Iron Deficiency and Low Ferritin in Women: Why So Many Moms Are Missing This
When I was asked to write about iron deficiency and low ferritin in women, I didn’t hesitate for a second. I immediately said yes. In my 25+ years as a Registered Dietitian, I’ve helped countless women identify and correct low iron levels. But for the first time in my career, I recently found myself on the other side of the lab results — treating my own iron deficiency.
This past summer, after completing my annual bloodwork, my physician told me my iron and ferritin levels were so low that if I couldn’t raise them on my own, I would likely need an iron transfusion. Hearing that stopped me in my tracks. I felt tired, sure — but like so many moms, I had chalked it up to a busy life, stress, broken sleep, and midlife hormonal changes. I also noticed more hair in the shower drain and less fullness in my ponytail, something I assumed was “just perimenopause” or aging. As it turns out, it wasn’t.
I immediately got to work, carefully and methodically, determined to fix this without an infusion if possible. Increasing red meat intake and starting an iron supplement were first on the agenda. Before diving into how to address low iron and ferritin, it’s important to understand what these labs actually mean — and why so many women are overlooked.
What iron and ferritin actually do
Iron is an essential mineral that the body needs to produce hemoglobin, the protein in red blood cells responsible for transporting oxygen from the lungs to every tissue in the body. Iron also plays a critical role in energy production, immune health, brain function, muscle performance, and hair growth. To assess iron status, physicians typically order an iron panel, which includes serum iron, ferritin, total iron-binding capacity (TIBC), and transferrin saturation — tests that together show how much iron is being stored, transported, and utilized, according to the Cleveland Clinic: https://my.clevelandclinic.org/health/diagnostics/iron-blood-tests.
While lab “normal” ranges vary, many list ferritin as normal anywhere from about 13 to 150 ng/mL. However, research suggests these cutoffs may underestimate iron deficiency in women and that symptoms can occur well before anemia develops: https://pmc.ncbi.nlm.nih.gov/articles/PMC5986027/.
From a functional and symptom-based perspective, optimal ferritin levels for women are often closer to 70–100 ng/mL. This matters because hair follicles, muscles, and the brain are particularly sensitive to iron availability. When ferritin drops, the body prioritizes survival over hair growth, and shedding often follows.
Why low ferritin is so common in women
Iron deficiency is extremely common among women. Globally, over two billion people are affected, including an estimated 38% of women of reproductive age. Menstrual blood loss is a major contributor, and iron needs may increase further during perimenopause due to heavier or irregular cycles and hormonal fluctuations.
Other contributors include inadequate dietary intake (particularly in vegetarian or vegan diets), poor absorption related to celiac disease, IBS, SIBO, low stomach acid, or gut inflammation, restrictive eating patterns, extreme exercise, and taking iron alongside absorption inhibitors. Environmental factors also play a role. Modern soil is increasingly depleted of minerals such as iron, copper, zinc, and magnesium, while exposure to environmental toxins can increase the body’s demand for iron. Iron status does not exist in isolation — adequate ferritin levels also depend on sufficient protein intake and supporting nutrients such as copper, zinc, and vitamin A. In reality, low ferritin is often the result of multiple overlapping factors, not just one: https://pmc.ncbi.nlm.nih.gov/articles/PMC11817370/
Why “normal” labs don’t always mean you’re fine
Many women are told they are fine because they do not meet the criteria for iron-deficiency anemia, which is only diagnosed once hemoglobin drops below a certain threshold. Yet studies show that when more optimal ferritin ranges are considered, over half of women may be functionally iron deficient: https://pmc.ncbi.nlm.nih.gov/articles/PMC11817370/
Even ferritin levels below 50 ng/mL can indicate depleted iron stores. At this stage, symptoms are often subtle at first — then increasingly disruptive.
Common symptoms include:
Persistent fatigue that doesn’t improve with sleep
Brain fog and headaches
Hair shedding or thinning
Reduced exercise tolerance
Anxiety or lightheadedness when standing
Brittle nails or restless legs
Cold hands and feet
For many moms, hair loss is the symptom that finally raises alarm. Increased shedding, thinning at the temples, or a shrinking ponytail is often blamed on stress, aging, or perimenopause — when in reality, low ferritin may be a key driver.
