Iron Deficiency Anaemia Symptoms in Women

You climb two flights of stairs and need to stop. Your hair comes out in the comb, your nails split, and by evening you are too tired to do anything but lie down. Most women put this down to a busy life. But iron deficiency anaemia symptoms look exactly like this, and in India more than half of women have anaemia.

This guide explains what anaemia is, the common and less obvious signs, why heavy periods matter so much, who is most at risk, which blood tests to ask for, the iron-rich Indian foods that help, and when to see a doctor.

What is iron deficiency anaemia?

Anaemia means your blood has less haemoglobin than it should. Haemoglobin is the protein in red blood cells that carries oxygen, and your body needs iron to make it. When iron runs low, whether from blood loss, a diet short on iron, or extra needs in pregnancy, haemoglobin falls and every part of you gets a little less oxygen.

WHO says iron deficiency is the most common nutritional cause of anaemia worldwide, and that around half a billion women aged 15 to 49 are affected. Other causes include low folate or vitamin B12, infections such as malaria and hookworm, and inherited blood conditions such as thalassaemia, which is why a doctor checks rather than assumes.

How common is anaemia in Indian women?

Very common. India's National Family Health Survey (NFHS-5, 2019 to 21) found anaemia in about 57% of women aged 15 to 49, up from about 53% in NFHS-4 (2015 to 16). That means more than one in every two women you know, including teenage girls, may have it, often without a diagnosis.

of Indian women aged 15 to 49 had anaemia in NFHS-5 (2019 to 21)Source: Indian Journal of Community Health, 2023, analysing NFHS data: About 57%
of women aged 15 to 49 worldwide have anaemiaSource: WHO: 30%
women in the WHO South-East Asia Region are affectedSource: WHO: 244 million

India runs a national programme, Anemia Mukt Bharat, to test and treat anaemia in girls and women. But the first step is often simply noticing the signs and asking for a test.

Iron deficiency anaemia symptoms: what are the signs?

The most common iron deficiency anaemia symptoms are tiredness and low energy, breathlessness, a fast or pounding heartbeat, pale skin, headaches and dizziness. Less obvious signs include hair loss, brittle or spoon-shaped nails, a sore tongue, cracks at the corners of the mouth, restless legs and cravings for ice, chalk, mud or paper.

Tiredness that does not get better with rest
Less obvious signs
Hair fall or thinning
Breathless on stairs or a short walk
Less obvious signs
Brittle or spoon-shaped nails
Fast or pounding heartbeat (palpitations)
Less obvious signs
A sore or smooth tongue, or mouth ulcers at the corners of the mouth
Pale skin, pale inner eyelids
Less obvious signs
Craving ice, chalk, mud, raw rice or paper (pica)
Headaches, dizziness or light-headedness
Less obvious signs
Restless legs at night
Cold hands and feet
Less obvious signs
Ringing in the ears, or itchy skin

Common and less common signs. Sources: NHS, WHO.
Common signs	Less obvious signs
Tiredness that does not get better with rest	Hair fall or thinning
Breathless on stairs or a short walk	Brittle or spoon-shaped nails
Fast or pounding heartbeat (palpitations)	A sore or smooth tongue, or mouth ulcers at the corners of the mouth
Pale skin, pale inner eyelids	Craving ice, chalk, mud, raw rice or paper (pica)
Headaches, dizziness or light-headedness	Restless legs at night
Cold hands and feet	Ringing in the ears, or itchy skin

Common and less common signs. Sources: NHS, WHO.

Iron can be low and causing symptoms even before haemoglobin drops into the anaemia range. If you have several of these signs, especially with heavy periods, ask for a test rather than waiting.

Can heavy periods cause anaemia?

Yes. Heavy periods are one of the most common causes of iron deficiency anaemia in women, and WHO lists consistent heavy menstrual losses as a cause. Each heavy period takes iron out of your body faster than a typical diet puts it back, so stores slowly run down over months and years.

Changing a pad every 1 to 2 hours, needing two products at once, or changing at night are signs of heavy bleeding.
Periods longer than 7 days, or clots bigger than a ₹5 coin, also count.
Treating the cause of heavy bleeding matters as much as restoring your iron, or it will run low again. On heavy days, a longer pad such as an XL+ changed every 4 to 6 hours helps you cope while you get checked.

Our guide to heavy periods explains the signs and causes in detail. Logging how heavy each period is, in our free period tracker, gives your doctor useful evidence.

Who is most at risk of anaemia?

Women with heavy periods, pregnant women, teenage girls who are growing fast and have started their periods, vegetarians who eat few iron-rich foods, and women who have had several pregnancies close together are most at risk. Frequent blood donation, stomach problems that affect absorption, and worm infections can also play a part.

Ask for a test if you

Have heavy or long periods, or have had them for years
Are pregnant, planning a pregnancy, or had a baby recently
Are a teenager with periods and feel constantly tired or breathless
Eat little iron-rich food, or follow a strict diet
Have had stomach or bowel problems, or blood in your stool
Have a family history of thalassaemia or another blood condition

Which blood tests check for iron deficiency anaemia?

A complete blood count (CBC) measures your haemoglobin and the size of your red blood cells. A ferritin test shows how much iron you have stored, and it can be low before your haemoglobin falls. Your doctor may also check vitamin B12, folate or thyroid levels, and look for the cause of any blood loss.

