Here’s a fact that should stop you in your tracks: Roughly 20 percent of women under 50 are iron deficient, according to the National Heart, Lung and Blood Institute. Women in their 40s are particularly at risk because of the hormonal changes brought on by perimenopause, explains Monte Swarup, MD, FACOG, and founder of HPD Rx.
Many women confuse the symptoms of iron deficiency—fatigue, hair loss, restless legs, dizziness, sleeplessness, temperature changes—with symptoms of perimenopause itself. But the real culprit of your woes may be heavier bleeding during perimenopausal periods in your 40s. Heavier periods mean increased blood loss, which can lead to an iron deficiency when you can’t take in enough iron to keep up.
The good news, says Dr. Swarup, is that iron deficiency is easy to treat with supplements. Here’s what you need to know.
What exactly is iron?
Iron is an important mineral that’s a key ingredient of hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of your body. “It’s also essential for brain cell development and physical growth, and also helps vital functions in your body—things like focus, energy, GI processes, immune system function, and body temperature regulation,” explains Dr. Swarup.
Can you get enough iron through food?
For most people, the answer is yes, says Dr. Swarup. Some of the best sources of iron are red meat, organ meats, seafood, beans, nuts, and leafy greens. Vegetarians and vegans take note: Iron from animal sources is more easily absorbed by the body than iron from plant sources.
Your doctor may recommend supplementation if blood tests show you’re low in iron. The symptoms of deficiency can be vague and mimic other issues, especially if your levels are only mildly low. So, it’s wise to get your levels checked at your annual doctor visit.
How much iron do you need to consume each day?
Generally, the recommendation for adult women between 19 and 50 is 18 mg daily, but iron needs can be highly individual. How much you need each day depends on your age, diet, and whether or not you’re deficient.
What should you look for in an iron supplement?
Visit any drug store or Amazon and you’ll find endless options for iron supplements. Although iron is included in many multivitamins, Dr. Swarup recommends taking an iron-only supplement. “That’s because other nutrients in multivitamins can inhibit iron absorption,” he says.
The other thing to look for is how much “elemental iron” a supplement contains. Elemental iron is the amount that can be absorbed by your body. When reading labels, you’ll find different supplements use different sources of iron, such as ferrous sulfate or ferrous gluconate. There isn’t one that’s better than the other necessarily, but they do contain different levels of elemental iron (which may affect the dosage you need) and may have different side effects. Some people find certain sources to be constipating, for example.
The best advice? Work with your doctor to find the appropriate dose and source of iron for you, says Dr. Swarup. You may need to try a few different types before you find one that both improves your levels and that you tolerate well.
How often should you take an iron supplement?
Recent research suggests it’s best for absorption to take iron supplements every other day. It’s also best to take your iron pill with a glass of orange juice or a vitamin C supplement, as vitamin C has been shown to enhance iron absorption, says Dr. Swarup. Coffee, tea, and milk, on the other hand, have been shown to decrease absorption.
Amelia Harnish is a journalist with a focus on women, health, and culture. She’s written for Women’s Health, Cosmopolitan, New York Times, the Wall Street Journal, and more.
The Explainer: What Is Functional Medicine?