Nikki was changing a super tampon and pad every one to two hours when she first came to see me. Even these would fail her on her heaviest days. Beyond the bleeding she was struggling with fatigue, anxiety and hair loss. The reality was, her periods had caused her to become anemic and that anemia was causing her to have such a heavy flow. But the question still remained, why did those periods start to flow so heavy?
Anemia & menorrhagia are directly linked. Heavy menstrual bleeding can cause a significant loss of iron-rich blood, resulting in iron deficiency anemia.
It’s estimated that there are 468.4 million menstruating women worldwide with iron deficiency anemia.
I’ve seen hundreds of women walk through my clinic doors feeling fatigued, weak, and overall unwell—but they don’t know where it’s coming from. When a woman has overwhelming tiredness or weakness she can’t explain, one of the first questions I ask is: do you have heavy periods?
Anemia due to menorrhagia (heavy periods) is one of the most common cases of iron deficiency anemia. For Nikki, those heavy periods were leaving her exhausted. “I’m unable to workout like I used to and I find I can be short of breath just going up stairs,” she explained.
Anemia symptoms often include general tiredness, weakness, anxiety, hair loss and other seemingly “inexplicable” symptoms. If you have any of these symptoms it is a good idea to get your iron levels checked.
BTW if you have hair loss then consider starting the Capillus laser light therapy stat. It's what I recommend in my clinic for women who are experiencing hair loss. It helps increase circulation to your scalp and nourish luscious locks.
If you have heavy periods, you may be losing more iron-rich blood than your body can keep up with, which is making you anemic.
Let’s dive into how to know if you have anemia and what you can do about it!
What Is Anemia?
Anemia is when there is a decreased number of red blood cells or the hemoglobin found in the red blood cells. Hemoglobin is the protein that carries oxygen to your tissues. All of your organs, especially your brain, need oxygen to function properly. Low levels of hemoglobin mean low levels of oxygen.
There are several types of anemia, including those caused by B12 and folate deficiency, which can be determined with lab testing. For Nikki, her lab testing revealed iron deficiency anemia.
Iron Deficiency Anemia
Iron deficiency is the most common type of anemia. This occurs when your body doesn’t have enough of the mineral iron. Your body uses iron to make healthy hemoglobin. In fact, each hemoglobin requires four iron molecules in order to properly bind oxygen.
Without iron, your body can’t make hemoglobin. Without hemoglobin, your blood can’t transport necessary oxygen to the organs. Without oxygen, your organs aren’t able to work properly.
Iron is also necessary for making neurotransmitters, growing cells, making DNA, and liver detoxification. Yeah, it’s a big deal!
This lack of oxygen was preventing Nikki from exercising and was a driving force behind her anxiety, hair loss, and incredibly heavy periods.
What Are The Symptoms Of Anemia?
Not all women experience easily recognizable symptoms of anemia like Nikki. In fact, symptoms of anemia can be very subtle and unobtrusive, which means women can go years before they discover a problem.
If you’re showing any of the below symptoms, it might be time to visit your doctor to have your iron levels tested.
Common symptoms of anemia include:
- General fatigue
- Racing heart
- Heart palpitations
- Shortness of breath
- Immune dysregulation
- Tingling or crawling feeling in legs
- Restless leg syndrome
- Brittle nails
- Easy bruising
- Cold hands or feet
- Fast or irregular heartbeat
- Heavy periods
- Low thyroid hormone
- Hair loss
- Strange cravings (ice, clay and other non-food items)
- Beeturia – When your urine turns red after eating beets.
Quick Detour: Beeturia is totally a thing. You eat beets. Your pee turns red. And your freak out. Or maybe you think it is normal. It is estimated 49 to 80% of people with beeturia have iron deficiency anemia. If you see this, get tested.
Three subtle signs of anemia that women can miss are pale skin, strange cravings, and anxiety. For Nikki, she just figured she needed more sun, that her crazy desire to crunch ice was due to stress and that her anxiety was genetic.
It’s amazing how often we will negotiate with our symptoms and rationalize them away. As women, we’ve become conditioned to dismiss our own experience and believe there must be something else to the experience. Hey, I’m not judging, I’m just saying—honor your body talking to you, which is what symptoms are.
Hemoglobin gives blood its red color, which gives your skin a healthy appearance. In patients with a light complexion, it can be easier to spot anemia because their skin will appear pale and less reddish.
You can also sometimes spot anemia in visibly blood-rich areas of the body. If the inside of your lips, gums, or lower eyelids are less red than usual, you may be anemic. Yes, I know this is the part where you go to the mirror and do a quick check. No worries. I’ll be here when you get back. 😉
Back? Ok good. Now check the palm of your hands. Are the creases pale? This could also be a sign you're in need of iron.
