Women's Health special issue. Credit: Julia Yellow for The Washington Post. (Julia Yellow for The Washington Post)

Pregnant women and pre-menopausal women who still get their periods are at the highest risk of iron deficiency and iron-deficiency anemia, both of which can cause such problems as fatigue and severe neurological damage. But how concerned should women in general be?

Pretty concerned — especially given the risks of full-blown anemia. Although most of the 5,200 Americans who die of the condition annually are women age 65 and older, iron-deficiency anemia in younger women can cause pregnancy complications and serious health problems including persistent fatigue and even heart failure.

"Iron is generally fairly difficult to get rid of except by losing blood or by having babies," says Nancy Berliner, chief of hematology at Brigham and Women's Hospital and deputy editor of Blood, the medical journal of the American Society of Hematology.

Menstruation and pregnancy are the main causes of iron deficiency in women. The National Heart, Lung, and Blood Institute says that 1 in 5 women of childbearing age has iron-deficiency anemia, and about half of all pregnant women develop the condition, at least temporarily.

“Babies are excellent at siphoning iron away from their moms,” Berliner says. During pregnancy, women’s bodies create more blood not just for themselves but also for their babies, which can deplete their own iron stores. But regular menstruation and heavy periods — especially the heavier flows experienced by pre-menopausal women — also take their toll.

If it’s not corrected, iron deficiency — low stores of iron — can lead to iron-deficiency anemia, in which red blood cells don’t make enough hemoglobin, the protein that carries oxygen through the body. In addition to fatigue and neurological issues, the blood disorder can cause dizziness, a rapid heartbeat, less strength and cardiac complications.

Iron supplements can correct deficiencies and iron-deficiency anemia, but proceed with caution, doctors say. "I don't recommend people self-medicating with iron," Berliner says. The recommended daily allowance of iron is 18 milligrams for women age 19 to 50, and more for pregnant or lactating women.

While too little iron is not good, too much can lead to overload and can increase a person's risk for such problems as heart failure, liver disease, diabetes and neurodegenerative conditions. Berliner recommends that women ask their doctor for testing before pursuing supplementation.

Sometimes, eating more of such foods as lean meat, chicken, seafood, fortified cereal and bread, nuts and beans can correct a deficiency. Iron supplements can be hard to stomach — literally — because they can cause an upset stomach or constipation. In cases where women need supplementation but don't tolerate iron pills, physicians can administer intravenous iron.

Even though iron deficiency is the first stop on the road to iron-deficiency anemia, it doesn't have to progress that far. "If people are aware" of warning signs and get tested for iron deficiency, Berliner says, "they can prevent the development of severe symptoms." So if you're fatigued, weak or pale, or you are having shortness of breath or problems concentrating, among other symptoms, it's worth asking your physician whether iron deficiency may be the reason.

Learn more: hematology.org/patients/anemia/iron-deficiency.aspx.

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