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86% of women with anemia have undetected internal bleeding.
June 12, 2011 10:33 AM   Subscribe

Iron-deficiency is not something you get just for being a lady. "There is no support for the prevailing medical assumption that menses is correlated with [iron-deficiency anemia]."
posted by stoneweaver (31 comments total) 10 users marked this as a favorite

 
I really love people like this: people who, when encountering something contradictory, do not simply shrug their shoulders but instead decide to delve deeper.
posted by Deathalicious at 10:44 AM on June 12, 2011 [8 favorites]


So does blood-letting not help if you have too much iron in your blood?
posted by banished at 10:46 AM on June 12, 2011


So does blood-letting not help if you have too much iron in your blood?

"And I didn't understand how it was that menses, which is only about thirty milliliters of blood loss per menses, could have such a profound impact on women's iron status."

Not 30ml, no. You'd barely notice it.
posted by jaduncan at 10:48 AM on June 12, 2011


Probably not if you're only letting 30 milliliters of blood over a 5-7 day period.
posted by stoneweaver at 10:49 AM on June 12, 2011


This part seemed pretty important (I never notice topic titles; the one here kind of spells it out).

Ladies, unless you are menorrhagic (bleeding more than 120 milliliters each cycle) your period is not doing you wrong. If you have iron-deficiency anemia and your doctor is insisting it's because you slough off your endometrium from time to time without doing a single test to confirm it, you may want to insist on an endoscopy. It could save your life.

Um, being a dude, do you all measure your flow to the milliliter? Who knew?
posted by msalt at 10:59 AM on June 12, 2011


You've never seen a tampon wringer before, msalt? Sheltered life you lead.
posted by 0xFCAF at 11:05 AM on June 12, 2011 [5 favorites]


I have often wondered about this. When I try to give blood and get deferred due to low iron, usually the tech will ask if I'm on my period, or if I've just had it. But it never made sense to me. If I was on my period, wouldn't I actually not be "losing" any blood? Hasn't it all been built up in the following weeks? It's not like during my few days of "bleeding" I am losing blood from my circulatory system. If anything, the follicular stage would be when I would be depleting my blood supply. Can anyone with a better anatomy background speak to this?
posted by lizjohn at 11:07 AM on June 12, 2011


According to this page 20-25% of women are menorrhagic. That would seem to suggest periods still may play a significant role in iron loss, no? Quite a few women are losing quite a bit more than 30 mL a month, anyway.
posted by banished at 11:12 AM on June 12, 2011 [4 favorites]


It helps being a female if you carry one or more of the twenty or so mutations that contribute to Hemochromatosis, at least until menopause.
posted by francesca too at 11:14 AM on June 12, 2011 [1 favorite]


Finally I understand the phrase "I've been through the wringer."
posted by msalt at 11:16 AM on June 12, 2011


Um, being a dude, do you all measure your flow to the milliliter? Who knew?

I had no idea what the volume of blood was before I got a menstrual cup, which has mL markings on its side. It is kind of awesome to know exactly how much I am bleeding, though it sure weirds out any doctors who ask about the heaviness or lightness of my periods (they are surprised by an answer in millilitres! but they asked! sheesh!).
posted by bewilderbeast at 11:17 AM on June 12, 2011 [17 favorites]


Ladies, unless you are menorrhagic (bleeding more than 120 milliliters each cycle) your period is not doing you wrong. If you have iron-deficiency anemia and your doctor is insisting it's because you slough off your endometrium from time to time without doing a single test to confirm it, you may want to insist on an endoscopy. It could save your life.

While in principle, I agree with the point being made, I find this post troubling. It's based largely on a single article with a case series of a total of 7 women. It wouldn't hurt for our author to have been a bit more circumspect in her description of this data. A second, considerably larger study showed a much lower (though still notable) rate of GI sources for bleeding. Extrapolating this to a general recommendation for endoscopy being life saving is a dangerous overstatement to direct at lay-readers. In a population, the endoscopy itself might be just as likely to cause you considerable harm if these GI sources are self-limited (as they most often are).