Step 1: Tell the doctor about your periods
Say how heavy they are and how long they last. This is often the key clue, and it is easy to forget to mention.
Step 2: Get the right tests
Usually a CBC and ferritin. No special preparation is normally needed for a CBC; follow the lab's instructions for any other tests.
Step 3: Ask what the result means
Ask for your haemoglobin and ferritin numbers, whether they are low, and what is causing it.
Step 4: Treat the cause and the iron
Your doctor may suggest iron treatment and will look into why it is low, for example heavy periods. Go back for a repeat test to check it is working.

Iron-rich Indian foods: how to eat more iron every day

Food helps keep your iron up and supports treatment, though it usually cannot correct anaemia on its own once it has developed. Good Indian sources include dal, rajma, chana, soya, leafy greens such as palak, methi and sarson, ragi and bajra, jaggery, dates, sesame seeds, and eggs, fish, chicken or meat if you eat them.

Pair iron foods with vitamin C (amla, lemon on dal, guava, orange, tomato)
Why
Vitamin C helps your body absorb iron from plant foods
Have tea and coffee between meals, not with them
Why
WHO and the NHS say tea and coffee reduce iron absorption
Take calcium-rich foods or supplements at a different time from iron-rich meals
Why
Calcium can reduce iron absorption
Add sprouted or fermented foods (sprouted moong, idli, dosa)
Why
Sprouting and fermenting are traditional ways to make grains and pulses easier to digest
Eat a green vegetable and a pulse every day
Why
Regular small amounts add up

Simple ways to get more iron from an Indian plate.
Do more of	Why
Pair iron foods with vitamin C (amla, lemon on dal, guava, orange, tomato)	Vitamin C helps your body absorb iron from plant foods
Have tea and coffee between meals, not with them	WHO and the NHS say tea and coffee reduce iron absorption
Take calcium-rich foods or supplements at a different time from iron-rich meals	Calcium can reduce iron absorption
Add sprouted or fermented foods (sprouted moong, idli, dosa)	Sprouting and fermenting are traditional ways to make grains and pulses easier to digest
Eat a green vegetable and a pulse every day	Regular small amounts add up

Simple ways to get more iron from an Indian plate.

A simple rule: squeeze lemon on your dal and sabzi, eat a fruit after lunch, and save the chai for an hour or two later.

When to see a doctor about anaemia symptoms

See a doctor if you feel tired, breathless or dizzy for weeks, or if you have heavy periods and feel drained. Get urgent help for chest pain, fainting, a racing heart at rest, severe breathlessness, or black or bloody stools. In pregnancy, tell your doctor or midwife about any of these signs promptly.

Very heavy bleeding: soaking through an XL+ pad (or a period panty) in under 2 hours for several hours in a row, or passing clots bigger than a ₹5 coin.
Periods that last longer than 7 days, or that come less than 21 or more than 35 days apart once your cycle has settled.
Severe period pain that stops you from your day, or that doesn't ease with the usual measures.
Bleeding between periods, after sex, or ANY bleeding after menopause.
Periods that stop for 3 months or more when you are not pregnant.
Signs of infection: unusual discharge, a strong smell, itching, or burning when you pee.
After childbirth: a fever, foul-smelling discharge, or very heavy bleeding that does not ease after the first week.
No period by age 15, or no signs of puberty by age 13.

This is guidance, not a diagnosis. If something feels off, trust yourself and see a doctor or gynaecologist. Most causes are common and treatable.

Frequently asked questions

What are the first signs of iron deficiency in women?

The first signs are often tiredness that does not improve with rest, feeling breathless on stairs, headaches, and looking paler than usual. Hair fall, brittle nails and craving ice or mud can also appear. These signs build slowly, so many women do not notice them. A simple blood test, a CBC with ferritin, can check your iron levels.

Why is anaemia so common in Indian women?

Several reasons add up: heavy periods, pregnancies close together, diets low in iron or in foods that help absorb it, tea with meals, worm infections and inherited conditions such as thalassaemia. NFHS-5 found anaemia in about 57% of Indian women aged 15 to 49. Testing and treating the cause, such as heavy bleeding, matters as much as diet.

Can heavy periods cause low haemoglobin?

Yes. Losing a lot of blood each month uses up your iron stores, and without enough iron your body cannot make haemoglobin. WHO lists consistent heavy menstrual losses as a common cause of anaemia. If your periods are heavy and you feel exhausted or breathless, ask your doctor for a blood test and a check on why your periods are heavy.

Which Indian foods are richest in iron?

Good sources include dal, rajma, chana, soya, leafy greens such as palak, methi and sarson, ragi, bajra, jaggery, dates and sesame seeds, plus eggs, fish, chicken and meat for non-vegetarians. Pair them with vitamin C from amla, lemon, guava or tomato, and keep tea and coffee for between meals so more iron is absorbed.

Can hair fall be caused by low iron?

It can. The NHS lists hair loss among the less common symptoms of iron deficiency anaemia. Hair fall has many other causes too, including thyroid problems, PCOS, stress and recent illness or childbirth. If you have hair fall with tiredness or heavy periods, ask your doctor to check your haemoglobin, ferritin and thyroid levels.

Should I take iron tablets if I feel tired?

Not without a test. Tiredness has many causes, and taking iron when you do not need it is not harmless and can hide a problem that needs investigating. See a doctor for a blood test first. If your iron is low, your doctor will advise on treatment and dose, and look for the cause, such as heavy periods.

Sources

Team Potent Hygiene

Written by the Potent Hygiene team in Jaipur, the people behind Ovy period care and Looway travel hygiene. Every article is checked against the public health sources listed with it.

Share on WhatsApp

#Anaemia
#Irondeficiency
#Heavyperiods
#Nutrition
#Women'shealth

Found this useful?

Share it with someone who needs it, or keep reading the Journal.

Browse all guides