Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane St Lucia, QLD, Australia.
Hum Reprod. 2021 May 17;36(6):1481-1491. doi: 10.1093/humrep/deab055.
Are physical activity (PA) and body mass index (BMI) associated with irregular periods and heavy menstrual bleeding (HMB) in Australian women?
Overweight and obese women have higher odds of both irregular periods and HMB than underweight/normal-weight women, but high levels of PA reduce the odds of HMB.
Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies.
STUDY DESIGN, SIZE, DURATION: Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women's Health (ALSWH) who completed mailed surveys in 1996, with follow-ups in 2000, 2003, 2006, 2009, 2012, and 2015.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were aged 22 to 27 in 2000. They were asked to report their PA levels and the frequency of irregular periods and HMB in each survey. BMI was calculated at every survey from self-reported weight and height. Generalised estimating equation population-averaged model analyses were conducted to calculate odds ratios (OR) and 95% confidence intervals (95% CIs).
At age 22 to 27 years, the prevalence of irregular periods was 19.4%. This remained stable over 15 years. There were no associations between PA and irregular periods. Overweight and obese women had higher odds of irregular periods [overweight: OR 1.08, (95% CI 1.00-1.17); obese: OR 1.29, (95%CI 1.18-1.41)] than women who were underweight/normal weight.The prevalence of HMB at age 22-27 years was 15.9%; this doubled over 15 years. Women who were highly active had 10% lower odds of HMB than women who reported no PA [OR 0.90, (95%CI 0.82-0.98)]. Overweight and obese women had higher odds of HMB [overweight: OR 1.15, (95%CI 1.07-1.23); obese: OR 1.37, (95%CI 1.26-1.49)] than women who were underweight/normal weight. Among obese women, high levels of PA were associated with 19% [OR 0.81, (95%CI 0.68-0.97)] reduction in the odds of HMB.
LIMITATIONS, REASONS FOR CAUTION: Data collected in the ALSWH are self-reported, which may be subject to recall bias. Reverse causation, due to menstrual problems impacting PA, is possible although sensitivity analyses suggest this is unlikely to have affected the results. Other conditions, e.g., polycystic ovary syndrome, for which no or incomplete data were available, could have affected the results.
Intervention studies are needed to assess the effect of increasing PA in women with HMB, but these preliminary findings suggest that promoting PA could be an affordable and feasible strategy for reducing HMB in young adult women.
STUDY FUNDING/COMPETING INTEREST(S): The ALSWH is funded by the Australian Government. Funding for these analyses was provided by a University of Queensland (UQ) International Postgraduate Research Scholarship and a UQ International Development Fellowship. The authors declare no conflicts of interest.
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身体活动（PA）和体重指数（BMI）与澳大利亚女性的不规律经期和月经过多（HMB）有关吗？
超重和肥胖女性比体重不足/正常体重的女性更有可能出现不规律经期和 HMB，但高水平的 PA 会降低 HMB 的几率。
大多数关于 PA 与月经问题关系的研究都集中在女性运动员身上，但很少有基于人群的研究。
研究设计、规模、持续时间：前瞻性队列研究，10618 名参加澳大利亚女性健康纵向研究（ALSWH）的参与者在 2000 年完成了邮寄调查，随后在 2000 年、2003 年、2006 年、2009 年、2012 年和 2015 年进行了随访。
参与者/材料、设置、方法：参与者在 2000 年时年龄在 22 至 27 岁。他们被要求在每次调查中报告他们的 PA 水平以及不规律经期和 HMB 的频率。从自我报告的体重和身高计算每个调查中的 BMI。使用广义估计方程人群平均模型分析计算比值比（OR）和 95%置信区间（95%CI）。
在 22 至 27 岁时，不规律经期的患病率为 19.4%。在 15 年内，这一比例保持稳定。PA 与不规律经期之间没有关联。超重和肥胖女性比体重不足/正常体重的女性更容易出现不规律经期[超重：OR 1.08，（95%CI 1.00-1.17）；肥胖：OR 1.29，（95%CI 1.18-1.41）]。在 22-27 岁时，HMB 的患病率为 15.9%；在 15 年内翻了一番。高度活跃的女性比没有 PA 的女性发生 HMB 的几率低 10%[OR 0.90，（95%CI 0.82-0.98）]。超重和肥胖女性比体重不足/正常体重的女性更容易出现 HMB[超重：OR 1.15，（95%CI 1.07-1.23）；肥胖：OR 1.37，（95%CI 1.26-1.49）]。在肥胖女性中，高水平的 PA 与 HMB 几率降低 19%相关[OR 0.81，（95%CI 0.68-0.97）]。
局限性、谨慎的原因：ALSWH 收集的数据是自我报告的，可能存在回忆偏差。由于月经问题影响 PA，可能存在反向因果关系，尽管敏感性分析表明这不太可能影响结果。其他疾病，例如多囊卵巢综合征，没有或只有部分数据，也可能影响结果。
需要进行干预研究来评估增加 HMB 女性的 PA 的效果，但这些初步发现表明，促进 PA 可能是一种负担得起且可行的策略，可减少年轻成年女性的 HMB。
研究资金/利益冲突：ALSWH 由澳大利亚政府资助。这些分析的资金由昆士兰大学（UQ）国际研究生研究奖学金和 UQ 国际发展奖学金提供。作者声明没有利益冲突。
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