Iron deficiency anemia in patients with heavy menstrual bleeding: The patients' perspective from diagnosis to treatment

Background: Heavy menstrual bleeding (HMB) associated with iron deficiency anemia (IDA) negatively affects quality of life (QoL). Management of IDA usually begins with oral iron supplementation or, if ineffective/poorly tolerated, then intravenous iron (IVI) is given; however, no guidance exists on transitioning from oral to IVI in patients with HMB. While various IVI products exist, safety profiles and distinct properties affecting treatment logistics make product choice important.Objectives: Assess the IVI treatment journey for patients with HMB and IDA.Design: A survey was designed to assess multiple aspects of IVI treatment to evaluate patient perspectives.Methods: Patients (>= 18 years) from the United States with IDA currently prescribed IVI completed a survey conducted by The Harris Poll in 2023. Questions covered symptoms, time to diagnosis/treatment, IVI appointment logistics, IVI infusion experience, impact on daily activities, and patient preferences.Results: Of 323 respondents, 71 (22.0%) were prescribed IVI for HMB and received >= 2 IVI infusions monthly. The mean age for these patients was 33.5 years; they experienced a mean of 2.9 years from symptom onset until IDA diagnosis, and 1.4 years between diagnosis and IVI treatment. Most patients agreed that navigating IVI treatment logistics interfered with productivity and social commitments, and felt they must schedule their life around treatment. Patients who were also diagnosed with hypophosphatemia following IVI (12/71; 16.9%) reported a mean of 8.2 additional hospital visits. Furthermore, 36.6% of patients missed an IVI dose; of these, 80.8% preferred single-dose IVI.Conclusion: Patients with IDA and HMB experienced substantial delays from symptom onset to subsequent IVI treatment, demonstrating a gap in management. Therefore, oral iron may not be an appropriate first-line treatment for some of these patients. Multiple-dose IVI and associated appointment logistics can negatively impact patients' perspectives on treatment. Single-dose IVI preferences should be considered to improve patients' adherence and QoL.