Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study

• Type of Material: Article
• Authors: Sheela Selin Sinharoy, Emory University; Lyzberthe Chery, Emory University; Madeleine Patrick, Emory University; Amelia Conrad, Emory University; Anupama Ramaswamy, Athena Infonomics; Aparna Stephen, Athena Infonomics; Jenala Chipungu, Centre for Infectious Disease Research in Zambia; Y. Malini Reddy, Athena Infonomics; Rinchen Doma, Emory University; Sant-Rayn Pasricha, The Walter and Eliza Hall Institute; Tanvir Ahmed, Bangladesh University of Engineering and technology; Chibwe Beatrice Chiwala, Lusaka Water Supply and Sanitation Company; Niladri Chakraborti, Indian Institute for Human Settlements; Bethany Caruso, Emory University
• Language: English
• Date: 2023-10-03
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/S2214-109X(23)00416-3
• Title of Journal or Parent Work: The Lancet Global Health
• Volume: 11
• Issue: 11
• Start Page: e1775
• End Page: e1784
• Grant/Funding Information: This work was supported by the Bill & Melinda Gates Foundation (OPP1191625 and INV-028835; to SSS and BAC), the Emory Specialized Center of Research Excellence on Sex Differences (National Institutes of Health award number U54AG062334; to SSS), and the United States Agency for International Development under the Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project (AID-OAA-I-14-0068/A ID-OAA-TO-16-00016; to BAC).
• Keywords: low-income and middle-income countries; sub-Saharan Africa; women's health; heavy menstrual bleeding; southern Asia
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes. Methods Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes. Findings 4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β –3·34, 95% CI –7·04 to 0·37). Interpretation Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem.