Variation In Haemoglobin Levels During Menstrual Cycle

Introduction :

Menstrual cycle is cyclic process that occurs in women of childbearing age i.e. between menarche and menopause. During this cycle, secretion of steroid hormones namely, oestrogen and progesterone occur. The average length of menstrual cycle is 28 days, although variation of 21-40 days is normal.¹

The phases of menstrual cycle are pre-ovulatory or follicular phase and post-ovulatory or luteal phase. During the follicular phase, the oestrogen concentration is higher while during the luteal phase, progesterone surge occurs.¹

Haemoglobin is an iron-containing metalloprotein, found in the red blood cells. It is responsible for carrying oxygen to the tissues and carbon-dioxide from the tissues.¹During menstruation, blood loss of 30-80L occurs. This results in loss of iron from the body.

This may indirectly affect the haemoglobin levels in red blood cells.²

The aim of the study was to assess the variation in haemoglobin levels during the menstrual cycle.

Materials and Methods:

Fifteen females between 18years to 35 years of age were a part for this research. A written consent was obtained from them. All the selected females were non-smokers, nondrinkers, and free from infections. Through questionnaires, the average duration of their menstruation and their menstrual cycle, age, and their diet was collected. For estimation of haemoglobin, whole blood samples were collected in the morning at around 9A.M. on the 4^th day of menstrual cycle and approximately four days prior to the menstruation. The study was carried over 3 months. An average of three readings for each phase for an individual was taken. Haemoglobin measurement was carried out using colorimetric method. The data collected during the two phases of menstrual cycle was statistically analysed using Student t-test.

Results :

The mean haemoglobin concentration during the follicular phase is 12.88 ± 1.1g/dl and during the luteal phase is 13.06 ± 0.93g/dl (Fig. 1). The p-value obtained was 0.041, which means there is significant variation (p<0.05) in the levels of haemoglobin during menstrual cycle.

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Figure 1

Comparison of the mean haemoglobin levels in follicular and luteal phases of menstrual cycle

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Discussion :

Haem synthesis occurs within the mitochondria. There is no evidence for variation in mitochondria number, ability to synthesize haem, or absorption of iron from the same diet, between males and females. Even the erythropoietin and thyroxine levels show no variation. The only possible cause for the variation in red blood cell count, haemoglobin and serum ferritin levels amongst males and females is the influence of hormones.³

This finding is in accordance with our study. The haemoglobin levels obtained were higher during the luteal phase. This could be due to the loss of blood during the menstruation. This would have possibly affected the levels ofhaemoglobin in red blood cells.

The blood loss during menstruation results in a negative iron load in women and increases the risk for developing iron-deficiency anaemia.^4,5,6,7 Other studies indicate postmenopausal women have higher haemoglobin levels than premenopausal women during the luteal phase. This may be due to the high levels of progesterone during the luteal phase in premenopausal women. In addition, it is suggested that variation in the levels of oestrogen and progesterone during the menstrual cycle influences haematopoiesis.⁸

Conclusion :

In the present study, it has been found that statistically significant variation occurs in haemoglobin levels during the menstrual cycle.