Hirsutism: Understanding Excessive Hair Growth In Women
The healthyher.life team supports a holistic approach to managing women’s hormonal healthcare. Our goal is to help our members be well-informed about their hormonal health, by providing them with evidence-based integrated health information that includes the current standard of medical care advised by qualified physicians, clinical insights from licensed allied health professionals (naturopathic doctors, nurse-practitioners, nutritionists, psychotherapists) and new health innovations that will be soon coming to market. Always consult with your doctor regarding your medical condition, diagnosis, treatment, or to seek personalized medical advice.
Hirsutism: Understanding Excessive Hair Growth In Women
Reviewed by Rina Carlini, PhD
Why do some women experience excessive hair growth on areas of their face and body where it's not usual for most women?
This could be due to hirsutism, a medical condition that causes excess hair growth, affecting approximately 5–10% of women worldwide. While it doesn’t severely affect physical health, excessive hair in unwanted areas can lead to significant social discomfort, psychological stress, and feelings of embarrassment for women, especially in social settings and the workplace, where it can affect their confidence and impact career growth opportunities. [1]
While hirsutism is often dismissed as a minor cosmetic issue, it can be a sign of abnormal androgen activity in the body, stemming from underlying endocrine disorders such as polycystic ovary syndrome (PCOS) or, in rare cases, more serious medical conditions. Beyond the physical symptoms, the emotional toll it can have on a person can be profound—impacting a woman's self-esteem, relationships, and mental health.
Hirsutism Is More Than Just Abundant Hair Growth
Hirsutism is characterized by excessive hair growth on certain parts of the body, especially in areas where men typically grow hair, such as the chin, upper lip, chest, back, and abdomen. This hair is usually coarse, curly, and pigmented (terminal hair) rather than the fine, soft, and lightly pigmented hair (peach fuzz) commonly present on a woman’s body.
While the primary symptom of hirsutism is the excessive growth of dark hair, women with more body hair than what’s considered normal shouldn’t assume they have the condition. A physician or healthcare professional will be able to provide an accurate diagnosis after assessing the symptoms and extent of hair growth.
What Causes Hirsutism In Women?
Hirsutism is often a symptom of other conditions and typically results from hormonal imbalances or disorders that increase the level of androgens in the body. [2]
Androgens are a group of hormones that are present in all people. However, men and people assigned male at birth naturally produce more of these androgen hormones than do females. When an adult woman has high androgen levels, it triggers a pattern of physical and sexual development that’s typical of males, including overstimulation of hair follicles, leading to excessive hair growth. This process is called virilization. [3]
Apart from hirsutism, other signs of virilization include:
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Acne
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Oily skin
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A deep or masculine voice
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Balding (temporal hair recession)
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Increased musculature
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Decreased breast size
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Irregular menstruation
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Enlarged clitoris
Other conditions that can cause hirsutism include:
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Polycystic Ovarian Syndrome (PCOS) – The leading cause of hirsutism, where nearly 70-80% of all people diagnosed with PCOS develop hirsutism. Those with PCOS have an imbalance of sex hormones. Over time, it leads to excess hair growth, abnormal menstruation, weight gain, and challenges with fertility. [4]
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Cushing’s Syndrome – Cortisol is a hormone that can affect various organs controlling the integumentary system–hair, skin, nails, glands, and nerves. In people with Cushing's syndrome, there is a high level of cortisol. Prolonged exposure to high cortisol levels can disrupt androgen production. [5]
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Congenital Adrenal Hyperplasia (CAH) – A genetic condition where the adrenal glands produce abnormal amounts of steroid hormones, including androgens and cortisol. [6]
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Androgen-Secreting Tumors – Rare ovarian or adrenal tumors can lead to high levels of male hormones, leading to rapid-onset hirsutism. [7]
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Medications – Some drugs, like anabolic steroids, testosterone, minoxidil, cyclosporine, danazol, and phenytoin, can cause hirsutism. [8]
Sometimes, hirsutism can be familial, meaning it is inherited and isn’t associated with any underlying medical condition. You might be more susceptible to developing hirsutism if you have a family history of conditions that cause it. In addition, the chances of developing hirsutism increases with age, especially after menopause, due to hormonal imbalances. [1]
Lastly, genetics significantly influences hair color, thickness, and density or distribution of hair follicles. For instance, women from regions like the Middle East, the Mediterranean, and the Indian subcontinent often naturally have darker and thicker body or facial hair. So, in these populations, more hair on the face and body is typically considered normal and may not be a sign of hirsutism.
Diagnosing Hirsutism
A physician would initially conduct a physical examination to determine the extent of uncommon hair growth, which is assessed using the Ferriman-Gallwey scale. [9]
The Ferriman-Gallwey scale examines nine areas of your body where male-pattern hair is likely to develop due to high androgen influence–the upper lip, chin, chest, upper abdomen, lower abdomen, upper arms, thighs, upper back, and lower back/buttocks. Each area is scored on a scale from 0-4 based on the density and thickness of terminal hair. Low numbers indicate mild hirsutism and higher numbers indicate severe male-pattern hair growth.
The scores from all nine areas are added to determine a total score between 0 and 36. Typically, the scores are interpreted as follows:
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≤8: Normal (no significant hirsutism)
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8-15: Mild hirsutism
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>15: Moderate to severe hirsutism
While the Ferriman-Gallwey score is a helpful diagnostic tool, it has some limitations. For instance, due to how genetics influence hair growth patterns, the threshold for what constitutes "normal" may vary slightly depending on factors like ethnicity. Here are the scores that are considered normal based on ethnicity.
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Black or white (Caucasian) people – 8
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Mediterranean, Hispanic, and Middle Eastern people – 9 or 10
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Asians – less than 2
So, in clinical practice, this scoring system is often combined with blood tests (which help measure androgen levels) and diagnostic imaging tests (CT, ultrasound, and X-ray) if an underlying cause is suspected.
Managing Hirsutism: Treatment Options
Managing hirsutism typically involves addressing its underlying cause. Generally, weight loss is the first step in treatment. According to studies, obesity can increase androgen production, worsening hirsutism. [10] [11] Hence, losing even 5% of the body weight can lower androgen levels and prevent excessive hair growth. [12]
In some cases, especially if the patient has mild hirsutism that is spontaneous or that happens without a known cause, cosmetic measures may be sufficient to manage it, such as shaving, bleaching, waxing, or plucking. Hair removal options like electrolysis (to destroy hair roots one by one) and laser (to destroy hair cells with a lot of pigment) can also be administered.
In other cases, a topical or systemic therapy might be necessary to treat hirsutism. [13] These options may include:
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Birth control pills / oral contraceptives – The first-line treatment for hirsutism, they lower androgen levels by suppressing ovarian activity.
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Androgen-suppressing medications – Medications like spironolactone, finasteride, and flutamide block androgens from binding to hair follicles, reducing hair thickness and growth rate.
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Low-dose steroid medications – Used if overactive adrenal glands are causing hirsutism. Adrenal glands produce sex hormones, including cortisol.
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Insulin-lowering medications – High insulin levels trigger ovaries to produce androgens. Metformin and pioglitazone improve insulin sensitivity, thereby indirectly lowering androgen production. However, they aren’t used as a first-line treatment due to their significant side effects.
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Gonadotropin-releasing hormone (GnRH) agonists – Rarely used, they suppress ovarian androgen production. Since they require injections, they can be expensive.
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Eflornithine skin cream – A topical product that slows down hair growth. It takes 6 to 8 weeks to see noticeable results.
The proper treatment option for hirsutism will depend on its severity. Medications for treating hirsutism often take weeks or months to show any noticeable results; lifestyle modifications through weight management are also beneficial and can give more impactful results that endure over your life.
Always consult with your family physician or nurse practitioners for any serious and persistent concerns about your medical condition, diagnosis, and treatment, or to seek personalized medical care. Join the Healthyher.Life as a community member and connect with others in our Community Forum who have had similar experiences with managing hirsutism.
References:
[1] Sachdeva S. Hirsutism: evaluation and treatment. Indian J Dermatol. 2010;55(1):3-7. doi: 10.4103/0019-5154.60342. PMID: 20418968; PMCID: PMC2856356. [PubMed]
[2] Rosenfield, R. L. (2005). Hirsutism. New England Journal of Medicine, 353(24), 2578-2588. [The New England Journal of Medicine]
[3] Spritzer PM, Marchesan LB, Santos BR, Fighera TM. Hirsutism, Normal Androgens and Diagnosis of PCOS. Diagnostics (Basel). 2022 Aug 9;12(8):1922. doi: 10.3390/diagnostics12081922. PMID: 36010272; PMCID: PMC9406611. [PubMed]
[4] Spritzer PM, Barone CR, Oliveira FB. Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management. Curr Pharm Des. 2016;22(36):5603-5613. doi: 10.2174/1381612822666160720151243. PMID: 27510481. [ResearchGate]
[5] Haouat, E., Ben, S. L., Kamoun, I., Zrig, N., Turki, Z., & Ben, S. C. (2012, May 1). Androgens profile in Cushing. https://www.endocrine-abstracts.org/ea/0029/ea0029p953 [Endocrine Abstracts]
[6] Baskin HJ. Screening for Late-Onset Congenital Adrenal Hyperplasia in Hirsutism or Amenorrhea. Arch Intern Med. 1987;147(5):847–848. doi:10.1001/archinte.1987.00370050043007 [JAMA Network]
[7] Varma T, Panchani R, Goyal A, Maskey R. A case of androgen-secreting adrenal carcinoma with non-classical congenital adrenal hyperplasia. Indian J Endocrinol Metab. 2013 Oct;17(Suppl 1):S243-5. doi: 10.4103/2230-8210.119585. PMID: 24251173; PMCID: PMC3830319. [PubMed]
[8] Patel A, Malek N, Haq F, Turnbow L, Raza S. Hirsutism in a female adolescent induced by long-acting injectable risperidone: a case report. Prim Care Companion CNS Disord. 2013;15(3):PCC.12l01454. doi: 10.4088/PCC.12l01454. PMID: 24171143; PMCID: PMC3795580. [PubMed]
[9] Bhns. (n.d.-a). https://bhns.org.uk/ccs_files/web_data/Resources/Diseases%20(severity%20scoring)/Hirsuitism.pdf [British Hair and Nail Society]
[10] Mazza, E., Troiano, E., Ferro, Y., Lisso, F., Tosi, M., Turco, E., Pujia, R., & Montalcini, T. (2024). Obesity, Dietary Patterns, and Hormonal Balance Modulation: Gender-Specific Impacts. Nutrients, 16(11), 1629. https://doi.org/10.3390/nu16111629 [MDPI]
[11] Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006 May;85(5):1319-40. doi: 10.1016/j.fertnstert.2005.10.054. PMID: 16647374.[PubMed]
[12] Zapała B, Marszalec P, Piwowar M, Chmura O, Milewicz T. Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet. Exp Clin Endocrinol Diabetes. 2024 Jan;132(1):6-14. doi: 10.1055/a-2201-8618. Epub 2024 Jan 18. PMID: 38237611; PMCID: PMC10796197. [PubMed]
[13] Hunter MH, Carek PJ. Evaluation and treatment of women with hirsutism. Am Fam Physician. 2003 Jun 15;67(12):2565-72. PMID: 12825846. [PubMed]
What are Uterine Fibroids?
By Henry Xu PhD., Joanne Tejeda, PhD.
July 12, 2024
Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths in the uterus composed of muscle and fibrous tissue. They can range in size from a pea to as large as a melon.
Globally, there are 226 million cases of uterine fibroids, with the highest prevalence among women aged 40-50. About 80% of women will develop uterine fibroids in their lifetime.
