Iron, periods and feeling wiped out

Every period, you lose some iron with the blood. For most people a balanced diet tops it back up. But if your periods are heavy, iron levels can slowly drain. The NHS says heavy periods are a very common cause of anaemia (low red blood cells from low iron).

Signs of low iron

• Tiredness and low energy.
• Shortness of breath.
• Noticeable heartbeats (palpitations).
• Paler skin than usual.
• Headaches.
• Less commonly: hair loss, a sore tongue, craving ice or paper, restless legs, or spoon-shaped nails.

These signs are not specific to iron. Tiredness has many causes, which is why a blood test is more helpful than guessing.

What about low iron without anaemia?

Your body stores iron as ferritin. Stores can run low before anaemia shows up in a standard blood count. The evidence on whether this causes tiredness is mixed. In one trial of women with unexplained fatigue but no anaemia, iron tablets gave a small improvement, mostly in those with low ferritin. If you are tired and have heavy periods, ask your GP about a full blood count and whether ferritin should be checked.

Iron-rich foods

• Red meat (and liver, but avoid liver if you are pregnant). The Department of Health advises limiting red and processed meat.
• Beans, chickpeas, lentils and other pulses.
• Dark green leafy veg, like watercress and curly kale.
• Iron-fortified breakfast cereals and bread.
• Dried fruit like apricots and raisins, and nuts.

The NHS says tea, coffee, milk and dairy, and foods high in phytic acid (such as wholegrain cereals) can make it harder to absorb iron, especially in large amounts. Try not to have them with iron-rich meals. Vitamin C, like a glass of orange juice, may help your body absorb iron.

Iron tablets

If a blood test shows you are anaemic, a GP will usually recommend tablets for about 6 months, plus treating the cause (such as heavy periods). Side effects can include constipation or diarrhoea, tummy pain, and darker poo. Taking them with or soon after food can help. The NHS says 17 mg a day or less of supplement iron is unlikely to cause harm, but more than that should be advised by a doctor, and iron tablets can be dangerous for young children, so keep them out of reach. It is best to get tested first rather than self-treating, because low iron has a cause that should be found.