Medical Research: Dr. Nelson: The clinical impact heavy
menstrual bleeding has often been expressed in terms of quality of life
issues, but many women have heavy and prolonged bleeding that can lead
to serious medical problems. The frequency with which women were treated
at Harbor-UCLA Medical Center with profoundly low hemoglobin levels
prompted us to do a comprehensive review of such women during a recent
five year period to remind readers that even in the 21st
century, this is not an uncommon problem. Overall 149 woman were treated
168 times for severe anemia (hemoglobin < 5.0 g/dL); 40% had
previously been transfused (but not effectively treated). Over a quarter
had reactive thrombocytosis which placed them at high risk for
thrombosis (DVT, PE, and stroke). Over a third were discharged without
therapy to prevent recurrence.
Medical Research: What should clinicians and patients take away from your report?
Dr. Nelson: Both clinicians and patients
should recognize that excessive menstrual bleeding may present as acute
crisis, but it usually represents a chronic problem that also needs long
term therapy. Clinicians should recognize that severe anemia from any
source is associated with increased risk for thromboembolism. In this
context, use of high dose estrogen therapy may not be the most prudent
first line therapy. High dose progestin-only therapy has been shown in
at least two perspective studies to be effective in rapidly controlled
acute excessive uterine bleeding for a wide range of endometrial
pathologies.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Nelson: The numbers of women who have
been prospectively studied in clinical trials designed to arrest acute
vaginal bleeding are embarrassingly small (< 150 women). More
research is clearly needed. In particular, the efficacy of high dose
progestin therapies should be studied in women with very low hemoglobin
levels. Other agents, including selective progesterone receptor
modulators, should be investigated both for acute and chronic excessive
bleeding.
Citation:
Severe Anemia From Heavy Menstrual Bleeding Requires Heighened Attention
Nelson, Anita L. et al.
American Journal of Obstetrics & Gynecology
DOI: http://dx.doi.org/10.1016/j.ajog.2015.04.023