It's interesting to note that pre-menopausal women still have considerably higher rates of clinically defined anemia than their male counterparts. Why is that? The differential prevalence of GI bleeding doesn't seem like it would explain it. Menorrhagia is likely quite understated as well, and generally poorly assessed quantitatively by most patients. How much of a role does it really play? Intersting stuff.
posted by drpynchon at 11:25 AM on June 12, 2011 [12 favorites]


From the graphs: Made-up data to demonstrate...

Um... wait, what?
posted by underflow at 11:40 AM on June 12, 2011 [3 favorites]


She's showing what the conventional wisdom looks like vs the what Bergstrom et al's work suggests. I've done a similar thing to show how people think antibody binding works compared to the answer you get with the equation KD = [antibody][antigen]/[complex].*

What I want to know is how is it that the real data for that isn't out there somewhere. There are several ways you could measure things to get exactly the data you wanted. Red count, an ELISA for hemoglobin, atomic absorption for iron - none of these are exactly cutting edge technologies. Of course this probably falls into the realm of super secret medical data that you couldn't get, even if it was heavily blinded, without every patient involved signing a small deciduous forest worth of paperwork.

*People really like little schematic diagrams and then like to extrapolate wildly from them. Pointing out that if their diagram showed everything, it wouldn't quite fit inside the orbit of Saturn, or that their 0.1 mL of antibody solution contained more molecules of antibody than their head did neurons will not dissuade them from this.
posted by Kid Charlemagne at 11:56 AM on June 12, 2011 [1 favorite]


It's not like during my few days of "bleeding" I am losing blood from my circulatory system.

That's always puzzled me too -- way back in sex ed one of the FAQs was about being worried about blood loss during your period, and the answer was that it was okay because it was not blood that was in circulation.
posted by statolith at 12:06 PM on June 12, 2011 [1 favorite]


Menorrhagia is definitely underreported because many women have no idea what "normal bleeing" means; they only know what they have experienced.

The 86% number is 6 of a total of 7 anemic women in one study, which is good data to consider but is really not good enough to assign a risk value (as secondary reporting of the specific percentage implies). As to anemia, the blame may be placed too readily on menstruation or insufficient dietary iron, but unless anemia is severe those are the less invasive things to check and treat first.
posted by zennie at 12:13 PM on June 12, 2011 [1 favorite]


Though the author makes a good point about making assumptions, many more women than men have iron-deficiency anemia (about 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body).

So the title of the post is a bit misleading, since being a 'lady' does significantly up your risk of IDA.

Also, 86% of women in the study having internal bleeding is really scary, and attention-getting, and it is significant, but the fact there were only 7 women in the study should really also be emphasized.

Anyway, this is a still good argument for studying IDA in women further.
posted by misha at 12:35 PM on June 12, 2011


You've never seen a tampon wringer before?

We usually just call them "production assistants."
posted by nevercalm at 12:42 PM on June 12, 2011 [6 favorites]


I had an undiagnosed ulcer for quite some time and the doctors just said it was because of my period. Not fun. I wonder how much of the GI bleeding in the study is caused by NSAIDs like mine was.

Another not fun thing is iron supplements. I wish someone had told me that a significant number of people experience severe GI effects from them like cramping, gas, and diarrhea.

Either way, when I started eating better and lost weight, my period went from a heavy week to a light three days and I'm very grateful for that.
posted by melissam at 12:49 PM on June 12, 2011 [2 favorites]


My father has had iron deficiency for as long as I can remember. I don't have it and neither does my wife but both my daughters do. We all found out as a result of giving blood (or trying to).
posted by tommasz at 1:22 PM on June 12, 2011


I was diagnosed recently with IDA and the doctor was pretty sure it was due to heavy periods - I have an IUD which makes them very heavy indeed.
posted by mippy at 1:41 PM on June 12, 2011 [1 favorite]


I suffered from anemia throughout childhood. I weighed a good 5 kg less than my peers, and I did't have menses before I was 16. Actually, it was probably pretty obvious that I was undernourished, but the doctor gave me iron-supplements (which I threw up) rather than a diet.
It'll take a while before I refrain from feminism.

