Women, especially those of reproductive age, are the group most likely to have iron deficiency. Heavy menstrual periods, pregnancy and diet can all play a role in reducing iron stores in the body.
“There’s no standard recommendation for testing iron levels in women of reproductive age, except during pregnancy,” says Alexis Federman, D.O., an internal medicine specialist at Henry Ford Health. “That means iron deficiency often goes undiagnosed even though it can lead to a variety of physical and cognitive symptoms.”
What Is Iron-Deficiency Anemia?
Anemia—which is a low concentration of red blood cells—can have many different causes. Not having enough iron is one of the most common reasons why people have anemia. That type is called iron-deficiency anemia.
Iron helps make hemoglobin, a protein in red blood cells that carries oxygen from your lungs to the rest of your body. “Iron also gets stored in the form of a protein called ferritin,” says Dr. Federman. “If your body uses up the stores and they aren’t fully replenished, it can lead to a decrease in the number of healthy red blood cells.”
Symptoms Of Iron Deficiency
Iron is a key nutrient that’s involved in many of the body’s important functions. Having low iron can cause symptoms including:
- Anxiety
- Brain fog
- Fatigue
- Heart palpitations
- Increased sensitivity to cold temperatures
- Lightheadedness
- Sleep disturbances
Iron deficiency during pregnancy can also lead to neurodevelopmental problems with the growing fetus.
Heavy Periods And Iron Deficiency
Heavy periods are the most common cause of low iron in women. Up to one third of women experience heavy menstrual bleeding (soaking through a pad or tampon every two hours).
“If you’re not having heavy periods, but are experiencing symptoms of low iron, talk to your doctor,” says Dr. Federman. Less common causes of low iron can be serious and may include cancer or bleeding in your gastrointestinal system.
Why Aren’t More Women Diagnosed With Iron Deficiency?
“The symptoms of iron deficiency can be vague and easily mistaken for other conditions,” says Dr. Federman. “That can make it hard to pin down a diagnosis.”
Part of the problem is that iron levels aren’t part of routine annual bloodwork—unless your doctor suspects you may be iron deficient. In 2023, the International Federation of Gynecology and Obstetrics decided that all menstruating girls and women should be regularly checked for iron deficiency. But the U.S. Preventative Task Force (which makes these decisions for the U.S.) hasn’t yet approved the same guidelines.
“If you have heavy periods, eat a vegetarian or vegan diet or have symptoms—like lightheadedness or fatigue—talk to your doctor about having your iron levels checked,” says Dr. Federman. While routine testing for everyone isn’t covered by insurance, testing for someone who has risk factors or symptoms may be.
Treating Low Iron
If your hemoglobin levels are lower than 12.0g/dl or your ferritin is below 30 ng/L, your doctor may want to treat your iron deficiency. They may start by trying to address the heavy periods, because if you lose less blood, your iron levels stay higher. Hormonal birth control pills or an IUD, taking an NSAID (like ibuprofen or naproxen), and increasing exercise can all help manage heavy periods.
You can also look at your diet to boost your iron levels. When you eat foods that are rich sources of iron, be sure to consume them along with sources of vitamin C to help with iron absorption.
Iron-rich foods include:
- Beans
- Enriched breads, pastas and cereals
- Lentils
- Meat
- Nuts
- Poultry
- Whole grains
Taking an iron supplement may be the best approach for some women with heavy periods or those who have low iron during pregnancy. Talk to your doctor about what type of iron supplement might be most effective for you. Remember to take it with vitamin C (or a glass of orange juice). Iron supplements can sometimes cause constipation; a daily dose of Miralax can help.
If you’re concerned about your iron levels, don’t suffer in silence. Talk to your doctor about managing your iron intake and supplementing if necessary.
Reviewed by Dr. Alexis Federman, a primary care doctor who sees patients at Henry Ford Medical Center - Livonia.
