Help for iron deficiency anemia symptoms?
April 21, 2011 10:20 AM   Subscribe

Iron deficiency anemia causing sustained exhaustion and fuzzyheadedness. How can I treat the symptoms? (Underlying cause is undiagnosable so far and only worsening.)

(Underlying cause is heavy menstrual bleeding that happens for about 35% of my days, globally -- undiagnosed after more than a year of multiple doctors and thorough ultrasounds -- and unfixable so far, even after trying continuous-dosage hormonal birth control for half a year [!].)

Forgetting the cause for the moment, I'm trying to focus on treating the symptoms of the iron deficiency anemia I'm experiencing when I'm bleeding (exhaustion and sleepiness; intermittent fuzzyheadedness and a feeling that I can't really wake up or really focus; constant physical weakness).

- I'm averaging c. 250% of both my iron RDA (via iron pills and foods) and my protein RDA (all via good foods);
- I'm averaging 8+ hours of sleep per night;
- I'm eating enough calories (averaging 1750/day, only about a 100-calorie deficit relative to my estimated baseline) and I'm taking a daily multivitamin;
- I'm only minimally exercising (simple day-to-day walking/etc. is as much as I can do before getting exhausted, which is completely atypical for me);
- I'm a lifelong vegetarian, so proteins/supplements made from bodies are out of the question, although I do eat eggs and dairy; and
- I'm in my early 30s and I'm about 40 lbs above my ideal weight ("overweight" BMI).

(- FWIW, my mom also had very heavy periods and chronic iron deficiency that was uncorrectable with supplements; and her mom had low thyroid, for which I have not been tested [I know I need to see an endocrinologist as a next diagnostic step].)

Please let me know about anything you've found that helped you with anemia OR sustained exhaustion in general. I'm not used to this and it's really affecting my life. Thank you.
posted by sparrows to Health & Fitness (17 answers total) 9 users marked this as a favorite
Your regular doctor can at least order a blood test to check your thyroid functions. You may still need to be seen by an endocrinologist, but you can get started with your GP if nothing else. If your doc comes back and says you're borderline, or quotes you a number of 3 or higher, get to the endocrinologist. I have Hashimoto's (hypothyroid) and was utterly exhausted prior to being diagnosed. My head felt like it was wrapped in a wool blanket a lot. Hypothyroidism can also impact your menstruation. So, at the very least, this is one blood test you should get done sooner rather than later.
posted by onhazier at 10:37 AM on April 21, 2011

How's your vitamin K intake? A deficiency would cause increased bleeding. Greens are an excellent source.

Untreated or undertreated hypothyroidism frequently does cause horrible menstrual bleeding. Note that some of us can be quite hypothyroid with a "normal" TSH blood test.
posted by Ery at 10:38 AM on April 21, 2011

Your previous AskMe history indicates you're in NYC, and if you still are, I highly, highly recommend Dr. Ascher-Walsh at The Fibroid Center of New York. Their practice is almost entirely dedicated to dealing with abnormal menstrual bleeding, including treating the accompanying symptoms such as iron deficiency anemia.

For the time being, I agree with the other responses about getting blood tests for thyroid function from your GP as soon as possible - untreated hypothyroidism can certainly contribute to menorrhagia as well as the exhaustion you're feeling. Try also upping your vitamin D + calcium + magnesium intake - I found that even after being treated for hypothyroidism, my general feelings of tiredness got better once I started taking a D/calcium/magnesium supplement. This is the one I use; the doctor who developed it suggests that deficiencies in D and calcium can contribute to PMS, and I have to say I've noticed an improvement there as well, though that's not why I started taking it.

Also, drink a lot of water. I feel super tired if I'm even a little bit dehydrated.
posted by bedhead at 10:54 AM on April 21, 2011

A great way to increase iron intake is to cook acidic foods in an iron skillet. I'd start making tomato sauce in cast iron ASAP. Also, for the underlying problem, look up endometrial ablation. They basically go in and sear the lining of your uterus. One of my friends had it and was super happy. It does affect fertility though so not an option unless you are done with that. There are videos on YouTube of the procedure being performed that are pretty nifty.
posted by bq at 10:54 AM on April 21, 2011

P. S. Drink oj with your iron!
posted by bq at 10:55 AM on April 21, 2011 [1 favorite]

First, I'm sorry for what you're going through. I've been there and it totally sucks to be anemic and not have energy to do the things you want to do.

