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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Iron Deficiency and Symptom Burden in Patients with Heavy Menstrual Bleeding Mahalya Gogerly-Moragoda, MD1, Supreet Kaur Goraya, MPH, IBCLC2, 3, Alice Ma, MD, FACP2, 3, Callie Berkowitz, MD2, 3. 1Internal Medicine Residency Program, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.2Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.3Blood Research Center, University of North Carolina, Chapel Hill, NC, USA |
Abstract
BACKGROUND: Heavy menstrual bleeding (HMB) affects up to 20% of women in the United States, with an even higher prevalence in low and middle-income countries. Patients with HMB are at risk of iron deficiency, which has been observed in up to 45-80% of cases. Iron deficiency, even without anemia, has been associated with fatigue, reduced exercise tolerance, headache, impaired concentration, and depression. However, the relationship between iron deficiency and symptom burden in patients with HMB remains unclear. OBJECTIVE: To describe the relationship between iron deficiency and patient-reported outcomes in adult women with heavy menstrual bleeding evaluated in a hematology clinic. METHODS: Adult patients presenting to a hematology clinic for evaluation of undiagnosed bleeding disorder were invited to participate in an IRB approved (IRB Study # 23-0409) cross-sectional study. Patients reporting HMB on the Menorrhagia Impact Questionnaire were included in this analysis. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of fatigue, anxiety, depression, sleep, social roles, physical function, and pain interference which were standardized to the reference population as T-scores with a general population mean score of 50 (standard deviation 10). Patients were defined as being iron deficient if ferritin <30 ng/mL and anemic if hemoglobin <12 g/dL. Statistical analysis was performed using STATA. T-tests were used to examine the relationship between iron deficiency and PROMIS measures. Pearson’s r was used to assess correlation between fatigue and serum ferritin. RESULT: HMB was identified in 58 patients referred for bleeding disorder evaluation. The mean age was 29 and majority of patients were White (63.8%), followed by Black (24%). Bleeding disorder diagnoses included Bleeding Disorder of Unknown Cause (41.5%), qualitative platelet defect (10.3%), von Willebrand disease (10.3%). Iron deficiency was present in 36 (62%) of patients while anemia was present in 13 (22.4%). Demographic and clinical characteristics were similar between iron and non-iron deficient patients. HMB patients experienced on average 1 standard deviation (SD) worse fatigue compared to the general population (T-score=60.4), and greater than ½ SD worse anxiety (T=57.2) and sleep (T=55.8). In univariate analysis comparing patients with and without iron deficiency, there was no statistically significant difference in PROMIS scores in any symptom domain. There was no correlation between fatigue and serum ferritin value (r= 0.0046). CONCLUSIONS: Iron deficiency was present in a majority of patients with HMB referred for bleeding disorder evaluation, primarily without anemia. Patients with HMB reported significant symptoms including fatigue, cognitive and mood disturbances, and impact on social and physical function. However, there was no statistically significant difference between symptom burden in patients with and without iron deficiency. Limitations include small sample size, univariate analysis, and a selected bleeding disorder referral population who may have bleeding symptoms beyond HMB. Addressing iron deficiency is critical for those with HMB, but that alone may be insufficient to improve quality of life, particularly in those with bleeding disorders.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.