Iron Deficiency and Fatigue: When 'Normal' Labs Don't Explain Your Exhaustion
When your "just tired" might actually be something more.
"Everything looks normal… maybe you're just stressed."
You're dragging yourself through meetings, surviving on coffee, and by 3 PM you feel like you've been hit by a truck. You're crying over things that never used to bother you. You can't make it up a flight of stairs without getting winded.
But your doctor glances at your labs and says everything looks "normal."
I hear this story all the time, and here's what's actually happening: Iron deficiency is one of the most overlooked causes of fatigue in women.
The reality is that we've normalized women feeling exhausted, and many women struggle with their iron stores, so we're accustomed to seeing low levels. What should be concerning lab results get brushed off as "normal for someone like you." (Sound familiar?)
The Truth About Iron Deficiency
You can be iron deficient without being anemic - you need to know your numbers!
Iron deficiency means your iron stores (ferritin) are depleted. Anemia means it's gotten so bad that your hemoglobin has finally dropped. Here's the key part: anemia is a late-stage change. By the time your hemoglobin drops, you've probably been suffering from iron deficiency for months or years.
The medical term is "iron deficiency without anemia" - ferritin below 30 µg/L with normal hemoglobin.
Translation: You feel like hell, but your doctor says you're "fine."
Here's the shocking reality: The latest Canadian health data from 2012-2019 shows the average ferritin for women aged 19-50 is only 34 µg/L, with 18.2% having iron deficiency (that's nearly 1 in 5 women!). When doctors see these low levels every day, they become desensitized. I've seen women with ferritin levels of 18 µg/L told they're "perfectly fine" - and they're left with no answers to their exhaustion, hair loss, etc. It's honestly maddening.
But what we know is that many women experience low ferritin fatigue when their levels are under 50 µg/L. Which is why we should be targeting optimal levels that restore your energy, not just avoiding anemia.
The Symptoms Stealing Your Life
Iron deficiency symptoms in women go far beyond just feeling tired - they hijack your brain, mood, and entire quality of life. And honestly? You might be sitting there thinking "WTF, this is exactly how I feel."
Physical:
Persistent exhaustion despite adequate sleep
Needing daily naps just to function (thanks, iron deficiency)
Breathless from normal activities (stairs, chasing kids)
Cold hands and feet constantly
Hair thinning, brittle nails
Ice cravings (yes, this is a real thing)
Mental/Emotional:
Brain fog and poor concentration
Irritability, anxiety, or depression that feels different
Feeling overwhelmed by normal tasks
Low motivation and patience (especially with kids or partners)
The mood connection is critical and often missed: Iron is essential for neurotransmitter production. When you're deficient, your brain literally can't make enough serotonin and dopamine. Research shows low ferritin is directly linked to higher depression scores - but how often have you been asked about your iron when you're feeling depressed?
If you're reading that list and thinking that also sounds like perimenopause or hypothyroidism, you're absolutely right. The symptoms overlap significantly, which is exactly why testing your ferritin is so important - we need to rule out iron deficiency before assuming it's all hormonal or thyroid-related.
Making Sense of Your Iron Results
Here's what your ferritin levels actually mean for how you feel:
Below 15 µg/L: Iron deficiency
15-30 µg/L: Probable deficiency (you'll feel symptoms here)
30-50 µg/L: Gray zone (some doctors will even say up to 75) - many women still symptomatic
So where should we be targeting?! Even the BC Health Guidelines recommend targeting ferritin above 100 µg/L - significantly higher than what most doctors aim for.
Could Your Labs Be Lying to You?
Here's what I tell my patients: just because your ferritin is in the "normal" range doesn't mean it's optimal for how you want to feel.
But here's what complicates things even more: ferritin can be falsely elevated by inflammation. If you have PCOS, IBD, autoimmune conditions, or even a minor infection, your ferritin might look "normal" when you're actually deficient. (It's like your body is playing tricks on both you and your doctor.)
What you actually need tested:
Ferritin (iron stores)
Serum iron (iron in your bloodstream at that moment)
Transferrin saturation (below 20% suggests deficiency, even with "normal" ferritin)
Complete blood count (to check for anemia)
What Causes Low Iron
Simply put, iron deficiency happens from one of two things: not getting enough iron in (insufficient intake or poor absorption) or losing too much iron out.
Getting iron in can be a problem when:
Diet is low in iron (especially plant-based diets)
Absorption is poor (due to low stomach acid, celiac disease, certain medications)
Losing iron out happens from:
Blood loss from any source
Heavy menstrual periods
Other bleeding (GI tract, frequent blood donation)
Excess exercise (like in runners)
But for most women, there's one cause that dominates everything else...
The Real Cause: It's Your Period (And Nobody Talks About It)
For most women, the culprit is menstrual blood loss. Here's the math that will shock you (and should make your doctor pay attention):
Average cycle = 30 mg iron lost
Typical diet = 10-15 mg iron daily (only 10-15% absorbed)
The balance is impossible for most menstruating women
As you get older, periods often become heavier, longer, and more frequent (especially in perimenopause - because apparently that wasn't challenging enough already). I see this in practice all the time (and we have the research to back it up): it's nearly impossible to maintain adequate iron stores without supplementing if you have regular periods.
What Happens When You Fix Your Iron
The difference can be dramatic. Women go from exhausted and crying daily to feeling like themselves again. From getting breathless walking upstairs to running 5Ks. From needing afternoon naps to having energy all day.
This is what happens when you actually address iron deficiency instead of just preventing anemia.
So what can you do right now? Know your numbers and know that you deserve treatment even when you're not anemic. If the results seem okay but don't match how you feel, discuss getting a full iron panel.
Treatment should have two parts: rebuilding your iron stores (oral supplements or IV iron) AND solving the underlying problem. If we only replace the iron without addressing the cause, you'll just become deficient again.
Work with a provider who will listen to your symptoms and help you feel your best.
The Bottom Line
You don't need to settle for tired or accept that this is just how it is. Iron deficiency can steal months or years of your life, but addressing this common women's health issue around iron can dramatically improve your energy, mood, and quality of life.
"You don't need to settle for tired or accept that this is just how it is."
You deserve to feel strong, energetic, and like yourself again. Not just "fine" - actually good.
Exhausted despite "normal" labs? I help women identify and treat the iron deficiency that conventional medicine misses. Book a discovery call to get the thorough evaluation you deserve and start feeling like yourself again.