Being told your labs are “normal” while your body is clearly struggling is frustrating. This is why we must stop aiming for normal and start aiming for optimal.
What actually helps raise ferritin
Successfully raising ferritin requires far more than simply eating iron or taking a supplement. Ferritin reflects stored iron, and repletion depends on a coordinated approach that includes diet, absorption optimization, supplementation, and identifying underlying barriers to iron metabolism.
From a dietary standpoint, heme iron, found in animal foods, is the most efficiently absorbed. Sources include red meat such as beef, lamb, and bison; dark meat poultry; shellfish like clams, oysters, and mussels; and liver in small amounts once or twice per month. Heme iron absorption ranges from approximately 15–35%, compared with only 2–20% for non-heme iron.
For vegetarians and vegans, iron intake must be higher and more strategic. Non-heme iron sources include lentils, beans, tofu, tempeh, pumpkin seeds, tahini, quinoa, amaranth, spinach, Swiss chard, blackstrap molasses, and fortified cereals. Because non-heme iron is highly sensitive to inhibitors, food combinations and timing are critical.
Iron absorption can be doubled or even tripled when iron-rich foods are paired with vitamin C–rich foods such as citrus, kiwi, strawberries, bell peppers, broccoli, tomatoes, lemon juice, or vinegar. Research shows vitamin C enhances iron absorption, while coffee, tea, calcium, and fiber can significantly reduce uptake: https://pmc.ncbi.nlm.nih.gov/articles/PMC8350021/.
Common habits that block iron absorption include:
Coffee and tea
Calcium-rich foods or supplements
Magnesium or zinc supplements
High-fiber supplements
Antacids or acid-reducing medications
When ferritin falls below 50 ng/mL, diet alone is often not enough. In these cases, supplement form and timing matter. Better-tolerated options include iron bisglycinate, iron glycinate, iron fumarate when tolerated, or heme iron polypeptide. Iron should be taken with vitamin C and away from calcium, magnesium, zinc, fiber, and caffeine. Mid-morning, mid-afternoon, or bedtime dosing often works best. Emerging research also supports alternate-day dosing, which may improve absorption by reducing hepcidin activity. Hepcidin is a hormone that regulates iron absorption and storage, and when levels are elevated — often due to inflammation, stress, or frequent iron dosing — the body actually blocks iron from being absorbed or released from storage: https://pmc.ncbi.nlm.nih.gov/articles/PMC8350021/.
Why working with a functional RD matters
Ferritin repletion is rarely a one-variable problem. Conditions such as SIBO, gut dysbiosis, chronic inflammation, impaired digestion, perimenopause, irregular menstrual cycles, and stress-related hormonal shifts can all interfere with iron absorption and retention. In these situations, iron intake may appear adequate on paper, yet ferritin remains stubbornly low because the underlying physiology is working against repletion.
This is where working with a functional Registered Dietitian becomes essential. An experienced RD can personalize iron-rich food targets, optimize nutrient timing, select appropriate supplement strategies, and identify absorption blockers or ongoing losses that prevent ferritin from rising. When these factors are addressed together, iron stores rise more efficiently, symptoms improve sooner, and unnecessary long-term supplementation can often be avoided.
When ferritin repletion is approached strategically — through diet, timing, supplementation, and root-cause work — energy returns, hair shedding slows, and women finally begin to feel like themselves again.
Final note for moms:
If you’ve been told your labs are “normal” but you’re exhausted, shedding hair, or just don’t feel like yourself, trust that your symptoms matter. Getting iron status right can be life-changing — and you don’t have to figure it out alone.
Editor’s note: At Hello Mamas, we love sharing great health and wellness tips, but this is not medical advice. Always consult your doctor or healthcare team before starting any new routine or treatment. Also, at Hello Mamas, we share products we personally love and may earn a small commission from affiliate links. This doesn’t affect the price you pay. We only recommend products we genuinely believe in, but your experience may vary.
