Recognising anaemia symptoms in women

Anaemia means your blood contains too little haemoglobin, the protein that carries oxygen. The most common cause in women is iron deficiency, often from menstruation. Almost 1 in 3 women worldwide deals with anaemia or low iron (WHO). Three blood values usually give the most insight here.

I notice that many women brush off their fatigue for a long time as being busy or sleeping badly. Yet a creeping iron deficiency can be behind it just as easily. The complaints build gradually, so you get used to them and recognise them late.

Below you walk through the signs calmly.

What exactly is anaemia?

Anaemia is a shortage of healthy red blood cells or of haemoglobin. As a result your tissues get less oxygen, and you notice that mainly as fatigue and reduced stamina. It is not a disease in itself, but a sign that something underlying is going on.

In women, iron deficiency is the most common cause. Monthly blood loss, a pregnancy or a diet low in iron can slowly deplete your stores. A shortage of vitamin B12 or folate can also cause anaemia.

Which symptoms fit anaemia?

The complaints of anaemia mainly revolve around oxygen shortage: you feel tired, breathless and exhausted faster. Because the complaints build gradually, you easily attribute them to being busy. Only when you lay them side by side does a pattern appear.

Signs that often fit anaemia:

• Persistent fatigue that does not go away with rest
• Pale skin, lips or inner eyelids
• Breathlessness during effort you used to manage
• Palpitations or a fast heartbeat
• Headache, dizziness or trouble concentrating
• Cold hands and feet or brittle nails

Many of these complaints also fit other causes, such as a slow thyroid or long-term stress. That is why a single symptom says little. If you want to look more broadly at the cause of your tiredness, read our pillar always tired: which blood values to test for fatigue.

Why do women get anaemia more often?

Women are more at risk of anaemia than men, mainly because of monthly blood loss. With a heavy or long period, the loss of iron can be greater than what you replenish through food. So your stores slowly drop.

A pregnancy also requires a lot of iron, because your blood volume increases and your baby grows. On top of that, some women eat few iron-rich products, for example on a plant-based diet.

By the way, low iron is not always true anaemia. You can have complaints while your haemoglobin is still normal. You can read more about that in our article on iron deficiency without anaemia and what a low ferritin means.

Which blood values give insight?

No single value tells the whole story, but three values together paint a clear picture. Haemoglobin shows whether anaemia is present, while ferritin and iron say something about your stores. The table below links each value to what it shows.

Ferritin is often the most sensitive early value. It can already be low while your haemoglobin still looks normal, and that is exactly when you can already feel tired. That is why the combination of values is more valuable than one isolated number.

Want to test specifically? The Anaemia panel looks at the values that bring anaemia into view, and the Iron status gives a fuller picture of your iron stores. Which fits depends on your complaints.

When should you have your values checked?

Being tired once is normal. It gets more interesting if the complaints last longer or if several signals come together. Then it makes sense to have your values checked instead of waiting.

Consider a check if you recognise this:

• You have been tired for weeks without a clear reason
• You have a heavy or long period
• You eat few iron-rich products or are vegetarian or vegan
• You notice paleness, breathlessness or palpitations

If you would rather prevent a shortage, also read how you prevent iron deficiency with nutrition, supplements and testing. You always discuss an abnormal result with your GP.

Frequently asked questions

Can you have anaemia without being pale?

Yes, you can. Paleness is a possible sign, but not everyone with anaemia looks pale. Fatigue and breathlessness are often clearer signals, though this differs per person.

How quickly do you notice improvement after treatment?

That varies greatly. Some women notice more energy after a few weeks as the stores recover, but fully replenishing iron often takes months. Your doctor decides what fits and how to follow it.

Is anaemia dangerous?

Mild anaemia is usually treatable, but long-lasting or severe anaemia can weigh on you and needs attention. Because there can be different causes, it is important to trace the source with a doctor.

References

1. World Health Organization. Anaemia in women and children. WHO Global Health Observatory, 2023.
2. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124.
3. Dutch College of General Practitioners (NHG). Anaemia guideline. Available via nhg.org.
4. Thuisarts.nl. I have anaemia. Dutch College of General Practitioners. Available via thuisarts.nl.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.