Serum Ferritin and Hemoglobin Levels as Predictors of Clinical Severity and Response to Pharmacological Therapy in Women with Heavy Menstrual Bleeding

Abstract

Background: Heavy menstruation is a frequent gynecological issue that can cause progressive iron deficiency, tiredness, anemia, and diminished quality of life. Hb is routinely ordered for the evaluation of anemia, and serum ferritin is an estimation of body iron stores and can help detect iron deficiency even before anemia occurs.

Objective: To evaluate serum ferritin and hemoglobin levels as predictors of clinical severity and response to pharmacological therapy in women with heavy menstrual bleeding.

Methodology: This prospective observational study was conducted at Pak International Medical College, Peshawar, from January 2025 to June 2025 and included 75 women with heavy menstrual bleeding. Baseline hemoglobin, serum ferritin, hematocrit, mean corpuscular volume (MCV), and other hematologic parameters were measured, along with clinical severity determined with the Pictorial Blood Loss Assessment Chart (PBAC). Participants were given treatment based on the indications and re-evaluated after therapy. The change in PBAC score, bleeding time, hemoglobin, and serum ferritin was noted. Identifiers of treatment response were done by correlation and multi-variate logistic regression.

Results: The mean baseline hemoglobin level was 9.9 ± 1.5 g/dL and mean serum ferritin was 15.8 ± 8.9 ng/mL. Severe heavy menstrual bleeding was associated with significantly lower hemoglobin and ferritin concentrations compared with mild and moderate disease (p < 0.001). PBAC scores showed significant inverse correlations with hemoglobin (r = −0.58, p < 0.001) and serum ferritin (r = −0.62, p < 0.001). Following pharmacological treatment, mean PBAC score decreased from 186.7 ± 58.4 to 92.6 ± 39.7, hemoglobin increased to 11.2 ± 1.3 g/dL, and serum ferritin increased to 26.9 ± 12.1 ng/mL (all p < 0.001). Overall, 57 women (76.0%) responded to therapy. Higher baseline hemoglobin and ferritin were independently associated with successful treatment response.

Conclusion: Lower serum ferritin and hemoglobin levels were associated with greater clinical severity of heavy menstrual bleeding and poorer response to pharmacological therapy. Combined assessment of hemoglobin and serum ferritin may help stratify disease severity, identify iron depletion, and support individualized therapeutic management.