Contents

Heavy menstrual bleeding: diagnosis and management options

Alternative management options

In secondary care, gonadotropin-releasing hormone (GnRH) agonists have been used to stop the production of oestrogen and progesterone, thereby decreasing menstrual blood loss and resulting in amenorrhoea in 89% of women,. Owing to their AEs (e.g. osteoporosis, vasomotor symptoms) long-term use (>6 months) is not recommended. GnRH agonists are principally used pre-operatively to decrease peri-operative blood loss and to reduce uterine and fibroid size.

Surgical treatments (i.e. hysterectomy, endometrial ablation, myomectomy and uterine artery embolisation ) are also treatment options; however, hysterectomy and ablation can result in loss of fertility. There is currently no strong evidence to support fertility preservation following surgery with either myomectomy or UAE, but it has been suggested that myomectomy may increase pregnancy rates compared with UAE.

Ulipristal acetate is indicated for use in adult women of reproductive age for either peri-operative treatment of moderate-to-severe symptoms of uterine fibroids or for the intermittent treatment of moderate-to-severe symptoms of uterine fibroids. However, in February 2018, the European Medicines Agency (EMA) made a recommendation that no new patients should be started on ulipristal acetate owing to reports of hepatotoxicity, including hepatic failure resulting in liver transplantation. The Pharmacovigilance Risk Assessment Committee (PRAC) — a sub-committee of the EMA — has recommended monthly liver function tests (LFTs) for all patients currently on ulipristal acetate, with cessation of treatment if LFTs are twice the upper limit of normal. Patients are advised to repeat LFTs two to four weeks after treatment cessation, and to report any nausea, vomiting, upper abdominal pain, lack of appetite, tiredness or signs of jaundice. These are temporary measures until the pending conclusion of a review of ulipristal acetate by the EMA (start date of November 2017).

Fertility preservation

While hormonal treatments (LNG-IUS, COCs, norethisterone, injected progesterone and GnRH analogues) have contraceptive actions, they are reversible and therefore preserve fertility. Likewise, while NSAIDs and tranexamic acid are contraindicated in pregnancy and may affect fertility (e.g. mefenamic acid), the effects are reversible,. However, surgical intervention is often irreversible and should be avoided in patients where fertility preservation is important.

Quality of life

It is important for pharmacists and other healthcare professionals to be aware of cultural, social and educational backgrounds of patients that present with HMB to ensure that the best quality of care is offered and that informed decisions are always made.

One review found the health-related quality-of-life score for women with HMB was below the 25th percentile for the general female population because it causes absence from work and affects physical, emotional and social wellbeing.

In 2014, the RCOG National HMB Audit found that ethnicity-influenced treatments, outcomes and experience of care, where improvements in condition and surgery were less likely for those of a non-white ethnicity. Non-white women reported being less satisfied with both the information they received and the decision-making process. It has been suggested that these findings may be a result of cultural differences. While differences in treatment and outcomes have also been reported in women from less affluent backgrounds, the difference in their overall experience of care was relatively small.

Summary

A wide range of treatments (including OTC options) for HMB or menorrhagia is available in pharmacies. Community pharmacists, in particular, are able to help women manage this condition that can negatively impact quality of life. Effective history-taking is key for effective management, as is identification of patients requiring urgent referral. Women seeking advice from pharmacists about HMB should be given evidence-based information and be actively involved in treatment decisions, as outlined in this article.

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Treatment


Heavy periods

Endometrial ablation

Endometrial ablation involves thinning, removing or destroying the lining of the womb (the endometrium). It may lighten your periods or stop them all together, depending on how much of your womb lining remains.

Different techniques can be used for endometrial ablation, including:

  • endometrial ablation using heat – an electrical source, radio waves or lasers are used to destroy the womb lining via the vagina and cervix
  • endometrial ablation using ultrasound energy – high levels of ultrasound energy from outside the body are used to destroy fibroids without harming healthy womb lining

These procedures can be carried out either under local anaesthetic or general anaesthetic. They’re fairly quick, and you can usually go home on the same day.

You may experience some vaginal bleeding, like a light period, for a few days after endometrial ablation. Use sanitary towels rather than tampons. Some women can have bloody discharge for 3 or 4 weeks.

You may also experience tummy cramps, like period pains, for a day or 2 after the procedure. These can be treated with painkillers, such as paracetamol or ibuprofen.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

It’s unlikely you’ll be able to get pregnant after endometrial ablation. If you do, you’ll have an increased risk of miscarriage or other complications. The procedure is not recommended if you still want to have children.

Sometimes, endometrial ablation does not lighten the periods, or the heavy periods may come back. If this happens you may be offered a repeat treatment.

Iron Supplements May Help Women with Heavy Periods

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Heavy periods are awful for many obvious reasons-cramping, bleeding through countless tampons and pads, limiting your daily activity-plus they can leave you iron deficient, which can cause all sorts of physical and emotional side effects.

But there’s hope, at least for part of the problem: According to a new study, iron supplements can improve quality of life for women who experience heavy bleeding each month.

When we lose blood, we lose iron-roughly 220 to 250 milligrams per pint. For women with especially heavy flows, menstruation can cause iron-deficiency anemia-a condition that occurs when the body can’t make enough healthy red blood cells. Anemia can cause fatigue, shortness of breath, headache, and dizziness, and previous studies have also linked it to decreases in physical performance, cognitive function, and mood.

So a group of researchers from Finland’s Hyvinkää Hospital set out to see if treating anemia might help improve these symptoms for women with heavy menstrual bleeding. They studied 236 women who were either being given hysterectomies or put on an IUD, both common treatments for controlling heavy periods. These procedures would stop or lessen the patients’ monthly flow pretty much immediately, but the researchers suspected that many of the women also had low iron levels that could take a while to replenish.

