Anaemia is so widespread among Indian women that it has become invisible. Persistent tiredness gets attributed to household workload, to being a working mother, to stress. A simple blood test often tells a different story.
Iron deficiency is one of the most correctable causes of feeling permanently exhausted.
Why It Is So Common Here
Several factors compound one another, which is why the prevalence is so much higher than in comparable countries.
- Menstrual blood loss, sustained month after month for decades
- Predominantly vegetarian diets, where iron is in a form the body absorbs poorly
- Tea and coffee with meals, which markedly reduce iron absorption
- Pregnancies close together, each depleting stores substantially
- Intestinal worm infestations in some regions
- Women in many households eating last and least
Plant iron is absorbed at roughly a fifth the efficiency of iron from meat, which means a vegetarian diet needs deliberate attention rather than simply including spinach.
The Symptoms That Get Dismissed
Anaemia develops slowly, so the body adapts and the symptoms feel like normal life.
- Fatigue that sleep does not fix
- Breathlessness climbing stairs or carrying shopping
- Palpitations, as the heart compensates by beating faster
- Poor concentration and irritability
- Hair fall and brittle nails
- Cracks at the corners of the mouth
- Restless legs at night
- Craving ice, mud or chalk, which is a specific and often ignored sign of iron deficiency
- Feeling cold constantly
Hair fall in particular sends many women to dermatologists and shampoos when the cause is a ferritin of eight.
Haemoglobin Is Not the Whole Picture
This distinction matters enormously and is missed routinely. Haemoglobin falls only after iron stores are already exhausted.
Ferritin measures your stored iron. A woman can have a haemoglobin at the bottom of the normal range with a ferritin of ten, meaning she is iron deficient without being technically anaemic, and she will feel every bit as tired.
Ask for ferritin specifically when you have symptoms, not just a haemoglobin. Ferritin below thirty generally indicates deficiency, and below fifteen is definite. Our laboratory reports both together.
Finding the Cause Matters
Iron deficiency is a symptom, and treating it without asking why can miss something important.
- Heavy periods: by far the most common cause in premenopausal women
- Pregnancy and lactation
- Poor dietary intake
- Coeliac disease: underdiagnosed in India and a recognised cause of unexplained deficiency
- Gastrointestinal blood loss: ulcers, and in older women, bowel cancer
- Long term use of acid suppressing medicines
In a postmenopausal woman or in any man, iron deficiency requires investigation of the gastrointestinal tract, usually with endoscopy and colonoscopy. In that group it is a bowel cancer symptom until proven otherwise.
Taking Iron So It Actually Works
Many women take iron for months without improvement because of how they take it.
- Take it on an empty stomach where tolerated, or with a small snack if not
- Take it with vitamin C, such as a citrus fruit or a glass of lemon water, which substantially improves absorption
- Avoid tea, coffee, milk and calcium supplements within two hours either side
- Alternate day dosing is often absorbed better than daily dosing and causes fewer side effects
- Continue for at least three months after haemoglobin normalises, to refill stores
Black stools are expected and harmless. Constipation and nausea are common, and switching to a different iron salt or to alternate day dosing usually resolves them. Stopping because of side effects is the most common reason treatment fails.
Dietary Iron for Vegetarians
Diet alone rarely corrects established deficiency, but it prevents recurrence.
- Ragi, bajra and other millets, which are considerably richer in iron than polished rice
- Green leafy vegetables, particularly drumstick leaves and amaranth
- Pulses, chana, rajma and soya
- Sesame seeds, jaggery and dates
- Cooking in iron vessels, which genuinely adds absorbable iron to food
- Always pairing these with a source of vitamin C, such as tomato, lemon or amla
- Moving tea and coffee to between meals rather than with them
That last change alone makes a measurable difference and costs nothing. Our dietetics team works through this within existing family meal patterns.
When Tablets Are Not Enough
Intravenous iron is appropriate when oral iron is not absorbed, not tolerated despite adjustment, when losses exceed what tablets can replace, or when correction is needed quickly, such as late in pregnancy or before surgery.
Modern intravenous preparations allow substantial replacement in one or two sittings with a good safety profile, given under supervision. It is considerably more common now than it was a decade ago and is worth asking about if you have taken tablets for six months with little change.
Blood transfusion is reserved for severe anaemia with symptoms such as chest pain or breathlessness at rest.
Anaemia in Pregnancy
Pregnancy increases iron requirements substantially, and anaemia in pregnancy is associated with preterm birth, low birth weight and increased blood loss at delivery.
Haemoglobin is checked at booking and again in the third trimester. Iron supplementation is routine from the second trimester once nausea has settled. Where anaemia is significant and time is short, intravenous iron is often used in the third trimester.
Correcting anaemia before delivery matters because a woman who starts labour anaemic tolerates normal blood loss far less well. Our antenatal care programme monitors this at each visit.
Persistent tiredness in a woman with heavy periods is iron deficiency until proven otherwise, and it is one of the easiest things in medicine to fix. Ask for a ferritin alongside your haemoglobin, and treat the cause as well as the number.
For assessment and treatment, contact our general medicine department or the gynaecology team at T. Nagar, Chennai.
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