Low Ferritin In Women - The Female Health Doctor Clinic

Iron deficiency is one of the most common nutritional problems affecting women, and certainly really commonly seen in our clinic, yet it is frequently misunderstood and missed. Many women are told their blood tests are “normal” despite ongoing symptoms such as fatigue, hair thinning, breathlessness, or brain fog.

One key reason is that iron and ferritin are not the same thing, and ferritin is often overlooked.

This article explains the difference between iron and ferritin, why ferritin matters so much for women, and what to do if yours is considered “normal” but you’re still having symptoms.

Table of Contents

What Is Iron?

Iron is an essential mineral needed to:

Produce haemoglobin (which carries oxygen in the blood)
Support energy production
Maintain immune and cognitive function

Most routine blood tests focus on haemoglobin levels. If haemoglobin is within range, iron deficiency is often ruled out, but this can be misleading.

What Is Ferritin?

Ferritin is a protein that reflects iron stores in the body.

A helpful way to think about this:

Haemoglobin shows what your body is using now
Ferritin shows what your body has in reserve

It is possible, and common, to have normal haemoglobin with low ferritin. This is known as iron deficiency without anaemia and is particularly common in women.

Why Ferritin Is Especially Important for Women

Women are at increased risk of low ferritin due to:

Blood loss from periods
Heavy or prolonged periods cause by things like adenomyosis or fibroids
Pregnancy and breastfeeding
Short menstrual cycles
Dietary restriction or low iron intake
Endurance exercise
Perimenopause-related changes
Gut absorption problems

Ferritin levels often fall long before haemoglobin drops. By the time anaemia develops, symptoms may already be significant.

Symptoms of Low Ferritin (Even With Normal Iron Levels)

Low ferritin can cause a wide range of symptoms, including:

Persistent fatigue or low energy
Brain fog or poor concentration
Hair shedding or thinning
Breathlessness on exertion
Headaches
Restless legs
Reduced exercise tolerance
Low mood or anxiety
Feeling “run down” despite adequate sleep

Because these symptoms overlap with stress, thyroid problems, and perimenopause, low ferritin is frequently missed.

What Is a Normal Ferritin Level for Women?

Laboratory reference ranges for ferritin are broad. A result may be labelled “normal” but still be suboptimal, particularly if symptoms are present.

In clinical practice:

Ferritin below ~30 µg/L is commonly associated with symptoms
Many women feel better with ferritin levels above 50–70 µg/L
Athletes and menstruating women may require higher iron stores

Ferritin should always be interpreted alongside symptoms and clinical context, not in isolation.

Why Low Ferritin Is Often Overlooked

Low ferritin may be missed because:

Ferritin is not always included in routine blood tests
Clinicians may focus solely on haemoglobin
Symptoms are attributed to stress, hormones, or ageing
Women frequently think that being exhaused is normal and push through symptoms

Common Causes of Low Ferritin in Women

Potential contributors include:

Heavy period bleeding
Copper coil use
Closely spaced pregnancies
Vegetarian or vegan diets without adequate planning/supplementing
Coeliac disease or inflammatory gut conditions
Frequent blood donation
High endurance or intensity exercise

Identifying and addressing the underlying cause is as important as replacing iron.

What Blood Tests Are Helpful?

A comprehensive assessment may include:

Full blood count
Ferritin
Inflammatory markers (as ferritin can rise with inflammation)
Vitamin B12 and folate
Thyroid function tests (where symptoms overlap)

Ferritin results should always be interpreted in clinical context.

What Can Be Done If Ferritin Is Low?

Management depends on symptoms, severity, and cause. Options may include:

Dietary optimisation
Oral iron supplementation (with appropriate dosing)
Managing heavy periods
Treating absorption issues
Monitoring ferritin over time

Iron supplementation should be individualised. Taking too much or the wrong formulation can cause side effects and is not always effective.

Key Takeaway

If you’ve been told your iron levels are normal but you still feel exhausted, foggy, or unwell, ferritin may be the missing piece.

Low ferritin is common, treatable, and often overlooked in women.

Feeling tired all the time is not something you should have to accept.

Frequently Asked Questions (FAQ)

Can you have iron deficiency without anaemia?

Yes. This is common in women. Ferritin levels fall before haemoglobin drops, meaning symptoms can occur long before anaemia is diagnosed.

What ferritin level is too low for women?

Ferritin below 30 µg/L is often associated with symptoms. Many women feel best with levels above 50–70 µg/L, depending on individual circumstances.

Why does ferritin matter more than iron alone?

Ferritin reflects iron stores. You may have normal circulating iron but depleted reserves, leading to symptoms.

Can low ferritin cause hair loss?

Yes. Low ferritin <70 µg/L is associated with hair shedding and thinning, particularly in women.

Should all women take iron supplements?

No. Iron supplementation should be guided by blood tests and clinical assessment. Excess iron can cause harm.

Does inflammation affect ferritin results?

Yes. Ferritin is what is known as “an acute-phase reactant” and may appear falsely normal or elevated during inflammation or infection. High levels of ferritin should be explored further.

Low Ferritin in Women: Why “Normal” Levels Can Still Cause Symptoms