Anaemia: The Red Flags Women are Living With

Heavy menstrual bleeding is a leading cause of low iron stores and anaemia in young women. World Health Organisation statistics show that 43% of reproductive-age women in Sub-Saharan Africa suffer from iron-deficiency anaemia, and for many of them this is due to abnormal bleeding and menstruation cycles.

Anaemia Is A Red Flag For Women’s Health

Experts warn that iron-deficiency anaemia is worsening as girls are starting menstruation at younger ages than in previous generations.

“This earlier onset means a longer lifetime exposure to monthly blood loss. When combined with limited health awareness, insufficient iron replacement, and inadequate management, it creates the perfect conditions for chronic iron deficiency,” says Sister Karin Davidson of the Cape Town Infusion Centre.

Sister Davidson, an outspoken advocate for recognising the impact of anaemia and an expert in treating iron deficiency anaemia, notes that the increase in menstruating women needing intervention is evident in her practice. “The statistics reveal a health emergency hiding in plain sight,” she says. “When one in three women globally lives with anaemia, we cannot continue treating abnormal bleeding as OK.”

Normalisation is part of the problem

Normalisation of heavy periods and irregular bleeding is a threat to combating low iron stores and associated anaemia. Be it in the media, by peers, caregivers, or medical practitioners, this minimising of what are abnormal menstruation symptoms actively prevents patients from seeking advice and treatment.

The belief that menstruation involves a level of suffering is outdated, and this mindset delays diagnosis and treatment, allowing anaemia to develop and worsen unchecked.

“Patient advocacy and encouraging people to examine and speak about unusual or abnormal symptoms or health patterns is a big part of our work – suffering in silence is not just about masking discomfort, it’s potentially harmful,” says Sister Davidson.

Heavy menstrual bleeding depletes iron stores faster than the body can replenish them, creating a cycle of increasing deficiency. Each month of untreated heavy bleeding compounds the problem. Women lose approximately 30-40ml mL of blood during normal menstruation, but abnormal bleeding can result in losses exceeding 80ml monthly. 

Warning signs of heavy menstrual bleeding include:

• Needing to change sanitary products every two hours or more frequently.
• Use double protection – a tampon and a sanitary pad.
• Bleeding lasting longer than seven days.
• Bleeding that soaks through to clothes or bedding.
• Passing clots larger than a 50c coin.
• Flooding or gushing that’s difficult to control.

Know the symptoms of anaemia

Low iron stores and anaemia symptoms include persistent fatigue and weakness, shortness of breath during normal activities, cold hands and feet, anxiety and/or depression, insomnia despite feelings of exhaustion, restless legs, and pica (unusual cravings often related to non-nutritive substances such as sand/ice).

“Heavy and/or abnormal bleeding is a prime cause for concern and should be flagged by any caregiver, patient, or practitioner,” says Sister Davidson.

Fertility risks and implications, and what anaemia means for perimenopause

Anaemia can have a significant impact on fertility and pregnancy outcomes. Iron deficiency can impact hormonal balances necessary for ovulation and egg maturation, and can be associated with the prevention of successful conception. For women who do conceive, anaemia increases the risk of preterm delivery, low birth weight babies, and postpartum depression. “Addressing anaemia can typically help to restore reproductive health,” says Sister Davidson.

Likewise, there are also unique challenges for perimenopausal women. Perimenopause regularly brings heavier, more frequent periods, and the associated iron deficiency can exacerbate menopausal symptoms, worsening depression and anxiety, and even leading to cognitive and cardiovascular issues. “We often see women complaining of hair loss and chronic fatigue, and so often it points to their continued heavy bleeding and subsequent anaemia. We’re so conditioned to think ‘that’s life,’ but there is help and treatment available – your periods should not control your life. When bleeding becomes abnormal, your body is asking for help. Listen to that call.”

Suspect you might be at risk?

• Track symptoms and menstrual patterns.
• Request comprehensive iron testing from your healthcare providers.
• See a gynaecologist or women’s health doctor to help manage heavy menstrual bleeding.
• Seek second opinions if concerns are dismissed.
• Consult registered dietitians for nutritional guidance.

Low iron stores and anaemia can be treated

• If iron store levels are low but not critical, oral iron can typically correct the issue.
• If iron stores are too low and anaemia is definitive, a medical-grade iron infusion will help restore iron stores to an acceptable level.
• Once iron stores and abnormal bleeding have been corrected, appropriate nutrition and management can maintain a status quo in iron stores.