Heavy periods increase risk of heart disease in young women

A new study published in the journal BMC Medicine has identified a relationship between heavy periods (HMB) or menorrhagiaand cardiovascular disease (CVD) in the presence and absence of irregular menses (IM) among women hospitalized in the United States (US).

Cardiovascular disease is the leading cause of death worldwide. Given gender differences and the increasing incidence of cardiovascular disease and metabolic syndrome (MS), especially among women, it is important to identify modifiable risk factors for the prevention of cardiovascular disease in the female population. Menorrhagia is defined as excessive blood loss during menstruation or clinically excessive menstrual bleeding that impairs the physical, mental and social well-being and quality of life of women. Menorrhagia places a significant financial burden on those affected in terms of treatment costs and lost productivity. It is also associated with anemia, fatigue, headaches and discomfort. The link between menorrhagia and iron deficiency anemia may interfere with oxygen transport and alter heart function.

In this retrospective cross-sectional study, researchers examined the effect of menorrhagia and irregular menstruation on the risk of cardiovascular disease. The researchers extracted hospitalization records among women with menorrhagia and regular menstrual cycles aged 18 to 70 years in 2017 from the publicly available National Inpatient Sample (NIS) database. They used the International Classification of Diseases, Tenth Revision (ICD-10) to define menorrhagia, including current or past history of menorrhagia.

The study excluded hospitalizations due to amenorrhea, hematocolpos, excessive menstrual bleeding during puberty, dysmenorrhea, ovulation bleeding and those who have only had irregular periods. The main exposure factor in the study was heavy menstrual bleeding. Outcomes included major adverse cardiovascular events (MACE), stroke, atrial fibrillation (AF) or arrhythmias. coronary heart disease (CHD), diabetes (DM), heart failure (HF) and myocardial infarction (MI), defined by ICD-10 diagnostic codes.

The researchers performed proportionality matching and logistic regression modeling to determine odds ratios (ORs) for the analysis. Study covariates included age, ethnicity, race, household income, primary payer, smoking status, alcohol consumption, obesity, hormone or contraceptive use, metabolic syndrome, polycystic ovary syndrome (PCOS), uterine leiomyoma, nonsteroidal anti-inflammatory drug (NSAID) prescriptions. And the use of anticoagulants.

Of 2,430,851 hospitalized women with a mean age of 44 years, menorrhagia was observed in 0.7% (n=7,762) of women aged 40 years or younger and in 0.9% (n=11,164) of women over 40 years of age. In the study cohort, 0.8% (n=18,926) had a diagnosis of heavy menstrual bleeding, including 15,180 (0.6%) admissions without irregular menstruation and 3,746 (0.2%) with irregular menstruation. Only 20% were obese, and only 9.0% had metabolic syndrome. 

The proportions of obesity, contraceptive use, PCOS, infertility, anemia, NSAIDs, and uterine leiomyomas were higher in the menorrhagia hospitalization group compared with the regular menstrual cycle group. Among hospitalizations in women under 40 years of age, the researchers found a significant association between menorrhagia and an increased likelihood of cardiovascular events, including major adverse cardiovascular events (OR, 1.6), coronary heart disease (OR, 1.7), stroke (OR, 2.0), heart failure (OR, 1.5) and atrial fibrillation or arrhythmias (OR, 1.8). Sensitivity analyzes yielded similar results.

In contrast, menorrhagia did not show consistent associations with cardiovascular events among hospitalized women over 40 years of age. Menorrhagia without irregular menses was strongly associated with diabetes, heart failure, atrial fibrillation, and MACE events. Menorrhagia with irregular periods showed a strong association with atrial fibrillation and coronary artery disease outcomes among young hospitalized women.

Mediator analysis showed a direct association between menorrhagia and major adverse cardiovascular events after accounting for metabolic syndrome (OR, 1.5), obesity (OR, 1.4), hypertension (OR, 1.4), diabetes (OR, 1.5) and anemia ( OR, 1.5). Anticoagulant use (OR, 5.3), black race/ethnicity (OR, 2.1), insulin use (OR, 2.5), contraceptive/hormone use (OR, 1.9), obesity (OR, 1.8), metabolic syndrome (OR, 1.8 ), smoking (OR, 1.7), anemia (OR, 1.3) and alcohol consumption (OR, 1.1) were associated with an increased likelihood of MACE events in addition to menorrhagia (OR, 1.3).

Hormonal imbalance in patients with menorrhagia can cause cardiac abnormalities such as hypoxia, inflammation and impaired hemostasis. Restoration of menstruation and hypoxia are affected by decreased expression of hypoxia-inducible factor (HIF-α), vascular smooth muscle proliferation, and transforming growth factor-beta 1 (TGF-β1). Reducing your environmental exposure may help with menstrual problems and the risk of heart disease.

The study found an association between menorrhagia and cardiovascular events in young women, independent of obesity, metabolic syndrome, hormone use, anemia or uterine fibroids. Regular examinations and screening for menstrual disorders, especially menorrhagia, can help stratify and manage the risk of cardiovascular disease. Menorrhagia should be diagnosed early and treated optimally to minimize adverse outcomes. Future studies should consider age of onset and evaluate its long-term impact on cardiovascular outcomes.