Running on Empty? 5 Things Every Woman Should Know About Iron

Your lab report says "normal," but your body says something's off. That disconnect is exactly why we're talking about iron in a more useful way than the usual anemia checklist. I'm Dr. Sheri Erwin, and I'm walking you through five things I want every woman to understand about iron status, so you can stop guessing and start having clearer, more productive conversations with your healthcare provider.

We unpack the most common trap: assuming a normal CBC and hemoglobin means iron is fine. I explain how iron deficiency can show up before anemia, why ferritin reflects iron stores, and why ferritin is not a single magic target number for fatigue, hair loss, brain fog, or restless legs. You'll hear how inflammation can change ferritin, why clinicians often look at additional iron studies like serum iron, TIBC, and transferrin saturation, and how to interpret labs in the context of real symptoms.

Then we move to the question that matters most: why is iron low in the first place? We talk through common root causes in women, including heavy or changing periods in perimenopause, low dietary iron intake, absorption issues tied to gut health, and why new iron deficiency after menopause deserves a careful look. I also share why more iron is not always better, what side effects to watch for, and the three questions to ask before starting any supplement: Do I need it, how much do I need, and how will I know it's working?

If you're tired of being told everything looks fine when you don't feel fine, press play. Follow the show, share it with a friend who needs it, and leave a review so more women can find these conversations.

Start Here: Take the Healthspan Baseline quiz. About three minutes, covering energy, brain fog, mood, sleep, and long-term health patterns. You'll see where to focus and receive a one-page guide: 👉 https://rootremedyic.involve.me/next-decades-healthspan-quiz

Personalized Care: I work with women in AZ, CO, FL, ID, KY, MT, OR, WA, and WY through Root & Remedy Integrative Care. We start with a Health Consultation, then I select labs based on your symptom pattern and send you a written Next Steps Plan within 72 hours: 👉 https://www.rootremedyic.com/work-with-me

Courses & Digital Guides: Not in a state I serve? Browse self-paced courses and clinically written guides on hormones, energy, sleep, cortisol, and gut health:
 👉 https://www.rootremedyic.com/guides
👉 https://www.rootremedyic.com/foundations

Explore More: Find all links, resources, and ways to connect:
 👉 https://linktr.ee/rootremedyic

Transcript

HEALTHSPAN ON HER TERMS
Episode 18: Running on Empty? 5 Things Every Woman Should Know About Iron
With Dr. Sheri Erwin, DNP, FNP-C, founder of Root & Remedy Integrative Care


Your CBC came back normal, so you assume your iron must be fine. But here's something a lot of women don't realize: you can be iron deficient without being anemic. And if you've been exhausted, noticing more hair in the shower, getting winded more easily during your workouts, struggling to concentrate, or dealing with restless legs at night, iron may be one piece worth looking at.

But before you run out and buy an iron supplement, there's something else I want you to know. More iron is not always better. And if your iron is low, the most important question isn't simply, "How do I raise it?" It's, "Why is it low in the first place?"

Today I'm going to give you five things I want every woman to understand about iron, including what your regular blood work can and can't tell you, what ferritin actually means, and what to ask your healthcare provider if something doesn't look right. Because this isn't going to be an Iron 101 lecture. By the end of this episode, I want you to know how to look at your own health a little differently. Let's get into it.

Welcome back to Healthspan on Her Terms. I'm Dr. Sheri Erwin, a Doctor of Nursing Practice, board-certified family nurse practitioner, certified integrative clinician, and founder of Root & Remedy Integrative Care. Today we're talking about iron, but I want to look at it a little differently. Rather than giving you a long lesson on iron physiology, I'm going to give you five things I want every woman to understand about her iron status, and more importantly, what you can actually do with that information.


ONE: IRON DEFICIENCY AND ANEMIA ARE NOT THE SAME THING

This is probably the most important thing I want you to understand today. When you have routine blood work, your healthcare provider will often order something called a CBC, or complete blood count. One of the numbers on that test is your hemoglobin. Hemoglobin is the protein inside your red blood cells that carries oxygen throughout your body. When your hemoglobin falls below a certain level, it may be diagnosed as anemia.

But here's where women sometimes get confused. You can have a normal hemoglobin and still have iron deficiency. Think about iron like money in a savings account. Your body has iron available for everyday use, but it also keeps iron stored for when it's needed. One of the ways we estimate those iron stores is with a blood test called ferritin. As iron stores begin to decline, ferritin may fall before your hemoglobin does. Your body is essentially dipping into that savings account to keep producing hemoglobin. And for a while, it may be able to keep up. Your CBC still looks pretty good. You're not anemic, but your iron stores may already be depleting.

