Ferritin, Iron Deficiency, and Why “Low-Normal” May Not Be Good Enough
Dr. Jackie Piasta, DNP, WHNP-BC
Iron is an essential mineral for energy, oxygen transport, and overall vitality. Yet for many women, especially during the midlife transition, iron deficiency can sneak up long before anemia ever shows up on routine bloodwork. One of the most important (and most under-recognized) markers in this conversation is ferritin.
What Is Ferritin?
Ferritin is a protein that stores iron in your body. Think of it as your “iron savings account.” While hemoglobin (the oxygen-carrying protein in red blood cells) reflects what’s in your “checking account” right now, ferritin tells us how much you’ve got in reserve.
Low ferritin = your body is using up iron faster than it can be replaced.
Optimal ferritin = you have enough iron on hand to support oxygen delivery, energy production, and countless metabolic processes.
Why Ferritin Matters in Midlife
1. Energy and Fatigue
Iron is central to making hemoglobin, which delivers oxygen to your cells. When ferritin is low, oxygen delivery becomes less efficient, even if your hemoglobin is still technically “normal.” This is one reason women with “low-normal” labs can still feel profoundly tired.
2. Hair Health
Low ferritin is strongly associated with hair thinning and excessive shedding in women. Many dermatologists recommend maintaining ferritin above 50–70 ng/mL for optimal hair growth, even if anemia is not present.
3. Cognitive Function and Mood
Iron plays a role in neurotransmitter synthesis (dopamine, serotonin, norepinephrine). Suboptimal ferritin levels may contribute to brain fog, poor concentration, irritability, or even mood disorders, issues already common in perimenopause.
4. Thyroid Function
Ferritin is essential for proper thyroid hormone conversion (T4 → T3). Women with borderline thyroid labs and persistent symptoms often also have low ferritin. Optimizing iron stores can enhance thyroid efficiency.
5. Exercise and Recovery
Low ferritin reduces exercise tolerance, increases fatigue, and slows recovery. This is especially important for women working to build or maintain muscle mass during midlife.
How Common Is Low Ferritin?
Menstrual blood loss remains a major cause of iron depletion in women, especially with the heavy or irregular cycles common in perimenopause.
Dietary intake: Vegetarian or vegan diets, or diets low in iron-rich foods, increase risk.
Absorption issues: Conditions like celiac disease, inflammatory bowel disease, or even long-term antacid use can impair absorption.
Chronic inflammation: Ferritin is also an acute-phase reactant (rises with inflammation), which can mask deficiency. This is why clinical context is so important when interpreting results.
What Are Optimal Ferritin Levels?
Lab “normal ranges” vary, often starting as low as 10–15 ng/mL. But “normal” is not the same as optimal.
Below 30 ng/mL: strongly associated with iron deficiency symptoms (fatigue, hair loss, brain fog).
30–50 ng/mL: may be “acceptable” on paper, but often insufficient for symptom relief.
50–100 ng/mL: generally considered optimal for women, especially for hair growth and energy.
Above 100 ng/mL: typically safe, though extremely high levels (>300) warrant evaluation for iron overload.
Addressing Low Ferritin
Nutrition
Heme iron (best absorbed): red meat, poultry, fish.
Non-heme iron: lentils, beans, spinach, pumpkin seeds (absorption improved when paired with vitamin C).
Avoid pairing iron-rich foods with calcium, coffee, or tea during the same meal, as these inhibit absorption.
Supplementation
Oral iron: usually ferrous sulfate, gluconate, bisglycinate, or malate (the latter often better tolerated and with superior absoprtion).
We usually recommend EVERY OTHER DAY DOSING of oral iron to improve absorption.
Intravenous (IV) iron: may be necessary for women with severe deficiency, malabsorption, or intolerance to oral iron.
This is done at a hematologist office and usually requires insurance approval.
Monitoring: ferritin should be checked after ~12 weeks of supplementation to gauge response.
The Bigger Picture
Low ferritin is not just a lab number, it’s a window into your energy reserves, hair health, cognitive clarity, and overall metabolic function. For women in midlife, optimizing ferritin can make the difference between “just getting by” and feeling vibrant.
Don’t wait until your hemoglobin drops or you’re officially “anemic.” Suboptimal ferritin can affect quality of life long before that point. If you’re struggling with fatigue, hair loss, brain fog, or exercise intolerance, it’s worth asking: what’s my ferritin level?
At our practice, we look beyond “normal ranges” to help you find your optimal, ensuring your iron stores truly support your health, energy, and longevity.
