Menstruation: the fifth vital sign in women of reproductive age

Authors

  • Sze Yan Charleen Cheung HKU

Keywords:

Anemia, iron deficiency, Menstruation, Metrorrhagia, Women’s health

Abstract

Menstruation is a vital sign of women’s health; every woman typically experiences 400 to 450 ovulations and 7 years of menstruation over her lifetime. Abnormal uterine bleeding (AUB) affects up to one-third of women during their reproductive years, impacting quality of life, but menstrual complaints are frequently under-reported. Healthy menstruation is determined by non-modifiable factors (age, ethnicity, and genetics) and modifiable factors (smoking, diet and nutrition, exercise, body weight, stress, gynaecological disorders, and systematic disorders). Healthy menstruation encompasses regularity, normal flow and duration, and the absence of dysmenorrhoea. These characteristics are indicators of a healthy reproductive system and overall well-being. AUB is a leading cause of iron deficiency and anaemia, particularly in women of reproductive age. In Hong Kong, 17.5% of women of reproductive age have iron deficiency. Comprehensive evaluation of menstruation is crucial in managing anaemia. Femtech (female technology) facilitates menstrual education and personalised health management. Recognition of menstruation as the fifth vital sign in women of reproductive age is important to overall health assessment. Early detection and management of AUB, along with related complications, namely iron-deficiency anaemia, can optimise women’s health outcomes.

References

‎1. FAST FACTS: Nine things you didn’t know about menstruation. Unicef Press release. 25 ‎May ‎‎2018.‎

‎2.‎ United Nations Population Fund. Menstrual health. Accessed 30 December 2024. Available ‎from: ‎https://www.unfpa.org/menstrual-health

‎3.‎ Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related ‎‎quality of life, work impairment, and health-care costs and utilization in abnormal uterine ‎bleeding. ‎Value Health 2007;10:183-94.‎

‎4. Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of ‎menstrual ‎symptoms on everyday life: a survey among 42,879 women. Am J Obstet ‎Gynecol ‎‎2019;220:569.e1-569.e7.‎

‎5. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two ‎FIGO ‎systems for normal and abnormal uterine bleeding symptoms and classification of ‎causes of ‎abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J ‎Gynaecol Obstet ‎‎2018;143:393-408.‎

‎6. Liang J, Ali F, Ramaiyer M, Borahay MA. Determinants and assessment of menstrual ‎blood ‎flow. Curr Epidemiol Rep 2023;10:210-20.‎

‎7. Ruth KS, Beaumont RN, Tyrrell J, et al. Genetic evidence that lower circulating FSH ‎levels ‎lengthen menstrual cycle, increase age at menopause and impact female reproductive ‎health. Hum ‎Reprod 2016;31:473-81.‎

‎8. Jung AN, Park JH, Kim J, et al. Detrimental ‎effects of higher body mass index and smoking ‎habits on menstrual cycles in Korean ‎women. J Womens Health (Larchmt) 2017;26:83-90.‎

‎9. Grossman MP, Nakajima ST. Menstrual cycle bleeding patterns in cigarette smokers. ‎‎Contraception 2006;73:562-5.‎

‎10. Onieva-Zafra MD, Fernández-Martínez E, Abreu-Sánchez A, et al. Relationship between diet, ‎‎menstrual pain and other menstrual characteristics among Spanish students. Nutrients ‎‎‎2020;12:1759.‎

‎11. Hahn KA, Wise LA, Riis AH, et al. ‎Correlates of menstrual cycle characteristics among ‎nulliparous Danish women. Clin ‎Epidemiol 2013;5:311-9.‎

‎12. Roberts RE, Farahani L, Webber L, Jayasena C. Current understanding of hypothalamic ‎‎amenorrhoea. Ther Adv Endocrinol Metab 2020;11:2042018820945854.‎

‎13. Martini MG, Solmi F, Krug I, et al. Associations between eating disorder diagnoses, behaviors, ‎and menstrual ‎dysfunction in a clinical sample. Arch Womens Ment Health 2016;19:553-7.‎

‎14. Vyver E, Steinegger C, Katzman DK. Eating disorders and menstrual dysfunction in ‎‎adolescents. Ann N Y Acad Sci 2008;1135:253-64.‎

‎15.‎ Algars M, Huang L, Von Holle AF, et al. ‎Binge eating and menstrual dysfunction. J ‎Psychosom Res 2014;76:19-22.‎

‎16. Seif MW, Diamond K, Nickkho-Amiry M. Obesity and menstrual disorders. Best Pract ‎Res ‎Clin Obstet Gynaecol 2015;29:516-27.‎

‎17. Motzer SA, Hertig V. Stress, stress response, and health. Nurs Clin North Am 2004;39:1-17.‎

‎18. Maybin JA, Watters M, Rowley B, Walker CA, Sharp GC, Alvergne A. COVID-19 and ‎‎abnormal uterine bleeding: potential associations and mechanisms. Clin Sci (Lond) 2024;138:153-‎‎71.‎

‎19. Pollack B, von Saltza E, McCorkell L, et al. ‎Female reproductive health impacts of Long ‎COVID and associated illnesses including ‎ME/CFS, POTS, and connective tissue disorders: a ‎literature review. Front Rehabil Sci ‎‎2023;4:1122673.‎

‎20. Jain V, Chodankar RR, Maybin JA, Critchley HOD. Uterine bleeding: how understanding ‎‎endometrial physiology underpins menstrual health. Nat Rev Endocrinol 2022;18:290-308.‎

‎21. World Health Organization. Anaemia. Accessed 30 December 2024. Available from: ‎https://www.who.int/news-‎room/fact-sheets/detail/anaemia

‎22.‎ ‎Thematic Report on Iron Status. Population Health Survey 2020-2022. Accessed 30 December ‎‎2024. Available from: ‎https://www.chp.gov.hk/files/pdf/dh_phs_2020-22_iron_report_eng.pdf‎

‎23. Coulter A, Peto V, Jenkinson C. Quality of life and patient satisfaction following treatment ‎for ‎menorrhagia. Fam Pract 1994;11:394-401.‎

‎24. ACOG Committee Opinion No. 651: menstruation in girls and adolescents: using the ‎menstrual ‎cycle as a vital sign. Obstet Gynecol 2015;126:e143-e146.‎

‎25. American Academy of Pediatrics Committee on Adolescence; American College of ‎Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, ‎Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. ‎Pediatrics 2006;118:2245-50.‎

‎26. Faubion SS. Femtech and midlife women’s health: good, bad, or ugly? Menopause ‎‎2021;28:347-8.‎

‎27. Broad A, Biswakarma R, Harper JC. A survey of women’s experiences of using period ‎tracker ‎applications: attitudes, ovulation prediction and how the accuracy of the app in ‎predicting period ‎start dates affects their feelings and behaviours. Womens Health (Lond) ‎‎‎2022;18:17455057221095246.‎

‎28. Association of Health Care Journalists. Impact of expected Roe v. Wade reversal on telehealth ‎and femtech providers. Accessed 30 December 2024. Available from: ‎‎https://healthjournalism.org/blog/2022/06/impact-of-expected-roe-v-wade-reversal-on-‎telehealth-‎and-femtech-providers/‎

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Published

2025-05-22

How to Cite

1.
Cheung SYC. Menstruation: the fifth vital sign in women of reproductive age. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2025 May 22 [cited 2025 May 29];25(2). Available from: https://hkjgom.org/home/article/view/388

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Section

Perspective (Gynaecology)