Strange or unusual cravings are another side effect of anemia. Your body recognizes that it’s lacking iron and puts you on a quest to consume food that might be iron-rich.
In many cases, those with anemia crave items that aren’t food, like dirt, ice, or clay. The medical term is “pica,” which is when someone craves substances with no nutritional value. For Nikki, the munching of ice was actually her body saying, “girl, you best get us some iron stat.”
Pica is something well recognized in pregnant women. I once had a pregnant patient tell me she felt compelled to eat cigarette butts. She shared that she couldn’t be anywhere near an ashtray without thinking about grabbing a fist full and cramming it in her mouth. I’m not kidding, the compulsion to eat cigarette butts was a struggle for her.
Neurological symptoms like anxiety, brain fog, restless leg syndrome, and depression can be some of the first signs of anxiety.
If you’re feeling overly anxious on a daily basis, it’s time to chat with a doctor to overcome this potentially damaging health problem.
What Are The Causes Of Anemia?
One of the most common causes of iron deficiency anemia in menstruating women is due to heavy periods. And More on that soon.
Hormone imbalanced, gut infections, a diet lacking iron are among other causes of anemia.
Causes of anemia include:
- Inadequate iron intake, like vegetarians or vegans who are not mindful about their nutrient intake
- Internal bleeding
- Digestive ulcers
- Inability to absorb iron from certain disorders or surgeries
- Intestinal infections like SIBO and parasites
- Low stomach acid
- Inflammatory disease of the gut like Crohn’s or Ulcerative Colitis
- Supplements like calcium and zinc can interfere with iron absorption
- Stomach acid blocking drugs
Hypothyroidism and Anemia
An underactive thyroid can be another cause of anemia. Triiodothyronine (T3) is necessary for stomach acid production. When T3 goes low, stomach acid dips and you are no longer to able to free iron from the foods you’re eating. Basically, this creates a negative feedback loop of low iron and hypothyroidism. Learn more about the link between hypothyroidism and iron deficiency.
You need stomach acid to free iron from your food and a functioning small intestine to absorb it.
Gut Infections and Anemia
You need a healthy gut (small intestine specifically) to absorb iron. You depend on a healthy mucosa and enzymes to get that iron you're eating into your body to be used.
If you have SIBO, yeast overgrowth or anything funky in your gut then those little critters may be stealing your iron and keeping you from rebuilding your stores.
Most iron you consume is not absorbed but pooped out (and you’re losing a whole lot more if you have heavy periods). If you’re taking a lot it can make your stool black and the cheap stuff, like iron sulfate can cause constipation. If constipation is already your issue then consider taking a prenatal with a highly absorbable form of iron.
Stomach Acid and Anemia
If you have ANYTHING driving low stomach acid then you can NOT get your dietary iron free and therefore can’t absorb it. Bummer.
If you take acid blockers daily or just when you feel the burn then know this could be messing with your iron absorption… not to mention other vitamins and minerals.
Heartburn and low iron? Try Digest, which supplies HCl (that stuff made in your stomach that helps with nutrient absorption) and other digestive support to help you get the most out of your nutrients.
Heavy Period. How Much Blood is Too Much?
Heavy menstrual bleeding, otherwise called menorrhagia, is one of the most prevalent causes of anemia. This is because you’re losing iron-rich blood. Every. Single. Month. If you’re not offsetting blood loss with an appropriate intake of iron, your body will start to run through its iron stores, leading to an iron deficiency.
And in reality, if your periods are heavy like Nikki’s then you’re going to need to take a supplement. I recommend a prenatal for women experiencing heavy periods because it contains a higher amount of iron, along with B12, B6, and folate to support healthy blood cells. No, prenatals are not just for women wanting to become pregnant and they definitely won’t cause you to get pregnant. Setting the record straight here.
How do you know if you have heavy bleeding?
- Your period that lasts longer than seven days.
- You're changing a pad or large/super tampon every hour for three or more hours in a single day.
- You're changing a full menstrual cup three times in a day.
- You need to double up on menstrual products to control your flow.
- You're waking to change menstrual products during the night.
- Your period flow stops you from being able to go about your day or prevents you from participating in activities
- You see blood clots that are larger than the size of a quarter.
For reference, the average woman has a period about 4 to 5 days. If you’re 3, 6, or 7 that doesn’t mean there is anything wrong with you. But if you're 7+ days and most days are heavier than not then it is time for lab testing. Keep reading!
What Causes Heavy Periods?
Yeah, like how did this party get started in the first place?
