How should young menstruating women with iron deficiency anemia be evaluated?
The evaluation of iron-deficiency anemia in pregnant or relatively young menstruating females is individualized according to clinical presentation and menstrual and obstetric history. Iron deficiency during pregnancy is common. In a series of 186 menstruating women, 12% had a clinically important lesion detected by endoscopy. The most common cause of bleeding was peptic ulcer disease in 3%, and gastric cancer in 3%. On multivariate analysis, independent predictors of a significant lesion at endoscopy included a positive FOBT, hemoglobin less than 10 g/dL, and abdominal symptoms. Menstruating females presenting with iron-deficiency anemia who have a positive FOBT, anemia out of proportion to menstrual blood loss, abdominal symptoms, are 40 years old or older, or have a family history of GI malignancy should be strongly considered for GI endoscopy.