月经过多、缺铁和缺铁性贫血之间的关系。

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

机构信息

Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA.

Versiti Blood Research Institute, Milwaukee, WI.

出版信息

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

Abstract

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.

摘要

对于育龄妇女而言,月经过多是一种高发症状,也是导致缺铁及其最严重表现——缺铁性贫血的主要原因。人们认识到,这两种临床病症不仅普遍存在,而且它们之间的关系还未被充分认识,社会、医疗服务提供者以及受影响的女孩和妇女本身往往对此习以为常。月经过多、缺铁(无论是否伴有贫血)都会对生活质量产生不利影响——月经过多会在出血期间产生影响,缺铁则会在日常生活中产生影响。这些综合问题会对所有年龄段育龄期女孩和妇女的生活产生不利影响,从初潮到绝经,而这些问题往往具有隐匿性,容易被忽视。这些问题对认知功能的影响以及相关的旷工和出勤问题会影响各行各业女性的努力和工作,无论她们是学生、教育工作者、雇主还是员工。越来越多的证据表明,即使在妊娠早期,缺铁也可能对胎儿神经发育产生不利影响,从而对一系列认知和心理障碍产生持久影响,这一重要证据迫切需要将铁储备正常化纳入育龄妇女的常规检查。作者希望以一种能够为临床指导和医疗保健政策带来有意义的、基于证据的改变的方式,提高个人、社会和专业人士对这一被低估情况的认识,从而预防、筛查、诊断和妥善处理这两种疾病。本文档提供了采取行动的必要性的证据,并描述了应对这一组普遍存在的疾病所需的要素,这些疾病不仅影响育龄期女孩和妇女,也影响世界各地儿童的生活。

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