The Serious Health Complications Of Low Iron

Posted on February 25, 2020February 25, 2020 by Andrew Orr

In the last couple of weeks I have been talking about the serious complications of people not having their health managed properly. It seems to be a big issue and with my latest post, the issue of unmanaged, or undiagnosed low iron is also becoming a very serious issue indeed. So for this post I will be talking about the serious health complications of low iron.

Two thirds of body iron is present in circulating red blood cells known as haemoglobin. Each gram of haemoglobin contains about 4gms of iron and each ml of blood lost from the body results in a loss of about half a milligram of iron.

Bleeding is the most common cause of iron deficiency. This could be from either a diagnosed, or undiagnosed gynaecological issues (endometriosis, adenomyosis, fibroids, polyps, other) or it could be from a parasite infection. It could also be from bleeding as part of a gastrointestinal issue, or part of inflammatory bowel diseases (IBS, Crohn’s Coeliac disease).

There could be other reasons for blood loss in the body, or reduction of iron and many of these conditions, and the conditions above, can go unrecognised and then cause iron deficiency anaemia. Some of these issues can be very serious, or even fatal.

Excessive menstrual losses are often overlooked with many women. This is something that should not happen and should be part of the questioning with any low iron status. The problem is, unless the menstrual flow changes, patients typically do not seek medical attention for heavy menstrual bleeding. Sometimes when a healthcare practitioner asks, these patients generally report that their menses are normal. It may be normal to them, but we need to educate women that heavy blood loss is not normal and can lead to anaemia.

Because of the marked differences among women with regard to menstrual blood loss (10-250 mL per menses), patients meed to be asked about their menstrual history and about a specific history of bleeding, blood flow, abnormal bleeding in between cycles, clots, cramps, and the use of multiple tampons and pads. These are very important questions to ask and sadly many women are not being asked these questions, or having further questioning about their menstrual, or overall health, including dietary intake etc.

What is iron deficiency anemia?

Anaemia occurs when you have a decreased level of haemoglobin in your red blood cells (RBCs). Haemoglobin is the protein in your red blood cells that is responsible for carrying oxygen to your tissues.

Iron deficiency anaemia is the most common type of anaemia that women present with, and it occurs when your body doesn’t have enough iron. Your body needs iron to make haemoglobin. When there isn’t enough iron in your blood stream, the rest of your body can’t get the amount of oxygen it needs. Today in a recent post I talked about iron being like trucks, or the transporters of oxygen around the body.

While iron deficiency may be common, many people don’t know they have iron deficiency anemia. It’s possible to experience the symptoms for years without ever having it diagnosed, or the cause of the iron deficiency diagnosed either. It is a very serious issue that needs some serious attention.

In women of childbearing age, the most common cause of iron deficiency anemia is a loss of iron in the blood due to heavy menstruation or pregnancy. A poor diet or certain intestinal diseases that affect how the body absorbs iron can also cause iron deficiency anemia. Women who adopt a vegan diet will also be prone to being iron deficient and vitamin B12 deficient.

Disruption to the microbiome and leaky gut syndrome can also cause iron deficient anaemia too.

One of the best ways to treat the condition is through iron infusion, and also with iron supplements, or changes to diet. We also need to make sure the cause of the iron deficiency is addressed as well.

Symptoms of iron deficiency anaemia

The symptoms of iron deficiency anaemia can be mild at first, and some people may not even notice them. Many people are completely unaware that they may be low in iron, or are actually iron deficient.

The symptoms of moderate to severe iron deficiency anaemia include:

general fatigue
weakness
pale skin
Bruising easy
shortness of breath
Palpitations
dizziness
Strange cravings to eat items that aren’t food, such as dirt, ice, or clay
Tingling or crawling feeling in the legs
Tongue swelling or soreness
Cold hands and feet
Tachycardia
Brittle nails
Headaches and migraines
Sore joints
Brain fog and lack of concentration.

The serious complications of unmanaged iron deficiency.

