Low Iron
Iron Deficiency: Symptoms, Causes and Treatment Options
Iron deficiency is common, particularly in women, but the symptoms can sometimes be subtle. Fatigue, reduced exercise tolerance, headaches, difficulty concentrating and hair shedding can have many different causes, which is why appropriate medical assessment is important before assuming that low iron is responsible.
What does iron do?
Iron is an essential mineral used by the body to produce haemoglobin, the protein in red blood cells responsible for carrying oxygen around the body.
When the body's iron stores become depleted, this is known as iron deficiency. If iron deficiency progresses sufficiently to affect haemoglobin production, iron-deficiency anaemia can develop.
Importantly, it is possible to have depleted iron stores without being anaemic.
What are the symptoms of iron deficiency?
Symptoms vary between individuals and can depend on the severity and duration of the deficiency. They may include:
Fatigue or reduced energy
Reduced exercise tolerance
Shortness of breath on exertion
Headaches or dizziness
Difficulty concentrating
Restless legs
Hair shedding
Palpitations
Feeling unusually cold
These symptoms are not specific to iron deficiency, so blood tests and an appropriate medical assessment are important.
Why does iron deficiency occur?
Finding the reason for iron deficiency is just as important as correcting the deficiency itself.
Common causes include heavy menstrual bleeding, pregnancy, inadequate dietary iron intake, gastrointestinal blood loss and reduced absorption of iron from the gastrointestinal tract.
Depending on a person's age, symptoms and medical history, further investigation may be needed to identify the underlying cause.
Simply replacing iron without considering why the iron became low may mean an important underlying condition is missed.
How is iron deficiency diagnosed?
Assessment usually includes a medical history and blood tests. These may include a full blood count and iron studies, including ferritin.
Results need to be interpreted in context. For example, ferritin can be influenced by inflammation and illness, so there isn't always a single blood-test result that tells the whole story.
Your doctor may also recommend additional investigations depending on your symptoms, menstrual history, diet, medications, gastrointestinal symptoms and other medical conditions.
How is iron deficiency treated?
Treatment depends on several factors, including:
The severity of the deficiency
Whether anaemia is present
The likely cause
Symptoms
Dietary intake
The ability to absorb iron
Previous response to treatment
Whether oral iron is tolerated
How quickly iron replacement is clinically required
Treatment may include dietary changes, oral iron replacement or, in selected circumstances, intravenous iron.
Oral iron
For many people, oral iron is an appropriate initial treatment.
Oral iron is convenient and avoids the need for intravenous administration. However, treatment generally needs to continue for a period of time to replenish the body's iron stores rather than simply improving the haemoglobin level.
Some people experience gastrointestinal side effects such as nausea, abdominal discomfort, constipation or diarrhoea. Absorption can also vary considerably between individuals.
The dose and frequency of oral iron should therefore be individualised rather than assuming that more iron is necessarily better.
Intravenous iron
Intravenous iron is another method of replacing iron and may be considered in certain clinical circumstances.
For example, a doctor may consider intravenous replacement where oral treatment has not been tolerated or has not adequately corrected the deficiency, where absorption is impaired, or where there is a clinical reason that iron needs to be replaced more rapidly.
Intravenous iron is a medical treatment and is not automatically the better option simply because it can replenish iron more quickly.
It also has potential risks and adverse effects. These can include temporary headache, nausea, flushing, changes in blood pressure and reactions around the intravenous site. Less commonly, more significant reactions can occur. Some forms of intravenous iron can also cause low phosphate levels, which can occasionally be significant or prolonged.
For this reason, the decision to use intravenous iron should follow an individual medical assessment.
Oral iron or intravenous iron - which is better?
There isn't one treatment that is best for everyone.
For some people, oral replacement is simple, effective and well tolerated. For others, factors such as gastrointestinal side effects, impaired absorption, ongoing iron losses, the severity of deficiency or the clinical circumstances may make intravenous replacement worth considering.
The aim is not simply to increase ferritin. It is to determine why iron is low, whether replacement is required, and which treatment is most appropriate for the individual patient.
What about diet?
Diet is an important part of maintaining healthy iron levels.
Iron is found in foods such as meat, seafood, legumes, tofu, nuts, seeds, whole grains and leafy green vegetables. Iron from animal sources is generally more readily absorbed than non-haem iron from plant foods.
For established iron deficiency, however, dietary changes alone may not always provide enough iron to adequately replenish depleted stores.
When should you see a doctor?
If you have persistent fatigue, heavy menstrual bleeding, unexplained low iron, recurrent iron deficiency or abnormal blood-test results, it is worth discussing these with your doctor.
Particular attention should be given to new or unexplained iron deficiency, especially when there is no obvious source of iron loss, as further investigation may be appropriate.
Iron deficiency assessment at Mind Body Skin Institute
At Mind Body Skin Institute, our doctors can assess iron deficiency in the context of your broader health.
This may include reviewing symptoms and previous blood results, arranging further investigations where appropriate, considering possible causes of iron deficiency and discussing suitable management options.
Treatment recommendations are individualised following medical assessment.
