skip to main content

Iron Deficiency Menorrhagia CKD Dual Cause — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic Kidney DiseaseIron Deficiency Menorrhagia CKD Dual CauseESENeph

A 55-year-old woman with CKD G3b develops iron deficiency (ferritin 25, TSAT 10%). She has menorrhagia from uterine fibroids. Oral iron has been tried for 3 months without response. Before starting IV iron, what gynaecological cause should be addressed?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Menorrhagia from fibroids is the likely primary cause of iron deficiency – addressing the cause (gynaecological referral for fibroid management) is as important as iron replacement; treating the symptom (iron deficiency) without addressing the cause leads to recurrence

While CKD-related anaemia involves multiple mechanisms (reduced EPO, hepcidin-mediated iron sequestration, reduced RBC lifespan), superimposed iron loss from gynaecological, GI, or other sources must be identified and treated. In this pre-menopausal woman, menorrhagia from fibroids is the most likely cause of iron deficiency (ferritin 25, TSAT 10% – true iron depletion, not just functional deficiency). IV iron will temporarily correct the deficiency, but without addressing the fibroid-related blood loss, it will recur. Gynaecological referral for fibroid management is essential alongside CKD anaemia treatment.

Reference: KDIGO 2025 – Anemia in CKD; NICE NG88 – Heavy Menstrual Bleeding