Clinical efficacy of combination therapy with iron and folic acid in reproductive-age patients with abnormal uterine bleeding
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.812
Abstract
Introduction. The high prevalence of iron deficiency in women with abnormal uterine bleeding (AUB) requires optimizing therapeutic approaches.
Aim: to evaluate the clinical efficacy and safety of therapy with iron fumarate in combination with folic acid in reproductiveage patients with AUB complicated by iron deficiency anemia (IDA) and latent iron deficiency (LID).
Materials and Мethods. There were retrospectively analyzed 75 outpatient patient records (2021–2025) stratified as follows: 40 patients with IDA (hemoglobin level < 120 g/L) and 35 patients with LID (ferritin content < 30 ng/ml). Patients received iron fumarate 163.56 mg (equivalent to 50 mg iron) + folic acid 540 μg (equivalent to 500 μg dry matter) for a course of 12 weeks. Treatment efficacy was assessed according to the hemoglobin, ferritin and sideropenic syndrome severity scales.
Results. A statistically significant increase in red blood parameters in all groups (p < 0.001) was recorded during treatment. The following changes were found: in IDA group median hemoglobin and ferritin level increased from 110 to 123 g/L and from 12 to 21 ng/ml, respectively; in LID group – from 123 to 136 g/L and from 22 to 34 ng/ml, respectively.
Conclusion. Combination therapy with iron and folic acid preparations demonstrates high efficacy and safety in correcting anemic and sideropenic syndromes in patients with AUB, which justifies the expediency of its inclusion in the management standards for this category of patients.
Supporting agencies: The authors conducted the study independently. Alcea LLC supported the publication (a publication fee was provided to the publisher). Alcea LLC employees were able to review the study results. All final decisions regarding the text of the publication were made by the authors personally.
About the Authors
T. M. Sokolova
Novosibirsk State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Tatiana M. Sokolova, MD, Dr Sci Med, Prof.
52 Krasny Prospekt, Novosibirsk 630091
K. Yu. Makarov
Novosibirsk State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Konstantin Makarov, MD, Dr Sci Med, Prof.
52 Krasny Prospekt, Novosibirsk 630091
V. M. Kuleshov
Novosibirsk State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Tatiana V. Kiseleva, MD, Dr Sci Med, Prof.
52 Krasny Prospekt, Novosibirsk 630091
T. V. Kiseleva
Novosibirsk State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Vitaly M. Kuleshov, MD, Dr Sci Med, Prof.
52 Krasny Prospekt, Novosibirsk 630091
A. V. Yakimova
Novosibirsk State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Anna V. Yakimova, MD, Dr Sci Med, Prof.
52 Krasny Prospekt, Novosibirsk 630091
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What is already known about this subject?
► Abnormal uterine bleeding (AUB) is the leading modifiable risk factor for iron deficiency in reproductive age women, and the association between AUB and latent iron deficiency (LID) is often underestimated in clinical practice.
► Up to 53 % of reproductive age women have symptoms of abnormal blood loss, thereby referring them to high risk group of developing both anemia and LID, which requires timely correction.
► Combined preparations based on ferrous fumarate demonstrate high bioavailability due to the distal release of the active substance, which minimizes gastrotoxicity and ensures better patient therapy tolerability.
What are the new findings?
► For the first time within the Russian retrospective study, the statistically significant efficacy of ferrous fumarate was proven in patients with AUB, where continued blood loss usually neutralizes the results of standard ferrotherapy.
► It has been established that folic acid added to iron supplement not only corrects anemia, but also reliably relieves sideropenic syndrome (hair loss, muscle hypotonia) faster than historically reported for iron monotherapy.
► The lack of clinically significant adverse events while using this drug combination has been proven even in case of concomitant uterine pathologies (adenomyosis, fibroids), thereby justifying the safety of a long-term 12-week treatment regimen for outpatient care.
How might it impact on clinical practice in the foreseeable future?
► The results substantiate the advisability of prescribing iron and folic acid preparations by gynecologists as early as at the stage of AUB diagnosis, without waiting for severe anemia. This may shorten temporary disability and improve women’s quality of life due to the early relief of sideropenic syndrome.
► The confirmed safety of the combining ferrous fumarate with folic acid may contribute to revise the standards of management for patients with fibroids and adenomyosis. Physicians will be able to use oral drugs instead of injections more actively due to the proven low gastrotoxicity of the former.
► The inclusion of this therapeutic regimen in the updated clinical guidelines of the Ministry of Health of the Russian Federation standardizes patient routing. This will ensure a uniformity of approaches to iron deficiency treatment in АUВ Russia-wide and reduce frequency of unjustified prescriptions of parenteral therapy.
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For citations:
Sokolova T.M., Makarov K.Yu., Kuleshov V.M., Kiseleva T.V., Yakimova A.V. Clinical efficacy of combination therapy with iron and folic acid in reproductive-age patients with abnormal uterine bleeding. Obstetrics, Gynecology and Reproduction. 2026;20(4):669-677. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.812
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