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Iron supplements + Anemia

running among the “iron”

Fatigue, weakness, headaches, irritability.  Sound familiar?  

These are the most common signs of anemia. If you’re feeling these I’m not guaranteeing you are anemic. You may just be grumpy. Or stressed. Or not sleeping enough. Or depressed. But you can (and should) be checked for anemia through a simple blood test called a CBC (complete blood count).

If you are anemic, the most likely cause is iron deficiency. A little more than 10% of women ages 16 to 50 have iron deficient anemia. Iron is important because low levels lead to decreased red blood cell production, and red blood cells are the carriers of oxygen through your body (this is over simplified, but you get the gist). Women can even have symptoms with a mild iron deficiency before it’s low enough to cause anemia.


How do we lose iron? 

Usually gradually and slowly. Women often loose it through chronically heavy periods, but it can also be caused by inadequate diet intake or poor absorption (celiac disease and gastric bypass are the two most common of these). Bleeding from the intestines can be a cause, and pregnancy, delivery, and breastfeeding all lower our iron levels too.


How can we correct it?

First, fix any bleeding problem! 

If the problem is heavy periods, an evaluation is necessary, and then treatment can be directed at the underlying cause. You should see your trusted gynecologist for this eval.

Second, increase your iron intake! 

There are a couple ways to do this: diet and supplements.

Iron is found naturally in many foods.

Iron from meat (“heme iron”) is better absorbed than iron from plant sources (“non-heme iron”). Heme iron is highest in liver (beef and chicken) and mussels and clams. Cooked beef is an excellent. Chicken and turkey and other meats have relatively lower levels but are still good sources. Common non-heme iron sources: beans, nuts, and spinach or broccoli. Breakfast cereals are often enriched with iron so look for that label too.

And then there are supplements.

The problem is that iron supplements can have some pretty nasty side effects – about 70% of women report some stomach upset like nausea, sometimes even vomiting, bloating, black poop. They can cause a metallic taste and pretty annoying constipation. Here are some tips to optimize absorption and minimize those side effects to help you:

  • Taking them every other day is as good as taking them daily
  • They’re best absorbed on an empty stomach.
  • But … more side effects are common when taking them on an empty stomach.
  • DO NOT take them with milk or dairy, calcium supplements, cereals, fiber, tea, coffee, and eggs. These all decrease how effectively they’re absorbed.
  • Acidity helps with absorption! Vitamin C or other acidic drinks can help. A big glass of orange juice is a nice chaser. Don’t take them with antacids like Tums or Pepcid for this reason.
  • Enteric coated and sustained release are not as effective.
  • Most women notice an improvement in symptoms within 2 weeks of consistent use.
  • But treatment can take more time to fully correct anemia and often a full 6 months to replete iron stores altogether.
  • There are different formulations. Ferrous sulfate is the cheapest. But ferrous gluconate may be gentler on the stomach. Play around with different formulations to see which sits best with you. Ask your doctor how much “elemental iron” you should be looking for. A standard is to supplement with about 65mg of elemental iron every other day. You can find this info on the supplement box or container – something like “Per tab: ferrous sulfate 325mg; elemental iron 65mg”).


Nov 6, 2019

Original post published: 

* Content reviewed annually for accuracy 

  1. SJ says:

    When I took Health Class in middle school and high school, they all said that girls don’t bleed THAT much during their periods. That we lose maybe “A teaspoon” of blood.

    Even then, I remember thinking what a disconnect it was between MY experience as a teenager, and what the Health teacher told us to expect on our periods.

    Why is this information still circulated? And why don’t Health curriculums include Iron Deficiency or a predisposition to losing Iron, as part of our education?

    Also, WHY do we lose so much blood?

    • Sara Twogood says:

      Is that still being taught to teenagers? How long ago was that for you?
      The teens I talk to about their periods are my patients, and they certainly know they bleed more than a teaspoon! Are they getting better information from the internet? Or is the health information better now? I don’t know. And same about the iron deficiency – there is so much to cover with health class, this doesn’t get a lot of attention.

      All this to say, my colleague and I are making a health information course for teens and I will be sure to include this! If you have more feedback, I’d love to hear it!
      Dr. Twogood

  2. […] periods can be painful and are a major contributor to anemia. They can affect normal life, like work and exercise and keep you housebound. Periods should not be […]

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