Iron deficiency has quietly become one of the most widespread issues affecting women’s health – and if you’re seeing it in your friends, clients, or yourself, you’re not imagining it.

Fatigue, breathlessness, poor sleep, hair shedding, dizziness, low mood, brain fog, burning muscles during exercise, PMS, and cold hands and feet are now so common that many women assume they’re “just part of life.” But in reality, they’re might be the sign of chronically low iron stores.

But it’s not just about eating more red meat.
Modern women are living in a physiology that actively blocks iron absorption.

This is the iron story no one is talking about.

The Modern Iron Crisis: Why So Many Women Are Running on Empty

1. Stress Physiology Shuts Down Iron Absorption

Chronic stress isn’t just a mental experience. It literally reshapes how your body handles nutrients.

When cortisol stays high, your liver produces a hormone called hepcidin, which literally blocks iron from crossing the gut wall into the bloodstream.

Think of hepcidin as your body’s “iron gatekeeper.”
In stress mode, the gate stays shut.

This means you can eat the most perfectly cooked grass-fed steak… and absorb almost none of the iron from it.

For women living in a constant low-grade stress response; juggling careers, families, emotional labour, and internal pressures, this is a huge, unseen driver of iron deficiency.

2. Low Stomach Acid is at Epidemic Levels

Contrary to popular belief, most people with reflux or indigestion have low stomach acid, not too much.

Women are especially prone to low stomach acid due to:

• chronic stress
• perimenopause
• thyroid issues
• postpartum depletion
• long-term use of antacids or PPIs
• under-eating (especially protein)
• high-caffeine lifestyles

Iron needs stomach acid to be converted into its absorbable form.
Without enough acid, it can simply pass through the gut unused.

Low stomach acid also reduces the absorption of:

• B12
• copper
• zinc
• protein
  – all necessary for healthy iron metabolism.

3. Inflammation Turns Off Iron Uptake

Even if you don’t “feel inflamed”, inflammation signals the body to increase hepcidin (the iron-blocking hormone). This happens because pathogens love iron, so the immune system hides it during infection.

But in today’s world, inflammation is chronic and subtle:

• IBS or bloating
• dysbiosis
• food sensitivities
• histamine issues
• perimenopause hormone swings
• autoimmune thyroid or other autoimmune issues
• high stress
• poor sleep
• metabolic dysregulation

When inflammation is present, the body behaves as if it’s “unsafe” to absorb iron. So ferritin drops, and supplements often don’t work.

4. Heavy Periods Are Common – But Not Normal

Many women are losing more iron than they can physically replace.

“Normal” healthy menstrual bleeding is 30–40ml.
Many women lose double or triple that through:

• low progesterone
• estrogen dominance
• copper IUD
• endometriosis
• fibroids
• thyroid issues
• perimenopause
• nutrient deficiencies
• chronic stress

Even the smallest increase in monthly blood loss can drain iron stores rapidly. To add insult to injury, the lower your iron stores, the heavier your period can be. 

5. Gut Health Problems 

Iron is absorbed in the duodenum – a delicate, easily disrupted part of the gut. When it’s inflamed or imbalanced, absorption drops dramatically.

Common culprits include:

• SIBO
• IBS
• H. pylori
• gluten sensitivity
• post-antibiotic dysbiosis
• intestinal permeability
• low digestive enzymes

This is why so many women have low iron despite eating “very well.”

6. Copper Deficiency is Increasing

Copper is essential for:

• getting iron out of cells
• converting it into haemoglobin
• recycling iron internally
• regulating inflammation
• stabilising mast cells

But modern lifestyles deplete copper:

• excess zinc supplementation
• stress
• low stomach acid
• vegan or low-meat diets (meat has an ideal ratio of copper and iron)
• hormonal contraception
• HRT without mineral support

Low copper looks exactly like iron deficiency – and can make ferritin almost impossible to raise.

7. Perimenopause Changes Iron Dynamics

Hormonal fluctuations can cause:

• heavier or irregular bleeding
• lower stomach acid
• decreased thyroid efficiency
• more inflammation
• increased stress sensitivity
• shifts in gut bacteria

Even women who never struggled with iron suddenly find themselves depleted in their late 30s to mid-40s.