In the United States, about 26 million women aged 15 to 50 that are diagnosed with fibroids [1]. By age 50, nearly 80% of Black women and 70% of white women will develop fibroids. While experiences vary, about 25% of women with fibroids suffer from severe symptoms requiring treatment [2].
What Causes Uterine Fibroids?
The exact cause of uterine fibroids is not fully understood, but several factors are believed to contribute to their development, these include [3]:
1. Hormones that regulate the menstrual cycle, estrogen and progesterone, promote the growth of fibroids. When hormone levels drop after menopause, fibroid growth tends to decrease [4].
2. Evidence suggests that family genetics is a contributing factor as uterine fibroids tend to occur within the family [5].
3. Race is a key factor for uterine fibroids, as African-American women are 3-times more likely to develop fibroids and at a younger age compared to women of other racial groups [6].
4. Obesity has been linked to an increase in the risk of fibroids [7].
5. Vitamin D deficiency is also associated with increased risk of uterine fibroids [8].
6. Women with high blood pressure typically have a significantly higher risk of developing uterine fibroids [5].
Symptoms of Uterine Fibroids [2]:
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Heavy menstrual bleeding
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Prolonged periods (lasting more than a week)
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Iron Deficiency Anemia
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Pelvic pain or pressure
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Frequent urination
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Difficulty emptying the bladder
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Constipation
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Backache
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Leg pains
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Reproductive issues, such as infertility or pregnancy complications
Diagnosis of Uterine Fibroids:
Diagnosis typically begins with taking the patient’s history and identifying symptoms related to uterine fibroids. A pelvic exam is then conducted to check for irregularities in the shape and size of the uterus. In certain cases, blood tests may be conducted to rule out other causes of symptoms, like anemia from heavy bleeding.
Imaging tests are crucial for an accurate diagnosis. Ultrasound is the primary imaging technique used due to its ability to visualize fibroids and assess their size, number, and location. Saline infusion, involving the injection of a salt solution into the uterus, is often used to create clearer ultrasound images [9].
Magnetic resonance imaging (MRI) is another valuable tool, especially for detailed mapping of fibroids, which is essential for treatment planning. MRI also helps distinguish fibroids from other pelvic conditions. Other traditional imaging techniques include hysteroscopy, which allows direct visualization of the uterine cavity using a thin, lighted scope, aiding in the identification of fibroids. [10].
Treatments of Uterine Fibroids:
Medications
For mild symptoms, over-the-counter pain relief can be used. Hormonal treatments, such as oral contraceptives or special injections that lower hormone levels, can also help shrink fibroids [4].
Non-Invasive Procedures
Radiofrequency ablation is a procedure that uses radio energy and heat to remove uterine fibroids. It is performed with a small, energized probe that is passed through the vagina and cervix into the uterus, guided by ultrasound throughout the procedure [11].
Minimally Invasive Procedures
Uterine artery embolization (UAE) is a treatment in which surgeons inject small particles into the arteries surrounding the fibroid to cut off its blood flow, causing it to shrink [12].
Radiofrequency ablation can also be used in minimally invasive procedures, where laparoscopic scopes are inserted into small incisions to guide the procedure [13].
Traditional Surgical Procedures
An abdominal myomectomy involves making an incision in the abdominal wall to access the uterus and surgically remove fibroids from its surface.
For women with severe symptoms who do not plan on having more children in the future, hysterectomy is used as a last resort [14].
Treatment of uterine fibroids can be time-consuming. Many women often go through multiple doctor visits before being diagnosed, and up to 32% of diagnosed women wait more than 5 years before seeking treatment [2]. Improved access to educational resources is needed to help guide women in their journey when seeking treatment for uterine fibroids.
New Medical Innovations
Medical device innovators are constantly developing new treatment tools for the non-invasive removal of uterine fibroids. Radiologist Dr. Elizabeth David at Sunnybrook Health Sciences Centre in Toronto is working on shrinking fibroids using high-intensity focused ultrasound guided by MRI. She recently completed a clinical trial in which 90% of patients reported being symptom-free after the procedure. [15].
Helpful Resources:
Living with fibroids can be challenging, with women reporting an average loss of 5.1 work hours per week due to the condition [1].
The Uterine Fibroids Toolkit: A Patient Empowerment Guide by the Society for Women's Health Research is a fantastic resource, offering information to help you understand your condition and make informed decisions.
Join the Healthyher.Life community to connect with others who have had similar experiences with fibroids.
References:
[1] Lou, Zheng et al. “Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study.” BMC public health vol. 23,1 916. 19 May. 2023, doi:10.1186/s12889-023-15765-x
[2] Society for Women's Health Research. *Uterine Fibroids Toolkit: A Patient Empowerment Guide*. Society for Women's Health Research, 2023.
[3] Stewart, E A. “Uterine fibroids.” Lancet (London, England) vol. 357,9252 (2001): 293-8. doi:10.1016/S0140-6736(00)03622-9
[4] Bulun, Serdar E. “Uterine fibroids.” The New England journal of medicine vol. 369,14 (2013): 1344-55. doi:10.1056/NEJMra1209993
[4] American College of Obstetricians and Gynecologists. “Management of Symptomatic Uterine Leiomyomas.” ACOG Practice Bulletin No. 228, July 2021.
[5] Stewart, E A et al. “Epidemiology of uterine fibroids: a systematic review.” BJOG : an international journal of obstetrics and gynaecology vol. 124,10 (2017): 1501-1512. doi:10.1111/1471-0528.14640
[6] Eltoukhi, Heba M et al. “The health disparities of uterine fibroid tumors for African American women: a public health issue.” American journal of obstetrics and gynecology vol. 210,3 (2014): 194-9. doi:10.1016/j.ajog.2013.08.008
[7] Pavone, Dora et al. “Epidemiology and Risk Factors of Uterine Fibroids.” Best practice & research. Clinical obstetrics & gynaecology vol. 46 (2018): 3-11. doi:10.1016/j.bpobgyn.2017.09.004
[8] Baird, Donna Day et al. “Vitamin d and the risk of uterine fibroids.” Epidemiology (Cambridge, Mass.) vol. 24,3 (2013): 447-53. doi:10.1097/EDE.0b013e31828acca0
[9] Palheta, Michel Santos et al. “Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning.” Radiologia brasileira vol. 56,2 (2023): 86-94. doi:10.1590/0100-3984.2022.0048
[10] De La Cruz, Maria Syl D, and Edward M Buchanan. “Uterine Fibroids: Diagnosis and Treatment.” American family physician vol. 95,2 (2017): 100-107.
[11] Christoffel, Ladina et al. “Transcervical Radiofrequency Ablation of Uterine Fibroids Global Registry (SAGE): Study Protocol and Preliminary Results.” Medical devices (Auckland, N.Z.) vol. 14 77-84. 3 Mar. 2021, doi:10.2147/MDER.S301166
[12] Gupta, Janesh K et al. “Uterine artery embolization for symptomatic uterine fibroids.” The Cochrane database of systematic reviews ,5 CD005073. 16 May. 2012, doi:10.1002/14651858.CD005073.pub3
[13] Milic, Andrea et al. “Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroids.” Cardiovascular and interventional radiology vol. 29,4 (2006): 694-8. doi:10.1007/s00270-005-0045-9
[14] Guarnaccia, M M, and M S Rein. “Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy.” Clinical obstetrics and gynecology vol. 44,2 (2001): 385-400. doi:10.1097/00003081-200106000-00024
[15] Single Arm Study Using the Symphony -- MRI Guided Focused Ultrasound System for the Treatment of Leiomyomas (HIFUSB). ClinicalTrials.gov identifier: NCT03323905. Updated July 9, 2024. Accessed July11, 2024 https://clinicaltrials.gov/study/NCT03323905
The Silent Burden: Iron Deficiency and Anemia in Women
By Henry Xu, Ph.D, Joanne Tejeda, Ph.D
original post: July 2, 2024 | updated: Sept 16, 2024
Iron is an essential mineral for your body, playing crucial roles in your immune and cardiovascular systems. It is mainly used to produce a protein called hemoglobin, which carries oxygen in red blood cells. When your body lacks sufficient iron, it can result in iron deficiency anemia, a common health issue affecting many women worldwide. Globally, more than 33% of women aged 15-49 suffer from anemia, with over 800 million cases due to iron deficiency – twice as many compared to men [1]. In Canada, an estimated 29% of women aged 19-50 experience iron deficiency anemia. [2]. These conditions can lead to various health complications, impacting overall quality of life and productivity.