RELATED: 4 Foods to Beat PMS

Tests showed that 27 percent of the women were anemic (based on their red blood cell count) and 60 percent had severe iron deficiencies. A year after the women received treatment for their heavy periods, their red blood cell counts had increased to non-anemic levels-but those who had been anemic still had significantly lower blood cell counts than those who hadn’t. Iron levels for those who were previously deficient took even longer-five whole years-to return to normal.

At the one-year mark, researchers noticed that the previously anemic group reported significant increases in energy and physical and social functioning, along with decreases in anxiety and depression, when compared with the women who hadn’t been anemic to start. This suggests that their improved “quality of life” scores had at least something to do with correcting their anemia and not just stopping their heavy bleeding.

This shows iron supplements may help prevent or treat anemia, says lead author Pirkko Peuranpää, M.D., and should be recommended to women with heavy periods who test positive for a deficiency. (The study also suggests that even if you’ve started using birth control to keep your periods under control, it can still take months or years for your iron levels to correct themselves.)

The researchers were also surprised that only 8 percent of women diagnosed as anemic at the start of the study had been taking iron supplements. “A possible explanation for low supplementation is that clinicians focus solely on treatment of itself, and may not pay specific attention to diagnosis and treatment of anemia and iron deficiency,” they wrote in the study.

It can’t hurt to ask your doc about your iron levels. (Too much iron can be toxic, though, so don’t self-diagnose yourself or start taking anything without talking to your physician first.) While the researchers didn’t actually test the effect of iron supplementation, the study does suggest that anything a woman can do to treat underlying anemia is likely to improve her health and well-being-not just during her period, but all month long.

  • By Amanda MacMillan

Why is iron important
during periods?

Monthly periods are the most common cause of iron loss worldwide and research shows that women of childbearing age need up to x2 more daily iron than men. The average menstrual period lasts anywhere from two to five days. It is estimated that 220 to 250mg of iron per pint of blood is lost during menstruation. This can vary over a woman’s lifetime and may be affected by changes in iron stores, changing contraceptives, use of intrauterine devices or certain medications.

A woman’s natural iron regulatory system increases absorption of iron from her diet during these times of blood loss. Her normal absorption rate of 1 milligram is stepped up to 1.5–3 milligrams per day—the female body’s natural response to blood loss. However it may be difficult to meet this increased need for iron through diet alone, particularly in women with low red meat intake, those on plant based diets and those who have recently given birth.

Amongst women who experience heavier periods adequate daily iron intake is particularly important and may be difficult to achieve with diet alone.

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Can I always get enough iron from my food during periods?

You can get iron from food but it may not be absorbed well, and it may not be sufficient to meet your requirements due to menstruation. Women can lose up to half a pint of blood during each menstrual cycle.

Even if you are making an effort to ingest more iron by eating meat, most health authorities recommend a safe upper intake of only 500g of red meat per week. Also, several factors must be present before iron can be absorbed and used by the body, such as a healthy digestive system and adequate amounts of nutrients such as zinc, vitamin C and B complex. Proteins that bind with and carry nutrients into the bloodstream are also needed in the diet for iron to be absorbed. Also, other daily habits like drinking tea and coffee after your meals or taking calcium supplements with iron rich meals can reduce iron absorption.

Some iron rich foods include:

  • Red meat
  • Poultry
  • Fish
  • Grains
  • Tofu
  • Beans
  • Dark, leafy greens.

Avoid caffeine immediately after your meals, since this substance can decrease iron absorption. Vitamin C, on the other hand, can make it easier for your digestive system to absorb iron.

Supplementing your diet with iron tablets

If you do decide to increase your iron intake through iron supplements, it is important to choose one that is kind on your stomach and strong on absorption. While ferrous sulfate is considered the ‘gold standard’, these tablets may cause gut irritation leading to constipation and nausea.

Active Iron contains a non-constipating iron formula that uses innovative technology to target the body’s natural site of absorption in the small intestine. Active Iron is clinically proven to have x2 better absorption of ferrous sulfate and is kind enough to take on an empty stomach.

This blog post was written by Lara Elena Thiele. Disclaimer: I am not a medical professional, so this article does not substitute a doctor’s visit. I was also consulted by a physician before treatment, so please do not experiment on your own.

Earlier this year I had a blood test done that revealed pretty low iron levels. I was diagnosed with Iron Deficiency Anemia. Finally, I had an explanation why I always felt so tired and weak almost every day.

After doing some research and speaking to a physician I decided to tackle this problem with a long-term approach. Iron-deficiency Anemia is a common condition, so I thought it would be useful to share my journey with you – from being diagnosed to finding the right treatment. Hopefully, you’ll find some of my tips helpful. Here is what I did!

What is Iron Deficiency Anemia?

Iron Deficiency Anemia is a condition, where you have a low amountof red blood cells or not enough haemoglobin in the blood. Haemoglobin is a protein, which gives the blood its red color and helps the red blood cells to carry oxygen throughout the body.

Iron Deficiency Anemia often causes fatigue, pale skin and weakness, all symptoms that I experienced. Depending on the case of anemia, treatment is relatively easy and it improves your quality of life immensely! Of course, there are more severe cases that require a more intense medical treatment, this is why a doctor’s visit is important.

Iron Deficiency Anemia and Periods – how are they related?

Heavy periods can cause Iron Deficiency Anemia, but so can other conditions.

During pregnancy, the body has a higher demand for blood and therefore iron levels are naturally lower while pregnant. That’s why it is paramount that the cause of your anemia is determined before you start treatment.

Menstruators are at greater risk of getting Iron Deficiency Anemia due to their periods, especially when they are heavy. In fact, over 460 Million non-pregnant women worldwide suffer from Iron Deficiency Anemia which makes it the population with the highest number of anemic people. (If you put the numbers in relation: South America’s population is 422.5 million).

