Iron, B12, and the vegetarian plate

Heavy periods (above 80 ml per cycle, or any flow that soaks through protection every 1–2 hours) cause iron loss every month. Vegetarian iron sources, daal, saag, chickpeas, tofu, are non-haem iron, which is less well absorbed than the haem iron in meat. Combined, many women are running on low iron for years without realising.

Iron is also needed for healthy follicular development in the follicular phase of the cycle. In one prospective study (research cited in the Nurses' Health Study II / Chavarro dataset), women with better iron status showed healthier follicular growth than those who were persistently low.

A full blood count on its own is not enough, you can have normal haemoglobin and depleted iron stores. Ask specifically for ferritin (iron stores) and serum B12. If you have heavy periods, fatigue, brittle hair, restless legs, or tingling in your hands and feet, say so.

The British Society for Haematology (2021) guidance: a ferritin below 30 µg/L in the context of symptoms is worth treating even if haemoglobin looks 'normal'. For B12, levels at the lower end of the reference range with symptoms, tingling, fatigue, low mood, forgetfulness, can still matter, and your doctor can review active-B12 testing or a treatment trial.

Pair iron-containing foods with vitamin C (lemon on daal, tomato in sabzi, amla, guava, pepper on saag), this dramatically improves absorption of non-haem iron. Avoid chai and coffee within an hour of iron-rich meals, as tannins block absorption.

For B12, if you are vegetarian or vegan a daily supplement is reasonable even without proven deficiency, it is cheap, safe, water-soluble (excess is excreted), and corrects a common silent gap. Fortified foods (some plant milks, nutritional yeast) help but do not usually replace a supplement on their own.