Heavy menstrual bleeding and anemia: The problem is growing and requires a solution. A review

Abstract

Anemia is a global health problem, affecting about a quarter of the world's population, especially women of reproductive age and young children. In 50–75% of cases, anemia is secondary to iron deficiency (ID). Despite the high prevalence of heavy menstrual bleeding (HMB), the associated iron deficiency disorders are underestimated, although they sharply reduce the quality of life and carry significant risks for the mother, fetus and newborn in case of pregnancy. For this purpose, routine screening of girls and women of reproductive age for the presence of ID and anemia is recommended. The new FIGO initiative aims to raise awareness among women and clinicians about the relationship between HMB and ID conditions. Of key importance are: early diagnosis of HMB, elimination of the possible cause, identification of associated iron deficiency disorders, especially preclinical forms. The main task of the gynecologist is to prescribe therapy aimed at quickly stopping high monthly iron losses and replenishing the existing ID. According to Russian clinical guidelines, combined oral contraceptives and an intrauterine system with levonorgestrel are considered first-line therapy to reduce the volume of menstrual blood loss in patients with HMB who require contraception. Qlaira® and Mirena® are the only hormonal drugs registered for contraception and the treatment of HMB not associated with structural disorders of the uterus, since their high effectiveness in reducing menstrual blood loss, restoring hemoglobin and ferritin levels has been confirmed in studies with a high level of evidence.