Iron deficiency anemia affects around 3 million women in the United States alone, not to mention women all over the world. It is a common problem affecting women, which often goes undiagnosed and untreated. Heavy bleeding during menstrual periods is the most common cause of iron deficiency anemia in women. Often, iron supplement medications are needed to correct this type of anemia. However, if you suspect you have anemia, then consult your healthcare provider first and don’t take iron supplements on your own without determining the real reason behind your problem.

How Are Anemia and Menstruation Related?

29% of non-pregnant women and about 38% of pregnant women suffer from iron deficiency anemia. Due to heavy menstrual bleeding every month, the iron within the red blood cells is also lost. If this iron which is lost with menstrual bleeding is not replaced from the meals that you consume or from iron supplement medications, you will end up eventually with an iron deficiency anemia.

Women who lose more than 80 ml of blood with every menstrual period are more likely to develop this kind of anemia related to menstruation. Now you know how anemia and menstruation related, but what can lead to heavy menstrual bleeding? Certain medical conditions affecting the genitourinary system can lead to heavy menstrual bleeding, over 80 ml of blood during a menstrual period, such as uterine polyps, adenomyosis, uterine fibroids, bleeding disorders, etc.

On the other hand, if a woman is pregnant or breastfeeding, she has greater risks of developing iron deficiency anemia. These two periods are a special condition for a woman’s body. First, during pregnancy, the woman’s body needs to support the growth of a new life inside her body, so there is normally an increased need for iron. A pregnant woman needs 2 to 3 times more iron compared to the time when she is not pregnant, so developing an iron deficiency is quite easy during pregnancy. The blood that is lost during childbirth can make the condition get worse.

During breastfeeding the woman’s body needs to work more in order to produce the necessary amount of breast milk. Developing an iron deficiency anemia is also possible while breastfeeding especially when not eating well.

What Are the Symptoms of Anemia?

How do you know you have anemia and menstruation? Anemia and especially iron deficiency anemia can develop for a prolonged period of time. It might take years for the first symptoms to become noticeable. On the other hand, in cases of severe blood loss for a short period of time, the symptoms become noticeable immediately. Symptoms of anemia due to menstrual periods usually become noticeable after weeks, months, or years. Common signs and symptoms of iron deficiency anemia include:

• Lightheadedness
• Tiredness
• Weakness
• Poor concentration
• Heart palpitations
• Cold intolerance
• Skin paleness
• Brittle nails
• Hair loss
• Chapping at the corner of the mouth,
• Poor circulation

How to Deal with Iron Deficiency Anemia

Once you are diagnosed with iron deficiency anemia, you could start by increasing the iron intake through the diet. There are two types of dietary iron:

• Nonheme
• Heme iron

Nonheme iron is iron originating from plant sources such as beans, grains, kale, beet, lentils, oats, wheat, tofu, etc. This type of iron is not absorbed that much compared to heme iron. Limit the intake of coffee or tea immediately after a meal as they can reduce the absorption of nonheme iron from the digestive system. On the other hand, certain types of foods and beverages such as citrus fruits, strawberries, peppers are rich in vitamin C. It is known that vitamin C helps the absorption of iron from the digestive system.

Heme iron is only found in meat sources. This type of iron is more rapidly absorbed compared to the nonheme iron. Great sources of heme iron are red meat, chicken, turkey, pork, shellfish, oysters, fish, etc. However, red meat is the one with the highest concentration of heme iron.

However, often a diet change only is not enough to restore the iron that is missing in the body. In general, iron supplements are recommended and prescribed as the primary treatment of iron deficiency anemia. As there are many types of anemia, first of all, it is very important to determine if this is an iron deficiency anemia or any other type of anemia.

How to Manage the Heavy Bleeding

As mentioned, various factors can lead to heavy bleeding during menstrual periods, a condition commonly known as menorrhagia. The treatment of heavy menstrual bleeding depends from its cause.

Medications commonly prescribed for the treatment of menorrhagia include:

• Iron supplements to treat the iron deficiency anemia
• Oral contraceptives for the regulation of menstrual cycle, especially in cases of an irregular menstrual cycle, as well as, to decrease the duration and quantity of menstrual bleeding
• Oral progesterone for the treatment of hormonal imbalance as one of the causes of menorrhagia
• Hormonal IUD in order to reduce the menstrual cramping and the heavy bleeding by thinning the inner lining of the uterus, known as endometrium
• Tranexamic acid to reduce the bleeding

In cases when heavy menstrual bleeding is caused by a bleeding disorder, Stimate or Desmopressin nasal spray is recommended.

NSAIDs are also prescribed for the treatment of menstrual cramps and painful menstrual periods.

In order to relieve the signs and symptoms of heavy menstrual bleeding, certain surgical interventions are recommended as well, such as:

• Uterine artery embolization, a surgical procedure which consists in blocking the arteries that feed the fibroids, as part of the fibroid treatment
• Focused ultrasound ablation, a surgical procedure which consists in using ultrasonic waved to destroy the fibroid tissue, also as part of the fibroid treatment
• Endometrial ablation, a surgical procedure which permanently destroys the inner lining of the uterus, the endometrium
• Endometrial resection, a surgical procedure which uses an electrosurgical wire loop to remove the inner lining of the uterus, the endometrium
• Dilatation and curettage, a surgical procedure which consists in scraping the inner lining of the uterus, the endometrium
• Hysteroscopy, a surgical procedure which helps evaluate the inner lining of the uterus. It also helps remove any polyps or fibroids that are growing inside the uterus
• Myomectomy, a surgical procedure which consists in removing the uterine fibroids, through the vagina
• Hysterectomy, a surgical procedure which consists in the partial or total removal of the uterus, sometimes even with the ovaries