Yes, iron deficiency can cause heavy periods and heavy periods can cause iron deficiency. This can make it tricky to understand which came first. Let’s explore some of the common reasons women develop heavy periods that can lead to iron deficiency anemia.
Hormone Imbalance and Heavy Periods
For Nikki, her periods problems began with breast tendeneress, irritability, and mild cramping before her period. These signs of PMS were pointing towards estrogen dominance. She shared that over time her period became increasingly heavy. “It seemed like each month I was bleeding more and more until it was completely unmanageable.”
While we very much needed to adress Nikki’s anemia, we also need to correct her hormone imbalance.
Click here to get your FREE hormone starter kit with 7 day meal plan and recipe guide to start balancing your hormones!
Copper IUD Birth Control
It is well understood the copper IUD can lead to heavy and painful periods. If you’ve had a copper IUD placed this may be the root cause of your increased menstruation and can lead to anemia.
Read more about IUD side effects.
Fibroids or Polyps
Fibroids and uterine polyps can lead to increased blood flow during menses.
Endometriosis can also be a cause of heavy periods with significant pain. Learn more about how to manage endometriosis naturally.
Inadequate thyroid hormone can lead to long and irregular periods. You can read more about symptoms of hypothyroidism.
A more rare cause of heavy periods are genetic disorders. This should be investigated if your doctor is unable to identify the root cause. This can be bleeding disorders, like platelet function disorder or Von Willebrand disease.
This can also be from non-bleeding disorders like pelvic inflammatory disease or liver, kidney, or thyroid disease. Intestinal disorders can also impact the hormonal imbalance, which can lead to heavy bleeding.
Women on blood thinners, like aspirin or warfarin, may also have increased bleeding during their periods.
Do You Have Iron Deficiency Anemia?
If your periods are feeling ridiculously heavy, you were nodding your head as you read the list of menorrhagia symptoms or you suspect you may have iron deficiency, it’s time to investigate the cause with lab testing.
Complete Blood Count (CBC)
This is the first line testing for screening iron deficiency anemia.
A CBC will look at your red blood cells, hemoglobin, hematocrit, white blood cells and platelets. A low hemoglobin and hematocrit and small red blood cells indicate iron deficiency anemia.
This test is typically run as part of an annual exam. If not, ask your doctor. And if you have symptoms, definitely get this checked. It can tell you a lot about your current state of health.
Your red blood cells (RBCs) are made in your bone marrow and contain the oxygen transporting molecule hemoglobin. If your RBCs are low you are either losing them like cray (ie bleeding), you’re destroying them (more rare than a heavy period, but warrants investigation), or you are not making enough.
Hematocrit tells us how much of your blood is made up of RBCs. Low hematocrit means low RBCs… and anemia.
Nikki’s red blood cells were small and CBC was clear that she was in need of iron.
Ferritin is the storage form of iron. Red blood cells are like your checking account spending iron and your ferritin is the savings account storing it for you to draw from later. Your ferritin levels can help determine how depleted your iron levels truly are.
This is also how your body protects you when infections strike. You see, pathogenic (disease causing) organisms use iron to wreak havoc in your body. When your body detects and infection it grabs all your usable iron and drives it into the storage form. Phew! You’re safe. Oh, but dang. You can’t use your iron now.
If you have chronic infections then you may be showing symptoms of being chronically low in iron.
If you have low ferritin levels you can experience symptoms like restless leg syndrome and hair loss. Ideal ferritin levels are between 70 and 90 ng/mL.
Your entire supply of red blood cells is replaced in four months, so it is a good idea to follow up on this test if it has been more than 4 months and symptoms of iron deficiency are setting in. It’s important to get tested when you’re showing symptoms to avoid any long-term health complications.
Serum Iron, Total Iron Binding Capacity and Transferrin
Why not just test serum iron? Eat a steak, take a supplement or do anything to boost iron and your blood will follow. Like all labs, this is one snapshot in time and iron is highly variable. It’s why if you look at iron then you must look at transferrin, the protein that carts your iron around, along with other markers like ferritin and total iron binding capacity (TIBC).
Transferrin is the main protein that transports iron in the blood. If you have iron deficiency then it should be elevated. But here’s the tricky part, it is higher in women using oral contraceptives or who are pregnant.
Total Iron Binding Capacity is a marker of your ability to transport iron, but also, it tells us just what is up with your iron. If you have a high TIBC it means your body is ready for iron, but there just isn’t enough. If it is low, your ability to transport iron may be low or your liver may need some love. You can have a low TIBC, but be able to move around all the iron you do have in your system.
