Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: Framing the issue

Abstract

For girls and women in their reproductive years, the symptom of heavy menstrual bleeding (HMB) is the most common cause of iron deficiency (ID), including the extreme manifestation of iron deficiency anemia (IDA). It is recognized that these two clinical entities are not only ubiquitous, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both HMB and ID/IDA adversely impact quality of life—HMB during the episodes of bleeding and ID daily as long as the ID exists. These combined issues undermine the lives of reproductive‐aged girls and women of all ages, from menarche to menopause. At the same time, pervading culture and the often insidious nature of these disorders frequently lead to societal normalization, including by healthcare professionals. The effects on cognitive function as well as the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence suggesting that ID, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders—effects that can have widespread impacts on society. Collectively, this critically important evidence begs the implementation of diagnostic and management guidelines aimed at identifying iron‐deficient girls and women, repleting their iron stores, and, when present, effectively treating the most common reason for the problem—the various causes of the symptom of HMB.

Tranexamic acid for management of heavy vaginal bleeding: barriers to access and myths surrounding its use

“…Due to the limited awareness on HMB among patients and health care providers, coupled with poorly defined methods to quantify blood loss, symptom dismissal is a core theme for women who suffer from HMB [ 1 , 15 , [56] , [57] , [58] ]. Lending literature from women with bleeding disorders, where HMB is the most commonly reported symptom, contributors to the normalization of HMB can be classified into individual, provider, and societal levels.…”

Is It Time to Alter the Standard of Care for Iron Deficiency/Iron Deficiency Anemia in Reproductive-Age Women?

“…High circulating serum iron levels, inflammation, and infection result in increased synthesis of hepcidin, while ID, tissue hypoxia, and increased erythropoiesis lead to decreased synthesis [12]. Given the closely regulated nature of iron levels, iron deficiency is often due to low intake of dietary iron and/or excessive iron loss associated with heavy menstrual bleeding or a present or previous pregnancy [13].…”

“…However, heavy menstrual bleeding has remained a largely overlooked contributor to IDA due to the normalization and stigma associated with menstruation in many societies. There is a lack of a structured approach to diagnosing and treating heavy menstrual bleeding, and this further contributes to the frequency of hysterectomies, reflecting the sub-optimal education of gynecologists and disproportionate emphasis on procedural interventions over medical alternatives [13].…”

“…In a multicenter, open-label, randomized controlled trail, 96 individuals were randomized to the IV iron arm, while 106 were allotted to the oral iron arm. The IV iron group received 1-2 g of FCM for a median of 14 days (interquartile range (IQR) 11-22) before surgery, and the oral iron group received three tablets of 200 mg of oral ferrous fumarate daily for a median of 19 days [IQR [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] prior to surgery. The study reported a similar normalization of hemoglobin at the day of admission in both the study groups (RR = 1.08 [95% CI 0.55-2.10]; p = 0.83); however, the proportion of patients with normalized hemoglobin significantly increased for the IV iron group later, at 30 days (RR 2.92 [95% CI 1.87-4.58]; p < 0.0001).…”

Prevalnce of Anemia and Associated Factors in Jashore District of Bangladesh – A Cross-Sectional Study

“…Problem of excessive menstrual bleeding is common in female [10][11]. About 63.10% females had been suffering from this problem including pregnant and non-pregnant females.…”