How do I know if I have Iron Deficiency Anemia

First step is to do some research and look into the topic with further detail. If you experience some of the typical symptoms of Iron Deficiency Anemia such as intense fatigue and weakness, or pagophagia to enjoy chewing on ice and an irregular heartbeat, one of the very first things you should do is to get a blood test done and consult your doctor.

How to keep your iron levels up when you’re anemic

I believe that a diet based treatment is the way to go for many health-related issues. Though in this case, as a person who only scarcely consumes meat with heavy flow periods, I felt like I needed a little help.

Find a support group and exchange experiences

I entered a support group on Facebook to see how other people experience Iron Deficiency Anemia and how they cope. You can find lots of useful information in there and simply being in this group with so many other people sharing the same experiences is a huge support.

Iron Supplements for Iron Deficiency Anemia

My doctor recommended a liquid iron supplementation since iron pills can be hard to digest. I finally opted for this vegan iron supplement.

I take it twice a day, after breakfast and after dinner, as recommended. The iron in it is derived from berries and it is really sweet and tasty with no sugar added. It also has vitamin C, which helps to absorb iron.

What food to eat if you have Iron Deficiency Anemia

Regarding your diet there are a few things to keep in mind: phytates (e.g. in legumes and cereals), polyphenols (e.g. in coffee and wine), calcium and some proteins (e.g. soy and milk proteins) are iron inhibitors, whereas ascorbic acid (aka vitamin C) and muscle tissue (meat, fish, poultry) are enhancers of iron absorption. Make sure to always include vitamin C (e.g. citrus fruits, tomatoes, peppers) and/or other high iron inhibitor in your meals.

There are two types of dietary iron: Heme iron (found in animal foods) and nonheme iron (found in plant-based foods). >Top heme iron-rich foods are liver, seafood, beef and fish.

But what about a vegan and vegetarian diet?

Don’t worry! If combined smartly, you should have no problems absorbing enough iron. Leafy greens (e.g. kale, broccoli, cabbage, spinach) are high in nonheme iron and other vegan foods as well: almonds and cashews, sprouted beans and seeds, dried fruit etc. A vegan supplementation (like the one I use) helps you even further in keeping your iron levels up.

Further natural treatment for Iron Deficiency Anemia

In the Facebook group, I also read that using a cast-iron skillet for cooking can help you manage your iron levels, plus they last for a long time. Similar to this, but a little cuter is my next discovery…

How does the lucky iron fish work?

In the Facebook support group, somebody posted about the Lucky Iron Fish and I immediately fell in love: “What is this cute little fish?” Browsing their website I found that their philosophy really resonated with mine:

  • Reusable with daily use for up to 5 years
  • Cheaper than supplementation
  • Buy One Give One program
  • A B-Corp and Social business

Much like our little Ruby Cup… So, of course, I was sold!

Here’s how the Lucky Iron Fish works: The Lucky Iron Fish should be added daily for 10 minutes into your cooking or you can boil 1 litre of water for 10 minutes with 1-2 drops of lemon juice to make iron-rich drinking water and slowly but steadily you supply your body with the iron you need.

I was so fascinated and impressed by the company and their mission so I contacted them. We had a lovely conversation which I would like to share with you: “Like Ruby Cup, Lucky Iron Fish is committed to improving the lives of women and girls. We believe that a business can and should help to solve some of the world’s greatest social challenges. Ruby Cup’s actions and values clearly demonstrate that business can be a force for good.” – Tania Framst, vice president of operations, Lucky Iron Fish

Last but not least, don’t forget to check out their recipe tank full of iron-rich recipes and creative ways of how to include the lucky fish in your daily cooking.

My iron supplementation journey isn’t over yet – but that’s ok

With all this information in mind, my follow-up blood test 3 months later showed that I am at healthy levels in nearly all iron-related indicators, except my hemoglobin, which is still a little low at 12.2.

As long as I menstruate, I will have to continue with my supplementation. If I don’t, I’d become anemic repeatedly but that’s ok, now that I feel confident about how to keep my iron levels up.

Happy menstruating everybody and reach out to us or comment below, if you have any other tips or inputs regarding periods, Iron Deficiency Anemia and iron levels!

Overview


Heavy periods

What causes heavy periods?

In about half of women with heavy menstrual bleeding, no underlying reason is found.

But there are several conditions and some treatments that can cause heavy menstrual bleeding.

Some conditions of the womb and ovaries can cause heavy bleeding, including:

  • fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods
  • endometriosis – where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods)
  • adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb; this can also cause painful periods
  • pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and a high temperature
  • endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb)
  • cancer of the womb – the most common symptom is abnormal bleeding, especially after the menopause
  • polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again

Other conditions that can cause heavy periods include:

  • blood clotting disorders, such as Von Willebrand disease
  • an underactive thyroid gland (hypothyroidism) – where the thyroid gland does not produce enough hormones, causing tiredness, weight gain and feelings of depression
  • diabetes

Medical treatments that can sometimes cause heavy periods include:

  • an IUD (intrauterine contraceptive device, or “the coil”) – this can make your periods heavier for the first 3 to 6 months after insertion
  • anticoagulant medicine – taken to prevent blood clots
  • some medicines used for chemotherapy
  • some herbal supplements, which can affect your hormones and may affect your periods – such as ginseng, ginkgo and soya

Nikki was changing a super tampon and pad every one to two hours when she first came to see me. Even these would fail her on her heaviest days. Beyond the bleeding she was struggling with fatigue, anxiety and hair loss. The reality was, her periods had caused her to become anemic and that anemia was causing her to have such a heavy flow. But the question still remained, why did those periods start to flow so heavy?

Anemia & menorrhagia are directly linked. Heavy menstrual bleeding can cause a significant loss of iron-rich blood, resulting in iron deficiency anemia.

