Can there be no menses when anemic?

Question

Hi doctor,

I am a 40-year-old woman. I had a hysterectomy surgery four years back. Now, I have no periods or blood loss of any measure. I am having a balanced diet with plenty of meat and kale chips. For three months, I have started taking raw food and prenatal vitamins because of cracks in my mouth that would not heal and it seemed like hair was falling out. After over a year of severe insomnia, exhaustion, mouth sores, constant itchiness, and RLS issues that made my husband wonder, I went to my doctor last week wondering if it could be hypothyroid.

As I have not had periods for four years, I did not suspect any anemia. The doctor has done two CBCs. The second one had even lower hemoglobin and hematocrit levels. My last CBC that was taken four years back showed a Hb of 14.4 but vitamin B12 results were within the normal range. I am attaching all my reports for your reference.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query and reports (attachments removed to protect patient identity), my opinion is as follows:

The low hemoglobin at present is not due to blood loss; it is nutritional. If you look at the iron studies, the iron levels are very low, indicating inadequate iron in the body. They can be secondary to reduced intake and may be a cause of malabsorption.
As the other vitamin levels are normal, it is more likely to reduce iron intake or absorption. The reticulocyte count would increase in case of anemia if the nutrition were improved. It is staying within the normal range. If you start iron supplements along with vitamin C (for better absorption of iron), you will find your reticulocyte count increasing within two weeks.
There is no hemolysis or hemorrhage, as in both conditions, if nutrition was adequate, the reticulocyte count would have also increased. At present, all studies including red blood cell volume distribution (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) are iron studies that are pointing toward iron deficiency. Good to know your thyroid profile is good.
Insomnia and exhaustion can be easily explained by anemia. Also, improve hydration (take at least 21 to 25 cups of water per day). Avoid coffee or tea along with food, as it inhibits iron absorption. Adding citrus fruits or a vitamin C-rich diet during food intake improves iron absorption.
At present, nothing to worry about except iron deficiency. Supplements of iron with iron-fortified food and an iron-rich diet should help. Also, take vitamin B-complex supplements, as early changes like ovalocytes are also seen in the blood. Both iron and vitamin B-complex supplements are to be taken, and within two months, you will return to your normal self.

I hope this helps you.

Thank you