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This review discusses the mechanisms linking uterine disorders like leiomyomas, adenomyosis, polyps, and cesarean scar defects to abnormal uterine bleeding and subsequent iron deficiency anemia.
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by claude@2026-06, 2026-06-09
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This 2022 review discusses abnormal uterine bleeding (AUB) as a cause of iron deficiency anemia and outlines mechanisms linking uterine disorders to AUB using the PALM-COEIN classification, spanning structural and non-structural etiologies. It highlights that heavy menstrual bleeding is more closely related to uterine fibroids, while noting that the connection remains poorly characterized—especially regarding endometrial function in women with structural myometrial features. For uterine adenomyosis, it summarizes evidence that its pathogenesis is multifactorial, with theories including direct invasion of the myometrium by endometrial cells versus de novo development, and it emphasizes a tissue injury-and-repair model for lesion development; the review also covers other AUB causes such as endometrial polyps and cesarean scar defects. Relevance to endometriosis: the paper does not explicitly discuss endometriosis, but it centers on adenomyosis as a key uterine disorder in AUB-related iron deficiency anemia. This paper is centrally about adenomyosis — it reviews mechanisms by which adenomyosis causes abnormal uterine bleeding leading to iron deficiency anemia.
Abstract
Abnormal uterine bleeding (AUB) is a clinical entity which can lead to iron deficiency anemia. Classification according to the acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia; coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise classified) provides a structured approach to establish the cause of AUB. The goal of this review is to discuss the different mechanisms and the relationship between uterine disorders and AUB. Heavy menstrual bleeding, a subgroup of AUB, is more closely related to the presence of uterine fibroids. The relationship between heavy menstrual bleeding and uterine fibroids remains poorly characterized, particularly the understanding of endometrial function in women with structural myometrial features such as leiomyomas. A number of theories have been proposed in the literature and are discussed in this review. Uterine adenomyosis is also a frequent cause of AUB, and its pathogenesis is still far from being fully elucidated. The mechanisms contributing to its development are multifactorial. Many theories lean toward invasion of the myometrium by endometrial cells. Both clinical and basic studies favor the theory of direct invasion, although de novo development of adenomyosis from Müllerian rests or stem cells has not been ruled out. Development of adenomyotic lesions involves repeated tissue injury and repair. In addition, this review describes the other causes of AUB such as endometrial polyps, cesarean scar defects, and uterine vascular abnormalities. Endometrial polyps are often asymptomatic, but approximately 68% of women have concomitant AUB. Histologic alterations in the lower uterine segment in patients who had undergone cesarean sections were identified and may explain the cause of AUB.
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Uterine disorders and iron deficiency anemia.
(2022) Fertility and sterility — Vol. 118, n° 4, p. 615-624 (2022)
(2022) Fertility and sterility — Vol. 118, n° 4, p. 615-624 (2022)
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Donnez, Jacques - Author
Carmona, Francisco - Author
Maitrot-Mantelet, Lorraine - Author
- Author
Chapron, Charles
- Abstract
- Abnormal uterine bleeding (AUB) is a clinical entity which can lead to iron deficiency anemia. Classification according to the acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia; coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise classified) provides a structured approach to establish the cause of AUB. The goal of this review is to discuss the different mechanisms and the relationship between uterine disorders and AUB. Heavy menstrual bleeding, a subgroup of AUB, is more closely related to the presence of uterine fibroids. The relationship between heavy menstrual bleeding and uterine fibroids remains poorly characterized, particularly the understanding of endometrial function in women with structural myometrial features such as leiomyomas. A number of theories have been proposed in the literature and are discussed in this review. Uterine adenomyosis is also a frequent cause of AUB, and its pathogenesis is still far from being fully elucidated. The mechanisms contributing to its development are multifactorial. Many theories lean toward invasion of the myometrium by endometrial cells. Both clinical and basic studies favor the theory of direct invasion, although de novo development of adenomyosis from Müllerian rests or stem cells has not been ruled out. Development of adenomyotic lesions involves repeated tissue injury and repair. In addition, this review describes the other causes of AUB such as endometrial polyps, cesarean scar defects, and uterine vascular abnormalities. Endometrial polyps are often asymptomatic, but approximately 68% of women have concomitant AUB. Histologic alterations in the lower uterine segment in patients who had undergone cesarean sections were identified and may explain the cause of AUB.
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Donnez, J., Carmona, F., Maitrot-Mantelet, L., Dolmans, M.-M., & Chapron, C. (2022). Uterine disorders and iron deficiency anemia. Fertility and sterility, 118(4), 615-624. https://doi.org/10.1016/j.fertnstert.2022.08.011 (Original work published 2022)
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