月经初潮后，逐渐成为生活的一部分。您可能学会识别情绪何时开始大起大落、储备止痛药来应对痛经，以及确保您在您的包里准备好卫生巾。然而，除了应对月经的实际情况之外，它们对您身体的伤害可能比您意识到的要大。
在您的月经期间，您会失血，而血中含有铁。此失血意味着女性需要从饮食中摄取的铁量是男性的两倍1。
如果您饮食中的铁含量不足以补充您在月经期间丢失的铁量，您就会变得缺铁。缺铁意味着没有足够的铁来满足您身体的需要2。缺铁可能会导致缺铁性贫血，在这种情况下，您不再能够产生所需数量的健康红细胞2。缺铁或缺铁性贫血会使您感到精疲力尽、难以集中注意力和抗感染能力降低3。
月经过多和缺铁
即使您不认为您月经过多，您也可能仍然在替换您月经期间丢失的铁方面存在问题。缺铁在女性中常见，并可能对您的总体健康产生影响。
缺铁体征
疲倦似乎可能是经期的正常后果，但如果您极度疲惫，并且您在两次月经之间总体未感觉好转，那么您可能正在出现疲乏，其可能是由缺铁所致5。您可以使用我们的“疲乏调查”来评估您的疲倦程度，并且您可以使用评估结果来帮助向您的医生解释您的疲倦如何影响您的生活。
缺铁和缺铁性贫血的其他体征包括面色苍白6和容易丧失注意力3。若要了解更多有关缺铁的体征和症状的信息，请参阅我们的“症状浏览器”。
我可能缺铁，我能做些什么？
月经已成为生活中不可或缺的一部分，以至于您可能不想考虑就其咨询您的医生。您可能会觉得，虽然月经量很大，但您只需要顺其自然。但是，如果您的月经正在影响您的生活，那么不管是否量大，您都应该寻求建议。别忘了您可以要求看女医生，或者起初您可能会觉得和护士交谈更自在。
您的医生可能会要求您做一项血液检查，本指南可能能够帮助您理解检查结果。健康、均衡的饮食也可以帮助您将您的铁储备保持在正确的水平上。
月经过多
Emily，32岁|已订婚|专业人士
当我在念大学的时候，如果我起身太快，那么我会开始感到晕眩。我妈妈给了我一些补充剂让我服用，但我以为这些药片会对我有帮助，并且我的头晕只是因为我忙于学习和结识朋友。几年后，当我升职时，头晕变得非常糟糕。有时，我不得不重新坐下来，这样我才不会昏倒。我头痛，而且一直都很疲惫；我太累了，以至于不能和我的朋友们外出。我的未婚夫说我比以往任何时候都要暴躁。我的新工作意味着我要工作很长时间，而且睡不好觉，因为我总是担心，所以我总是把我的症状归因于忙碌的生活。
直到我和一位密友聊到我感觉疲惫的时候，我才意识到我的月经不寻常。她很惊讶我的经期会持续这么长时间，以及我不得不在夜里起床更换卫生巾。我确实注意到当我月经量最大时，我感到最疲倦和晕眩，所以我确实认为也许我的月经正在影响我。
疲倦最困扰我。这个世界似乎一直都是雾蒙蒙的，我无法集中注意力，有时我不得不努力保持清醒，即使在工作中也是如此。如果我在周末睡一觉，那么我会感觉好一点，但即使是长时间睡懒觉也不会真的有所帮助。我喜欢摄影，如果我出去拍照或去看展览，我会感觉压力小些 – 但然后我会非常疲惫，以至于晚上什么也做不了。
随着婚礼的临近，我意识到我不能再一天一天地挣扎下去，于是去看了我的医生。她说，我的月经以及因此产生的铁丢失可能是我感到如此疲惫的原因之一。我做了关于贫血的血液检查，并检查了我的铁水平，结果显示我确实患有缺铁性贫血，其是由我的月经过多引起。医生已开始治疗，并且我已感觉好些。我希望现在我会有精力去做所有我想做的事情，并真正享受我的婚礼和与我的新丈夫共处的时光！
- Zimmermann M, Hurrell R. Nutritional iron deficiency.Lancet.2007;370:511-520.请参见：http://www.sciencedirect.com/science/article/pii/S0140673607612355.2013年10月13日访问。
- Crichton R, Danielson B, Geisser P. Iron therapy with special emphasis on intravenous administration P32.2008.
- Koduru P, Abraham BP.The role of ferric carboxymaltose in the treatment of iron deficiency anemia in patients with gastrointestinal disease.Therap Adv Gastroenterol.2016;9(1):76-85. doi:10.1177/1756283X15616577.
- Liu Z, Doan Q V, Blumenthal P, Dubois RW.A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding.Value Health.2007;10(3):183-94. doi:10.1111/j.1524-4733.2007.00168.x.
- Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review.Am J Clin Nutr.2015;102(6):1585-94. doi:10.3945/ajcn.114.103366.
- Stoltzfus R, Edward-Raj A. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe.J Nutr.1999;129(May):1675-1681.请参见：http://jn.nutrition.org/content/129/9/1675.short.2014年2月11日访问
WHEN LIVING
WITH HEAVY PERIODS,
YOUR IRON COUNTS.
If heavy periods impact your quality of life and disrupt your day, it could be due to low iron.1-3
Here you'll learn the symptoms of iron deficiency. You'll also learn about steps you can take to get your iron levels back on track for a better quality of life.2
Many women who experience heavy bleeding are living with iron deficiency or iron deficiency anaemia, yet it may go under diagnosed and under treated.1,4
Periods are a fact of life. While you'll be familiar with the signs of your cycle and how it can make you feel, you may be iron deficient or have iron deficiency anaemia as a result of your period.2 This can leave you feeling off your game.1-2
As you lose blood, you also lose iron. When the iron in your diet is not enough to match the amount of iron you lose in your period, your body's iron stores deplete.
This can lead to iron deficiency and iron deficiency anaemia.5
IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA ARE COMMON IN WOMEN
WHO HAVE EXCESSIVE MENSTRUAL BLEEDING.1
Up to 1 in 4 women of reproductive age experience heavy menstrual bleeding6
2 in 3 women are living with iron deficiency or anaemia1*
It is reported that menstruating women are 10x more likely to be iron deficient or anaemic than men7
Nearly half of women who have a heavy flow during their menstrual cycle do not seek help.1* But remember, it is a recognised medical condition, called heavy menstrual bleeding (HMB) or menorrhagia.1,3
DO YOU KNOW
THE SIGNS
OF LOW IRON LEVELS
When living with heavy periods, knowing the symptoms of iron deficiency is essential as low iron can impact your quality of life.2
Iron deficiency and heavy periods share many presenting signs and symptoms, which can be broad and non-specific, including fatigue.1,8
Tiredness may seem like a normal consequence of having a period, but if the exhaustion is severe and doesn't improve between periods, this may be fatigue due to iron deficiency.8
Other signs of iron deficiency and iron deficiency anaemia include:6-11
Headache
Poor
concentration
Reduced work
performance
Looking
pale
Feeling
cold
Hair loss
While living with heavy menstrual bleeding can be hard, keeping your iron levels on track could play an important role in your health and wellness.2
In a survey, up to
9 in 10
women living with heavy menstrual bleeding who were iron deficient or had iron deficiency anaemia reported that it adversely impacted their health and their physical and emotional wellbeing.2
Did you know? Iron is essential for:
Your health and wellbeing as well as mental, physical performance and work productivity. Iron is also involved in numerous functions in the body.1,2
Your skin, hair and blood cells. Iron is a fundamental part of the process of growing and renewing these cells12
Your energy levels, muscle and brain function, and immune system. Iron is also needed to help keep your body warm.13-16
If you’re feeling off your game, talk to your doctor about your signs and symptoms.
You may feel that although your periods are very heavy, you just need to get on with it. Keep in mind that while heavy periods and low iron can impact your quality of life, medical intervention can also help to address and improve it. 2,17
Indeed, studies show that women with restored iron levels treated for heavy menstrual bleeding experienced improved quality of life, physically, emotionally and in their social lives, including a feeling of having more energy and less anxiety. 2
start the
conversation
When your doctor is assessing the length and severity of your period, it is important to tell them how you are really feeling. Speaking openly about your symptoms will help your physician to understand if you are low on iron.18
Don’t forget you can ask to see a female doctor, or you may feel more comfortable talking to a nurse at first.
Your healthcare professional may:
Investigate what's causing your heavy periods and the related impacts on your life2,17
Test your iron levels through a ferritin test alongside other blood tests17-19
Advise on different therapeutic options to restore your iron levels2,20
And remember, even if you feel that your period isn’t particularly heavy, you should still talk to your doctor if you are experiencing the signs of low iron.
To prepare for your consultation, try the symptoms browser
don’t let iron deficiency distrupt your day
Keeping your iron on track when living with heavy periods can support improved quality of life for you.1,21
* Based on an internet-based survey conducted among 4,506 women (aged 18-57 years) in five European countries between January and February 2012
** Not an actual patient
- Fraser IS, et al. Int J Gynecol Obstet 2015;128:196–200.
- Peuranpaa P, et al. Acta Obstet Gynecol Scand 2014;93:654–60.
- Opinium Research. Practice Nurse 2018;48(7):1–7.
- Mirza F, et al, Expert Review of Hematology 2018;11(9):727–36.
- Crichton R, et al. UNI-MED Verlag AG 2008;D-28323.
- Marret H, et al. Eur J Obstet Gynecol Reprod Biol 2010;152:133–7.
- Breymann C, et al. Geburtshilfe Frauenheilkd 2013;73:256–61.
- Breymann C, et al. Hematol 2014, Am Soc Hematol Edu Prog Book 2017(1);152–9.
- Patil AV and Malagi U. The Pharma Innovation Journal 2019;8(9):523–7.
- Percy L, et al. Best Pract Res Clin Obstet Gynaecol 2017;40:55–67.
- Dugan C, et al. Anaesthesia 2021;76:56–62.
- Zhang C. Protein Cell 2014;5(10):750–60.
- Agarwal R. Am J Nephrol 2007;27(6):565–71.
- Stugiewicz M, et al. Eur J Heart Fail 2016;18:762–73.
- Lozoff B, et al. Nutr Rev 2006;64:S34–S91.
- Piñero DJ and Connor JR. Neurosci 2000;6(6):435–53.
- NICE. Heavy Menstrual Bleeding: Assessment and management. 2018. Available at: https://www.nice.org.uk/guidance/ng88 (accessed July 2021).
- Soppi ET. Clinical Case Reports 2018;6(6):1082–86.
- World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization 2020.
- Peyrin-Biroulet L, et al. Am J Clin Nutr 2015;102(6):1585–94.
- Kocaoz S, et al. Pak J Med Sci 2019;35(2):365–70.
HQ-NA-2100153. Date of preparation: September 2021.