It’s estimated that there are 468.4 million menstruating women worldwide with iron deficiency anemia.

Is anemia caused by your periods? Find out how to get tested & understand your root cause!

I’ve seen hundreds of women walk through my clinic doors feeling fatigued, weak, and overall unwell—but they don’t know where it’s coming from. When a woman has overwhelming tiredness or weakness she can’t explain, one of the first questions I ask is: do you have heavy periods?

Anemia due to menorrhagia (heavy periods) is one of the most common cases of iron deficiency anemia. For Nikki, those heavy periods were leaving her exhausted. “I’m unable to workout like I used to and I find I can be short of breath just going up stairs,” she explained.

Anemia symptoms often include general tiredness, weakness, anxiety, hair loss and other seemingly “inexplicable” symptoms. If you have any of these symptoms it is a good idea to get your iron levels checked.

BTW if you have hair loss then consider starting the Capillus laser light therapy stat. It’s what I recommend in my clinic for women who are experiencing hair loss. It helps increase circulation to your scalp and nourish luscious locks.

If you have heavy periods, you may be losing more iron-rich blood than your body can keep up with, which is making you anemic.

Let’s dive into how to know if you have anemia and what you can do about it!

What Is Anemia?

Anemia is when there is a decreased number of red blood cells or the hemoglobin found in the red blood cells. Hemoglobin is the protein that carries oxygen to your tissues. All of your organs, especially your brain, need oxygen to function properly. Low levels of hemoglobin mean low levels of oxygen.

There are several types of anemia, including those caused by B12 and folate deficiency, which can be determined with lab testing. For Nikki, her lab testing revealed iron deficiency anemia.

Iron Deficiency Anemia

Iron deficiency is the most common type of anemia. This occurs when your body doesn’t have enough of the mineral iron. Your body uses iron to make healthy hemoglobin. In fact, each hemoglobin requires four iron molecules in order to properly bind oxygen.

Without iron, your body can’t make hemoglobin. Without hemoglobin, your blood can’t transport necessary oxygen to the organs. Without oxygen, your organs aren’t able to work properly.

Iron is also necessary for making neurotransmitters, growing cells, making DNA, and liver detoxification. Yeah, it’s a big deal!

This lack of oxygen was preventing Nikki from exercising and was a driving force behind her anxiety, hair loss, and incredibly heavy periods.

Give your body the nutrients it needs to create amazing hormones. .

What Are The Symptoms Of Anemia?

Not all women experience easily recognizable symptoms of anemia like Nikki. In fact, symptoms of anemia can be very subtle and unobtrusive, which means women can go years before they discover a problem.

If you’re showing any of the below symptoms, it might be timeto visit your doctor to have your iron levels tested.

Common symptoms of anemia include:

  • General fatigue
  • Weakness
  • Dizziness
  • Racing heart
  • Heart palpitations
  • Shortness of breath
  • Anxiety
  • Depression
  • Immune dysregulation
  • Tingling or crawling feeling in legs
  • Restless leg syndrome
  • Brittle nails
  • Easy bruising
  • Cold hands or feet
  • Fast or irregular heartbeat
  • Headaches
  • Heavy periods
  • Low thyroid hormone
  • Hair loss
  • Strange cravings (ice, clay and other non-food items)
  • Beeturia – When your urine turns red after eating beets.

Quick Detour: Beeturia is totally a thing. You eat beets. Your pee turns red. And your freak out. Or maybe you think it is normal. It is estimated 49 to 80% of people with beeturia have iron deficiency anemia. If you see this, get tested.

Three subtle signs of anemia that women can miss are pale skin, strange cravings, and anxiety. For Nikki, she just figured she needed more sun, that her crazy desire to crunch ice was due to stress and that her anxiety was genetic.

It’s amazing how often we will negotiate with our symptoms and rationalize them away. As women, we’ve become conditioned to dismiss our own experience and believe there must be something else to the experience. Hey, I’m not judging, I’m just saying—honor your body talking to you, which is what symptoms are.

Pale skin

Hemoglobin gives blood its red color, which gives your skin a healthy appearance. In patients with a light complexion, it can be easier to spot anemia because their skin will appear pale and less reddish.

You can also sometimes spot anemia in visibly blood-rich areas of the body. If the inside of your lips, gums, or lower eyelids are less red than usual, you may be anemic. Yes, I know this is the part where you go to the mirror and do a quick check. No worries. I’ll be here when you get back. 😉

Back? Ok good. Now check the palm of your hands. Are the creases pale? This could also be a sign you’re in need of iron.

Unusual cravings

Strange or unusual cravings are another side effect of anemia. Your body recognizes that it’s lacking iron and puts you on a quest to consume food that might be iron-rich.

In many cases, those with anemia crave items that aren’t food, like dirt, ice, or clay. The medical term is “pica,” which is when someone craves substances with no nutritional value. For Nikki, the munching of ice was actually her body saying, “girl, you best get us some iron stat.”

Pica is something well recognized in pregnant women. I once had a pregnant patient tell me she felt compelled to eat cigarette butts. She shared that she couldn’t be anywhere near an ashtray without thinking about grabbing a fist full and cramming it in her mouth. I’m not kidding, the compulsion to eat cigarette butts was a struggle for her.

Anxiety

Neurological symptoms like anxiety, brain fog, restless leg syndrome, and depression can be some of the first signs of anxiety.

If you’re feeling overly anxious on a daily basis, it’s time to chat with a doctor to overcome this potentially damaging health problem.

What Are The Causes Of Anemia?

One of the most common causes of iron deficiency anemia in menstruating women is due to heavy periods. And More on that soon.

Hormone imbalanced, gut infections, a diet lacking iron are among other causes of anemia.

