Would this be making me feel so unwell as my gp disagrees?

[Littleladybugs]

I have extremely heavy periods- during them I cannot leave the house as the bleeding is so severe and I get so dizzy.

I take ferrous fumarate (x2 a day ) have done for 3 years now, gp said add spatone if I really thought I needed to which I did and now also feroglobin liquid.

Im exhausted and can’t function , a 10 min walk makes me so exhausted I have to sleep afterwards, I get breathless. The gp told me ‘this ISNT biological’ asked me to do a depression questionnaire but so many questions were focused on fatigue issues that she scored me as being depressed (I’m not)

My ferritin is 9 and my haemoglobin 113 of relevant - they said ferrous fumarate is all they can/ will prescribe but it’s not the cause of my issues so I don’t know what to do

I became very anemic once I was pregnant. If you can barely function as it is, I certainly wouldn't be putting additional stress on your body until you figure out what's going wrong.

My ferritin was 4! But my HB normal when I had excessive bleeding.

I felt like I was wading through treacle most days.

So I'd say it could be what's making you feel that way.

I read on one of the menopause sites that anaemia can cause heavy periods which obviously then makes you more deficient so you're just in a loop until youcan get your levels back up.
I also recommend tranexamic acid. It virtually stopped my periods. I was going through a box of tampons a day then only needed two a day.
I hear people say oh it didn't work but it only works if you take it properly. It lasts for about 4-6 hours then you have to take more. I'd only need to take it for about 3 days.

That’s exactly how I’d describe it I’m totally wiped out I wake up tired and struggle to get up

I'm sure it's 75 your ferritin needs to be over for hair growth so the hair loss makes sense

Mine said the same; I didn’t meet the criteria.
My ferritin is never higher than 7 and haemoglobin 111.

Every single time I have a blood test the people taking it tell me I have to get my GP to take it seriously. But I have no idea how!! I’ve asked and asked, what more can I do?

If you manage to get your GP to do anything please come back and update.

My heavy periods were caused by fibroids. Not that anyone told me for 6 years.

Have you ever been tested for Celiacs? It can cause your body to not be able to absorb iron

What helped me was very high doses of vitamin B....b 100 or something from h&b. But also really being careful about caffeine around my ferrous tablets as can really reduce their effectiveness if taken too close

It sounds like you are really going through it at the moment, you can always get a second opinion but I wouldn’t dismiss the depression diagnosis. I have had many friends swear that they were not but just got so used to feeling one way they didn’t know any difference.

TTC is a really bad idea, you are feeling so rubbish now imagine what growing a human is going to do and running after a small child when you are so fatigued over gentle exercise.

It might be worth having a look at how often you should be taking iron. Guidelines changed recently to suggest once a day is best to reflect the understanding that iron can inhibit uptake of more iron for 24 hours after you take it. So, it's possible that the more often you take it the less able to absorb it you are. Obviously discuss with your GP or pharmacist but that may be something to look into more.

This is true! We absorbed so little iron of what we take in. Also, is it a good idea to look at your diet?

If you feel you couldn't imagine looking after a baby as well as yourself due to feeling so rubbish, then that's a different story.

You have two children! You don’t need a third, but you do need to be healthy for them!!! I can’t imagine how high risk you would be being pregnant in this state!

Honestly, they’re not taking the symptoms seriously. I think you need you cardiac function checked.

This is totally unacceptable of GP. You are supplementing and your Hb and ferretin are still low, this needs further treatment. Either try another GP or request a referral from current one, telling you those numbers are fine is not ok.

While you ideally want to start pregnancy with optimal iron status but assuming your periods are the cause of iron depletion for you, you'll probably find due to cessation of menstruation that your iron levels stabilise.

re. your cycle length reducing, I've found the same as I've got older, another delightful part of being a woman- more periods before peri hits us!

Edit- fertility and iron do have some association so getting your iron levels sorted could help with that too.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/

These are the nice guidelines for the management of anaemia.

If your Hb levels hadn't decreased after 2-4 WEEKS (not months, definitely not years!) they are meant to put you through a specialist assessment. Has that happened? It doesn't sound like it?

I would want to dig out my historical blood results and preferably graph them over time. Show that the iron supplement isn't working, be clear that you still meet the NICE definition of anaemic and ask them what they intend to do to resolve it.

