Obese women can be more likely to have heavy monthly periods and experience fibroid growth, and now new research hints at why.
In addition to stirring up inflammation, excess weight may slow down the uterine repair process, U.K. researchers reported. Menstruation occurs when the lining of the uterus (endometrium) sheds each month, but the healing process stops the bleeding so the lining can build back up.
Heavy periods -- defined as needing to change your tampon or pad after less than two hours and/or passing large blood clots -- can take a dramatic toll on a woman's quality of life, says study author Dr. Jacqueline Maybin, a researcher at the MRC Centre for Reproductive Health at the University of Edinburgh.
"Some people have such heavy periods that they can't leave the house when menstruating as they flood through their menstrual products onto their clothes," she shares. "This results in work or school absence, an increased financial burden due to paying for extra menstrual products and an inability to carry out caring roles."
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When Maybin and her colleagues measured the body mass index (BMI) and menstrual blood loss of 121 women with regular menstrual cycles, they found that as BMI increased, so did menstrual blood loss. (BMI is a measure of weight in relation to height.) The relationship was weak, but still statistically significant after controlling for other factors that may affect blood loss during menstruation, she says.
The team conducted a companion study in mice to get a better handle on why higher BMIs might cause heavier periods. Mice fed a high-fat diet had significantly greater body weight than those on a normal diet. After shedding their uterine lining, the mice on a high-fat diet showed delayed repair of the remaining lining and greater levels of inflammatory markers than mice on a normal diet did.
Dr. Andrea Dunaif is a professor of medicine at the Icahn School of Medicine at Mount Sinai and chief of the Division of Endocrinology, Diabetes and Bone Disease at the Mount Sinai Health System in New York City. The new findings mirror what she sees in her practice.
Heavy and irregular periods are more common in women with higher BMIs, Dunaif says.
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Dr. Michael Jensen, an endocrinologist at the Mayo Clinic in Rochester, Minn., was skeptical about the new findings.
"Women, as they get heavier, are more prone to heavy periods, but the mouse model is hard to link back to women," Jensen notes. Weight loss may help reduce blood loss during menstruation, but more research is needed to fully understand why and how obesity affects menstruation in overweight or obese women, he says.
Heavy Menstrual Bleeding and Uterine Fibroids: The Importance of Doctor & Patient Dialogues
The importance of weight loss
More research is needed to confirm the findings, but weight loss and anti-inflammatory medications may lighten monthly periods in obese women.
"A common-sense approach would be to offer weight-loss support to women experiencing heavy menstrual bleeding with a high BMI as part of their treatment," Maybin adds.
There are other causes of heavy menstrual bleeding, including bleeding disorders, fibroids or other abnormal growths in the uterus, she notes.
Losing weight may make a difference for these women, but this is often easier said than done, she notes. Many women tend to overeat as a result of feeling anemic after losing so much blood. Heavy periods may also make women feel lightheaded due to iron deficiency causing them to skip out on exercise. In short, trying to control other symptoms of heaving periods can lead to weight gain.
Given how hard it is to lose weight and keep it off, doctors often treat the symptoms of heavy menstrual periods after ruling out other potential causes.
"It is important to emphasize that [weight loss] should not replace investigations and treatment of [other] underlying causes for their heavy periods," Maybin adds.
The following tips can help control your heavy periods, weight gain or fibroids:
- Be aware of the iron deficiency and use vitamins or diet to correct it.
- Eat brightly colored fruits and vegetables.
- Eat foods high in fiber, such as cruciferous vegetables or oats.
- Get enough vitamin D, which can lower your risk of uterine fibroids by 32 percent.
- Avoid foods that affect estrogen, like soy, tofu and red meat.
- Avoid sugary foods and refined carbs.
How do fibroids cause weight gain?
When fibroids grow large in size, they can cause weight gain in the abdomen, weigh several pounds or even push on other organs. In severe cases, some women may appear pregnant because of excess weight gain.
A large fibroid cluster can measure more than eight inches in diameter, which is around the size of a small watermelon. Fibroids of this size can directly impact a woman’s weight.
When to see a doctor
If your symptoms are affecting your daily life or if you notice a bulge in your lower abdomen, you should check in with a doctor to see if you may have fibroids. Fibroids have symptoms in common with more serious diseases. So as you aim to lose weight, keep a watchful eye on them.
Additionally, if you have fibroids that go beyond four inches in diameter, or the size of a grapefruit, you need to consult your doctor. This can impact other organs such as your bladder and lungs. There is also an increased risk of blood clots or ruptures.
If you are looking to treat your heavy periods, talk to your doctor about oral contraceptives.
"Oral contraceptives containing the hormones estrogen and progestin can keep the uterine lining thinner, resulting in less bleeding," Dunaif shares.