Eventually, if iron deficiency becomes significant enough, your body may no longer have enough iron available to maintain normal red blood cell production. And that is when iron deficiency can progress into iron-deficiency anemia. We've depleted that savings account.

So here's your first tool from today's episode. If you're concerned about iron, don't assume that a normal CBC automatically answers the question. Look at what was actually tested. Was it only the CBC, which is quite common? Was ferritin checked? Were additional iron studies performed? And if you're experiencing persistent symptoms or have risk factors for iron deficiency, that's a conversation worth having with your healthcare provider.

Now I also want to add an important caution here. Fatigue does not automatically mean you have low iron. Hair loss does not automatically mean low iron. And brain fog does not automatically mean low iron. These symptoms can have many different causes, which is exactly why testing and clinical context matter. We don't want to take a vague symptom of fatigue and immediately attach a diagnosis to it. What we want to ask is a better set of questions. And one of those questions may be, "Have we actually looked at my iron status?" That's a very different question. We don't assume iron is the problem right away. We want to investigate it.


TWO: FERRITIN IS HELPFUL, BUT IT IS NOT A MAGIC NUMBER

That brings us to the second thing, because ferritin is one of the tests we use to evaluate iron stores, and there's something important you need to know about that number. Ferritin isn't quite as simple as social media sometimes makes it sound.

This is an area where I see a lot of confusion online. You may have heard or read, "Your ferritin needs to be above 50." Or, "If your ferritin isn't 70, that's why your hair is falling out." Or maybe you've looked at your own results and thought, "I'm technically in the normal range, but I'm barely normal. Does that mean I'm iron deficient?" The answer isn't as simple as picking one number.

Ferritin is a protein that stores iron, and measuring ferritin gives us useful information about how much iron your body has in reserve in that bank account. A clearly low ferritin can be a strong indicator of iron deficiency. But here's the part I want you to understand: ferritin has to be interpreted in context. Ferritin is also what's called an acute-phase reactant. That means it can increase when there's inflammation in the body. So someone may have depleted iron stores, but if there's significant inflammation happening at the same time, their ferritin may appear higher than we would otherwise expect. That's one reason clinicians sometimes look at additional information, such as serum iron, total iron-binding capacity, transferrin saturation, the CBC, and what's happening clinically. We're putting pieces together, not chasing one number.

And that's where I want to bust another myth. There is not one universal optimal ferritin number that explains every woman's fatigue, hair loss, or brain fog. Could iron deficiency contribute to those symptoms? Absolutely. But if someone tells you that every woman needs her ferritin at one specific number to feel well, we're oversimplifying the science.

And remember what we talked about in the last section. You can have iron deficiency before you develop anemia. So we don't want to dismiss a low ferritin simply because the hemoglobin is still normal. But we also don't want to look at a single ferritin result and blame every symptom you're experiencing on iron.

Here's your tool for this section. If you're looking at your lab results, don't just ask, "Is my ferritin normal?" Ask, "What does my ferritin mean in the context of my symptoms, my CBC, my other iron studies, and my overall health?" That's a much better question to pose to your healthcare provider.

And if your iron stores really are low, there's an even more important question we need to ask next. Not, "Which iron supplement should I buy?" but, "Why am I low on iron in the first place?" Because iron deficiency is not the end of the investigation. Sometimes it's a clue that tells us where we need to look next.


THREE: IF YOUR IRON IS LOW, ASK WHY

If your iron is low, don't stop at replacing it. Ask why it is low. This is probably the most important clinical thinking point in today's episode, because iron deficiency doesn't just happen. Iron is getting low for a reason.

Sometimes the reason is fairly straightforward. For women who are still menstruating, one of the most common causes is blood loss from periods. And this is where I want you to think beyond simply asking, "Do I have heavy periods?" Because what we've considered normal for years may actually represent significant blood loss. Are you changing a pad or tampon every hour or two? Are you needing both a tampon and a pad? Are you passing large clots? Are you waking during the night because you need to change your protection? Are your periods lasting longer than they used to? Have they become heavier during perimenopause? Those are details that matter to your clinician.