Vitamin C can help iron absorption, and since you're vegetarian you're getting most of your iron from non-heme iron sources, so it looks like it would be even more important for you. One thing I did was to use a lemon juice dressing (or just squeezing a lemon) over iron-rich foods. Or you can use or create the vitamin C condiment of your choice. You may want to also consider that calcium can inhibit iron absorption and try to have high-calcium foods at a different meal so you don't combine them with high-iron foods. Does your multivitamin contain large amounts of calcium? You might want to check that.

Another thing that helped me was reconsidering my relationship to caffeine. Tannins in teas can inhibit iron absorption, and for me, drinking caffeinated beverages didn't really make me feel less tired. So I tapered off them slowly and instead focused on getting enough sleep. 8+ hours is great, especially if you can get your sleep into a regular schedule. I realize caffeine habits and preferences are individual but this is what worked for me.

These things were helpful, but I have to say what really made a huge difference for me was going to the hospital and having an IV iron infusion. I could really feel the difference and it made my sleep much more refreshing. I'd recommend asking your doctor if that's an option for you. Mine told me that my iron was so low that it would take years to catch up with diet and supplements alone.
posted by bbq_ribs at 11:00 AM on April 21, 2011

To expand on bq's post, really you don't need just acidic foods cooked in cast iron. In fact, acidic is actually not so good for the pan. That said, any foods cooked in cast iron will increase your intake of iron.

I am a nurse, but besides that when my daughter went through this type of anemia, that's the first thing her doctor told me to do. It's also recommended for treatment in a lot of medical books.
posted by magnoliasouth at 11:30 AM on April 21, 2011

I had/have both hypothyroidism (Graves disease) and iron deficiency anemia. At age 36 I had a hysterectomy which ended the menstrual cause of the anemia but didn't discover the other causes and didn't resolve the (undiagnosed) thyroid problem. I am not suggesting surgery for you, please don't think so; this is just my experience.

When I began to feel so much better after the hysterectomy, I avoided doctors and I gradually became very sick. It took the concerted efforts of my family and friends and a very dedicated (woman) primary care physician to take my symptoms seriously and get the proper specialists involved. I don't know if it is still this way or if my experience was unique but, back then and for many years, doctors seemed to dismiss my symptoms as attention seeking or some other annoying female trait. This certainly discouraged me from seeing a doctor many times when I should have. A few decades later the technology is better and a readily available blood test can determine thyroid imbalance as well as anemia and a host of other suspect causes.

As a result of the Graves disease, I now take a thyroid pill every morning, dosage determined by the findings of regular blood tests and, in my case, this dosage has been stable for several years. The anemia is a different matter. During the past few years, I had to have blood transfusions on two different occasions. I now take 750mg of iron daily (and must do so for the rest of my life) and watch carefully for symptoms of anemia--which I now understand a little better. Feeling unduly tired is one of them which I always want to attribute that to something else. It's tricky, isn't it? Not only am I feeling well but also I am enjoying my life when, without good care, I would not lived this long and certainly not as happily.

Please pursue both investigations because only the blood transfusions actually helped once I had reach the fuzzyheaded stage of anemia. You can and should be properly diagnosed and treated and you can and should be able to feel a whole lot better. I wish you strength and happiness. I hope you find a great doctor and use the wonders of modern medicine to have a joyful life. And I hope you won't wait.
posted by Anitanola at 11:34 AM on April 21, 2011

I'm not generally a big pusher of "alternative" medicine, but I had some very impressive results with Traditional Chinese Medicine when I was in a "try anything" phase with bleeding similar to yours. There was some herbal concoction that stopped the bleeding like turning off a faucet. (I eventually opted for a hysterectomy, which was even better.) If you're up for it, give some old Chinese herbalist a try.
posted by Corvid at 1:07 PM on April 21, 2011

Also, this thread may be of use.
posted by bq at 1:27 PM on April 21, 2011

2nd bbq_ribs. It may be worth your time to speak to a doctor / nutritionist about ways to combine foods in one meal for optimal iron absorbtion.