Undiagnosed, or unmanaged iron-deficiency may cause the following severe complications:

Heart problems.If you do not have enough hemoglobin-carrying red blood cells, your heart has to work harder to move oxygen-rich blood through your body. When your heart has to work harder, this can lead to several conditions: irregular heartbeats called arrhythmias, a heart murmur, an enlarged heart, or even heart failure.
Severe anemia due to any cause may produce hypoxemia and enhance the occurrence of coronary insufficiency and myocardial ischemia.
Increased risk of infections- Research has shown that iron deficiency anaemia can affect your immune system (the body’s natural defence system), making you more susceptible to illness and infection.
Motor or cognitivedevelopment delays- This mainly occurs in children. Children deficient in iron may exhibit behavioral disturbances.
Behaviour issues and mood disorders- Behavioral disturbances may manifest as an attention deficit disorder, or mood disorder such as : Depression Unipolar depressive disorder, Bipolar disorder, Anxiety disorder, Autism spectrum disorder, Attention-deficit/hyperactivity disorder, Tic disorder, Delayed development and other some other psychiatric issues.
Pregnancy complications- Iron deficiency can lead to preterm delivery or giving birth to a baby with low birth weight.
The neurologic damage to an iron-deficient foetus results in permanent neurologic injury and typically does not resolve on its own, or by supplementation.
Chronic Health Conditions worsened- In people with chronic conditions, iron-deficiency anaemia can make their condition worse or result in treatments not working as well.
Dysphagia (Difficulty swallowing)- This may occur with foods due to abnormal muscle and nerve control. This could result in choking. It can also lead to throat cancers.
Atrophic gastritis – This occurs in iron deficiency with progressive loss of acid secretion, and causes inflammation of the gastric mucosa with loss of the gastric glandular cells and replacement by intestinal-type epithelium, and fibrous tissue
Tiredness- As iron deficiency anaemia can leave you tired and lethargic (lacking in energy), you may be less productive and active at work. Your ability to stay awake and focus can be reduced, and you may not feel able to exercise regularly.
Fainting– Low iron can cause fainting and this could be dangerous in many situations, especially at work places, or working on machinery, or driving a car.
Cold Intolerance– Cold intolerance develops in one fifth of patients with chronic iron deficiency anaemia and is manifested by neurologic pain, vasomotor disturbances, or numbness and tingling.
Issues with Brain and Optic Nerve– Rarely, severe iron deficiency anaemia is associated with papilledema (optic disc swelling), increased intracranial pressure, and the clinical picture of pseudotumor cerebri. These manifestations are all corrected with iron therapy.
Migraines– Research has now shown that there are certain types of migraines caused by iron deficiency
Death – Caused by some of the issues mentioned above

The importance of proper management

Hopefully now everyone can see why iron is so important and that people with iron deficiency need to see their healthcare practitioner for proper help and proper management . Iron deficiency anemia isn’t something to self-diagnose or treat. It needs to be diagnosed, treated and managed properly. In many cases an iron infusion is the best and quickest way to get iron levels back up. Have a read of my post about iron infusions. Click here

Iron infusions are the quickest way of getting iron levels back up

In the case of low, or severely low iron, supplements just are not enough. They take too long to get levels up and the damage to your body in waiting too long can also be serious. Always see your healthcare practitioner, or specialist, for a diagnosis rather than trying to manage low iron on your own, or just taking iron supplements on your own. Overloading the body with too much iron can be dangerous too, because excess iron accumulation can damage your liver and cause other complications.

Final Word

This is why everyone needs to be managed by a properly trained healthcare professional with any health issue, especially low iron. If your practitioner is not able to assist you, please make sure you get a second or third opinion. Some practitioners may not be well versed in the serious complications of low iron, or know much about iron infusions etc.

If you do need help with managing the symptoms of low iron, you can call my friendly staff and find out how I can assist you. For more information please call +61 07 38328369 or email info@drandreworr.com.au

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicince

-Master of Reproductive Medicine

-Women’s and Men’s Health Advocate

Let’s Talk About Adenomyosis

Posted on November 12, 2019November 12, 2019 by Andrew Orr

As a healthcare practitioner with a special interest in women’s health, more and more I am seeing women presenting with all the symptoms of Adenomyosis. This is why this post is called “Let’s Talk About Adenomyosis”.

Just like endometriosis, many women have had this condition missed and dismissed and then have to suffer the consequences and think that they just have to put up with it month after month.

Some women are completely unaware that they have adenomyosis. Those that have already been diagnosed with endometriosis often believe that all their symptoms are just related to this disease only, when it fact, they could have two diseases creating all their issues.