8. Chronic Under-eating is Normalised

Iron absorption requires:

• adequate calories
• protein
• vitamins
• minerals
• healthy fats
• a regulated nervous system

But many women are unintentionally under-fuelling due to:

• dieting history
• skipping meals
• “clean eating” but low-protein habits
• emotional eating but poor nutrient intake
• intermittent fasting
• adrenal fatigue patterns

It’s hard to fix iron when the body perceives scarcity.

9. The Problem with “Eat More Leafy Greens” 

Many women with low ferritin are told to eat more leafy greens and legumes. 

While well intentioned, this advice doesn’t reflect how iron physiology actually works.

There are two types of iron in food:

Heme Iron

Found in red meat, poultry and fish.
This is the form your body recognises and absorbs efficiently.

Absorption rate: approximately 15–35%.

It is absorbed via a specific transporter in the gut and is far less affected by inhibitors.

Non-Heme Iron

Found in spinach, lentils, beans, fortified cereals and plant foods.

Absorption rate: approximately 2–10%.

And that’s under ideal conditions.

Non-heme iron must first be converted into a different chemical form before absorption. It is easily blocked by:

• phytates (grains, legumes)
• tannins (tea, coffee)
• calcium
• low stomach acid
• gut inflammation

Spinach does contain iron.
But it also contains oxalates, which inhibit iron absorption.

So telling a woman with a ferritin of 18 to “eat more leafy greens” is not just simplistic, it can be physiologically unrealistic.

This doesn’t mean plant foods are bad.
It means bioavailability matters.

Why “Normal Range” Doesn’t Mean Optimal

This is where things get particularly frustrating for women.

In the UK, ferritin reference ranges often list anything above 10 µg/L as “normal.”
Some labs use 20 or 30 as the lower limit. The NICE guidelines in the UK confirm iron deficiency in people with a ferritin of less than 30 micrograms/L.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/

But it still means a woman with a ferritin of 27 is often told her iron is normal when she could be struggling.

Ferritin below 30 is associated in the literature with:

• fatigue
• hair shedding
• reduced exercise tolerance
• restless legs
• low mood
• impaired thyroid function
• reduced cognitive performance

Many functional medicine practitioners and nutritionists consider:

• <30 µg/L = deficient
• 30–50 µg/L = suboptimal for many women
• 50–100 µg/L = optimal range for symptom resolution

You can technically be “in range” and still be deeply symptomatic.

Reference ranges are based on population averages – not optimal physiology.

And when a large portion of the population is depleted, the average shifts downward.

So 27 may be statistically normal.
But it is rarely metabolically optimal.

But Here’s the Hopeful Part…

Low iron isn’t a “female curse.”
It’s a biology-under-stress issue.

When we support the root causes – digestion, minerals, hormones, and the nervous system – iron levels can restore and symptoms transform.

Women begin to feel:

• calmer
• clearer
• warmer
• stronger
• more resilient
• better slept
• hormonally balanced
• emotionally stable

Iron is not just a mineral – it’s a metabolism, mood, and energy transformer.

So What Can You Do If You Suspect Low Iron?

Get proper testing:
Blood ferritin alone is not enough. A full panel (ferritin, iron, TIBC, transferrin saturation, CRP, thyroid markers, B12, folate, copper, zinc) tells the real story.

Support digestion:
Stomach acid, bitters, stress regulation, chewing well and slowing down at meals.

Address inflammation:
Gut support, stress reduction, sleep, anti-inflammatory nutrition.

Check mineral balance:
Especially copper and zinc.

Balance hormones:
Support progesterone, stabilise cycles, nourish metabolism (make sure you’re eating enough).

Reduce stress signals:
Breathwork, Pilates, nervous system regulation, boundaries!.

These are the same mechanisms we support through coaching, functional nutrition, and lifestyle medicine.

Final Thoughts

Women aren’t failing to get enough iron.
Our systems are overwhelmed, under-resourced, and inflamed – and iron is caught in the crossfire.

When we restore safety to the body, nourish deeply, and support the foundations of digestion, hormones, minerals, and the nervous system, iron levels rise naturally.

If low iron is something you struggle with personally or see frequently in women you work with, know that it’s not always about diet. It’s your physiology and it can be healed. I work 1-1 with women who struggle with this, so do reach out to me if I can help.