Iron deficiency anaemia

Overview

Iron deficiency anaemia is a common condition where your blood does not have enough healthy red blood cells because your body is low on iron. Iron is a mineral your body needs to make haemoglobin, the part of red blood cells that carries oxygen to your organs and tissues. Without enough iron, your body cannot deliver enough oxygen, making you feel tired and weak.

Yes, iron deficiency anaemia is very common. It affects about 1 in 5 women of childbearing age and about 1 in 50 men. It can happen at any age, but it is more common in women, people with heavy periods, pregnant women, people with gut disorders, and those who follow a vegetarian or vegan diet without enough iron-rich foods.

Anyone can get iron deficiency anaemia, but it is more likely in: women who have heavy periods, pregnant people, babies and young children (especially if they were born early or are not getting enough iron in their food), people with conditions that affect the gut (like coeliac disease or Crohn's disease), people who take anti-inflammatory medicines regularly, and people with chronic kidney disease.

Symptoms

Common symptoms

• Feeling very tired and lacking energy
• Shortness of breath, especially when you are active
• Heart pounding or feeling like it is racing
• Pale or 'washed-out' skin
• Headaches, feeling dizzy or lightheaded
• Cold hands and feet
• Brittle nails or nails that spoon outward
• Cracked corners of the mouth
• A sore or swollen tongue
• Unusual cravings for non-food items like ice, dirt, or starch (a condition called pica)
• Restless legs syndrome — an uncomfortable feeling in your legs that makes you want to move them

Symptoms in children

• Pale skin and lips
• Irritability or being fussy
• Poor appetite
• Slower growth and development
• Getting tired more easily than usual
• Breathing faster during play or feeding
• In babies, pale gums and frequent infections

Symptoms in older adults

• Confusion or feeling more forgetful than usual
• Feeling weak and unsteady on your feet, which can increase the risk of falls
• Shortness of breath during everyday activities like walking to the kitchen
• Worsening of other chronic conditions like heart failure or lung disease
• Unexplained tiredness that does not get better with rest

Causes

Main causes

• Blood loss: This is the most common cause. Examples include heavy periods, bleeding in the stomach or bowel from ulcers, polyps, or colon cancer, and frequent blood donation.
• Not enough iron in your diet: Eating too little iron-rich food like red meat, beans, lentils, dark leafy greens, and fortified cereals can lead to low iron stores over time.
• Poor iron absorption: Even if you eat enough iron, certain gut conditions (like coeliac disease, Crohn's disease, or after weight-loss surgery) can prevent your body from absorbing iron properly.
• Increased need for iron: Growing children, pregnant people, and athletes need more iron, and if they do not get it, they can become deficient.

Risk factors

• Being a woman of childbearing age (especially with heavy periods)
• Pregnancy and breastfeeding
• Being a vegetarian or vegan (if you do not eat enough iron-rich plant foods)
• Having a gut condition that affects absorption
• Taking antacids or medicines that reduce stomach acid for a long time
• Being a teenager (rapid growth increases iron needs)
• Chronic blood loss from conditions like a stomach ulcer or inflammatory bowel disease
• Regularly taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin

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 (such as 999 or 911) immediately.
• If you notice black, tarry stools or vomit that looks like coffee grounds, go to the emergency department right away — this could be a sign of serious internal bleeding.
• If you are pregnant and have any symptoms of anaemia, see your midwife or GP as soon as possible.

Book a routine appointment if:

• If you feel unusually tired for several weeks and have other symptoms like pale skin, shortness of breath, or rapid heartbeat.
• If you have heavy periods that cause soaking through pads or tampons every 1–2 hours.
• If you have a family history of anaemia or gut conditions like coeliac disease or Crohn's disease.
• If you are a vegetarian or vegan and feel tired despite a healthy diet.

Diagnosis

Your doctor will diagnose iron deficiency anaemia by asking about your symptoms, checking your medical history, and doing a blood test. The main test is a full blood count (FBC) to measure your haemoglobin and red blood cell levels. If you are anaemic, your doctor will also check your iron levels with a ferritin test. Sometimes additional tests are needed to find the cause, such as a stool test for blood, or an endoscopy to look at your stomach and bowel.

Tests that may be done

• Full blood count (FBC) – measures haemoglobin and the number of red blood cells
• Ferritin test – checks your body’s iron stores
• Serum iron and total iron-binding capacity (TIBC) – to see how much iron is in your blood
• Stool test for hidden blood (faecal occult blood test) – to check for bleeding in the digestive tract
• Endoscopy or colonoscopy – if internal bleeding is suspected
• In women, a gynaecological exam if heavy periods are a concern

What to expect at your appointment

Your doctor will explain the results and what they mean. If you have iron deficiency anaemia, they will discuss possible causes and treatment options. In many cases, you will be prescribed iron tablets (usually ferrous sulphate, ferrous fumarate, or ferrous gluconate) and you will be advised to eat more iron-rich foods. Your doctor may also recommend a follow-up blood test in a few months to check your iron levels have improved. They might refer you to a specialist if an underlying cause needs more investigation.

Treatment

Treatment for iron deficiency anaemia aims to raise your iron levels to normal and treat the underlying cause. Most people are prescribed iron supplements (tablets or liquid) and given dietary advice. If the cause is blood loss, that needs to be treated separately. In severe cases, iron may be given through an intravenous drip (IV iron) or a blood transfusion. Always follow your doctor's advice about how much iron to take and for how long.

