How Heavy Bleeding Leads to Anaemia

Chronic blood loss depletes red blood cells and iron stores, reducing the body’s ability to produce haemoglobin. Over time, this leads to iron-deficiency anaemia — the most common type worldwide.

Heavy menstrual bleeding (HMB), defined as more than 80 mL per cycle, is one of the leading causes of anaemia in women of reproductive age. Uterine fibroids, endometrial polyps, adenomyosis, and hormonal imbalances such as those seen in polycystic ovary syndrome (PCOS) frequently underlie this condition. Inherited bleeding disorders, particularly von Willebrand disease, are also important contributors.

Outside gynaecology, chronic gastrointestinal (GI) blood loss — from peptic ulcers, gastritis, colorectal cancer, diverticular disease, or inflammatory bowel conditions — remains a key cause of anaemia, especially in men and postmenopausal women. Even small, persistent losses can eventually exhaust iron reserves and result in low ferritin and haemoglobin levels.

How Anaemia Worsens Bleeding

Anaemia doesn’t only result from bleeding — it can also increase bleeding risk. Red blood cells play a vital role in blood clotting by helping platelets reach the damaged vessel wall. When haemoglobin levels fall, this mechanism weakens, delaying clot formation. Severe anaemia can therefore exacerbate menstrual or gastrointestinal bleeding, creating a vicious cycle where blood loss and anaemia feed into one another.

Key Clinical Conditions

• Gynaecological causes: Fibroids, adenomyosis, endometrial polyps, hormonal imbalance, and bleeding disorders.

• Gastrointestinal causes: Peptic ulcers, cancers, inflammatory bowel disease, haemorrhoids, and vascular malformations.

• Systemic contributors: Anticoagulant use, liver disease, and platelet function disorders.

Diagnostic Approach

Assessment begins with a complete blood count (CBC) to measure haemoglobin and red cell indices, followed by iron studies (serum ferritin, iron, transferrin saturation).

Identifying the source of bleeding is essential. In women with HMB, evaluation may include pelvic ultrasound, hysteroscopy, or hormonal assessment. NICE guidelines recommend testing for bleeding disorders if heavy periods have been lifelong or if there is a family history.

In men and postmenopausal women with unexplained anaemia, upper and lower endoscopy are the investigations of choice to rule out ulcers, malignancy, or other GI lesions.

Conventional-Based Management

Controlling Bleeding

For menstrual bleeding, the levonorgestrel-releasing intrauterine system (LNG-IUS) is first-line therapy. Alternatives include tranexamic acid, NSAIDs, combined oral contraceptives, or cyclic progestogens.

Correcting Anaemia

Iron replacement is crucial. Oral iron (e.g. ferrous sulfate or ferrous fumarate) is usually first-line, though side effects like nausea may limit tolerance. Intravenous iron provides a faster and more complete correction, particularly in moderate-to-severe cases or when ongoing bleeding continues.

Blood transfusions are reserved for acute or life-threatening anaemia. Importantly, treating anaemia without identifying its source is poor practice — both problems must be addressed simultaneously.

Naturopathic and Nutritional Support

Iron-Rich, Wholefood Nutrition

Prioritise iron-rich foods such as grass-fed red meat, sardines, lentils, chickpeas, pumpkin seeds, spinach, and quinoa. Combine plant-based iron with vitamin C sources (e.g. lemon juice, berries, bell pepper) to enhance absorption. Avoid consuming tea, coffee, and dairy alongside iron-rich meals, as tannins and calcium inhibit absorption.

Support for Iron Utilisation

Optimal iron metabolism requires cofactors such as vitamin B6, B12, folate, copper, and vitamin A. A diverse, nutrient-dense diet supports erythropoiesis (red cell formation).

For vegans or vegetarians, consider a B12 supplement and iron bisglycinate for better absorption.

Gut Health and Absorption

Inflammation or dysbiosis can reduce iron uptake. Including fermented foods (kefir, sauerkraut) and prebiotic fibre (onions, leeks, flaxseed) helps maintain a healthy microbiome, which supports nutrient assimilation.

If low stomach acid is suspected, gentle support with lemon water or bitter herbs before meals may improve absorption.

Reduce Inflammation and Oxidative Stress

Chronic inflammation can trap iron in storage form (ferritin) and limit its release. An anti-inflammatory diet supports iron mobilisation and overall vascular health.

Restoring Energy and Recovery

Fatigue and low resilience are common in anaemia. Including B-complex vitamins, magnesium, and adaptogenic herbs can support energy production and adrenal recovery under supervision.

Conclusion

Heavy bleeding and anaemia are not isolated conditions but manifestations of deeper systemic imbalance.

By identifying and treating the root cause — whether hormonal, gastrointestinal, or inflammatory — long-term recovery becomes achievable.

Integrating evidence-based medicine with targeted naturopathic nutrition allows the body to restore equilibrium, rebuild strength, and prevent recurrence.

For more precise, personalised advice Choose a Consultation.

Together we can create a tailored nutrition and lifestyle plan to optimise your iron levels, improve symptoms and improve overall wellbeing.

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References:

• Akpan, I.J. et al. (2025) ‘Iron deficiency anemia in patients with heavy menstrual bleeding: The patients’ perspective from diagnosis to treatment’, Women’s Health, 21, p. 17455057251321221. https://doi.org/10.1177/17455057251321221

• Kim, B.S.M. et al. (2014) ‘Diagnosis of gastrointestinal bleeding: A practical guide for clinicians’, World Journal of Gastrointestinal Pathophysiology, 5(4), pp. 467–478. https://doi.org/10.4291/wjgp.v5.i4.467

• Thakar, S. et al. (2021) ‘Anemia-Induced Bleeding in Patients with Platelet Disorders’, Transfusion Medicine Reviews, 35(3), pp. 22–28. https://doi.org/10.1016/j.tmrv.2021.06.001