Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding.
OBJECTIVE
To assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in women treated for heavy menstrual bleeding (HMB).


DESIGN
Secondary analysis of a randomized controlled trial.


SETTING
Five university hospitals in Finland.


SAMPLE
A total of 236 women referred for HMB.


METHODS
Women were randomized to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. We defined groups based on women's pretreatment hemoglobin [hemoglobin <120 g/L (anemic) vs. hemoglobin ≥120 g/L (nonanemic)] and serum ferritin (ferritin <15 μg/L vs. ≥15 μg/L) concentrations. HRQoL was compared between groups at baseline, 6 and 12 months after treatment. Hemoglobin and ferritin were followed for 5 years.


MAIN OUTCOME MEASURES
HRQoL was measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing.


RESULTS
At baseline, 63 women (27%) were anemic and 140 (60%) were severely iron deficient (ferritin <15 μg/L). Only 8% of the anemic women had taken iron supplementation. Twelve months after treatment hemoglobin had increased in both hemoglobin groups, but was still significantly lower (p < 0.001) in initially anemic women (128 g/L) compared with nonanemic women (136 g/L). Twelve months after treatment three domain scores of RAND-36 increased more (energy, p = 0.002; physical functioning, p = 0.04; social functioning, p = 0.05), and anxiety (p = 0.02) and depression scores (p = 0.002) decreased more in anemic compared with nonanemic women. Serum ferritin took 5 years to reach normal levels.


CONCLUSIONS
Improved HRQoL after treatment of HMB is associated with correction of anemia. Clinicians should actively screen for anemia in women with HMB and emphasize early iron substitution as an integral part of treatment.
['Peuranpää|Pirkko|P|', 'Heliövaara-Peippo|Satu|S|', 'Fraser|Ian|I|', 'Paavonen|Jorma|J|', 'Hurskainen|Ritva|R|']
D000328:Adult D000740:Anemia D001007:Anxiety D003271:Contraceptive Agents, Female D003863:Depression D005260:Female D005293:Ferritins D005500:Follow-Up Studies D006454:Hemoglobins D006801:Humans D007044:Hysterectomy D007436:Intrauterine Devices, Medicated D007501:Iron D000090463:Iron Deficiencies D016912:Levonorgestrel D016014:Linear Models D008595:Menorrhagia D008875:Middle Aged D011788:Quality of Life D011795:Surveys and Questionnaires
Anemia iron deficiency quality of life heavy menstrual bleeding menorrhagia