Iron Deficiency Anaemia in Women

The most common cause of anaemia in Singapore​ is iron deficiency. Your body requires iron to make haemoglobin in red blood cells that enable them to carry oxygen. When there is insufficient iron in your body, your red cell count falls, and you become anaemic. Iron-deficiency anaemia affects more women than men, and the risk of iron-deficiency anaemia is highest for women who:

1. Are pregnant. Pregnant women require additional iron during pregnancy to support foetal development. Severe anaemia during pregnancy could increase the risk of premature birth, a low birth weight baby and postpartum depression. 
2. Have heavy menstrual periods. Women of childbearing age with heavy bleeding during their periods may develop iron-deficiency anaemia because of the excessive blood loss, depleting the body’s iron stores. This may cause fatigue, hair loss and frequent infections.
   

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According to a survey carried out by Sata CommHealth, almost half of the women in Singapore could have an iron deficiency and are unaware of it. In addition, some recent studies have indicated that more than half of pregnant Singapore women are iron deficient during the late phases of pregnancy.
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The symptoms of iron deficiency can easily be ascribed to other causes; hence many women tend to have had them for years without ever knowing why. The symptoms include physical and mental fatigue, hair loss and brittle fingernails, which women may put down to stress and a lack of sleep.
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How much iron do I need?

Health Promotion Board recommends 19mg of iron for women between the ages of 18 and 59 years old, while women aged 60 years and above require 6mg of iron a day. During pregnancy, your iron needs rise to 27 mg to support the needs of the foetus.
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How can I tell if I have Iron-deficiency anaemia?

Iron-deficiency anaemia can go unnoticed due to its mild symptoms. However, as the conditions worsen, the signs and symptoms intensify.
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Iron deficiency anaemia signs and symptoms include:

• Extreme fatigue and weakness
• Pale skin, brittle nails and hair loss
• Chest pain, fast heartbeat or shortness of breath
• Headache or dizziness
• Cold hands and feet
• Inflammation or soreness of the tongue
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When should I see a doctor?

If you develop signs and symptoms that suggest iron deficiency anaemia, refrain from self-diagnosing or taking iron supplements on your own. We recommend that you see a doctor for a diagnosis and treatment. Overloading the body with iron can be dangerous because excess iron accumulation can damage your liver and cause other complications.
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How can I prevent Iron-deficiency anaemia if I am pregnant?

• Treat the cause of blood loss. Talk to your doctor if you have digestive system problems, such as frequent diarrhoea or blood in your stool.
• Eat foods high in iron. Chicken, lean meat, dark leafy vegetables, and beans are good sources of iron.
• Eat foods that help absorb iron. Include orange, strawberries, broccoli, or other fruits and vegetables with vitamin C into your diet.
• Talk to your doctor about supplements. For women who do not get enough iron from their regular diet.
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Does birth control help to improve Iron-deficiency anaemia?

Yes, if the cause of the iron deficiency is heavy menstrual periods. Birth control such as the oral contraceptive pill and hormonal intrauterine device (IUD) help to lighten the menstrual flow which reduces the risk of iron-deficiency anaemia.
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What are the causes of iron deficiency anaemia in women? 

Causes of iron deficiency anaemia include:

• Inadequate iron intake
  Lack of adequate iron in the diet is the most common cause of iron deficiency anaemia. Vegetarians are at higher risk because meat is high in iron.
  
• Pregnancy
  Iron is essential for the growth and development of the foetus. Hence, the requirement of iron increases during pregnancy. Pregnant women may develop iron deficiency anaemia when the increased demand of the body is not compensated by increasing iron intake. Excessive blood loss during childbirth can also cause iron deficiency.
• Blood loss due to menstruation
  Women who suffer from heavy menstrual flow may develop iron deficiency anaemia.
• Internal bleeding
  Certain conditions that cause internal bleeding may increase the risk of iron deficiency anaemia. Such conditions include peptic ulcers, polyps in the intestines, ulcerative colitis, or colon cancer. Regular use of medications such as non-steroidal anti-inflammatory drugs (eg. ibuprofen, aspirin) may also cause bleeding in the stomach.
• Inability to absorb iron
  Disorders affecting the intestines may interfere with the process of absorption of nutrients from the food. As a result, you may develop a deficiency of vitamins and minerals including iron in spite of eating a nutritious diet.
  
• Endometriosis
  Excessive blood loss caused due to uterine conditions such as endometriosis and fibroids can lead to iron deficiency anaemia.

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What are the signs & symptoms of iron deficiency anaemia in women?

The common symptoms of iron deficiency anaemia in women include:

• General fatigue or unusual weakness
• Shortness of breath
• Pale skin
• Tingling and crawling sensation in the legs
• Dizziness
• Coldness of the hands and feet
• Swelling and soreness of the tongue
• Brittle nails
• Fast and irregular heartbeat
• Frequent headaches

How is iron deficiency anaemia in women treated?

Even if the cause of iron deficiency can be identified and treated, it is still usually necessary to increase iron intake. Click here to learn more about iron therapy.
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There are several ways in which to increase iron intake:

Increasing dietary intake of iron
Foods high in iron:

• Iron-fortified breads and cereals
• Beans and lentils
• Oysters
• Liver
• Green leafy vegetables, especially spinach
• Tofu
• Red meat
• Fish
• Dried fruit, like prunes, raisins and apricots

Vitamin C helps to improve iron absorption so consuming fruits high in vitamin C such as oranges will help to increase the iron level. Vitamin C supplements may be prescribed.
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Oral iron supplements
Oral iron therapy offers an easy and convenient way to replenish iron stores. It is the recommended treatment for patients who suffer from mild iron deficiency anaemia where there is no urgency to replenish the iron stores quickly.
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As antacids may reduce the absorption of iron, it is advisable to avoid taking iron supplements together with antacids or medications that relieve heartburn. You may take iron supplements 4 hours after or 2 hours before the doses of antacids.
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Intravenous iron infusion
Intravenous iron is the recommended therapy for patients suffering from severe iron deficiency or existing intestinal conditions that affect the absorption of oral iron supplements. 

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Who should receive Intravenous Iron therapy?

• Those who cannot tolerate oral iron supplements.
• Those who are unable to absorb iron adequately such as those with chronic malabsorption conditions.
• Those with continuous blood loss where oral iron supplements are unable to replenish the iron stores fast enough. For example, women with heavy periods.
• Those who require rapid correction of their iron deficiency.
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What are the advantages and disadvantages of Intravenous Iron Therapy?

Advantages:

• Patients having iron infusions can avoid the side effects of oral supplements such as nausea, abdominal pain, diarrhoea and constipation.
• It works faster than oral iron therapy to improve haemoglobin levels. Patients should start feeling improvements shortly after their treatment.
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Disadvantages:

• It is less convenient compared to oral iron therapy as it requires venous access and the procedure needs to be done in clinic.  
• In some cases, patients may develop allergic reactions or low blood pressure during treatment.

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What are the common side effects of Intravenous Iron Therapy?

You may experience some side effects right after the procedure, most of which are mild. These include:

1. Temporary changes in your taste of food and drinks
2. Headache
3. Nausea and vomiting
4. Muscle and joint pain
5. Breathlessness
6. Itchiness and rash
7. Increased or decreased blood pressure or heart rate
8. Burning sensation or swelling at the site of injection

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Red blood cell transfusion
Red blood cell transfusions may be given to patients with severe iron deficiency anaemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness. Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency.

For more information on iron deficiency anaemia, click here.

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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.