Chronic Fatigue as a Symptom: Recognizing Iron Deficiency Anemia in Women
- Juhi Madala
- Apr 6
- 5 min read
Iron deficiency is the leading nutrient deficiency in the world and a primary cause of anemia, a blood disorder that makes it difficult to transport oxygen throughout the body (Cleveland Clinic, 2025).
Iron deficiency disproportionately affects pre-menopausal women, yet largely goes undiagnosed and untreated (Capellini et. al, 2022, Fernandez-Jimenez et. al, 2020).
Considering its association with adverse health impacts, understanding iron deficiency, its symptoms, and its management are important steps in helping women improve and preserve their quality of life.
Understanding Iron Deficiency (ID) and Iron Deficiency Anemia (IDA)
Iron is an essential nutrient that plays a critical role in the distribution of oxygen throughout the human body. Oxygen transport from the lungs to the rest of the body is made possible by the protein hemoglobin, which is present in red blood cells. Hemoglobin cannot be formed — and therefore cannot facilitate the transport of oxygen within the body — without iron (Berg, 2024).
Usually, the amount of iron an individual absorbs in a day is proportional to the amount of iron they have lost. However, when iron intake decreases or output increases to a degree where the body cannot compensate for the loss of proportionality, iron deficiency and iron deficiency anemia can develop (Bermejo, García-López, 2009). Menstruating women, who lose a significant quantity of blood for several days every month, live with an iron balance that is constantly disrupted. This is problematic because iron is difficult to immediately replenish since only a portion of the iron we consume is taken up by the bloodstream (Bermejo, García-López, 2009). Unsurprisingly, iron deficiency is especially prevalent in menstruating women, at a rate of about 38% in the United States according to recent studies (Weyand et. al, 2025).
When considering symptoms and treatments, it is important to distinguish iron deficiency from iron deficiency anemia. Iron deficiency (ID) occurs when the total iron content within the body decreases, whereas iron deficiency anemia (IDA) is a progression of ID to the point of decreased production of red blood cells (Bermejo, García-López, 2009). Common physical symptoms of both ID and IDA include fatigue, hair loss, brittle nails, headaches, decreased cognitive function, cold hands and feet, cold intolerance, restless legs syndrome, decreased immune function, and behavioral changes such as heightened irritability or a tendency to chew on ice (Berg, 2024, Fernandez-Jimenez et. al, 2020). However, the presentation of these symptoms is more severe in IDA, with affected individuals experiencing chronic fatigue, heavy hair loss and thinning, decreased endurance, and other negative effects. Most of the effects of ID and IDA are not permanent as reestablishing a healthy iron concentration within the body should eliminate associated symptoms (Cleveland Clinic, 2025). It is also important to remember that because iron intake and iron output operate on a cycle, there is no one-time cure for ID/IDA, rather, once the balance is restored it needs to be maintained through proper iron intake.
Diagnosis and Treatment of ID/IDA
Both ID and IDA are diagnosed by way of blood tests, most commonly a complete blood count and serum ferritin test (Hematology.org). Once diagnosed, there are multiple paths that can be taken to treat and manage iron deficiency and iron deficiency anemia. Some common treatments include changes to diet, oral supplements, intravenous (IV) iron, and blood transfusions. Dietary changes would involve increasing consumption of red meats or organ meats, some poultry, seafood, leafy greens, legumes, and iron-enriched grains. Examples include beef, duck, liver meat, shellfish, sardines, broccoli, kale, lima beans, and iron-enriched pastas or cereals (Hematology.org). This list is not exhaustive, and more specific examples can be found online that cater to specific dietary preferences or restrictions.
Oral supplements (ex. multivitamins) are mentioned as a good tool for maintaining a healthy baseline once normal iron levels are achieved (especially during times of heavy iron loss such as menstruation), but are not as useful for actually rectifying the iron imbalance in ID or IDA. As the amount of iron needed to mitigate the effects of ID/IDA is higher than what can be found in standard multivitamin supplements, it is important to refer to a doctor for prescription iron tablets and other pertinent advice (Hematology.org). IV iron is usually recommended as an alternative to oral pills for people who have preexisting conditions that would prevent proper absorption in the GI tract (Hematology.org, Cleveland Clinic, 2025). Red blood cell transfusions are not a common treatment for ID/IDA, and are usually only given to patients with severe IDA who are experiencing other complications such as chest pain (Hematology.org).
While the existing treatments for iron deficiency and iron deficiency anemia are very effective, the best management strategy is always prevention. According to a study conducted by Dr. George Goshua at Yale School of Medicine, annual iron screenings at 25 micrograms per liter were shown to enhance life benefits without introducing additional risk factors (Dohrn, 2025). Regular screenings for iron deficiency can catch ID before symptoms worsen or it devolves into IDA, resulting in much easier treatment paths and a greatly improved quality of life.
Conclusion
Iron deficiency and iron deficiency anemia are conditions that are most prevalent among pre-menopausal women, but remain underdiagnosed and undertreated. The first step to addressing the gap between acknowledgement and treatment is educating women about ID/IDA, which has to begin with primary care physicians. The discussion surrounding iron deficiency needs to shift from reactive to proactive, with doctors informing their female patients about the risks and causes of low iron during menstruation. In informing women of relevant symptoms and methods of maintaining a healthy bodily iron content, we would facilitate a system where female patients could better monitor their health and wellbeing and prevent a simple nutrient deficiency from becoming a detriment to their quality of life.
Citations
Berg, S. (2024). What doctors wish patients knew about iron deficiency. American Medical
Bermejo, F., & García-López, S. (2009). A guide to diagnosis of iron deficiency and iron
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Cappellini, M. D., Santini, V., Braxs, C., & Shander, A. (2022). Iron metabolism and iron
deficiency anemia in women. Fertility and sterility, 118(4), 607–614.
Dohrn, G. (2025). Why screen for iron deficiency? it’s common, consequential & curable. Yale
School of Medicine. https://medicine.yale.edu/news-article/why-screen-for-iron-
Fernandez-Jimenez, M. C., Moreno, G., Wright, I., Shih, P. C., Vaquero, M. P., & Remacha, A. F.
(2020). Iron Deficiency in Menstruating Adult Women: Much More than Anemia.
Women's health reports (New Rochelle, N.Y.), 1(1), 26–35.
Iron-deficiency anemia. Hematology.org. (n.d.).
Iron-deficiency anemia could be the reason you’re so tired. Cleveland Clinic. (2025).
Weyand, A. C., Chaitoff, A., Freed, G. L., Sholzberg, M., Choi, S. W., & McGann, P. T. (2023).
Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21
Years, 2003-2020. JAMA, 329(24), 2191–2193. https://doi.org/10.1001/jama.2023.8020
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