Fatigue, weakness, headaches, irritability. Sound familiar?
These are the most common signs of anemia.
If you’re feeling these I’m not guaranteeing you are anemic. You may just be grumpy. Or stressed. Or not sleeping enough. Or depressed. But you can (and some may say should) be checked for anemia through a simple blood test called a CBC (complete blood count).
Read more to find out about anemia and iron supplements!
If you are anemic, the most likely cause is iron deficiency.
More than 10% of women ages 16-50 years old have iron deficient anemia. Iron is important because it helps with red blood cell formation and red blood cells carry oxygen throughout the body. Low iron levels lead to decreased red blood cell production which can lead to lower levels of oxygen getting to vital organs. That is anemia. This is over simplified, but you get the gist. Females may even experience these types of symptoms from a mild iron deficiency before it even shows up as anemia.
What affects our iron levels?
Iron levels become low when we lose more iron than we take in. Iron loss is usually gradual and slow. Women often loose it through chronically heavy periods, but bleeding from the intestines can be a cause, and pregnancy, delivery, and breastfeeding all lower our iron levels too. Acute blood loss, like during surgery, is a reason for faster iron loss.
Intake is from diet, both food and supplemental iron. This is usually from inadequate diet intake or poor absorption (celiac disease and gastric bypass are the two most common of these)
When will I feel symptoms if my iron level is low?
Because the iron loss is usually gradual, our bodies compensate for the changes gradually too. That makes the symptoms harder to identify. Additionally, many of the symptoms are vague or can be from other sources! Feeling fatigue can be from poor sleep, bad diet, not exercising, chronic medical problems, depression, etc etc etc – not just anemia. But this is why some simple blood work is warranted!
How can we correct it?
First, fix any bleeding problem!
If the problem is heavy periods, an evaluation is necessary, and then treatment can be directed at the underlying cause. You should see your trusted gynecologist for this eval.
Second, increase your iron intake!
There are a couple ways to do this: diet and supplements.
Iron is found naturally in many foods. Iron from meat (“heme iron”) is better absorbed than iron from plant sources (“non-heme iron”). Heme iron is highest in liver (beef and chicken) and mussels and clams. Cooked beef is an excellent. Chicken and turkey and other meats have relatively lower levels but are still good sources. Common non-heme iron sources: beans, nuts, and spinach or broccoli. Breakfast cereals are often enriched with iron so look for that label too.
Then there are supplements. The problem is that iron supplements can have some pretty nasty side effects – about 70% of women report some stomach upset like nausea, sometimes even vomiting, bloating, black poop. They can cause a metallic taste and pretty annoying constipation. Here are some tips to optimize absorption and minimize those side effects to help you:
- Taking them every other day is as good as taking them daily
- They’re best absorbed on an empty stomach.
- But … more side effects are common when taking them on an empty stomach.
- DO NOT take them with milk or dairy, calcium supplements, cereals, fiber, tea, coffee, and eggs. These all decrease how effectively they’re absorbed.
- Acidity helps with absorption! Vitamin C or other acidic drinks can help. A big glass of orange juice is a nice chaser. Don’t take them with antacids like Tums or Pepcid for this reason.
- Enteric coated and sustained release are not as effective.
- Most women notice an improvement in symptoms within 2 weeks of consistent use.
- But treatment can take more time to fully correct anemia and often a full 6 months to replete iron stores altogether.
- There are different formulations. Ferrous sulfate is the cheapest. But ferrous gluconate may be gentler on the stomach. Play around with different formulations to see which sits best with you. Ask your doctor how much “elemental iron” you should be looking for. A standard is to supplement with about 65mg of elemental iron every other day. You can find this info on the supplement box or container – something like “Per tab: ferrous sulfate 325mg; elemental iron 65mg”).
I am a board certified OBGYN at Cedars Sinai in Los Angeles.
I am co-founder of Female Health Education, a platform offering digital courses, striving to empower females through health education.
My passion is promoting and demystifying health information to the public. My blog, Dr. Sara Twogood’s LadyParts Blog, provides comprehensive information about fertility, pregnancy, and gynecology topics. I am on the medical board for the period tracker app Flo; contribute as a medical expert for pregnancy app and website The Bump; and serve on the Byrdie Beauty and Wellness Review Board (Byrdie.com). I have been featured as an expert for the podcasts The Dream and Her body, Her Story and quoted in numerous online and print publications.
I am honored to be named “Top Doctor” in Los Angeles magazine for years.