Medically reviewed by Dr. Rashmi Kudesia

Weakness, headaches, even feeling out of breath. These symptoms are common, but they may point to a larger problem: iron deficiency anemia (IDA). Although IDA is sometimes linked to insufficient iron intake or poor nutrient absorption, it is most often caused by blood loss, including from heavy menstrual periods.

If you’re one of the millions of women who experience a heavy flow, known as heavy uterine bleeding (HUB), you’re no doubt aware of the cramp it can put in your style. Perhaps you consider it a messy inconvenience — something you just need to get through every month. Seeing a health care provider, however, will help you get to the bottom of whether your heavy periods and nonspecific symptoms are signs that you may have IDA.

What is IDA?

Having IDA means there’s a shortage of iron in your body. Iron is essential, because it helps make a substance called hemoglobin, which helps red blood cells carry oxygen throughout the body.

Dr. Cindy Duke, a board-certified gynecologist, obstetrician and reproductive endocrinologist at the Nevada Fertility Institute, said that if your blood cells don’t have enough oxygen, you may feel tired and short of breath or like your heart is racing. She added that this is because “your heart is working harder, trying to pump blood more quickly to get oxygen to your cells.”

In addition to these warning bells, weakness, brittle nails, headaches, dizziness, lightheadedness and pale skin are symptoms of IDA. But because IDA may also be asymptomatic, some women may not experience any symptoms.

Diagnosis and treatment of IDA

A heath care provider can give you a simple blood test to determine whether or not you have IDA. “We check to see the total iron level in the blood and the ability of the blood to carry iron,” said Duke. “It’s a straightforward test and it’s inexpensive, even without insurance.”

Treatment of IDA is also fairly straightforward. “If it’s severe, sometimes we do sessions of intravenous iron infusions, usually over the course of four to six weeks,” said Dr. Duke. “If it’s moderate to mild iron deficiency, I start patients on an oral version of iron.”

You might need to supplement with iron regularly, especially to compensate for blood lost due to HUB. While HUB is common—nearly 25 percent of women have HUB—many don’t know that experiencing it for six months or more may lead to IDA. “Some women have to stay on iron, especially if they don’t get enough in their diet. Women who are vegan, for example, tend to have low dietary iron intake so may need long-term iron supplementation,” explained Duke.

How do you know if you have HUB?

There’s bleeding, and then there’s bleeding that seems more like a rushing river. In fact, HUB is defined by heavy bleeding or bleeding that lasts more than seven days. Other symptoms of HUB to watch for include needing to change your pad or tampon overnight and passing blood clots that are quarter-sized or larger.

Duke said a good way to gauge your bleeding is to look at how quickly you go through menstrual products: “If you use pads and need to change your pad more than every couple hours, that’s too heavy.” She added, “I spend a lot of time explaining this to patients because, growing up, nobody really tells you what qualifies as heavy, light or normal bleeding.”

About one out of four American women has been diagnosed with HUB, making it a common condition. Yet many women with HUB don’t consider it a problem worth mentioning to their health care providers. “I would say about 40 percent of women with heavy uterine bleeding are acutely aware of it and come in complaining of heavy bleeding,” says Duke. “More often, though, it comes out as we go through a patient’s medical history.”

What happens if HUB goes undiagnosed?

While some women may view HUB as nothing more than an inconvenience, it’s still important to bring up your symptoms with a health care provider. Sometimes HUB is caused by hormone imbalance or growths in the uterus such as fibroids, which might require treatment.

“Fibroids are very common. Between 50 percent and 70 percent of women have them. And of that group of women with fibroids, up to a third may have a type of fibroid called a submucosal fibroid that causes heavy bleeding,” said Duke.

The importance of speaking up

HUB and IDA may be serious if they go untreated. While they may not be the kind of things you chat about with your girlfriends over brunch, there is one place where you shouldn’t hesitate to discuss it — your health care provider’s office.

Duke said some women learn that their heavy periods caused their severe IDA only after they’ve been hospitalized. One woman, she said, simply didn’t realize that her bleeding was abnormal. “She thought it was just the ways things were for her,” said the doctor.

Duke added that health care providers may ask questions about your period that seem intrusive, but your answers will help determine if you’re having symptoms that need to be addressed. “We have some objective ways of looking — blood pressure, heart rate, things like that. But the rest of it is just good old-fashioned medicine, which means sitting down and talking with you and having you share with us what’s going on so we can figure out what to do next.”

You can learn more about HUB and IDA by visiting imayhaveida.com.