Iron deficiency is one of the most common nutritional problems worldwide and one of the most common reversible causes of fatigue, breathlessness, and brain fog. It’s also commonly under-treated — many patients are told their "iron levels are normal" when their ferritin is still suboptimal for symptom resolution. Proper assessment and treatment changes lives.
Educational information — not a substitute for clinical assessment
This page describes iron deficiency and iron deficiency anaemia in general terms to help you decide whether assessment may be helpful. It is not a diagnostic tool. If you recognise yourself in what follows, please book a consultation.
Iron is essential for producing haemoglobin (the protein in red blood cells that carries oxygen), myoglobin (in muscles), and various enzymes throughout the body. Iron deficiency progresses through stages:
Importantly, symptoms can develop at the first stage — before anaemia develops. Many patients are told "your haemoglobin is normal" while their ferritin is dramatically low and their symptoms entirely due to depleted iron stores.
of pre-menopausal UK women are iron deficient. Many more have ferritin below optimal range. Most don’t know it.
Iron deficiency can cause symptoms across many systems:
By far the largest group. Menstrual blood loss is the dominant cause. Women with heavy periods are at particular risk — see our HMB page. Even women with "normal" periods often have ferritin below optimal levels.
Increased requirements; common cause of fatigue in second and third trimesters. Routine antenatal screening usually identifies it.
Plant-based iron is less well absorbed than animal-source iron. Most can maintain adequate levels with good planning but some develop deficiency.
Particularly endurance athletes (running, cycling). Multiple contributors: increased turnover, foot-strike haemolysis, gut malabsorption.
Coeliac disease, inflammatory bowel disease, gastric surgery, atrophic gastritis all impair iron absorption.
Iron deficiency anaemia in older patients (particularly men or post-menopausal women) warrants careful investigation for gut blood loss, including from cancer.
Iron deficiency has three main mechanisms:
Iron deficiency anaemia in men, in post-menopausal women, or in anyone over 50 with no obvious cause (e.g. heavy periods) warrants careful investigation for gut blood loss. NICE guidance recommends gastrointestinal investigation (gastroscopy and/or colonoscopy) in these groups to exclude treatable conditions including bowel cancer. We don’t just replace iron and move on.
Symptoms, duration, menstrual history (women), bowel habit, dietary history, family history, medications, previous iron treatment if any, weight changes, other symptoms.
Looking for signs of iron deficiency (pallor, koilonychia, glossitis), checking for sources of blood loss, abdominal examination, rectal examination where indicated.
Targeting both treatment and investigation of the cause.
Useful for maintenance, less useful for treating established deficiency. Animal-source (haem) iron is more absorbable than plant (non-haem) iron:
First-line treatment for established deficiency. Several preparations exist with varying tolerability. Common approach: starting dose for several weeks, retest at 3 months, continue until ferritin reaches target. UK law prevents naming specific medications; choices are discussed in consultation.
Common challenges with oral iron:
Strategies: take with food (slightly reduces absorption but improves tolerability), alternate-day dosing (newer evidence suggests this may improve absorption and reduce side effects), try different preparations if one isn’t tolerated.
For patients in whom oral iron isn’t working or isn’t tolerated, or where rapid replenishment is needed (e.g. pre-surgery, severe symptoms). See dedicated section below.
Heavy periods, gastrointestinal sources, coeliac disease, etc. — treating these prevents recurrence.
IV iron has become much more accessible in recent years with development of newer preparations that allow rapid, well-tolerated infusion. Indications include:
The infusion typically takes 15–30 minutes. Patient must be observed for a period after. Side effects can include temporary changes in taste, mild flu-like symptoms, and rarely allergic reactions (the reason for observation). We can arrange IV iron through our facility or partner providers.
Once levels are restored, maintenance includes:
Consider booking if:
Reference ranges allow ferritin as low as 15–20 to be classed as "normal," but many patients have symptoms until ferritin is 50–70 or higher. For hair regrowth, restless legs, and fatigue, levels above 70 are often needed. We discuss target levels individually.
NHS reference ranges identify clinical deficiency at the population level, but don’t target optimal levels for individual symptom resolution. Many patients with ferritin 20–50 are told they’re "fine" when they actually have symptoms of iron depletion.
Oral iron raises ferritin slowly — typically 3–6 months to fully replenish stores. IV iron acts within days to weeks but takes longer for some clinical benefits (e.g. hair regrowth) to appear.
Current consultation, blood test, and treatment prices are on our Fees page. IV iron is the most expensive option (several hundred pounds for the infusion plus consultation) but transformative for many.
Most UK PMI policies cover iron deficiency assessment and treatment. IV iron coverage varies. We provide procedure codes.
Low-dose iron supplements (e.g. as part of a multivitamin) are generally safe. Higher doses without confirmed deficiency aren’t recommended — iron overload is a real concern in some genetic conditions and unnecessary supplementation can cause GI side effects.
Yes — vitamin C enhances non-haem iron absorption. Taking iron supplements with orange juice or a vitamin C supplement is reasonable.
Yes — iron is involved in neurotransmitter synthesis. Some patients with low ferritin notice mood improvement with replenishment. Worth checking iron in anyone with new or persistent mood symptoms.
Yes, without addressing the underlying loss. Treatment of heavy periods (see HMB page) plus iron replenishment usually solves the problem. Some women benefit from low-dose maintenance iron long-term.
Care at MHW Clinic is delivered by a small clinical team, with Dr Haydar Bolat as Clinical Director. The specific clinicians involved in your care depend on the plan agreed with you at consultation.
UK-registered GP and Clinical Director at MHW. Conducts comprehensive iron deficiency assessments including history, examination, full iron panel, investigation of underlying cause, oral iron supplementation, and arrangement of IV iron where appropriate.
View profileLanguages spoken across the team: English, Turkish, Bulgarian, Bengali, Hindi, Albanian, Azerbaijani, German, Romanian. We can also arrange professional telephone interpreters in most other languages at no extra cost. More on languages and interpreters →
This page was reviewed by Dr Haydar Bolat, Clinical Director at MHW Clinic. Content is based on NICE Clinical Knowledge Summaries on anaemia — iron deficiency, British Society of Gastroenterology guidance, and current UK clinical practice and current UK clinical practice. It is updated when guidance changes. Educational information only — not a substitute for clinical assessment.
Book an appointment for proper assessment, identification of cause, and a treatment plan that actually works for you.