Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders

Jianmin Shan; Hongjun Tian; Chunhua Zhou; Haibo Wang; Xiaoyan Ma; Ranli Li; Haiping Yu; Guangdong Chen; Jingjing Zhu; Ziyao Cai; Chongguang Lin; Langlang Cheng; Yong Xu; Sha Liu; Congpei Zhang; Qinghua Luo; Yunshu Zhang; Shili Jin; Chuanxin Liu; Qiuyu Zhang; Luxian Lv; Lei Yang; Jiayue Chen; Qianchen Li; Wei Liu; Weihua Yue; Xueqin Song; Chuanjun Zhuo; China; MODMD Group of China (CMODG)

doi:10.3389/fphar.2022.904908

Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders

Front Pharmacol. 2022 Jul 13:13:904908. doi: 10.3389/fphar.2022.904908. eCollection 2022.

Authors

Jianmin Shan^{1

2}, Hongjun Tian², Chunhua Zhou³, Haibo Wang⁴, Xiaoyan Ma⁵, Ranli Li⁵, Haiping Yu¹, Guangdong Chen¹, Jingjing Zhu¹, Ziyao Cai¹, Chongguang Lin¹, Langlang Cheng¹, Yong Xu⁶, Sha Liu⁶, Congpei Zhang⁷, Qinghua Luo⁸, Yunshu Zhang⁹, Shili Jin¹⁰, Chuanxin Liu¹¹, Qiuyu Zhang¹¹, Luxian Lv¹², Lei Yang¹³, Jiayue Chen¹⁴, Qianchen Li³, Wei Liu¹⁵, Weihua Yue¹⁴, Xueqin Song¹⁵, Chuanjun Zhuo^{1

2

15

16}; China; MODMD Group of China (CMODG)

Affiliations

¹ Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China.
² Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.
³ Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
⁴ Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
⁵ MECT Center, Sleep Disorder Center, Tianjin Anding Hospital, Tianjin, China.
⁶ Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.
⁷ Inpatient Department of Harbin First Psychiatry Hospital, Harbin, China.
⁸ Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁹ Inpatient Department of Hebei Mental Health Center, Baoding, China.
¹⁰ Inpatient Department, Shandong Daizhuang Hospital, Jining, China.
¹¹ Institute of Psychiatry, Jining Medical University, Jinning, China.
¹² Department of Psychiatry, Henan Psychiatry Hospital, Xinxiang, China.
¹³ Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
¹⁴ Department of Psychiatry, The First Hospital Affiliated to Harbin Medical University, Harbin, China.
¹⁵ Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁶ Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity, Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China.

Abstract

There has been limited studies examining treatment-induced heavy menstrual bleeding (HMB) in women with severe mental illnesses. The aim of this study was to examine HMB prevalence and HMB-associated factors in young women (18-34 years old) diagnosed with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia (SCZ) who have full insight and normal intelligence. Eighteen-month menstruation histories were recorded with pictorial blood loss assessment chart assessments of HMB. Multivariate analyses were conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Drug effects on cognition were assessed with the MATRICS Consensus Cognitive Battery (MCCB). HMB prevalence were: BP, 25.85%; MDD, 18.78%; and SCH, 13.7%. High glycosylated hemoglobin (HbA1c) level was a strong risk factor for HMB [BP OR, 19.39 (16.60-23.01); MDD OR, 2.69 (4.59-13.78); and SCZ OR, 9.59 (6.14-12.43)]. Additional risk factors included fasting blood sugar, 2-h postprandial blood glucose, and use of the medication valproate [BP: OR, 16.00 (95%CI 12.74-20.22); MDD: OR, 13.88 (95%CI 11.24-17.03); and SCZ OR, 11.35 (95%CI 8.84-19.20)]. Antipsychotic, antidepressant, and electroconvulsive therapy use were minor risk factors. Pharmacotherapy-induced visual learning impairment was associated with HMB [BP: OR, 9.01 (95%CI 3.15-13.44); MDD: OR, 5.99 (95%CI 3.11-9.00); and SCZ: OR, 7.09 (95%CI 2.99-9.20)]. Lithium emerged as a protective factor against HMB [BP: OR, 0.22 (95%CI 0.14-0.40); MDD: OR, 0.30 (95%CI 0.20-0.62); and SCZ: OR, 0.65 (95%CI 0.33-0.90)]. In SCZ patients, hyperlipidemia and high total cholesterol were HMB-associated factors (ORs, 1.87-2.22). Psychiatrist awareness of HMB risk is concerningly low (12/257, 2.28%). In conclusion, prescription of VPA should be cautioned for women with mental illness, especially BP, and lithium may be protective against HMB.

Keywords: bipolar disorder; heavy menstrual bleeding; lithium; major depressive disorder; schizophrenia; visual learning.