Iron deficiency is extremely common in women of reproductive age, and it is routinely put down to stress, a busy life or simply “being tired”. By the time it shows up as anaemia on a blood test, it has usually been developing for a long time.
Why women are more affected
Menstrual blood loss is the main reason — heavy or prolonged periods can outpace dietary intake month after month. Pregnancy increases requirements substantially. Diets low in animal iron sources, and conditions such as coeliac disease that impair absorption, add to the risk.
Symptoms people notice but do not connect
- Fatigue that sleep does not fix — the most common presentation by far.
- Breathlessness on stairs you used to climb without thinking.
- Hair shedding — often the first thing that prompts a doctor visit.
- Brittle, spoon-shaped or ridged nails.
- Restless legs at night — a well-documented association.
- Pale inner eyelids or gums.
- Difficulty concentrating and low mood.
- Cravings for ice, chalk or soil (pica) — unusual but strongly suggestive.
- Cracks at the corners of the mouth.
- Feeling cold when others do not.
The test that matters
A standard haemoglobin test can be normal while iron stores are already depleted. Ferritin is the measure of stored iron and is the more sensitive early indicator. If you have these symptoms, ask specifically for ferritin alongside a full blood count.
Improving iron intake from food
Iron from animal sources (haem iron) is absorbed far more efficiently than iron from plants.
- Haem sources: red meat, liver, chicken, fish.
- Plant sources: lentils, chickpeas, beans, spinach, tofu, pumpkin seeds, fortified cereals.
Two practical rules make a large difference: pair plant iron with vitamin C (lemon over daal, tomato in the salad, an orange afterwards), and avoid tea or coffee with meals — the tannins can substantially reduce absorption. Move the tea an hour either side.
About supplements
Do not start iron supplements without a blood test. Excess iron accumulates and is harmful, and some people carry a genetic condition that makes supplementation dangerous. Where a doctor does prescribe iron, taking it on an empty stomach with vitamin C improves absorption; if it upsets your stomach, alternate-day dosing is often better tolerated and, in some studies, absorbed just as well.
Find the cause, not just the number
Iron deficiency is a symptom, not a diagnosis. Heavy periods, fibroids, coeliac disease and gastrointestinal bleeding all cause it, and simply topping up iron without asking why leaves the underlying issue in place. In women past menopause and in men, unexplained iron deficiency always warrants investigation.