In this article, we explore how to identify iron deficiency anemia and manage iron levels. Catching symptoms of anemia early and taking steps to maintain healthy iron levels are crucial for women's health.
What Causes Iron Deficiency Anemia in Women?
Iron deficiency is a condition where the body does not have enough iron to produce hemoglobin. When this condition worsens and there isn’t enough oxygen in red blood cells, it can result in iron deficiency anemia, potentially leading to tissue and organ damage. [3]. Several factors contribute to the increased prevalence of iron deficiency in women. Women of reproductive age are particularly susceptible to iron deficiency due to blood loss during menstruation [4].
Abnormal uterine bleeding (AUB) – where bleeding from the uterus is abnormal – affects up to 25% of women of reproductive age. The most common subtype of AUB is heavy menstrual bleeding (menorrhagia), which significantly increases iron loss [5]. An ongoing comprehensive review by Dr. Michelle Zeller from McMaster University is examining the effectiveness of iron treatments for AUB [6]. This research aims to improve our understanding of how iron treatments can enhance health outcomes for women with iron deficiency due to AUB.
Iron deficiency is also a common issue for expecting and postpartum mothers. The increased iron demands during pregnancy and lactation can lead to the rapid depletion of iron stores in the mother’s body, especially if the pregnancy is not supported with additional iron through nutrients or supplements.
An unbalanced diet with limited consumption of iron-rich foods, such as red meat, poultry, and fish, is another common factor leading to iron deficiency. Vegetarian and vegan diets may also pose a risk if not carefully managed to include alternative iron sources. In addition, several gastrointestinal conditions, such as celiac disease, Crohn's disease, inflammatory bowel disease (IBS), and those who have undergone gastric bypass surgery, can decrease iron absorption, leading to iron deficiency.
Common Symptoms of Iron Deficiency Anemia
The symptoms of iron deficiency and iron deficiency anemia can vary in severity and may include [4, 7]:
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The Impact of Iron Deficiency Anemia on Women’s Health
Adolescent Women
During these developmental years, bodies are rapidly changing and growing, making iron even more important. Without enough iron, adolescents can feel tired, weak, and have trouble concentrating, impacting their performance and daily activities. Additionally, as girls begin menstruating, they lose iron each month, increasing their risk of deficiency. Ensuring sufficient iron is essential for maintaining their energy levels, supporting growth, and promoting overall well-being [8].
Adult Women
Iron is equally important for adult women. Without healthy levels of iron, they might feel tired, weak, or even dizzy, greatly impacting their work and social life. Women periodically lose iron during menstruation, making it even harder to meet the body’s iron needs. Heavy and prolonged athletic activities also increase iron loss through sweating [4].
Pregnant Women
Iron needs increase significantly to support fetal development and increased blood volume. Pregnant women are often advised to take prenatal vitamins that include iron to prevent deficiency. Monitoring iron levels throughout pregnancy is essential to ensure both maternal and fetal health. Iron-deficient mothers can encounter complications during pregnancy, including preterm delivery and low birth weight [4].
Perimenopausal Women
During perimenopause, women may experience irregular or increased menstrual volume. These changes can contribute to increased iron loss and result in iron deficiency anemia. Some symptoms of perimenopause, such as fatigue and headaches, might overlap with iron deficiency symptoms, making it important for perimenopausal women to regularly check their blood iron levels to avoid developing anemia [4].
