Prevalence and Factors Associated with Anemia among Women with Uterine Fibroids at Mbarara Regional Referral Hospital, Uganda

Background Uterine fibroids are common during reproductive years and are frequently symptomatic, with anemia being a major complication following heavy menstrual bleeding. However, the burden of anemia and the characteristics of affected women with uterine fibroids remain poorly documented in low-resource settings, including Uganda, limiting evidence-based care. We determined the prevalence and factors associated with anemia among women with uterine fibroids at a tertiary referral hospital in southwestern Uganda. Methods We conducted a cross-sectional study among women with a sonographic diagnosis of uterine fibroids attending the gynecology clinic and ward at Mbarara Regional Referral Hospital (MRRH), Uganda, between July and December 2024. Sociodemographic, gynecological, and medical characteristics were collected using interviewer-administered structured questionnaires. Menstrual blood loss was assessed using the pictorial blood loss assessment chart, with scores ≥ 100 indicating heavy menstrual bleeding (> 80 mL per cycle). Anemia was defined as a hemoglobin concentration < 12.0 g/dL, in accordance with World Health Organization criteria for non-pregnant women, and severity was classified as moderate (8.0–10.9 (g/dL) or severe (< 8.0 g/dL). Modified Poisson regression with robust variance was used to identify factors independently associated with anemia, reported as adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs). Results In total, 273 women were enrolled. The mean age was 40 ± 9 years; most participants were married (67.4%), urban residents (52.7%), and unemployed (72.9%). Overall, 179 women had anemia, giving a prevalence of 65.6% (95% CI: 59.6%–71.2%), predominantly moderate (46.4%) and severe (29.0%). Presence of fibroids in multiple uterine sites (aPR = 1.89; 95% CI: 1.02–3.52) and a history of heavy menstrual bleeding (≥ 80 mL) (aPR = 2.17; 95% CI: 1.68–2.81) were independently associated with anemia. Conclusion The prevalence of anemia was high, affecting two-thirds of women with uterine fibroids. There is need for strengthening routine anemia screening among women presenting with multiple uterine fibroids and heavy menstrual bleeding so as to prevent them for developing anemia associated complications.