After the initial shock of starting to menstruate, periods gradually become part of life. You might learn to recognise the onset of emotional upheaval, stock up on pain killers to deal with the cramps and make sure you are prepared with tampons in your bag. However, aside from coping with the practical side of periods, they may be taking a greater toll on your body than you realise.

During your period you lose blood, which contains iron. This loss means that women need up to twice as much iron from their diet as men.1

If the amount of iron in your diet is not enough to match the amount of iron lost through your period, you could become iron deficient. Iron deficiency can lead to a condition known as iron deficiency anaemia, where the number of healthy red blood cells in your body is reduced.2 Iron deficiency and/or iron deficiency anaemia can make you feel exhausted, have difficulty concentrating and be less able to fight infections.3,4

Heavy Menstrual Bleeding and Iron Deficiency

The most common cause of iron deficiency anaemia in the developed world is exceptionally heavy periods, known as heavy menstrual bleeding or HMB.5 Almost a third of women of reproductive age suffer from HMB, which has an impact on their quality of life.5 But how do you know if your periods are particularly heavy?

A doctor will typically diagnose HMB when a woman loses more than 80ml of blood during a period. This is tricky to measure, of course, so doctors will often look for other signs of HMB to help with diagnosis. For example, medical guidelines in the UK say that a woman is suffering from HMB if her blood loss is so great it is affecting her quality of life.6 The section below, ‘are my periods unusually heavy?’ may help you understand whether or not you are suffering from HMB.

You may have already been diagnosed with HMB and be receiving treatment. However, if you are still experiencing extreme tiredness you may be struggling to replace the amount of iron lost every month. Take a look at the signs of iron deficiency section below and talk to your doctor about checking your iron levels.

Are My Periods Unusually Heavy?

It may be hard to know if your periods are worse or heavier than your friends’ and difficult to explain to your doctor what an impact they have on your life. The questions below will help you judge how heavy your periods are, and give you a starting point for a conversation with your doctor.

  • Do you need to use double sanitary protection (tampons and towels)?
  • Do you sometimes leak through your clothes or on to your bedding?
  • Do you need to change your pad/tampon every two hours or more?
  • Do you pass large blood clots (more than 1 inch across)?

If you answered yes to two or more of the above questions you may have HMB. Talk to your doctor as they may be able to offer you treatment to ease some of these symptoms. If you are losing a lot of blood with your periods you are at risk of low iron levels, known as iron deficiency. Check the signs below and also discuss this with your doctor.

Even if you don’t think you have HMB you may still have trouble replacing the iron lost during your period. Iron deficiency is common in women and can have an impact on your general health. One study found that iron deficiency affected 19% of female students.7 If you think you might have low iron levels, the ‘signs of iron deficiency’ section beneath may help you to spot some of the symptoms.

Signs of Iron Deficiency

Tiredness may seem like a normal consequence of having your period, but if your exhaustion is extreme, and you don’t generally feel better in between your periods, you might be experiencing fatigue and exhaustion, which could be due to iron deficiency.3 You can use our Fatigue Survey to assess your level of tiredness, and you can use the results of the Fatigue Survey to help explain to your doctor how your tiredness is affecting your life.

Other signs of iron deficiency and/or iron deficiency anaemia include looking pale8 and losing concentration easily.3 To find out more about the signs and symptoms of iron deficiency see our Symptom Browser.

I May Have Iron Deficiency, What Can I do?

Periods become such a part of life that you may not think to talk to your doctor about them. You may feel that although they are very heavy, you need to just get on with it. But if your periods are impacting on your life, whether they are heavy or not, you should seek advice. Don’t forget you can ask to see a female doctor, or you may feel more comfortable talking to a nurse at first.

Your doctor may ask you to take a blood test, and this guide may help you understand the results. Having a healthy, balanced diet can also help keep your iron stores at the right level.

Remember, periods are just a part of life, don’t let them take over.