Association Between Subjective Assessment of Menstrual Bleeding and Measure of Iron Deficiency Anemia in Women

Introduction: Menstrual blood loss is the most common cause of iron deficiency anemia (IDA) in women of reproductive age. However, clinical quantification of menstrual bleeding remains challenging in routine practice and is often based on subjective reporting. Understanding the relationship between perceived menstrual blood loss and laboratory measures of iron status can help guide earlier identification and management of IDA. Objective: To assess the association between women’s subjective assessment of menstrual bleeding and laboratory-confirmed iron deficiency anemia. Methods: A cross-sectional study was conducted at Combined Military Hospital, Malir, Karachi from 2 June to 2 Sep 2023, involving 155 women of reproductive age. Participants completed a structured questionnaire designed to assess menstrual characteristics, including cycle length, duration, and subjective bleeding volume categorized as light, normal, or heavy. Results: Among 155 women, 39 (25.2%) reported heavy menstrual bleeding, while 52 (33.5%) reported normal and 64 (41.3%) reported light flow. The prevalence of iron deficiency anemia was significantly higher in women reporting heavy menstruation (66.7%, p < 0.001), compared to 23.1% in the normal group and 9.4% in the light group. Mean hemoglobin and ferritin levels were lowest among the heavy bleeding group (Hb: 10.4 ± 1.3 g/dL; Ferritin: 11.6 ± 4.8 ng/mL). Subjective bleeding volume was moderately correlated with laboratory markers (Spearman’s r = −0.49 for Hb, r = −0.53 for ferritin). Conclusion: Women’s subjective assessment of menstrual bleeding volume is significantly associated with the presence of iron deficiency anemia. This finding highlights the clinical utility of simple history-taking to guide early screening and prevention of IDA in menstruating women.