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Monthly blood loss through menstruation can cause anemia
Heavy menstrual bleeding can make you more susceptible to iron deficiency anemia
Symptoms of iron deficiency anemia include: tiredness, weakness, shortness of breath, poor concentration, lightheadedness
Anemia can sneak up on you—especially iron deficiency anemia. It can happen slowly, over years, so that you might not notice the changes. A fatigue that you can’t shake, regardless of how much you rest. Feeling easily out of breath from activities you could always do before. Unexplained changes in your hair, nails, skin. These are just some of the symptoms of iron deficiency. Anemia is a huge public health problem globally, with 1.62 billion people (24.8% of the world population) predicted to be impacted (1).
First: what is anemia?
Anemia is the reduction in red blood cells or hemoglobin within the body (2). Hemoglobin is an iron-containing protein within your red blood cells. Hemoglobin binds and transports oxygen molecules to the cells of your body. With fewer red blood cells, your body (including your brain) cannot receive enough oxygen and function optimally.
What causes anemia?
Red blood cells are made in your bone marrow and have a lifespan of approximately 110 days, during which they circulate and deliver gases throughout the body (3). As they age, they are eventually broken down in the spleen, lymph nodes, and liver, and their parts are recycled within the body. Any disruption along the lifecycle of the red blood cell (creation, functional life span, or destruction) could cause anemia. Common causes of anemia include: blood loss, parasitic infections, nutritional deficiencies, absorption problems, and chronic disease (1,2). Anemia is a broad topic. There are many different causes and manifestations of it.
For the purpose of this article, though, we’ll only be focusing on iron deficiency anemia—a particular type of anemia—and how it relates to menstrual and gynecological health.
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Periods and anemia
People who menstruate are disproportionately affected by anemia due to the fact that they lose blood through their periods.
In fact, 29% of non-pregnant women and 38% of pregnant women worldwide are affected by anemia (4).
When blood is lost every month during menstruation, the iron within those red blood cells is also lost. If monthly iron intake and absorption does not replace the iron lost during your period, you can end up with iron deficiency anemia (2).
People with heavy menstrual bleeding are more susceptible to iron-deficiency anemia. A person is considered to have heavy menstrual bleeding when their menstrual period is typically over 80 ml (5). Some causes of heavy menstrual bleeding can be attributed to fibroids (abnormal growth of muscle tissue on your uterus), adenomyosis (a condition where endometrial tissue invades into the muscular wall of the uterus), polyps (abnormal growths on your cervix or the inside of your uterus) or bleeding disorders (6).
Menstrual periods are not the only gynecological source of iron-deficiency anemia. During pregnancy and lactation, as with any time of increased growth and development, there is an increased need for iron (2,7). It is important for pregnant people to ensure that they have adequate iron, since low iron levels can harm both parent and child (2). During pregnancy, you need 2 to 3 times the normal amount of iron you’d need when not pregnant (8). Blood loss during childbirth can also further contribute to anemia.
What are the symptoms of anemia?
Anemia, particularly the iron deficient type, can have an insidious onset as it can take years to slowly develop. Some of the symptoms of iron deficiency anemia include: tiredness, weakness, shortness of breath, poor concentration, lightheadedness, cold intolerance, and heart palpitations (1,2,9).
Other physical signs that your healthcare provider will look for are: paleness (particularly on your inner eyelids), hair loss, chapping at the corners of your mouth, nail changes, and poor circulation (cold fingers and toes) (1,2,9).
I have iron deficiency anemia. What now?
Seems obvious — just eat more iron, right? Well, not necessarily. Increasing iron intake through your diet is a great place to start. There are two types of dietary iron: heme iron and nonheme iron.
Heme iron sources contain hemoglobin (remember: this is the iron containing protein within blood cells), and is only found in meat sources (10). Heme iron is more readily absorbed than nonheme iron. Organ meats (like liver) generally have the highest concentrations of heme iron (11). All meat contains heme iron, not just red meat (although it does have higher concentration of heme iron), but chicken, pork and turkey are good sources. Fish, seafood, and especially shellfish like oysters are also great sources of iron (11).
Nonheme iron is available from plant sources, such as grains, beans, and some vegetables (10). Nonheme iron is not absorbed as well as heme iron sources. Populations where meat intake is low can struggle to obtain enough dietary iron. Other compounds found within nonheme iron sources (such as phytates, tannin, and calcium) can also *decrease* iron absorption — so try to limit your coffee and tea intake directly after meals (12,13). Eating iron sources with vitamin C (citrus fruits, peppers, strawberries, etc) will help make dietary iron more readily absorbed (13). Some sources of high nonheme iron include: soybeans/tofu, lentils, oats, wheat (this is often fortified), beets, kale, nuts, molasses, and beans (11).
Once a person has iron deficiency anemia, unfortunately, dietary iron intake isn’t always enough to correct the deficiency. Oral iron tablets and supplements are the primary treatment for iron deficiency anemia. Before taking any supplement for anemia, talk to your healthcare practitioner. There are many different types of anemia with different causes, so it is important to make sure that you are treating the appropriate type of anemia and its underlying cause.
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