Iron deficiency and iron deficiency anemia are fairly common medical problems that can make people feel tired and even short of breath. But new research has found one group at particular risk of developing iron deficiency: young women and girls who are on their periods.
The study, which was published in JAMA, analyzed data on blood iron levels from more than 3,400 women and girls ages 12 to 21 who participated in the National Health and Nutrition Examination Survey. The researchers found that between 2003 and 2020, nearly 40% of women and girls were iron deficient and 6% had iron deficiency anemia — a condition in which the blood doesn’t have enough healthy red blood cells, which carry oxygen to the body’s tissues.
Menstruation was a risk factor for both conditions, although more than 25% of those who had not yet started their periods also had an iron deficiency. As a result, the researchers concluded that “current screening guidelines may miss many people with iron deficiency.”
“I see a lot of iron deficiency and iron deficiency anemia in menstruating adolescents, but assumed that as a specialist I was only seeing the tip of the iceberg and that this problem was incredibly common in the general population,” said lead study author Dr. Amanda Weyand, a pediatric hematologist at the University of Michigan Medical School, tells Yahoo Life. “We know that menstruation, especially heavy menstrual bleeding, which is also quite common in the general population, is a risk factor for iron deficiency. But menstruation is stigmatized in our society, so issues should not be raised by patients or dismissed by healthcare providers.
But why can having a period lead to iron deficiency – even anemia – and how concerning is this? Experts break it down.
Why do young women and girls struggle with iron deficiency?
It’s easy to assume that the blood loss during menstruation causes a temporary iron deficiency during a woman’s period, but experts say it doesn’t work that way. “Iron deficiency is not something that happens for a week or a month and then goes away,” Deborah Cohen, an associate professor in the Department of Clinical and Preventive Nutrition Science at Rutgers University, tells Yahoo Life.
Weyand agrees. “People are less likely to be low for only a week or so a month,” she says. “Period do lead to iron deficiency, but this is more of a chronic problem with longer term iron stores.”
Being low in iron “means you probably don’t have enough to meet your needs, including enough to fill your iron storage proteins. Otherwise, you could use iron stores when you need them, like during your period,” Sonya Angelone, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, tells Yahoo Life.
The study didn’t look at why this population might be low in iron — it just found that this happens. However, there are some theories.
One is that monthly bleeding can increase the risk of iron deficiency and even anemia. “During menstruation, a woman loses iron in menstrual blood. That can deplete iron stores,” says registered dietitian Jessica Cording, author of The little book of game changers, tells Yahoo Life. Women and girls who have heavier periods may be at greater risk for this, she says.
Weyand says she thinks iron deficiency may be “secondary to menstruation” and is an intergenerational problem. “Iron deficiency has been normalized systemically by our reference ranges and ignoring women’s symptoms,” she says. “Menstruation is stigmatized and we know that while heavy menstrual bleeding is common – affecting one in four to one in two during a lifetime – many women do not seek care for this problem and may not even recognize it as abnormal.”
People as a whole also have less iron in their diets, which may play a role, says Weyand, though she says “it plays a lesser role.”
Regardless of the reason behind it, “the numbers are pretty surprising,” Dr. Women’s health expert Jennifer Wider told Yahoo Life. “It’s an issue doctors need to discuss with their patients and suggest ways to effectively treat and prevent it,” she adds.
What is the danger of low iron levels?
There is a range of iron deficiency and with that the symptoms can vary. “Some people don’t feel their best when their iron is even on the low side,” says Angelone. “Some people may end up feeling completely exhausted,” says Cording.
Iron deficiency and iron-deficiency anemia may also cause no symptoms or vague symptoms, such as fatigue, headaches, and difficulty concentrating, “which often get brushed off,” says Cohen. That can lead to people going undiagnosed, she says.
But while iron deficiency can lead to uncomfortable symptoms like headaches and fatigue, Cohen notes that most people who experience it have no signs at all. “‘Impair’ from iron deficiency is uncommon and really depends on the cause of the iron deficiency,” she says.
However, if iron deficiency anemia is left untreated for a long period of time, it can lead to heart problems such as a fast or irregular heartbeat, low birth weight babies during pregnancy, and growth problems in children and infants, according to the Mayo Clinic.
How to treat low iron
Weyand says women and girls on their periods should be aware of how common iron deficiency is in them. Cording recommends that people watch their iron intake and focus on consuming iron-rich foods such as fortified breakfast cereals, white beans, lentils, spinach and tofu.
If you suspect you or a loved one has low iron, Cohen says it’s important to get checked by a doctor just to be sure (it’s a simple blood test). Your doctor may recommend that you take an iron supplement if your iron deficiency is severe, but Cohen says you shouldn’t start supplementing right away without first consulting a doctor. “Self-prescribing iron supplements is not recommended because they have side effects — significant constipation that can be serious, especially if taken in high doses or taken by a young person — and, if the iron deficiency anemia is due to a medical condition, the signs and symptoms may go away, but the underlying medical condition may not,” she says.
If you have signs of iron deficiency or are concerned about your iron intake, talk to your doctor. They can offer personalized next steps.
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