Endometriosis and Iron Deficiency

Women with endometriosis often experience heavy or irregular periods. This means having periods lasting for more than five days, needing more than five pads each day, and having menstrual clots. These are accompanied by irregular uterine contractions and intense pain and can lead to anemia and iron deficiency.

Why is iron important for the body?

Iron is an important mineral for various bodily functions, particularly for the production of blood. Nearly 70% of the body’s iron is in a red blood cell pigment called hemoglobin and its equivalent in muscles, myoglobin. Hemoglobin and myoglobin are responsible for ferrying oxygen and releasing it in all cells and tissues.

Women only have about 300 mg of stored iron compared to 1,000 mg in men. Adult menstruating women need about 18 mg of iron per day (27 mg per day when pregnant) compared to only 8 mg per day for men. The body uses only about 10 to 30% of consumed iron for various metabolic functions.

Red blood cells have a lifespan of about 100 days, so the body needs to constantly replenish them. This happens in the bone marrow by a process called erythropoiesis. Reduction of iron stores below normal values results in iron depletion. This, in turn, leads to reduced red blood cell production and consequently, iron deficiency and anemia.

How are endometriosis and iron linked?

Women with endometriosis often report symptoms such as fatigue, weakness, headaches, and poor appetite. These symptoms are also characteristic of anemia. The body naturally loses about 1 mg of iron per day. However, iron loss during excessive menstrual bleeding is more severe and is the most common reason for iron deficiency in women.

In endometriosis, there is also inflammation due to an overactive immune response. Additionally, metabolic changes caused by increased production of pro-inflammatory cytokines result in decreased iron absorption in the blood. This means that less iron and less utilization of iron to produce new red blood cells.

Researchers now understand that endometriosis cells show resistance to ferroptosis. This is an iron-mediated programmed cell death that becomes active whenever there is excess iron accumulation. Endometriosis lesions can bypass ferroptosis, especially in case of excess cholesterol (hypercholesterolemia), spread via retrograde menstruation, and establish themselves in various sites in the pelvic and extra-pelvic regions.

How to manage iron deficiency during endometriosis?

While diagnosing endometriosis, your doctor may order a blood test that will indicate any signs of iron deficiency and anemia. Increasing your iron intake via diet can help in satisfying daily iron requirements. These include eating foods rich in iron and vitamin C and/or supplementing with ferrous sulfate. However, iron supplementation can only help replenish the iron that you have lost and is not a long-term solution if iron loss continues. Completely removing all visible endometriosis lesions is the only real treatment for not only iron deficiency but endometriosis symptoms as a whole.

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