Iron deficiency is very common amongst people with Endometriosis. There is a bit of a vicious cycle between iron deficiency and heavy and long bleeds during your period: heavy and/or long bleeds increase your iron deficiency, and iron deficiency causes longer and heavier bleeds.

Iron plays a very important role in many body processes, such as energy production, immune function, regulating body temperature and muscle performance. Your body needs it to make DNA, enzymes and red blood cells, to transport oxygen around your body, and for metabolism.

Your first defence against iron deficiency is to make sure your diet contains good levels of iron. And that’s where things get a bit tricky.

Iron from food (or supplements, but more about that later) is absorbed in the gut. Your gut contains specific receptors that transport iron through the gut wall into your blood stream.  Unfortunately, these receptors do dual duty: they are also transporters for calcium, but they can only transport one mineral at a time.

That means that if you have a meal that contains foods high in iron and in calcium, your gut won’t be absorbing the maximum amount of iron from your food as some receptors are too busy with calcium.

It is also important to understand the difference between the two types of iron you’ll find in food.

The first type of iron, haem, is found in animal products and meat, poultry and seafood and is a high source of this haem iron. This type is easily absorbed.

The second type of iron, non-haem, is found in plants – wholegrains, seeds, nuts legumes and leafy green vegetables and in the meat and products of animals that eat plants. It is not in a form that the iron receptors can transport and needs to undergo a change before it will be absorbed. This means that if you eat a vegetarian or vegan diet, the only iron in your diet is non-haem and you’re even more likely to be iron deficient.

So how can you maximise the iron you get from your food?

• If you eat animal products and meat, make sure you include high quality, non-processed meat in your meals. You don’t need large amounts.
• To maximise getting iron from your food, you don’t want to combine calcium rich foods with iron rich foods or calcium supplements.
• You can also improve the absorption of non-haem iron from plant-based foods by combining them with foods high in vitamin C. Think about red capsicum or peppers and tomatoes. Many fruits are high in vitamin C as well.

Now let’s talk about iron supplements for a moment.

One of the key symptoms is fatigue and when you go see your doctor they will often quickly do a blood test and when your iron levels are low, suggest you take a supplement. Often these supplements cause constipation and if you have Endometriosis on your bowel, this can make going to the toilet extra painful and difficult.

The type of iron in the supplement can make a difference. In supplements, the iron come in different forms, usually ferric and ferrous and is bound to a salt (sulphate, gluconate, citrate or bisglycinate, for example). To get the best absorbed supplement that causes the least gut issues you may want to look for ferrous iron as amino acid chelate, diglycinate or bisglycinate.

Start on a low dose because your body will only absorb so much. The iron it doesn’t absorb will travel down the colon and contribute to constipation.

Many people with Endometriosis are iron deficient. Making sure that you eat a diet high in iron that is easily absorbed will go a long way to getting back to healthy iron levels.

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