Objective

To assess the degree to which heavy menstrual bleeding is associated with depression, independent of hormonal contraception.

Study design

We performed a retrospective cohort study of 1168 female adolescents 9-18 years old presenting to general pediatricians for heavy menstrual bleeding or well visits. Depression was the primary outcome and defined as a diagnosis in the health record. Univariable and multivariable regression models were fit to the data to identify factors associated with depression diagnosis.

Results

In total, 581 adolescents with heavy menstrual bleeding and 587 without heavy menstrual bleeding were included. Depression diagnoses occurred with greater frequency in youth with heavy menstrual bleeding compared with those without heavy menstrual bleeding (50.9% vs 24.2% P < .001; risk ratio 1.67, 95% CI 1.39-2.01) but did not significantly differ between those taking vs not taking hormonal contraception (risk ratio 0.99; 95% CI 0.84-1.17). Most patients with depression and heavy menstrual bleeding developed depression following or concurrent with heavy menstrual bleeding (261/296, 88%). Of these, 199 of 261 (76%) were treated with hormonal contraception, but the majority (168/199; 84%) were diagnosed with depression before initiation.

Conclusions

Heavy menstrual bleeding is associated with depression diagnosis in female adolescents. The use of hormonal contraception was not associated with depression diagnosis in multivariable analysis, covarying heavy menstrual bleeding, age, body mass index, anxiety, sexual activity, and substance use. As hormonal contraception is often used to treat heavy menstrual bleeding, heavy menstrual bleeding may be partially driving previous reports of increased depression risk in those taking hormonal contraception.

中文翻译：

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月经出血过多的女性青少年的抑郁症

客观的

评估月经过多与抑郁症的相关程度，与激素避孕无关。

学习规划

我们对 1168 名 9-18 岁的女性青少年进行了一项回顾性队列研究，这些女性青少年因月经出血过多或就诊而向普通儿科医生就诊。抑郁症是主要结局，被定义为健康记录中的诊断。将单变量和多变量回归模型与数据进行拟合，以确定与抑郁症诊断相关的因素。

结果

总共有 581 名月经出血量较多的青少年和 587 名没有月经量较多的青少年被纳入研究。与没有大量月经出血的青少年相比，患有大量月经出血的青少年抑郁症诊断的发生率更高（50.9% vs 24.2% P  < .001；风险比 1.67，95% CI 1.39-2.01），但服用避孕药的青少年与服用避孕药的青少年之间没有显着差异。未服用激素避孕（风险比 0.99；95% CI 0.84-1.17）。大多数患有抑郁症和月经大量出血的患者在月经大量出血后或同时出现抑郁症（261/296，88%）。其中，261 人中有 199 人 (76%) 接受了激素避孕治疗，但大多数 (168/199；84%) 在开始治疗前被诊断患有抑郁症。

结论

月经过多与女性青少年的抑郁症诊断相关。多变量分析中，激素避孕的使用与抑郁症诊断、月经出血量、年龄、体重指数、焦虑、性活动和物质使用无关。由于激素避孕药通常用于治疗月经过多，因此月经过多可能在一定程度上导致了之前关于服用激素避孕药的人抑郁风险增加的报道。