Abstract
To identify the prevalence and impact of heavy menstrual bleeding (HMB) in exercising females where anemia may have a significant effect on training and performance a ‘Female Health Questionnaire’ was designed incorporating a validated diagnostic HMB series, demographics, exercise ability data, training status, anemia, iron supplementation and whether the menstrual cycle had affected training and performance. The survey was conducted in two stages; initially online, advertised via social media, and then repeated via face-to-face interviews with runners registered for the 2015 London Marathon. 789 participants responded to the online survey, and 1073 completed the survey at the marathon. HMB was reported by half of those online (54%), and by more than a third of the marathon runners (36%). Surprisingly, HMB was also prevalent amongst elite athletes (37%). Overall, 32% of exercising females reported a history of anemia, and 50% had previously supplemented with iron. Only a minority (22%) had sought medical advice. HMB is highly prevalent in exercising females, associated with self-reported anemia, increased use of iron supplementation and a perceived negative impact on performance. Further research is needed to investigate the impact of HMB, iron deficiency and anemia in exercising females.
Highlights
Heavy menstrual bleeding (HMB) is common, affecting a quarter of the female population.[1]
The four-symptom definition of HMB [1] was used to identify HMB sufferers and information was collected on age, ‘personal best’ sports performance times, current training volume, previous history of anemia and iron supplementation, the menstrual cycle and difficulties caused by it, and oral contraceptive pill (OCP) usage (S1 Appendix)
More than half (54.1%) of the participants had experienced HMB at some point (Table 1).[16] 55.4% stated that their menstrual cycle impacts upon their training and performance (Table 1), with those meeting the HMB criteria (n = 427) being more likely to state this (69.3% vs. 39.0%; χ2 = 867.593, p
Summary
Heavy menstrual bleeding (HMB) is common, affecting a quarter of the female population.[1] HMB can negatively impact on physical, emotional and social quality of life and reduce work capacity.[2,3]. Diagnosing HMB can be subjective and definitions include; blood loss of more than 80ml per menstrual cycle or “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life”.[3,4] In a recent Europe-wide study a diagnosis of HMB was given if two or more of the following criteria were met; 1. Diagnosing HMB can be subjective and definitions include; blood loss of more than 80ml per menstrual cycle or “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life”.[3,4] In a recent Europe-wide study a diagnosis of HMB was given if two or more of the following criteria were met; 1. passing of large
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