Low iron and fatigue
July 17, 2017 12:58 PM   Subscribe

I was diagnosed with mild anemia and a pretty severe iron deficiency at the beginning of June. It's been seven weeks on supplements and I'm still exhausted. I'm seeing my PCP tomorrow. Help me know what to say to her/what to ask in order to feel better.

previous question, for reference.

So basically, I went on nexplanon in January, and I had a period from the beginning of February to the middle of June. My numbers at the time were hemoglobin 10.8, iron 43, ferritin of 3, saturation 10%. I was so weak I felt like I was gonna pass out all the time. I really felt horrible, like scary horrible. Went on supplements and symptoms started improving.

Two weeks ago I got my period again, early. It was short but heavy. Like, I bled through a panty liner in thirty seconds (I had it on while I was getting my diva cup ready--which, for what it's worth, kept leaking from the bleeding, and it NEVER leaks for me). It was heavy for two days. The period started two weeks ago today. Guys, I am so so tired, still. I get to mid day and I just crash. I mainly experience it as a heaviness/pressure behind my eyes. I'm just fucking exhausted. Other symptoms:

My ears are ringing (they get louder as I feel worse)
I am lightheaded (very lightheaded at times)
Some shortness of breath
Brain fog
Occasional gum bleeding (very occasional)
Heart palpitations
Anxiety
Occasional headaches
And I am just... So tired.

I have had:
Most recently, a stress test, which was normal
A blood test for all my electrolytes (normal)
A thyroid test (normal... Like really normal)
Vitamin D tested (normal)
B12 (a little low... I'm taking supplements)
Mono test (negative)

The lab accidentally rechecked my iron levels two weeks after I had them checked originally (so about a month ago). They were: hemoglobin 11.6, iron 37, ferritin 13, saturation 9%.

I feel like I should be feeling better by now. I'm also having some pretty bad abdominal pain and digestive issues. I mostly haven't been constipated but my stool has been soft. The pain was so bad the other night it woke me up. It's been better since then but I still kind of feel it.

Guys... I'm at a loss. I'm so tired of feeling this way and being sick all the time. I'm starting grad school in the fall and I'm really, really worried I won't be feeling better by then. I was seeing the PA and she told me I could be feeling crappy because my heart was racing but that isn't from the low iron.

I'm seeing my doctor tomorrow. Is there something I should ask/say? I feel like it must be the iron but I really don't know.
posted by Amy93 to Health & Fitness (25 answers total) 4 users marked this as a favorite
 
Maybe you could ask your doctor if you are a candidate for an iron infusion.
posted by hungrytiger at 1:01 PM on July 17 [3 favorites]


At some point you may want to request a consultation with a hematologist.
posted by Pantalaimon at 1:19 PM on July 17


Oh I'm so sorry! I know EXACTLY how you're feeling. My numbers are lower than yours right now and it's absolutely miserable. How much iron are you taking? I'm in the midst of an anemia nightmare. I have literally felt like I'm dying for much of the last month. I'm not able to do anything. I am taking 1000mg iron/day (the average supplement is about 16 mg.) I will be undergoing an endometrial ablation on Friday. Several drs have now insisted that there is nothing else to be done except stop the flood, rest, eat well, and wait for the massive iron doses to catch my ferretin and blood levels back up. To answer your question, yes, ask about an infusion (my drs wouldn't do it, but maybe you're lucky!) and up your dose if you can. Good luck! I'll be watching this thread too.
posted by Cloudberry Sky at 1:21 PM on July 17


While my symptoms have never been as bad as you describe, I do find that my body better absorbs some types of iron than others. Specifically, my body does better with bisglycinate iron than ferrous sulfate at similar doses.

However, I believe there is not a scientific consensus on the difference between bisgylcinate iron and other types; see, for example: http://ajcn.nutrition.org/content/72/6/1592.full vs. https://www.ncbi.nlm.nih.gov/pubmed/24152889

So, maybe try bisglycinate iron as a stop-gap while you wait for more significant medical intervention ...?
posted by monkeymonkey at 1:34 PM on July 17


Have you been checked for fibroids?
posted by CoffeeHikeNapWine at 1:39 PM on July 17 [2 favorites]


Iron IV drip. I was low for a decade, couldn't absorb ferritin through food or supplements -- after a summer of infusions I felt like a million bucks and can now maintain healthy levels on my own.
posted by fritillary at 1:50 PM on July 17 [3 favorites]


Do they know what is causing your anemia and iron deficiency? I had heavy periods in high school all the time (it never stopped, so it was more like a "period" -- singular) and I felt tired all the time. I eventually went on birth control to regulate and lessen my periods, which fixed it. I also only recently realized that my period causes migraines and malaise, which I never managed to connect the dots on before. Now I suppress my period entirely by skipping blank birth control pills.

