What is the treatment for anemia due to vaginal bleeding in a perimenopausal female?

From the Guidelines

For perimenopausal women experiencing anemia due to heavy vaginal bleeding, the most effective treatment approach is to address both the anemia and the underlying bleeding, with oral iron supplementation as the first-line treatment, typically ferrous sulfate 325 mg taken 1-3 times daily between meals with vitamin C to enhance absorption, as recommended by the British Society of Gastroenterology guidelines 1. The treatment of anemia due to vaginal bleeding in perimenopausal females should prioritize the restoration of iron stores and the management of abnormal bleeding patterns.

• Key considerations in the treatment approach include:
  • Oral iron supplementation: ferrous sulfate 325 mg taken 1-3 times daily between meals with vitamin C to enhance absorption 1
  • Intravenous iron for severe anemia (hemoglobin <7 g/dL) 1
  • Hormonal options to control bleeding: combined oral contraceptives, cyclic progestins, or continuous progestins 1
  • Non-hormonal options to control bleeding: tranexamic acid or NSAIDs like ibuprofen 1
  • Increasing dietary iron intake through foods like red meat, spinach, and beans 1
• The goal of treatment is to restore iron stores while managing the abnormal bleeding pattern that occurs as ovarian function declines during perimenopause, with regular monitoring of hemoglobin levels to assess treatment effectiveness 1.
• In cases where bleeding remains uncontrolled or anemia is severe despite these measures, endometrial ablation or hysterectomy may be considered, with a multidisciplinary approach involving gastroenterologists, hematologists, and nutritionists often needed in complex cases 1.

From the Research

Treatment for Anemia due to Vaginal Bleeding in Perimenopausal Females

• The treatment for anemia due to vaginal bleeding in perimenopausal females may involve the use of tranexamic acid, which has been shown to increase hemoglobin and ferritin levels in women with heavy menstrual bleeding 2, 3.
• Tranexamic acid is an antifibrinolytic agent that can reduce menstrual blood loss by 40% to 60% 4.
• Hormonal therapies, such as oral progestogens, combined oral contraceptives, or the levonorgestrel intrauterine system, may also be used to reduce menstrual bleeding and improve anemia symptoms 5, 4.
• Iron replacement therapy is also an important aspect of treating anemia in women with heavy menstrual bleeding, with oral iron administration generally recommended as first-line treatment 6.
• In some cases, intravenous iron administration may be necessary for severe anemia or for women who do not respond to oral iron therapy 6.

Management of Heavy Menstrual Bleeding

• The management of heavy menstrual bleeding in perimenopausal females may involve a combination of medical and surgical treatments 5.
• Medical treatments may include the use of non-steroidal anti-inflammatory drugs, tranexamic acid, and hormonal therapies 5, 4.
• Surgical treatments may include endometrial ablation, endometrial resection, or hysterectomy in severe cases 5.

Screening and Diagnosis

• Screening for anemia and iron deficiency is an important aspect of managing heavy menstrual bleeding in perimenopausal females 6.
• The diagnosis of anemia and iron deficiency may involve the measurement of hemoglobin and ferritin levels, as well as other laboratory tests 2, 6.