CATES: Anemia in young women

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

Sometimes when I read studies, I think, “Well duh, did we really need a study to tell us that?” Then there are studies that I read and go, “Oh wow, that would have never occurred to me.” The ones that always seem to hit me the hardest though are the ones where I think, “we should have thought about that a long time ago.” Today, I saw a study that hit that exact note with me. It was a study that looked at iron-deficiency anemia in teenaged girls and young women.

In a study published this week in the Journal of the American Medical Association (JAMA), researchers found that almost 40% of American teenaged girls and young women have low iron levels. Since iron is crucial for building red blood cells, it should not be a surprise that low iron levels translated to low levels of blood cells, known as iron-deficiency anemia, in many of those young women. The study looked at data collected over 20 years by the National Health and Nutrition Examination Survey, part of the Centers for Disease Control and Prevention.

In that study they looked at iron levels and iron-deficiency anemia in young women from ages 12-21. They found that 40% of these girls had low iron levels, and 6% had iron-deficiency anemia as a result. Unfortunately, the current guidelines for testing for anemia in women of reproductive age don’t catch the problem quickly. The reasons are many. First, anemia testing looks at red blood cell levels, rather than specifically for ferritin, the iron carrying protein that contributes to making blood cells and helps us store iron for future use. Second, the recommendations in young women are for those of reproductive age, yet nearly a quarter of the young women in the study who were iron deficient had yet to start their periods. Lastly, routine, anemia screening is recommended every 5-10 years, so it can be easily missed in teenaged girls.

Symptoms of iron deficiency anemia can also be subtle and easily mistaken for other problems like a lack of sleep. Those symptoms include fatigue, cold extremities, hair loss, brittle nails, “brain fog”, decreased athletic performance, shortness of breath with exertion, junk food cravings, headache, lightheadedness, and sleep disorders.

Experts worry that these symptoms can lead to issues that will have life-long impacts on quality of life for these young women. For instance, “brain fog” and fatigue can contribute to poor school performance. Poor athletic performance can lead to negative feelings about exercise.

While menstruation is not the only factor for anemia in young women, it can be a major contributor, especially in those who experience heavy periods. Unfortunately, heavy periods are often something young women are not comfortable talking about with parents or health care providers. They also don’t always know what defines a heavy period, either. While there is no exact definition, if a woman is changing pads or tampons every 4-6 hours and needing additional protection at night because of leaks, that is a good indicator. There are multiple ways to treat heavy periods so they don’t lead to bigger health concerns, and your primary health care provider can help direct you towards a specialist or help you decide on the best options for you.

If you are concerned that you or a young woman in your life has or is at risk for iron-deficiency anemia, you can start by increasing iron rich foods in your diet. Leafy green vegetables, eggs, seafood such as tuna or sardines, tofu, and beans are all good sources of iron. Cooking in cast iron has also been shown to increase dietary iron intake. And, as with any health concern, speak to your primary health care provider. They can help you determine if you need to increase your iron levels and the best way to do that safely and with minimal side effects.

Finally, this study also shows why it is so important to speak frankly with your health care provider about your concerns. It’s okay to ask questions about anything you are not sure of, even if it’s not a comfortable topic. I promise, your healthcare provider would much rather listen to and intervene with concerns early even when they are uncomfortable, than deal with the consequences later when that problem is affecting your quality of life.