Question:

I have been having very heavy periods after stopping the pill a few years ago. I am now 44. My hair is beginning to get thinner. I am taking iron supplements, but my iron/ferritin levels are a little low. However, my hemoglobin level is borderline high.

1. Is endometrial ablation contraindicated in someone with a bicornuated uterus?

2. What would cause low iron but high hemoglobin?

3. How much iron supplementation per day is needed to replenish iron stores?

Answer:

Answered by Dr. Jonathan Schaffir:

1. Endometrial ablation is a procedure through which the lining of the uterus (endometrium) is destroyed by a variety of techniques. Ablation can be performed with heat, freezing, electrical current, or microwave energy. Various tools are available to perform this procedure, each with a slightly different design.

A bicornuate uterus is one in which the uterine cavity is divided into two horns, creating more surface area from which bleeding can occur. Most of the devices that perform ablation are not designed to conform to a cavity of this shape. Of those that are available, the device that uses circulating hot water to scald the endometrium is the one most likely to be used on a bicornuate uterus. Of course, the decision of whether or not an ablation is appropriate also depends on factors that have to do with your health and other gynecological concerns, so it is best to discuss the matter with your gynecologist.

2. You can have a normal hemoglobin, but yet still have low iron stores. This can be seen in either a developing anemia or in one that is getting better.

As for the questions on iron stores and iron supplementation, they would best be answered by a specialist in blood and blood diseases.  That answer appears below.

Answered by Dr. Spero Cataland:

3. In general you need about 100-150 mg of elemental iron per day to treat an iron deficiency anemia. You can find the amount of elemental iron in each pill on the side of the bottle. Typically you need 6 months to completely replenish your iron stores, but that is also dependent on the amount of ongoing iron/blood loss.

For more information:

Go to the Bleeding and Clotting Disorders health topic.