Postmenopausal Women
Postmenopausal women generally have a lower risk of iron deficiency due to the cessation of menstrual blood loss. However, they can still be affected by insufficient dietary iron or gastrointestinal issues. Regular health check-ups and maintaining a balanced diet are important for preventing iron deficiency in this age group [4].
How is Iron Deficiency Anemia Diagnosed?
Diagnosing iron deficiency anemia involves a combination of clinical evaluation and laboratory tests [3], including:
1. A Complete Blood Count (CBC), which is a comprehensive blood test used to evaluate overall health and detect a variety of disorders, including anemia, infection, and many other diseases. The CBC measures several components and features of your blood, such as Red Blood Cells (RBCs), White Blood Cells (WBC), Hemoglobin (Hgb), Hematocrit (Hct), and Platelets.
2. A Serum Ferritin Test that measures the level of ferritin in your blood. Ferritin is a protein that stores iron in your body's cells, and the amount of ferritin in your blood reflects the amount of stored iron. This test helps to evaluate your body's iron levels and diagnose conditions related to iron deficiency or excess. Low ferritin levels indicate low iron stores, which can lead to iron deficiency anemia.
Interpretation of Serum Ferritin Test Results
Table adapted from NIH National Heart, Lung, and Blood Institute [9, 10]
3. A Serum Iron and Total Iron-Binding Capacity (TIBC) test that measures the amount of circulating iron and the blood’s capacity to bind iron, respectively. Low serum iron and high TIBC levels are indicative of iron deficiency.
4. The Transferrin Saturation Test used to evaluate how much iron is bound to transferrin, the protein that transports iron in the blood. Low transferrin saturation indicates insufficient iron supply.
Treatment and Prevention
The primary goals in treating iron deficiency anemia are to replenish iron stores and address any underlying causes [3,4]. Dietary changes are usually a fundamental step in treatment and prevention. Heme iron, found in animal products, is more readily absorbed by the body compared to non-heme iron in plant-based foods. Including vitamin C-rich foods in meals can enhance non-heme iron absorption.
For women with dietary restrictions or needing additional iron, ferrous sulfate and other oral supplements are commonly used to treat iron deficiency. While effective, these supplements can cause gastrointestinal side effects like constipation and nausea, which can be mitigated by taking them with meals and consuming fiber. For those who cannot tolerate oral iron or have severe deficiencies, intravenous iron infusions may be necessary, especially in cases of absorption issues. Always consult your doctor to determine which supplement option is best for you.
If you're persistently tired or noticing other symptoms, consult a healthcare professional about iron deficiency anemia. Proactive steps like eating a balanced diet and getting regular check-ups can help maintain healthy iron levels and ensure your well-being.
New Update: September 2024 Iron Deficiency Revised Guidelines for Ontario
New guidelines introduced in Ontario on September 9, 2024, have raised the thresholds for diagnosing iron deficiency, allowing for earlier detection and improved treatment. Previously, ferritin levels below 10 to 15 micrograms per litre were flagged as abnormal, but many patients with symptoms of iron deficiency went undiagnosed due to these low thresholds. The updated standards now raise the baseline to 30 micrograms per litre for adults and 20 for children, aligning with global research and evidence dating back to 1992. This change is expected to significantly improve patient care, especially for women, marginalized communities, and those at higher risk due to conditions like heavy menstrual bleeding.
Below is the updated table reflecting the new serum ferritin level thresholds:
Interpretation of Serum Ferritin Test Results ( Per New Ontario Guidelines)
These guidelines are a major step forward in addressing health equity and improving outcomes for those who have long suffered from undiagnosed iron deficiency.
Don’t Miss Out – Access the Video Recording Now!
On July 24th, 2024, Healthyher.Life had the privilege of hosting Dr. Michelle Zeller, a clinical hematologist and Associate Professor at McMaster University, for an insightful Women Talking™ Wednesday event: "Iron is Essential for Your Health and Vitality – Are You Getting Enough?"
