Iron is the number one nutrient deficiency experienced by females (especially premenopausal women), causing many of the symptoms women often attribute to just living a busy life.
What does it mean to have low or deficient iron levels? Basically, that the body doesn’t have enough iron for its needs. This can bring on many symptoms and health issues.
However, low or deficient iron levels are also relatively easily diagnosed, and once they are addressed can make a big difference to how a woman feels physically.
Let’s look into the what and why of iron for female hormonal and general health.
Why do women need iron?
Optimal levels (not too little, not too much) are important for women of all life stages, particularly from teenage years up until perimenopause.
This is because the body uses iron to make the red blood cells that transport oxygen around your whole body via the bloodstream.
It is also needed for cellular energy production, a strong immune system, the metabolism of carbohydrates and protein, protection against free radical damage and gastrointestinal motility.
This is why, when iron levels are low, it can affect many different pathways and processes in the body and cause so many different types of signs and symptoms.
What are signs and symptoms of low iron levels in women?
- Chronic, constant tiredness
- Poor work performance
- Negative mood states
- Reduced resistance to infection
- Feeling cold/intolerance to cold
- Poor concentration
- Exercise-induced heavy/laboured breathing (dyspnoea)
- Pale skin, inside lower eye, mouth, nail beds
- Ridged, spoon-shaped, thin flat nails
- Brittle hair
- Reduced thyroid function and capacity to make thyroid hormones
- Cracking at mouth corners
- Preterm birth
- Restless leg syndrome
Iron depletion occurs progressively if it isn’t diagnosed and addressed, occurring in the following stages:
- Stage 1 – iron deficiency: iron stores in the bone, liver and spleen are depleted.
- Stage 2 – iron deficient non-anaemia: red blood cell production diminishes as iron supply is reduced.
- Stage 3 – iron deficient anaemia: haemoglobin production falls resulting in anaemia.
What causes low iron levels?
Insufficient dietary intake:
- Low carbohydrate intake
- Low energy/calorie diets.
- Growth periods (adolescence, pregnancy)
- Physical activity (particularly frequent high-intensity endurance exercise).
- Blood losses (heavy menstrual bleeding, haemorrhoids, parasites, peptic ulcers, Helicobacter pylori infection, NSAID-induced, hookworm, postpartum haemorrhage)
- Caused by conditions including coeliac disease, atrophic gastritis, Helicobacter pylori, peptic ulcer, inflammatory bowel disease
- Other micronutrient deficiencies (vitamin B12, folate, riboflavin).
- Hashimoto’s thyroiditis (due to autoimmune gastritis that is common in this condition impairing iron absorption)
- Uterine fibroids
- Infections (HIV, cancer)
- Obesity (due to inflammation reducing absorption)
- Proton pump inhibitors, NSAIDs, salicylates, glucocorticoids, anticoagulants
Can I get levels tested?
To get an accurate diagnosis of current iron status, the following measurements should be taken and the results need to be accurately assessed:
- Serum ferritin
- Serum iron
- Transferrin saturation
- Total iron-binding capacity
How often women get tested is dependent on several factors, but a general guide is:
- Yearly: if there is no history of the following:
- iron deficiency
- low dietary iron intake
- irregular menstrual cycles
- absence of iron-deficient symptoms
- underlying pathologies
- Biannually: if in the last 2 years there has been either:
- stage 1 iron deficiency
- irregular menstrual cycles
- high training loads.
- Quarterly: if in the last 2 years there has been either:
- stage 1, 2 or 3 iron deficiency
- high training loads
- presence of irregular menstrual cycles
- ongoing fatigue (or other symptoms associated with low iron levels),
- low dietary iron or energy intake.
Where can I get iron from?
The body can’t make iron, so it is vital to have adequate, regular intake from the diet.
Dietary sources of iron exist in two forms: haem and non-haem iron.
Haem iron is found in animal products, which is 2-3 times better absorbed than non-haem iron found in non-animal products. This is because non-haem iron is bound with other substances in food and needs to be released by stomach acid before it can be absorbed.
Haem iron can be found in:
- Red meat
Non-haem iron can be found in:
- Egg yolks
Food substances that can enhance the absorption of iron include:
- Vitamin C-rich foods (citrus, capsicum, leafy greens, tomatoes)
- Meat (when eaten with non-haem food sources)
For individuals diagnosed with low or deficient iron levels, appropriate forms and doses of oral supplementation or blood iron infusions may be appropriate.
Who can benefit from it?
Anyone who has been diagnosed with low or deficient levels of iron needs to increase their intake and address underlying factors causing low iron levels.
Individuals at particularly high risk of low or deficient levels include:
- Young children
- Women during child-bearing years
- Pregnant women.
Any side effects or interactions with supplemental iron?
Too much iron in the body can be toxic so it is vital supplemental iron is only taken if iron deficiency is diagnosed.
Signs of iron overload include vomiting, bloody diarrhoea, liver toxicity, shock and impaired consciousness.
If iron supplements are prescribed, ensure they are taken at the recommended dose and taken 2 hours away from substances that can interfere with its absorption including:
- Medications (ACE inhibitors, antacids, cimetidine, erythropoietin, anti-ulcer drugs, L-dopa, omeprazole, penicillamine, quinolone or tetracyclic antibiotics, sulfasalazine, thyroxine)
- Dairy products
- High-tannin tea (green, raspberry leaf, bilberry – adding milk to tea may reduce this iron-binding effect)
- Phytates (found in wholegrains and legumes)
- Oxalic acid (spinach, chard, chocolate, berries, tea)
- Zinc supplements.
Iron supplements tend to be tolerated better when taken with food.