Endometriosis and Anemia
Last updated: April 2023
Many of us with endometriosis are familiar with the bone-crushing fatigue that usually arrives with our periods (or in some cases, just before it during PMS) every month. But, if that fatigue also persists throughout much of the month, and you also find yourself feeling dizzy and lightheaded often, you may want to check in with your doctor, as you could have anemia.
What is anemia?
There are several types of anemia, but the most common is iron-deficient anemia, which, at its name suggests, is due to a deficiency of iron in the blood and in the body. Iron is a vitamin that is responsible for replenishing red blood cells and offers energy to its consumer, so a lack of it can be an indicator that your iron levels are running low.
The connection to endometriosis
And as it turns out, women with endometriosis are at higher risk of developing iron-deficient anemia than the general population. Why is this? Well, many women who have endometriosis tend to suffer from "menorrhagia"- which is basically a fancy term that means "heavy menstrual bleeding". And if you're bleeding too heavily or too frequently, that blood loss can adversely impact iron levels- as you're literally bleeding out your iron supply.
As noted by the Mayo Clinic on their webpage as one of the foremost complications of menorrhagia, anemia is described as resulting from the "body [attempting] to make up for... lost red blood cells by using your iron stores to make more hemoglobin, which can then carry oxygen on red blood cells... Although diet plays a role... the problem is complicated by heavy menstrual periods".1
Of course, endometriosis is not the only condition that can cause menorrhagia. Uterine polyps or fibroids, polycystic ovary syndrome (PCOS), or adenomyosis (which is when the endometrial cells actually invade the muscular walls of the uterus- also sometimes called "endo of the uterus"), can also be responsible for causing heavy menstrual bleeding. However, many of these conditions tend to be co-morbid with endo.
I have had uterine polyps in the past, and currently have diagnoses of both fibroids and adenomyosis. Additionally, one need not have any underlying condition or diagnosis and can still suffer from menorrhagia. Or, they may not bleed particularly heavily, but may have very long cycles and bleed for many days or weeks at a time or have a lot of breakthrough bleeding, which can also contribute to anemia. Nonetheless, those with definitive diagnoses of endo and co-morbid reproductive disorders are more likely to suffer from heavy or prolonged bleeding, and therefore usually more likely to develop iron-deficient anemia.
I have had anemia on and off since I was 11 years-old and I have no doubt that my endo and companion heavy bleeding have played a large role in that. As such, I try to get my iron levels checked several times a year to ensure I am not deficient. Though I try to take an iron supplement regularly, I sometimes slack off and when I do, it usually catches to me.
What the research shows
Additionally, a peer-review study from 2009 found that "Several important endometriosis-specific genes overlap with those known to be regulated by iron" and that "Iron has a significant impact on endometriotic-cell gene expression".2 This indicates that having healthy levels of iron in one's blood may actually have a mitigating role in endometriosis as well (though it seems more studies need to be done to confirm this).
In the meantime, if you experience heavy or prolonged periods and also feel weak, tired, and dizzy frequently, and haven't had your iron levels checked in awhile, it may be in your best interest to make an appointment with your doctor and discuss your risk of anemia. This simple test can potentially determine an underlying cause for your exhaustion and then (if recommended by your doctor) a daily iron supplement can at the least can assuage some symptoms and improve your quality of life.
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