Feature Articles

Women & Anemia: Heavy Menstrual Bleeding and Fibroids

August 13, 2008
This three part series on Women & Anemia discusses a few common causes of anemia unique to women, including heavy menstrual bleeding, pregnancy and child delivery. Part 1 focuses on anemia from heavy menstrual bleeding.  Part 2 | Part 3

Pull-out quote from Patricia FordIron deficiency anemia in women of reproductive age is a problem that is both under-recognized and under-treated. The U.S. Preventive Services Task Force, the Centers for Disease Control and Prevention, and the American College of Obstetrics and Gynecologists have all identified this as an important public health issue. In the United States, 6 million women of reproductive age are iron deficient and approximately 3 million of these iron deficient women will develop iron deficiency anemia.1

Heavy menstrual bleeding, also known as menorrhagia, is one common cause of iron deficiency anemia and affects nearly 2 million women. Heavy menstrual bleeding has been reported in approximately 10-15% of all women at some point during their life. Among these women, as many as 20% will go on to develop anemia.2

Symptoms of Menstrual Bleeding
  • Soaking through a tampon and/or pad every hour or less for several hours in a row
  • Needing to use double protection during your period
  • Having to change your pad or tampon during the night
  • Passing large blood clots in your menstrual flow
  • Periods that last longer than 7 days
  • Severe cramping

Typically, women have a period about every twenty eight days. It lasts for four to five days, and they lose somewhere between 4 tablespoons and 1 cup of blood. You may suffer from heavy menstrual bleeding if you need to use double protection during your period, have to change your pad or tampon during the night, or soak through a tampon and/or pad every hour or less for several hours in a row. You may also be a sufferer if you pass large blood clots in your menstrual flow, have periods that last longer than seven days, or experience severe cramping.3

If you are having symptoms of heavy menstrual bleeding, it is very important for you to talk to your healthcare professional. You could be losing more blood and iron than during a typical period.

In many women, excessive menstrual bleeding is caused by a medical condition, most commonly uterine fibroids. Uterine fibroids are non-cancerous growths in the uterus that often appear during childbearing years. They almost never lead to cancer, and are not linked to any increased risk of cancer. Fibroids are very common in women in their thirties and forties and about 80% of women have fibroids by the time they reach their fifties.4

Symptoms of Iron
Deficiency Anemia
  • Shortness of breath
  • Heart palpitations
  • Craving ice
  • Headaches
  • Dizziness
  • Nervousness
  • Lack of concentration
  • Forgetfulness
  • Fatigue
  • Sexual dysfunction

In some women, uterine fibroids may cause heavy bleeding; pelvic pain and can create pressure on other organs. Medical treatment such as anti-inflammatory drugs or surgery can shrink or remove fibroids. Hysterectomy is the most drastic of the available treatments. According to Dr. Patricia Ford, a hematologist at the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital, “If women have symptoms and can’t get their anemia treated and their symptoms under control, they may choose to undergo more radical surgical procedures, such as hysterectomy, rather than more conservative options.”

Women don’t always recognize the signs of iron deficiency anemia, which can include shortness of breath, palpitations, ice craving, headaches, dizziness, nervousness, lack of concentration, forgetfulness, fatigue, sexual dysfunction and decreased job performance. Dr. Ford stated that “Women frequently will not bring these symptoms to the attention of their physicians who also may not routinely ask these questions. That’s why no treatment or inadequate treatment is often the norm for many women.”

If you’ve been feeling some of these symptoms and think you may have anemia, we recommend you talk to your healthcare professional. See the Symptoms Quiz form which you can fill out and take to your doctor or gynecologist. If you are diagnosed with anemia, there are treatments available to help.

Read the full series on Women & Anemia. Part 2: Pregnancy | Part 3: Child Delivery


  1. US Census Bureau. Recommendations to Prevent and Control Iron Deficiency in the US MMWR.1998;47:1-36. Census 2000 Summary file 1, Table PCT12.
  2. Vercellini P, Vendola N, Ragni G, Trespidi L, Oldani S, Crosignani PG. Abnormal Uterine Bleeding Associated with Iron-Deficiency Anemia. J Reprod Med. 1993 July;38(7):502-4.
  3. Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol. 2004 May;190(5):1216-23.
  4. Healthwise, Incorporated. BC Health Guide: Uterine Fibroids. Link.