Causes of anemia include:

  • Inadequate iron intake, like vegetarians or vegans who are not mindful about their nutrient intake
  • Internal bleeding
  • Digestive ulcers
  • Inability to absorb iron from certain disorders or surgeries
  • Intestinal infections like SIBO and parasites
  • Low stomach acid
  • Inflammatory disease of the gut like Crohn’s or Ulcerative Colitis
  • Supplements like calcium and zinc can interfere with iron absorption
  • Stomach acid blocking drugs

Hypothyroidism and Anemia

An underactive thyroid can be another cause of anemia. Triiodothyronine (T3) is necessary for stomach acid production. When T3 goes low, stomach acid dips and you are no longer to able to free iron from the foods you’re eating. Basically, this creates a negative feedback loop of low iron and hypothyroidism.

You need stomach acid to free iron from your food and a functioning small intestine to absorb it.

Gut Infections and Anemia

You need a healthy gut (small intestine specifically) to absorb iron. You depend on a healthy mucosa and enzymes to get that iron you’re eating into your body to be used.

If you have SIBO, yeast overgrowth or anything funky in your gut then those little critters may be stealing your iron and keeping you from rebuilding your stores.

Most iron you consume is not absorbed but pooped out (and you’re losing a whole lot more if you have heavy periods). If you’re taking a lot it can make your stool black and the cheap stuff, like iron sulfate can cause constipation. If constipation is already your issue then consider taking a prenatal with a highly absorbable form of iron.

Eating a nutrient dense diet is one of the crucial steps in reversing anemia and heavy periods. .

Stomach Acid and Anemia

If you have ANYTHING driving low stomach acid then you can NOT get your dietary iron free and therefore can’t absorb it. Bummer.

If you take acid blockers daily or just when you feel the burn then know this could be messing with your iron absorption… not to mention other vitamins and minerals.

Heartburn and low iron? Try Digest, which supplies HCl (that stuff made in your stomach that helps with nutrient absorption) and other digestive support to help you get the most out of your nutrients.

Heavy Period. How Much Blood is Too Much?

Heavy menstrual bleeding, otherwise called menorrhagia, is one of the most prevalent causes of anemia. This is because you’re losing iron-rich blood. Every. Single. Month. If you’re not offsetting blood loss with an appropriate intake of iron, your body will start to run through its iron stores, leading to an iron deficiency.

And in reality, if your periods are heavy like Nikki’s then you’re going to need to take a supplement. I recommend a prenatal for women experiencing heavy periods because it contains a higher amount of iron, along with B12, B6, and folate to support healthy blood cells. No, prenatals are not just for women wanting to become pregnant and they definitely won’t cause you to get pregnant. Setting the record straight here.

How do you know if you have heavy bleeding?

  • Your period that lasts longer than seven days.
  • You’re changing a pad or large/super tampon every hour for three or more hours in a single day.
  • You’re changing a full menstrual cup three times in a day.
  • You need to double up on menstrual products to control your flow.
  • You’re waking to change menstrual products during the night.
  • Your period flow stops you from being able to go about your day or prevents you from participating in activities
  • You see blood clots that are larger than the size of a quarter.

For reference, the average woman has a period about 4 to 5 days. If you’re 3, 6, or 7 that doesn’t mean there is anything wrong with you. But if you’re 7+ days and most days are heavier than not then it is time for lab testing. Keep reading!

What Causes Heavy Periods?

Yeah, like how did this party get started in the first place?

Yes, iron deficiency can cause heavy periods and heavy periods can cause iron deficiency. This can make it tricky to understand which came first. Let’s explore some of the common reasons women develop heavy periods that can lead to iron deficiency anemia.

Hormone Imbalance and Heavy Periods

For Nikki, her periods problems began with breast tendeneress, irritability, and mild cramping before her period. These signs of PMS were pointing towards estrogen dominance. She shared that over time her period became increasingly heavy. “It seemed like each month I was bleeding more and more until it was completely unmanageable.”

While we very much needed to adress Nikki’s anemia, we also need to correct her hormone imbalance.

to get your FREE hormone starter kit with 7 day meal plan and recipe guide to start balancing your hormones!

Copper IUD Birth Control

It is well understood the copper IUD can lead to heavy and painful periods. If you’ve had a copper IUD placed this may be the root cause of your increased menstruation and can lead to anemia.

Read more about IUD side effects.

Fibroids or Polyps

Fibroids and uterine polyps can lead to increased blood flow during menses.

Endometriosis

Endometriosis can also be a cause of heavy periods with significant pain. Learn more about how to manage endometriosis naturally.

Hypothyroidism

Inadequate thyroid hormone can lead to long and irregular periods. You can read more about symptoms of hypothyroidism.

Genetic Disorder

A more rare cause of heavy periods are genetic disorders. This should be investigated if your doctor is unable to identify the root cause. This can be bleeding disorders, like platelet function disorder or Von Willebrand disease.

This can also be from non-bleeding disorders like pelvic inflammatory disease or liver, kidney, or thyroid disease. Intestinal disorders can also impact the hormonal imbalance, which can lead to heavy bleeding.

Medications

Women on blood thinners, like aspirin or warfarin, may also have increased bleeding during their periods.

Do You Have Iron Deficiency Anemia?

If your periods are feeling ridiculously heavy, you were nodding your head as you read the list of menorrhagia symptoms or you suspect you may have iron deficiency, it’s time to investigate the cause with lab testing.

Complete Blood Count (CBC)

This is the first line testing for screening iron deficiency anemia.

A CBC will look at your red blood cells, hemoglobin, hematocrit, white blood cells and platelets. A low hemoglobin and hematocrit and small red blood cells indicate iron deficiency anemia.

This test is typically run as part of an annual exam. If not, ask your doctor. And if you have symptoms, definitely get this checked. It can tell you a lot about your current state of health.

