Association Between Subjective Assessment of Menstrual Bleeding and Measure of Iron Deficiency Anemia in Women

Authors

  • Sindhu Farid Department of Gynaecology and Obstetrics, Lady Dufferin Hospital, Karachi / CMH Malir Karachi, Sindh, Pakistan.
  • Zeryab Sethna Department of Gynaecology and Obstetrics, Lady Dufferin Hospital, Karachi, Pakistan.
  • Ayisha Raja CMH Malir Karachi, Sindh, Pakistan.
  • Kanwal Amolakh Liyari General Hospital, Karachi, Sindh, Pakistan.
  • Reema Gul CMH Malir Karachi, Sindh, Pakistan.
  • Areej Asghar Liyari General Hospital, Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.2281

Keywords:

Iron Deficiency Anemia, Heavy Menstrual Bleeding, Ferritin, Hemoglobin, Subjective Assessment, Women’s Health

Abstract

Introduction: Menstrual blood loss is the most common cause of iron deficiency anemia (IDA) in women of reproductive age. However, clinical quantification of menstrual bleeding remains challenging in routine practice and is often based on subjective reporting. Understanding the relationship between perceived menstrual blood loss and laboratory measures of iron status can help guide earlier identification and management of IDA. Objective: To assess the association between women’s subjective assessment of menstrual bleeding and laboratory-confirmed iron deficiency anemia. Methods: A cross-sectional study was conducted at Combined Military Hospital, Malir, Karachi from 2 June to 2 Sep 2023, involving 155 women of reproductive age. Participants completed a structured questionnaire designed to assess menstrual characteristics, including cycle length, duration, and subjective bleeding volume categorized as light, normal, or heavy. Results: Among 155 women, 39 (25.2%) reported heavy menstrual bleeding, while 52 (33.5%) reported normal and 64 (41.3%) reported light flow. The prevalence of iron deficiency anemia was significantly higher in women reporting heavy menstruation (66.7%, p < 0.001), compared to 23.1% in the normal group and 9.4% in the light group. Mean hemoglobin and ferritin levels were lowest among the heavy bleeding group (Hb: 10.4 ± 1.3 g/dL; Ferritin: 11.6 ± 4.8 ng/mL). Subjective bleeding volume was moderately correlated with laboratory markers (Spearman’s r = −0.49 for Hb, r = −0.53 for ferritin). Conclusion: Women’s subjective assessment of menstrual bleeding volume is significantly associated with the presence of iron deficiency anemia. This finding highlights the clinical utility of simple history-taking to guide early screening and prevention of IDA in menstruating women.

Downloads

Download data is not yet available.

References

1. Bernardi, L. A., Ghant, M. S., Andrade, C., Recht, H., & Marsh, E. E. (2016). The association between subjective assessment of menstrual bleeding and measures of iron deficiency anemia in premenopausal African-American women: A cross-sectional study. BMC Women's Health, 16(1).

https://doi.org/10.1186/s12905-016-0329-z

2. Munro, M. G., Mast, A. E., Powers, J. M., Kouides, P. A., O’Brien, S. H., Richards, T., Lavin, M., & Levy, B. S. (2023). The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. American Journal of Obstetrics and Gynecology, 229(1), 1-9.

https://doi.org/10.1016/j.ajog.2023.01.017

3. Peuranpää, P., Heliövaara‐Peippo, S., Fraser, I., Paavonen, J., & Hurskainen, R. (2014). Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding. Acta Obstetricia et Gynecologica Scandinavica, 93(7), 654-660.

https://doi.org/10.1111/aogs.12394

4. Wang, W., Bourgeois, T., Klima, J., Berlan, E. D., Fischer, A. N., & O'Brien, S. H. (2012). Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding. Haemophilia, 19(2), 225-230.

https://doi.org/10.1111/hae.12046

5. Johnson, S., Lang, A., Sturm, M., & O'Brien, S. H. (2016). Iron deficiency without anemia: A common yet under-recognized diagnosis in young women with heavy menstrual bleeding. Journal of Pediatric and Adolescent Gynecology, 29(6), 628-631.

https://doi.org/10.1016/j.jpag.2016.05.009

6. Puri, K., Famuyide, A. O., Erwin, P. J., Stewart, E. A., & Laughlin-Tommaso, S. K. (2014). Submucosal fibroids and the relation to heavy menstrual bleeding and anemia. American Journal of Obstetrics and Gynecology, 210(1), 38.e1-38.e7.

