Is it iron deficiency or perimenopause? The hidden impact of low iron in midlife
Iron deficiency anaemia (IDA) is a prevalent condition among women in midlife, significantly impacting their health and quality of life. Understanding its causes, symptoms, diagnostic criteria, and nutritional management is crucial for prevention and effective treatment.
Understanding Iron Deficiency Anaemia
Iron deficiency anaemia (IDA) occurs when the body lacks sufficient iron to produce adequate haemoglobin, the protein in red blood cells responsible for transporting oxygen. This deficiency leads to reduced oxygen delivery to tissues, manifesting in various symptoms.
Common Causes in Midlife Women
Menstrual Blood Loss: Heavy or prolonged periods can result in significant iron loss.
Dietary Intake: Insufficient consumption of iron-rich foods contributes to deficiency.
Increased Demand: Periods of rapid growth, pregnancy, or breastfeeding elevate iron requirements.
Gastrointestinal Blood Loss: Conditions like ulcers or gastrointestinal disorders can cause internal bleeding.
Recognising the Symptoms
Symptoms of IDA can be subtle and often overlooked. They include:
Persistent fatigue and weakness
Shortness of breath
Dizziness or light headedness
Pale skin
Cold hands and feet
Brittle nails
Unusual cravings for non-nutritive substances (a condition known as pica)
Absent mindedness
Decreased cognitive function and memory problems
Decreased exercise tolerance
Depression
Dry skin
Headache
Hair loss
Joint pain
Muscle pain
Palpitations
Restless leg syndrome
Sleep disturbances
Weight gain
Diagnostic Criteria for Iron Deficiency and Iron Deficiency Anaemia
Accurate diagnosis of iron deficiency and IDA involves specific laboratory tests:
Serum Ferritin: This protein reflects iron stores in the body.
Levels below 30 µg/L are indicative of iron deficiency.
In the presence of inflammation or chronic disease, ferritin levels may be elevated; thus, a higher threshold (e.g., below 50 µg/) may be considered for diagnosing iron deficiency in such contexts.
Haemoglobin (Hb): Measures the oxygen-carrying capacity of blood.
For adult women, an Hb level below 120 g/L indicates IDA.
Mean Corpuscular Volume (MCV): Indicates the average size of red blood cells.
Low MCV (microcytosis) suggests iron deficiency.
Transferrin Saturation: Represents the percentage of transferrin (iron transport protein) saturated with iron.
A saturation below 20% is indicative of iron deficiency.
Nutritional Strategies for Prevention and Management
Diet plays a pivotal role in both preventing and managing IDA. Here are some nutrition tips to consider:
Incorporate Iron-Rich Foods:
Heme Iron Sources: Found in animal products and more readily absorbed by the body. Examples include:
Lean red meats (beef, lamb)
Poultry (chicken, turkey)
Seafood (oysters, clams, tuna)
Non-Heme Iron Sources: Plant-based sources that are less easily absorbed. Examples include:
Legumes (lentils, chickpeas, beans)
Tofu and tempeh
Dark leafy greens (spinach, kale)
Fortified cereals and whole grains
Nuts and seeds (pumpkin seeds, cashews)
2. Enhance Iron Absorption:
Pair with Vitamin C: Vitamin C significantly boosts the absorption of non-heme iron. Combine iron-rich foods with sources of vitamin C such as:
Citrus fruits (oranges, grapefruits)
Berries (strawberries, raspberries)
Bell peppers
Tomatoes
Broccoli
Cooking Methods: Using cast-iron cookware can increase the iron content of food.
3. Be Mindful of Inhibitors:
Limit Calcium Intake Around Iron-Rich Meals: Calcium can interfere with iron absorption. Try to consume dairy products or calcium supplements at different times than iron-rich meals.
Avoid Tannins and Polyphenols with Iron-Rich Foods: Substances found in tea, coffee, and red wine can inhibit iron absorption. It's advisable to consume these beverages between meals rather than with iron-rich foods.
