Feature Articles

When it comes to their health, women need all the help they can get – especially from their doctor. According to a recent poll by the National Women's Health Resource Center, women are not seeking medical advice as often due to health care costs, even though more than 40% of the 754 adult women polled said their health had declined in the past year.¹ This means their health may be suffering. That’s why there is a great opportunity for physicians and healthcare professionals to help empower women to make their health a top priority!

Anemia is one of many important lifelong health considerations for women as well as an important U.S. public health issue. The magnitude of the quality of life deficiency suffered by women with anemia is frequently underestimated and underappreciated. Consequently, the Healthy People 2010 Initiative has identified anemia as one of their concerns in women of childbearing age and several health groups have developed screening guidelines for anemia in women.

• USPSTF: Screening for Iron Deficiency Anemia
• CDC: Recommendations to Prevent and Control Iron Deficiency in the US
• ACOG: Anemia in Pregnancy

Iron deficiency, the most common nutritional deficiency among U.S. women of childbearing age, is associated with reduced work capacity and impaired cognitive function. When this is allowed to progress to iron deficiency anemia, it is associated with impaired aerobic activity, decreased voluntary activity and decreased economic productivity.² In the United States, 6 million women of reproductive age are iron deficient – roughly 10%. Approximately half of these women who are iron deficient will subsequently go on to develop iron deficiency anemia.^3-5 In addition, anemia can be the first sign of other medical conditions. Recognizing the symptoms and evaluating the cause of anemia can lead to an early diagnosis of potentially treatable conditions.

What can physicians and healthcare professionals do?

This article provides ideas and tools on how to discuss anemia with female patients.

Recognize Women Who Are At Risk

Women With A Chronic Illness
Take time to review the role anemia plays in chronic illness and how you can recognize, diagnose and treat it. Anemia can be a symptom or consequence of many common chronic conditions such as diabetes, chronic kidney disease, cancer, rheumatoid arthritis, inflammatory bowel disease and others. You can improve patient outcomes by paying attention to the role anemia plays and treating it appropriately.

Heavy Menstrual Bleeding and Fibroids
Anemia commonly occurs in women of reproductive age secondary to heavy uterine bleeding. Of the more than 73 million women between the ages of 15 and 49 in the United States, 6.6-10.3 million women experience heavy uterine bleeding and are at risk for iron depletion, iron deficiency, and iron deficiency anemia. Approximately 10-15% of all women develop heavy uterine bleeding sometime during their lifetime, and among women with heavy uterine bleeding, as many as 20% develop anemia.⁶ For an in-depth discussion of this topic, including tips on how to recognize heavy menstrual bleeding, please refer to the feature article Women & Anemia – Heavy Menstrual Bleeding and Fibroids.

Pregnancy
Most anemia during pregnancy results from an increased need for iron. It is estimated that women will need approximately 50% more iron during pregnancy; increasing from 18 to 27 milligrams (mg) per day.⁷ The simplest way to prevent anemia during pregnancy is for women to eat a well balanced diet and to take their recommended iron supplements. For more information visit the feature article Women & Anemia – Increased Need for Iron During Pregnancy.

Postpartum
One out of 8 women will have iron deficiency well after delivery – up to 12 months after child birth. And, this is a complication of up to 5% of deliveries.⁸ Maternal iron deficiency has been associated with a two-fold increase in preterm deliveries and a three-fold increase in low birth weight babies.⁹ Physicians can help mothers prevent postpartum anemia by encouraging patients to take their iron supplements while they are pregnant. Physicians play a vital role in helping women recognize anemia, and in screening high-risk patients for the presence of anemia. For more information visit the feature article Women & Anemia – Childbirth and Postpartum Anemia.

Older Women
Anemia is often considered to be relatively harmless and a normal part of the aging process, but anemia is neither normal nor harmless and may have far-reaching effects. Anemia in elderly women is more commonly observed than appreciated and is often multifactorial. Multiple factors contributing to the problem in the individual patient include nutritional deficiencies (34%), anemia of chronic disease (33%), and just as many remain unexplained (33%).¹⁰ For more information visit the feature article Tracking and Treating Anemia in Elderly Patients.

Educate Patients Who May Be At Risk For Anemia

Sure, you may be aware of the increased risk of anemia for women, but do your patients? Many women come to believe that it’s normal to feel tired, weak, or irritable – just the price they pay for leading a busy life. Women frequently don’t recognize the signs of iron deficiency anemia, which can include cognitive dysfunction, headaches, dizziness, nervousness, lack of concentration, forgetfulness, fatigue, sexual dysfunction and decreased job performance. They frequently will not bring this to the attention of their physicians and they’re not commonly asked questions. This leads to anemia being inadequately recognized, and therefore inadequately treated or untreated.

Teach your patients the different symptoms of anemia and encourage them to regularly report any occurrences in a timely manner. To help your patients remember some of these symptoms, see the anemia Symptoms Quiz. This convenient and useful tool can be used or distributed in your office, especially to women who are at the highest risk of developing anemia.

With many women visiting the doctor less frequently, the time you do get to spend with them is ever-so valuable. Encourage women to take control of their health and specifically teach them to recognize and report any symptoms related to anemia. Also support their desire to learn more by referring them to our website, www.anemia.org, which has anemia handouts and reliable information for female patients. A quick discussion about anemia with your patients could help them catch symptoms quickly and stay healthy.

References

1. Doheny K. Economy Driving Women to Skimp on Health Care: Poll. Link. Accessed: April 14, 2009.
2. Bodnar L, Cogswell M, Scanlon K. Low income postpartum women are at risk of iron deficiency. J Nutr. 2002 Aug;132(8):2298-2302. Link.
3. Anemia goes undiagnosed in a significant number of women. Link. Accessed: April 14, 2009.
4. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep 1998;47:1-36. Link.
5. US Census Bureau 2000, Summary file 1, Table PCT12 Link.
6. James AH, Patel ST, Watson W, Zaidi QR, Mangione A, Goss TF. An assessment of medical resource utilization and hospitalization cost associated with a diagnosis of anemia in women with obstetrical bleeding in the United States. J Womens Health (Larchmt). 2008 Oct; 17(8):1279-84. Link.
7. Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand. 1999 Oct;78(9):749-57. Link.
8. Bodnar LM, Siega-Riz AM, Miller WC, Cogswell ME, McDonald T. Who should be screened for postpartum anemia? An evaluation of current recommendations. Am J Epidemiol. 2002 Nov 15;156(10):903-12. Link.
9. Bodnar LM, Scanlon KS, Freedman DS, Siega-Riz AM, Cogswell ME. High prevalence of postpartum anemia among low-income women in the United States. Am J Obstet Gynecol. 2001 Aug;185(2): 438-43. Link.
10. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004 Oct 15;104(8):2263-68. Link.
11. Cusick SE, Mei Z, Freedman DS, Looker AC, Ogden CL, Gunter E, Cogswell ME. Unexplained decline in the prevalence of anemia among US children and women between 1988-1994 and 1999-2002. Am J Clin Nutr. 2008 Dec;88(6):1611-17. Link.