Should I take extra iron?
Q. I have been diagnosed with a chronic form of anaemia. The explanation I have been given is that my body is inefficient in using iron and that I just have to live with it. I get tired very quickly and would like suggestions for what I can do to improve the way I feel. The problem is not lack of iron, but would it still be worth my while to take an iron supplement?
A. Anaemia means that the concentration of haemoglobin in your blood is low. Since the haemoglobin carries oxygen to all your cells and oxygen is needed to generate energy, it is no wonder that anaemia makes you feel as if you are wading through treacle. Your body does adapt to anaemia and becomes efficient at using the more limited energy supply but, generally, once your haemoglobin is under 10g/dl, you will feel below par.
You become anaemic when you are not getting enough of one of blood's components (eg iron, folic acid or B12); you have an inherited tendency to a mild anaemia (eg thalassaemia, sickle cell); your body is gobbling up blood cells too fast (eg leukaemias) or your body is under long-term pressure fighting off a serious underlying disease (eg rheumatoid arthritis, cancers, kidney or liver failure). Iron deficiency is by far the most common cause of treatable anaemia and happens when you lose lots of blood (heavy periods, operations, accidents, bleeding peptic ulcers). You can have too much of a good thing and taking iron supplements if you do not need them will overload your stores and can damage your liver. If you are not absorbing iron efficiently, your blood cells should be small and pale. This is reflected in the full-blood-count blood test by a low MCV (mean corpuscular volume) and low MCHC (mean corpuscular haemoglobin concentration).
If the problem is unrelated to iron and due to an underlying disease, the cells are more likely to be a normal colour and size. Your GP can talk you through the details of your blood test. I would want to know the rate of fall of my haemoglobin (you can ask for a print out of all blood tests over the years) and why your GP thinks it is due to poor iron absorption, and would ask for referral to a haematologist. There are other causes of chronic tiredness such as depression, viral infections and disturbed sleep. A mild anaemia may not be the reason you are tired.
Is my fertility OK?
Q. I am a 24-year-old woman planning to start a family in the next four to five years. My mother had the menopause in her late 30s/early 40s (although had no trouble conceiving me - her only child - at 37). I would appreciate some advice on how to prepare myself for maximum fertility in my late 20s.
A. To be fertile, you need to ovulate regularly, have fallopian tubes that aren't blocked and have access to good-quality sperm. I am sorry to be blunt, but age is the key determinant of fertility. The best advice to women who are concerned about fertility is not to leave it too long. If you have a period every month, you probably ovulate. There are four ways you can check whether you have ovulated; test your vaginal mucus for stickiness by stretching it between your fingers and looking for the change that occurs mid-cycle; take your temperature every day with a fertility thermometer waiting for the subtle rise at mid-cycle; buy an ovulation prediction kit and check your urine for the rise in hormones that occurs around ovulation; or have a blood test on day 21 of your cycle at your doctor's.
You won't know for certain whether your fallopian tubes are open enough to allow sperm and an egg to pass until you get pregnant, unless you have an operation to shoot dye up your vagina and check whether it dribbles out of the end of your tubes.
The most common cause of blocked tubes is inflammation from conditions such as endometriosis, sexually transmitted infections including chlamydia, or operations on the tubes for ectopic pregnancies.
If your sperm is coming from a sperm bank, it will be checked for quality and tested to make sure it is free of infections. But most of us get sperm from source and that comes with no guarantees. Men who have already fathered children have proven fertility, but sperm can wax and wane, so even that is not a guarantee. Eating moderate amounts of soy products is highly unlikely to affect your fertility significantly. If there is no specific reason to worry about your fertility, I wouldn't.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.