Association between heavy menstrual bleeding and depression among women in South Asia: a cross-sectional study

Heavy menstrual bleeding-clinically defined as excessive menstrual blood loss that interferes with physical, emotional, social, or material quality of life -adversely affects health and functional outcomes among individuals who menstruate. However, the full extent of the relationships between heavy menstrual bleeding and health outcomes remains unknown, especially in low- and middle-income countries. To begin to fill this evidence gap, we investigated associations between heavy menstrual bleeding and depression symptomology among women in South Asia.

We carried out a secondary analysis of cross-sectional data from household surveys conducted with 3438 adult women between August 2021 and June 2022 in 5 cities: Meherpur and Saidpur, Bangladesh; and Narsapur, Tiruchirappalli, and Warangal, India. Heavy menstrual bleeding was measured using the clinically validated SAMANTA scale, and depression symptomology was measured using the Center for Epidemiological Studies Short Depression scale. Regression analyses examined associations between heavy menstrual bleeding and depression symptomology among our analytic sample of 2564 women who had experienced a menstrual period in the previous 12 months.

The prevalence of heavy menstrual bleeding was 45% across the pooled sample, with city-specific prevalences ranging from 41% to 46%. The median Center for Epidemiological Studies Short Depression scale score was 6 (range: 4-29, out of a possible 30), with 30% of women scoring above the screening threshold for depression. Pooled analyses revealed a significant association between heavy menstrual bleeding and increased Center for Epidemiological Studies Short Depression scale scores (β: 0.07; 95% confidence interval, 0.03, 0.12) and a 15% increased risk of a binary depression outcome (95% confidence interval, 1.03, 1.29) among women with heavy menstrual bleeding. City-level analyses showed variability in the strength and significance of these associations, with some cities demonstrating stronger associations than others.

The findings highlight the substantial burden of heavy menstrual bleeding on women's mental health in South Asia. Addressing heavy menstrual bleeding as part of comprehensive women's reproductive healthcare is crucial for improving overall well-being. The study underscores the need for further research to explore the mechanisms linking heavy menstrual bleeding and depression, and to develop effective interventions tailored to the specific needs of women in different contexts. Understanding these relationships can provide healthcare providers and policymakers with evidence to better support women's health and mental well-being.