Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski-Wende, J., & Schisterman, E. F. (2012). Menstrual bleeding patterns among regularly menstruating women. American Journal of Epidemiology, 175(6), 536-545. https://doi.org/10.1093/aje/kwr356
Dasharathy SS, Mumford SL, Pollack AZ, Perkins NJ, Mattison DR, Wactawski-Wende J, Schisterman EF. Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol. 2012;175(6):536-545. doi:10.1093/aje/kwr356
Dasharathy, Sonya S., et al. "Menstrual bleeding patterns among regularly menstruating women." American Journal of Epidemiology, vol. 175, no. 6, 2012, pp. 536-545.
For EndNote, Zotero or Mendeley:
Open access
Free to read
No reuse license
Open Access
Free full text on PubMed Central (PMC3299419)
Author affiliations
4 institutions
Eunice Kennedy Shriver National Institute of Child Health and Human Development04byxyr05
Department of Epidemiology and Environmental Health, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY.01y64my43
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
Healthy women with regular cycles bleed a median of 5 days
Healthy women with regular cycles bled for a median of 5 days. This prospective cohort, the BioCycle Study, analyzed 470 cycles from 250 women. Among 201 with two consecutive cycles, higher FSH and progesterone went with heavier periods. About 5 out of 100 women had spotting between periods.
Key Findings
Across 470 cycles from 250 women, bleeding lasted a median of 5 days (range: 1–16). The second day of menstruation carried the heaviest flow in most cycles.
Spotting between periods showed up in 13 episodes, or 2.8% of cycles. Twelve women (4.8%) had it, and each episode lasted 1 or 2 days.
In 201 women, each log-unit rise in FSH went with about 22% more blood loss (β = 0.202, 95% CI: 0.130, 0.274). Split by age, the link held only under 30.
Each 1 log-unit increase in progesterone went with about 6% more blood loss (β = 0.057, 95% CI: 0.023, 0.092). No associations were observed between estrogen or LH and blood loss.
After anovulatory cycles (no ovulation), geometric mean blood loss was 29.6 mL vs. 47.2 mL after ovulatory ones (P = 0.070). Menses lasted 4.5 vs. 5.4 days (P = 0.025).
Interpretation
This cohort study, the BioCycle Study, followed 250 healthy women ages 18 to 44 for two menstrual cycles. They lived in western New York, had cycles of 21 to 35 days, and used no hormonal birth control. Rising FSH and progesterone went with heavier bleeding. Cycles with ovulation ran heavier and longer than cycles without it. The authors call for larger studies to confirm these hormone links.
RRM Context
Restorative reproductive medicine charts bleeding day by day, like this study did. The authors think progestins for heavy bleeding, such as many birth control pills, cut blood loss by stopping ovulation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Menstrual bleeding patterns are considered relevant indicators of reproductive health, though few studies have evaluated patterns among regularly menstruating premenopausal women. The authors evaluated self-reported bleeding patterns, incidence of spotting, and associations with reproductive hormones among 201 women in the BioCycle Study (2005-2007) with 2 consecutive cycles. Bleeding patterns were assessed by using daily questionnaires and pictograms. Marginal structural models were used to evaluate associations between endogenous hormone concentrations and subsequent total reported blood loss and bleeding length by weighted linear mixed-effects models and weighted parametric survival analysis models. Women bled for a median of 5 days (standard deviation: 1.5) during menstruation, with heavier bleeding during the first 3 days. Only 4.8% of women experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20, 95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval: 0.03, 0.09) throughout the cycle were associated with heavier menstrual bleeding, and higher follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and volume were reduced after anovulatory compared with ovulatory cycles (geometric mean blood loss: 29.6 vs. 47.2 mL; P = 0.07). Study findings suggest that detailed characterizations of bleeding patterns may provide more insight than previously thought as noninvasive markers for endocrine status in a given cycle.
04byxyr05 