Iron deficiency
Heavy periods are the most common cause of iron deficiency in people who menstruate. Low iron causes fatigue and other symptoms long before it causes anemia, and it is easy to test for and treat.
Signs of low iron
- Fatigue, weakness, or trouble concentrating
- Shortness of breath or a racing heart with activity
- Headaches or dizziness
- Craving ice or non-food items
- Restless legs, hair shedding, or brittle nails
Testing
Ferritin measures iron stores. It can be low even when a blood count is normal, so both are checked when periods are heavy.
Oral iron
Iron tablets are the usual first step. Taking iron once a day, or every other day, may be absorbed as well as more frequent doses and is often easier on the stomach. Absorption is better on an empty stomach or with vitamin C, and worse with tea, coffee, calcium, or antacids taken at the same time. Constipation and dark stools are common.
IV iron
Iron given by infusion replaces stores faster. It is used when tablets are not tolerated or not absorbed, when iron is very low, or when time is short, such as before surgery.
Treat the cause too
Iron replacement works best alongside treatment that reduces the bleeding. Your physician will recheck your levels after a few months.
Sources
- Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women. Lancet Haematol. 2017;4(11):e524–e533.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206 (reaffirmed).