Women and Anemia

We all feel tired and run down from time to time. Sometimes this tiredness is due to stress, or lack of sleep, and can be easily remedied with a vacation or a mental health day. But what if you’re exhausted all the time, and you don’t know why? It could be that you’re suffering from iron deficiency anemia.


Iron deficiency anemia is very common– and even more so among women than men. While only 2% of adult men suffer from iron deficiency anemia, 9-12% of non-Hispanic white women and nearly 20% of black and Mexican-American women do. Women of childbearing age are the most at risk. Many develop iron-deficiency anemia due to heavy or longer-than-normal menstrual periods, when they lose more red blood cells and iron through bleeding than their bodies are able to replace. And pregnant women require about twice as much iron per day as women who are not pregnant, so it’s easy for them to become anemic if those needs are not met.


Iron deficiency anemia can lead to serious health problems if left untreated—but fortunately, with the right information, it’s usually easy to treat and prevent. This article will point out the warning signs to look out for, so you know when it’s time to see a doctor. It will also go over some of the different treatment options available for women with iron deficiency anemia, so you can go back to feeling your best as quickly as possible.


Signs that you might have iron deficiency anemia


The symptoms of iron deficiency anemia are often mild at first. You might even have no symptoms. As the anemia gets worse, however, you will probably notice that you feel exhausted all the time. Fatigue and weakness are the two most common symptoms of iron deficiency anemia. Another common early symptom is trouble concentrating, or a reduced attention span.


Other warning signs include dizziness, headaches, low body temperature, pale or yellowish skin, rapid or irregular heartbeat, brittle nails, and shortness of breath or chest pain (especially during physical activity). You might even find yourself craving strange things, like ice, paper, or dirt (unusual cravings like this are known as pica).  


If you are experiencing any of these symptoms, you should see a doctor and ask to be tested for iron deficiency anemia.


Getting diagnosed


To determine whether or not you have iron deficiency anemia, your doctor will probably perform a physical exam, and ask you some questions about your family and medical history. She will also need to take a blood sample in order to run a test called a complete blood count (CBC), which counts the percentage of red blood cells (hematocrit) and the amount of hemoglobin in your blood. Normal hematocrit values for women are generally between 35-47 percent, and normal hemoglobin levels for women are generally between 12-16 grams per deciliter of blood—so if your results are lower than this, you probably have anemia.


Your doctor might also examine the size, shape, and color of your red blood cells. A CBC often includes an MCV (mean corpuscular volume) test, which measures the average volume of red blood cells in your blood sample. Iron deficiency anemia is also called microcytic anemia, which refers to microcytosis, a condition in which red blood cells are unusually small. If your MCV is low (below 70), it means your average red blood cell is small, indicating that you have iron deficiency anemia.


If you are diagnosed with iron deficiency anemia, your doctor will probably first suggest making some dietary changes, or taking iron supplements (more on this below). If those steps don’t increase your blood-iron levels after a certain period of time, she might need to perform some additional tests to determine the root cause of your anemia (like a colonoscopy or endoscopy to rule out internal bleeding, or a pelvic ultrasound to discover potential causes of excessive menstrual bleeding, like uterine fibroids).


What to do about it


If you are diagnosed with iron deficiency anemia, the first thing you’ll probably need to do is make some changes to your diet. While it’s a myth that you must eat animal products in order to get enough iron, it is true that the iron in meat, chicken, and fish is two to three times more easily absorbed by the body than the iron in plant-based foods. Therefore, if you are vegetarian or vegan, you’ll need to eat more iron per day than someone who eats meat, because your body won’t absorb all of the iron as easily.


Good plant-based sources of iron include beans, peas, tofu, canned tomatoes, and dark, leafy greens (like kale, spinach, and chard). Many foods, like cereals, are often fortified with up to 100% daily value of iron, as well. Furthermore, iron is more easily absorbed when it’s combined with vitamin C, so try enjoying these iron-rich foods with an orange, or other vitamin-C-rich food. But don’t drink coffee or tea with your meals—they make it harder for your body to absorb the iron in your food.


Most women are able to get all the iron they need from their diets. However, if you are severely anemic and need to raise your iron levels quickly, your doctor might recommend iron supplements. And if you are pregnant, you should take a prenatal vitamin that includes iron every day.


If your anemia is the result of heavy menstrual periods, and you are not already using some form of hormonal birth control, you might want to discuss doing so with your doctor. Some birth control pills can regulate your periods, making them lighter, shorter, and in some cases, less frequent. Meanwhile, certain non-hormonal birth control methods, like the copper IUD, can make your periods heavier, putting you more at risk for iron deficiency anemia.


In the rare case that your heavy menstrual bleeding does not improve, even after switching to hormonal birth control, your doctor may recommend surgery. Endometrial ablation (removal of the uterine lining) or hysterectomy (removal of all or part of the uterus) can prevent you from losing too much blood, when all other options have failed to do so.


Many women suffer from iron-deficiency anemia at some point in their lives, and it is not often serious. However, if left untreated, it can have serious consequences. Iron deficiency anemia forces the heart to work harder to compensate for the lack of red blood cells or hemoglobin, and this extra strain can lead to heart problems.


If you are pregnant, iron deficiency anemia can also cause problems for your baby. Not getting enough iron during pregnancy increases the risk of premature birth or a low birth weight. Both of these things increase a baby’s risk of further health and developmental issues later on, and premature birth is the most common cause of infant death.


So, the best thing to do is to get tested early. If you are pregnant, you should be tested for iron deficiency anemia, even if you have no symptoms. And if you experience heavy bleeding during your periods, talk to your doctor about getting tested for anemia as part of your regular annual health exam.


If it turns out you do have iron deficiency anemia, remember that you’re far from alone. Your diagnosis will make it possible for you to receive the right treatment, so you can get back to being your strong, energized self.