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June 18, 2014
Heavy Menstruation Affects Iron Levels, Quality of Life

Hyvinkää, Finland—To improve their quality of life, women with heavy menstrual periods should be screened for anemia and prescribed iron supplements if their hemoglobin levels are too low, according to a new Finnish study.

In a report published recently in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, researchers from Hyvinkää Hospital suggest that treating anemia caused by menorrhagia can help improve physical performance, cognitive function, mood, and overall quality of life.

“Clinicians should actively screen for anemia in women with HMB and emphasize early iron substitution as an integral part of treatment,” the authors recommend, while cautioning that prescribers should not expect a quick turnaround in iron levels.

The prospective study involved 236 women being treated for heavy menstrual bleeding. The participants, who were randomized to either hysterectomy or treatment with a levonorgestrel-releasing intrauterine system such as Mirena, were separated into two groups.

Women with hemoglobin levels less than 120 g/L were defined as anemic, while those with higher levels were put in the nonanemic group. Levels of ferritin in the blood also were measured to assess iron stores in both groups.

At the start of the study, 27% of women were anemic and 60% were severely iron deficient with ferritin levels less than 15 µg/L, yet only 8% took an iron supplement. After 1 year of treatment, hemoglobin levels had increased in both groups, but women who were initially anemic still had significantly lower levels compared to those in the nonanemic group.

Health-related quality of life was measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing. Despite still having low iron levels, women in the anemic group had a significant increase in energy, along with physical and social function, and a decrease in anxiety and depression after a year, compared to the nonanemic group.

That was documented by domain scores of RAND-36, which improved more in the anemia group than the control group: (energy, P = 0.002; physical functioning, P = 0.04; social functioning, P = 0.05), and anxiety (P = 0.02) and depression scores (p = 0.002).

Serum ferritin took 5 years to reach normal levels, however.

“Our findings suggest that clinicians should screen for anemia in women with heavy menstrual bleeding and recommend early iron supplementation as part of the treatment process,” said lead author Dr. Pirkko Peuranpää.

 



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