Women with iron deficiency anemia will have low hemoglobin, small red blood cells, low ferritin and high TIBC. Ferritin typically drops first with a rise in transferrin and a drop in TIBC. Then the hemoglobin drops. If you know this, then you know that just checking a CBC and calling it “normal” when your periods are crazy heavy is pretty short sighted. CBC is still the place to start. And if you do heavy bleeding, supplementing with iron is generally considered a good idea.
How Can You Increase Iron?
For Nikki we needed to make shifts in her diet and add supplements that support healthy red blood cell formation. While her labs pointed to iron deficiency anemia, it isn’t enough to give iron alone. Instead, I recommend increasing iron, while also bringing on methylated or active B vitamins. The easiest way to do this for Nikki was to begin with a prenatal vitamin.
Increase Iron Rich Foods
The greatest bio-available sources of dietary iron are found in meats like beef, chicken, pork, bison, and venison. These are referred to as heme iron and are the most easily absorbed. I also recommend grass-fed organic liver, beef heart, and bone marrow, which are major iron-boosting super foods that can dramatically improve your iron stores.
A lack of meat is why vegetarians and vegans often have a high prevalence of iron deficiency.
Iron is also found in leafy greens, like spinach and kale, as well as dried fruits, chickpeas, potatoes, broccoli, and beans. However, this non-heme source of iron is not as bio-available, meaning your body can’t absorb it fully. This is why vegans and vegetarians can be at higher risk of developing iron deficiency and sometimes have a hard time replenishing iron stores. If you are a vegan or vegetarian and experiencing anemia then a supplement is a must.
Vitamin C aids in the absorption of iron when they are eaten together or taken as a supplement. You can find vitamin C in citrus, strawberries, red and green bell peppers, kiwis, guavas, papayas, pineapples, melons, mangos, tomatoes.
You can grab this meal plan and recipe guide to help replenish iron and balance hormones.
What about phytates?
Real talk. If you have iron deficiency anemia then beans aren’t going to be the best way to boost your iron levels.
Phytates are found in beans, tea, wine, coffee, grains, and nuts and they block iron from being absorbed. Lame. Well, maybe not. Maybe this is a complex mama nature protective mechanism so don’t go judging nature too harshly.
But you should know that if you’re having heavy periods, plant based iron won’t bring you back quick enough and you may very well end up on the pill to slow that flow. Gasp, yes, Dr. B just said that you might need a contraceptive to block that flow. It’s not ideal, but it might be necessary… more on that later.
Consider a Prenatal
In cases of iron deficiency anemia, like Nikki’s, where there is also continued blood loss having an iron supplement not only replenishes stores, but also corrects the underlying cause of heavy periods, poor moods, and fatigue that are a result of iron deficiency.
Not all iron is created equal. Iron bisglycinate is non-constipating and won’t make you nauseous when you take it, which can be a problem with some forms of iron supplements. I usually recommend 3 caps twice daily of Prenatal Plus to quickly boost iron levels with minimal amount of side effects. You need to take minerals in divided doses for maximum absorption.
I also advise a vitamin C supplement to enhance absorption of the iron and for other immune-boosting and hormone benefits.
Should You Go On The Pill?
In some cases, the pill can reduce bleeding or stop a heavy flow and may very well be the best temporary solution for you. But make no mistake, this should only be temporary and only used in extreme cases while you also work to treat the underlying cause.
Because birth control can have serious side effects it is important to have a conversation with your doctor to understand all the risks before starting. It would be my preference that women do not start the pill for symptoms, but also recognize that there are extreme cases that make this necessary. If you do choose to start the pill, make sure you have a plan to come off and that you are in fact treating your root cause, not masking it.
I encourage you to make shifts in your diet, begin iron supplementation and work with your doctor to determine the underlying cause of your symptoms. The pill is never a solution to an imbalance in your body.
Learn more with my article: Using The Pill To Stop Periods – Is It Really A Good Idea?
Conquer Anemia & Menorrhagia Now
With the diet, supplements and root cause medicine you can start feeling healthier and more energetic in no time.
I invite you to work with my team to get on a hormone-regulating regimen that will help stop heavy periods that can contribute to iron deficiency anemia.
We can help you unlock the cause of your heavy bleeding and anemia, so you can ditch those period problems and enjoy lighter, easier periods and a whole more more energy.
We believe strongly in using food as medicine. Here is a sample meal plan from my clinic to support women with iron deficiency anemia and menorrhagia.
Sample One Day Meal Plan to Boost Iron
Poached eggs over sautéed spinach, kale, and bell pepper
Lamb Kababs leafy green salad with Citrus Vinaigrette and topped with pumpkin seeds
Sneaky Meatballs (with chopped liver mixed in!) in marinara sauce over zucchini noodles
Roasted Bone Marrow spread on sweet potato wedges