So, if you’re reading this you probably already know a little bit about Endometriosis. One of those facts is that the Endometriosis implants/lesions shed (or bleed) inside the pelvic cavity (or wherever else the Endo is located). Another fact is that women with Endometriosis tend to have much longer and heavier periods than women who do not suffer from Endo. Recently at our support group meeting, the question of iron levels and anemia came up. With all that bleeding, can we suffer from anemia or an iron deficiency?
And, again, the topic of iron levels and Endo came up at our Endometriosis Awareness & Support Walk : could the blood left in my pelvic region from shedding Endo have caused the “abnormally high” iron levels during a blood test?
Just what does Endometriosis and iron do to our bodies? Anemia? An iron deficiency? High levels of iron? What does iron do? Why do we need it? All of these questions have been swimming around in my head and its’ time to get them out…and you know what that means : RESEARCH!
I don’t know about you, but every time I swallow a multivitamin with iron in it, I’m throwing up within five minutes. When I spoke with my primary care physician a few years ago about iron making me throw up, he asked me why I was taking it. My response was simply, “Because I thought I had to…” He clucked his tongue, shook his head, and told me he generally only advised pregnant women to take iron. So, I steer clear of iron supplements or vitamins that contain any iron.
Anyway, on with the research!
How do you know if you have an iron deficiency? Symptoms may include shortness of breath while exerting, fatigue, weakness, dizziness, an urge to eat ice, headaches, depression, temperature sensitivity, a sore tongue, restless leg syndrome, an increase of infections, poor muscle coordination, and a decreased mental function.
Many women who are anemic suffer from an iron deficiency (without iron, enough red blood cells cannot be created/maintained and less oxygen is delivered throughout the body). This deficiency may be due to blood loss, a lack of red meat in a diet, their bodies may have trouble absorbing iron, they may not take enough vitamins, GI issues, or some diseases such as fibroids or cancer.
According to the Iron Disorders Institute, blood loss may be due to heavy menstruation, Endometriosis, and fibroids, which may lead to anemia. An average healthy woman’s body increases iron absorption during her period to make up for the loss of blood during her cycle. With Endo, we tend to have lengthy or heavy periods and the iron regulatory systems in our bodies may not be able to properly regulate the amount of blood (and iron) we are losing, leading to anemia. With that being said; however, a 2006 study claims to debunk the theory that heavy periods lead to anemia.
You can also not get enough iron into your body through diet and supplements, which can lead to anemia. The Center for Disease Control estimates that only one-fourth of women between 12-49 years old meet the daily recommendation of iron intake. Red meat is supposedly the best food-source for iron, which, for many following the Endo diet, is out of the question. If you must eat red meat, try to get the organic, grass-fed beef. Also, eggs, beans, fish, nuts, dried fruits, whole grains, and dark leafy vegetables are rich in iron. A word of warning, calcium may inhibit the absorption of iron. A healthy digestive system and nutrient-rich diet is critical to ensure good iron absorption.
Looking to restore your iron levels if you’re anemic? Adjust your diet or talk to your physician about iron supplements (taking it orally, injecting it, or infusions) or, in extreme cases, a blood transfusion may be necessary.
Too Much Iron:
Too much iron may be indicated by chronic fatigue, joint pain, abdominal pain, skin color changes, the loss of your period, loss of libido, and even hair loss.
Women who no longer have their periods are at risk for having too much iron in their systems. (This is interesting to me since I’m on the pill and haven’t bled since Sept. 25, 2014). Other causes of heightened levels of iron could include hereditary factors, genetic mutations in the cells, autoimmune diseases, or an iron overload due to blood transfusions, excessive alcohol, or too much iron supplementation in the diet.
Some of the risks of having too much iron include premature heart attack (especially of interest given recent studies that women with Endo are at a higher risk of heart disease), diabetes, liver disease, osteoarthritis, and hormonal imbalances.
How Can I Know My Iron Levels?
You an ask your physician to order a blood panel. Give up a vial or two of blood, lab work is done, and *presto* you have a magical piece of paper that only medical professionals can understand. You may prod your doctor asking to check your ferritin, transferrin, iron, TIBC (total iron-binding capacity), CBC (complete blood count), and reticulocyte count. You may even want him/her to order a check on your thyroid levels, as these may come into play.
