The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia

Am J Obstet Gynecol. 2023 Jul;229(1):1-9. doi: 10.1016/j.ajog.2023.01.017. Epub 2023 Jan 24.


For reproductive-aged women, the symptom of heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia. It is recognized that these 2 clinical entities are not only highly prevalent, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both heavy menstrual bleeding and iron deficiency, with or without anemia, adversely impact quality of life-heavy menstrual bleeding during the episodes of bleeding and iron deficiency on a daily basis. These combined issues adversely affect the lives of reproductive-aged girls and women of all ages, from menarche to menopause, and their often-insidious nature frequently leads to normalization. The effects on cognitive function and the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence that suggests that iron deficiency, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders, critically important evidence that begs the normalization of iron stores in reproductive-aged women. The authors seek to raise individual, societal, and professional awareness of this underappreciated situation in a fashion that leads to meaningful and evidence-based changes in clinical guidance and healthcare policy directed at preventing, screening, diagnosing, and appropriately managing both disorders. This manuscript provides evidence supporting the need for action and describes the elements necessary to address this pervasive set of conditions that not only affect reproductive-aged girls and women but also the lives of children everywhere.

Keywords: abnormal uterine bleeding; heavy menstrual bleeding; iron deficiency; iron deficiency anemia.

Publication types

  • Review

MeSH terms

  • Adult
  • Anemia, Iron-Deficiency*
  • Child
  • Female
  • Humans
  • Iron
  • Iron Deficiencies*
  • Menorrhagia* / etiology
  • Pregnancy
  • Quality of Life


  • Iron