Heavy periods and iron deficiency, why you are not imagining it

If you’ve been told your bloods are normal while still feeling exhausted every month, you are not imagining it, and you are far from alone. Heavy menstrual bleeding is one of the most common, and most consistently under-treated, causes of iron deficiency in women.

Why heavy periods drain your iron so effectively

Each millilitre of blood lost carries iron with it. A normal period involves losing roughly 30-40ml of blood in total. Heavy menstrual bleeding, clinically defined as blood loss that interferes with your physical, social, or emotional quality of life, can mean losing significantly more than that, month after month.

Your body can typically only absorb a small amount of iron from food each day. When monthly losses consistently outpace what you can replace through diet, iron stores decline gradually, often over years, until symptoms become impossible to ignore.

Why this gets missed

Many women are reassured that their bloods are fine because their haemoglobin sits within the normal range, without ferritin, which reflects your actual iron stores, ever being checked. You can have significantly depleted iron stores and feel genuinely unwell long before haemoglobin falls low enough to be classed as anaemia.

Periods are also still, frustratingly, sometimes treated as an inevitability rather than a treatable cause of a treatable problem. Both the bleeding itself and the resulting iron deficiency deserve proper investigation.

What can be done

Two separate things usually need addressing: the bleeding itself, and the iron deficiency it has caused. Gynaecological assessment can identify treatable causes of heavy bleeding, from fibroids to hormonal imbalances, while iron levels can be corrected through diet, oral supplementation, or, where levels are significantly depleted or tablets aren’t tolerated, intravenous iron.

You don’t have to choose between living