From the Guidelines
Intravenous (IV) iron therapy is not known to directly cause or worsen menorrhagia (heavy menstrual bleeding). In fact, IV iron is often used as a treatment for anemia resulting from menorrhagia rather than being a cause of it, as stated in the expert consensus guidelines 1. If a patient receiving IV iron notices an increase in menstrual bleeding, this is likely coincidental or related to the underlying condition that necessitated iron therapy in the first place. Common causes of menorrhagia include hormonal imbalances, uterine fibroids, polyps, adenomyosis, or bleeding disorders. IV iron preparations such as iron sucrose, ferric carboxymaltose, or iron dextran are designed to replenish iron stores and treat iron deficiency anemia, which is often a consequence of heavy menstrual bleeding.
The most common side effects of IV iron include infusion reactions, hypersensitivity, temporary skin discoloration, and sometimes gastrointestinal symptoms, but changes in menstrual flow are not typically associated with these treatments, as noted in the AGA clinical practice update on management of iron deficiency anemia 1. If menorrhagia worsens during IV iron therapy, patients should consult their healthcare provider to investigate other potential causes rather than discontinuing their iron treatment, as adequate iron replacement is crucial for treating anemia associated with heavy menstrual bleeding. It is essential to recognize that patients with inflammatory conditions may have ID or IDA in the setting of a ferritin level greater than 45 mg/dL, and confirmatory testing with transferrin saturation, soluble transferrin receptor, or reticulocyte hemoglobin equivalent may be helpful in these situations, as recommended in the AGA clinical practice update 1.
Key points to consider:
- IV iron is used to treat anemia resulting from menorrhagia, not cause it
- Common side effects of IV iron do not typically include changes in menstrual flow
- If menorrhagia worsens during IV iron therapy, investigate other potential causes
- Adequate iron replacement is crucial for treating anemia associated with heavy menstrual bleeding
- Multidisciplinary management, including gastroenterologists, hematologists, and nutritionists, may be needed in complex cases, as stated in the AGA clinical practice update 1.
From the Research
Intravenous Iron and Menorrhagia
- There is no direct evidence in the provided studies to suggest that intravenous (IV) iron causes worsening menorrhagia (heavy menstrual bleeding) 2, 3, 4, 5, 6.
- The studies focus on the medical management of menorrhagia, iron deficiency, and iron-deficiency anemia, as well as the treatment of heavy menstrual bleeding, but do not specifically address the effects of IV iron on menorrhagia.
- Iron supplementation is commonly used to treat iron deficiency and iron-deficiency anemia associated with menorrhagia, and oral iron supplements are often recommended 3, 4.
- The management of heavy menstrual bleeding may involve hormone therapies, such as the levonorgestrel intrauterine system, and other medical interventions, but the use of IV iron is not discussed in the context of worsening menorrhagia 2, 5, 6.