Anemia originates from a decreased number of circulating red blood cells, a decreased concentration of hemoglobin, or both. Resulting symptoms can include fatigue, shortness of breath, or difficulty concentrating. Menstrual periods are cyclical physiological changes that indicate a woman is not pregnant and may be associated with bleeding and anemia. Regular menstrual cyclicity is also an indicator of a woman’s overall health. Anemia remains a significant global health burden, mainly impacting women of reproductive age. The main reason for this high disease burden is the coexistent worldwide prevalence of other causes such as nutrition or inflammation. Several negative effects on mental, motor, and cognitive performance have been associated with anemia, affecting the quality of life and, consequently, social and economic development, especially in developing countries. During menstruation, women lose both iron and blood. As iron is crucial for ensuring overall body health and well-being, beneficial strategies and regulations are essential to promote iron homeostasis throughout the menstrual period to ensure women’s health. In this regard, more studies have focused on the impact of anemia among women suffering from abnormal intensity and duration of menstruation. In addition, changes in monthly estrogen and progesterone levels in women lead to several biochemical, hematologic, and morphologic variations in different parts of the body. As variations in ovarian hormones occur throughout the menstrual cycle, they can affect gastrointestinal and renal functions long before a woman experiences overt menstrual bleeding. Furthermore, some studies have reported menstrual phase-associated changes in hematological parameters such as erythrocyte, leukocyte, and platelet numbers; red blood cell, hemoglobin, and hematocrit levels; or hormonal variations such as prolactin, estrogen, progesterone, follicle-stimulating hormone, and luteinizing hormone during the menstrual cycle. In addition, an association between anemia and menstruation has been reported in some studies. However, some biochemical and hormonal pathways underlying menstrual cycle variations and their relationship with anemia remain to be elucidated in future studies.
Causes of Anemia in Women
Anemia, or low hemoglobin in the red blood cells, is predominantly caused by a lack of specific nutrients or an underlying chronic condition. The former most commonly occurs due to a shortage of iron, a key nutrient needed for blood production. As a result, many cases of anemia are attributed to nutritional deficiencies, particularly the lack of iron, folate, or vitamin B12. Iron deficiency anemia tends to be most common among childbearing women, associated with menstrual blood loss. More often than men, women experience fluctuations in estrogen and progesterone hormones during their menstrual cycle, pregnancy, and menopause. These hormones can affect how the body uses iron stored in the body for making new red blood cells. If the body’s demands for iron are higher than the available supply, especially in menstruating women, anemia could increase.
Although less common than nutritional deficiencies and hereditary anemias, iron deficiency anemia is also present as a result of chronic conditions. The causes of continuous or heavy blood loss include having long periods or heavy menstrual flow, which may increase the risk of anemia. Heart, blood, and bone defects, or overactive bone marrow for treating leukemia, can also prevent the production of healthy blood. Uterine tissue growth among women of childbearing age is common. In the uterus, noncancerous growths called fibroids may develop and, as a result, contribute to very heavy or long periods. Both fibroids may be nearly undetectable. In addition to the aforementioned causes, pregnant women, Crohn’s disease sufferers, and individuals following a vegetarian diet may be at higher risk of developing iron deficiency anemia. As such, a greater understanding of the many causes of anemia in women is required in order to treat and prevent this sometimes hidden condition. Some patients may see the symptoms of anemia as a normal part of life or choose to ignore them, both of which only increase the potential consequences. Furthermore, many treatment options are available, as those with anemia can avoid its progression by paying attention to their iron intake. Prevention and early diagnosis are often as simple as periodically taking blood tests to screen for anemia. To provide guidance on anemia management, health practitioners should discuss the unique iron requirements of women during their reproductive years.
Impact of Menstrual Periods on Anemia
When women have their monthly periods, they actually lose blood. This is because the uterus sheds its lining and causes bleeding. This shedding is called menstruation. Most women bleed for about two to eight days every month. The average woman loses about two or three tablespoons of blood during her period. Women with heavy menstrual bleeding may lose more blood. The blood contains red blood cells, white blood cells, and platelets. It also contains iron. The main component of red blood cells is hemoglobin. Women who develop anemia typically do so slowly over time. Many factors, including menstruation, can contribute to anemia.