If your ferritin rose that much in two weeks, then that's good because it means your supplements are working, but 13 is still rather low. I'm a vegetarian and I've had trouble raising my ferritin to the normal level, even with supplements.
posted by AppleTurnover at 1:52 PM on July 17


IANYhematologist but I would say that you need an evaluation by a hematologist for an iron infusion, and an appointment with an OBGYN for heavy menses. Iron deficiency will continue to be a problem for as long as you have heavy bleeding. It takes a long time to replace iron orally and lots of patients just don't tolerate it for other reasons (constipation among reasons).
posted by honeybee413 at 1:53 PM on July 17


I would ask for infusions.

In addition to investigating why you're having heavy periods, see if they'll also run a blood panel for celiac disease. Perhaps there's a digestive reason you aren't absorbing iron enough.
posted by purple_bird at 1:55 PM on July 17


Another vote for seeing a hematologist. I had severe anemia not long ago too, with much lower numbers (my hemoglobin was less than 7 at one point!) -- I saw a hematologist and ended up getting several IV iron infusions and started on oral supplements. Not sure if your numbers are low enough, but it's worth asking.
posted by odin53 at 1:58 PM on July 17


You need to find out why you're anemic instead of just throwing iron at the problem. So yes, if you're in the US, ask for a referral to a hematologist.
posted by FencingGal at 2:15 PM on July 17


Yo, it also takes FOREVVVVVVVER to feel better with this stuff. Have them test you for pernicious anemia -- that'll give you low B12 and you need B12 INJECTIONS to resolve it, NOT just pills, because your body can't absorb the B12 normally. So your supplementation possibly isn't doing anything. Guess what the symptoms are?

shortness of breath
Brain fog
Occasional gum bleeding
Heart palpitations
Anxiety
headaches

Like, ALL OF THEM. I know because I have it. (Weirdly, my iron levels are decent.) It'll take a few months to pep up but I would bet money this is part of your issue. The pills probably aren't making enough of a dent to feel better.
posted by Countess Sandwich at 2:35 PM on July 17


I Am Also Not Your Doctor, and have had low ferritin for years until recently. I am a male, but that somehow hasn't stopped me from having low ferritin. They presume it's related to my thyroiditis and IBS. (And yes, I've been examined all over, multiple times, by cameras, scopes, and hematologists).

I agree with the others that seeing a hematologist can't hurt, just to rule out anything else besides "yes, you have very low iron."

So assuming that you're back at simply "how the heck do I boost iron" - yes, there are infusions. Despite me getting down to ferritin of 6 at one point, nobody ever suggested I do them, but they clearly work great for a lot of people.

I tried most of the supplements available, with little success. After much much research, I discovered that I had macrocytic anemia, which is supposed to mean that I don't absorb b vitamins well -in my case, however, NOT b12, which I absorb easily, part of which was info I learned via this pretty thorough article I read by Chris Kresser on anemia , whose health blog stuff I generally like.

At the link, scroll down until you get to 'everything you need to know about anemia". He digresses a little bit in the middle, but is otherwise very informative.

If you are vegan: supplement wise, these did something for me compared to the competition, with no side effects, but not enough

- Floravital - which is a liquid supplement that tastes like fruity metal (because that's what it is), but it is kind of expensive and must be refrigerated after opening. I had to drink a non-trivial amount.
- Purabsorb - which is just iron-rich water in packets; also not cheap.


If you are *not* vegan / also, my personal solution has been

1. a good b-complex with folate
* 2. eating more iron-rich meats, fish, liver. A lot more than I was used to, unfortunately.
3. lactoferrin, an OTC dairy-based supplement, which is a glycoprotein that has been shown in some clinical trials to bind free iron well and is as effective as ferrous sulfate, without the digestive side effects that people often get from iron supplements. Comes in capsules. Here's one of the studies. I am a person who otherwise eats zero dairy, and I was able to tolerate it.

There are also iron supplements that contain heme-iron from meat, which are better absorbed than non-heme/vegan supplements, but I figured I'd try the food-based route first.


YMMV. Good luck friend.
posted by bitterkitten at 2:51 PM on July 17


Couple things--Countless Sandwich (lmao nice name btw) my B12 was actually in the normal range but low normal. I always thought you had to be REALLY low to have pernicious anemia. Do you know if that's true?