Your red blood cells (RBCs) are made in your bone marrow and contain the oxygen transporting molecule hemoglobin. If your RBCs are low you are either losing them like cray (ie bleeding), you’re destroying them (more rare than a heavy period, but warrants investigation), or you are not making enough.

Hematocrit tells us how much of your blood is made up of RBCs. Low hematocrit means low RBCs… and anemia.

Nikki’s red blood cells were small and CBC was clear that she was in need of iron.

Ferritin

Ferritin is the storage form of iron. Red blood cells are like your checking account spending iron and your ferritin is the savings account storing it for you to draw from later. Your ferritin levels can help determine how depleted your iron levels truly are.

This is also how your body protects you when infections strike. You see, pathogenic (disease causing) organisms use iron to wreak havoc in your body. When your body detects and infection it grabs all your usable iron and drives it into the storage form. Phew! You’re safe. Oh, but dang. You can’t use your iron now.

If you have chronic infections then you may be showing symptoms of being chronically low in iron.

If you have low ferritin levels you can experience symptoms like restless leg syndrome and hair loss. Ideal ferritin levels are between 70 and 90 ng/mL.

Your entire supply of red blood cells is replaced in four months, so it is a good idea to follow up on this test if it has been more than 4 months and symptoms of iron deficiency are setting in. It’s important to get tested when you’re showing symptoms to avoid any long-term health complications.

Serum Iron, Total Iron Binding Capacity and Transferrin

Why not just test serum iron? Eat a steak, take a supplement or do anything to boost iron and your blood will follow. Like all labs, this is one snapshot in time and iron is highly variable. It’s why if you look at iron then you must look at transferrin, the protein that carts your iron around, along with other markers like ferritin and total iron binding capacity (TIBC).

Transferrin is the main protein that transports iron in the blood. If you have iron deficiency then it should be elevated. But here’s the tricky part, it is higher in women using oral contraceptives or who are pregnant.

Total Iron Binding Capacity is a marker of your ability to transport iron, but also, it tells us just what is up with your iron. If you have a high TIBC it means your body is ready for iron, but there just isn’t enough. If it is low, your ability to transport iron may be low or your liver may need some love. You can have a low TIBC, but be able to move around all the iron you do have in your system.

Women with iron deficiency anemia will have low hemoglobin, small red blood cells, low ferritin and high TIBC. Ferritin typically drops first with a rise in transferrin and a drop in TIBC. Then the hemoglobin drops. If you know this, then you know that just checking a CBC and calling it “normal” when your periods are crazy heavy is pretty short sighted. CBC is still the place to start. And if you do heavy bleeding, supplementing with iron is generally considered a good idea.

How Can You Increase Iron?

For Nikki we needed to make shifts in her diet and add supplements that support healthy red blood cell formation. While her labs pointed to iron deficiency anemia, it isn’t enough to give iron alone. Instead, I recommend increasing iron, while also bringing on methylated or active B vitamins. The easiest way to do this for Nikki was to begin with a prenatal vitamin.

Increase Iron Rich Foods

The greatest bio-available sources of dietary iron are found in meats like beef, chicken, pork, bison, and venison. These are referred to as heme iron and are the most easily absorbed. I also recommend grass-fed organic liver, beef heart, and bone marrow, which are major iron-boosting super foods that can dramatically improve your iron stores.

A lack of meat is why vegetarians and vegans often have a high prevalence of iron deficiency.

Iron is also found in leafy greens, like spinach and kale, as well as dried fruits, chickpeas, potatoes, broccoli, and beans. However, this non-heme source of iron is not as bio-available, meaning your body can’t absorb it fully. This is why vegans and vegetarians can be at higher risk of developing iron deficiency and sometimes have a hard time replenishing iron stores. If you are a vegan or vegetarian and experiencing anemia then a supplement is a must.

Vitamin C aids in the absorption of iron when they are eaten together or taken as a supplement. You can find vitamin C in citrus, strawberries, red and green bell peppers, kiwis, guavas, papayas, pineapples, melons, mangos, tomatoes.

You can grab this meal plan and recipe guide to help replenish iron and balance hormones.

What about phytates?

Real talk. If you have iron deficiency anemia then beans aren’t going to be the best way to boost your iron levels.

Phytates are found in beans, tea, wine, coffee, grains, and nuts and they block iron from being absorbed. Lame. Well, maybe not. Maybe this is a complex mama nature protective mechanism so don’t go judging nature too harshly.

But you should know that if you’re having heavy periods, plant based iron won’t bring you back quick enough and you may very well end up on the pill to slow that flow. Gasp, yes, Dr. B just said that you might need a contraceptive to block that flow. It’s not ideal, but it might be necessary… more on that later.

Consider a Prenatal

In cases of iron deficiency anemia, like Nikki’s, where there is also continued blood loss having an iron supplement not only replenishes stores, but also corrects the underlying cause of heavy periods, poor moods, and fatigue that are a result of iron deficiency.

Not all iron is created equal. Iron bisglycinate is non-constipating and won’t make you nauseous when you take it, which can be a problem with some forms of iron supplements. I usually recommend 3 caps twice daily of Prenatal Plus to quickly boost iron levels with minimal amount of side effects. You need to take minerals in divided doses for maximum absorption.

I also advise a vitamin C supplement to enhance absorption of the iron and for other immune-boosting and hormone benefits.

Should You Go On The Pill?

In some cases, the pill can reduce bleeding or stop a heavy flow and may very well be the best temporary solution for you. But make no mistake, this should only be temporary and only used in extreme cases while you also work to treat the underlying cause.

Because birth control can have serious side effects it is important to have a conversation with your doctor to understand all the risks before starting. It would be my preference that women do not start the pill for symptoms, but also recognize that there are extreme cases that make this necessary. If you do choose to start the pill, make sure you have a plan to come off and that you are in fact treating your root cause, not masking it.