Self-care at home

• Eat more iron-rich foods: red meat, liver (in moderation), poultry, fish, beans, lentils, tofu, dark leafy greens (like spinach and kale), dried fruit (apricots, raisins), fortified cereals, and whole grains.
• Combine iron with vitamin C: having foods rich in vitamin C (like oranges, strawberries, tomatoes, broccoli, peppers) at the same meal can help your body absorb more iron.
• Avoid drinking tea or coffee with meals: these drinks contain compounds that can reduce iron absorption. Wait at least an hour after eating before drinking them.
• If you take iron supplements, take them on an empty stomach or with a small amount of food to reduce stomach upset. But first ask your pharmacist or doctor for specific instructions.
• Do not take iron supplements without a doctor's guidance — too much iron can be harmful.

Medical treatments

The main medical treatment is iron replacement therapy. Your doctor may recommend iron tablets (usually ferrous fumarate, ferrous sulphate, or ferrous gluconate). These come in different strengths and doses. Some people have side effects like constipation, nausea, or dark stools. If tablets are not suitable or not helping, your doctor may give you iron as a liquid or as an intravenous (IV) infusion in a clinic or hospital. In severe anaemia with symptoms like chest pain or extreme shortness of breath, a blood transfusion may be given to quickly increase red blood cells. The underlying cause is also treated — for example, if you have a stomach ulcer, you might be given medicines to heal it; if you have heavy periods, your GP may recommend treatments like hormonal contraceptives or tranexamic acid (never start these without a doctor).

When is surgery considered?

Surgery is not a treatment for the anaemia itself. However, surgery may be needed to treat the cause of the blood loss, such as removing a bleeding polyp or repairing a stomach ulcer that does not heal with medicine. If you have heavy periods, surgery like endometrial ablation or fibroid removal might sometimes be considered after other treatments have been tried. Your doctor will discuss any surgical options with you.

Living with this condition

Managing iron deficiency anaemia usually means taking iron supplements as prescribed and adjusting your diet. You may need to take supplements for at least 3–6 months to build up your iron stores. During this time, be patient — your energy levels should improve gradually. If you have side effects from supplements, talk to your doctor or pharmacist about different formulations or tips to reduce discomfort. Keep up with follow-up blood tests so your doctor can check your progress.

Lifestyle tips

• Plan meals to include iron-rich foods and vitamin C (like a spinach and orange salad).
• Spread out your iron intake: eat small amounts of iron throughout the day rather than one large source.
• If you take iron supplements, set a reminder so you do not forget.
• Stay active at a level that feels comfortable — gentle walking or stretching can help, but listen to your body and rest when you need to.
• If you drink alcohol, do so in moderation, as heavy drinking can affect iron absorption and liver health.
• Keep a symptom diary to track how you are feeling — this can help your doctor adjust your treatment.

Diet and exercise

Aim for a balanced diet that includes a variety of iron-rich foods. For plant-based iron sources (non-haem iron) like beans, lentils, and spinach, pair them with vitamin C (for example, a squeeze of lemon over your lentils). For animal sources (haem iron) like lean red meat, poultry, and fish, your body absorbs this type more easily. Avoid drinking tea or coffee for an hour before and after meals. For exercise, start slowly: walking, yoga, or light cycling can improve circulation and energy. Do not push yourself too hard, especially if you feel dizzy or very tired. Talk to your doctor before starting a new exercise programme.

Mental health and emotional wellbeing

Living with iron deficiency anaemia can affect your mood and mental wellbeing. Constant fatigue, brain fog, and feeling unwell can lead to frustration, anxiety, or low mood. It can also affect your concentration and memory. It is important to acknowledge these feelings and talk about them — with your doctor, your family, or a counsellor. Treatment for the anaemia often improves mental symptoms, but if you continue to feel down, seek help. Remember, your mental health is just as important as your physical health.

Prevention

Not all cases can be prevented, but many can be. The best way to prevent iron deficiency is to eat a balanced diet with enough iron for your age and gender. People at higher risk — like women with heavy periods, pregnant women, and vegetarians/vegans — should pay extra attention to their iron intake. If you are at risk, talk to your doctor about whether you should have routine blood tests to check your iron levels before you become deficient. Iron supplements should not be taken preventively without medical advice, because too much iron can be harmful.

Vaccines

There are no vaccines to prevent iron deficiency anaemia, but keeping up with vaccinations for other conditions can help prevent illnesses that might lead to bleeding (for example, hepatitis B or H. pylori infection) — though this is not a main prevention strategy.

Screening programmes

Routine screening for iron deficiency is not recommended for everyone, but your doctor may suggest it if you are in a high-risk group. For example, pregnant women are routinely screened at their antenatal appointments. Also, if you have a family history of anaemia or a condition like coeliac disease, your doctor may check your iron levels from time to time.

Complications

If left untreated

• Heart problems: Your heart has to work harder to pump oxygen around the body, which can lead to an irregular heartbeat (arrhythmia), an enlarged heart, or even heart failure.
• In pregnancy: Iron deficiency anaemia increases the risk of preterm birth, low birth weight, and postpartum depression.
• In children: Untreated anaemia can slow growth, delay development, and increase the risk of infections.
• Restless legs syndrome can become more severe and disrupt sleep.
• Chronic fatigue can affect your ability to work, study, or enjoy daily life.
• Severe anaemia can lead to a condition called 'pica' (craving non-food items like ice, dirt, or clay), which can be harmful.

Long-term outlook

The outlook for iron deficiency anaemia is very good. Once diagnosed and treated, most people feel much better within a few weeks, although it may take a few months for your iron stores to fully replenish. With proper treatment and follow-up, complications are rare. If the cause is a chronic condition (like a gut disorder), you may need to manage your iron levels long-term, but you can still live a full and active life. The key is to work with your healthcare team and not ignore symptoms.

Find support

International organisations

• World Health Organization (WHO) – Anaemia ↗
• NHS UK – Iron deficiency anaemia ↗

Local organisations

• Your local GP practice or health centre · All regions
• Dietitian (ask your doctor for a referral) · All regions

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