Managing anaemia in women's health

Anaemia in women is common, affecting around 11% of women of reproductive age in Australia, with a higher prevalence in pregnancy (up to 25%) and among Aboriginal and Torres Strait Islander women. It has important implications for women’s health, contributing to fatigue, reduced quality of life, and adverse pregnancy outcomes if unrecognised.

Anaemia in women

Anaemia is defined as haemoglobin <120 g/L in non-pregnant women and disproportionately affects women due to menstrual blood loss and the increased demands of pregnancy. 

Anaemia may present with symptoms such as tiredness, dyspnoea, headaches, palpitations, or reduced exercise tolerance. It should be considered in women with heavy menstrual bleeding, during pregnancy or postpartum, in those with gastrointestinal conditions, or with restricted diets such as vegetarian or vegan diets. Importantly, anaemia is also often detected incidentally, for example, during routine antenatal testing or preoperative blood work.

Investigations for anaemia

The first-line investigation is a full blood count. Haemoglobin <120 g/L confirms the diagnosis. A blood film helps to differentiate causes: microcytic anaemia is usually due to iron deficiency or thalassaemia, macrocytic anaemia is more likely to result from B12 or folate deficiency, and normocytic anaemia may reflect anaemia of chronic disease or acute blood loss. Serum ferritin should be checked in all cases; levels <30 μg/L are highly suggestive of iron deficiency, although inflammation may mask deficiency.

Additional investigations may include B12, folate, thyroid function, and coeliac serology. Women over 50 or postmenopausal with unexplained iron deficiency should be referred for gastrointestinal evaluation. Referral is also indicated for severe or recurrent anaemia, suspected haematological disorders, or gynaecological pathology.

Management of anaemia

Management depends on the underlying cause, which can often be identified through a careful history, including questions about menstruation, gastrointestinal blood loss (e.g. melaena), and dietary habits.

Heavy menstrual bleeding is the leading cause of iron deficiency in women. Options to reduce menstrual loss include a levonorgestrel-releasing intrauterine device or combined hormonal contraception. Women with menorrhagia should also be evaluated for conditions such as fibroids or other uterine pathology.

In confirmed iron deficiency anaemia, oral iron such as ferrous sulphate is first line. Alternate-day dosing may improve absorption and reduce gastrointestinal side effects. Full blood count and ferritin should be repeated after four to six weeks. Treatment should continue until haemoglobin normalises and for a further three months, aiming for ferritin >50 μg/L.

Intravenous iron preparations are indicated when oral iron is not tolerated, ineffective, or rapid correction is required, such as in late pregnancy or before surgery. Blood transfusion is generally reserved for severe anaemia with haemodynamic compromise.

For B12 or folate deficiency, treatment includes parenteral B12, folic acid supplementation, and dietary modifications. Anaemia of chronic disease requires optimal management of the underlying condition, with iron or erythropoiesis-stimulating agents considered in selected cases such as chronic kidney disease.

Anaemia in women is common, under-recognised, and has multiple causes. General practitioners should maintain a high index of suspicion, particularly in women with heavy periods, during pregnancy, or postpartum. Timely investigation, appropriate treatment, and addressing underlying causes can significantly improve outcomes and enhance quality of life.

- Dr Samantha Miller, MBChB

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1. World Health Organisation. Anaemia. https://www.who.int/health-topics/anaemia#tab=tab_1 and https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-women-of-reproductive-age-(-)
2. Australian Red Cross (2025). Iron Deficiency Anaemia. https://www.lifeblood.com.au/health-professionals/clinical-practice/clinical-indications/iron-deficiency-anaemia
3. National Institute for Clinical Excellence (NICE)(2024). Anaemia – Iron Deficiency https://cks.nice.org.uk/topics/anaemia-iron-deficiency/
4. BMJ Best Practice (2025). Assessment of Anaemia https://bestpractice.bmj.com/topics/en-gb/93?
5. The Royal Australian College of General Practitioners (2003). Diagnostic and
6. management strategies for anaemia in adults. https://www.racgp.org.au/getattachment/ec21c057-d128-4236-ba1d-9d44b2370bbd/attachment.aspx
7. NHS (2024). Iron Deficiency Anaemia. https://www.nhs.uk/conditions/iron-deficiency-anaemia/
8. MacLean, B., Fuller, J., Lim, J., Dugan, C., & Richards, T. (2025). Greater prevalence of anaemia and heavy menstrual bleeding reported in women of reproductive age in the United Kingdom compared to Australia. British Journal of Haematology, 206(5), 1479–1484. https://doi.org/10.1111/bjh.20075
9. Ebrahim, M., Vadive, P. D., Dutton, T., Anyasodor, A. E., Osuagwu, U. L., & Bailey, J. (2024). Retrospective audit compares screening and treatment of pregnancy-related anaemia in regional New South Wales with Australian guidelines. BMC pregnancy and childbirth, 24(1), 457. https://doi.org/10.1186/s12884-024-06634-5