A dull headache hummed in Jenny's head as she tried to stir the energy to get up and get ready for work. She started a new diet last week. This one, unlike the last, was guaranteed to help her lose those last five pounds by her 30th birthday. But instead of feeling refreshed, she feels weak and exhausted.

"I shouldn't have started a diet the same week as my period," she thought, vowing to plan better next time.

Finally, she drags herself from bed and puts on a pot of coffee. A little kick start should do the trick, she hopes.

Although Jenny is imaginary, she is not unlike many women. She suffers from anemia caused by iron deficiency.

Iron, which is found in red blood cells, is used to transport oxygen throughout the body. Anemia is when there aren't enough healthy, red blood cells to do the job.

"Women are constantly losing blood during menstrual cycles, and they are certainly at risk [for anemia] if they are not replacing the iron they are losing," said Dr. Arnold Friedman, chairman of the department of obstetrics and gynecology at Beth Israel Medical Center in New York City and board member of the National Anemia Action Council.

In fact, three-fourths of women ages 12 to 49 do not get the recommended dietary allowance for iron through their diets, according to a 1996 survey by the U.S. Department of Agriculture.

"A lot of women in their childbearing years are dieting and they may not be getting enough red meat, and we all don't get enough green vegetables," said Dr. Cora F. Salvino, an obstetrician and gynecologist at Women's Primary Health in Casper.

Since women use more blood at certain stages of their lives, their iron needs change, too.

Childbearing Years

(about ages 12 to 49)

Women ages 9 - 13: 8 mg a day

Women ages 14 - 18: 15 mg a day

Women ages 19 - 50: 18 mg a day

Twelve percent of women ages 12 to 49 in the U.S. have iron-deficiency - enough iron to function, but none in storage - and women who lose an excessive amount blood during menstruation have a greater risk for developing it.

Heavy menstrual blood loss affects 10 percent of women in this group. To help identify heavy menstrual blood loss, The National Anemia Action Council lists the following symptoms:

• Soaking through a tampon and/or pad every hour or less for several hours in a row

• Needing to use double protection during your period

• Having to change your pad or tampon during the night

• Passing large blood clots in your menstrual flow

• Periods lasting longer than seven days

• Severe cramping

Women who experience heavy menstrual blood loss should contact their doctors. They may be able to pinpoint a cause, such as uterine fibroids. Fibroids, muscular tumors on the wall of the uterus, cause heavy bleeding and are common in women over age 30.

The Paragard IUD Contraceptive can also increase blood loss.

In some cases, switching or starting a prescription for oral contraception may help.

"One of the side-effects is a shorter, lighter period, so we prescribe it to get that side affect," Salvino said.

Pregnant women: 27 mg a day

As women's bodies grow during pregnancy, their red blood cell mass increases 20 to 30 percent, increasing their need for iron. Iron goes directly to the growing fetus, and whatever is left goes to the mother.

Iron supplements are included in all prenatal vitamin regimens because most women cannot get enough iron through diet alone.

"Even if a woman thinks she is getting everything she needs, it's a nice safety net to protect both the mother and baby," said Chris Douglas, a registered dietician and state supervisor and nutrition coordinator for Wyoming's Women, Infants and Children program.

If a woman is iron deficient at the start of pregnancy, it can be difficult to catch up.

"Even if her blood count is normal in the beginning of the pregnancy, if her iron stores are low, the baby is going to take it and she becomes anemic as a result," Friedman said.

Anemia during pregnancy increases the risk for preterm delivery, delivering a child having fetal growth retardation and low birth weight. Mothers who are severely anemic can have difficulty bonding with their child after birth and have a higher risk of needing a blood transfusion, Friedman said.

Anemia can be difficult to spot during pregnancy. One symptom that stands out is unusual cravings, and not just for pickles and ice cream. Craving ice cubes, paint fragments or even dirt, a condition called Pica, could be a sign of anemia, Friedman said.

To increase iron levels, doctors may prescribe additional iron supplements.

Be cautious after the birth, too. If a woman's iron stores are low from the pregnancy, birth and the return of periods, she may be more likely to become or stay anemic.

Women ages 51 and over: 8 mg a day

Iron-deficiency anemia is very uncommon after menopause because women in this group aren't constantly losing blood, as they once did.

"Post menopausal women need to be careful about getting too much iron," Salvino said. "Once you stop menstruating you need to stop taking excessive amounts of iron because you could overload."

Iron overload is when unused iron collects in vital organs, causing them to function poorly or not at all.

According to the The Iron Disorders Institute, symptoms of iron overload include:

• chronic fatigue

• joint pain

• abdominal pain

• irregular heart rhythm

• loss of period

• loss of interest in sex

• hair loss

• changes in skin color

People who experience these symptoms should contact their doctor.

One cause of iron overload is hemochromatosis, a genetic condition in which too much iron is absorbed. While hemochromatosis is more common in older men, it can also affect post-menopausal women.

Sources: U.S. Department of Health and Human Services Centers for Disease Control's 1998 report titled, "Recommendations to Prevent and Control Iron Deficiency in the United States." The National Institute of Health's Office of Dietary Supplements. The National Anemia Action Council. U.S. Department of Health and Human Services Centers for Disease Control. The Iron Disorders Institute.

Where to get iron

Iron comes in two forms: heme and non-heme. Heme iron is found in meat, poultry and fish, while non-heme iron is found in plant-based foods and iron-fortitfied foods.

Heme iron is two to three times more absorbable than non-heme iron. When eaten with other foods, heme iron increases absorption from the other sources, as well.

Because non-heme iron is more difficult to absorb, vegetarians must plan diligently to get enough iron in their diets.

One way to increase the amount of iron one absorbs is to take Vitamin C with meals. It enhances iron absorption.

For more information about

iron disorders, see:

• www.anemia.org

• www.irondisorders.org

On the Web

Healthy people can get iron from a variety of food sources.

After menopause

During pregnancy