https://doi.org/10.1016/j.ajog.2013.09.038

7. Mansour, D., Hofmann, A., & Gemzell-Danielsson, K. (2020). A review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Advances in Therapy, 38(1), 201-225.

https://doi.org/10.1007/s12325-020-01564-y

8. Fernandez-Jimenez, M. C., Moreno, G., Wright, I., Shih, P., Vaquero, M. P., & Remacha, A. F. (2020). Iron deficiency in menstruating adult women: Much more than anemia. Women's Health Reports, 1(1), 26-35.

https://doi.org/10.1089/whr.2019.0011

9. Toxqui, L., Pérez-Granados, A. M., Blanco-Rojo, R., Wright, I., & Vaquero, M. P. (2014). A simple and feasible questionnaire to estimate menstrual blood loss: Relationship with hematological and gynecological parameters in young women. BMC Women's Health, 14(1).

https://doi.org/10.1186/1472-6874-14-71

10. Lee, E. J., Ahn, J. E., Ryu, J. M., Jeong, Y. Y., & Choi, Y. S. (2023). Association between patients’ self-judgement, coagulated menstrual blood, and menorrhagia: Results from a questionnaire survey and blood test analysis. Medicina, 59(5), 874.

https://doi.org/10.3390/medicina59050874

11. De Souza, S. S., Camargos, A. F., Ferreira, M. C., De Assis Nunes Pereira, F., De Rezende, C. P., Araújo, C. A., & Silva Filho, A. L. (2009). Hemoglobin levels predict quality of life in women with heavy menstrual bleeding. Archives of Gynecology and Obstetrics, 281(5), 895-900.

https://doi.org/10.1007/s00404-009-1207-9

12. Akpan, I. J., Narang, M., Zampaglione, E., Marshall, S., & Stefanik, D. (2025). Iron deficiency anemia in patients with heavy menstrual bleeding: The patients’ perspective from diagnosis to treatment. Women's Health, 21.

https://doi.org/10.1177/17455057251321221

13. Magnay, J. L., O’Brien, S., Gerlinger, C., & Seitz, C. (2018). A systematic review of methods to measure menstrual blood loss. BMC Women's Health, 18(1).

https://doi.org/10.1186/s12905-018-0627-8

14. Sekhar, D. L., Murray-Kolb, L. E., Kunselman, A. R., Weisman, C. S., & Paul, I. M. (2017). Association between menarche and iron deficiency in non-anemic young women. PLOS ONE, 12(5), e0177183.

https://doi.org/10.1371/journal.pone.0177183

15. Low, M. S., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S. (2016). Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database of Systematic Reviews, 2016(4).

https://doi.org/10.1002/14651858.cd009747.pub2

16. Nikzad, Z., Iravani, M., Abedi, P., Shahbazian, N., & Saki, A. (2018). The relationship between iron deficiency anemia and sexual function and satisfaction among reproductive-aged Iranian women. PLOS ONE, 13(12), e0208485.

https://doi.org/10.1371/journal.pone.0208485

17. Enhos, S., Duran, I., Erdem, S., & Buyukbas, S. (2009). Relationship between iron‐deficiency anemia and periodontal status in female patients. Journal of Periodontology, 80(11), 1750-1755.

https://doi.org/10.1902/jop.2009.090209

18. Stoffers, V. L., Weyand, A. C., Quint, E. H., & Rosen, M. W. (2022). Assessment of iron status in adolescents presenting to the emergency department with heavy menstrual bleeding. Pediatric Emergency Care, 38(5), e1266-e1270.

https://doi.org/10.1097/pec.0000000000002591

19. Barr, F., Brabin, L., Agbaje, S., Buseri, F., Ikimalo, J., & Briggs, N. (1998). Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutrition, 1(4), 249-257.

https://doi.org/10.1079/phn19980041

Downloads

Published

2025-05-30

How to Cite

Farid, S., Sethna, Z., Raja, A., Kanwal Amolakh, Gul, R., & Asghar, A. (2025). Association Between Subjective Assessment of Menstrual Bleeding and Measure of Iron Deficiency Anemia in Women. Indus Journal of Bioscience Research, 3(5), 1015-1018. https://doi.org/10.70749/ijbr.v3i5.2281