Many Women Still Have Heavy Menstrual Bleeding Leading To Anemia

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 21^st 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