Do Heavy periods cause Anemia?

Short answer

Iron Deficiency Anemia can be caused by heavy periods. Loosing blood more than 80 ml in one cycle is considered heavy periods. But anemia can also be caused by intestinal infestation with worms. And sometimes the cumulative effect of both can lead to anemia.

Let us discuss both the causes of anemia and then we see which of those are more likely cause. Generally definition of anemia (in women) is hemoglobin below 12 gms %. Whilst the vast majority of the British and other European population may have that level of Haemoglobin, I remember when I worked in public hospitals for six years as a gynaecologist in Mumbai, probably most of my patients would have hemoglobin less than 12 g%. For doctors, doing Cesareans or hysterectomies on woman of Hemoglobin 10 g% was quite common. In the UK 10g% hemoglobin would be looked upon with grave concern.

The following discussion is about the causes of anemia mainly in India.

Intestinal worms can be of a few types however for our purpose we limit the discussion to hook worms which mainly cause anemia through blood loss. The important point to note is these two factors are not exclusive. As a matter of fact their effect could be cumulative which means if you are unlucky to have heavy periods whilst having a parasitic infestation in your gut you have an even more serious problem!

How does menstrual blood loss cause anemia?

Typically woman losses 20-80 mls during menstrual period (average around 40 mls). Not all menstrual loss is blood – endometrium which is shed, is there as well. The healthy body will probably be able to replace these 80 mls of blood in absolutely no time.

I have explained elsewhere that menstrual blood does not clot. This is because the small clots have been digested by fibrinolytic enzymes and other protein digested enzymes secreted in the endometrial. When the amount of blood loss is much more than the uterus can cope with, the woman will start losing clots. In heavy periods the woman may bleed 300 to 500 mls, which the body will find increasingly difficult to make up in the time between periods. If in addition to the heavy blood we have poor dietary protein intake and poor iron and vitamin intake the hemoglobin concentration starts dropping faster.The woman rarely notices it as it happens over a long period of time. She gradually starts noticing the ill effects of anaemia such as tiredness, weakness etc

How do hook worms cause anemia?

There are two types of hook worms and both suck between 0.03 to 0.15 ml of blood from the upper intestine per worm per day. The typical infestation may have scores to hundreds of such worms so you are now losing between 5 to 10 mils of blood every day multiply that by 30 days and you have lost 150 to 300 mls every month, which is more than your heavy menstrual periods! In addition to losing iron, all the blood loss can make you loose valuable proteins as well.

Whilst we are on the topic of worms, Tape-worms and round worms affect your body by depriving it of proteins rather than directly sucking blood. Reduced nutrition, reduced protein intake and inadequate vitamins will mean that the bone marrow cannot cope well. Heavy worm infestation can also caused decreased appetite and thus reduce valuable nutrient intake.

Do remember, whether through heavy menses or hook-worm infestation, you are losing not just iron but also proteins. How soon you will show signs of anemia will depend on how well and how long can your body cope with the increased requirements of iron and proteins. So a good diet rich in iron and protein is important, especially for women.

The final score

Whilst hook worms have the potential to cause more damage, I suspect, amongst the female readers of Menstrupedia, the chance of getting hook worm infestation is quite low. This is because hookworms are not transmitted feco-orally (unlike say tape worms). You get hook-worms when your bare feet touch soil contaminated with hook-worm larvae. It is thus more relevant in the village dwelling, farm working communities. So i guess in the urban population, especially in those with office type work environment, heavy menstrual periods may cause more anemia than hook-worms.