Iron deficiency is one of the most common health problems worldwide. The women of reproductive age who experience excessive menstrual bleeding are most susceptible to this mineral deficiency (Mirza et al., 2018). Specifically, females from 16 to 19 years old with heavy menses were found to have the highest prevalence of iron deficiency in the United States (Cooke et al., 2017). Iron is necessary for various biochemical processes in the human organism. For example, iron is an essential component of hemoglobin vital for oxygen transport to organs and tissues that can be damaged quickly without oxygenation (Mirza et al., 2018).
Iron deficiency can lead to microcytic anemia, which is the condition that develops when smaller red blood cells are produced in the bone marrow due to insufficient iron stores (Bayen et al., 2020). The consequences of anemia can affect physical performance, memory, immunity, and mental health (Bayen et al., 2020). Furthermore, iron deficiency was associated with developing such psychiatric conditions as depression, sleep deprivation, and anxiety disorder (Lee et al., 2020). Treating this micronutrient deficiency in women with heavy menstruation should be the common goal for patients and healthcare workers.
King’s Theory: Collaboration Between Nurses and Patients to Improve Iron Deficiency
Nurses are knowledgeable and skilled professionals who work on the frontline of healthcare and often spend more time with patients. The modern nursing practice involves implementing evidence-based theories that revolve around patient communication (Adib-Hajbaghery & Tahmouresi, 2018). One of these theories is King’s theory of goal attainment that focuses on patient-centered care (Adib-Hajbaghery & Tahmouresi, 2018). This theory comprises four main elements: patient-nurse relationship, mutual understanding, common goals, and nurse’s knowledge (Adib-Hajbaghery & Tahmouresi, 2018). According to this theory, nurses need to apply their knowledge and skills to establish good communication with patients and their families to achieve specific health goals (Adib-Hajbaghery & Tahmouresi, 2018).
Nurse-patient relationships are built upon understanding each other’s goals and accurate perception of personal beliefs and values (Adib-Hajbaghery & Tahmouresi, 2018). For example, female nurses may better comprehend iron insufficiency in women with heavy menstruation or abnormal uterine bleeding. Thus, the rationale for choosing King’s theory for this project is that nurses that can establish excellent communication with patients have higher chances of convincing patients about the importance of treating this deficiency. It will result in better health outcomes in women with mineral deficiency.
Iron supplementation in women with abnormal menstrual bleeding can prevent negative consequences of anemia on their health and revert some existing health issues associated with the deficiency. Since iron participates in various biochemical reactions in the human body, its shortage presents multiple clinical signs (Dziembowska et al., 2019). The symptoms include fatigue, headache, dizziness, tachycardia, restless leg, pica, impaired memory, and higher susceptibility to infections (Lee et al., 2020). Cognitive functions are affected because iron deficiency causes improper myelination of neurons that impairs the formation of new synapses (Lee et al., 2020).
Furthermore, iron participates in serotonin and dopamine reuptake; thus, lower levels of these neurotransmitters in anemic patients can result in mood disorders (Dziembowska et al., 2019). Still, there is no precise data about the role of this micronutrient in psychiatric disorders (Lee et al., 2020). One nationwide cohort study in Taiwan showed that anemic patients had a greater risk of developing anxiety disorders and depression and that treatment of iron deficiency was associated with the reduced sleep disturbances (Lee et al., 2020). It appears that iron loss during heavy menses requires supplementation to achieve normal levels.
Iron deficiency can be defined based on the laboratory ranges of ferritin in the patient’s serum. Ferritin is a carrier protein that stores iron in cells, and a value lower than 15 ug/L is considered iron deficiency (O’Brien, 2018). The first-line therapy is oral iron additives in mild and moderate cases (Mirza et al., 2018). However, intravenous iron can be utilized in severe deficiencies of this essential element (Mirza et al., 2018). Iron is usually given in ferrous sulfate form, an active state of the molecule, combined with ascorbic acid to facilitate absorption in the stomach (Low et al., 2016).
The recommendations for iron supplementation vary, but most guidelines suggest the low-dose intervention of ferrous sulfate in adolescents with substantial blood loss during menstruation who should receive 3mg/kg of iron once a day (O’Brien, 2018). Adult female patients should receive 65-130 mg of iron per day until the complete resolution of the deficiency (O’Brien, 2018). However, excessive blood loss during menstruation should be addressed and treated accordingly with hormonal therapy because the management of symptoms is effective in the short term, but it can be harmful in a longer perspective.
The Outcomes of Iron Supplementation
Although data is contradictory about the role of iron supplementation in women’s psychiatric health, some studies demonstrated significant improvement in those who received treatment for iron deficiency. According to Low et al. (2016), women who received an oral supplement of ferrous sulfate had better physical performance and lower fatiguability, but no significant effect on psychological health was found. In contrast, another study demonstrated the positive influence of restoring normal serum iron levels on physical fitness and the significant risk reduction for anxiety disorders and clinical depression compared to the placebo group (Lee et al., 2020).
The results of the studies are contradictory, but the importance of iron in oxygen transport, reuptake of neurotransmitters, and myelination of axons suggest that iron deficiency should be treated in the population at risk. Specifically, female patients complaining about heavy menstrual bleeding and mood disturbances should be evaluated for micronutrient insufficiency. Because this issue is complex, a multi-disciplinary approach is needed to manage symptoms and the underlying cause in these patients.
In conclusion, iron supplementation in women with heavy menstruation is essential for increasing physical performance, reducing fatigue, strengthening immune function, and improving memory. Iron is necessary for tissue oxygenation, myelination of nerve cells, and neurotransmitter reuptake. Although some researchers suggest that iron deficiency is associated with such psychiatric disorders as anxiety and depression, the results of different trials are still inconsistent. A large cohort study showed that iron supplements improved the physical fitness of the participants, but there was no statistically significant improvement in psychological status.
On the other hand, another research found that restoring iron stores led to a risk reduction of depression and anxiety disorder in women with heavy menstrual bleeding than those who received a placebo treatment. Undoubtedly, restoring normal iron levels is critical in women who become deficient due to abnormal uterine bleeding, and health practitioners should explain this information to patients. Specifically, nurses, who spend more time with patients, should utilize their knowledge and communication skills to help women achieve better health. However, it is also crucial to address other underlying causes of excessive bleeding during menses to prevent long-term complications.
Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse-patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141-144.
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Cooke, A. G., McCavit, T. L., Buchanan, G. R., & Powers, J. M. (2017). Iron deficiency anemia in adolescents who present with heavy menstrual bleeding. Journal of Pediatric and Adolescent Gynecology, 30(2), 247–250. Web.
Dziembowska, I., Kwapisz, J., Izdebski, P., & Żekanowska, E. (2019). Mild iron deficiency may affect female endurance and behavior. Physiology & Behavior, 205, 44–50. Web.
Lee, H.-S., Chao, H.-H., Huang, W.-T., Chen, S. C.-C., & Yang, H.-Y. (2020). Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: A nationwide database analysis. BMC Psychiatry, 20(1). Web.
Low, M. S., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S.-R. (2016). Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database of Systematic Reviews. Web.
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O’Brien S. H. (2018). Evaluation and management of heavy menstrual bleeding in adolescents: The role of the hematologist. Hematology. American Society of Hematology. Education Program, 2018(1), 390–398. Web.