title: Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding.
abstract: 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).
  
  
  METHODS
  Secondary analysis of a randomized controlled trial.
  
  
  METHODS
  Five university hospitals in Finland.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa, Hyvinkää, Finland.
authors.forename: Pirkko
authors.initials: P
authors.lastname: Peuranpää
authors.forename: Satu
authors.initials: S
authors.lastname: Heliövaara-Peippo
authors.forename: Ian
authors.initials: I
authors.lastname: Fraser
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.forename: Ritva
authors.initials: R
authors.lastname: Hurskainen
mesh_terms: D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003863:Depression / Q000175:diagnosis; D005260:Female; D005293:Ferritins / Q000032:analysis; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D007436:Intrauterine Devices, Medicated; D007501:Iron / Q000627:therapeutic use; D000090463:Iron Deficiencies; D016912:Levonorgestrel / Q000008:administration & dosage*; D016014:Linear Models; D008595:Menorrhagia / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D003271:Contraceptive Agents, Female; D006454:Hemoglobins; D016912:Levonorgestrel; D005293:Ferritins; D007501:Iron
keywords: Anemia; heavy menstrual bleeding; iron deficiency; menorrhagia; quality of life