I encourage you to make shifts in your diet, begin iron supplementation and work with your doctor to determine the underlying cause of your symptoms. The pill is never a solution to an imbalance in your body.

Learn more with my article: Using The Pill To Stop Periods – Is It Really A Good Idea?

Conquer Anemia & Menorrhagia Now

With the diet, supplements and root cause medicine you can start feeling healthier and more energetic in no time.

I invite you to explore my Period Problems Solution Course to get on a hormone-regulating regimen that will help stop heavy periods that can contribute to iron deficiency anemia.

In it we can help you unlock the cause of your heavy bleeding and anemia, so you can ditch those period problems and enjoy lighter, easier periods and a whole more more energy.

Learn more about the Period Problems Solution Course!

We believe strongly in using food as medicine. Here is a sample meal plan from my clinic that we use in our online programs to support women with iron deficiency anemia and menorrhagia.

Sample One Day Meal Plan to Boost Iron

Breakfast

Poached eggs over sautéed spinach, kale, and bell pepper

Lunch

Lamb Kababs leafy green salad with Citrus Vinaigrette and topped with pumpkin seeds

Dinner

Sneaky Meatballs (with chopped liver mixed in!) in marinara sauce over zucchini noodles

Snack

Roasted Bone Marrow spread on sweet potato wedges

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is one of the leading experts in women’s medicine and is a pioneer in her exploration of the far-reaching impact of hormonal birth control and the little known side effects that impact health in a large way. In her best selling book, Beyond the Pill, she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. A trained nutritional biochemist and Naturopathic Physician, Dr. Brighten is the founder and Clinic Director at Rubus Health, an integrative women’s medicine clinic. She is a member of the MindBodyGreen Collective and has been featured in prominent media outlets such as Forbes, Cosmopolitan, ABC news, and the New York Post. Read more about me here.

Top things to know

  • 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.

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.

Know your body. today and track your period.

When Your Period Tries to Kill You

Sitting cross-legged on a hospital bed, I was relaying the history of my period to a doctor. He looked at me quizzically, glancing at my notes. “25? You’re very young.” That afternoon, I found out that I was severely anemic. I was admitted to hospital for a blood transfusion; over 12 hours, I slowly absorbed three bags of blood, hooked up to a drip in a ward amongst women three times my age.

Earlier that day, I’d received a call from my doctor about my blood test results. She had ordered me to go to A&E immediately, telling me that my hemoglobin levels were dangerously low. Disorientated and alone, I’d quietly wept as nurses attached plastic valves into my veins. I was so tired that I could barely walk, and found myself being pushed around the hospital’s lengthy corridors in a wheelchair. Even sitting up was difficult. My body kept folding in half. It can be easy to forget the vulnerability of being human when you’re kept occupied by a stream of distractions to the extent that you stop listening to your body. That night I’d been sharply reminded that none of us are infallible.

Every month since I’d hit puberty, I was losing a life-threatening amount of blood–and I’d thought it was the norm.

The intense tiredness had started at the end of June. Fresh home from a festival, I’d felt a bit exhausted from carrying heavy things, but thought that a day of rest would sort me out. Instead, the lethargy got worse. Everyday tasks became extremely difficult. I felt exhausted all the time, and frustrated to the point of tears. I struggled with my work and could barely walk up flights of stairs. Trying to do my usual light exercises filled me with dread–most days I just couldn’t muster up the energy. I couldn’t even drag myself to the kitchen to cook, and a lot of the time I wanted to lie on the sofa and give up. I’d started falling asleep in the middle of the day.

Read More: Living with My Mother’s Mental Illness

This was sleep I didn’t want, and couldn’t fight–sleep that made me feel out of control and helpless. In the morning, if I stood up too quickly I’d be besieged with dizziness and headaches. And of course, I had been craving ice like an addict.

Life deals you these hands sometimes, throwing signals at you to stop before it’s too late. At first, I didn’t listen, plagued with mild thoughts of illegitimacy: Was I tired, or just lazy? Most people took one look at me and I assumed I was fine. In a political atmosphere in which your worth and value is so closely tied to your productivity, I felt guilty, and kept pushing myself to do things and be places.

It was a relief to be diagnosed, for my physical exhaustion to have a source. The severe anemia had been caused by my heavy periods. Every month since I’d hit puberty, I was losing a life-threatening amount of blood–and I’d thought it was the norm. Night pads would have to be changed at midnight, and on my heaviest days I couldn’t leave the house without at least 5 super tampons.

I first got my period when I was 11. Thanks to my school’s subpar sex education, I’d learnt that a tampon could expand up to three times its original size, but I had no idea how much bleeding was average for someone my age. The focus was on the form of our bodies, rather than the function. So I struggled silently through my teens and early twenties, with only those closest to me understanding the extent of my pain.

Read More: How It Feels to Be Pregnant For Ten Years in a Row

I endured cripplingly debilitating periods, with pain so bad that I’d have to call in sick to school or work. I’d wake in the middle of the night in pain on the first day of my cycle. The nausea was so bad I’d sit in the bathroom vomiting, too wary to eat in case it happened again. I’d lose hours of sleep, breaking out in clammy sweats. My period would come on at work and I’d have to find a way to get permission to go home. My time of the month didn’t inspire mild inconvenience, but rather dread and fear. It had felt like my period was trying to kill me–and years later, it almost did.

Anemia is common in women who have heavy periods, but the two don’t always correlate. It can usually be countered with a balanced diet of iron rich foods. In my case, eating spinach and kidney beans wasn’t enough to counter my blood loss. It seems women are more at risk, and less likely to be initially flagged.

With no point of reference as I came of age, I didn’t question what was happening to me.

“Iron deficiency in menstruating women is not taken seriously as an indicator of disease as it is in men and post-menopausal women,” explains Sophie Osbourne, a NHS doctor in Enfield, north London.

