title: Benefit of concomitant gastrointestinal and gynaecological evaluation in premenopausal women with iron deficiency anaemia.
abstract: BACKGROUND
  Iron-deficiency anaemia (IDA) is common in premenopausal women and menorrhagia is often considered responsible. Aim To evaluate prospectively the occurrence of bleeding and iron malabsorption related gastrointestinal (GI) diseases likely responsible of IDA in premenopausal women regardless of their menstrual flow.
  
  
  METHODS
  One hundred and eighty-seven premenopausal women [median age 39 (20-56) years] irrespective of their menstrual flow underwent gastroscopy with gastric and duodenal biopsies and faecal occult blood test (FOBT). Patients over 50 years, positive 1st degree family history for colonic cancer and/or positive FOBT underwent colonoscopy too.
  
  
  RESULTS
  Menorrhagia was present in 67.4% of premenopausal women. A possible GI cause of IDA was found in 129/187 patients; in 65.2% the cause of IDA was possibly related to iron malabsorption diseases. GI bleeding as a cause of IDA was found in seven patients. An exclusive GI cause of IDA was found in 26.7% of premenopausal women, whereas a possible GI cause was observed in 34.2% of menorrhagic premenopausal women. The main risk factor for the presence of likely GI causes was the presence of upper GI symptoms (OR 5.2: 95% CI = 1.6-16.4).
  
  
  CONCLUSIONS
  Most premenopausal women had a possible upper GI cause of IDA because of diseases related to iron malabsorption. Menorrhagia and a GI cause coexist in one-third of women with iron-deficiency anaemia.
authors.affiliation: Department of Digestive and Liver Disease, Hospital Sant'Andrea, II School of Medicine, University Sapienza of Rome, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Vannella
authors.forename: M A
authors.initials: MA
authors.lastname: Aloe Spiriti
authors.forename: G
authors.initials: G
authors.lastname: Cozza
authors.forename: L
authors.initials: L
authors.lastname: Tardella
authors.forename: B
authors.initials: B
authors.lastname: Monarca
authors.forename: A
authors.initials: A
authors.lastname: Cuteri
authors.forename: M
authors.initials: M
authors.lastname: Moscarini
authors.forename: G
authors.initials: G
authors.lastname: Delle Fave
authors.forename: B
authors.initials: B
authors.lastname: Annibale
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D005260:Female; D005293:Ferritins / Q000097:blood; D005773:Gastroscopy; D006801:Humans; D008286:Malabsorption Syndromes / Q000150:complications*; D008595:Menorrhagia / Q000150:complications*; D008598:Menstruation / Q000502:physiology*; D008875:Middle Aged; D009780:Occult Blood; D017697:Premenopause / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D016387:Women's Health
chemical_list: D005293:Ferritins