Community study of menstrual iron loss and its association with iron deficiency anaemia.

Abstract

Although anaemia, as conventionally defined, appears to be common in Great Britain (Kilpatrick, 1961; Elwood, 1964), little is known about the factors which are likely to cause a negative iron balance and eventually lead to iron deficiency anaemia. The main loss of iron from the body in females is by menstruation, but the relative impor tance of menstrual loss and dietary intake of iron in the determination of the level of circulating haemoglobin does not seem to have been examined in a representative sample of the community. A series of epidemiological studies was conducted recently to investigate a variety of aspects of iron deficiency. The basic study is described in Elwood, Waters, Greene, and Wood (1967). In the study reported here, the association between haemato logical state and menstrual loss of iron is examined in a representative sample drawn from a total community. Details of the dietary intake of iron in these women will be presented elsewhere but the relevance to iron balance of both menstrual loss and dietary intake is examined. Method An area in the Rhondda Fawr was selected and the 1,005 female residents aged 20 to 64 years we e invited to co-operate in a haematological survey. Women who were pregnant were omitted. The 355 women who were between 20 and 39 years inclusive were stratified by haemoglobin level at intervals of 1 g./lOO ml. blood, and within these groups sub-samples of up to eleven subjects were chosen at random to give a total sample of 59 (Table I). Of these, four who had become pregnant since the initial survey were excluded, as were a fu ther six whose menstrual periods occurred at such irregular intervals that estimates of the iron lost in one or two menstrual periods could not be used as guide to the loss over long periods of time. Each woman was visited by a doctor and asked co-operate in the present study. Those who agreed were visited by a health visitor (G.R.) and the method for collection of the menstrual loss was explained. Soluble pads or tampons of a single make were supplied throughout the study.