Disparities in Discussion of Heavy Menstrual Bleeding in Patients With Iron Deficiency

Heavy menstrual bleeding (HMB) is a common cause for iron deficiency amongst menstruating patients, yet it is often not discussed as a potential cause of iron deficiency by both patients and providers. This objective of this study is to evaluate documentation and workup of heavy menstrual bleeding in patients with known iron deficiency.

This was a retrospective chart review of female patients (age, 18-50 years) with a ferritin value of less than 50 μg/L between February 1, 2024, and May 1, 2024 and visited a primary care clinic in our academic medical center. The visit was evaluated for documented discussion of menstruation and additional laboratory or imaging workup within a month of ferritin lab result.

Among 383 participants, the mean age (SD) was 36.3 (8.6) years, mean BMI was 28.7 (8.7). Our population comprised of 63% non-Hispanic white (NHW), 11% Hispanic, 9% Black, 14% Asian, 3% Native Hawaiian/Pacific Islander. Discussion of menstruation was documented in 46% of NHW participants versus 59% of non-white patients (P = .015). There was no significant difference in workup ordered. Male providers documented menstruation discussions in 42% of cases. Female providers documented it in 55% (P = .014).

Non-white patients were more likely to be asked about HMB than NHW patients. Only about half of patients are asked about menstruation at the time of diagnosis for iron deficiency. Male providers are significantly less likely to ask about menstruation than female providers. The findings of this study highlight the infrequency of thorough discussion of menses in patients with ID, as this may improve diagnostic clarity, guide further workup, and thus reduce costs for unnecessary tests.