4.Consider Iron Supplements if Necessary:
If dietary adjustments are insufficient, consult with a healthcare provider about the possibility of taking iron supplements. It's essential to do this under medical supervision, as excessive iron intake can be harmful.
The often overlooked role of Iron in midlife: How Iron Shapes Your Mood, Mind, and Motivation
Iron is more than just a blood-building mineral — it plays a vital role in your mental well-being too. It’s essential for synthesising key neurotransmitters that help regulate your mood, focus, and emotional resilience:
Dopamine, which supports motivation, pleasure, and attention
Serotonin, often called the “feel-good” chemical, associated with calm and contentment
GABA, a calming neurotransmitter that helps reduce anxiety and promote relaxation
When iron levels drop, the brain’s ability to produce these chemicals is reduced. This can lead to symptoms like:
Low mood or persistent sadness
Anxiety or heightened stress responses
Difficulty concentrating or "brain fog"
A general sense of emotional flatness or feeling disconnected
What’s especially important to understand is that you don’t need to be clinically anaemic to feel these effects. Even mild iron deficiency —often referred to as “non-anaemic iron deficiency”—can affect how you feel, particularly when combined with common midlife stressors like disrupted sleep, perimenopausal hormone shifts, or mental overload.
This connection between iron and brain health underscores the importance of catching and addressing low iron levels early—not just to boost physical energy, but to support mental clarity and emotional balance too.
Bringing It All Together
Iron deficiency—whether mild or more advanced—can quietly erode energy, mood, mental clarity, and overall wellbeing. For women in midlife, this is especially important, as hormonal changes, menstrual losses, stress, and shifting nutritional needs can all contribute to low iron levels. The good news? With the right knowledge, testing, and targeted nutrition strategies, iron deficiency can be identified and addressed before it spirals into more serious symptoms.
Whether you're feeling unusually tired, foggy, flat, or just not like yourself lately, it could be your body's way of saying it's time to check in on your iron status.
As a women's health dietitian specialising in midlife, I’m here to help you uncover the why behind your symptoms and create a personalised, evidence-based plan that fits your life. Let’s work together to ensure you feel energised, focused, and emotionally balanced.
👉 Book your discovery call today—and let’s get you back to feeling like you again.
References
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Lozoff, B., & Georgieff, M. K. (2006). Iron deficiency and brain development. Seminars in Pediatric Neurology, 13(3), 158–165. https://doi.org/10.1016/j.spen.2006.08.004
Murray-Kolb, L. E. (2011). Iron and Brain Functions. Current Opinion in Clinical Nutrition and Metabolic Care, 14(2), 110–115. https://doi.org/10.1097/MCO.0b013e328343b6f6
Houston, B. L. et al. (2018). Treatment of iron deficiency in adults with non-anaemic iron deficiency: a systematic review. Blood Advances, 2(24), 3198–3206. https://doi.org/10.1182/bloodadvances.2018021395
Gastroenterological Society of Australia (2022) Iron Deficiency - Clinical Update. https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/Iron%20Deficiency/Iron%20Deficiency%20Clinical%20Update%202022%20APPROVED.pdf
Lee, H. S., Chao, H. H., Huang, W. T., Chen, S. C., & Yang, H. Y. (2020). Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis. BMC psychiatry, 20(1), 216. https://doi.org/10.1186/s12888-020-02621-0
Totten, M. S., Davenport, T. S., Edwards, L. F., & Howell, J. M. (2023). Trace Minerals and Anxiety: A Review of Zinc, Copper, Iron, and Selenium. Dietetics, 2(1), 83-103. https://doi.org/10.3390/dietetics2010008
Berthou, C., Iliou, J. P., & Barba, D. (2021). Iron, neuro-bioavailability and depression. EJHaem, 3(1), 263–275. https://doi.org/10.1002/jha2.321