If you’re wondering whether you have unmet iron needs or how iron plays a critical role in your health, this is your chance to get informed. Dr. Zeller’s expert insights on the importance of iron and how to ensure you’re getting enough could make a real difference in your well-being.
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References:
[1] GBD 2021 Anaemia Collaborators. “Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021.” The Lancet. Haematology vol. 10,9 (2023): e713-e734. doi:10.1016/S2352-3026(23)00160-6
[2] Cooper, M., Bertinato, J., Ennis, J. K., Sadeghpour, A., Weiler, H. A., Dorais, V.. “Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012-2019.” The Journal of Nutrition, Mar 2023, Volume 153:5, pp1534-1543. doi:10.1016/j.tjnut.2023.03.012
[3] Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J., “Iron deficiency anaemia: pathophysiology, assessment, practical management.” BMJ open gastroenterology, 2022, Volume 9:1:e00759, doi: 10.1136/bmjgast-2021-000759
[4] Percy, L., Mansour, D., Fraser, I. “Iron deficiency and iron deficiency anaemia in women.” Best Practice & Research Clinical Obstetrics & Gynaecology, 2017, Volume 40, pp 55-67, doi: 10.1016/j.bpobgyn.2016.09.007
[5] Whitaker, Lucy, and Hilary O D Critchley. “Abnormal uterine bleeding.” Best practice & research. Clinical obstetrics & gynaecology vol. 34 (2016): 54-65. doi:10.1016/j.bpobgyn.2015.11.012
[6] Nazaryan, H., Watson, M., Ellingham, D., Thakar, S., Wang, A., Pai, M., Liu, Y., Rochwerg, B., Gabarin, N., Arnold, D., Sirotich, E., Zeller, M. P. “Impact of iron supplementation on patient outcomes for women with abnormal uterine bleeding: a protocol for a systematic review and meta-analysis.” Systematic reviews, Jul 2023, Volume 12:1, pp 121, doi: 10.1186/s13643-023-02222-4
[7] “Iron-Deficiency Anemia.” Office on Women's Health, U.S. Department of Health and Human Services, Feb. 2022, www.womenshealth.gov/a-z-topics/iron-deficiency-anemia.
[8] Aksu, Tekin, and Şule Ünal. “Iron Deficiency Anemia in Infancy, Childhood, and Adolescence.” Turkish archives of pediatrics vol. 58,4 (2023): 358-362. doi:10.5152/TurkArchPediatr.2023.23049
[9] “Iron-Deficiency Anemia.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, 24 Mar. 2022, www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia.
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[11] Harrison, L. (2024, September 9). Ontario's new iron deficiency guidelines may change lives: Doctors. CBC News. www.cbc.ca/news/canada/toronto/iron-deficiency-bloodwork-testing-ontario-1.7314795
Switching to the Mediterranean Diet can be effective at reducing chronic endometriosis-related pelvic pain
Reviewed by Rina Carlini, PhD
November 17, 2023
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A study of 35 women with endometriosis found a positive correlation between switching to a Mediterranean diet for at least 6 months and significantly reduced non-menstrual pelvic pain, especially during intercourse (dyspareunia), urination (dysuria), and defecation (dyschezia). After only three months on the Mediterranean diet, pain experienced during intercourse (dyspareunia) and defecation had lessened, and after six months, pain from urination was significantly reduced.
The researchers also found both positive and negative correlations between lipid metabolism (from unsaturated plant oils) and non-menstrual pelvic pain. The research study had a few notable limitations, including a small population size of only 35 women, all of whom were Causasian, and the study was conducted during a short 6 month period of time. However researchers concluded with relative confidence that switching to a Mediterranean diet holds promise as an effective strategy for managing chronic endometriosis-related pain over the long term.
Reference
[1] M. Cirillo et al.; “Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis.” Int J Mol Sci, 2023, 24(19):14601; DOI: 10.3390/ijms241914601
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