A variety of studies over four decades have shown clearly that loss of iron can be a direct result of blood loss. It is well-documented that many of the typical dietary vitamins and minerals needed to produce hemoglobin can influence anemia progression or prevention, including iron, vitamin B12, folate, vitamin A, and riboflavin. Iron is modestly lost in shed blood. Only approximately 75% of this iron is recovered from fecal and urinary iron losses. Menstrual blood loss can typically be between 10-30 mL blood per 1-6 uterine lining tissue. Some older studies find that some women may lose more than 200 mL. Much of this blood loss occurs in the first 2 days, with up to 80 mL of a typical 5-7 day menstruation. More than 30 mL loss or fewer days means an abnormal flow classification requiring further care. Women normally increase blood levels by producing more red blood cell units every 120-day lifespan. A woman’s risk of anemia is related to how low her iron levels become over several months or years based on how much extra iron is in her diet and inherited hemochromatosis. Hemoglobin needs iron to carry oxygen from the lungs to all parts of the body. When iron levels fall, hemoglobin decreases in the cyclic 28 days of the menstrual cycle. When free in the blood, this iron is toxic, so the body stores excess iron in the liver and other tissues. When iron storage decreases, hemoglobin production slows. Women manage occasional small decreases in hemoglobin amounts by increasing red blood cell use. Hemoglobin is a primary cause of any side effects for women, like those who have premenopausal fibroids and/or endometriosis. Symptoms such as fatigue, heavy blood loss, pelvic pain, and abnormal uterine bleeding get markedly worse, yet many women are already anemic or prediabetic. Women who are anemic lose more than 15 mL of blood with their 1-2 fecal clots a month. Methylmercury can also destroy hemoglobin, leading to severe anemia in animal models if the dose does not lead to death instead. No animal studies on the destruction of human hemoglobin and on the dose, age, and polymorphism correlations have been done. Neither any environmental agency nor any related federal food agencies have required safe and effective methods to monitor mercury and other anemia risks each cyclic period.
Symptoms and Diagnosis of Anemia in Relation to Menstrual Cycles
It was emphasized that the symptoms of anemia associated with the menstrual cycle are not only fatigue and weakness but also pallor. Anemia has been known to cause pale skin and can be recognized by teachers. In tachycardia, palpitations, and dyspnea, it was reported that females after menarche may feel the same symptoms, while in males, anemia was detected by blood donation for the first time. Fatigue and weakness are said to depend on the severity of anemia. Symptoms may fluctuate in the menstrual period, and the menstruation period of the menstrual cycle is usually more severe than the other periods.
The presence of menstruation is one of the characteristics of female patients. Each time, there are a small number of cases in which the complaints mentioned above are regarded as premenstrual syndrome, polyarthralgia, premenstrual dysphoric disorder, vertigo, decreased neutral secretion, sleep irregularities, infertility, and exercise treatment when new symptoms occur. As already pointed out, in women with low hemoglobin and ferritin, it is important to examine the hemoglobin numbers, including the MCV, MCH, RDW-CV, and RDW-SD parameters, as well as the causes of anemia using serum iron, total iron-binding capacity, and ferritin associated with inflammation and normal iron-body balance. Based on the results of these findings, the timing of the menstrual cycle in premenopausal women needs to be known in more detail. A hemogram can be performed by asking them to do so. During menstruation and 2–3 days later, it is recommended that an hour of tests depending on the type and time of erythropoiesis in the bone marrow is performed. When the level of serum ferritin, an iron-storage protein, is below 100 µg/L, low serum iron may also contribute to anemia. It has been determined that the standard iron and anemia parameters unrelated to iron and menstruation are affected by menstrual flow, flow, and duration. As a result of this study, the anemia-related assessment of parameters was evaluated. It was suggested to the physicians treating these female patients to pay more attention.
Treatment and Management Strategies for Anemia During Menstruation
Various strategies relieve or ease anemia caused by menstruation. We already touched on the importance of blood tests to understand lab findings and monitor iron status while using medications that suppress or stop menstrual periods to remedy heavy menstrual bleeding. However, medications are not the only tool in the toolkit. Effective treatment plans are personalized to meet the needs of women with heavy menstrual periods and anemia related to bleeding, such as the type of anemia, treatment costs, overall health, and risks or benefits for future pregnancies.
Dietary Approaches: Incorporate more iron-rich foods into your diet. If you require iron supplements, use them as recommended. Include vitamin C, a natural iron enhancer, with your meals to help your body better absorb iron-dense foods and supplements in your diet. The best non-meat sources of vitamin C are fruits, strawberries, kiwi, tomato juice, red or green bell peppers, and potatoes.
Medical Interventions: Ask your healthcare professional about offering contraception or hormonal therapies to patients whose primary treatment goal is to reduce menstrual blood flow. While awaiting the effect of other treatments on iron levels, anemia, and the return of monthly menstrual periods, hormonal therapies can help slow monthly blood loss. Likewise, it is important to keep a close eye on hemoglobin levels and menstrual cycles while treating iron-poor anemia caused by chronic menstrual loss. Individual treatment plans should be adjusted based on your overall goals and menstrual and treatment response, as well as your medical history, health, and comfort with hormonal medications.
Supportive Care: During menstruation, women should get rest, take medications like ibuprofen or naproxen sodium, and keep their bodies hydrated. Consulting your healthcare professional or pharmacist is a good idea.