Iron Deficiency

I am a 50-year-old woman diagnosed in December with a severe iron deficiency probably from having very heavy periods. I had many symptoms of iron deficiency: extreme fatigue memory problems restless legs and irregular heartbeat, but didn’t realize what was wrong. I thought my problems were from stress. I did not think I could be anemic because I do eat red meat. My ferritin level was 4.

I have been taking iron now for 3 months 325 mg (=65mg elemental iron) 2-x day the restless leg went away after 2 weeks on iron. I feel better than I did but nowhere near normal. Paperwork takes twice as much work because I have to safeguard everything against my memory lapses. But I still feel drained. What more can I do to correct this? I had an endometrial biopsy and an ultrasound, which showed no uterine problems.

My gynecologist says just wait for menopause (in the last year my periods are becoming a little irregular) and keep taking the iron. But she’s not living with this exhaustion. I’m self-employed and my business and family are suffering. My last period was still very heavy. Is there anything I can do nutritionally either to encourage my body to have lighter periods or to build me up in other ways?

I think I eat well in general: cook from scratch no fast food no soft drinks. Anything else I can do to recover faster? Also the iron makes me constipated. I have to take loads of Metamucil and stool softeners to keep things moving. I had no problem in this area before taking the iron. It seems like my abdomen is always bloated and achy now. Thank you!

Severe iron deficiency does not allow oxygen to be carried to your body’s tissues, and patients often complain of the symptoms you described, tired being most common. Other symptoms include pale skin color, dizziness, headaches, and sleep and mood disorders. A low ferritin level can diagnose this deficiency as you described (less than 15-30micrograms/Ll). Serum iron is also low less than 30-60mg/dL. It can also be confirmed with a hemoglobin level less that 12g/dL and small/pale look to your red blood cells. Both of these values appear on blood work called a complete blood count (CBC).

This type of anemia does respond well to oral iron supplements, but you will only raise your hemoglobin level 1mg/dL each week, taking iron three times each day. I am glad you are feeling better, but in order to correct any anemia you need to raise your hemoglobin level above 12 g/dL (12-15g/dL is normal) before you feel the full effects of your iron replacement. Iron supplements then need to be continued an additional three months after your iron levels have been restored to normal to help replace the iron loss from your liver, spleen and bone marrow. Vitamin C will help with iron absorption. It is helpful to supplement your diet with iron containing foods like red meats.

If you become severely anemic, Hemoglobin less than 7g/dL there is a concern that the heart may develop an irregular beat, the arrhythmia you described. Correction of the anemia should resolve your heart problem, but if not further heart evaluation may be needed.

With a normal menstrual cycle we loose about 10-15 mg of iron daily and even more with heavier periods. It appears you had the proper evaluations for your heavy periods, which is important, since we do become concerned if our periods become heavy or irregular after age 40. An endometrial biopsy will rule out a cancer or abnormal changes in the lining of the womb. The ultrasound could look at the size of your womb and rules out fibroids (non-cancerous tumors in the womb) and tumors on the ovaries. However, the heavy periods would need to be treated, because if they continue, you will become anemic again over time despite iron therapy, especially if your blood loss is greater than your iron supplements.

There can also be other reasons for tiredness including thyroid disorder, diabetes, chronic fatigue syndrome, anxiety, depression, sleep disorders, poor diet and nutrition. 80% of perimenopausal and/or menopausal women complain of tiredness.Get enough rest, reduce caffeine, increase your water intake, good nutrition and exercise may help.

The memory lapses may or may not be due to your anemia, especially if your hemoglobin levels are corrected to normal and you are still having concerns. This may be associated with entering the peri-menopause. Other symptoms include hot flashes, irritability, anxiety, and insomnia.

I think your health care provider may need to do additional blood work to rule out other medical problems and provide treatment for the heavy bleeding.

Some temporary help with your paperwork may be to try to do it during the day as opposed to at night when you have more energy. Visit an office supply store, I find they have many new gadgets that help us organize. Bringing on a helper may provide some benefit. You may be lacking in other nutrients beside iron, so a multivitamin daily may help.

Eat healthy; you don’t want to skip meals. Take a quick nap when you end your day, just one hour may give you an energy boost. Energy boosting foods include whole grains; power snacks (combine protein, a little fat and some fiber).

Foods that drain your energy are, L-tryptophan, an essential amino acid with a documented sleep inducing effect, found in chicken, turkey and cheese. You may want to stay away from them.