Or you can contact and pay Health e-Iron to test you with their FeGGT LifePro test. (I don’t know or endorse these guys…just found them through the Iron Disorders Institute webpage).
Iron & Endometriosis
A study published in 2002 found that the iron concentrations in the peritoneal fluid of the pelvic cavity of women with Endometriosis was higher than women without, and that those high concentrations remained throughout each stage of the disease. It also found that the higher iron concentrations were found alongside the lesions, suggesting a link between the two. The study surmised that “…cellular defenses might be overwhelmed owing to repeated bleeding of lesions…” and further research was needed.
A study in 2006 proved that iron deposits and iron overload are found within the pelvic cavity where Endometriosis is present and may contribute to the growth and spread of the disease. Lab rats who were treated with an “iron chelator” known as Desferoxamine (aka DFO) had less iron deposits, less cell growth, and less iron concentrations! An iron chelator is a drug which removes excess iron from the body. The study concluded that iron may contribute to the growth of the disease and the use of an iron chelator may be beneficial to help control iron levels in women with Endometriosis. A 2009 study confirmed the findings that iron chelators may prove beneficial in reducing iron overload and controlling inflammation.
In 2008 several scientists from the 2006 study published another. This time it was to review and discuss the potential consequences of iron overload in women with Endometriosis. Again, they conclude that treatment using an iron chelator with Endometriosis patients should be considered to help lessen the effects of iron overload. Table 1 of the 2008 study identifies 21 prior studies which demonstrate iron overload in women with Endometriosis. The study suggests that women with Endometriosis are unable to stabilize the amounts of iron in their bodies as easily as women who do not suffer from Endo. These excess iron levels may contribute to the development of Endometriosis, add to inflammation, or even aggravate symptoms.
I found it interesting reading different articles, blogs, and studies today. In one corner, you have the “eat iron-rich foods and take supplements to make up for what you lose during your period” campaign – and in the opposite corner, you have the “women with Endometriosis have an iron overload.” And throw in the 2006 study that blood loss during a period doesn’t lead to anemia. So just what to do?
I think Step One is talk to your physician. Get an iron deficiency test done. Find out what those levels are. Are they too little? Too excessive?
Possible Step Two(s):
a. Increase the amount of iron-rich foods in my diet (if iron deficient);
b. Find a good iron supplement that’s right for my body (if iron deficient);
c. Talk about iron chelators (if you have too much iron);
d. Do nothing different than what I have been doing (assuming test numbers are juuuust fine).
What are you going to do? And what are your thoughts on iron, anemia, and Endometriosis?
(Updated March 27, 2019)
American Journal of Human Biology – (2006; Article) Menstruation Does Not Cause Anemia: Endometrial Thickness Correlates Positively with Erythrocyte Count and Hemoglobin Concentration in Premenopausal Women
American Red Cross – Iron Information for All Donors
Endometriosis.org – Overload of Iron in the Pelvic Cavity May Promote Proliferation of Endometriosis Lesions’ Epithelial Cells
Fertility & Sterility – (Oct. 2002, Article) Iron Overload in the Peritoneal Cavity of Women with Pelvic Endometriosis
Human Reproduction– (July 2006, Article) Iron Overload Enhances Epithelial Cells in Endometriotic Lesions Induced in a Murine Model
Iron Disorders Institute – Iron Deficiency Anemia
Iron Disorders Institute – Iron Out-of-Balance in Women
Iron Disorders Institute – Iron Overload
Livestrong – Iron-Rich Foods for Iron-Deficiency and Anemia
Molecular Human Reproduction – (May 2008, Article) Potential Involvement of Iron in the Pathogenesis of Peritoneal Endometriosis
Scientific American – (July 2011, Article) Iron-Deficiency is Not Something You Get Just for Being a Lady
The Curriculum in Iron Metabolism & Related Disorders – Iron Chelation Basics
US National Library of Medicine – (Sept. 2006, Abstract) Menstruation Does Not Cause Anemia: Endometrial Thickness Correlates Positively with Erythrocyte Count and Hemoglobin Concentration in Premenopausal Women
US National Library of Medicine – (Dec. 2009, Article) Synthetic and Natural Iron Chelators: Therapeutic Potential and Clinical Use
US National Library of Medicine – (Jan. 2009, Abstract) The Role of Iron in the Pathogenesis of Endometriosis
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa