132. Low Iron, High Impact: How Ferritin Affects Energy, Periods, and Ovulation

Fatigue that won’t lift. Hair shedding. Shortness of breath during workouts. Heavy periods that leave you drained. In this episode of Cycle Wisdom, Dr. Monica Minjeur breaks down how low iron—especially low ferritin—can quietly disrupt ovulation, energy, and menstrual health, even when blood counts are “normal.” Through Quinn’s story, you’ll learn how iron deficiency impacts hormones, why ferritin matters more than you think, how to test correctly, and how to rebuild iron stores safely and effectively.

If you suspect iron may be playing a role in your symptoms—or you’ve been told everything is “normal” but don’t feel like yourself—personalized evaluation matters.
 Request a free discovery call at radiantclinic.com to learn how our team helps restore energy, balance cycles, and promote fertility.

Transcript

Speaker 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if your mystery, fatigue, hair shedding, and exercise intolerance weren't just stress, but low iron, quietly sabotaging your cycles and your energy? Today we're going to unpack how iron status affects ovulation, menstrual flow, and most importantly, your energy levels. We'll discuss how to test it the right way and what actually helps you to refill the tank for good. So let's get started with the story about Quinn. Now, Quinn came to see us at about 34 years of age. She was trying for baby number two. However, she mentioned to us at the first visit that she was feeling exhausted. She was short of breath during light workouts, got lightheaded when she was climbing a flight of stairs and anxious that her cycles were seeming to. Stall out. She wasn't having ovulation happen consistently, and her periods were very heavy the first couple of days. Her last doctor had told her that her blood counts were normal, so she worried that there was something else going on. We started as always, with getting some charting of her cycles, which revealed cycles happening approximately every 28 to 30 days, which was quite normal. However, she did have extremely heavy flow on the first couple days of her cycle. In fact, she noted that she was changing her menstrual products every one to two hours throughout the day and having to use double protection in order to avoid bleeding. Through her initial labs from her past doctor were reviewed, which showed that she had a normal blood count, but she did not have any iron stores checked. So when we started with blood work for Quinn, we started off with checking our normal hormone panel because at that time we weren't sure exactly what was going on. We always include checking a ferritin, which is a marker of your iron stores. Now iron stores aren't just what's circulating in your bloodstream, but also what your body is storing up in the bone marrow and in other places to be able to produce more hemoglobin or more blood cells when it's needed. In Quinn's case, her ferritin was quite low at 12. Now, normally we like to see that at least at a minimum, 15 or above, but most people feel better when we're in the 30 to 40 range or higher. Her thyroid was normal. She did have some mildly low progesterone after her ovulation, and we also ordered an ultrasound to further assess why she might be having this heavy bleeding. We did find that she had a significant. Two and a half centimeter fibroid that could likely be contributing to that heavy bleeding. So while we awaited surgical evaluation for that fibroid, we worked on repleting, her iron stores. So this meant helping to increase specifically different foods that could increase iron. And we also added in an iron supplement. Unfortunately, Quinn was unable to tolerate the oral supplement, which can be common. And we'll talk about some troubleshooting for this a bit later. And she ended up actually having an IV iron infusion, which helped her to feel better quite quickly. She did get the fibroid treated by one of our local gynecologists and had it removed Hysteroscopically, and we worked on balancing the remainder of her hormones to try and offset some of the excess bleeding that she was experiencing. In the meantime. After the fibroid was treated and after we were restoring the iron counts, we were able to see that Quinn's energy rebounded. Her new menstrual cycle flow regulated down to just four or five moderate days, and over time she felt more like herself. So why does iron matter and why is it so overlooked? Iron is crucial for oxygen delivery. If you have low iron stores or low ferritin, it can mean that you're getting less oxygen to. All of the tissues in your body, your brain, your ovaries, your uterus, your muscle, tissues, and iron is this crucial for stabilizing blood counts because it is the major building block required for hemoglobin because it is what binds the oxygen to those red blood cells. If you have troubles with low iron stores. This can lead to decreased hemoglobin or blood counts, which is oftentimes seen with symptoms like fatigue, brain fog. Heart palpitations, headaches, reduced exercise tolerance and cycles that can feel heavier or more erratic. So it's really important to check ferritin because again, that tells you your iron reserve, not just the snapshot. And as was seen in Quinn's case, you can have a normal hemoglobin or be told you don't have anemia. You can still have low ferritin or depleted iron stores, and this is why it's so important to understand the full picture of why you are having issues. Things that oftentimes will show up with your menstrual cycle if your ferritin levels are low, can actually be heavier periods leading to that iron loss, continue to create heavier cycles. Again, as I mentioned, shortness of breath or dizziness oftentimes will worsen around the time of your menstrual cycle when you're losing more blood, and we oftentimes will also see losing hair that telogen effluvium that we talked about a couple of weeks ago in our episode, all about post pill acne and hair loss. This telogen effluvium also is this stressful state where your body cannot have enough of that ferritin in order to help boost your counts. And finally, we oftentimes will see impaired ovulation, quality and instability of your luteal phase. If you are chronically under fueled or chronically not able to have enough energy in order to restore those blood counts over time, your ovulation quality can decrease over time. Now, most importantly, when we find low iron or low ferritin, we want to understand why that's happening in the first place. Now, very commonly it can be from heavy menstrual bleeding, and we always need to make sure that we're ruling out any anatomic causes. So fibroids are a common reason that we can see heavy bleeding like we saw for Quinn. You can also have endometrial or cervical polyps, so again, benign tissues, benign growths, but these can increase your chance of bleeding or have heavier bleeding. Chronic endometritis is another reason why you can have ongoing bleeding and it may not be associated with heavy bleeding, but if you're having an increased number of days of total bleeding or spotting or brown bleeding throughout your cycle, chronic endometritis can be a cause of that. Again, we discuss chronic endometritis in more detail in episode 113. We also can see hormone imbalances causing heavy bleeding. So for example, women that have especially high estrogen or estrogen dominance, or a low progesterone, or sometimes both. In those cases, that lining of the uterine wall can become thicker because of the excess estrogen. So when you have a period, there is more tissue that needs to be eliminated. And finally, if you're somebody who has an IUD or is on birth control, sometimes the hormones from that can also lead to irregular or erratic or heavy bleeding. Again, it doesn't have to be that you bleed really heavy for just a couple of days. For some people, it can be prolonged bleeding throughout their entire cycle. So basically the body is just not able to keep up with restoring and replacing the blood loss in a timely fashion if you don't have enough of the iron that's around. Now other reasons that you can have low ferritin or iron include being depleted after delivering a baby. As many women know or realize that have been through a delivery, you can lose a lot of blood during this timeframe. And if you don't restore that by helping to nourish your body, it can be difficult to make up for those iron losses. Another common cause that we see within our practice is either low iron intake or issues with absorbing the iron. So for some people that have food sensitivities like celiac disease, if they don't know and they're still having a lot of inflammation in their gut, or maybe you're somebody with low stomach acid. So we see this in patients who are on chronic medications to help with acid reflux. It can sometimes impair your body's ability to absorb iron. We also can see issues with gut microbiome, meaning my gut bacteria is not absorbing those things well. So whether that is manifested as full-blown bacterial overgrowth as in the case with small intestinal bacterial overgrowth or h pylori, which is a bacteria that can live in your gut. Any of these things can impair your body's ability to absorb iron. And then the other piece of this is if you're not getting enough iron in, so we'll talk about certain foods that can help this, but especially in people that may be following a vegetarian or vegan diet, it can be a little bit difficult in order to get enough iron in unless they are specifically focusing on increasing iron stores. And then finally we do occasionally see that women who either donate blood frequently or plasma can also be quite low in iron. And so we typically will recommend stopping blood donations or plasma donations while we try to help boost the iron stores. All right, so how do we evaluate if I have low iron, low iron stores, low blood counts? What does all of this look for? Now, if you have not already had a complete lab work panel done, that's typically where we would start a complete blood count, which includes your hemoglobin hematocrit, and something called your mean corpuscular volume, which basically tells us the overall. Size of your blood cells. Most commonly, if you have iron deficiency, your blood cells are going to be smaller in size overall, even if the number of those cells is normal. Obviously. We also want to check that ferritin. That's really the crucial marker for us is looking at your iron stores and in some cases, if your picture isn't clear, we can do a complete iron panel, which includes your total iron counts. And other markers like transferrin or your total iron binding capacity. All of this can help us to discern if iron stores are the culprit or if there may be something else going on with your body's inability to produce enough red blood cells. Again, as was the case for Quinn, oftentimes we don't know everything that's going on initially just by looking at charting and history. So we typically are also evaluating for other things that can have overlap symptoms of fatigue or energy loss, including a full thyroid panel. Looking at the luteal phase labs and considering other vitamin deficiencies. Again, I, I'm always checking for vitamin D and vitamin B12 deficiencies, and especially if I see that you are deficient in all of your vitamins and you have a fairly healthy, well-rounded diet, it does lead me to consider more heavily if we're having absorption issues from a standpoint of your gut. And then finally, we always want to make sure we include that ultrasound and consider evaluation for chronic endometritis. Again, always looking for any anatomical issues that may be causing that excess bleeding, like fibroids or polyps or an excessively thick uterine wall whining. So when it comes to treatment, there are a couple of different avenues we take here. The first is going to be the short term, which means we need to restore those iron counts. Now I am a big fan of focusing on foods that will be rich in iron to start with, primarily because they're typically easier to digest and will help us to