Iron Deficiency

Overview

Iron deficiency is when your body does not have enough iron. Iron is a mineral that helps make red blood cells, which carry oxygen to all parts of your body. Without enough iron, your body cannot make enough healthy red blood cells, and you may feel tired and weak.

Yes, iron deficiency is one of the most common nutritional problems worldwide. It affects people of all ages, but it is especially common in women of childbearing age, pregnant women, and young children.

Iron deficiency can affect anyone, but it is more common in people who lose blood (such as women with heavy periods), people with a diet low in iron (like vegetarians or vegans), people with gut conditions that affect absorption (like coeliac disease), and infants and young children during rapid growth.

Symptoms

Common symptoms

• Feeling very tired and weak
• Pale skin
• Shortness of breath, especially with activity
• Dizziness or lightheadedness
• Cold hands and feet
• Brittle or spoon-shaped nails
• Unusual cravings for non-food items like ice, dirt, or starch (this is called pica)

Symptoms in children

• Slow growth and development
• Frequent infections
• Poor appetite
• Being irritable or fussy
• Short attention span

Symptoms in older adults

• Confusion or memory problems
• Falls due to weakness or dizziness
• Worsening of heart conditions like angina or heart failure

Causes

Main causes

• Blood loss: heavy periods, or slow bleeding in the stomach or intestines (from an ulcer, polyp, or cancer)
• Not getting enough iron in your diet: especially in vegetarian or vegan diets, or in diets low in red meat, beans, and leafy greens
• Poor absorption: conditions like coeliac disease, Crohn's disease, or after stomach surgery reduce how much iron your body absorbs

Risk factors

• Being a woman of childbearing age (due to periods)
• Pregnancy or breastfeeding
• Being a vegetarian or vegan
• Frequent blood donation
• Taking medicines that can cause bleeding, such as aspirin or ibuprofen
• Having a condition that causes inflammation in the gut (e.g., inflammatory bowel disease)
• Being an infant, especially if born early or with low birth weight

When to see a doctor

See a doctor urgently if:

• If you have chest pain, severe shortness of breath, or feel like you might faint, call your local emergency number (999 in the UK) or go to the nearest emergency room.
• If you notice blood in your stool (red or black) or vomit, see a doctor urgently.

Book a routine appointment if:

• If you have ongoing tiredness, pale skin, dizziness, or other symptoms that last more than a few weeks
• If you have heavy menstrual bleeding that affects your daily life
• If you are pregnant and feel very tired or have other symptoms

Diagnosis

Iron deficiency is diagnosed with a blood test. Your doctor will check your iron levels and red blood cell count. They will also talk to you about your symptoms, diet, and medical history to find the underlying cause.

Tests that may be done

• Full blood count (FBC) — to measure red blood cells and haemoglobin
• Ferritin test — to check the amount of iron stored in your body
• Iron studies — to see how well iron is being used
• Further tests if bleeding is suspected, like a stool test for hidden blood

What to expect at your appointment

A blood sample will be taken from your arm. The test is quick and may cause a small sting. Results usually come back within a few days. Your doctor will explain the results and discuss next steps.

Treatment

Treatment for iron deficiency focuses on two main goals: restoring your iron levels and fixing any underlying cause. Most people will take iron supplements and make changes to their diet. In some cases, your doctor may need to treat a condition causing iron loss, like an ulcer or heavy periods.

Self-care at home

• Eat iron-rich foods: red meat, poultry, fish, beans, lentils, tofu, spinach, kale, dried fruit, and fortified cereals
• Pair iron-rich foods with vitamin C (like oranges, strawberries, or bell peppers) to help absorption
• Avoid drinking tea or coffee with meals, as they can reduce iron absorption
• Cook in a cast-iron skillet to add a small amount of iron to your food

Medical treatments

Your doctor may recommend iron supplements taken by mouth (tablets or liquid). These are usually taken once daily, but your doctor will tell you the right amount and timing. Some people experience side effects like constipation or stomach upset. If tablets do not work or cause problems, iron may be given through a drip in a vein (intravenous iron) at a clinic or hospital. Always follow your doctor's advice — do not take extra iron without their guidance, as too much can be harmful.

When is surgery considered?

Surgery is rarely needed for iron deficiency itself. However, if the cause is a bleeding source like an ulcer, polyp, or tumour, a procedure (such as an endoscopy) or surgery may be necessary to stop the bleeding.

Living with this condition

Most people start to feel better within a few weeks of starting treatment, but it can take several months for your iron stores to fully recover. Continue taking your supplements as directed by your doctor, even if you feel better. Keep up a healthy diet and attend follow-up appointments to check your levels.

Lifestyle tips

• Take your iron supplement at the same time each day, with a glass of orange juice or water, but not with milk, tea, or coffee
• If you have heavy periods, talk to your doctor about options to reduce bleeding
• Stay hydrated and get enough sleep to help with fatigue

Diet and exercise

Eat a balanced diet that includes a variety of iron-rich foods. Gentle exercise like walking or yoga can boost your energy and mood, but listen to your body and rest if you feel worn out. If you have severe anaemia, avoid strenuous activity until your levels improve.

Mental health and emotional wellbeing

Iron deficiency can affect your mood, concentration, and energy, which may lead to feelings of frustration or low mood. It is normal to feel this way. Talk to your doctor if you feel anxious or depressed — they can offer support. Remember, treatment usually helps you feel better over time.

Prevention

In many cases, yes. Eating a diet rich in iron, including meat, beans, and leafy greens, can help prevent deficiency. For people at high risk — such as pregnant women or those with heavy periods — your doctor may recommend regular blood tests and supplements as a preventive measure. Managing underlying conditions like ulcers or heavy bleeding also helps.

Screening programmes

Routine blood tests may be offered to people at higher risk, such as pregnant women, infants, and those with chronic gut conditions. Talk to your doctor about what is right for you.

Complications

If left untreated

• Severe anaemia (very low red blood cells), which can cause extreme fatigue and weakness
• Heart problems: an enlarged heart, irregular heartbeat, or heart failure
• Increased risk of infections
• Pregnancy complications: premature birth or low birth weight
• In children, delayed growth and learning difficulties

Long-term outlook

The good news is that iron deficiency is highly treatable. Most people recover fully once they get enough iron and address the cause. With proper care and follow-up, you can prevent it from coming back and enjoy good health.

Find support

International organisations

• World Health Organization (WHO) — Nutrition ↗

Local organisations

• NHS (UK) — Iron deficiency anaemia ↗ · United Kingdom
• British Dietetic Association ↗ · United Kingdom

Helplines

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