Iron Deficiency in Women: From Teen Years to Menopause

Hi, I’m Dr. Daniela Steyn. As a physician, triathlete, and mom, I’ve seen firsthand how iron deficiency can affect women at every stage of life—from teenage years to pregnancy, postpartum, and menopause. I want to share what I’ve learned from both clinical practice and personal experience.

Understanding Iron Deficiency vs. Iron-Deficiency Anemia

1. Iron Deficiency:

• This means your body’s iron stores are running low.

• You may not have any symptoms yet.

• Blood tests may show low ferritin or low iron, but hemoglobin might still be normal.

• Think of it like your “iron savings account” getting empty, but your “red blood cell bank” hasn’t run out yet.

2. Iron-Deficiency Anemia:

• This occurs when iron deficiency progresses enough to lower hemoglobin.

• Symptoms can include fatigue, weakness, pale skin, and shortness of breath.

• Blood tests confirm low hemoglobin and low iron.

• Here, the “iron bank” is empty, and your body can’t make enough healthy red blood cells.

• Iron deficiency is the early stage; anemia is the late stage.

• Treating iron deficiency early can prevent anemia from developing.

Who’s at Risk?

• Women of reproductive age (especially with heavy menstrual periods)

• Pregnant women, due to increased iron needs for fetal growth and blood volume expansion

• Perimenopausal women might have heavier menstrual periods

• Other risk factors: frequent blood donation, vegetarian/vegan diets, gastrointestinal conditions affecting absorption (inflammatory bowel disease / leaky gut)

Prevalence:

• Up to 30% of non-pregnant women of reproductive age may have iron deficiency.

• During pregnancy, 40–50% of women may develop iron deficiency, and 20–30% may develop anemia.

How Iron Deficiency Impacts Daily Life

Even without anemia, low iron can cause:

• Fatigue and low energy

• Reduced exercise tolerance

• Difficulty concentrating and poor memory

• Mood changes like irritability or low mood

• Decreased libido

For pregnant women, the stakes are even higher:

• Maternal risks: preterm delivery, low birth weight, postpartum depression, impaired physical performance

• Infant risks: low iron stores at birth, delayed neurodevelopment

Ask your doctor for bloodwork

Essential Blood Tests for Anemia Assessment:

1. Hemoglobin (Hgb)

• Measures the oxygen-carrying capacity of the blood.

• Low Hgb indicates anemia but doesn’t reveal the cause.

2. Ferritin

• Reflects iron stores in the body.

• Important caveat: Ferritin is an acute-phase reactant, meaning it can be elevated in inflammation or infection, even if iron stores are low.

3. C-Reactive Protein (CRP)

• Helps detect inflammation.

• Used alongside ferritin to interpret iron status accurately.

• High CRP + normal/high ferritin could mask iron deficiency.

4. Transferrin Saturation

• Calculated from serum iron and total iron-binding capacity (TIBC).

• Low transferrin saturation indicates iron deficiency, even if ferritin is normal due to inflammation.

Optional/Additional Tests (if needed):

• Reticulocyte count (bone marrow response)

• Vitamin B12 and folate (for macrocytic anemia)

• Peripheral blood smear (morphology of red blood cells)

A Personal Perspective

As an athlete competing for Canada at the international triathlon World Championships, I’ve felt firsthand how even mild anemia affects my stamina, endurance, and recovery. Workouts and races feel harder, and performance suffers.

It's not only athletic performance that suffers.

As a mom and woman with a monthly menstrual cycle and three C-sections, I have experienced how iron deficiency can sap energy for daily life. Balancing recovery, work, and parenting becomes much harder.

During postpartum and breastfeeding, iron is critical for healing, sustaining energy, and supporting milk production. Iron deficiency at this stage affects both mom and baby.

Iron deficiency affects more than labs—it impacts athletic performance, daily functioning, mood, and maternal health. Early detection restores energy and supports both personal and maternal goals.

What you can do:

1. Identify & Address Underlying Causes

• Heavy menstrual bleeding, evaluation for fibroids

• Pregnancy & lactation: monitor iron and optimize intake

• Gastrointestinal loss/malabsorption: investigate celiac disease, ulcers, or gastritis if anemia persists. 

2. Dietary Interventions

• Iron-rich foods: red meat, poultry, fish, lentils, beans, tofu, fortified cereals, dark leafy greens

• Boost absorption: pair plant-based iron with vitamin C-rich foods (citrus, peppers, strawberries)

• Limit inhibitors: tea, coffee, and high-calcium foods at mealtime can reduce absorption

3. Lifestyle & Practical Tips

• Regular labs to monitor response

• Track fatigue or worsening symptoms

• Support overall wellness: sleep, stress management, and balanced nutrition

4. Special Considerations for Heavy Menstrual Bleeding

• Hormonal management (e.g., Mirena IUD) can significantly reduce blood loss. Some women might require endometrial ablation or hysterectomy.

• Diet and lifestyle alone may not be enough if bleeding is substantial

Clinical Takeaway:

Iron supplementation is often necessary. Addressing underlying causes and using dietary, lifestyle, and hormonal strategies ensures sustainable improvement.

Iron Deficiency in Menopause: The Hidden Challenge

Fatigue, brain fog, and low energy in perimenopausal and postmenopausal women are often attributed to aging or hormonal changes, but iron deficiency may be an underlying cause.

Strategies for Better Conversations with your healthcare provider

1. Normalize the Topic: Ask about energy, cognition, and exercise tolerance—fatigue isn’t “just aging.”

2. Screen Proactively: Check hemoglobin, ferritin, transferrin saturation, and CRP if symptoms persist.

3. Integrate Symptom Discussion: Ask about diet, menstrual history, GI issues, and blood loss during routine visits.

4. Empower Women: Iron deficiency is treatable; correcting it improves energy, mental clarity, and quality of life.

5. Avoid Assumptions: Don’t automatically attribute fatigue to menopause; treat each symptom individually.

Key Takeaway:

Proactive discussion, screening, and education help catch iron deficiency early, preventing unnecessary functional decline.

Iron-Rich Foods for Menstrual Health Heme Iron (best absorbed) Lean red meat, poultry, salmon, tuna, sardines. Plant-Based Iron Lentils, beans, tofu, quinoa, pumpkin seeds, spinach, broccoli, fortified cereals. Boosting Absorption Pair iron foods with Vitamin C (citrus, bell peppers, strawberries). Avoid tea, coffee, or calcium supplements with iron meals — they block absorption. Iron Supplements in Canada If diet alone isn’t enough, iron supplements may be needed. Options include:

• Ferrous sulfate, ferrous gluconate, or ferrous fumarate — effective and widely available.

• Gentle alternatives: heme iron polypeptide (e.g., Proferrin®) or polysaccharide iron (less stomach upset).

• Feramax 150 

• SiderAL® Forte (for adults), SiderAL® Gocce (for children), 

  Always supplement under medical supervision. Too much iron can be harmful, so your dose should be guided by your lab results.
  

Key Takeaways

• An anti-inflammatory diet rich in plants, omega-3s, magnesium, and herbs like ginger can significantly reduce cramps.

• If you have heavy bleeding, ask your doctor to test for anemia.

• Support your iron levels with both diet and, if needed, supplements.

For more info on how to reduce period cramps and support iron levels, click here:

Nutrition Strategies to Reduce Period Cramps and Support Iron Levels

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