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
NGAN, 42 YEARS OLD / SINGLE MUM / PROFESSIONAL
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.
WHEN LIVING
WITH HEAVY PERIODS,
YOUR IRON COUNTS.
If heavy periods impact your quality of life and disrupt your day, it could be due to low iron.1-3
Here you'll learn the symptoms of iron deficiency. You'll also learn about steps you can take to get your iron levels back on track for a better quality of life.2
Many women who experience heavy bleeding are living with iron deficiency or iron deficiency anaemia, yet it may go under diagnosed and under treated.1,4
Periods are a fact of life. While you'll be familiar with the signs of your cycle and how it can make you feel, you may be iron deficient or have iron deficiency anaemia as a result of your period.2 This can leave you feeling off your game.1-2
As you lose blood, you also lose iron. When the iron in your diet is not enough to match the amount of iron you lose in your period, your body's iron stores deplete.
This can lead to iron deficiency and iron deficiency anaemia.5
IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA ARE COMMON IN WOMEN
WHO HAVE EXCESSIVE MENSTRUAL BLEEDING.1
Up to 1 in 4 women of reproductive age experience heavy menstrual bleeding6
2 in 3 women are living with iron deficiency or anaemia1*
It is reported that menstruating women are 10x more likely to be iron deficient or anaemic than men7
Nearly half of women who have a heavy flow during their menstrual cycle do not seek help.1* But remember, it is a recognised medical condition, called heavy menstrual bleeding (HMB) or menorrhagia.1,3
DO YOU KNOW
THE SIGNS
OF LOW IRON LEVELS
When living with heavy periods, knowing the symptoms of iron deficiency is essential as low iron can impact your quality of life.2
Iron deficiency and heavy periods share many presenting signs and symptoms, which can be broad and non-specific, including fatigue.1,8
Tiredness may seem like a normal consequence of having a period, but if the exhaustion is severe and doesn't improve between periods, this may be fatigue due to iron deficiency.8
Other signs of iron deficiency and iron deficiency anaemia include:6-11
Headache
Poor
concentration
Reduced work
performance
Looking
pale
Feeling
cold
Hair loss
While living with heavy menstrual bleeding can be hard, keeping your iron levels on track could play an important role in your health and wellness.2
In a survey, up to
9 in 10
women living with heavy menstrual bleeding who were iron deficient or had iron deficiency anaemia reported that it adversely impacted their health and their physical and emotional wellbeing.2
Did you know? Iron is essential for:
Your health and wellbeing as well as mental, physical performance and work productivity. Iron is also involved in numerous functions in the body.1,2
Your skin, hair and blood cells. Iron is a fundamental part of the process of growing and renewing these cells12
Your energy levels, muscle and brain function, and immune system. Iron is also needed to help keep your body warm.13-16
If you’re feeling off your game, talk to your doctor about your signs and symptoms.
You may feel that although your periods are very heavy, you just need to get on with it. Keep in mind that while heavy periods and low iron can impact your quality of life, medical intervention can also help to address and improve it. 2,17
Indeed, studies show that women with restored iron levels treated for heavy menstrual bleeding experienced improved quality of life, physically, emotionally and in their social lives, including a feeling of having more energy and less anxiety. 2
start the
conversation
When your doctor is assessing the length and severity of your period, it is important to tell them how you are really feeling. Speaking openly about your symptoms will help your physician to understand if you are low on iron.18
Don’t forget you can ask to see a female doctor, or you may feel more comfortable talking to a nurse at first.
Your healthcare professional may:
Investigate what's causing your heavy periods and the related impacts on your life2,17
Test your iron levels through a ferritin test alongside other blood tests17-19
Advise on different therapeutic options to restore your iron levels2,20
And remember, even if you feel that your period isn’t particularly heavy, you should still talk to your doctor if you are experiencing the signs of low iron.
To prepare for your consultation, try the symptoms browser
don’t let iron deficiency distrupt your day
Keeping your iron on track when living with heavy periods can support improved quality of life for you.1,21
* Based on an internet-based survey conducted among 4,506 women (aged 18-57 years) in five European countries between January and February 2012
** Not an actual patient
- Fraser IS, et al. Int J Gynecol Obstet 2015;128:196–200.
- Peuranpaa P, et al. Acta Obstet Gynecol Scand 2014;93:654–60.
- Opinium Research. Practice Nurse 2018;48(7):1–7.
- Mirza F, et al, Expert Review of Hematology 2018;11(9):727–36.
- Crichton R, et al. UNI-MED Verlag AG 2008;D-28323.
- Marret H, et al. Eur J Obstet Gynecol Reprod Biol 2010;152:133–7.
- Breymann C, et al. Geburtshilfe Frauenheilkd 2013;73:256–61.
- Breymann C, et al. Hematol 2014, Am Soc Hematol Edu Prog Book 2017(1);152–9.
- Patil AV and Malagi U. The Pharma Innovation Journal 2019;8(9):523–7.
- Percy L, et al. Best Pract Res Clin Obstet Gynaecol 2017;40:55–67.
- Dugan C, et al. Anaesthesia 2021;76:56–62.
- Zhang C. Protein Cell 2014;5(10):750–60.
- Agarwal R. Am J Nephrol 2007;27(6):565–71.
- Stugiewicz M, et al. Eur J Heart Fail 2016;18:762–73.
- Lozoff B, et al. Nutr Rev 2006;64:S34–S91.
- Piñero DJ and Connor JR. Neurosci 2000;6(6):435–53.
- NICE. Heavy Menstrual Bleeding: Assessment and management. 2018. Available at: https://www.nice.org.uk/guidance/ng88 (accessed July 2021).
- Soppi ET. Clinical Case Reports 2018;6(6):1082–86.
- World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization 2020.
- Peyrin-Biroulet L, et al. Am J Clin Nutr 2015;102(6):1585–94.
- Kocaoz S, et al. Pak J Med Sci 2019;35(2):365–70.
HQ-NA-2100153. Date of preparation: September 2021.