For iron deficiency anemia due to heavy menstrual bleeding, what is your preferred method of controlling heavy menses?

I definitely loop in my GYN friends for this one! According to ACOG: "Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life." The consequences of HMB are substantial and multifaceted, and, as we frequently encounter, it can lead to iron deficiency and the consequences thereof.

It's important to rule out a structural/anatomic cause of heavy bleeding (fibroid, adenomyosis, malignancy, etc.), and...

Thanks for this important question. Too often, we see women in hematology clinics who have had terrible bleeding for years, and the menorrhagia has not been addressed, only the iron deficiency. From a hematology perspective, I make sure to do an ISTH bleeding score assessment to see if she needs to be evaluated for VWD. This diagnosis doesn’t change the management of the menorrhagia necessarily, but does impact future surgeries and pregnancies.

In terms of how to control the bleeding, I defer to...

When heavy menstrual bleeding (HMB) causes iron deficiency anemia (IDA) or interferes with quality of life, it is advised to offer treatment. There are hormonal, nonhormonal, and surgical options, depending on the etiology of HMB.

The main way to address HMB causing IDA is to control menses via hormonal contraception. Combined hormonal methods (pill/patch/ring) work very well, so long as your patient does not have any contraindications to estrogen (h/o breast cancer, CAD, CVA, uncontrolled hyper...