It also has something to do with fatigue, headaches, pain, and anemia. Iron deficiency-type anemia and menorrhagia are related; this relationship may affect cardiac function and oxygen transmission.

Concerning the study

Researchers investigated the impact of menorrhagia and irregular menstruation on the risk of cardiovascular disease in this retrospective, cross-sectional investigation.

Records of hospitalizations for women between the ages of 18 and 70 who had regular menstrual cycles and menorrhagia were taken from the National Inpatient Sample (NIS) Database, which is available to the public. They defined menorrhagia using the International Classification of Diseases, Tenth Revision (ICD-10), taking into account both recent and past occurrences of menorrhagia.

Hospitalizations for amenorrhea, hematocolpos, dysmenorrhea, ovulation bleeding, heavy menstrual bleeding throughout puberty, and sporadic menstruation were not included in the study. Heavy menstrual bleeding was the main study exposure. ICD-10 diagnostic codes were used to determine the outcomes, which included major adverse cardiovascular events (MACE), stroke, atrial fibrillations (AF) or arrhythmias, coronary heart disease (CHD), diabetes (DM), heart failure (HF), and myocardial infarctions (MI).

To find the odds ratios (OR) for analysis, the researchers used logistic regression modeling and prosperity score matching. Age, race, ethnicity, household income, primary payer, smoking status, alcohol consumption, adiposity, use of hormones or contraceptives, metabolic syndrome, polycystic ovarian syndrome (PCOS), leiomyoma uteri, prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs), and use of anticoagulant medication were among the study covariates.

Findings and conversation

Menorrhagia affected 0.7% (n=7,762) of the 2,430,851 hospitalized female patients with a mean age of 44 years, and 0.9% (n=11,164) of the patients over the age of 40. Among the study population, 3,746 (0.2%) and 15,180 (0.6%) hospitalizations without irregular menstruation and 3,746 (0.2%) with irregular menstruation were among the 0.8% (n = 18,926) with a heavy menstrual bleeding diagnosis. Non-Hispanic white, non-Hispanic black, and Hispanic patients made up more than 50% of hospital admissions; the majority of these women had household incomes in the top quartile. Merely 20% of the population was obese, and merely 9% had metabolic syndrome. Menorrhagia was closely linked to private insurance, age, and black racial background.

Hospitalizations for menorrhagia had greater rates of obesity, use of contraceptives, PCOS, infertility, anemia, NSAIDs, and leiomyoma uteri compared to the group with regular menstrual cycles. Researchers found a strong correlation between menorrhagia and a higher risk of cardiovascular disease outcomes among women ≤40 years old who were admitted to hospitals. These outcomes included major adverse cardiovascular events (OR 1.6), coronary heart disease (OR, 1.7), stroke (OR, 2.0), heart failure (OR, 1.5), and atrial fibrillations or arrhythmias (OR, 1.8). Results from sensitivity analyses were comparable.

In contrast, among hospitalized women over 40, menorrhagia did not demonstrate strong correlations with events related to cardiovascular disease. Menorrhagia without irregular menstruation was strongly associated with MACE episodes, diabetes, heart failure, and atrial fibrillation. Among young female hospitalizations, menorrhagia with irregular menstruation showed a high correlation with the outcomes of atrial fibrillation and coronary heart disease.

Menorrhagia and major adverse cardiovascular events were directly correlated in the mediation analysis, even after controlling for metabolic syndrome (OR, 1.5), adiposity (OR, 1.4), hypertension (OR, 1.4), diabetes (OR, 1.5), and anemia (OR, 1.5). Adiposity (OR, 1.8), metabolic syndrome (OR, 1.8), smoking (OR, 1.7), anemia (OR, 1.3), insulin use (OR, 2.5), black race/ethnicity (OR, 2.1), anticoagulant use (OR, 5.3), and alcohol consumption (OR, 1.1) were linked to increased odds of MACE events in addition to menorrhagia (OR, 1.3).

Patients with menorrhagia may experience cardiac problems such as ischemia, inflammation, and poor hemostasis due to hormonal imbalance. Reduced expression of hypoxia-inducible factor-alpha (HIF-α), vascular smooth muscle proliferation, and transforming growth factor-beta 1 (TGF-β1) are factors that affect menstrual healing and hypoxia. Lowering exposure to the environment can help lower the risk of cardiovascular disease and menstrual irregularities.

The study discovered that, in young girls in the United States, menorrhagia was associated with cardiovascular disease events independent of anemia, uterine fibroids, metabolic syndrome, obesity, or hormone use. Risk stratification and management for cardiovascular disease can be aided by routine exams and screens for menstrual problems, especially menorrhagia. To reduce negative effects, menorrhagia should be identified early and treated as best as possible. Future studies should examine the age at which a condition first manifests and assess its long-term impact on the course of cardiovascular disease.

For more information: Association of heavy menstrual bleeding with cardiovascular disease in US female hospitalizations, BMC Medicine, https://doi.org/10.1186/s12916-024-03426-8