Iron supplementation improves health-related quality of life in women with heavy menstrual bleeding, shows a recent study.
The secondary analysis of the randomised controlled trial included 236 women who had been referred from general practice for heavy menstrual bleeding. Women were randomised to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. Groups were defined based on women’s pretreatment haemoglobin [haemoglobin <120 g/L (anaemic) vs. haemoglobin ≥120 g/L (non-anaemic)] and serum ferritin (ferritin <15 µg/L versus ≥15 µg/L) concentrations. The main outcome measures were health-related quality of life, measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing. Health-related quality of life was compared between groups at baseline, six and 12 months after treatment. Haemoglobin and ferritin were followed for five years.
At baseline, 63 women (27%) were anaemic and 140 (60%) were severely iron deficient (ferritin <15 µg/L). Only 8% of the anaemic women had taken iron supplementation. Twelve months after treatment, haemoglobin had increased in both haemoglobin groups, but was significantly lower in initially anaemic women (128 g/L) compared with non-anaemic women (136 g/L). Twelve months after treatment energy, physical functioning and social functioning domain scores of RAND-36 increased further, and anxiety and depression scores decreased more in anaemic than in non-anaemic women. Serum ferritin took five years to reach normal levels (136g/L).
The researchers noted that, while reasons for reduced quality of life among women with heavy menstrual bleeding are complex and are not explained by anaemia or iron deficiency alone, their study showed that ‘after heavy menstrual bleeding treatment, health-related quality of life increased more in anaemic women than in non-anaemic women’. The researchers advise that their study emphasises ‘the importance of treatment of anaemia and iron deficiency by early iron supplementation as an integral part of treatment of heavy menstrual bleeding’.