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How can women know if they're iron-deficient, and what to do about it

Iron is an essential nutrient for many things our bodies do every day, and yet more than a third of adult women of reproductive age in the United States are deficient.

Menstrual bleeding and pregnancy are the main drivers of the deficiency. Symptoms are often nonspecific and vague, like fatigue, brain fog, lightheadedness, sleep disturbances and a reduced ability to exercise. If left untreated in the long term, iron deficiency can deplete healthy red blood cells in the body, causing anaemia. During pregnancy, iron deficiency and anaemia can have an adverse effect on the mother and the foetus.

If you have heavy periods, eat a vegetarian diet or are planning to get pregnant, consider asking your doctor to test your ferritin levels, which measures how much iron is stored in your body, said Dr Malcolm Munro, professor of obstetrics and gynaecology at the David Geffen School of Medicine at the University of California, Los Angeles. In annual checkups, most doctors will test only for haemoglobin levels, he said, but that is an indicator of anaemia, not iron deficiency. Getting your ferritin levels tested is usually covered by insurance, he added. “It’s not some fancy test.”

For women who are not pregnant, ferritin levels should be at least 15 micrograms per litre, and haemoglobin levels at least 12 grams per decilitre, according to the World Health Organization. But increasingly, researchers suggest that the cutoffs should be higher: For ferritin, between 30 and 50 micrograms per litre; and for hemoglobin, 13 grams per decilitre.

If you’ve determined that your iron levels are low, “we have this approach – we say we have to ‘stop the leak and fill up the tank’,” Dr Munro said. Here’s what that might look like.


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Many women don’t know whether their menstrual bleeding might be considered heavy, said Dr Angela Weyand, a paediatric haematologist at University of Michigan Medical School.

“I see a lot of adolescents who have very heavy menstrual bleeding and end up having severe anaemia where they have to be admitted to the hospital,” she said. “Oftentimes, these patients hadn’t even recognised that their bleeding was abnormal.”

Soaking through a pad or tampon every two hours, bleeding for more than seven days or needing double coverage (like a tampon and a pad) are all signs that your period is too heavy.

If you have heavy bleeding and are iron-deficient, talk to your gynaecologist to first rule out factors that might be causing the excess bleeding, like endometriosis or fibroids, Dr Munro suggested. From there you might consider approaches to reduce how much you bleed, such as birth control pills or the hormonal intrauterine device.

Taking naproxen (sold as Aleve) or ibuprofen can also help reduce blood loss if taken two days before your period starts and throughout it. Tranexamic acid, a prescription medication, is another option.


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There are many types of supplements, providing different amounts of iron, but a higher dose is not necessarily better; it’s best to take no more than 100 milligrams per day, Dr Munro said. Exceeding that amount can worsen side effects, like constipation or nausea, and the iron won’t be well absorbed. For example, the most common iron tablets contain 325 milligrams of ferrous sulfate, which provide 65 milligrams of iron, and one of those would be sufficient.

Studies suggest that taking your iron supplement every other day is just as effective as and has fewer side effects than dosing more frequently.

Avoid having calcium supplements, milk, coffee, tea or high-fibre foods at the same time as your iron supplement, since these may interfere with your body’s ability to absorb iron.

Consistent supplementation should improve ferritin numbers in about three months, Dr Munro said. Once your ferritin numbers are up and you are not losing as much blood during menstruation, you might be fine relying just on your diet for iron, he added.


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According to federal recommendations, men of any age and women over 50 should consume at least 8 milligrams of iron each day, while women ages 19 to 50 should aim for 18 milligrams. The requirement increases to 27 milligrams during pregnancy.

There are two types of iron found in foods: Heme and non-heme. Heme iron is found in any animal-derived source, including meat, poultry and fish; non-heme iron is found in plant-based foods like lentils and beans, some vegetables, grains and nuts, said Elaine McCarthy, a nutrition researcher at the University College Cork in Ireland. Both types of iron can be valuable sources, but your body absorbs heme iron more efficiently, Dr McCarthy said.

That said, plant-based foods can still be great sources of iron. A cup of cooked lentils, for example, contains 6.6 milligrams of iron – more than is found in a serving of beef – but you’ll want to use a few tricks to help your body absorb it, said Diane DellaValle, an associate professor of nutrition science at King’s College in Wilkes-Barre, Pennsylvania.

Drawing up a personalised plan with a registered dietitian is worthwhile, but here are a few of her tips on getting more iron:

Pair plant-based iron with absorption enhancers. Including a bit of meat or a good source of Vitamin C in the same meal will improve your absorption of non-heme iron, Dr DellaValle said. You can add tomato or bell pepper to your lentils, for example, or have strawberries or an orange on the side.Avoid absorption blockers. Certain compounds found in tea and coffee can interfere with the absorption of non-heme iron from food and supplements, so avoid having those beverages at the same time as plant-based iron sources, Dr DellaValle said.Look for enriched foods. Other good sources of iron include certain fortified foods, like breads and pastas that contain enriched wheat flour, Dr DellaValle said. Enriched rice also contains extra iron, though you’ll lose some of it if you rinse such rice before cooking. And many breakfast cereals are fortified with iron; just be aware that the iron will soak into the milk in your cereal bowl, so you’ll need to drink the milk to get the full dose.Cook with special tools. One of Dr DellaValle’s favourite tips is to cook with a Lucky Iron Fish. Place it in your cooking pot along with a couple drops of lemon juice or vinegar, and the product releases six to eight milligrams of iron into whatever you’re preparing, whether it’s rice, oatmeal or soup. Cooking in a cast iron pan can also add iron to your meal. Dr DellaValle often recommends the Lucky Iron Fish to the college athletes she works with, and she gives it as a holiday gift.

By Alisha Haridasani Gupta and Alice Callahan © The New York Times Company

The article originally appeared in The New York Times.

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