Trajectories of menstrual symptoms and blood pressure in midlife: A prospective cohort study on Australian women

Aim: To investigate the associations between the trajectories of menstrual symptoms over 18 years and blood pressure in midlife using longitudinal data. Methods: Using data from the Menarche-to-PreMenopause (M-PreM) study, sampled from the Australian Longitudinal Study on Women?s Health, 494 participants were followed from their early 20s to mid-40s. Distinct trajectories of heavy menstrual bleeding, irregular periods, and severe period pain were identified by group-based trajectory modelling. The associations between menstrual symptom trajectories and blood pressure were examined by linear regression models. Results: We identified three distinct heavy menstrual bleeding trajectories and two for irregular periods and severe period pain. After accounting for blood pressure monitors and socio-demographic factors, women in the chronic heavy menstrual bleeding group and late onset heavy menstrual bleeding group exhibited higher systolic (SBP) and diastolic (DBP) blood pressure compared to the normative group. The late onset irregular periods group also had higher DBP than the normative group. When we further adjusted for lifestyle factors, body mass index, and waist-to-hip ratio, the associations were attenuated (chronic heavy bleeding: SBP [B=3.0; 95% CI: -1.1, 7.0] and DBP [B=2.5; 95% CI: -0.3, 5.2]; late onset heavy menstrual bleeding: SBP [B=3.4; 95% CI: 0.3, 6.5] and DBP [B=3.1; 95% CI: 1.0, 5.2]). We found no associations between severe period pain and blood pressure. Conclusions: The trajectories of heavy menstrual bleeding and irregular periods during the reproductive span were associated with blood pressure in midlife. This suggests that tracking menstrual symptoms in women could help predict their midlife blood pressure. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study doesn't involve any interventions. ### Funding Statement GDM is supported by the Australian National Health and Medical Research Council Leadership Fellow (APP2009577). CJ is supported by China Scholarship Council (grant number: 202006010042) (https://www.csc.edu.cn/chuguo/s/1844). The M-PreM Study is supported by the National Health and Medical Research Council Project Grant (APP1129592). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study involves human participants and was approved by the Metro South Health and Health Services Human Research Ethics Committee (reference number: HREC/2019/QMS/52052) and ratified by the University of Newcastle and the University of Queensland Human Research Ethics Committees. All participants provided informed consent by completing an electronic or paper participant consent form. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data are available upon reasonable request. Access to the M-PreM dataset requires approval from the Australian Longitudinal Study on Women?s Health (ALSWH) Data Access Committee. More information can be found at the ALSWH website: https://alswh.org.au/for-data-users/.