PCOS, Periods and Iron Loss

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What are your periods like lately? While some women with PCOS may not experience a period at all, others may have several periods each month, prolonged bleeding, or heavy monthly flow.

According to Dr. Shahab Minassian, Chief of Reproductive Endocrinology and Infertility at The Reading Hospital and Medical Center and IVF-Fertility Division of the Women’s Clinic Ltd. in Reading, PA, women with PCOS can suffer from heavy uterine bleeding for numerous reasons. “Overgrowth of endometrial tissue inside the uterine cavity, which can cause heavy periods, is common. This overgrown tissue can also bleed irregularly causing dysfunctional uterine bleeding (D.U.B.).” Minassian adds “PCOS also puts patients at risk for endometrial polyps, which can also result from the overgrowth. These polyps can cause bleeding between periods as well as heavier flow during periods.”

Heavy bleeding associated with menstrual disturbances can increase a woman’s risk for iron deficiency, or the more severe iron deficiency anemia. Here’s what to know about iron deficiency and how to treat and prevent it.

Signs And Symptoms Of Iron Deficiency Include:

  • Extreme fatigue
  • Pale skin
  • Weakness
  • Shortness of breath
  • Bruising
  • Headache
  • Dizziness or lightheadedness
  • Cold hands and feet
  • Irritability
  • Depression
  • Inflammation or soreness of your tongue
  • Brittle nails
  • Fast heartbeat
  • Unusual cravings for non-nutritive substances, such as ice, dirt or starch
  • Poor appetite
  • An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome)

The Need For Iron

The primary function of iron is to transport oxygen throughout the body, which is why you may feel tired if your iron levels are low. Women need 18 mg/day until menopause when iron needs drop to 8 mg/day. Approximately 40% of the iron in meat products is heme iron, whereas 60% of iron in plant foods is nonheme iron. Because heme iron is better absorbed than nonheme, vegetarians typically absorb less iron. A list of iron rich foods can be found here.

Other Factors Contributing to Iron Loss:

  • Consuming a vegetarian or vegan meal plan
  • Following low-calorie diets or skipping meals
  • Consuming too much dietary fiber (>35 grams/day)
  • Consuming high amounts of coffee and/or tea (tannins found in coffee and tea can affect the absorption of iron)
  • Women who are pregnant and/or nursing
  • Recent loss of blood (i.e., surgery, ulcers, hemorrhoids)
  • Endurance athletes, who may have increased destruction of red blood cell breakdown
  • Taking medications that decrease absorption and/or utilization of iron

Tips to Increase Iron Intake:

  • Eat iron rich foods such as meat, whole grain cereals, lentils, spinach, leafy green vegetables
  • Cook with cast iron cookware
  • Consume vitamin C with each meal. Ascorbic acid found in vitamin C-rich foods increases iron absorption. Suggestions include oranges, orange juice, kiwi, tomatoes, red peppers, and grapefruit.
  • Avoid coffee or tea with meals which can inhibit absorption.
  • Consume heme-containing foods at most meals.

It’s important to see your doctor for a diagnosis and assessment of your iron stores, rather than taking iron supplements on your own. Overloading the body with iron can be dangerous because excess iron accumulation can damage your liver and cause other complications. Iron supplementation can cause GI side effects, mainly constipation. Taking iron supplements with food can decrease side effects, however, iron is best absorbed alone (not part of a multi-vitamin) and on an empty stomach.

Treatment For Heavy And Irregular Periods

If you experience heavy menses or D.U.B., don’t be shy to discuss treatment options with your doctor. If you have polyps, removing them may alleviate heavy flow. According to Dr. Minassian, medical treatments for heavy menses include oral contraceptives and progestins, which can be used monthly or bimonthly to induce regular periods to avoid having heavier periods. “We have also recommended the levo-norgestrel containing IUD. If patients have completed their child-bearing they can also consider endometrial ablation, or even hysterectomy as a last resort” suggests Minassian. Lysteda, a non-hormonal medication, may also reduce heavy bleeding in some women.


Did you suffer iron losses from your periods? Share your experience by leaving a comment below. 

