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Heavy periods increase risk of heart disease in young women
Last reviewed: 01.07.2025
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A new study published in the journal BMC Medicine has determined the association between heavy menstrual bleeding (HMB) or menorrhagia and cardiovascular disease (CVD) in the presence and absence of irregular menstruation (IM) among women hospitalized in the United States (US).
Cardiovascular diseases are the leading cause of death worldwide. Given the gender differences and the increasing prevalence of cardiovascular diseases and metabolic syndrome (MS), particularly among women, it is important to identify modifiable risk factors to prevent cardiovascular diseases 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 imposes a significant financial burden on those affected in terms of medical costs and productivity losses. It is also associated with anaemia, fatigue, headaches and discomfort. The association between menorrhagia and iron deficiency anaemia may impede oxygen transport and alter cardiac function.
In this retrospective cross-sectional study, the researchers examined the impact of menorrhagia and irregular menstruation on the risk of cardiovascular disease. The researchers retrieved hospitalization records of 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 previous history of menorrhagia.
The study excluded hospitalizations due to amenorrhea, hematocolpos, excessive menstrual bleeding during puberty, dysmenorrhea, ovulatory bleeding, and those with irregular menstruation only. The main exposure in the study was heavy menstrual bleeding. Outcomes included major adverse cardiovascular events (MACE), stroke, atrial fibrillation (AF) or arrhythmia, coronary artery disease (CHD), diabetes (DM), heart failure (HF), and myocardial infarction (MI) as 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 anticoagulant use.
Of 2,430,851 hospitalized women with a mean age of 44 years, menorrhagia occurred in 0.7% (n=7,762) of women aged 40 years and younger and 0.9% (n=11,164) of women aged 40 years or older. In the study cohort, 0.8% (n=18,926) had a diagnosis of heavy menstrual bleeding, including 15,180 (0.6%) hospitalizations 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 leiomyoma were higher in the group of hospitalizations with menorrhagia compared with the group with regular menstrual cycles. Among hospitalizations of women under 40 years of age, the researchers found a significant association between menorrhagia and an increased odds of cardiovascular disease, 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 arrhythmia (OR, 1.8). Sensitivity analyses yielded similar results.
In contrast, menorrhagia showed no 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 menses showed a strong association with atrial fibrillation and coronary heart disease outcomes among younger 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 use (OR, 1.1) were associated with an increased odds of MACE events in addition to menorrhagia (OR, 1.3).
Hormonal imbalance in patients with menorrhagia may cause cardiac abnormalities such as hypoxia, inflammation, and 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 environmental exposure may help with menstrual problems and cardiovascular risk.
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 check-ups and screening for menstrual disorders, especially menorrhagia, may help stratify and manage cardiovascular risk. Menorrhagia should be diagnosed early and optimally treated to minimize adverse outcomes. Future studies should consider age of onset and assess its long-term impact on cardiovascular outcomes.