Mippy, today I have heavy periods due to a IUD, and I don't like it, but no IDA, at all.
posted by mumimor at 1:45 PM on June 12, 2011 [1 favorite]


The sample size is too small to draw any solid conclusions, but the takeaway is important. Women are all too often casually dismissed with diagnoses of generic lady issues, anxiety, or straight up hypochondria when they present with vague or difficult symptoms; and it's important to not let doctors blow you off when you know there's something wrong.

Being female and having normal periods are not pathologies.
posted by ernielundquist at 3:59 PM on June 12, 2011 [6 favorites]


You've never seen a tampon wringer before?

Heh. My brain read that phonetically, as "tampon ringer," and I started imagining what it would be like if tampons really did ring. Maybe something like a ringtone to warn of impending leakage. It would be handy for those of us who have flow rates that range from a trickle to a deluge with no rhyme or reason, but I could see it quickly becoming annoying.

It might be fun to have custom tampon ringtones, though. I'd pick Led Zeppelin: "When the Levee Breaks."
posted by amyms at 6:06 PM on June 12, 2011 [2 favorites]


So does blood-letting not help if you have too much iron in your blood?
--banished

Well I've heard that it can be good for men's health to donate blood every now and again. Too much iron is supposed to cause all kinds of problems.

(I've heard this, which really means I have no idea but it sounds good. At least there's no question that giving blood is good for the health of the person receiving the blood).
posted by eye of newt at 7:19 PM on June 12, 2011


I've got a form of Hemochromatosis that puts my iron level into such a high range that I'm not allowed to give blood. I've known this since about the point I hit puberty, when doctors started insisting on testing my blood iron.

And no matter what I tell doctors, every OBGYN insists on testing my blood iron every year during my physical. Even if I tell them that I've had it regularly tested every 6 months for the last 8 years, and it never changes. I could have had it tested less than a week ago, and they will still insist, EVEN IF THEY HAVE THOSE RECORDS ON FILE.

The way women's health stuff is half old wives tales and half "Well male is normal, and you are female therefore not normal" pisses me the fuck off.
posted by strixus at 9:11 PM on June 12, 2011 [4 favorites]


Well, technically its Haemosiderosis - there is no tissue damage.
posted by strixus at 9:12 PM on June 12, 2011


You've never seen a tampon wringer before, msalt? Sheltered life you lead.
posted by 0xFCAF at 11:05 AM on June 12 [5 favorites +] [!]


Not everyone shops at SkyMall to have that kind of fully-appointed kitchen.
posted by FatherDagon at 10:44 PM on June 12, 2011 [1 favorite]


misha : Also, 86% of women in the study having internal bleeding is really scary, and attention-getting, and it is significant, but the fact there were only 7 women in the study should really also be emphasized.

That still doesn't explain the gender difference, though - Do females have a 6x higher risk of upper GI bleeds than males? And if so, that seems like an interesting detail to delve into on its own, totally separate from the anemia issue.

I appreciate that writing it off as "they bleed once a month, so we have our cause" counts as bad science, and quite likely wrong (though still, as a male, I rarely lose anywhere near a whole ounce of blood). Calling it a diagnostic failure for GI bleeds also counts as sloppy, and looks more like playing "let's blame the patriarchy" than "let's find the real cause".
posted by pla at 3:42 AM on June 13, 2011


The way women's health stuff is half old wives tales and half "Well male is normal, and you are female therefore not normal" pisses me the fuck off.

My mother's GP once said to her that he believed women to be a drain on the health service. Strange, as a) his wife was also a doctor b) my father, as someone who had several bypasses during his life partly due to poor lifestyle choices, probably cost the NHS more in his lifetime than my mother's three births. I had to see a doctor at her surgery for a sensitive issue (not lady-related) a few years ago and I made sure I saw a different one - how would I know he didn't see my health problems as some kind of tiresome female episode?
posted by mippy at 4:05 AM on June 13, 2011


Oh don't even get me started, mippy. I've got a doctor that's like that for one of my multitudes of specialists (dermatologist). If it is even remotely near my girl parts (like, lower belly, lower back, or upper legs) it is INSTANTLY not his problem. Even if it happens to be a giant sebaceous cyst that's been draining blood for 3 months and the reason I was fucking referred to him. Grrr.
posted by strixus at 10:02 AM on June 13, 2011


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