Your Fatigue Might Be a Number Nobody Checked
Michelle was 38 and had been running on empty for three years.
She had two children, a demanding job, and a completely reasonable explanation for being tired.
But several symptoms did not fit as neatly:
Her hair was thinning.
Her legs felt restless at night, making it difficult to sleep.
She became winded climbing stairs she once took without thinking.
She constantly craved ice, chewing through a cup of it most afternoons.
Michelle had bloodwork completed twice during those three years. Her hemoglobin was normal both times, so she was told that her blood count looked fine.
Nobody checked her ferritin.
When it was finally measured, her ferritin level was 9.
Michelle was profoundly iron deficient and had likely been deficient for years. The cause was her heavy periods—which she had always assumed were normal because they were normal for her.
The Gap Between Anemia and Iron Deficiency
This is the single most useful point in this article:
Hemoglobin measures whether you have enough red blood cells. Ferritin measures how much iron your body has in storage.
Your body protects hemoglobin for as long as possible. It draws down stored iron to keep producing red blood cells.
That means your iron stores can become severely depleted while your hemoglobin remains within the normal range.
By the time hemoglobin drops and anemia appears, iron deficiency may have been present for a long time.
Iron Does More Than Build Red Blood Cells
Iron is involved in:
Producing energy throughout the body
Synthesizing neurotransmitters
Supporting thyroid hormone metabolism
Maintaining immune function
Producing healthy red blood cells
Iron deficiency without anemia can cause real and sometimes disabling symptoms.
Yet it is routinely missed because ferritin—the test that measures stored iron—is not always included in a standard blood panel.
Understanding Your Ferritin Result
Ferritin results must be interpreted alongside symptoms, medical history, inflammation, and other laboratory findings.
In many clinical settings:
Ferritin below 30 ng/mL may indicate iron deficiency.
Ferritin below 15 ng/mL strongly supports iron deficiency.
Some laboratories list the lower end of the “normal” range as 12 or 15. Because of this, a woman with symptoms and very low iron stores may be told that her result is technically within range.
That is why the actual number matters—not only whether the result was flagged.
Why Iron Deficiency Disproportionately Affects Women
Menstruation
Heavy menstrual bleeding is one of the most common causes of iron deficiency in premenopausal women.
It is also dramatically underrecognized because women have no external reference point. If your period has always been heavy, it may feel normal to you.
Signs of heavy menstrual bleeding may include:
Soaking through a pad or tampon every hour for several consecutive hours
Bleeding for longer than seven days
Passing blood clots larger than a quarter
Needing to use two forms of period protection at the same time
Regularly needing to change protection overnight
Planning activities around the possibility of bleeding through clothing
A period can be normal for you without being medically normal.
Pregnancy and Breastfeeding
Iron requirements increase substantially during pregnancy. Those iron stores are not always fully replenished afterward.
Some women never return to their previous baseline before becoming pregnant again, allowing the deficiency to persist or worsen over time.
Dietary Patterns
Plant-based foods contain non-heme iron, which is absorbed less efficiently than the heme iron found in animal products.
A plant-based diet can provide adequate iron, but it may require more deliberate planning—particularly for women who menstruate or have another risk factor for deficiency.
Symptoms Beyond Tiredness
Iron deficiency can cause more than fatigue.
Possible symptoms include:
Diffuse hair shedding or thinning
Restless legs, particularly at night
Shortness of breath with modest exertion
A racing or pounding heartbeat
Brain fog
Difficulty concentrating
Cold hands and feet
Brittle nails
Spoon-shaped nails
Craving and chewing ice
The Ice-Craving Clue
The persistent craving and chewing of ice is called pagophagia.
It is an unusual but well-documented sign associated with iron deficiency. Many women never mention it because it seems too strange or unrelated to bring up during a medical appointment.
If you regularly crave or chew ice, tell your healthcare provider.
It may be an important diagnostic clue.
The Rule That Matters Most
In a postmenopausal woman—or any woman without a clear source of blood loss—iron deficiency requires further evaluation to identify the cause.
Iron deficiency without menstrual blood loss may mean that iron is being lost somewhere else. The gastrointestinal tract is one place that must be considered.
Slow bleeding from a gastrointestinal lesion can produce iron deficiency without causing any visible bleeding.
Treating that woman with an iron supplement may improve the laboratory result while leaving the underlying cause in place.
What a Complete Evaluation May Include
Depending on symptoms and medical history, a clinician may order:
A complete blood count
Ferritin
Serum iron
Total iron-binding capacity
Transferrin saturation
Tests for potential sources of blood loss
Gastrointestinal evaluation when appropriate
Do not begin long-term iron supplementation without discussing the dose and underlying cause with a healthcare professional. Too much iron can also be harmful.
What Bastion Clinicians Tell Women About Iron Deficiency
If you are persistently tired, ask whether your ferritin should be checked.
Do not ask only whether your “iron” or blood count was normal. Request the actual results and ask what they mean in the context of your symptoms.
A ferritin result near the bottom of a laboratory’s reference range may still deserve attention when symptoms are present.
If your periods are heavy, that is a medical finding—not a personality trait.
Heavy menstrual bleeding is treatable. Identifying and treating the cause may correct the iron problem at its source rather than requiring supplements indefinitely.
If you are past menopause and have low iron—or if you have iron deficiency without an obvious explanation—ask what evaluation is needed to find the cause.
Michelle’s ferritin is now in the 60s. Her hair stopped shedding. The ice craving disappeared within weeks, which she found genuinely uncanny.
Find Out Your Number
Bastion’s at-home wellbeing screening includes iron studies with ferritin. Your results are reviewed with a licensed provider who will consider your symptoms and look for the potential cause—not simply treat the deficiency.
Not sure which screening is right for you? Talk to a Bastion Care Coordinator.
