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Low iron levels causing fatigue, weakness, pale skin, and breathlessness. The most common nutritional deficiency worldwide, particularly affecting women of reproductive age.
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A blood test measuring serum ferritin (iron stores), serum iron, and full blood count is the gold standard. Common symptoms include fatigue, pale skin, breathlessness, and brittle nails — but these overlap with many other conditions, so testing is essential.
Common causes: heavy menstrual periods (the most common cause in premenopausal women), insufficient dietary intake (vegetarians/vegans), pregnancy, blood donation, and GI bleeding. In men and postmenopausal women, GI bleeding should always be investigated.
Ferrous sulfate or ferrous fumarate taken every other day (not daily) with vitamin C-rich food or drink maximises absorption with fewer side effects. Avoid taking iron with tea, coffee, or calcium within 2 hours.
With supplements, ferritin levels typically take 3-6 months to normalise. Haemoglobin improves within 2-4 weeks. Continue supplements for 3 months after levels normalise to replenish stores.
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