Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: Framing the issue

For girls and women in their reproductive years, the symptom of heavy menstrual bleeding (HMB) is the most common cause of iron deficiency (ID), including the extreme manifestation of iron deficiency anemia (IDA). It is recognized that these two clinical entities are not only ubiquitous, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both HMB and ID/IDA adversely impact quality of life-HMB during the episodes of bleeding and ID daily as long as the ID exists. These combined issues undermine the lives of reproductive-aged girls and women of all ages, from menarche to menopause. At the same time, pervading culture and the often insidious nature of these disorders frequently lead to societal normalization, including by healthcare professionals. The effects on cognitive function as well as the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence suggesting that ID, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders-effects that can have widespread impacts on society. Collectively, this critically important evidence begs the implementation of diagnostic and management guidelines aimed at identifying iron-deficient girls and women, repleting their iron stores, and, when present, effectively treating the most common reason for the problem-the various causes of the symptom of HMB.