The Link Between Low Iron and Heavy Periods.
I have been seeing a lot of people in clinic with low iron or anaemia who have also been experiencing heavy periods.
If you or someone you know experiences heavy menstrual bleeding, you might be all too familiar with the exhaustion that follows each cycle. What many people do not realise is that heavy periods and low iron status are intimately connected, creating a cycle that can significantly impact your energy, mood, and overall wellbeing.
Understanding the Connection
During menstruation, your body loses blood, and with it, iron. For most people with regular periods, this loss is manageable and the body can replenish its iron stores between cycles. However, when periods are heavy (medically termed 'menorrhagia'), the amount of iron lost each month can exceed what you can replace through diet alone.
Menorrhagia is generally defined as prolonged or heavy menstrual bleeding, losing more than 80ml of blood per cycle, although this can be difficult to measure. Practical signs include needing to change your pad or tampon every one to two hours, passing large blood clots, bleeding that lasts longer than seven days, or bleeding that interferes with your daily activities.
The Vicious Cycle
What makes this particularly challenging is that heavy periods and iron deficiency can create a self-perpetuating cycle. Heavy bleeding depletes your iron stores over time, leading to low ferritin levels (your body's iron stores). This iron deficiency can then impact your body's ability to regulate menstrual bleeding properly, potentially leading to heavier periods. Without adequate iron, your uterine lining may not develop or shed efficiently, and may contribute to prolonged or excessive bleeding, which leads to more iron loss - and the vicious cycle continues. If anaemia develops, you may experience worsening fatigue, which may affect your ability to prepare iron-rich meals and take care of your nutritional needs. The resulting inflammation and nutrient deficiencies can further disrupt your hormonal balance and menstrual health. How exhausting!
Recognising the Signs
Low iron can significantly impact your quality of life. If you are experiencing heavy periods alongside iron deficiency or anaemia, you might notice persistent fatigue that does not improve with rest, difficulty concentrating or "brain fog" (particularly around your period), increased breathlessness during normal activities, pale skin or pale inner eyelids, brittle nails, dizziness or feeling lightheaded when standing, frequent infections, unusual cravings (particularly for ice or non-food items), feeling cold more easily than usual, and longer recovery time after each menstrual cycle.
The Science of Iron Supplementation Timing
If you are taking an iron supplement, understanding how your body regulates iron absorption can help you get the most from your supplement. Your body produces a hormone called hepcidin, which acts as a gatekeeper for iron absorption. When you take an iron supplement, hepcidin levels rise. Elevated hepcidin levels can reduce iron absorption. This is why research now recommends taking iron supplements every second day, rather than daily, as this allows hepcidin levels to drop and actually results in better overall iron absorption. Additionally, hepcidin levels naturally rise throughout the day and are lowest in the morning, making morning (around 9-10am) the optimal time to take your iron supplement for maximum absorption.
It is also important to note that not all iron supplements are created equal. Traditional forms like ferrous sulfate are notorious for causing constipation, nausea, and other digestive discomfort in some people, which may lead to stopping taking them altogether. Once I have reviewed up-to-date blood tests for my clients, this is why I typically prescribe iron bisglycinate (also called iron glycinate), a chelated form of iron that is highly bioavailable (better absorbed) and significantly gentler on the digestive system, making it much easier to tolerate while still effectively restoring iron levels. Its absorption can also be enhanced by combining it with other nutrients and compounds, including lactoferrin and vitamin C.
Beyond Iron Supplementation
While iron supplementation is often the first line of treatment, it is important to address both the iron deficiency and the underlying cause of heavy bleeding. Several factors can contribute to heavy menstrual bleeding, including hormonal imbalances (particularly involving oestrogen and progesterone), fibroids or endometriosis, thyroid dysfunction, clotting disorders, and nutrient deficiencies beyond iron (such as vitamin A or zinc).
Your gut health also plays a role in this picture. Even with adequate iron intake, if your gut is not absorbing nutrients properly, you will likely struggle to maintain healthy iron levels. Conditions like coeliac disease, inflammatory bowel disease, or gut dysbiosis can significantly impair iron absorption. Also, low stomach acid production (known as 'hypochlorhydria') can negatively affect the absorption of iron from your gut. Ageing, stress and long term use of antacids can all lead to a reduction in the production of stomach acid, and therefore affect your body's ability to absorb iron effectively and efficiently.
A Comprehensive Approach
Managing heavy periods and iron deficiency may require a holistic approach that considers optimising iron-rich foods, supporting gut health to maximise nutrient absorption, addressing hormonal imbalances that may be contributing to heavy bleeding, identifying and correcting co-existing nutrient deficiencies, managing inflammation that can affect both menstrual health and iron status, and implementing appropriate supplementation tailored to your specific needs and tolerances.
It is also important to work with your healthcare team to investigate the underlying cause of heavy bleeding. Sometimes heavy periods are a symptom of a condition that requires specific medical treatment.
Your Unique Journey
Every person's experience with heavy periods and iron deficiency is different. Factors like your dietary patterns, gut health, stress levels, other health conditions, and genetic variations in iron metabolism all influence how your body handles iron and responds to treatment.
This is why a personalised approach is essential. What works for someone else might not work for you, and cookie-cutter solutions often fall short when addressing the complex interplay between menstrual health, iron status, and overall wellbeing.
Moving Forward
If you are struggling with heavy periods or suspect iron deficiency, do not dismiss your symptoms as "just part of being a woman (or someone who menstruates)." These issues can significantly impact your quality of life and deserve proper attention and treatment. Understanding the root cause rather than simply supplementing blindly can lead to more effective, lasting solutions.
Are you looking for support with your health and wellness?
If you or someone you know is struggling with heavy periods, low iron or anaemia, consider booking in a 1:1 Clinical Nutrition consultation where together we can get to the root cause and develop a personalised nutrition plan that supports your unique health needs. This may also include a referral for blood tests, functional gut testing, or other investigations where clinically indicated.
Katie practices at: Uprise Health, 136 Lennox Street, Richmond, 3121, Victoria.
Face-to-face and Telehealth appointments available (Australia wide).
If you have any questions or would like personalised guidance, feel free to reach out admin@katiehopcraft.com.au
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