March is Women’s History Month, which calls attention to the various health problems women face. All through recent history, research on women’s health issues was substantially lacking compared to their male counterparts. Not until 1993, representation of both sexes in NIH-funded studies was a requirement by federal law. Perhaps the most understated illness in modern medicine is iron deficiency, afflicting menstruating women six times more than men. It begs to question, how is it possible a condition carried by a quarter of the entire female population garners the least amount of attention? In honor of Women’s History Month, we call attention to a health problem exclusive to women, dysfunctional uterine bleeding, the root cause of iron deficiency in a two-part newsletter series.
Dysfunctional uterine bleeding is a common and often debilitating health concern of women of any life stage but primarily occurring at the onset of the first menstrual cycle or at the perimenopause stage. Dysfunctional uterine bleeding, also called abnormal uterine bleeding or menorrhagia, refers to uterine bleeding from the vagina that is abnormal in frequency, duration, and/or volume or that occurs between periods. It is estimated that heavy menstrual bleeding is responsible for up to 30% of hysterectomies performed in the United States (1).
Signs of Dysfunction Uterine Bleeding
- the need to change sanitary menstrual products more frequently than normal
- abdominal cramps and pain that continues throughout menstruation
- periods lasting more than a week
- irregular periods
- loss of more than 80 mL (2.7 ounces) of blood during a menstrual period
- Causes of dysfunctional uterine bleeding
- hormonal abnormalities
- blood clotting disorders
- neoplasia
- endometriosis
Complications of heavy menstrual bleeding are iron deficiency anemia, diminished quality of life affecting both social and emotional wellbeing, as well as reduced work power. (7)
Addressing the iron deficiency is crucial to prevent or alleviate the sequelae such as fatigue, impaired immune function, effects on the skin, hair and nails, mouth (lesions), trouble swallowing, and shortness of breath. The most common intervention is iron supplementation to replenish iron and normal hemoglobin levels (8).
Intravenous (IV) iron infusion is a viable option to alleviate iron deficiency due to dysfunctional uterine bleeding (9, 10). IV iron dosing has been found to be more effective and safer than oral supplementation, especially given the levels typically needed to restore severe iron losses. With over a decade of treating patients with iron deficiency due to menorrhagia, I noticed a peculiar not previously reported pattern emerge; a woman’s menstrual flow decreases after an adequate supply of IV iron. Iron does not affect clotting factors or change hormonal levels, then why does it lessen uterine bleeding? A theory I postulate is that similar to a sign of easy bruising with iron-deficient state, there is an inability to clot and stop menstrual blood flow that replenishment of iron level tends to resolve. Could there be a link between iron deficiency and platelet dysfunction such as in von Willebrand disease, or perhaps vitamin C deficiency, or vitamin K absorption, disorders predisposing you to easy bruising? Clearly more studies are needed to dive into this phenomenon observed by patients after receiving IV iron.
Supporting such research in women’s health issues is paramount to catch up with the many years of ignoring this sector of the population within scientific endeavors. Similarly, expanding knowledge and awareness of dysfunctional uterine bleeding, endometriosis, and other root causes of iron deficiency in women, will lead to enhanced sensitivity and earlier detection, which ultimately limits the development and progression of the diversity of its adverse consequences.
References:
Walker MH, Coffey W, Borger J. Menorrhagia. [Updated 2022 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536910/
Meggyesy M, Friese M, Gottschalk J, Kehler U. Case Report of Cerebellar Endometriosis. J Neurol Surg A Cent Eur Neurosurg. 2020 Jul;81(4):372-376.
González RS, Vnencak-Jones CL, Shi C, Fadare O. Endomyometriosis (“Uterus-like mass”) in an XY Male: Case Report With Molecular Confirmation and Literature Review. Int J Surg Pathol. 2014 Aug;22(5):421-6.
Jabr FI, Mani V. An unusual cause of abdominal pain in a male patient: Endometriosis. Avicenna J Med. 2014;4(4):99-101.
Archer DF, Soliman AM, Agarwal SK, Taylor HS. Elagolix in the treatment of endometriosis: impact beyond pain symptoms. Ther Adv Reprod Health. 2020 Dec 1;14:2633494120964517.
Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol. 2020;104(3):153-161.
Peuranpää P, Heliövaara-Peippo S, Fraser I, Paavonen J, Hurskainen R. Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding. Acta Obstet Gynecol Scand. 2014 Jul;93(7):654-60.
Palacios S. The management of iron deficiency in menometrorrhagia. Gynecol Endocrinol. 2011 Dec;27 Suppl 1:1126-30.
Estadella J, Villamarín L, Feliu A, Perelló J, Calaf J. Characterization of the population with severe iron deficiency anemia at risk of requiring intravenous iron supplementation. Eur J Obstet Gynecol Reprod Biol. 2018 May;224:41-44.
10.Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol. 2020;104(3):153-161.