Heavy menstrual bleeding is one of the leading causes of iron deficiency in women of reproductive age. With every menstrual cycle, blood loss results in iron loss. When bleeding is heavier than normal, prolonged, or involves large clots, the amount of iron lost can exceed the body’s capacity to replace it. Over time, this depletes iron stores and may progress to iron deficiency anaemia.

Iron deficiency is common in Australian women. National health data suggest that iron deficiency affects at least 1 in 5 women of reproductive age, with higher rates in younger women and those with heavy menstrual bleeding.

Despite this, many women remain undiagnosed, as symptoms are often non-specific and attributed to lifestyle factors rather than an underlying medical cause.

Iron plays a critical role in haemoglobin production, allowing red blood cells to transport oxygen throughout the body. It is also essential for cellular energy production, immune function, temperature regulation and numerous enzymatic processes. Because iron is involved in so many physiological systems, deficiency can affect multiple aspects of health.

Importantly, women can experience significant symptoms even before anaemia develops. Iron deficiency without anaemia is increasingly recognised as a clinically relevant condition and may impair physical performance, cognitive function and overall wellbeing, even when haemoglobin levels remain within the laboratory reference range.

Common symptoms associated with iron deficiency due to heavy menstrual bleeding include;

• Persistent fatigue.
• Reduced concentration.
• Impaired exercise tolerance
• Dizziness
• Shortness of breath
• Headaches
• Palpitations
• Brittle nails
• Hair thinning and hair loss (alopecia).

These symptoms often develop gradually and may be attributed to stress, poor sleep, perimenopause or the demands of work and family life, leading to delays in diagnosis.

If left untreated, iron deficiency can substantially impair quality of life. It may contribute to reduced workplace productivity, increased healthcare utilisation and diminished participation in physical and social activities.

Recognising heavy menstrual bleeding as a potential driver of iron deficiency allows for appropriate investigation, treatment of the underlying bleeding, and timely restoration of iron stores – helping women regain energy, clarity and resilience.