Iron

Overview

Iron is a mineral your body needs to make haemoglobin, a protein in red blood cells that carries oxygen around your body. When your iron is too low, your body cannot make enough healthy red blood cells. This is called iron deficiency. It is the most common cause of anaemia (a low level of red blood cells), which can make you feel tired, weak, and short of breath.

Yes, iron deficiency is very common. Many people will experience it at some point in their lives, especially women during their reproductive years.

Iron deficiency can affect anyone, but you are more likely to develop it if you have heavy periods, are pregnant or breastfeeding, have a diet low in iron, or have a condition that affects how your body absorbs iron, such as coeliac disease.

Symptoms

Common symptoms

• Feeling very tired or weak
• Pale skin or pale inner eyelids
• Shortness of breath during everyday activities
• Dizziness or lightheadedness
• Cold hands and feet
• Brittle nails or hair loss
• A craving to eat ice, dirt, or paper (known as pica)

Symptoms in children

• Looking pale
• Being more tired or grumpy than usual
• Poor appetite
• Slower growth or development
• Getting more infections than usual

Symptoms in older adults

• Feeling confused or forgetful
• Feeling weak or unsteady, leading to falls
• Shortness of breath on light activity
• Feeling tired all the time

Causes

Main causes

• Blood loss, for example from heavy periods or bleeding in the stomach or intestines (often caused by ulcers or long-term use of certain painkillers)
• Not getting enough iron from food, which can happen on a poorly planned vegetarian or vegan diet
• The body not absorbing iron properly, for example when someone has coeliac disease or has had surgery on the stomach
• A higher need for iron during pregnancy, growth spurts, or breastfeeding

Risk factors

• Being a woman, especially if you have heavy periods
• Being pregnant or breastfeeding
• Being a baby or young child during growth spurts
• Eating a strict vegetarian or vegan diet without iron-rich foods
• Giving blood frequently
• Having a condition that causes internal bleeding, such as a stomach ulcer or inflammatory bowel disease

When to see a doctor

See a doctor urgently if:

• If you feel severely tired, faint, or short of breath, contact your GP phone line or local out-of-hours service today
• If you are bleeding heavily or vomiting blood, get urgent same-day care

Book a routine appointment if:

• If you have been feeling tired and weak for more than a week with no clear reason
• If your skin looks pale and you have low energy
• If you have unusual food cravings like ice or dirt
• If your periods are heavy enough to interfere with daily life

Diagnosis

Your doctor will ask about your symptoms, your diet, and your medical history. They will also check your face and nails for paleness and may recommend a blood test.

Tests that may be done

• A full blood count to measure your red blood cells and haemoglobin
• A ferritin test to check the iron stores in your body
• Sometimes you may need tests for vitamin B12 or folate to rule out other causes of anaemia

What to expect at your appointment

The blood test is quick and simple. You may be asked not to eat for a few hours beforehand. Results usually come back within a few days, and your doctor will explain what they mean and next steps.

Treatment

Treatment for iron deficiency focuses on restoring your iron levels and treating the cause. This usually means changing your diet to include more iron-rich foods and, if your doctor recommends it, taking an iron supplement. If the cause is internal bleeding, your doctor will investigate and treat that as well.

Self-care at home

• Eat iron-rich foods such as lean meat, fish, eggs, beans, lentils, tofu, and dark green leafy vegetables
• Have vitamin C at the same time as iron-rich foods – for example, a glass of orange juice or some tomatoes – to help your body absorb iron
• Avoid tea and coffee close to mealtimes because they can block iron absorption
• Use a cast-iron pan when cooking, as it can add a small amount of iron to your food
• Do not take iron supplements on your own without talking to a doctor or pharmacist, as too much iron can be harmful

Medical treatments

Your doctor may prescribe an iron supplement and will tell you the exact dose and how long to take it. You will usually need to take it for several months to rebuild your iron stores. In some cases, such as if your body cannot absorb iron from tablets, iron may be given by infusion (through a drip) in a hospital. If the iron deficiency is caused by bleeding, you may need tests and treatment to stop the bleeding.

When is surgery considered?

Surgery is not normally needed for iron deficiency itself. However, if a bleeding ulcer or another source of bleeding in your digestive system is found, you may need a procedure or surgery to treat it. Your doctor will discuss this with you if it applies.

Living with this condition

Living with iron deficiency can be tough because the fatigue can affect work, family life, and social activities. Be patient with yourself. Most people start to feel better after a few weeks of treatment, though it can take a few months for your iron stores to fully rebuild.

Lifestyle tips

• Follow a balanced diet with iron-rich foods every day
• Get enough rest while your body recovers
• Keep a record of your symptoms so you can report back to your doctor
• Go to follow-up blood tests so you and your doctor can track progress

Diet and exercise

Gentle exercise, like walking or yoga, can help boost your energy, but do not push yourself when you feel very tired. Start slowly and build up gradually. Talk to your doctor about what level of exercise is right for you.

Mental health and emotional wellbeing

Constant tiredness can make you feel low, irritable, or frustrated. This is normal and understandable. If you notice your mood affecting your day-to-day life, tell your doctor or nurse. They can offer support and would not dismiss your feelings.

Prevention

In many cases, iron deficiency can be prevented. Eat a varied diet with plenty of iron-rich foods, and address any heavy or prolonged bleeding. If you have a health condition that affects iron absorption, keep up with follow-up appointments with your doctor.

Screening programmes

You may be checked for iron deficiency as part of routine care during pregnancy or if you have a long-term condition that raises your risk. There is no need for general screening in healthy adults, but your doctor may suggest a blood test if you have symptoms or risk factors.

Complications

If left untreated

• Iron deficiency anaemia can become severe, leaving you very weak, breathless, and less able to carry out everyday activities
• In pregnancy, untreated iron deficiency increases the chance of premature birth and low birth weight
• In children and teenagers, long-term iron deficiency can slow growth and affect learning and concentration
• In very severe cases, the heart has to work harder to carry oxygen, which can lead to an irregular heartbeat or heart failure

Long-term outlook

The outlook for iron deficiency is very good. With the right treatment and support, most people feel noticeably better within weeks and their iron stores return to normal within a few months. If an underlying cause is found and treated, the problem usually resolves and, with lifestyle changes, is unlikely to come back.

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