Menopause can bring about numerous challenges, and fatigue is one of the most common symptoms that many women experience during this transition. From hot flashes and sleep disturbances to depression and physical discomfort, a variety of factors contribute to the exhaustion that midlife women often face. However, new research suggests that abnormal uterine bleeding (AUB), including heavy or prolonged menstrual bleeding, may play a significant role in increasing fatigue during menopause.

A study recently published in Menopause, the journal of The Menopause Society, sheds light on this connection. As part of the Study of Women’s Health Across the Nation (SWAN), the research analyzed the experiences of over 2,300 midlife women. It found that one in three women reported AUB, and those experiencing heavy (HMB) or prolonged (PMB) menstrual bleeding were more likely to report fatigue symptoms, such as feeling worn out, lacking energy, or not feeling full of pep.

Understanding the Link Between Bleeding and Fatigue

While AUB is a common occurrence during menopause, past studies have often overlooked its impact on fatigue or overall quality of life. Heavy menstrual bleeding, in particular, is frequently associated with iron deficiency anemia, a well-known cause of fatigue. This study emphasizes the need for greater clinical awareness of bleeding changes during menopause, especially when women report feeling persistently tired.

The researchers concluded that addressing AUB and its related symptoms early on—such as through anemia treatment—could help women manage fatigue more effectively.

Why This Matters

Despite the high prevalence of AUB among midlife women, little attention has been paid to the issue in both medical research and public discussions about menopause. Raising awareness about these changes could empower women to seek timely medical advice and improve their quality of life during this transitional stage.

“This study highlights the need for greater clinical awareness of abnormal uterine bleeding, particularly given the increased frequency during the menopause transition and its association with low energy or fatigue symptoms,” says Dr. Stephanie Faubion, medical director of The Menopause Society. “Educating women about the possibility of prolonged or heavy menstrual bleeding during the menopause transition and the potential health consequences is also needed.”

What You Can Do

If you’re experiencing unusual bleeding patterns or persistent fatigue during menopause, it’s important to consult with your healthcare provider. Fatigue caused by anemia or other underlying conditions is treatable, and addressing these issues can make a big difference in your overall well-being.

For more information about menopause and healthy aging, visit www.menopause.org.