Iron deficiency due to menstrual periods

from Mag. Margit Weichselbraun
on 05.10.2022

Did you know that women on average menstruate the equivalent of seven years of their lives and in the course of this, lose up to 30 litres of blood? Impressive numbers – and yet most women still have the feeling that it is taboo for the effects of their menstrual periods to be noticed. But women have to deal not only with monthly blood loss, but also a dip in their nutrient balance. After all, every drop of menstrual blood is a loss of nutrients, especially iron.

Iron & periods: Why women lose iron during menstruation

From childhood to old age, female sex hormones shape the physical and mental well-being of women. With the onset of their first period, female teenagers get to experience a new facet of being a woman. To start with, girls usually greet menstruation with feelings ranging from a degree of uncertainty to stress and overload, but they soon come to accept this monthly event as a matter of course. After all, this first bleed is followed by many more. A woman menstruates around 500 times during her life, thus in total, she loses about 30 litres of blood from her first period until the menopause. If the trace element is not replaced by food or by additional iron preparations, the body gradually loses iron. Therefore, women of childbearing age should pay particular attention to their iron balance. This is also underscored by studies that show that women have a 10-fold higher risk of iron deficiency or iron deficiency anaemia than men.

Iron for women: Additional and daily requirements

Women need more iron for half of their lifetime. For example, the German Society for Nutrition (Deutsche Gesellschaft für Ernährung [DGE]) recommends that women of childbearing age should take 15 mg of iron daily, while men are only recommended 10 mg. In special situations in life, woman need even more: 30 mg daily during pregnancy or 20 mg daily after birth. Only with the onset of the menopause does the female iron requirement become similar to that of men’s.

Severe menstrual bleeding & iron

Heavy periods (hypermenorrhoea) not only cause women a certain amount of difficulty, but also cost them a lot of iron. IIf pads or tampons are fully soaked after less than two hours or your menstrual cup fills very quickly, or if you have  to get up at night to change your pads/tampons or empty your cup, this can be a sign of hypermenorrhoea. During a heavy period, thick clumps of blood often accumulate amongst the menstrual blood.

However, not only a heavy, but also a particularly long menstrual period, significantly increases the female iron requirement. The medical term menorrhagia refers to when periods last longer than seven days. In practice, both menorrhagia and hypermenorrhoea – which rob women of huge amounts of iron – often occur together.

Iron loss periods – the alarm signals at a glance:

  • Pads or tampons must be changed regularly after 1-2 hours, or menstrual cups must be emptied more often than usual.
  • The period lasts longer than 7 days
  • The menstrual blood contains many thick blood clots
  • During the period a feeling of weakness, fatigue and lack of drive

Women who are struggling with one or more of these symptoms lose increasing amounts of blood over their period (probably more than 80 ml per cycle). Severe menstrual bleeding is not only unpleasant, but is also a challenge for the iron reserves (which is a major problem for many people). Depending on the strength of their periods, there may be a greater or lesser additional iron requirement, which is only met with difficulty or not at all through diet alone. It is hardly surprising that up to 70% of women with hypermenorrhoea suffer from iron deficiency or suffer from anaemia caused by iron deficiency.

The facets of iron deficiency:

  • Central nervous system: decreasing performance, lack of strength and drive, stress, concentration problems, headache, sleep problems, restless legs syndrome, depressed mood, hyperactivity and attention disorder in children and adolescents
  • Skin and vessels: impaired hair and nail growth, hair loss, pale, dry skin, cracks at the side of the mouth, sensitivity to cold
  • Heart and respiratory system: Breathlessness, palpitations,fatigue, dizziness, shortness of breath
  • Anaemia
  • Defenses: increased susceptibility to infection
  • Unusual eating urges (e.g. ice cubes, celery, peanuts, but also earth)
  • Muscles: reduced endurance, muscular weakness, exhaustion, slump in performance

About iron deficiency and heavy periods: When diet alone is no longer sufficient

Women with severe menstrual bleeding should keep a particularly sharp eye on their iron levels and regularly replenish their iron reserves. Otherwise, these could hit rock bottom at some stage Once the reserves have been emptied, they cannot be refilled by diet alone. In this case, special iron preparations are required, whereby standard iron salts are known to lead to side effects such as nausea, constipation or diarrhoea. For this reason, tolerance should also be a priority, especially with iron, in addition to efficacy.

Taking iron during your period?

While women with well-stocked iron supplies do not necessarily need to take iron during their period, iron is definitely recommended for women with heavy menstrual bleeding and/or for those who tend to have low ferritin levels. However, in these cases, simply taking iron during your period is not enough, but supplements should be taken regularly over a longer period of time – preferably in consultation with a health care professional who regularly checks iron levels in the blood.

Reliable tips for stocking up on iron:

  • Plant-based special extracts provide complex-bound iron. This is easily available for the body and is particularly compatible with the mucosa.
  • Bivalent iron, such as iron gluconate or iron fumarate, is better absorbed into the body in combination with vitamin C
  • Low-dose iron is usually not only better tolerated: A research team at ETH Zurich showed in a study that lower iron quantities are absorbed much more efficiently than high doses of iron.
  • Certain additives can impair iron absorption into the body and even cause stress to the body. Therefore, only preparations that are as pure as possible and ideally free from additives should be selected.
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