Iron Deficiency Anemia in Women: Symptoms, Causes, and Treatment

What Is Anaemia?

Anaemia means a low level of haemoglobin, the protein in red blood cells that carries oxygen. In adult women, haemoglobin below about 12 g/dL generally indicates anaemia, and in pregnancy the threshold is about 11 g/dL. When haemoglobin is low, the heart pumps harder and the organs receive less oxygen, which explains the fatigue and breathlessness.

Anaemia is not a disease in itself but a sign of an underlying problem. Finding the cause is as important as correcting the number.

Why Women Are at Higher Risk

• Menstrual blood loss: heavy or prolonged periods remove iron every month.
• Pregnancy: the body needs much more iron to support the growing baby, placenta and the mother's increased blood volume.
• Breastfeeding: iron stores may remain low for months after delivery.
• Diet: vegetarian diets contain iron in a form that is less well absorbed, and tea, coffee and some foods reduce absorption further.
• Short gaps between pregnancies: iron stores do not have time to recover.
• Teenage years: growth spurts and the start of menstruation raise iron needs.
• Gut conditions: coeliac disease, ulcers, chronic acidity medicines and intestinal worms reduce absorption or cause hidden blood loss.
• Weight-loss diets and bariatric surgery: limited intake or absorption of iron and vitamin B12.

Types and Causes of Anaemia

Iron deficiency anaemia. By far the most frequent type, caused by low intake, poor absorption or blood loss.

Vitamin B12 and folate deficiency anaemia. Common in vegetarians and in people with poor absorption. Folate is especially important before and during pregnancy.

Anaemia of chronic disease. Seen with long-standing kidney disease, infection, inflammation or cancer.

Thalassaemia and other inherited anaemias. Some women carry thalassaemia trait, which causes small red cells and mild anaemia that does not respond to iron. Testing helps avoid unnecessary iron and is important before pregnancy.

Aplastic and other bone marrow problems. Uncommon, but need specialist evaluation.

Symptoms of Anaemia

Symptoms depend on how low the haemoglobin is and how quickly it dropped. Mild anaemia may produce few signs.

• Constant tiredness, weakness and low energy.
• Pale skin, lips, nails and the inner lining of the eyelids.
• Breathlessness on exertion and rapid heartbeat.
• Dizziness, headaches and difficulty concentrating.
• Cold hands and feet.
• Brittle nails, hair thinning and hair loss.
• Sore tongue, mouth ulcers or cracks at the corners of the mouth.
• Unusual cravings for ice, clay or starch (called pica), which is linked to iron deficiency.
• Restless legs, especially at night.
• Irregular or heavy periods, and in pregnancy, a higher risk of problems for mother and baby.

Risks of Untreated Anaemia

Long-standing anaemia affects work, mood, learning and immunity. In pregnancy it raises the risk of premature birth, low birth weight, heavy bleeding after delivery and the need for blood transfusion. In severe cases, it strains the heart and can cause heart failure. In adolescents, it affects growth and school performance.

How Anaemia Is Diagnosed

The doctor will ask about your diet, periods, pregnancies, medicines and family history and examine you for pallor and other signs. Common tests include:

• Complete blood count (CBC): measures haemoglobin, red cell size and other indices.
• Peripheral smear: shows the shape and size of red cells.
• Serum ferritin and iron studies: assess iron stores. Ferritin is the most sensitive test for iron deficiency.
• Vitamin B12 and folate levels.
• Thyroid and kidney tests, when relevant.
• Haemoglobin electrophoresis, to check for thalassaemia or sickle cell trait.
• Stool tests and endoscopy or colonoscopy, if hidden gut bleeding or malabsorption is suspected.
• Pelvic ultrasound, if heavy periods suggest fibroids or other gynaecological causes.

Treatment of Iron Deficiency Anaemia

Treatment has two parts: correct the iron shortage and find and treat the cause.

