Objectives: To estimate the prevalence of heavy menstrual bleeding among Australian women from young adulthood to midlife (22-48 years) and investigate the characteristics of women who experience this condition; to investigate the relationship of heavy menstrual bleeding and health-related quality of life.
Study design: Longitudinal cohort survey study (Australian Longitudinal Study on Women's Health, ALSWH).
Setting, participants: Australia; baseline cohort of 14 247 women born during 1973-1978, recruited in 1996; eight post-baseline surveys undertaken at 3-year intervals, 2000-2021.
Main outcome measures: Self-reported frequency of heavy menstrual bleeding during the preceding twelve months (never/rarely, sometimes, often); frequency of heavy menstrual bleeding by socio-demographic, behavioural, health, and reproduction-related characteristics; mean physical and mental health-related quality of life scores (36-item Short Form health survey, SF-36) by frequency of heavy menstrual bleeding. Results are weighted to adjust for oversampling of participants from rural and remote areas.
Results: Data for 11 311 respondents to at least one ALSWH post-baseline survey were included in our prevalence analysis. The prevalence of sometimes or often experiencing heavy menstrual bleeding increased from 17.6% at age 22 years (124 of 691 respondents) to 32.1% at 48 years (359 of 1132 respondents); the proportion who reported often experiencing the condition increased from 6.1% (45 participants) to 12.1% (136 participants). The likelihood of often experiencing heavy menstrual bleeding increased with body mass index (40 kg/m2 or greater v 18.5-24.9 kg/m2: risk ratio [RR], 2.27; 95% confidence interval [CI], 1.93-2.67), and was greater for respondents who reported low iron levels (RR, 2.26; 95% CI, 2.03-2.51) or endometriosis (RR, 2.29; 95% CI, 2.06-2.54). Similar associations were seen for sometimes experiencing heavy bleeding. Mean health-related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding.
Conclusions: Heavy menstrual bleeding was reported by large minorities of women of reproductive age, and the proportion increased with age. Many women experience symptoms that have a substantial impact on their physical and mental health-related quality of life.
Objective: To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.
Study design: Single arm, pre-post intervention study.
Setting, participants: Adult residents (18-65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women).
Intervention: Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.
Main outcome measures: Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.
Results: We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5-2.4 kg), and ten participants (18%; 95% CI, 9-31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was -0.60 kg/m2 (95% CI, -0.93 to -0.27 kg/m2), in waist circumference (53 participants) -3.2 cm (95% CI, -4.7 to -1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) -0.28 mmol/L (95% CI, -0.47 to -0.08 mmol/L); the relative decline in the HbA1c level geometric mean (50 participants) was 11% (95% CI, 6-15%). The intake of breads and cereals (median change, -1.5 [95% CI, -2.0 to -1.0] serves/day) and sugar-sweetened beverages (-0.6 [95% CI, -1.4 to -0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74-136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit.
Conclusions: Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas.
Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).
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