sustain things for the long run. So things that are high in iron sources of that heme gonna be any red meats. So beef, lamb. Liver. If you can tolerate that dark meat for chicken or Turkey, always want to be pairing any iron based foods along with vitamin crich foods. It helps it to absorb better and your body is able to bind it better. So think about having oranges or citrus fruits or other high vitamin C rich foods along with your red meats. Now, maybe you're somebody who's a vegetarian or you don't prefer red meats. There are lots of other ways that you can get iron into your diet. Any legumes, beans, lentils, almonds, cashews, and especially green leafy vegetables. So for our patients that are struggling with iron deficiency, I recommend that they aim for at least two to three servings per day of the green leafy veggies like spinach, broccoli, brussel sprouts, kale. You can put these into a smoothie, you can hide them in whatever else you're making for the day. But those are great ways to get a good source of iron in. And again, enhancing absorption with those vitamin C rich foods and ideally trying to avoid tea or coffee with those iron rich meals. It tends to impair your body's ability to absorb those things Now. If the food sources are not enough, we can also talk about adding in oral iron. So generally, my recommendation for oral iron is going to be Ferris sulfate or Ferriss gluconate, um, or in some cases Ferris BIS glycinate. Now those are all different forms of iron and some people tolerate them differently. Now we recommend starting with a low dosage or even trying every other day, and. Dead to help improve absorption and reduce GI side effects. Many, many people get GI upset or especially constipation when they start on iron again, always taking your iron along with vitamin C. In fact, many formulations do contain vitamin C right along with it, and I will say that many of our patients do better with utilizing. Liquid iron drops versus a tablet or a capsule. So if you can't tolerate the tablet or the capsule version, the oral version of Liquid Iron may tolerate better for you. And again, if you're not able to tolerate the oral iron. Or if you're not able to get enough into the dietary intake in order to bring the levels up, we do occasionally recommend those IV iron infusions. Again, if your ferritin or your blood counts are incredibly low from the start, we oftentimes will consider that. Or if you're not able to absorb it well or have some other GI absorption issue that may be causing issues. Now again, increasing the iron stores is step one. But that doesn't always fix the underlying problem. So again, we always want to be making sure that we're addressing the long-term issue, stop the excess blood loss, if that's going on. So again, treating or removing fibroids or polyps, if that's part of the problem. Treating chronic endometritis with targeted antibiotics. Treating chronic endometriosis if that is causing the estrogen excess, or creating increased inflammation leading to heavier bleeding, and again, balancing the hormones. Oftentimes women need that luteal phase support, especially if they have short luteal phases or if they have significant estrogen dominance. And finally always making sure that we're reassessing rechecking ferritin levels and they can take quite a while to come up. In many women, they find eight to 12 weeks before we see the ferritin actually start to increase. If your ferritin levels increase, but you still have symptoms present, make sure that all of the other pieces have been evaluated again, thyroid, vitamin D, vitamin B12, checking for other things like sleep disturbances or other issues that may be leading to the fatigue and the energy defic. So again, we'll wrap it up here today with a few of the commonly asked questions that we get. Well, my blood count is normal. Could I still have low iron? Yes, as was the case with Quinn, low iron counts or low ferritin can come well before anemia or seeing those blood counts actually tank, and this is why it's so important to check those iron stores. Another question we get asked, what is the ideal ferritin level that I should aim for? Now, as I mentioned, targets are very individualized and in our world, I say minimum of 15, however many of our patients feel better as their stores rise out of those low teen numbers into the 20, 30, 40 range. Your plan should be personalized to you. Where do you feel best? Where do you feel like you've got better energy levels and more stability? All right. How about how long until I feel better? Again, it can take four to six weeks or sometimes longer of consistent iron repletion before those energy levels have improved. And again, telogen effluvium or that halting of hair growth can mean that hair changes won't be present for six to 12 months or more in some cases. So stick with it. Try and continue to keep up with those iron stores of repletion, and oftentimes we'll see those symptoms improve over time. And then finally, will progesterone make my periods lighter? Well, this is kind of a mixed question because if your heavy flow is because of a weak luteal phase or estrogen dominance cycle, timed progesterone can help to stabilize the endometrium. However, it is again, not the long-term fix we always want to be considering. Why is it that I have estrogen dominance, or why is it that my luteal phase is weak? Always focusing on improving those reasons, whether it's poor ovulation quality from poor pot follicle growth, whether it's from insulin resistance or thyroid dysfunction. Always needing to look at the bigger picture for best long-term results. Imagine if your energy returned exercise felt easier, and your hair shedding slowed down because you rebuilt your iron stores and fixed the reason why you were low in iron in the first place. Over the course of a few cycles, your periods can be more manageable, your ovulation more stable, and your days less fatigued. All to improve health and promote fertility.

Speaker 2 19:21

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.