Severe anemia from heavy menstrual bleeding requires heightened attention

Nelson, Anita L.; Ritchie, Julia

doi:10.1016/j.ajog.2015.04.023

Cited by 67 publications

(40 citation statements)

References 45 publications

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“…In addition to this high prevalence, it is estimated that 25-40% of myomas generate symptoms that ultimately impact on the quality of life and the daily activities of the affected women, or become so severe as to require specific treatment [3][4][5]. Myomas can cause heavy menstrual bleeding, anaemia [6], bowel and bladder dysfunction, urinary incontinence, infertility and recurrent miscarriage [7]. Risk factors include genetics, ethnicity, age, early menarche, caffeine and alcohol intake, and obesity [3,8,9].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of uterine myomas and clinical practice in Spain: An observational study

Monleón

Cañete

Caballero

et al. 2018

European Journal of Obstetrics & Gynecology and Reproductiv

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The most frequent symptoms reported by women diagnosed with uterine myomas were heavy menstrual bleeding, pelvic or abdominal pain and dysmenorrhea; QoL was impaired reflecting high symptom distress. We found that surgery was the main therapeutic approach to manage uterine myomas in Spain. Both surgical and non-surgical treatments achieve relevant improvements in symptom severity and quality of life.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of uterine myomas and clinical practice in Spain: An observational study

Monleón

Cañete

Caballero

et al. 2018

European Journal of Obstetrics & Gynecology and Reproductiv

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“…This is a particularly relevant recommendation for the hematologist as iron deficiency anemia due to a variety of causes is an extremely common reason for consultation with a hematologist. Iron deficiency is under-recognized, under-treated, or not properly followed in transitions of health care settings in 35-65% of cases [33][34][35]. In addition, patients at risk for developing iron deficiency (e.g., bariatric surgery patients) are often inadequately monitored or educated on the signs and symptoms of iron deficiency leading to late stage presentations.…”

Section: Discussionmentioning

confidence: 99%

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

et al. 2016

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Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE TM relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields.

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“…In a retrospective review, we examined the charts of all 271 premenopausal women treated at Harbor-UCLA Medical Center in Torrance, California for hemoglobin less than 5 mg/dL during the six years 2008-2013 inclusive [10]. Here are some of the significant highlights from this study: 122 women had hemoglobin level below 5 mg/dL due to medical problems other than heavy menstrual bleeding, such as renal failure or leukemia.…”

Section: Short Communicationmentioning

confidence: 99%

Severe Anemia from Heavy Menstrual Bleeding Requires Heightened Attention

Ritchie¹,

Nelson²

2017

Clinics Mother Child Health

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Heavy menstrual bleeding is a common problem, it affects nearly one in seven women. It is very concerning that many women with heavy menstrual bleeding do not recognize their bleeding as abnormal. In a classic study by Hallberg et al., half of women with objectively measured monthly blood loss exceeding 80 mL characterized their flow as "mild or moderate" [1].Excessive bleeding results in iron deficiency anemia, which in turn leads to serious medical problems and impacts women's quality of life and their utilization of medical care services [2][3][4][5][6][7][8][9]. Iron deficiency can manifest with fatigue, oral lesions, dysphagia, reduced immune response, ischemic stroke, venous stasis, retinopathy or cerebral sinovenous thrombosis.Given that virtually all reproductive aged women in the state of California have access to family planning/reproductive well women care, we thought it would be interesting to investigate the prevalence and the causes of bleeding with which women with severe anemia due to chronic heavy menstrual bleeding were admitted to our public health hospital for transfusion.In a retrospective review, we examined the charts of all 271 premenopausal women treated at Harbor-UCLA Medical Center in Torrance, California for hemoglobin less than 5 mg/dL during the six years 2008-2013 inclusive [10]. Here are some of the significant highlights from this study: 122 women had hemoglobin level below 5 mg/dL due to medical problems other than heavy menstrual bleeding, such as renal failure or leukemia. Intriguingly, there was absolutely no documentation that any of these women was ever asked about their menses. This is very unfortunate since these severely anemic women could have benefitted from menstrual suppression, so that they would not lose any blood from menstruation.Conclusion: Menstrual bleeding is a vital sign in reproductive age women. At each visit, reproductive aged women should be asked about their menstrual bleeding. Frequency, duration and volume of flow need to be documented [11].Very severe anemia due to chronic heavy menstrual bleeding is not at all rare. In this study spanning six years, 149 women experienced 168 episodes of hemoglobin below 5 mg/dL leading to their hospitalization and treatment. The hemoglobin values leading to hospitalization for these women on admission varied between 1.6-4.9 g/dL.Some women did not realize their bleeding was heavy: 7.8% considered their menses to be normal; while 7% learned of their problem only as result of routine screening for other reasons.Many of the women who did recognize that their bleeding was heavy did not seek medical care, and suffered with this problem chronically. Nearly 40% of the women in our study reported having previous transfusions.Over one quarter of women had reactive thrombocytosis (platelet counts˃420,000). High platelet counts place the women at higher risk for venous thromboembolism. This risk can be compounded when combined with the elevated risk of venous thromboembolism from high dose estrogen therapy. This may help expla...

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Severe anemia from heavy menstrual bleeding requires heightened attention

Cited by 67 publications

References 45 publications

Epidemiology of uterine myomas and clinical practice in Spain: An observational study

Epidemiology of uterine myomas and clinical practice in Spain: An observational study

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Severe Anemia from Heavy Menstrual Bleeding Requires Heightened Attention

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