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Comments (11)
  • Owen H

    February 22, 2014 at 3:04 pm

    For ladies who are having issues with iron loss, don’t forget to eat lots of dark leafy greens. The darker the greens the more iron it has, spinach and kale are two great examples.

  • Meka

    August 22, 2014 at 3:04 pm

    I noticed once I stopped working from home and working outside the home which required more sun and more walking.. My body started to regulate itself and I started getting a period. I noticed craving for sex and food right before my period. So im guessing I was ovulating. I got a normal period on July 28th, it came without warning and I bled for about 5 days. It came on again around the same time in July.. Now that it’s august, im getting spontaneous bleeding and had just ended my period from the month of july. I feel extremley tired, fatigue, weak, and sleepy. I have not had a heavy period both times so I dont know what’s going on. Im so tired, I mean very fatigue. I went to bed at 8 pm last night and got plenty of sleep and Im still so tired and sleepy. Could this mean My iron levels are lower than normal? I have always been anemic, so im guessing this is why. I may have lost a lot of iron.

  • Ann

    June 10, 2016 at 3:24 pm

    I wish that the first treatment option was not birth control or hormones. I think there is something wrong with treating a hormonal/metabolic issue with more hormones. It’s not a solution it’s an attempt to control the symptoms

  • Tina

    November 16, 2016 at 3:54 pm

    My daughter is 11, she has started her period already which just amazes me since she is so young, she has been dealing with heavy periods, I was told that giving her iron would help regulate her periods, is this correct an if so how much should she be taking?

  • Angela Grassi

    November 18, 2016 at 9:06 am

    You may be mistaken. Iron levels do not regulate periods but restoring the hormone balance will. She is most likely iron deficient due to the heavy periods. You may want to look into Ovasitol which can regulate menstrual cycles naturally: http://www.pcosnutrition.com/product/ovasitol/

  • Caitlin

    February 7, 2017 at 5:15 am

    Should I take iron supplements supplements as well? If yes, how much a day?

  • Angela Grassi

    February 7, 2017 at 11:18 am

    I would advise getting your iron levels checked first. You don’t want to take iron unless you need it because it could cause cell damage. The amount you need will depend on how low your iron is. We recommend consulting with your doctor about the best amount for you.

  • Madeline

    March 1, 2017 at 2:01 pm

    I think this blog post was good because it suggested some great food options for dealing with low iron. I think that the suggestions that Dr. Minassian suggested should really be A LAST RESORT. There are so many less risky options for dealing with low iron/iron deficiency.

    1. Try iron rich foods.

    2. If your doctor tells you that you have low iron by blood work than supplement! Use a whole foods supplement such as this one:


    Whole food supplements usually contain 10 – 30 mg of iron which is absorbed more easily by the body than many of the iron supplements you find at the pharmacy which often contain 300 mg. If you do find you get constipated even from the whole food iron supplements you can use magnesium oxide or magnesium citrate to relieve the constipation. Most people can tolerate 400 mg before bed.

    2. Careful how you food combine: eggs, whole grains, dairy, coffee and tea inhibt iron absorption. Do not eat high iron foods (liver is a great source of iron!) around these food.

    3. If you a still struggling with iron try a candida diet as candida may use iron up, not leaving enough for you.

    In my personal option, if all of these suggestions don’t work after 6 months of treatment, than some of the riskier options mentioned by Dr. Minassian may be considered.

  • Lovelle Sison

    January 19, 2019 at 10:53 am

    I am experiencing it now. What can i do to restore my health. Thank you.

  • Angela Grassi

    January 23, 2019 at 5:10 pm

    Ovasitol can help shorten cycles. Taking iron or eating iron rich foods as discussed in the article are important.

  • Berry

    March 23, 2024 at 3:40 pm

    Thanks for shedding light on this crucial aspect of PCOS, Angela! It’s concerning how varied and challenging periods can be for women with PCOS, from irregularity to heavy bleeding. Dr. Minassian’s insights are invaluable, especially regarding the risks of iron deficiency anemia due to heavy bleeding. It’s essential for those affected to be aware of these risks and take proactive steps to address them. Education like this is vital for empowering individuals with PCOS to manage their health effectively.

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