If they still refuse to take action, make clear that you intend to complain about their failure to put you through a specialist assessment (assuming that that is indeed the case) and then ring the PALS team from your local ICB (generally googling "county + ICB + pals" will get you there, I can find it for you if not).

Oh and then this one says they should arrange a referral if you aren't responding to oral treatment:

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/management/management/

Your ferritin is your stored iron and with the heavy periods your body doesn't have a chance to increase its store. You need an iron infusion and maybe a blood transfusion to top it up and you need to go back to the gynaecologist to discuss treatment for the heavy bleeding.
My ferritin at its lowest was 3 and my haemoglobin was 68 which was when I had a blood transfusion on top of the iron infusion. Previously I'd just had the infusion.
I hope you have more success with a different gp at your next appointment.

Incidentally, I charged GP surgery recently and the difference in care between the two surgeries has been insane

This same experience happened to an acquaintance of mine. She was soooooo poorly. The difference between night and day when she changed GPs.

Turrned out She was seriously anaemic or lacking D or B vitamin (I forget which). It seems sone GPs are very lazy on the testing front. Sometimes you have to fight for it, or alternatively change GP.

Symptom or cause? It can either be A or B:

A - depression causes you to feel absolutely shit and unwell all the time.
or
B - feeling absolutely shit and unwell all the time makes you depressed.

Why do doctors ALWAYS seem to assume that in women, the answer is invariably A?

I was found to be severely anaemic in 2022, due to severe postmenopausal bleeding caused by endometrial hyperplasia and large fibroids. At its lowest, my ferritin was 7 and my haemoglobin was 82.

The pathway for my NHS Trust for iron deficiency anaemia has the cut off point for iron transfusions as less than 70 haemoglobin.

I was put on ferrous sulphate and did get my haemoglobin back up to just within range in time for a private operation (not connected with the gynae issues). If my iron levels were still not within range within a week or two of my operation date, the private hospital would have wanted me to have a private iron transfusion. This would have added just under £800 to the fees for my op. Luckily I avoided this.

Are you avoiding milk and dairy around the time of day you take your iron tablets as these are thought to reduce absorption? NICE Guideline now recommends only one tablet a day. I took my tablets with a Vitamin C tablet. Some of my symptoms resolved within three weeks of starting on iron, for example the dreadful restless legs at night.

I would change to another GP within the practice and also ask for a gynae referral.

I tried to explain how if anything I feel frustrated by my symptoms - not depressed or unhappy just really frustrated that I can’t do things I need to and she said ‘you are anxious ‘ I just gave up and decided I’ll see someone else now as she has just got me down as being depressed

https://www.southtees.nhs.uk/services/pathology/tests/ferritin/

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/investigations/#interpreting-ferritin-levels

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002799/

Glad you are seeing another GP. Your Hb is not yet above 120 and your ferritin is under 30, you still have iron deficiency anaemia according to WHO guidelines. It is biological, look at the picture which shows the effects of iron deficiency, it comes from the paper I linked, all your symptoms!

Click on the Manchester Anaemia Guide link for a pdf flow chart for what the GP should be doing. If the heavy periods are causing blood loss of leading to iron deficiency anaemia why aren't they offering you tranexamic acid.

https://mft.nhs.uk/the-trust/other-departments/laboratory-medicine/information-for-gps/laboratory-medicines-newsletter-for-gps/anaemia-your-questions-answered/

What is it about some GPs that they want to put any symptoms suffered by a woman down to depression!

You have my sympathies OP. I once went to my regular GP several times over a six month period suffering from worsening nausea and balance problems. By the last visit I was throwing up all day and couldn't walk across the room without holding on to the furniture. He said he thought it was depression!

Luckily I managed to get an appointment with a locum who referred me straight to neurology. Turns out I had a brain tumour and within days I was having an emergency operation to save my life.

OP, please see another GP. These are severe symptoms and are definitely not caused by depression!

GPS love to diagnose anxiety/depression in women. If they can't sort you out in 2 seconds you get the sympathetic smile and the "could you be anxious"

Personally I would print out the NICE guidelines and highlight the last part. Write everything down you want to say. Be clear that if they continue to insist it is anxiety without further assistance you will complain.

You also need help to manage the heavy periods, you will continue to be anaemic and iron defienciwnr because you are bleeding heavily every month