Menstrual bleeding can vary from person to person and throughout our lives. Some people experience heavier periods than others, which can be a sign of a medical condition or simply normal variance.
Can you get iron-deficiency anemia from your periods? If so, how do you know, and what can you do about it?
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Anemia is a condition where your red blood cells aren’t working correctly, or your blood contains too few red blood cells or not enough hemoglobin (protein that carries oxygen). Your red blood cells are what transport oxygen from your lungs to your tissues, so if you don’t have sufficient red blood cells, your body doesn’t get enough oxygen, which can result in a variety of symptoms.
Anemia isn’t a diagnosis in and of itself and can be caused by several factors, including deficiencies in iron or vitamin B12 or blood loss from an injury or surgery. In this context, we’ll be looking at iron-deficiency anemia.
In acute cases, such as due to blood loss, anemia can be seen in the context of hypovolemic shock, which can cause organ failure and be fatal.
The short answer is yes. Your periods can cause anemia if they are unusually heavy, also called abnormal uterine bleeding (AUB). Terms such as menorrhagia, metrorrhagia, or polymenorrhea are no longer used, as they’re poorly defined. A heavy period (menstrual bleeding) is defined as a volume of bleeding that interferes with your physical, social, emotional, or material quality of life. Furthermore, the heaviness is based on your perception of increased daily or total monthly volume of blood.
From a medical definition perspective, >80mL of blood loss per cycle is considered excessive. Subsequent anemia from menstruation is a chronic process, exacerbated typically by a lack of adequate iron intake. Even if your heavy bleeding is normal for you or has been “normalized” by friends, family, or healthcare providers, there are things that can help you cope with it and reduce the inconveniences involved and the risk of anemia.
A variety of things can cause heavy periods, some of which warrant the attention of a doctor. Heavy periods may be deemed common in adolescents, but HMB as a whole is “under-diagnosed and under-treated.”
Heavy periods can also be caused by:
Leiomyoma (benign tumors)
Malignancy and hyperplasia
Coagulopathy (problems forming blood clots)
Iatrogenic causes (caused by a medical treatment or evaluation)
However, some people have heavy periods without an apparent underlying cause. There is a lot of natural variation in the amount of "flow" from menstrual periods, and other individuals may have a much lighter than normal flow due to IUDs or stenosis.
You may have anemia if you consistently have heavy bleeding and experience the following symptoms:
Shortness of breath, particularly during exertion
Cold hands and feet
Pagophagia (ice craving/eating)¹
Anemia symptoms can be severe and debilitating, resulting in missing work or school and being unable to complete daily activities. While severe anemia can be life-threatening, iron deficiency anemia from menses is a chronic process and thus not acutely life-threatening.
First of all, if you suspect your heavy periods are causing anemia, you should talk to your doctor. They can work with you to establish the underlying cause and come up with a plan to treat the problem.
If you’re experiencing severe anemia, you’re likely to be given an intravenous iron infusion. Depending on the severity of your anemia as well as any other diseases you have, your physician may decide to do a blood transfusion. They may also recommend you take an oral iron supplement. Increasing your iron intake helps your body make more red blood cells to replace those lost. Your doctor might also encourage you to eat more iron-rich foods. They may also check you for vitamin B-12 deficiency, especially if you’re vegetarian or vegan, which places you at higher risk for deficiency.
However, ultimately, your doctor will want to address the underlying cause of your heavy periods, if there is one. This means treating you for any condition that is causing or influencing them, such as endometriosis. If you’re using an IUD and it is causing anemia, you may need to switch to a different means of contraception.
If you’re not using contraception and not trying to get pregnant, your doctor may recommend you use hormonal contraceptives. These can make your periods more regular and generally lighten bleeding.
Not always. However, if you’re menstruating, it’s a good idea to ensure that your diet contains sufficient iron and B12. While most people only lose a small amount of blood during their menstrual period, your body does need to replenish that and benefits from extra building tools. However, it’s important that you avoid taking high amounts of iron supplements without talking to your doctor, as you can “over-supplement”.
Leading an overall healthy lifestyle with a healthy, well-balanced diet can help you prevent anemia from all causes.
Heavy periods are not normal, especially once your cycle has settled after menarche. It’s best to talk to a doctor about your heavy periods and get their recommendation on what to do, as well as get tested for reproductive system abnormalities that might be causing them. Treating these conditions early can help you manage them better and improve your chances of having children.
If you have any symptoms of anemia, it’s important to talk to your doctor immediately. Severe anemia is a medical emergency that may necessitate a blood transfusion.
Anemia is easily treatable, and you don't have to live with heavy periods that cause it, as well as other inconveniences such as having to frequently change tampons.
An unusually heavy menstrual period can lead to anemia. This is treatable but may indicate an underlying condition that needs addressing, such as endometriosis or a bleeding disorder.
It’s important to talk to your doctor about heavy periods and watch out for symptoms of anemia. Eating a healthy diet can help, and for many people, relief can be had through the use of oral contraceptives.
The symptoms of anemia include cold hands and feet, shortness of breath, fatigue, and headaches. Consult your physician if you’re experiencing these or other unusual symptoms.
Your doctor may recommend taking an iron supplement or increasing the amount of iron-rich foods in your diet while on your period.
What is anemia? | National Heart, Lung, and Blood Institute