And there's something women in their 40s especially need to know. Periods don't always become lighter as you approach menopause. Hormonal fluctuations during perimenopause can sometimes make bleeding heavier or more unpredictable. So if your periods have changed and your iron is declining, that's an important connection to discuss with your healthcare provider.

But menstrual bleeding isn't the only possibility. Sometimes the issue is intake. Are you actually getting enough iron through your diet? Sometimes it's an absorption issue. Certain gastrointestinal conditions can interfere with your body's ability to absorb iron effectively. And sometimes iron is being lost somewhere else, including through gastrointestinal bleeding. This becomes particularly important after menopause. If you're no longer having menstrual periods and you develop iron deficiency, we don't simply say, "Well, you're low on iron, take a supplement." We need to understand why. Depending on your age, symptoms, medical history, medications, and other findings, your clinician may need to evaluate for a source of blood loss or another underlying cause.

And that brings me to your tool for this section. If you're told your iron is low, I want you to ask, "Do we know why?" That's it. Four words. Because replacing iron may help replenish what you've lost, but it doesn't necessarily explain why you lost it in the first place. And sometimes the why is the most important piece of information we can uncover. So before you leave an appointment with nothing more than a recommendation to take iron, make sure someone has considered the bigger picture.


FOUR: MORE IRON IS NOT ALWAYS BETTER

Now let's talk about something else I see all the time. A woman feels exhausted. She hears iron helps with energy. She walks into the supplement aisle and buys a bottle. Seems harmless, right? Not necessarily, because number four is one I really want you to remember. More iron is not always better.

This is one of those times when I really don't want you listening to this episode, deciding your fatigue must be caused by iron, and immediately ordering a supplement. Iron is essential, but it's also a nutrient we need in the right amount. Unlike some nutrients that the body can easily eliminate when we consume more than we need, excess iron can accumulate and become harmful.

And even when iron supplementation is appropriate, it isn't always pleasant. Iron supplements can cause constipation, nausea, abdominal discomfort, and dark stools. If you've ever taken iron and thought, "There has to be a better way to do this," you're definitely not alone. The type of iron, the dose, how often it is taken, what you take it with, and what else you're taking can influence absorption and side effects. For example, calcium can interfere with iron absorption when it's taken together. Coffee and tea can also reduce absorption. Vitamin C can improve the absorption of non-heme iron, which is the form found primarily in plant foods.

And here's another myth worth busting. If you're iron deficient, food alone isn't always enough to correct it. I absolutely want women eating iron-rich foods. Heme iron, which is found in foods like meat and seafood, tends to be more readily absorbed. Plant foods such as beans, lentils, tofu, fortified cereals, leafy greens, nuts, and seeds can also contribute iron to your diet. But if your iron stores are significantly depleted, simply eating more spinach may not be enough to replenish them. That's where an individualized treatment plan matters. Your clinician may recommend oral iron supplementation and then repeat your labs after a period of time to see whether you're actually responding.

And if you're not responding, that's information as well. Maybe the dose is inadequate. Maybe you're not tolerating it well enough to take consistently. Maybe absorption is an issue. Maybe you're continuing to lose iron faster than you're replacing it. Or sometimes another treatment approach needs to be considered. Again, we're asking, "What's the pattern?" not just, "What supplement should I take?"

So here's your tool for number four. Before starting iron, ask three questions: Do I actually need it? How much do I need? And how will I know if it's working? Because taking an iron supplement indefinitely without knowing whether you need it, or whether it's correcting the problem, isn't a plan. Testing, treating appropriately, and then reassessing is.


FIVE: IRON IS ABOUT MORE THAN ANEMIA

Now we're at number five. This one brings us back to the bigger reason we're having this conversation in the first place, because iron isn't just about preventing anemia. Iron plays a role in how your body functions every day. And I think this is where the conversation gets especially important when we're talking about women's healthspan.

Most of us learned to associate iron with red blood cells. And yes, iron is essential for making hemoglobin, which helps carry oxygen throughout your body. But that's not the only place your body uses iron. Iron is involved in energy production inside your cells. It's involved in muscle function. Your brain needs iron for normal neurological function and the production of certain neurotransmitters. Iron also plays a role in immune function and many of the enzymes your body relies on every single day.

So when iron becomes deficient, the effects may show up before someone develops obvious anemia. Some women may experience fatigue. They may feel more winded with activity. Exercise may suddenly feel harder. They may have difficulty concentrating. Some experience headaches or restless legs. Hair shedding can sometimes be part of the picture as well.

