Yes, you can become anemic on your period. This connection affects a significant number of menstruating individuals globally. Monthly blood loss is a primary route of iron depletion in reproductive-aged people. When this loss exceeds iron intake and absorption, it leads directly to iron deficiency, which may progress to anemia.
The Mechanism Linking Menstruation and Iron Loss
Menstruation causes a loss of blood, and with it, a loss of iron stored within the red blood cells. Iron is a component of hemoglobin, the protein responsible for transporting oxygen from the lungs to the rest of the body’s tissues. The body also maintains iron reserves, mainly stored in a protein called ferritin, found in the liver, spleen, and bone marrow.
The average person loses between 0.55 and 0.87 milligrams of iron per day through a normal menstrual cycle. When the monthly iron loss exceeds the amount that can be absorbed from diet, the body first uses up its ferritin reserves. Once these storage levels are low, the body struggles to produce enough hemoglobin, leading to Iron Deficiency Anemia (IDA).
A major risk factor is heavy menstrual bleeding, also known as menorrhagia, where blood loss is excessive or prolonged. Individuals with heavy flow can lose much more iron, sometimes losing an average of 5.2 milligrams per cycle. This accelerated depletion quickly exhausts iron stores, making the development of iron deficiency and anemia more likely.
Recognizing the Signs of Iron Deficiency
The symptoms of iron deficiency arise because the body’s tissues and organs are not receiving adequate oxygen. One common sign is fatigue, a weakness that persists regardless of how much rest you get. This lack of energy is often accompanied by shortness of breath, even during light activities.
Physical changes can also be visible, such as a pale appearance to the skin, a condition known as pallor. Iron deficiency can also affect the extremities, sometimes leading to cold hands and feet. Less common but important indicators include a severe craving for non-food items, such as ice, clay, or dirt, a condition referred to as pica.
Neurological and muscular symptoms can also develop due to low iron stores. Some individuals experience restless legs syndrome (RLS), characterized by an irresistible urge to move the legs, especially at night. Low iron can also cause inflammation or soreness of the tongue (glossitis) and make nails brittle or spoon-shaped.
Diagnosis and Comprehensive Management Strategies
If you suspect your menstrual cycles are causing iron deficiency, the first step is to consult a healthcare provider for confirmation. Diagnosis typically involves blood tests, most importantly a Complete Blood Count (CBC) and a check of your ferritin levels. The CBC measures the amount of hemoglobin and the size of your red blood cells, while ferritin is the most accurate indicator of the body’s iron stores.
A ferritin level below 15 micrograms per liter often indicates definitive iron deficiency, though some providers prefer a higher threshold to begin treatment. Other tests, such as transferrin saturation, help determine how much iron is circulating in the blood. Once iron deficiency or anemia is confirmed, management involves a two-part strategy: replenishing the iron and addressing the source of the blood loss.
Iron replenishment can be achieved through dietary changes and supplements. Iron-rich foods include heme iron sources like red meat, which are absorbed easily, and non-heme sources like legumes and leafy greens. To maximize the absorption of non-heme iron, it should be consumed alongside a source of Vitamin C, such as citrus fruits.
Oral iron supplements are a common first-line treatment, but they can cause side effects like constipation, which may require a change in formulation or dosage. For severe deficiency or cases where oral supplements are poorly tolerated, intravenous (IV) iron infusions may be necessary to rapidly restore iron stores. However, managing the anemia long-term requires addressing the heavy menstrual bleeding.
Options for reducing menstrual flow include hormonal birth control, which can lighten periods significantly, or nonsteroidal anti-inflammatory drugs (NSAIDs) taken during the heaviest flow days. If heavy bleeding is caused by underlying conditions like uterine fibroids or polyps, specific medical or procedural interventions may be necessary. Because excess iron can be toxic, it is important to work closely with a medical professional to determine the correct dosage and duration for any iron supplementation.