Iron and the Menopausal Transition

Iron is an essential mineral for health.

It is a key building block for hemoglobin. The hemoglobin's job is to transports oxygen to your cell. Oxygenated cells can then produce energy and oxygenation also aids in cellular development and repair.

With the roller coaster ride that we call the menopausal transition, your iron levels may also join in this fluctuation.

In peri-menopause - some women discover they are anemic. If you are having heavy bleeds, or longer bleeds it's certainly worth investigating. Women with lower levels of iron generally feel tired, but it’s a kind of exhausted that isn’t resolved with sleep. You generally wake just as exhausted as you were prior to going to bed, that's if you were lucky enough to get any sleep in the first place as insomnia is another sign of anemia. While you’re in bed restless legs and painful leg cramps might also plague you as another signal you need more iron. You may look pale, feel short of breath, with a rapid heartbeat, lacking concentration, and experience headaches. 

Depending on how low you are, you may be encouraged to eat more iron-containing foods such as red meat, seafood, poultry, there are also smaller amounts to be found in certain nuts, beans, and vegetables. In most cases, supplementation is required. At the extreme end, iron transfusion is recommended. Before you have an infusion it's certainly worth also checking your copper and ceruloplasmin levels to check you can absorb the iron about to be injected into you. Copper is a key building block of ceruloplasmin. I think of ceruloplasmin as a cup the holds the iron. If you don’t have enough ceruloplasmin your iron doesn’t have anywhere to sit and you won’t absorb it well. Copper is not a supplement I would self prescribe. It is toxic in high doses. When I use it with my patients I retest every 3 months to make sure we aren’t creating a new problem with copper toxicity, but for women with low iron and low copper, a little supplemental copper can be life-changing. Other co-factors to consider are Vitamin B12 and Vitamin C .

Let's look at the other end of the transition. In post-menopause, women are more likely to have issues with toxic iron overload. When you are no longer menstruating you don’t have the opportunity to release iron with your monthly bleed anymore. Over time your iron starts to store - in a blood test stored iron is called ferritin. Ferritin prefers to be stored in the liver. So it's quite common to see liver enzymes start to rise alongside ferritin as the excess ferritin is reducing the liver's ability to optimally function. Ferritin also likes your bones. Think about iron in general for a moment,  it starts to rust overtime outside the body, it does the same thing inside the body. Just as a rusted gate will creak as it opens, so will your joints start to creak with the movement of every day.  The gate may start to corrode and change shape and so can your bones start to develop osteoporosis. A rusty gate may open slowly and get jammed so may your joints and your overall energy levels may start to decline.

Other indications your ferritin levels are getting high can include abdominal pain, irregular heartbeat, blood sugar issues, depression, concentration, and cognitive issues.

You want to be proactive with rising ferritin levels, as it's likely to continue to rise with age.

Let's discuss what you can do if your ferritin levels are higher than the idea.

Lifestyle

• Get moving, women who have a long term exercise routine tend to have lower stored levels of iron than non-exercisers. 
• Smokers in general have higher ferritin stores. Be mindful if you are trying to quit as nicotine patches, sprays and gums may also increase your iron absorption. Second-hand smoke is also a problem. 

Diet

Dietary wise it can help if you shake things up in the kitchen. Assess the number of high iron foods such as red meat you are eating. I still want you to eat some red meat, just decrease the frequency. There are certain combinations of food that increase or decrease iron absorption in that meal. Having an alcoholic beverage with your red meat may increase absorption. Due to the liver-damaging effects of alcohol itself, it's worth cutting back on alcohol regardless. Drinking tea (black, green, chamomile) or coffee at the same time can reduce absorption from the tannins and polyphenols found in these drinks.

Make sure you are eating lots of fibrous foods or adding extra fiber in as this also impairs the absorption of iron.

Make sure you are NOT using iron cookware. As the iron once heated can transfer into your food, increasing the iron amount contained in your meal.

Supplement

It goes without saying to double-check your multivitamin doesn’t contain iron.

It’s also worth reassessing additional supplemental Vitamin C at this point in time, as it may also increase absorption. Vitamin C from fruit and vegetable consumption is not a problem and is actually encourages due to its fibre and other antioxidants to help protect against free radical damage created by the extra iron.

The most researched clinical effective supplement to reduce your ferritin levels is turmeric.  Turmeric is an iron chelator. Which means it helps to reduce stored iron. Turmeric is a liver-specific herb which means that not only will it reduce your ferritin levels, it will also help to optimise your liver function at the same time. Turmeric is probably best known for its anti-inflammatory effects, which is great news for your rusty joints. Turmeric is not just great for elevated ferritin levels it's also great for other menopausal symptoms such as hot flushes. A recent study found that postmenopausal women taking turmeric for at least 4 weeks experienced a significant reduction in hot flushes. 

Medical treatment 

Blood donation is a common strategy used to remove excessive ferritin. I think this is a win-win strategy as you might be saving someone else life as you improve your own health. Just double-check you have adequate hemoglobin and vitamin B12 to tolerate the procedure. Each blood draw removes roughly 30-50ng/ml ferritin.