Many of the symptoms are the same as endometriosis, except that women will usually have heavier menstrual bleeding, or irregular bleeding issues.

Women can have both endometriosis and adenomyosis at the same time and now research is showing that they are basically one in the same disease, but just in different locations.

What is Adenomyosis?

Adenomyosis is defined as the presence of endometrial glandular tissue occurring deep in the endometrial lining (myometrium). The exact cause of adenomyosis is unknown, but current research is showing that it is a similar process to how endometriosis is caused.

Histologically both endometriosis and adenomyosis are one in the same disease state, but just occurring in different locations. We know that both diseases are driven by estrogen and that they have all the same signs and symptoms. Adenomyosis and endometriosis are not caused by estrogen dominance either. Even small amounts of estrogen will drive both diseases.

The only difference between the two disease states is that adenomyosis typically causes more heavy bleeding symptoms. The abnormal bleeding occurs when the ectopic endometrial tissue induces hyperplasia and hypertrophy of the surrounding myometrium. This causes uterine enlargement and subsequent changes in vascularisation (the new vessels may also be more fragile than usual) in addition to an increase in the surface area of the endometrium.

One of the key diagnostics for adenomyosis is the presence of an enlarged uterus on ultrasound, or via MRI. The enlarged uterus can also impact the surrounding structures and often impacts the bladder, leading to urinary frequency and other bladder issues.

Adenomyosis can also have the same bleeding symptoms as fibroids but correct diagnosis and investigations, will differentiate the two and ensure correct management moving forward.

What Are the Symptoms of Adenomyosis?

As mentioned previously, adenomyosis has all the same symptoms as endometriosis. Just like endometriosis, some women often have no symptoms (are asymptomatic), and are only diagnosed when they are having issues trying to conceive.

The main symptoms of Adenomyosis are:

Heavy, prolonged menstrual bleeding
Severe pain and menstrual cramps
Abdominal pressure and bloating
Bladder issues (frequency, urge frequency, incontinence)
Anaemia

Other associated symptoms such are:

Irregular bleeding
Pain with bowel movement
Irritable Bowel like symptoms
Urinary Tract Infection (UTI) like symptoms
Fatigue
Mental and emotional disturbances (depression, premenstrual dysphoric disorder)
Pain with intercourse
Infertility
Musculoskeletal pain
Lack of quality of life

Diagnosis of Adenomyosis.

Ultrasound is the most common (and indeed most useful) first-line imaging tool used to diagnose adenomyosis in a women presenting with any abnormal uterine bleeding. While ultrasound cannot definitively diagnose adenomyosis, it can help to differentiate and rule out other conditions with similar symptoms.

Sometimes saline solution is injected in the uterus at the same time as ultrasound is performed to give better imaging and to help evaluate the symptoms associated with adenomyosis. This is called sono-hysterography.

While trans-vaginal ultrasound (TVU) can be used, it can also miss the disease, especially if the user doesn’t have an expert eye, or extra training, or specialises in the diagnosis of adenomyosis.

MRI is considered a much better tool for the finding of adenomyosis, but it is a more expensive option. Even though ultrasound is a cheaper option, it can be inaccurate.

Blood tests cannot diagnose adenomyosis, or endometriosis.

The only proper way to definitely diagnose adenomyosis is via surgical intervention and a biopsy, but this is rarely done prior to a hysterectomy due to risk factors of damage to the uterine lining. Unlike endometriosis, the disease cannot be excised and the only cure for adenomyosis is hysterectomy.

Treatment and Management Options For Adenomyosis

The treatment and management of adenomyosis will depend in part on your presenting symptoms, their severity, and whether you have completed childbearing.

The medical management options for adenomyosis are usually in the form of hormonal therapy (the Oral Contraceptive Pill, Mirena IUS or other types of progestogen therapy) or surgical.

The surgical options are endometrial ablation, uterine artery embolism and hysterectomy. When considering surgical therapy it must be acknowledged that endometrial ablation and uterine artery embolism is less effective compared with the more definitive but more invasive option of hysterectomy.

Research does show that a significant portion of women, who choose to do endometrial ablation, or uterine artery embolism, will end up needing a hysterectomy. Hysterectomy is not the major procedure it was years ago and many are done laparoscopically and done intravaginally. This also helps with the recovery time. It all gets back to quality of life for many women with endometriosis. This is why hysterectomy is now a better option than other surgical interventions.

