Should one be worried about high iron levels with a fibroid?

Question

Hello doctor,

I have a 3.4-inch pedunculated fibroid discovered during a private pelvic scan. Blood tests show high iron levels, but tests for hemochromatosis came back negative.

Given the association between low iron and fibroids, should I be concerned about high iron levels with fibroids? Are there additional tests I should consider?

For six months, I have experienced sharp left-sided pain, frequent urination, and heavy periods with large blood clots. The pain begins a week before my period and continues during and for a week after, with a week of no pain in between. It sometimes radiates across my abdomen, and I feel tired, dizzy, and have lost my appetite, though I have not lost weight. Pain medication is now necessary for my periods, whereas I previously managed with just hot water bottles.

Seven years ago, I had CIN 3 cells removed from my cervix following a smear test. Since then, I have had regular smear tests with no signs of abnormal cells or HPV. My next smear test is due in 2025. I am currently taking a tablet containing Mefenamic acid for fibroid-related pain and period issues. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

We feel glad that you reached out to us.

Your symptoms of sharp pain and heavy bleeding are associated with a pedunculated fibroid (a type of fibroid (or leiomyoma) that is attached to the uterus by a stalk or peduncle). Additionally, your tiredness and dizziness could be due to iron deficiency anemia (the body lacks sufficient iron to produce adequate amounts of hemoglobin) from the heavy bleeding.

Here is how iron deficiency anemia typically progresses:

Iron demand: The body first uses circulating serum iron, leading to decreased serum iron levels.
Stored iron: The body then uses stored iron from the liver, spleen, and bone marrow, which reduces serum ferritin levels.
Compensatory changes: If iron demands are still unmet, the body increases gastrointestinal absorption of iron, transferrin levels, and transferrin receptor concentrations.
Long-standing anemia can result from this process of hemodilution (the dilution of blood components due to increased blood volume).

I suggest the following tests:

Red blood cell (RBC) indices.
Peripheral smear.
Reticulocyte count.
Serum ferritin.

For definitive treatment, I suggest a hysteroscopic-guided removal of the fibroid is advised, along with evaluation and assessment of the endometrium.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.