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. 2023 Nov;11(11):e1775-e1784.
doi: 10.1016/S2214-109X(23)00416-3. Epub 2023 Oct 3.

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

Sheela S Sinharoy  1 , Lyzberthe Chery  2 , Madeleine Patrick  3 , Amelia Conrad  3 , Anupama Ramaswamy  4 , Aparna Stephen  4 , Jenala Chipungu  5 , Y Malini Reddy  4 , Rinchen Doma  2 , Sant-Rayn Pasricha  6 , Tanvir Ahmed  7 , Chibwe Beatrice Chiwala  8 , Niladri Chakraborti  9 , Bethany A Caruso  10
Affiliations

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

Sheela S Sinharoy et al. Lancet Glob Health. 2023 Nov.

Erratum in

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.

Funding: Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.

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Conflict of interest statement

Declaration of interests S-RP reports funding from the Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council; consultancy and speaker fees from Vifor Pharma; and consultancy fees for an external advisory role to WHO, all related to anaemia research. BAC reports research and consultancy funding from the Bill & Melinda Gates Foundation (via Columbia University) related to menstruation research. All other authors declare no competing interests.

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