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Understanding iron deficiency anemia
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Understanding Iron Deficiency Anemia

Risk Factors

Your chances of developing iron deficiency anemia are increased if you have any of the following risk factors:

  • Heavy menstrual bleeding 
  • Recently had a baby
  • Gave birth to multiple children in succession: pregnancy induced iron deficiency anemia usually resolves in a few months after giving birth, but may persist in women from low income groups due to lack of nutritional supplements
  • Lactation/Breastfeeding which increases the demand for iron
  • Vegetarianism: lack of red meat (high in iron) in diet. There are many vegetables that do not contain iron, however, not all vegetarians develop anemia
  • A lack of folic acid, vitamin B6, or vitamin B12
  • Gastrointestinal disease: Celiac and Crohn's Disease, inflammatory bowel disease (IBD), colon cancer, or gastric bypass or gastric banding
  • Blood loss
    • Recent surgical procedure
    • History of bleeding disorders or blood disease (hemophilia)
    • GI bleeding due chronic or continuous aspirin/NSAID use
  • Body Mass Index (BMI) over 30
  • History of eating disorders (bulimia, anorexia)
  • Certain types of hereditary conditions, such as sickle cell disease or thalassemia
  • Chemotherapy treatment

Heavy Menstrual Bleeding

Most women experience heavy menstrual bleeding at some point in their lives, but if you are one of the 1 in 5 women who bleeds so heavily each month that you have to put your life on hold, you may be at serious risk for developing iron deficiency anemia.

Typically, women have a period about every 28 days. It lasts for 4 to 5 days, and they lose somewhere between 4 tablespoons and 1 cup of blood. (1 tablespoon is equivalent to 15 mL). Each mL (milliliter) of blood loss results in 0.5 mg of iron loss.

But the menstrual cycle isn’t the same for all women. Your period may be more or less regular, last a longer or shorter time, and still be normal.

You may be suffering from heavy uterine bleeding (also known as menorrhagia). If you have some of the following symptoms, your periods may not be normal:

  1. Soaking through a tampon and/or pad every hour
    or less for several hours in a row
  2. Needing to use double protection during your period
  3. Having to change your pad or tampon during the night
  4. Passing large blood clots in your menstrual flow
  5. Periods that last longer than 7 days
  6. Severe cramping
  7. Restricting daily activities due to heavy menstrual flow
  8. Symptoms of anemia such as tiredness, fatigue or shortness of breath

The most common causes of heavy uterine bleeding are fibroids or polyps, which are noncancerous tumors and growths on the lining of the uterine wall. Other possible causes include: a thyroid problem, use of an intrauterine device IUD, cancer of the uterus, adenomvosis, pregnancy complications, medications, pelvic inflammatory disease (PID), endometriosis, or an infection of the cervix.

If you are having symptoms of heavy uterine bleeding, it is very important for you to talk to your healthcare professional. You could be losing more than twice as much blood as normal and more than twice as much iron. Menorrhagia may deplete iron levels enough to increase the risk of iron deficiency anemia. Signs and symptoms include pallor, weakness and fatigue.

If your healthcare professional diagnoses you with iron deficiency anemia, he or she may prescribe either oral iron supplements or intravenous iron. Intravenous iron can replenish your iron stores more rapidly than oral iron.

Pregnancy and Delivery

If you are pregnant, your daily requirement of iron doubles. Some of the extra iron that you need is to help supply oxygen to your growing fetus, some of it is to take care of your own body, and some of it is to prepare for the blood you will probably lose during and after delivery. Women lose varying amounts of blood during delivery, but 1 in 20 women actually lose more than 1,000 mL of blood (potentially more than 20% of the blood in her body). Blood loss of 1,000 mL calculates to an estimated iron loss of 500 mg. It is generally estimated that half of the anemia cases in pregnancy are related to iron deficiency.

If you are like most women, you probably don’t have enough stored iron to take you through your pregnancy, and it is very hard to get enough iron through your diet. The good news is that nature gives your fetus the ability to take the iron it needs—even if you are iron deficient. The bad news is that you may end up suffering from anemia after your delivery.

As any mother knows, taking care of a newborn is a demanding job. Delivery leaves most mothers feeling very tired, but if you are anemic, you may feel much more exhausted—just when your infant needs so much attention and care. Maternal iron-deficiency anemia has also been shown to be strongly associated with depression, stress and cognitive function in the postpartum period. This may result in difficulty for the mother to care for her baby, thereby influencing the emotional mother-infant bond. What’s worse is that you may not realize that your level of exhaustion isn’t normal, and that, with treatment, you could feel much, much better.

There are certain conditions that can increase your risk of postpartum anemia, such as:

  • A low level of prenatal iron. If you start out with too little iron, you will have a harder time dealing with the effects of blood loss during delivery. It will also be more difficult for you to rebuild your stores of iron after you have your baby
  • Overweight before pregnancy. Being overweight can increase your chances of losing blood—and iron—through complications during your pregnancy
  • Carrying multiple babies. Two or more growing fetuses will naturally require a greater amount of iron
  • Not breastfeeding. If you don’t breastfeed full time for the first 6 months after you give birth, you will probably begin menstruating during that time. And, since menstruating uses up about twice as much iron as breastfeeding does, you will have a greater risk of iron deficiency
  • Multiple pregnancies and deliveries. After giving birth, you may be iron deficient due to the loss of blood. If you become pregnant again within a year, you will begin your pregnancy with a low iron level, and that may greatly increase your risk of iron deficiency anemia

It is very important to talk to your healthcare professional if you have any symptoms of anemia during your pregnancy or postpartum. If you are diagnosed with iron deficiency anemia, he or she may prescribe either oral iron supplements or intravenous iron. The benefit of intravenous iron is that it can bring your iron level back to normal much more quickly.

An Inadequate Diet

Iron comes from food, and your body is only able to absorb a small portion of the iron you consume. This means that if your diet doesn’t include enough of the foods that are rich in iron, you may be at risk for iron deficiency anemia. For a list of some iron-rich foods, click here.

If you are dieting, it’s important that you make sure you are still getting enough iron. If you are a vegetarian, your risk for iron deficiency may be increased because it is harder to absorb the iron from plant foods than from animal foods.