While hysterectomy is not something to be taken lightly, we do need to be real about quality of life and the ongoing pain, other associated symptoms, long term bleeding and the dangers of long term anaemia that adenomyosis can cause to a woman. Many women often quote getting their life back and wished that they had the hysterectomy sooner, rather than putting up with the lack of quality of life. Hysterectomy is a cure for adenomyosis, but it is not a cure for endometriosis.

Other Management Options For Women With Adenomyosis

Medical treatments(pain medications, iron infusions)
Complementary medicines (Acupuncture, Chinese herbal medicine, vitamins and nutrient support),
Nutrition and diet
Counselling & Psychology
Meditation and Mindfulness
Pain management clinics
Physiotherapy
Exercise therapy(weight baring exercise, resistance training)
Core strengthening(pilates, yoga)
Pelvic floor management(Pilates, Kegels Exercises/Kegels balls, Vaginal stone eggs),
Urodynamics

For women who do not want to consider surgical options, adenomyosis requires a multimodality/team approach for ongoing management, treatment and support. In most cases it will need a combination of the therapies above, or all of them, in conjunction with medical interventions and medicines.

In nearly all cases, treatment and management is the same as endometriosis, except there needs to be more focus on the heavy bleeding symptoms. I always apply a multi-modality approach to assist all my patients who have adenomyosis, or endometriosis, or both combined.

Mild symptoms may be treated with over-the-counter pain medications, complementary medicines and supplements and the use of heating pads to ease pain and cramps. It is important to talk to your healthcare practitioner about treatment options to suit your individual needs and individual symptoms.

Outlook For Women With Adenomyosis

Adenomyosis is not a life-threatening condition, although if some symptoms, such as anaemia and emotional disturbances, aren’t managed properly, or early on, it could potential be life threatening. Many of the symptoms such as heavy bleeding, pelvic pain, pain with intercourse, anaemia and bladder and bowel issues can, and do negatively impact a woman’s life.

Women with adenomyosis are often anaemic and long-term anaemia can have serious health consequences. See my post of serious consequences of iron deficiency. Click here

Many women with adenomyosis, if not all, will need an iron infusion if their iron levels are low. See my post “Could you need an Iron Infusion?”

While surgical options such as hysterectomy can cure adenomyosis, there are both medical and complementary medicines available that may help alleviate the symptoms of adenomyosis.

Adenomyosis and associated symptoms can resolve on their own after menopause. If women have endometriosis as well, they will often require ongoing treatment and management after hysterectomy, as hysterectomy does not cure endometriosis. As mentioned previously, hysterectomy will cure adenomyosis.

Anyone with symptoms of adenomyosis should consult a medical specialist, a healthcare practitioner that specialises in adenomyosis and endometriosis.

Final Word

If you do need help and assistance with the management of adenomyosis, the please call my friendly staff to find out how I may be able to assist you. My motto is ‘no stone left unturned’ and I apply this to every person I see and help. I also have a network of other healthcare professionals I work with as well.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine and Master of Reproductive Medicine

-The Endometriosis Experts (incorporating adenomyosis as well)

Let’s Talk About Iron

Posted on May 8, 2019May 8, 2019 by Andrew Orr

Let’s talk about iron. After my recent post about me having haemochromatosis and the importance of regular venesection and proper screening, I thought we should talk more about iron.

We need to not only talk about high iron and genetic disorders, such as haemochromatosis, but also talk about iron deficiency and proper screening and management of that as well.

In this video post I talk high iron, low iron and everything in between. I also talk about genetics and auto-recessive genetic pathways and the parental mode of inheritance. This also goes for many other health conditions we see in people.

Please remember that early intervention, early screening, early treatments and early management is the key to any disease state.

Could you need an Iron Infusion?

Posted on August 9, 2017August 22, 2019 by Andrew Orr

Iron infusion: Uses, benefits, and what to expect

As a healthcare practitioner I am used to seeing women with really low iron, due to various gynaecological conditions.

Many women do not even know they are low in iron until they get bloods tests to show that they are. Being low in iron can be very dangerous for a woman on so many levels.

Many women who are suffering from fatigue are actually low in iron.

