By Most women know the feeling. You can sleep 8 hours, but you still wake up exhausted and hit your limit by 3pm. You probably blame your busy life, but sometimes the cause is simpler and easier to fix. Iron deficiency is one of the most common nutritional problems in the world, yet doctors often treat it without asking why it happened. Many colorectal surgeons in Melbourne see women who’ve had low iron for years before anyone looked for the source. Some put off asking because they’d feel more comfortable talking to a female surgeon about bowel symptoms. In some cases, only a colonoscopy finds the answer.
Why Enough Iron is Critical for Your Health
The body uses iron to make haemoglobin, the protein in red blood cells that carries oxygen. When iron stores run low, tissues get less oxygen. The result can be fatigue, breathlessness, brain fog, hair shedding, restless legs, brittle nails and sometimes cravings for ice.
The World Health Organization estimates that around 30% of women aged 15 to 49 worldwide have anaemia, and iron deficiency causes much of it. Iron deficiency can also cause symptoms well before anaemia appears on a blood test.
The Usual Suspects
So, why are anaemia numbers so high in women?
Heavy Periods
The Australian Commission on Safety and Quality in Health Care estimates that heavy menstrual bleeding affects about one in four women of reproductive age. Many women think their flow is normal because it always has been.
Warning signs include:
- soaking through pads or tampons every hour or two
- clots larger than a 50-cent coin
- needing to change protection overnight.
Diet
Around 1 in 4 Australian women don’t get enough iron from food, and women who eat a plant-based diet, diet often, or skip red meat face a higher risk.
Because the body absorbs iron from plants less easily than iron from meat, pairing plant foods with vitamin C helps, and so does keeping tea and coffee away from meals.
Pregnancy
During pregnancy, the recommended daily iron intake rises from 18 mg to 27 mg. Closely spaced pregnancies, having twins, and heavy blood loss at birth can drain stores further. Some women stay depleted for months after the baby arrives.
Hidden Gut Bleeding
This is the cause people most often miss. Small, invisible amounts of blood can come from stomach ulcers, regular anti-inflammatory use, inflammatory bowel disease, polyps or bowel cancer. Coeliac disease, which affects about 1 in 70 Australians, works differently. It blocks iron absorption rather than causing blood loss.
When Ferritin Results Need a Closer Look
Ferritin measures stored iron. A level below 15 to 30 mcg/L usually confirms deficiency. But inflammation pushes ferritin up, so a “normal” result can hide a real deficiency. That’s why the American Gastroenterological Association’s 2020 guideline uses a higher cut-off of 45 mcg/L. Labs and guidelines don’t all use the same thresholds, so it’s worth asking the GP how they interpreted a result.
Some guidelines recommend testing all adults with iron deficiency anaemia for coeliac disease. They also recommend that postmenopausal women and men have both a gastroscopy and a colonoscopy.
Premenopausal women should have further tests if they have:
- gut symptoms, such as a change in bowel habit or abdominal pain
- a family history of bowel cancer
- low iron that keeps coming back or doesn’t improve with treatment
- low iron that their periods or diet can’t explain.
Why an Iron Infusion Isn’t the Whole Answer
Infusions work well. They lift iron levels quickly, and many women feel better within weeks. But an infusion only refills the body’s stores temporarily and can’t do anything about whatever drained them.
A pattern would look like this. A 52-year-old woman has her second infusion in a year, feels great and puts off further tests. 18 months later, she learns she has a bleeding bowel polyp or an early cancer. Each infusion bought her time, but nobody looked for the cause. This is critical lost time in cases of bowel cancer, as it is very treatable in early stages.
Infusions also carry small risks, including skin staining and, with some products, low phosphate levels. They work best alongside a clear diagnosis.
What Can You Do?
- Ask for full iron studies and a full blood count, not just haemoglobin.
- Keep a period diary for two or three cycles.
- Write down any bowel changes, bleeding or reflux.
- Check the family history for bowel cancer or coeliac disease.
- Ask “what’s causing this?” before “how do we fix it?”
- If embarrassment is holding things up, ask for a referral to a female surgeon for a colonoscopy, especially if you are 45 or older.
When to See a Colorectal Surgeon in Melbourne About Iron Deficiency
No one should simply put up with constant tiredness, and low iron always deserves an explanation. A specialist review can bring answers and peace of mind if iron keeps dropping, gut symptoms appear, or periods don’t explain the problem. Many women feel more at ease talking through bowel symptoms with a female surgeon and deciding together whether a colonoscopy makes sense. A colorectal surgeon in Melbourne can help find the cause, so women don’t keep treating the same problem over and over.