This series of bite-sized episodes contains important information you need to know about iron deficiency and iron deficiency anemia in your female patients. Dr. Malcolm Munro and colleagues discuss recent evidence and provide practical approaches for screening, diagnosing, treating, and preventing the progression of this condition.
ID and IDA in Postmenopausal Women
ID and IDA in Postmenopausal Women
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This is CME on ReachMD, and I am Dr. Malcolm Munro from UCLA, and I'm here with Dr. Michael Auerbach, a hematologist from Georgetown and a clinical professor there.
Michael, the average woman lives at least a third of her life after menopause. And so this creates this unique circumstance in an individual who is no longer bleeding, although I might say that those who are early menopausal may still have carryover from their heavy menstrual bleeding, but in general, they don't have bleeding. How do you approach the woman who is postmenopausal differently, perhaps, than the younger individual?
The postmenopausal woman who has unexplained iron deficiency is the same as a man with iron deficiency, and you must exclude malignancy. So the first thing you say to yourself is that iron deficiency in a postmenopausal woman is cancer until proven otherwise. There aren't too many other causes other than gastrointestinal blood loss. Malabsorption is certainly one. We rarely see nutritional iron deficiency in the United States. So I think that a clinician who sees a woman who is no longer menstruating and no longer in reproductive years must take it as his or her responsibility to elucidate the cause.
The primary care physician may already know that up front, but what should they do or who should they involve to help them sort this out, including that search for malignancy?
Well, Malcolm, we're talking about iron deficiency here. So if someone has chronic kidney disease, they're not necessarily iron deficient. Inflammatory bowel disease, usually a disease of younger people, tends to cause iron deficiency because of blood loss and malabsorption. So iron deficiency unto itself, with or without chronic kidney disease, with or without inflammatory bowel disease, must be defined by etiology. I think with IBD, inflammatory bowel disease, you don't have to look further. A patient with chronic kidney disease with iron deficiency is not excluded from having a workup to identify the cause.
Very important to not assume that this is related to menstrual bleeding and to be very careful to investigate her differently from perhaps the younger woman.
So this has been a brief but great discussion. Unfortunately, our time is up. Thanks for tuning in.
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In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Malcolm G. Munro MD, FRCS(c), FACOG
Clinical Professor, Department of Obstetrics & Gynecology
David Geffen School of Medicine at UCLA
Chair, Women’s Health Research Collaborative
Los Angeles, CA
Research: AbbVie, Pharmacosmos
Ownership Interest: Channel Medical, Okon, Gynesonics, U-Vision 360
Patent Holder: Simulators – Assigned to AAGL
Consulting Fees: AbbVie, American Regent
Michael Auerbach, MD
Clinical Professor of Medicine
Georgetown University School of Medicine
Research: Covis Pharma
Arjeme Denise Cavens, MD
Instructor of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine
No relevant relationships reported.
Michael K. Georgieff, MD
Martin Lenz Harrison Land Grant Chair in Pediatrics
Professor of Pediatrics, Obstetrics and Gynecology, and Developmental Psychology
University of Minnesota Medical School
No relevant relationships reported.
Lee P. Shulman, MD, FACOG, FACMG
The Anna Ross Lapham Professor and Chief
Division of Clinical Genetics
Feinberg School of Medicine of Northwestern University
Consulting Fees: Agile, Aspira, Bayer, Biogix, Celula China, Daiichi Sankyo, Mayne, Organon, Shield
Other: Astellas (DSMB Chair)
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP
Owner and Family Nurse Practitioner
Wright & Associates Family Healthcare
Consulting Fees: AbbVie, Biohaven, GSK, Idorsia, Merck, Moderna, Pfizer, Sanofi, Seqirus, Shield Therapeutics
- Jennifer Brutsche, RN, BSN, AHA BLS Instructor, has nothing to disclose.
- Cindy Davidson has nothing to disclose.
- Libby Lurwick has nothing to disclose.
- Kate Nagele has nothing to disclose.
- Robert Schneider, MSW, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Describe the basics of iron physiology, including its critical role in cellular processes, and impact on growth and development throughout the life span.
- Identify appropriate screening and diagnosis methods throughout the life span.
- Describe the potential impact of iron deficiency (ID)/ ID anemia (IDA) and its treatment, throughout the life span.
- Identify the benefits and disadvantages of using oral iron therapies in the management of iron deficiency (ID) and ID anemia (IDA).
This activity is designed to meet the educational needs of obstetrician-gynecologists, other women’s health HCPs, and primary care physicians.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until March 31, 2024. PAs should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is supported by an independent educational grant from Shield Therapeutics.
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