Causes of iron deficiency in women - why women need so much iron

There's a German children’s rhyme that contains the line “Enough iron to make a nail.” It describes what human beings are made of - and it’s true that our body, blood and organs contain about 4 grams of iron. But many women have less than this for a wide variety of reasons - three out of four women have chronically low iron intake until the age of 50. This was confirmed most recently in 2008 in a study carried out by the Max Rubner Institute (German National Diet Study II MRI – Max Rubner Institute, German Federal Research Institute for Diet and Food (2008); 5.7.5. Iron, p.135f). Their diet does not allow them to reach the recommended target figures, and so they must either live with the consequences of low iron levels or adjust their diet and iron intake accordingly. But why are specifically women suffering from low iron levels, and what are the symptoms?

TOPIC OVERVIEW

What iron does in our body

Iron is an essential trace element that carries out several important functions in our body. These include regulating energy production in our cells and producing important hormones and neurotransmitters in the brain. Iron is also needed for the synthesis of collagen, and so for the continuous regeneration of bones, cartilage and connective tissue. But most of the iron in our body is used to make our blood or, more precisely, to make the red blood cells and the blood pigment hemoglobin. A red blood cell lives for about 120 days, which means that new hemoglobin has to be produced constantly. Iron is also needed to transport oxygen in our muscles, specifically for the production of the transport protein myoglobin. If we lack iron, this task cannot be fulfilled and the transport of oxygen through our body suffers. Our cells, muscles and organs do not get enough oxygen from the lungs, and our whole body is, to some extent, “not firing on all cylinders.”

Symptoms of iron deficiency: what happens when we do not have enough iron?

If you do not get enough iron, you often feel tired and listless without any clear external reason. Even though you’ve had enough sleep and haven't had a cold for a while, you feel weak and unable to concentrate. Climbing stairs and other types of physical exertion quickly lead to shortness of breath and palpitation. You are more sensitive to cold and more likely to shiver. If you recognize these symptoms of low iron intake, you should consider seeing your physician for a blood test. If you do have iron deficiency, the resulting anemia can also cause visible symptoms - your skin is pale and dry, your fingernails are brittle, and you experience hair loss. But since severe iron deficiency can easily be prevented by a carefully chosen, balanced diet, things fortunately rarely get this bad in healthy people.

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High iron requirement: women are the largest at-risk group for iron deficiency

Most women are at risk of iron deficiency - they need one and a half times as much iron as men in order to ensure that they have adequate iron levels. One obvious reason for this is normal monthly blood loss during menstruation. A less obvious reason is that women are more likely to eat salad than steak and therefore consume less iron. On average, a woman loses between 5 and 80 ml of blood while menstruating, and this has to be made up in her bone marrow and spleen. So women lose between 2.5 and 40 mg of iron during a normal menstrual period. However, this is not a problem for most women who eat a normal, balanced diet; and, with a little care, even a strict vegetarian will also be able to get enough iron. But women who have very heavy or prolonged menstrual periods are at risk of iron deficiency because their iron intake is often low, which can lead to iron deficiency. They need much more iron to make up the higher blood loss of up to 200 ml per menstrual period. If you are very active, your iron need is even greater, as more iron than usual is secreted in sweat and urine, while higher levels of energy production and oxygen transport use up more iron. But it is mainly women who are pregnant or breastfeeding who need much more iron for the infant they are supplying from their own body. It is true that pregnant women don’t have the monthly blood loss associated with menstrual periods, but the additional iron requirement needed to supply the fetus, form the placenta and produce the additional blood needed comes to about 800 mg per pregnancy. So pregnant women should consume twice as much iron every day as women who are not pregnant.

This is how much iron women need on average

The German Dietary Association calculates and publishes recommendations for the daily intake of iron. Until the age of puberty and the first menstrual period, boys and girls have the same iron requirement, which increases with age to up to 12 mg a day. As soon as growth has been completed, men only need 10 mg of iron a day to cover their normal iron requirement. Menstruation means that girls and women need more iron than men: on average, 15 mg per day. After menopause, women’s iron requirement drops back to the same level as that of men. These figures apply to healthy people. If a physician detects iron deficiency, he or she may recommend a drug to supply more iron to treat this.

Women should pay particular attention to their iron intake if their iron need is higher

Men and women can cover their normal iron requirement by a carefully-chosen, healthy, balanced diet. But things are more difficult when the iron need is higher, and for women with heavy or more frequent menstrual periods. Here, a normal diet is often insufficient, especially for people who already have a mild, undetected low iron intake. This is why gynecologists often recommend supplements to be on the safe side. Pregnant women in particular need more iron to supply the fetus - they are advised to consume double the normal amount of iron, or 30 mg a day. Breastfeeding women need slightly less iron than pregnant women, with the recommended daily intake being 20 mg a day. Please bear in mind that this increased figure also applies if you are not breastfeeding - you need the extra iron in the initial period after childbirth to make up for the blood lost during childbirth, among other things. A balanced iron level just after giving birth also helps prevent the “baby blues.”

You can find tips for an iron-rich diet here.

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