Persistent fatigue, difficulty concentrating, paleness, and even shortness of breath when performing daily activities. Many women attribute these symptoms to stress, lack of sleep, or the fast pace of daily life. However, in many cases, the cause may be different: anemia, a condition that, according to data from the WHO worldwide, affects 37% of pregnant women and 30% of women aged 15 to 49.
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Anemia occurs when the blood does not have enough healthy red blood cells or the adequate amount of hemoglobin, the protein responsible for transporting oxygen to the tissues. As a result, the body receives less oxygen than it needs, and symptoms that can go unnoticed for months appear.
And, once again, women bear the brunt. This is because women of childbearing age are the group at greatest risk of developing anemia, mainly due to blood loss associated with menstruation, especially when bleeding is heavy or prolonged.
Dr. María Soledad Undurraga, hematologist at Clínica Universidad de los Andes, explains that “since there is no clear parameter on what amount of bleeding is normal and it is not a topic usually discussed, many minimize very heavy menstruations and only consult when fatigue is already significant.” She adds that, “since iron loss occurs progressively, they usually seek help late, when anemia is already established.”
Dr. José Luis Briones, clinical hematologist and master in Precision Medicine and Genetics, agrees. He says that women are much more exposed to events that reduce their iron stores, through menstruation, pregnancy, and breastfeeding. “The severity will depend on many factors, such as how heavy the menstrual bleeding is, how rich in iron the diet is, or the proper replacement during pregnancy.” However, he also warns that anemia can appear at any stage of life and its causes change with age. “Later on, there may be anemias that no longer depend on iron deficiency, so it is always important to consult when symptoms that are out of the ordinary appear.”
Pregnancy is another critical time, because during this period iron needs increase considerably to support the baby’s development and the formation of the placenta. If these stores are not replenished after delivery, the risk of developing anemia persists during the postpartum period, a stage in which the body continues to demand nutrients for recovery and, in many cases, for breastfeeding.
“The mother needs to expand her blood volume and mobilize her iron stores to form the baby’s red blood cells, especially during the second and third trimesters. Also, we know that maternal iron deficiency can affect pregnancy development and the neurological and cognitive performance of the child,” explains Briones.
Under normal conditions, a balanced diet is usually sufficient to maintain adequate iron levels. However, there are situations where diet alone is not enough. “When there is significant bleeding, diseases that hinder absorption, or high-demand stages such as pregnancy, it is very difficult to correct the deficiency with diet alone. In those cases, it is usually necessary to resort to iron supplements prescribed by a doctor,” says Dr. Briones.
Dr. Undurraga adds that “a person with normal intestinal absorption and an adequate diet, including animal proteins such as meat, chicken, or fish, does not need supplementation. The exception is, for example, women with very heavy menstruations. In those cases, not only should they be supplemented with iron, but they should also be referred to a gynecologist to evaluate if there is any problem explaining that blood loss and to correct it.”
Both specialists warn that, in case of a significant decrease in iron in the body, care should be taken with foods that interfere with absorption, such as tea, coffee, and dairy products. “This does not mean they should be eliminated, but consumed away from main meals or iron supplements,” explains Briones. They also recommend complementing the diet or supplements with citrus fruits and foods containing vitamin C, as they enhance iron absorption in the body.
Regarding supplements, Dr. Undurraga warns that, “before prescribing them, it is always necessary to perform these tests, since not all anemias have the same cause. Some congenital diseases, such as thalassemias, cause iron accumulation, and administering supplements in those cases can cause damage to various organs.”
Persistent fatigue is usually the most well-known symptom of anemia, but it is not the only one. Weakness, dizziness, headaches, brittle nails, hair loss, or difficulty concentrating can also appear.
For Briones, one of the biggest problems is that many women normalize these symptoms. “The call is to know your own body. Any change from normal should raise concern.” Undurraga adds that, “in more severe cases, pica syndrome may appear, characterized by the desire to consume unusual substances, such as ice, dirt, or even cement.”
Diagnosis usually begins with a complete blood count, although this test is not always sufficient. “Anemia is the final consequence of iron deficiency. Before it appears, the body has already exhausted its stores,” explains Briones. That is why he insists on the importance of measuring ferritin, the test that allows knowing the body’s iron stores. “If there are symptoms suggestive of iron deficiency, even if anemia has not yet appeared, ferritin can detect the problem in time.”
Women with heavy periods, pregnant women, those in the breastfeeding period, with intestinal diseases, or with low weight or obesity are some of the groups that should have regular medical check-ups. In many cases, an annual check-up allows detecting the deficiency before complications arise.
This is important because not treating this condition has consequences. “Anemia affects quality of life. It decreases physical performance, concentration capacity, favors chronic fatigue, and can even increase susceptibility to infections. All this ends up impacting family, work, and personal life,” concludes Briones.
Undurraga adds that “when blood loss is very slow, the body can take years to exhaust its stores. During that time, the person progressively adapts, but there comes a point when fatigue is so significant that even simple activities like walking can become very difficult.”
