Women’s health : Iron deficiency anaemia

Iron deficiency anaemia is extremely common among women. According to the WHO, close to 30% of women between the ages of 16 and 49 suffered with iron deficiency anaemia in 2019. This translates to over half a billion women of child bearing age. This figure has remained stagnant over the last few years.

What are the symptoms of iron deficiency anaemia?

• Tiredness and fatigue
• Weakness
• Palpitations
• Chest pain
• Shortness of breath
• Pica (craving soil or other unusual substances)
• A sore tongue
• Difficulty swallowing

Why is iron important?

Iron is an element used to produce haemoglobin, a protein in the red blood cell to which oxygen attaches. Haemoglobin transports and delivers oxygen to all cells and vital organs, without which cells are unable to produce energy leading to the symptoms listed above.

How do you diagnose iron deficiency anaemia?

This can be diagnosed by blood tests. If the haemoglobin is low and the size of the red blood cells (mean corpuscular volume) is reduced this is highly suggestive of iron deficiency anaemia. The next test is an iron study which will confirm the diagnosis.

Why is iron deficiency common in women?

Women, especially those of child bearing age have monthly blood loss through menstrual bleeding. If the intake of iron is not sufficient enough to replace the blood loss, anaemia will follow.

How do you treat iron deficiency anaemia?

The first step is to identify the source of the blood loss. In the case of menstrual blood loss, it is important to determine whether the blood loss is normal or heavy. In the case of heavy bleeding (menorrhagia) the aim would be to reduce or stop the bleeding. There are a few medical causes of menorrhagia e.g. hypothyroidism and bleeding disorders but the vast majority of causes are gynaecological.

Your gynaecologist will be able to assist with an ultrasound, blood hormone levels and a pelvic examination to determine the cause. Based on the cause of the menorrhagia appropriate treatment can be offered.

The next step would be to increase the haemoglobin. There are a few ways that we can do this. The first is by blood transfusion. This is a temporizing measure used when the haemoglobin is extremely low and where there is compromise to the heart.

The second measure is using iron. The commonest form of iron replacement is oral and your doctor will be able to prescribe this for you if you blood tests confirm iron deficiency. Sometimes iron supplements can be poorly tolerated but there are many types available.

Intravenous iron is also available and can be used in select patients.

What are some of the other causes of iron deficiency anaemia?

In men and post-menopausal women, the diagnosis of iron deficiency requires urgent and further exploration. Gastrointestinal (GI) bleeding is not uncommon and a gastroscope and colonoscopy may be required.

In post-menopausal women gynaecological malignancies need to be ruled out.

How do you prevent iron deficiency?

Try to include iron-rich food in your diet e.g. red meat, eggs, liver, spinach and beetroot.

Tannins found in tea and coffee reduce absorption of iron. A regular tea or coffee drinker may benefit from reducing intake by a cup or two or spacing them 2 hours after a meal.

The use of non-steroidal anti-inflammatories e.g. brufen or diclofenac is a major cause of GI bleeding and these should be avoided unless absolutely necessary.

All women above 35 years of age should have regular pap smears.

Iron deficiency is common but is easy to diagnose and treat so if you experience symptoms or have risk factors contact your doctor for further evaluation.