Reproductive
Neighborhood disadvantage and menstrual disturbances among pregnancy planners in the U.S. Ruth J. Geller* Ruth Geller Mary D. Willis Collette N. Ncube Donna D. Baird Lauren A. Wise Amelia K. Wesselink
Introduction: Neighborhood disadvantage is associated with adverse reproductive outcomes, but its relation to menstruation is largely unknown. We hypothesized that neighborhood disadvantage would be associated with higher prevalence of abnormal uterine bleeding (AUB) and dysmenorrhea.
Methods: We analyzed baseline data from the Pregnancy Study Online, an internet-based preconception cohort study of pregnancy planners not using contraceptives or fertility treatments. We included 5,525 U.S. participants aged 21-39 years who enrolled during 2013-2019, lived at their current residence for ≥1 years before baseline, and reported on their typical menstrual cycle characteristics in the absence of hormonal contraceptive use. We linked participants’ baseline residential addresses to the 2015 Area Deprivation Index (ADI), a Census block group measure of within-state neighborhood disadvantage. We defined AUB as cycle length <24 or >38 days, duration of flow ≥7 days, irregular cycles, and/or heavy flow. We defined dysmenorrhea as the report of severe cramps requiring medication and bed rest. We used log-binomial regression to estimate prevalence ratios (PR) and 95% CIs for the associations of ADI tertiles with AUB and dysmenorrhea, adjusting for age (21-24, 25-29 [ref.], 30-34, or 35-39 years) as a potential confounder and multivitamin use, season, and calendar year as precision variables. Covariates were modeled using indicator variables.
Results: The median ADI was 5 (IQR 2-7; higher scores represent greater disadvantage). The frequencies of AUB and dysmenorrhea were 34% and 8%, respectively. Adjusted PRs comparing the highest versus lowest ADI tertiles were 1.22 (95% CI 1.11-1.34) for AUB and 1.53 (95% CI 1.22-1.92) for dysmenorrhea.
Conclusions: Living in a disadvantaged neighborhood was associated with a higher prevalence of AUB and dysmenorrhea. Further investigation in longitudinal studies could inform interventions that improve menstrual health at the population level.