Also--I'm a vegetarian, was bleeding for months, and was talking Dexilant, which I know can hinder the absorption of nutrients, including iron. I've been assuming this is why I'm anemic and now it's just a matter of fixing it. Not taking Dexilant anymore, btw.
posted by Amy93 at 4:04 PM on July 17


I've had ferritin levels in the 3-5 range for YEARS and nobody ever suggested an infusion. Finally I saw a hematologist and she was like, you need infusions urgently and if I could get you in today I would. What a GP apparently won't know is once your ferritin levels drop below a certain level (20? I think?) then it's just about impossible to get them all the way back up with oral supplementation alone. See a hematologist!
posted by HotToddy at 4:07 PM on July 17


Just nthing when I had numbers like yours my doctor (who specializes in women's health) gave me one month to try supplements to get my numbers up or she was going to send me for a transfusion. I managed, but like a lot of the above the pills don't work so well for me - the liquid iron (Floradix) works much better - the first few days I felt like I was on speed (or, um, what I imagine that to feel like...). It was kinda scary. I was also avoiding dairy, eating lots of meat and spinach (with citrus) etc. so YMMV. And it was still sort of borderline and she still wanted to see continuous improvement.
posted by jrobin276 at 4:30 PM on July 17


First, I want to sympathize. I, too, have a ferritin level in the single digits, and my doctors pretty much shrug their shoulders at my fatigue, light headedness, and inability to climb stairs effectively. I'm trying to figure out how to convince my doctor to do an infusion.

Second, your stomach pains could definitely be from supplements. Despite my anemia, I actually don't take any supplements because they all destroy my stomach. Granted, I have unrelated GI stuff going out that makes me more sensitive, but even the iron-containing Flinstones vitamins make me feel like my intestines are dying a slow and painful death. Note that iron doesn't cause constipation for me... just green diarrhea and HORRIBLE pain. I've tried every pill and liquid there is and they all hurt me.

SO - I would emphasize that to your doctor and ask if there is any way around oral supplementation because you aren't tolerating it. This may lead them to suggest IV supplementation.
posted by raspberrE at 4:30 PM on July 17


Iron takes a while to improve. I've been taking Nature Made 65mg (Target) daily and over the course of 3 months, my ferritin levels went up 19 points--which is a decent improvement.

So I see that your ferritin went from 3 to 13, which is an indication that your regimen is working. But 13 is still extremely low. If you're still bleeding heavily, then you are no doubt still clinically anemic even though your levels will likely have improved from 13 by now. I would recommend asking to have your levels checked again, just to give you an idea of how quickly your levels are improving.

Perma-period is a symptom of anemia, infuriatingly, and of course continuing to bleed reduces ferritin stores, so it's like being on a hamster wheel of iron in, iron out.

Stomach upset is a side effect of taking iron. I personally take it at night, with a glass of OJ to both help absorption and to mitigate side effects. (I'm about to take it now, in fact.) If you are not currently taking iron in the evening and/or with Vitamin C/food, you might consider doing that to see if it helps with your stomach issues.

I personally started feeling a significant improvement in shortness of breath and fatigue once my ferritin levels hit about 60. It was quite noticeable.

So, action items:

1. Get levels tested so you can see where your iron levels are at, and get an idea at the rate at which they are increasing
2. Keep taking iron
3. Ask for ideas on how to mitigate bleeding so that you're not lowering your iron stores while trying to build them. I am not suggesting this because I take hormonal birth control lightly, but a few months of consistent BC pills where you don't take the placebos might help? So you basically trick your body into not bleeding for a few months? You know better than I do about how well your body might tolerate this, but it's a thought.
posted by Autumnheart at 4:33 PM on July 17


Oh, another suggestion is that the brand "Blood Builder" by Megafood has gotten a lot of good reviews for effectively raising iron, especially (anecdotally reported by reviewers) people who had a hard time with other supplements.
posted by Autumnheart at 4:34 PM on July 17


Let me correct what I said about BCPs to say instead that if the Nexplanon might be contributing to this, maybe it should come out. I know that sucks, but it might be a solution.
posted by Autumnheart at 4:39 PM on July 17


Nthin iv iron infusion, which for me was a long term solution to a long term problem.
posted by bq at 4:39 PM on July 17


Yet again nthing an iron transfusion. It changed my life and I felt better almost immediately!
posted by fairlynearlyready at 5:06 PM on July 17


If you don't want to try a heme-based iron supplement, maybe try a polysaccharide-iron complex like FeraMax?
posted by blerghamot at 6:50 PM on July 17


Couple things--Countless Sandwich (lmao nice name btw) my B12 was actually in the normal range but low normal. I always thought you had to be REALLY low to have pernicious anemia. Do you know if that's true?

Mine was 212, which is (very) low normal and I have it and I felt LIKE SHIT. So it's definitely possible. FOR SURE bring this up to your doc.

the brand "Blood Builder" by Megafood has gotten a lot of good reviews for effectively raising iron, especially (anecdotally reported by reviewers) people who had a hard time with other supplements.

Anedoctally, this has been good for me!
posted by Countess Sandwich at 7:37 PM on July 17


I was given B12 injections for low normal range B12 levels because it appears the precision of measuring B12 levels is in fact not precise at all so actual levels can be quite a lot under what came back from the lab. The effect of the injections (for unrelated health concern) was pretty much immediate.
posted by koahiatamadl at 9:52 PM on July 17


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