Tired All The Time?
Sam, a 38-year-old mother of two, began feeling dizzy and exhausted after having her second baby in 2024. So, she went to see her doctor.
“They suggested I was just tired and dehydrated,” Sam said in an interview with The Guardian. “They didn’t check my blood and told me to drink more water.” Sam knew that wasn’t the real reason why she felt so tired.
Earlier this year, Sam started taking a new contraceptive pill. It made her bleed for a whole month. Her doctor told her to stop taking it. She did, and her symptoms got worse. Sam said her hair fell out, she was often dizzy, extremely fatigued, and felt nauseous in the evenings.
She went back to the doctor, who ordered blood tests and an electrocardiogram (ECG, which records electrical activity in the heart). Her ECG was normal, but her serum ferritin (the protein that stores iron in the blood) was low, which indicated iron deficiency. Sam was relieved to have an answer. But her doctor dampened her enthusiasm.
“She told me I was ‘only just’ below the healthy range, so it was unlikely to be causing my symptoms,” Sam said. “Iron tablets were suggested as I was at the low end of the scale, but she did not prescribe them.”
Sam’s problem with iron deficiency mirrors the same challenges faced by women across the globe. Although Sam lives in the city of Bath in Southwest England, Dr. Andrew Klein, who operates an iron clinic in Cambridge, England, estimated that nearly one billion women worldwide have iron deficiency.
Women with iron deficiency report losing their hair, experiencing brain fog, and feeling constantly fatigued. Other hallmark symptoms of iron deficiency include:
-
• Aching joints
• Breathlessness
• A metallic taste in the mouth
• Depression
• Anxiety
• Weakness
• Pallor (paleness)
According to Toby Richards, a global expert on iron deficiency and founder of the Iron Clinic in London, almost one in five women in the United Kingdom (UK) live with iron deficiency without realizing it. What’s more, getting diagnosed and treated takes an average of eight years. Why does it take so long?
“Medical misogyny,” Richards told The Guardian.
Dr. Kayathry John, a Manchester-based general practitioner (GP) and co-host of the Talking Longevity podcast, said there is growing awareness among the UK’s medical community of the extent and impact of iron deficiency. However, whether it’s identified in women depends on their own doctor’s experience.
“Once you qualify as a GP, you’re on your own and expected to do your own research,” Dr. John told The Guardian. “We get updates and emails for new findings and medications, but that’s in every field of every topic.” Dr. John said this may explain why Sam’s doctor didn’t see the connection between her ferritin level and her symptoms.
The Common Causes of Iron Deficiency
Heavy periods, which affect one in three women, are among the most common causes of iron deficiency, according to Richards.
“Heavy periods can be categorised as those that require you to change your tampon or pad every one to two hours (or use both at once), to get up at night to change, to bleed for more than seven days, or to worry about leaving the house for fear of accidents or passing clots,” Richards explained.
Richard claims heavy periods can lead to blood loss beyond what the National Health Service (NHS) considers the normal range of 20ml-90ml a month. A recent study conducted in the UK by Randox Health, a blood-testing and diagnostics company, supports Richards’ statement. The study found that women of menstruating age are the most common group to have a ferritin level below 30 (85 percent of women with absolute iron deficiency fell into this category), with 47.5 percent reporting heavy periods.
Caffeine can also slow the absorption of non-haem iron, found in plant sources like beans, lentils, and fortified foods such as breakfast cereals.
“But try telling an exhausted woman she can’t drink coffee!” Dr. John said. “Instead, I recommend leaving a two-hour window before or after a coffee or tea when eating iron-rich food or taking tablets, to aid absorption.”
According to nutritionist Nichola Ludlam-Raine, ultra-processed foods don’t impact iron too much, but they often crowd out our diets with calorie-dense foods high in fat, salt, and sugar. This leaves less room for the nutrient-rich food that our bodies need to function. However, Ludlam-Raine says that foods can only do so much in terms of iron.
“If someone’s already got iron deficiency anaemia, it’s really hard, or even impossible, to correct through food,” she says.
Do Iron Supplements Work?
Desperate to feel better, Sam bought over-the-counter iron tablets and began taking them right away. But the pills made her feel worse. So, she went back to her doctor’s office and saw a different GP, who acknowledged that she had an iron deficiency. “It was very validating for me,” Sam said.
The doctor prescribed a different form of oral iron. However, it didn’t work for Sam.
Women often take iron supplements in hopes of boosting their low iron levels. However, Richards noted that one in four people cannot handle iron tablets due to the gut-related side effects, such as constipation or nausea.
It’s not just tablets, but one in three people cannot absorb oral iron, according to Dr. Klein. Another option is taking iron intravenously. Intravenous (IV) iron infusion can last over an hour, depending on the reason for the deficiency, and can replenish a person’s iron supply for a long time.
Hannah, a 33-year-old mother of two, said her ferritin level had been low for years, and she had been going back and forth with doctors for help. Each time she was given oral iron tablets, even though she told several doctors that it made her worse.
“I was so tired of the GP not taking me seriously,” Hannah told The Guardian. When asked by The Guardian whether she believes her gender played a part in her experience, she responded: “100%.” After reading online that an iron infusion would help her feel better, Hannah asked her GP for a referral and eventually received the treatment.
While IV iron treatment is effective, it costs more than taking pills, Dr. Klein pointed out. There are also not many studies on the subject. Dr. Klein said that the only randomized clinical trial he is aware of found that IV iron showed more benefits than oral iron. Unfortunately, a lack of high-quality research leads to fewer effective, affordable options, Dr. Klein noted.
“If I were to develop a cheaper alternative, I would be the richest person in the world,” Dr. Klein said.
Medical experts say that women experiencing iron-deficiency symptoms should see a doctor and request a ferritin test. If oral iron tablets are recommended but do not work, experts recommend requesting an iron infusion.
After 10 months of feeling bad, Sam was able to arrange an iron infusion through the NHS. She finally started to feel better after getting the infusion. “These are the most precious years of my children’s lives,” she said. “I just want to be awake for them.”
Source Links:
