An examination of the effect of heavy menstrual bleeding on women's quality of life compared with women with normal menstrual loss

Abstract

Aims This study is designed to evaluate the impact of heavy menstrual bleeding on women’s quality of life and to explore their help-seeking behaviour patterns by comparing women with objectively measured heavy menstrual bleeding to women with measured normal menstrual loss, to correlate actual measured menstrual blood loss with the individual woman’s perceptions of her bleeding, and to compare women who perceive they have heavy menstrual bleeding with women who perceive their bleeding to be normal in relation to their assessment of the impact of menstrual bleeding on their quality of life. Background & methodology Heavy menstrual bleeding has a significant effect on women’s daily life and economic consequences for society. This thesis presents the results of a novel study of a self-selected group of women from the NSW community, who responded to an online survey by a market research company. The survey asked a range of questions around menstruation and the woman’s perception and tolerance of the menstrual cycle. Of 1,575 women who answered the original survey and 628 of these offered to participate in further research about menstruation. Most of these women were contacted later by phone and 63 agreed to take part in the present study. The sixty-three respondents had their menstrual blood loss (MBL) measured for three cycles using the alkaline haematin method. Women were categorised according to measured blood loss into normal or heavy menstrual bleeding groups. Women with more than 80 mL of blood loss for at least two cycles were included in the heavy group. Data were analysed using SPSS version 20. Alpha was set at 0.05 for all analyses. Results The 63 participants (10%), out of the group of 628 who were interested in further research and agreed to collect their used sanitary protection, were not significantly different from the original group. Women with measured HMB comprised 16%. Women with demonstrated HMB were more likely to be older than women with normal menstrual blood loss. There were no significant differences in quality of life parameters or seeking medical consultation between the two groups. There was no significant association between perception of women of their menstrual bleeding and estimated menstrual blood loss. However, there were significant differences between women who said that they had mild or moderate bleeding, women who said that their bleeding was heavy and women who said their bleeding was very heavy in some aspect of their quality of life assessments. There was significant correlation between the amount of menstrual bleeding and the duration of bleeding (r = .40, p < 0.001). There was also a significant strong correlation between the amount of the menstrual blood loss (the mean of the three cycles) with serum ferritin, transferrin, TIBC, and a weak correlation with haemoglobin. There was a significant association between menstrual pain and quality of life parameters and also a strong association between the degree of menstrual pain and seeking a medical consultation. However, there is no correlation between the severity of the menstrual pain and the amount of menstrual blood loss. There was no significant difference in variability of menstrual cycles between women with measured HMB and women with measured NMB. In the sample of 25 women, low serum ferritin levels were not associated with low general health parameters. Conclusion In conclusion, estimated heavy menstrual bleeding was found not to have any a significant impact on women’s physical, psychological and social well-being, quality of life or their medical consultation behaviour. It could be said that women’s perceptions of their menstrual bleeding does not reflect the amount of their menstrual bleeding but can affect their quality of life assessment and thus their behaviour regarding medical consultation. There is a strong association between women’s perception of menstrual bleeding and their scores on quality of life. Women who perceive their bleeding as heavy have a low score on quality of life and these women tend to have more medical consultations than women with normal quality of life scores. Pain during the menstrual period can profoundly effect women’s quality of life. Women who have moderate or severe pain during the period were more likely to have poor quality of life and more likely to ask for medical consultation than women with mild pain. The study also indicates that menstrual blood loss is positively correlated with age, duration of menstrual bleeding and practical difficulties and is negatively correlated with serum ferritin, transferrin, total iron binding capacity and haemoglobin level.