But here's where I want to stop us from making the same mistake social media often makes. Those symptoms do not prove you have iron deficiency. Fatigue can come from poor sleep. Hair loss can be related to thyroid disease, hormonal changes, nutritional deficiencies, medications, illness, or several other causes. Feeling winded with activity deserves thoughtful evaluation, because there are many possible explanations, some of which have nothing to do with iron. Symptoms are clues. They're not diagnoses. And that is actually one of the reasons I want you to understand your iron status, rather than simply assuming everything is fine because you're not anemic.

Now let's connect this back to healthspan. Healthspan isn't simply about avoiding disease. It's about preserving the ability to live well for as many years as possible. I want you to have the energy to move your body. I want you building and maintaining muscle. I want you staying physically active. I want your brain functioning well. And I want you to be able to participate in the things that make your life meaningful. And if something as fundamental as iron deficiency is interfering with your ability to do those things, it's worth identifying and addressing.

But here's the important distinction. The goal isn't simply to optimize one lab number. The goal is to understand what that number may be telling us about your overall health.

So here's your final tool. If you've been feeling different lately, especially if you're experiencing persistent fatigue, changes in exercise tolerance, hair shedding, restless legs, or other unexplained symptoms, don't immediately assume you need iron. Instead ask, "Could iron deficiency be one piece we haven't looked at yet?" And if the answer is yes, evaluate it appropriately. Find out whether you are actually deficient. If you are, understand why. Treat it appropriately, and then make sure you're responding to the treatment. That's a much more useful approach than chasing symptoms, or chasing an optimal ferritin number.

And if you remember nothing else from today's episode, remember this. Normal hemoglobin does not always mean normal iron stores. Low iron deserves a why. And more iron is not always better. Those three things alone will help you have a better conversation with your healthcare provider.


YOUR IRON CHECKLIST

Before we wrap up, I want to give you something practical you can take from this episode. If you've wondered whether iron could be part of what's going on with you, here are a few things to think about before your next healthcare visit.

First, look at your previous labs if you have access to them. Was your iron status actually evaluated, or did you only have a CBC, which is the most common practice? Remember, they're not the same thing.

Second, think about your symptoms. Have you noticed persistent fatigue, changes in your exercise tolerance, more hair shedding, restless legs, difficulty concentrating? Again, none of those symptoms automatically mean iron deficiency, but they're worth discussing if they're persistent.

Third, if you're still having periods, pay attention to your bleeding. Have your periods become heavier, longer, more frequent, or unpredictable? Are you passing large clots or changing menstrual products more frequently than you used to? Don't just say, "My periods are normal." Tell your healthcare provider what you're actually experiencing.

And finally, if testing shows that your iron is low, ask the question I hope you remember from this episode: "Do we know why?" Because treating the iron deficiency matters, but understanding why it developed matters more.

So three big takeaways from today's episode. A normal CBC doesn't necessarily tell you that your iron stores are adequate. If your iron is low, ask why. And don't start iron just because you're tired. That's it. You don't need to memorize every lab marker we talked about today. You don't need to diagnose yourself. You just need to know enough to ask better questions. And that's exactly what I want this podcast to help you do.

If today's episode made you think of another woman who's exhausted, losing hair, struggling through workouts, or wondering why she doesn't feel like herself, send her this episode.

And before you go, remember we talked about another reason iron could be low, and that was related to absorption. That brings us directly into next week's episode, because we're going to go into the gut. If you're constantly bloated, you've tried changing what you eat, maybe you've added a probiotic, and you're still wondering what your digestive system is telling you, you're going to want to hear this one. We're talking about five things your gut may be trying to tell you, including a few gut-health myths I really want women to stop believing. And I'm going to give you something simple you can do for seven days to start recognizing your own patterns. So next week: "Bloated Again? 5 Things Your Gut May Be Trying to Tell You."

If you're enjoying Healthspan on Her Terms, follow the show and leave a review. It helps more women find these conversations. You can also find me and learn more about Root & Remedy Integrative Care at rootremedyic.com.

Thank you for spending part of your day with me. Until next time, remember: your body isn't working against you. It's communicating with you. And every symptom is an opportunity to better understand the remarkable woman you're becoming. Take care, and I'll see you next week.


This episode is for general education and is not medical advice. It does not diagnose or treat any condition. Please talk with your own healthcare provider about your individual situation.