Medical Adherence and Efficacy of Weekly vs Daily Iron Treatment in Teenage Girls With Heavy Menstrual Bleeding

To evaluate the impact of daily versus weekly iron supplementation on changes in hemoglobin (Hb) and ferritin over 12 weeks in adolescents with iron deficiency and heavy menstrual bleeding (HMB).

This was a randomized pilot study including females age 12-18 years recruited from Pediatric Hematology/Oncology or Adolescent Gynecology clinic. Participants received either daily or weekly 325 mg ferrous sulfate. Hb and ferritin levels were measured at baseline, 6 weeks, and 12 weeks. Menstrual patterns were categorized by WHO criteria for menstrual classification at each time point. A Linear Mixed Model (LMM) and Kruskal-Wallis H test analyzed changes over time.

Eighteen subjects completed the study. At baseline, 94.4% (17/18) of participants had Heavy/Prolonged bleeding. By 6 weeks, 83.3% (15/18) had improved menstrual patterns, though all three non-responders were in the weekly group. Weekly supplementation showed a significant increase in Hb from baseline to 6 weeks (p ≤ .001), but the increase by week 12 was not statistically significant (p = .24), whereas the daily group showed a steady rise in a between group comparison of daily versus weekly supplementation. Ferritin increased significantly over time in the weekly group (p = .044), but not daily, with the most rapid rise by 6 weeks. By 12 weeks, ferritin levels of the weekly and daily groups were similar to each other.

Weekly dosing led to faster ferritin increase, but both daily and weekly iron dosing improved Hb and ferritin over time. For patients undergoing menstrual improvement for HMB that also require iron supplementation, weekly or daily dosing may be appropriate. but both led to a similar endpoint.