Falling hair may be a symptom of a silent illness that robs women of enjoying a better quality of life. That is iron deficiency anaemia.
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CONSTANTLY drained and fatigued, dizzy when standing too quickly, extra hair falling in the shower and around the room, heavy menstrual cycles? Those are the concerns that countless women, many of whom are teenagers and young adolescents, sometimes attribute to stress. But these may be symptoms of a silent illness that robs women of enjoying a better quality of life, that is iron deficiency anaemia.
Anaemia directly translated means a condition of less red blood cells called haemoglobin. Haemoglobin is a molecule that is responsible for carrying oxygen in the body, and iron is an important component of it. Therefore less iron means less haemoglobin and less oxygen carrying capacity. As there are other conditions that result in anaemia and even some that may mimic it, it is essential that initial investigations are done, and the cause of anaemia is proven on blood testing and not just diagnosed based on symptoms alone.
Iron deficiency is by far the commonest type of anaemia as it affects menstruating females and is compounded by diets lacking iron-rich foods. An individual may suspect that they have anaemia if they have some symptoms as listed above, particularly if they have heavy menstrual cycles. Other symptoms may include poor concentration, poor exercise tolerance, shortness of breath and even leg swelling.
Vegetarians may be at risk of a few types of anaemia due to the lack of iron and vitamin B12, both of which are used by the body to synthesise haemoglobin, with animal sources being the most abundant in these molecules. In children, iron deficiency can occur through malnutrition, parasitic infections like worms, and other chronic conditions. They may have problems with concentration or hyperactivity, constantly fall ill and look generally unwell.
When suspecting these symptoms, a doctor should be consulted and generally an examination is performed, a directed history trying to determine the cause of symptoms is taken, and blood tests are run. As the symptoms of iron deficiency may be common to other disorders, sometimes several different blood investigations are done depending on the discretion of the doctor.
Children are often dewormed and monitored thereafter. If iron deficiency is diagnosed on blood tests, then the cause must be treated simultaneously while trying to increase iron levels for improvement of symptoms. Too often patients remain on iron supplements for extended periods without a proper evaluation or necessary blood testing.
For example, heavy menstrual bleeding can be caused by underlying hormonal, ovarian or uterine pathology, and can be successfully treated. Diets should be optimised to include iron-rich food like red meat, beef liver, leafy green vegetables, fish, eggs, shellfish, etc. Vegans and vegetarians may need constant iron supplements, but this should also be monitored on blood testing.
Iron supplements can be obtained over the counter, and some forms are by prescription. In cases where blood testing reveals very low iron stores and/or haemoglobin in a patient who is very symptomatic, then they can be treated with iron infusions or even referred to a physician or haematologist for a blood transfusion as required, while addressing the underlying cause concurrently.
Prolonged untreated iron deficiency can lead to chronic, severe exhaustion, depressed immunity and cardiac compromise, among others. Young affected women who become pregnant have added demands on the blood system, and anaemia can severely compromise the health of both the mother and developing child. The process of birth and the postpartum period including breast-feeding is also well known to compound symptoms of existing untreated anaemia.
Iron deficiency does not only occur through heavy periods. Insidious, occult bleeding like gastric ulcers can also cause iron deficiency. In an older patient or one in which an obvious source of bleeding is not readily ascertained, then further investigations may be necessary, for example, investigations for chronic kidney or cardiac disease, upper endoscopy for ulcers or non-benign lesions, colonoscopy for bleeding lesions/masses, or inflammatory conditions. Early medical consultation is key to regain control over the symptoms of anaemia.
Dr Trish Manilall
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Dr Trish Manilall is a general medical practitioner based in Durban North. She has 12 years of experience as a practising doctor, and she established a private practice three years ago. Manilall takes a keen interest in women’s health and medical aesthetics. She engages in social media discussions around relevant health topics. Find her on TikTok: @drtrish.