When people hear the word “anemia,” the image that often comes to mind is someone looking pale and feeling tired.
While those are classic signs, anemia can cause a much wider range of symptoms — many of which are subtle and easily mistaken for perimenopause.
Recognizing these lesser-known signs can help you catch anemia early and prevent more serious health issues.
What Is Anemia?
Anemia occurs when your body doesn’t have enough healthy red blood cells to carry adequate oxygen to your tissues.
This lack of oxygen can affect almost every part of the body — leading to symptoms that may seem unrelated at first glance.
Surprising Symptoms of Anemia
1. Shortness of Breath
Even mild anemia can leave you feeling unusually breathless when climbing stairs, walking briskly, or even talking.
With less oxygen in your blood, your heart and lungs must work overtime to meet your body’s needs.
2. Strange Cravings (Pica)
One odd but telling sign of anemia — particularly iron-deficiency anemia — is pica: cravings for non-food items like ice, dirt, clay, or even paper.
Scientists believe this could be your body’s instinctive attempt to address a nutrient imbalance.
3. Changes in Skin and Nails
Pale or slightly yellowish skin can be a subtle indicator of anemia.
Your nails might also become brittle, thin, or take on a spoon-shaped appearance, where they curve upward.
4. Restless Leg Syndrome
An irresistible urge to move your legs, especially at night, can be linked to low iron levels.
This restless leg syndrome can disrupt your sleep and leave you feeling exhausted during the day.
5. Brain Fog and Mood Changes
Struggling to concentrate? Feeling forgetful or irritable?
Without enough oxygen, your brain can’t function optimally, leading to mental “fog,” memory problems, and mood swings. Also, anxiety is a common symptom in perimenopause but can also be a symptom of iron deficiency.
6. Dizziness and Fainting
In more severe cases of anemia, low blood oxygen levels can cause dizziness or even fainting spells — particularly when you stand up too quickly.
7. Hair Loss
Hair thinning is a common concern in perimenopause but it’s also a symptom of anemia. Oxygenated hemoglobin is essential for hair growth.
What Causes Anemia?
The most common cause of anemia is iron deficiency, often due to blood loss.
Common triggers include:
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Heavy menstrual periods (common in perimenopause)
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Gastrointestinal bleeding
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Frequent blood donations
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Poor dietary intake of iron or vitamins
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Chronic illnesses like kidney disease
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Genetic conditions like sickle cell anemia
Identifying and treating the root cause is essential for effective management.
When to See a Doctor and Lab Tests
If you’re experiencing persistent fatigue, shortness of breath, dizziness, or increased anxiety and brain fog, don’t dismiss these signs as “just perimenopause”.
A simple blood test can measure your hemoglobin levels and help diagnose anemia.
Depending on the cause, treatment might involve:
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Iron supplements
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Dietary adjustments
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Treating underlying conditions
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In severe cases, IV iron therapy or blood transfusions
Early diagnosis and intervention can prevent complications and restore your energy and well-being.
While the type of anemia can vary, there are some common labs that should be ordered to better understand what’s going on:
- complete blood count (checks red blood cells, hematocrit, and hemoglobin)
- iron panel including TIBC, total iron, and iron % saturation (in-depth iron testing)
- ferritin (iron storage but can be falsely elevated due to inflammation)
- homocysteine (marker for B12 and folate; if it’s elevated, it indicates a deficiency; however, like ferritin, it can be falsely elevated due to inflammation)
- methylmalonic acid (marker for B12; same as homocysteine, if it’s elevated, it indicates a deficiency)
How to Help Prevent Anemia
You can lower your risk of anemia by:
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Eating a balanced diet rich in iron (like leafy greens, red meat, beans)
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Getting enough vitamin B12 and folate
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Managing chronic conditions carefully like reducing heavy menstrual bleeding
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Staying on top of regular health screenings if you have risk factors
Final Thoughts
Anemia is more than just feeling tired. It can affect your entire body — sometimes in unexpected ways. Recognizing the early, surprising symptoms can help you get the care you need and protect your overall health.
If something feels “off,” trust your instincts and talk to your healthcare provider. A simple test could make a big difference.