I hate to tell you this, but nothing sustains my iron better than modest meat intake (like 2 times a week). If you can somehow adjust your thoughts on morals and eating, you may want to try eating some meat and see if that ups your baseline iron levels.
posted by WeekendJen at 1:52 PM on April 21, 2011 [1 favorite]

Response by poster: Thanks to everyone for the help so far. I will definitely make sure to include thyroid levels in my next round of bloodwork -- very good point that I don't need a specialist for the first round of that kind of testing. I have been very discouraged and confused, so it's easy to forget obvious stuff like that -- thank you!

Luckily I don't drink caffeine, but I will remember about the vitamin C when I take the iron pills. I will do more googling about dosage, too, since currently I am only taking 25mg a day.

WeekendJen... I was really hoping we could get through this without somebody suggesting I eat meat. That's why I was as explicit about it as I was -- somehow I doubt you would suggest to someone else with a lifelong commitment to a practice (that, obviously, they were raised with) to adjust their "thoughts." I don't like calling it a religion, because it's not, but I think I might need to just in functional terms, if I want to convey the idea and prevent it from seeming as casual as people sometimes consider it.
posted by sparrows at 3:08 PM on April 21, 2011

Ferrous sulfate elixir was the only thing that brought my iron levels up to normal. It was almost magical. I took it constantly for months, 4x a day. I was severely anemic. The thing that really solved the problem was a hysterectomy.

I purchased the elixir at Costco pharmacy.
posted by fifilaru at 3:22 PM on April 21, 2011

Have you considered seeing a nutritionist? If you are suffering from a deficiency that is interfering with your life, it's worth it to consult a professional, too.
posted by thinkingwoman at 4:28 PM on April 21, 2011

There are lots more ideas in this previous AskMeFi.
posted by exphysicist345 at 6:17 PM on April 21, 2011

I've just been given a Mirena IUD, for the same reason (at least 4 months of light bleeding 3/4 of the days - 10 days was the longest it stopped in 5 months!). You've tried BCP but possibly a more localised application of the hormones might help. Mine got subsidised because I finally got a little bit anemic. Frankly - Yay!
(As far as I can tell, mine got set off by stress, the stress caused weightloss so I don't know if that was a factor, but it also paralleled, and I have PCOS - so I'd formerly mostly had really light periods. Both those factors settled down, so I'm feeling better. Period not quite sorted out, but way down, and it's only been a month or two))

"250% of both my iron RDA"

Wait, what? You've already got anaemia and that's all you are on? IANAD, but
"The recommended iron intake for vegetarians is 1.8 times that of nonvegetarians" -
So that's 180% baseline for you.

I got put on daily Iron tablets with I'm calculating at least 600% my daily iron because of the above. I know people with absorption problems or anaemia during pregnancy who got put on way more than that.

Frankly, 250% just isn't sounding like much, given you have anaemia, and especially if you have any kind of absorption problems.
As mentioned above, cut caffeine and tea right out of your diet for awhile, they can interfere with absorption.

Get a Dr who'll treat the anaemia (and the bleeding frankly) a bit more aggressively.

Only extra advice I have is, given iron can cause constipation, and you need Vitamin C with it, basically a Kiwifruit or two is the best thing ever to take it with.
posted by Elysum at 10:48 PM on April 21, 2011

I can't absorb Iron vitamins orally, so I had to have an IV to get it up. They have iron solutions you can get, like iron dextran and iron sucrose. That worked wonders for me, and the symptoms faded super fast. I went from being unable to manage a flight of stairs without losing my breath to being able to do more than I had in ages. I ended up using birth control to suppress my periods too, which has made a difference in the rate I lost iron, I had no idea my periods were heavy.
posted by gilsonal at 12:42 AM on April 22, 2011

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