Heavy and Painful Menstrual Periods and their Relationship with Depressive Symptoms across the Life Course

Background

There is growing recognition amongst the media, policy makers and medical researchers that menstrual health is a critical issue for women and society. Heavy menstrual bleeding (HMB) and menstrual pain (MP) can have a significant negative impact on financial, social, physical, and mental wellbeing, and individuals with HMB/MP are at an elevated risk of depressive symptoms. Identifying the causes of, treating, and managing HMB/MP is a global health priority, but research and clinical practice are lagging behind public awareness and there are substantial knowledge gaps.

This project addresses gaps in this under-recognised, under-resourced and under-researched area of clinical need by bringing together the only cohort studies globally that have collected HMB and MP data. By harnessing existing, rich, longitudinal, and genetic data from these cohorts, we will provide evidence to inform better ways to predict, prevent and manage HMB/MP and reduce negative relationships with depressive symptoms over the life course.

Aims and Objectives

1) To understand the prevalence of HMB/MP, when individuals are most at risk, and how symptoms change over the reproductive life course.
We will leverage rich longitudinal data covering the entire reproductive life course to calculate the lifetime and age-specific prevalence of HMB, MP, and co-morbid HMB+MP. We will also plot trajectories and explore how HMB/MP changes with age.

2) To identify risk factors for developing HMB/MP across the life course.
We will conduct a scoping literature review and consult our Patient Participant Involvement and Engagement (PPIE) group to identify a list of potential risk factors for HMB/MP, which we will then assess longitudinally in our cohorts. We will also identify genetic variants associated with risk of HMB/MP by conducting the first genomewide association studies (GWAS) of these symptoms in the general population.

3) To understand the relationship between HMB/MP and depressive symptoms across the life course.
We will assess associations between HMB/MP and depressive symptoms and explore the direction of effect (i.e., does HMB/MP cause depressive symptoms, or are people with existing depressive symptoms more likely to develop HMB/MP?). We will triangulate evidence from two approaches: a) capitalising on repeat measures data to understand what came first, HMB/MP or depressive symptoms; and b) leveraging genetic data in an approach called bidirectional Mendelian Randomization, which will use genetic variants as proxies for HMB/MP and depressive symptoms to help infer causal e”ects and their direction. Finally, we will harness the rich data in these cohorts to explore potential mechanisms underlying relationships between HMB/MP and depressive symptoms.

Impact

Our project will address a leading priority for women’s health by generating new and robust knowledge about the prevalence, severity, risk factors, and mental health impact of two of the most common problematic menstrual symptoms, HMB and MP. We will leverage our existing strong clinical networks, track records in translational research, and embedded stakeholder and public engagement activities to ensure that this new knowledge is disseminated and applied. The information we generate can guide GPs, clinical psychologists, gynaecologists and other clinical care providers to stratify patients by risk and develop interventions promoting menstrual and mental health. Ultimately, this will help improve the health, wellbeing, and social, educational and workplace participation of people who menstruate, and reduce gender-based health and social inequalities.