After the initial shock of starting to menstruate, periods gradually become part of life. You might learn to recognize the onset of emotional upheaval, stock up on pain killers to deal with the cramps and make sure you are prepared with tampons in your bag. However, aside from coping with the practicalities of periods, they may be taking a greater toll on your body than you realize.
During your period you lose blood, which contains iron. This loss means that women need up to twice as much iron from their diet as men.1
If the amount of iron in your diet is not enough to match the amount of iron lost through your period, you could become iron deficient. Iron deficiency means there is not enough iron to meet your body’s needs.2 Iron deficiency can lead to iron deficiency anaemia, where you can no longer make the number of healthy red blood cells you need.2 Having iron deficiency or iron deficiency anaemia can make you feel exhausted, have difficulty concentrating and be less able to fight infections.3
Heavy menstrual bleeding and iron deficiency
Even if you don’t think you have HMB you may still have trouble replacing the iron lost during your period. Iron deficiency is common in women and can have an impact on your general health.
Signs of iron deficiency
Tiredness may seem like a normal consequence of having your period, but if your exhaustion is extreme, and you don’t generally feel better in between your periods, you might be experiencing fatigue, which could be due to iron deficiency.5 You can use our Fatigue Survey to assess your level of tiredness, and you can use the results to help explain to your doctor how your tiredness is affecting your life.
Other signs of iron deficiency and iron deficiency anaemia include looking pale6 and losing concentration easily.3 To find out more about the signs and symptoms of iron deficiency see our Symptom Browser.
I may have iron deficiency, what can I do?
Periods become such a part of life that you may not think to talk to your doctor about them. You may feel that although they are very heavy, you need to just get on with it. But if your periods are impacting on your life, whether they are heavy or not, you should seek advice. Don’t forget you can ask to see a female doctor, or you may feel more comfortable talking to a nurse at first.
Your doctor may ask you to take a blood test, and this guide may help you understand the results. Having a healthy, balanced diet can also help keep your iron stores at the right level.
Remember, periods are just a part of life, don’t let them take over.
Heavy Menstrual Bleeding
Emily, 32 years old | Engaged | Professional
I started getting dizzy, if I stood up too quickly whilst I was at university. My mum gave me some supplements to take, but I thought these pills would help me, and that my dizziness was simply because I was busy studying and seeing friends. A few years later, when I was promoted at work, the dizziness got really bad. Sometimes I had to sit back down again so that I didn’t pass out. I got headaches and was really exhausted all the time; too tired to go out with my friends. My fiancé said I was crankier than I used to be too. My new job means I work long hours and have trouble sleeping, because I’m worrying, so I always put my symptoms down to having a hectic life.
I didn’t realise my periods were unusual until I was chatting to a close friend about feeling tired. She was surprised how long my periods last and that I have to get up in the night to change my towel. I did notice that I felt the most tired and dizzy when I had my period though, so I did think that maybe my periods were affecting me.
The tiredness bothered me the most. The world seemed foggy all the time, I couldn’t concentrate and sometimes I had to really fight to stay awake, even at work. If I slept on the weekend I would feel a bit better, but even a long lie-in didn’t really help. I like photography and if I went out to take photos or went to an exhibition I felt less stressed – but then I was too exhausted to do anything in the evening.
With the wedding coming up I realised I couldn’t go on struggling from day to day anymore, so went to my doctor. She said that my periods and therefore the loss of iron could be one of the causes why I feel so exhausted. I had blood tests done for anaemia and to check my iron levels, and it turns out that I do have iron deficiency anaemia, caused by my heavy periods. The doctor has started treatment and I already feel better. I’m hoping now I’ll have the energy to do all the things I want to do, and really enjoy my wedding and time with my new husband!
- Zimmermann M, Hurrell R. Nutritional iron deficiency. Lancet. 2007;370:511-520. Available at: http://www.sciencedirect.com/science/article/pii/S0140673607612355. Accessed October 13, 2013.
- Crichton R, Danielson B, Geisser P. Iron therapy with special emphasis on intravenous administration P32. 2008.
- Koduru P, Abraham BP. The role of ferric carboxymaltose in the treatment of iron deficiency anemia in patients with gastrointestinal disease. Therap Adv Gastroenterol. 2016;9(1):76-85. doi:10.1177/1756283X15616577.
- Liu Z, Doan Q V, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183-94. doi:10.1111/j.1524-4733.2007.00168.x.
- Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr. 2015;102(6):1585-94. doi:10.3945/ajcn.114.103366.
- Stoltzfus R, Edward-Raj A. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999;129(May):1675-1681. Available at: http://jn.nutrition.org/content/129/9/1675.short. Accessed February 11, 2014.