Anaemia: Fatigue and headache aren’t part of ‘being a woman’. They can be signs of low iron

Recognising dangers and symptoms that come with low iron is factor in addressing issue

According to the World Health Organisation, it is estimated that a third of all women of reproductive age are anaemic, with 40 per cent of pregnant women also presenting with iron deficiency.

Without adequate iron, our body cannot produce enough haemoglobin in the red blood cells to enable them to carry oxygen around the body. As a result, iron deficiency can result in symptoms that affect the quality of life, such as fatigue, headaches, dizziness, reduced concentration, and shortness of breath. While some may show signs of iron deficiency, others will have no symptoms depending on the level of deficiency. These symptoms can significantly affect a person’s daily life, with more significant risks for pregnant people.

Recognising the dangers, frequency and symptoms that come with low iron is a factor in addressing the issue of low iron often being dismissed as a problem by women. A recent study published in Blood Advances found half of the participants had low iron levels, with one in four presenting with severe iron deficiency. However, the study, which included 44,552 pregnant women, found that 40 per cent of participants never had their iron levels checked with women of lower socio-economic backgrounds less likely to be tested or treated. The symptoms of fatigue, headaches and shortness of breath are often introspectively dismissed as issues that may simply come with the territory of pregnancy or of “being a woman.” However, if left untreated, iron deficiency can cause complications which otherwise could be easily be prevented and treated.

"Iron deficiency and anaemia during pregnancy are associated with adverse maternal and foetal outcomes, including neurocognitive deficits in children born to iron-deficient mothers," says Dr Aoibhe O'Driscoll of Blackrock Medical Centre, Women's Health Clinic and Menopause Specialist in Cork. "Inadequate iron during pregnancy is associated with several complications. In most developed countries, there is a national iron screening program in place for pregnant women to ensure early detection and intervention to reduce risks associated with inadequate iron. Unfortunately, screening for iron is not routinely used in the general populations, mostly due to cost."


The necessity of iron in pregnancy in order to support the developing foetus, the growing placenta, and the increased blood supply needed to sustain the pregnancy ensures a requirement for greater access to regular screening during and after pregnancy.

Despite being an easily treatable condition, it is not unusual for women to accept and live with the symptoms of low iron for years before seeking treatment

“Notwithstanding the national iron screening programs during pregnancy, an ideal opportunity to repeat screening is at the routine six-week check, to access how the pregnancy or breastfeeding affected the iron levels,” says Dr O’Driscoll. “This would be invaluable in assessing who needs iron supplementation, which could avoid issues with iron levels in subsequent pregnancies.

“Once a woman has inadequate iron levels during pregnancy, dietary sources of iron will be insufficient to replenish levels, and oral iron supplementation is required. Therefore, I would suggest that women focus on iron to reduce risks associated with inadequate iron levels in conjunction with folic acid supplementation as they both have key roles to play during pregnancy.”

As iron deficiency has been noted as a result of the challenges of pregnancy, it is also often most likely as a result of menstrual loss, with an estimated 2.1 billion people living with inadequate iron in this manner. It is the most common cause of anaemia in women of childbearing age worldwide. Despite being an easily treatable condition, it is not unusual for women to accept and live with the symptoms of low iron for years before seeking treatment. As such, women enter into pregnancy already deficient in iron.

New data suggests 64 per cent of women experience heavy periods and, as a result, are more likely to suffer symptoms such as tiredness and fatigue due to low iron. However, with only 33 per cent of participants believing inadequate iron contributes to tiredness and fatigue, the gap in knowledge surrounding the importance of iron intake is highlighted. Iron deficiency anaemia from heavy menstrual periods is prevalent with one-third of menstruating women at risk. The survey of 2,400 women, commissioned by the makers of Active Iron, says 71 per cent of participants recognised tiredness and fatigue as a symptom caused by the menstrual cycle. However, surprisingly, a third believe “there is nothing that can be done to make a difference” regarding the symptoms resulting from their period and the potential for low iron.

“Women of childbearing age are at higher risk of having inadequate iron levels because of menstrual blood loss each month. Pregnant women and women with restricted diets, endurance exercisers and those who have an intolerance to oral iron are also in the higher risk category. These common lifestyle factors contribute to inadequate iron levels and would therefore indicate that the prevalence of inadequate iron in women is much higher,” says O’Driscoll.

The average woman will spend an equivalent of almost ten years of her life menstruating, which is a significant time spent feeling less than her best

“People present daily in primary care with symptoms of inadequate iron levels such as TATT, “tired all the time”, low energy, or often presenting with heavy periods or restricted diets, and then it is clinically indicated to test for same. Inadequate iron levels are frequently managed using high dose oral iron, which can cause gastrointestinal side effects such as constipation and nausea in most women. This intolerance then results in poor adherence and failed treatment for many. When choosing an iron supplement, it is important that it is kind on the stomach yet strong on absorption.”

Dr O’Driscoll says she is surprised to learn that so many Irish women are putting up with symptoms of inadequate iron. “I have seen first-hand in my practice that treating inadequate iron levels has resolved the symptoms. The average woman will spend an equivalent of almost ten years of her life menstruating, which is a significant time spent feeling less than her best. This really needs to change.”

Tiredness and fatigue are the symptoms of menstruation women are most likely to accept as simply being a part of life. However, Dr O’Driscoll recognises simple changes to lifestyle and diet, as well as routine supplementation, can help ensure iron levels are topped-up, providing sustained energy and alleviating the common side effects of low Iron which can include extreme fatigue.

As iron deficient anaemia remains a globally under-recognised condition affecting women, increasing awareness of the causes, risks, and options available will encourage women to seek advice and help in managing low iron levels. With healthcare professionals supporting the effort to close the gap in awareness, iron deficiency anaemia can be properly targeted thereby welcoming better outcomes for women.