Oral iron. Tablets or syrups such as ferrous sulphate, ferrous fumarate or iron bisglycinate are usually taken once daily or on alternate days, which may improve absorption and reduce side effects. Take iron with vitamin C-rich food or juice and avoid taking it with tea, coffee, milk or calcium tablets. Haemoglobin usually starts rising within two to four weeks, but treatment often continues for three to six months after haemoglobin normalises, to rebuild stores.

Common side effects. Dark stools, constipation, nausea or stomach upset. Taking tablets after food, changing the type or using alternate-day dosing can help. Do not stop without discussing it with your doctor.

Intravenous iron. Given as an infusion under supervision when oral iron is not tolerated, absorption is poor, anaemia is severe, there is ongoing blood loss, or when rapid correction is needed, for example late in pregnancy. Modern preparations are safe in monitored settings.

Blood transfusion. Reserved for severe, symptomatic anaemia or emergencies such as heavy bleeding.

Treating the cause. Heavy periods may need hormonal treatment, tranexamic acid or treatment of fibroids or polyps. Intestinal worms, ulcers or malabsorption need their own therapy. B12 deficiency is treated with injections or high-dose tablets, and folate with supplements.

Eating for Healthy Haemoglobin

Food alone may not correct established anaemia, but it supports treatment and prevents recurrence.

• Iron-rich foods: leafy greens such as spinach and amaranth, beetroot, dates, raisins, jaggery in moderation, legumes, chickpeas, rajma, lentils, sesame seeds, pumpkin seeds, whole grains, and for non-vegetarians, liver, red meat, chicken and fish.
• Add vitamin C: lemon, amla, oranges, guava and tomatoes improve absorption of plant iron when eaten together.
• Cook in iron cookware to add small amounts of iron to food.
• Space out inhibitors: keep tea, coffee and calcium supplements at least an hour or two away from iron-rich meals.
• Include B12 and folate sources: dairy, eggs, fish, fortified foods, green leafy vegetables, citrus and legumes. Vegans often need B12 supplements.
• Soak, sprout and ferment grains and pulses to reduce natural inhibitors of iron absorption.

Preventing Anaemia

1. 1Eat a varied diet with iron, folate and B12 sources, starting in adolescence.
2. 2Get a haemoglobin test once a year, and more often if you have heavy periods.
3. 3Take iron and folic acid tablets during pregnancy as prescribed.
4. 4Keep a gap of at least two years between pregnancies, if possible.
5. 5Seek treatment for heavy menstrual bleeding rather than accepting it as normal.
6. 6Take deworming medicine as advised for children and adolescents.
7. 7Avoid excessive tea and coffee with meals.

Anaemia in Teenagers, in Pregnancy and After 40

Teenage girls need more iron because of growth and menstruation, and many skip meals or follow restrictive diets. School-based iron and folic acid programmes help, but a haemoglobin check once a year is sensible. In pregnancy, iron and folic acid are started early, haemoglobin is checked each trimester and intravenous iron is used when levels are low late in pregnancy. After 40, heavy periods from fibroids or perimenopause are a leading cause, and any new anaemia after menopause should prompt a search for bleeding from the gut.

Common Myths About Anaemia

• Eating more spinach alone will fix it. Greens help, but plant iron is poorly absorbed and diet rarely corrects established anaemia without supplements.
• Anaemia is normal for women. It is common, but it is never normal, and it should be treated.
• Iron tablets cause weight gain. They do not. Appetite often improves as anaemia is corrected.
• Jaggery and dates are enough. They contain some iron but not enough to replace medical treatment.

Care at Trustmed Hospital

At Trustmed Hospital in Badshahpur, Gurugram, our gynaecology and general medicine teams evaluate anaemia together, with in-house diagnostics to find the cause. We offer oral and intravenous iron therapy, treatment of heavy periods and antenatal anaemia management. Book an appointment for a check-up.

Frequently Asked Questions