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Anemia and Perimenopause

Image of a phone with a graphic of a needle and the words Anemia. Medications and a stethoscope are in the background.

Feeling tired all the time? Could you be anemic?

Perimenopause can increase the risk of anemia, caused by low iron, due to changes in menstrual bleeding and risks associated with increasing age.

What might be causing your low iron levels?

And most importantly, how can you increase your iron levels so you feel energetic again?

This article will explain the symptoms of anemia, why perimenopausal women may be low in iron, and how you can help increase your iron stores with changes to your diet.

Keep reading to find out more.

What is iron deficiency anemia?

If you are iron deficient, your body will produce less hemoglobin which is a protein found in red blood cells and carries oxygen around the body.

Our body can’t make iron so if we are not eating enough iron rich foods or if we are losing excess blood, we can become anemic.

What are the symptoms?

Symptoms of anemia include:

  • Feeling tired and weak
  • Shortness of breath
  • Feeling dizzy or light-headed
  • Having trouble concentrating
  • Getting sick regularly 

How does perimenopause cause anemia?

Increased menstrual bleeding

During perimenopause, menstrual bleeding can become heavier or more frequent. This can result in an increase in blood loss and therefore iron. If iron consumed in the diet is unable to replace the lost iron, the body’s iron stores will decrease and eventually result in anemia. 

Other causes of anemia 

Diet

If you follow a vegetarian or vegan diet you may not consume enough iron as one of the richest sources of iron is meat. 

Although iron can be found in vegetables and other plant-based foods, the absorption of iron is lower and other components in the food can inhibit absorption.

Even women who eat meat may not get enough iron to meet their requirements, especially if they are still having regular periods. They may not be eating these foods regularly enough, in large enough quantities or their overall diet is poor.

Poor absorption

Some medical conditions like coeliac disease can result in less iron absorption in the bowel. Since iron is also absorbed in the stomach, surgery such as bariatric surgery can reduce your capacity to absorb iron.

Blood loss

As mentioned above, increased menstrual bleeding during perimenopause can have an effect on iron levels in the body.

Other causes of blood loss include:

  • Bleeding internally (eg stomach, bowel)
  • Giving blood too regularly 
  • Surgery
  • Infections

How to treat iron deficiency anemia

Iron supplements

Depending on your iron levels, your health provider may recommend iron supplements as a first line of treatment. It’s important to only take iron supplements under the supervision of a health professional who can monitor your iron levels and advise when to stop or when other treatments may be required.

Iron supplements are usually taken daily until your iron levels are within the recommended range. 

Iron supplements can have side effects like constipation and black stools. Black stools are normal and are nothing to worry about however, constipation can be problematic. There are different types of iron supplements, some of which do not have the side effects that regular varieties have.

Iron Infusions

If your iron levels are very low or you can’t tolerate oral iron supplements, your doctor may recommend an iron infusion where an iron is delivered directly into the blood via a needle in the vein. 

Diet

Increasing the amount of iron you consume from food can be a first line treatment if your iron levels are only slightly low and if diet is the suspected cause. Increasing iron intake can also be recommended in addition to other treatments and can help prevent future issues with anemia, particularly if the cause is diet.

How much iron do you need?

The recommended daily intake for women who are still menstruating is 18mg iron per day.

After menopause, your requirements decrease to 8mg per day.

Foods High in Iron

There are two different types of iron; Heam iron and Non-heam iron. Haem iron is found in meat and animal products and is absorbed easily by the body. Non-haem iron is found in plant-based foods and is not absorbed by the body quite as well.

Foods high in haem iron include meat, poultry and seafood.

Foods high in non-haem iron include nuts and seeds, dark leafy greens, legumes, dried fruit and cereals. Try my recipe for Smoky Baked Beans for an iron rich plant-based meal.

Infographic showing list of iron rich foods

Increasing Iron Absorption

Vitamin C

Eating foods high in vitamin C at meals can help increase absorption of non-haem iron. 

Foods high in vitamin C include:

  • Citrus foods (organge, lemon, grapefruit)
  • Capsicum/Peppers
  • Broccoli
  • Kiwi fruit
  • Tomatoes
  • Berries
  • Cabbage

Reducing foods that inhibit iron absorption

Some foods contain compounds that can hinder iron absorption including:

  • Phytates found in wholegrains, nuts and legumes
  • Calcium found in dairy foods
  • Polyphenols found in coffee and tea

There is no need to avoid the above foods but it is recommended to soak legumes to reduce phytates and eat dairy foods, coffee and tea between meals where possible.

In Summary

Iron deficiency anemia is common in women who are still menstruating and increased bleeding during perimenopause can increase the risk of anemia.

Causes of low iron in the body include low iron intake in the diet, poor absorption or loss due to bleeding.

Foods high in iron include meat, seafood, poultry and eggs and plant sources include legumes, vegetables, some dried fruit, nuts and seeds.

To increase iron absorption try including Vitamin C rich foods with your meals and reduce phytates, calcium and polyphenols at meal times.

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