Her take mirrors my own experiences–a year ago, when my blood test results indicated minor anemia, my doctor didn’t think it was important enough to let me know.

“It is fairly uncommon for minor deficiency to develop into major deficiency unless there are other factors in play,” she continues. “Very heavy periods will certainly give some shockingly low iron values if persisting over time.”

Osbourne tells me that she had admitted many women with iron deficiency during her career. “In many cases,” she explains, “bleeding from the bowels was suspected, but in the end it was the periods that were to blame.”

In schools and workplaces and public spaces, people invent increasingly innovative ways to hide tampons up their sleeves on the journey to the toilet, or find discreet ways to empty menstrual cups in shared bathrooms. Period stigma taught me very early on that things happening to bodies that aren’t cisgender and male were weird and wrong, and they weren’t to be talked about.

There was a time when women fought to grasp full knowledge of their reproductive health. The women’s movement of 1969 lead to the collaborative book project Our Bodies, Ourselves. Fueled by an unprecedented thirst for knowledge against a backdrop of the then-heavily male dominated health profession, the book originated from a consciousness-raising workshop on women’s bodies.

Nowadays, we don’t really talk about our periods. With no point of reference as I came of age, I didn’t question what was happening to me. I was apprehensive to talk about my period problems with friends, and felt like a fraud telling employers that my pain was the reason I wouldn’t be turning up to work. Over the years, I learned to manage my condition. Switching to reusable cups rather than disposable pads and tampons drastically reduced embarrassing leakage situations. Avoiding sustained stressful situations alleviated monthly pain. Going freelance meant that I could take a few days off and not feel guilty, because I no longer had a boss to answer to.

Read More: The Broadly Guide to Pregnancy

A few days after the blood transfusion, I found myself still tired, frustrated, and dialing my doctor. Naively, I thought the procedure would have worked like charging a phone–pumping me up with brand new blood and sending on my way, good as new. Instead, I was sent home with a cellophane bag full of boxes of pills. At its peak, I was totaling ten tablets a day, the most significant designed to stop my period altogether so that heavy blood loss wouldn’t defeat the point of the transfusion.

Proper recovery took weeks, and I’m still in the process of it, but now I feel alive again. It’s the little things, like dashing up the stairs to grab something without having to take time to rest. It’s the absence of shattering headaches, and the ability to get on my bike without feeling like I might pass out. Along with the lethargy came a dulling of senses, but now my emotions are tuned into an overwhelming gratitude. That I’m better thanks to strangers donating their blood–that is now my blood–is a constant source of awe. I’m still a bit scared of my period. But I think I’ve experienced the worst of its consequences–at least for now.

Are You Anemic?

Causes of Anemia

There are three main reasons people become anemic: blood loss, a reduction in the body’s ability to produce new red blood cells, or an illness that leads to increased destruction of red blood cells.

Blood loss. When the amount of blood lost is greater than your body’s ability to replace the lost red blood cells, you can become anemic. Women who experience heavy menstrual periods, for example, and people who have internal bleeding due to ulcers or other digestive problems are at the greatest risk for anemia. Sometimes this type of blood loss is silent and unrecognized until anemia shows up on a blood test. External bleeding from surgery or trauma also can cause anemia.

Low production of red blood cells. Even if you’re not bleeding, old red blood cells constantly need to be replaced with new ones.

A number of factors can cause your body to produce too few red blood cells, or red blood cells lacking in sufficient hemoglobin.

These include:

  • Diet. If your diet is lacking in foods containing iron, folic acid, vitamin B12, and other essential nutrients, your red blood cell production can falter.
  • Medical conditions. Chronic illnesses like cancer, diabetes, kidney disease, and HIV/AIDS can interfere with the body’s ability to produce red blood cells. Women who are pregnant also can become anemic.
  • Genetic disorders. Children can inherit conditions, like aplastic anemia, that prevent them from producing enough red blood cells. Inherited conditions like sickle cell anemia and hemolytic anemia also can prompt the body to destroy red blood cells.
  • Increased red blood cell destruction. Certain diseases can cause your body to turn on its own red blood cells and destroy them. For example, you can become anemic due to an illness that affects your spleen, the organ that normally removes worn-out red blood cells from your body. A diseased or enlarged spleen can begin removing more red blood cells than necessary.

Anemia Signs and Symptoms

People who are anemic most often experience fatigue. While it’s normal to feel tired after a long day at work or a heavy exercise session, when you’re anemic, you feel weary after shorter and shorter periods of exertion as your body’s cells become starved for oxygen.

As anemia worsens, your body can experience visible physical changes — your skin could become pale, your nails brittle and cuts may take longer to stop bleeding.

Other symptoms associated with anemia include:

  • Shortness of breath
  • Irritability
  • Weakness
  • Dizziness
  • Cold hands and feet
  • Racing or irregular heartbeat
  • Inability to concentrate or think clearly
  • Chest pain
  • Sexual dysfunction

These symptoms are likely to be very light at first, especially if you have mild or moderate anemia. Our bodies are very adaptable, and will try to compensate for the loss of oxygen in the blood. As anemia advances, your body will be less able to adapt and the symptoms will become more obvious.

You should see your doctor if you are experiencing these symptoms. However, anemia is often discovered while investigating another illness, since early-stage anemia often involves few or no symptoms.

A diagnosis of anemia usually involves:

  • A Complete blood count (CBC), a blood test that measures all the different components of your blood.
  • A medical and family history that can indicate whether you’ve become anemic due to illness or a genetic condition.
  • A physical exam that can tell whether your breathing or heartbeat has become irregular due to anemia.
  • Other blood tests that will check for iron or vitamin deficiencies and look more closely at your red blood cells and hemoglobin.

If you feel consistently weak or have any of the other symptoms associated with anemia, your next step should be to see your doctor.

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