From the Guidelines
Yes, iron deficiency anemia (IDA) can occur during perimenopause, and it is essential to investigate the cause of IDA, considering GI pathologies, as it can be a presenting manifestation of serious underlying conditions, such as colonic or oesophago-gastric carcinoma 1. Perimenopause is often associated with changes in menstrual patterns, including heavier or more frequent bleeding, which can lead to increased iron loss and subsequent anemia.
- Key factors to consider in the management of IDA during perimenopause include:
- Monitoring for symptoms like fatigue, weakness, pale skin, and shortness of breath
- Investigating the underlying cause of IDA, including GI pathologies, as recommended by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1
- Treatment with oral iron supplements, such as ferrous sulfate, and addressing the underlying cause of heavy bleeding through hormonal treatments like oral contraceptives or progesterone therapy
- Considering intravenous iron formulations for severe cases or those who cannot tolerate oral supplements The connection between perimenopause and IDA stems from estrogen fluctuations that can lead to endometrial overgrowth and subsequent heavy bleeding, depleting iron stores faster than they can be replenished through diet alone.
- It is crucial to prioritize the investigation of IDA during perimenopause, as it can be a presenting manifestation of serious underlying conditions, and timely diagnosis and treatment can significantly impact morbidity, mortality, and quality of life 1.
From the Research
Iron Deficiency Anemia and Perimenopause
- Iron deficiency anemia (IDA) can occur during perimenopause, which is the period around menopause when hormone levels fluctuate 2.
- This condition is associated with a range of symptoms, including fatigue, hair loss, and restless legs, and can have a significant impact on a woman's quality of life 2, 3.
Risk Factors and Diagnosis
- The risk factors for IDA are well known and include blood loss due to menstrual periods and gastrointestinal bleeding 4, 3.
- The diagnosis of IDA is typically made by measuring hemoglobin and serum ferritin levels, with serum ferritin being the most efficient test 2, 3.
Treatment Options
- Treatment for IDA usually involves iron replacement therapy, which can be done orally or intravenously 2, 5, 3, 6.
- Oral iron supplements, such as ferrous sulfate, are often the first line of treatment, but intravenous iron therapy may be used in cases where oral iron is not effective or contraindicated 2, 5, 6.
Effectiveness of Treatment
- Both oral and intravenous iron therapy have been shown to be effective in correcting IDA, although intravenous iron may restore iron stores faster 5, 6.
- The choice of treatment will depend on the individual patient's needs and circumstances, and should be made in consultation with a healthcare provider 2, 5, 6.