Symptoms of low iron can include

Fatigue

Dizziness

Fainting, or feeling of feeling faint

Pale skin

Breathless

Frequent headaches

Palpitations, or racing heart

Easily irritated

Difficulty in concentrating

Cracked, or reddened tongue

Loss of appetite

Strange food cravings

Risk Factors For Low Iron

Heavy menstrual bleeds

Endometriosis

Adenomyosis

Fibroids

Coeliac disease

Inflammatory Bowel Disease

Pregnant and Breast Feeding Women

Certain Cancers

Vegetarians and Vegans

Girls going through puberty

Certain illnesses

Sometimes when Iron gets too low, supplements just will not be enough to get iron levels up to where they should be quick enough. This is where iron infusions can be very effective.

So what is an Iron Infusion?

An Iron infusion is when iron is delivered via an intravenous line into a person’s body.

Increasing the amount of iron a person has in their blood can cure anaemia, or increase a low red blood cell count.

The body uses iron to make hemoglobin. Hemoglobin is an important part of red blood cells and helps carry oxygen around the body.

If a person does not have enough hemoglobin, they can feel tired, or have symptoms mentioned previously. An iron infusion may be used for someone with an iron deficiency when supplements do not work.

As discussed before, there are a variety of medical reasons can cause low iron levels, so your doctor, or healthcare specialist will order iron studies and other tests to see what may be causing someone to be deficient in iron.

An iron infusion may be given if a person’s blood counts are so low that taking iron supplements or increasing their daily intake of iron-containing foods would be ineffective or too slow in increasing their iron levels.

What to expect

A person will go to a doctor’s office, hospital, or another healthcare facility to have an iron infusion. This is done intravenously and the infusion will take between 15-30 minutes if it is given in amounts of 200-300 milligrams (mg). In days gone by iron infusions would take hours to do and would have to be done in a hospital setting.

The new rapid iron infusions allow iron into the body much quicker and have little to no side effects compared to the older solutions that took hours to administer and were not as good as the new versions used now.

What happens after an iron infusion?

An individual can experience some mild side effects after an iron infusion. The symptoms are usually mild side effects such as headaches, metallic taste in the mouth, or some mild joint pain. Some people can feel faint and nauseas after an infusion but this is usually people who do not tolerate having blood taken, or having needles given. Reactions to infusion are rare, but your healthcare provider will explain all this too you. There are some people who may be allergic to iron, just like people can be allergic to certain foods.

Most people will only need one infusion done, but sometimes people with very low iron may need multiple infusions done. This will be after careful monitoring and testing to see where your iron levels are.

Usually iron levels will return to normal and symptoms of iron deficiency will decrease several weeks after the infusion. A doctor will regularly check the person’s iron levels and blood counts to ensure the iron infusion is working.

Iron infusion vs. injection

Doctors can administer iron to someone via an injection or an infusion.

Iron injections are given intramuscularly, but while iron injections may be faster than iron infusions to administer, they can have some unpleasant side effects. Some of the side effects can be pain at the site of the injection, bleeding into the muscle, and permanent discoloration at the injection site. This is why more doctors are now recommending iron infusions over the injections

Before and after the Infusion

Most people do not need to fast or stop taking their medications beforehand, and can also resume their everyday activities after an iron infusion.

If a person is taking regular iron supplements, however, a doctor will usually tell them to stop taking these about a week before the procedure. This is because the supplements may prevent the body from absorbing the iron from the infusion efficiently.

A person will need to resume iron supplements at some stage after the receiving iron infusions, t ensure levels stay where they should be. Your healthcare provider will tell you when to do this.

People who have a genetic issue called haemochromatosis should not ever have an iron infusion.

Iron infusions are now being used more and more, when iron levels are low and people are not responding to supplementation and adjustments to their diet. I recommend them to many of my patient who have low iron due to many varying reasons. Like I said said before, many of my gynaecology patients, fertility patients and pregnancy patients have very low iron levels and will actually need an infusion to get their levels up quickly.

If you are feeling tired, lethargic and may be at risk of low iron, have a talk to your healthcare provider about finding out if you are low in iron and also discuss having an iron infusion if your levels are really low. Your healthcare practitioner may not know about the new iron infusions and that they are now a great option to use and have very little side effects compared to the older methods and solutions. Some GP clinics now specialise in administering iron infusions too.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate