From The Straits Times    |


It’s amazing being a woman. We tend to live longer, and are generally healthier as we tend to take better care of our bodies. However, there are some downsides and one of them is the fact that we are more likely to suffer from iron deficiency.

Iron plays a vital role in our health and we get it from the food that we consume. Dr Esmeralda Teo, Consultant, Department of Haematology, Singapore General Hospital, reveals that iron is absorbed by our body and transported either to the liver for storage or into the bone marrow for red cell production.

“Iron is converted into a molecule called haem and is used to synthesise a protein called haemoglobin. This is incorporated into all red blood cells, which enables them to bind quickly to oxygen in order to carry it all around the body,” she explains.

So, if we have iron deficiency, there will be less iron available to make good functioning red cells. This then means we will not be able to transport or deliver enough oxygen to all the parts of our body.

Have you been feeling tired?

The lack of iron in our body could be because we are not getting enough from our food, or because we are losing too much blood which contains iron. You could be lacking in iron but not considered anaemic. Dr Teo explains this is because your body will start to use up its iron stores first, so the anaemia might not be present. But when the iron stores themselves are depleted, then the symptoms of anaemia will ensue. If we ignore the symptoms of anaemia, it will severely affect our health.

Dr Teo says symptoms can present in many ways, depending on the baseline health of the individual: “In the beginning, they may feel more easily tired, giddy, have headaches or feel breathless on physical exertion. But if they continue to ignore these symptoms, they may develop into more serious complications like chest pain, breathlessness on walking or fainting. At this point, iron deficiency can even be lethal.”

Our daily lives will be affected more and more, as the iron deficiency anaemia gets worse. Dr Teo describes the following trajectory – initially, we may feel that we do not have enough energy to do our usual work. We will get tired more easily and sleep more. We will not be able to exercise as much as previously. We may feel giddy when we stand up too fast or have headaches. We may even get used to these symptoms and think that it is our normal state. But as the iron deficiency worsens, these limitations become more pronounced.

Heavy periods and fibroids

As mentioned, iron deficiency is more prevalent in women. In Singapore, 2016 figures showed that 22% of non-pregnant women between the ages of 15 and 49 had anaemia. Among pregnant women, this figure was 31%.

“Iron deficiency is more prevalent in women because we have our menses and therefore are always losing blood,” says Dr Teo. “When women are pregnant, they use their own iron stores to make blood for the foetus. Then, after the birth, mothers continue to need iron as they produce breast milk for their new-born baby, which is iron-rich. If they do not take iron supplements during these times, they are more likely to become iron deficient.”

Sonia*, 43, a freelance writer, gets regular blood tests to keep on top of her health and has had low iron levels the last few years. While she does often feel tired, she chalked it up to getting older and didn’t have any other symptoms related to low iron. Her doctor suggested iron supplements but she didn’t take them for long as they gave her really bad tummy aches.

“My doctor wanted to investigate why my iron levels were consistently low as I eat meat and should have been getting enough iron in my diet,” she explains. “He checked for things like thyroid issues and celiac disease as iron deficiency is common with such conditions. I tested my faeces for blood and went for a colonoscopy and gastroendoscopy to check I wasn’t losing blood through my digestive system.”

Nothing unusual was found in any of these tests so Sonia’s doctor concluded that her low iron is likely because she has always had very heavy periods. She now monitors her iron levels through blood tests every six months and gets an iron infusion – where iron is delivered intravenously – if her levels are low.

Merchandiser Sarah*, 39, found out she had low iron about a year ago, from a random blood test.

“I didn’t have any symptoms so had no prior knowledge of the issue,” she recalls. “My gynaecologist found a few fibroids in my uterus and those make my periods very heavy so that’s why I’m losing iron. I currently take iron supplements every other day but I’ll only be able to tell if they are making a difference when I go for my next blood test.”

Steps to take to avoid iron deficiency

Unfortunately, there isn’t enough awareness of iron deficiency among women. Dr Teo says this is because women may feel that if they eat a balanced diet and are healthy, they could not become deficient.

“But they may not be aware that their iron loss may outweigh what they can get from their diet,” she adds. “In fact, during their periods, women may need double the amount of iron, compared to men.”

Also, because iron deficiency symptoms are very non-specific, some women may think that feeling ‘tired’ or ‘breathless’ is the norm. So they may not be aware that these are the symptoms of iron deficiency and may ignore them. But this could be potentially lethal in some people, especially when the condition is easily preventable, says Dr Teo.

There are steps to take to keep your iron levels up to par. Firstly, eat iron-rich foods such as red meat, shellfish, dark vegetables like spinach or broccoli, legumes, tofu, fish or white meat like chicken. Women who are expecting should take extra care.

“During times like pregnancy or post-birth, women should pre-emptively start taking nutritional supplements with extra iron,” Dr Teo advises. “If they develop symptoms of iron deficiency as described above, they should see their doctor early to check their blood and iron levels.

“Iron supplements can be given either in the form of tablets or as an intravenous infusion. In situations when the blood levels are extremely low, blood transfusions may be given,” she adds.

*not her real name