India has one of the highest rates of anaemia in the world. The National Family Health Survey consistently shows that nearly 50% of women of reproductive age and 52% of pregnant women are anaemic. Behind these numbers are real women — exhausted, breathless, losing hair, struggling to concentrate, told repeatedly that "it's just stress" when the real problem is a haemoglobin of 8.

Iron deficiency anaemia in women is common, predictable, and largely correctable. It is also frequently undertreated — not because iron supplements don't work, but because the underlying cause (usually heavy periods) is not addressed.

Dr. Shachi Singh, consultant gynaecologist at Prakash Hospital, Sector 33, Noida, explains.

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Why Women Are Particularly Vulnerable to Iron Deficiency

The female life involves repeated, significant iron losses that male physiology does not:

Menstruation: Each period involves blood loss — and blood contains iron (haemoglobin is iron-containing). The average blood loss per period is 30 to 40 mL. Women with heavy periods can lose 80, 100, or 200+ mL per cycle. Over months and years, this cumulative loss exceeds dietary intake for many women — particularly in a vegetarian diet where iron absorption is less efficient.

Pregnancy: Pregnancy requires an additional 700 to 1,000 mg of iron over nine months — for the expanding maternal red cell mass and for fetal iron stores. This demand, combined with the preceding years of menstrual losses, makes iron deficiency in pregnancy extremely common.

Childbirth: Even a normal delivery involves blood loss (300 to 500 mL). A complicated delivery or postpartum haemorrhage significantly depletes iron stores further.

Diet: The typical Indian diet — particularly vegetarian — is high in non-haem iron (from plant sources: dal, palak, rajma, methi). Non-haem iron is absorbed at only 2 to 10% efficiency, compared to 15 to 35% for haem iron (from meat and fish). Phytates in wheat (chapati) and tannins in chai further inhibit non-haem iron absorption when consumed together.

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Symptoms of Iron Deficiency

Early iron deficiency (before frank anaemia develops):

• Fatigue that seems disproportionate to activity level
• Reduced exercise tolerance — getting breathless on exertion that previously was easy
• Difficulty concentrating, cognitive fog
• Hair thinning and increased shedding (iron is essential for hair follicle function)
• Restless legs — an uncomfortable urge to move the legs, particularly at night
• Brittle nails, nail ridging
• Cold hands and feet
• Pica — craving for non-food substances (ice, chalk, mud — a recognised symptom of iron deficiency, culturally common but often dismissed)

Frank anaemia (low haemoglobin):

• All of the above, intensified
• Pallor — pale inner eyelids, pale palms, pale tongue
• Palpitations
• Breathlessness at rest or with minimal exertion
• Headaches
• Dizziness on standing (postural hypotension)

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Diagnosis

Full blood count (FBC/CBC): Haemoglobin level — below 12 g/dL in non-pregnant women, below 11 g/dL in pregnant women defines anaemia. Mean corpuscular volume (MCV) — low MCV (microcytic) in iron deficiency.

Serum ferritin: The most sensitive marker of iron stores. Ferritin below 30 ng/mL indicates depleted iron stores — even before haemoglobin falls. Ferritin below 12 ng/mL confirms deficiency. Important: ferritin is an acute-phase reactant — it is falsely elevated by infection or inflammation. A normal ferritin does not completely exclude iron deficiency in the context of active inflammation.

Serum iron, TIBC, transferrin saturation: Used to characterise the anaemia when the diagnosis is uncertain.

When to investigate further: Iron deficiency anaemia in an adult woman who is not pregnant and has apparently normal periods warrants investigation of the underlying cause — heavy periods are most common, but coeliac disease (malabsorption), inflammatory bowel disease, and gastrointestinal blood loss (from H. pylori gastritis, ulcers, or rarely colorectal lesions) should be considered, particularly if iron deficiency is severe or resistant to treatment.

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Treatment

Address the cause: If heavy periods are driving the iron deficiency — treating the underlying cause (fibroid, adenomyosis, PCOS, ovulatory dysfunction) is as important as supplementing iron. Without addressing the cause, iron supplementation will be a recurring cycle.

Oral iron supplementation:

• Ferrous sulphate 200 mg (containing 65 mg elemental iron) twice or three times daily on an empty stomach — gives maximum absorption
• Ferrous fumarate or ferrous gluconate — alternatives with slightly less elemental iron but sometimes better tolerated
• Side effects: constipation, dark stools, nausea — very common. Taking with food reduces side effects but also reduces absorption.
• Duration: 3 months minimum after haemoglobin normalises, to replenish stores (not just correct haemoglobin)
• Vitamin C taken simultaneously (amla, lemon juice, or a Vitamin C tablet) significantly improves non-haem iron absorption. Avoid taking with tea, coffee, or calcium-rich foods — these inhibit absorption.

Intravenous iron: For women with severe anaemia, poor oral tolerance, malabsorption, or pregnancy where rapid correction is needed. IV iron infusion (ferric carboxymaltose is the most commonly used in India) corrects iron stores rapidly and reliably. Given as a one-time or two-time infusion — very effective.

Dietary improvement: Dark green leafy vegetables (palak, methi, amaranth/chaulai), legumes (rajma, chana, moong dal), sesame seeds, dried fruits, jaggery (iron content is real, though variable). Cooking in iron vessels — traditional kadais — genuinely increases iron content of cooked food.

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Iron in Pregnancy

Routine iron supplementation is recommended for all pregnant women in India regardless of baseline levels — because diet alone is almost never sufficient to meet pregnancy's iron demands. The standard is:

• 60 mg elemental iron + 400 mcg folic acid daily from the first trimester
• Women with pre-existing anaemia need higher doses and careful monitoring

Haemoglobin should be checked at booking, again at 28 weeks, and at 36 weeks in pregnancy. Anaemia in the third trimester significantly increases the risk of postpartum haemorrhage and the consequences of intraoperative or postdelivery bleeding.

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Gynaecological Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, assesses and manages iron deficiency anaemia in women — including identifying and treating the underlying gynaecological cause — for women across Noida and Greater Noida.

To book a consultation, call: +91 97023 46853

Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM

Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, UP 201301

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This blog is for educational purposes only. Please consult Dr. Shachi Singh for assessment and treatment specific to your situation.