From age 11 to 22, I played competitive sports after recovering from a rare autoimmune condition called Dermatomyositis. Distance running, swimming, basketball, softball, rowing, volleyball, and more  I couldn’t seem to get enough.

I was so ingrained in sports following my illness, that I didn’t realize how much of a toll being an athlete was taking on my body, specifically my iron levels.  It wasn’t until high school when I started experiencing strange symptoms like fatigue, headaches, thinning hair and nails, and shaky legs that I finally began to take note.  

When I initially described these symptoms to my doctor, she tested several biomarkers, with serum iron, TIBC (Total Iron Binding Capacity), and transferrin being some of them. But all of my levels came back normal, and over the next few years, I felt like I had no choice but to tough it out. That’s what they teach you in sports, after all.   

It wasn't until I went for my first physical exam as a collegiate athlete that they finally tested my ferritin levels and discovered they were almost non-existent. 

Ferritin: The missing part of my iron deficiency puzzle 

Ferritin captures your iron stores, which, as it turns out, was the missing piece of my undiagnosed iron deficiency puzzle.

After speaking with numerous other active women, I learned that they, too, had been misdiagnosed as having “normal” iron levels, only to discover later on that their ferritin levels were in the drain.   

The good news is that once I discovered my iron stores were less than optimal, I was able to address the issue by taking an oral iron medication, and it was mind-blowing how much my state of health shifted after that. 

Not only did I become a better athlete, but my energy levels, recovery, and mental clarity entered a whole new range. It was like waking up to a whole new existence.  

Knowing the risk factors for iron deficiency in women

The moral of the story is: You know your body better than anybody else, so if you feel like something is off or if you've seen a decline in any area of your health, go with your gut and keep asking questions. 

Being a woman of reproductive age alone puts you at risk for iron deficiency due to monthly blood loss. Following a vegan or vegetarian diet, pregnancy, heavy exercise, excessive alcohol consumption, inflammation, autoimmune conditions, poor nutrient absorption, and taking certain medications are some other potential risk factors. 

Here are some of the symptoms of iron deficiency to look out for:

  • Persistent and unexplained tiredness  

  • Shortness of breath, especially during physical activity 

  • Muscle weakness

  • Cold hands and feet 

  • Frequent headaches

  • Dizziness or lightheadedness

  • Brittle nails 

  • Hair loss 

  • Difficulty concentrating

  • Soreness in mouth, tongue, and/or throat 

  • Irregular heartbeats and, or heart palpitations

  • Restless leg syndrome (ie, an urge to move your legs while resting or sleeping)

  • Getting sick often 

If you’re experiencing any of the above, or if you meet criteria that put you at risk of iron deficiency, it's definitely recommended that you speak to your doctor about getting your iron levels tested.  

Why it's important to be aware of your iron levels 

Iron can sometimes be a forgotten nutrient. However, for women, it’s one of the most vital ones. Across all stages of female life, it’s crucial for:

  • Transporting oxygen from your lungs to every single cell in your body 

  • Red blood cell production 

  • Regular menstrual cycles: iron is lost on a monthly basis due to menstrual bleeding and in order to keep your cycles healthy and consistent, that iron has to be restored

  • Healthy conception and pregnancy: iron needs increase significantly during pregnancy due to how it supports the expansion of a mother’s blood volume and development of the placenta to nourish a growing baby 

  • Breastfeeding: breastfeeding mothers require additional iron to maintain healthy milk production and support their own health during an energy-intensive time 

  • Physical activity and proper recovery: if you’re an active gal, iron’s your BFF, given how much iron is lost during sweat and temporarily muscle damage that’s a natural byproduct of lifting weights and challenging your body 

  • Cognitive and immune function: iron plays a critical role in your immune system’s response to infection as well as the synthesis of neurotransmitters, maintenance of myelin (the fatty substance that protects your nerves), and prevention of early cognitive decline

The 5 labs to request for iron deficiency

If you suspect you have iron deficiency, have one or more of the risk factors, or simply want to get a pulse check for where you’re at for general health purposes, here are the set of biomarkers we recommend you get evaluated as part of a comprehensive iron panel:  

1. Complete blood count (CBC): A standard blood test that measures various components of your blood, including red blood cell count, hemoglobin, hematocrit, and more (abnormalities in this can indicate anemia, which is often suggestive of prolonged iron deficiency)

2. Serum iron: Measures the concentration of iron in your blood 

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3. Transferrin (Total Iron-Binding Capacity, TIBC): Measures the total amount of iron in your blood that can be bound by the protein transferrin, whose role is to bind to iron and transport it throughout your body 

4. Serum ferritin: Reflects how much iron is stored in your body  

5. Transferrin saturation: This is calculated by dividing your serum iron by your TIBC, then multiplying by 100; it provides insight into how many of your transferrin binding sites are actually occupied by iron 

How to treat iron deficiency

If it ends up that you do have an iron deficiency, you may want to begin by working with your healthcare provider to identify the underlying cause and address it. Some of the low-hanging fruit is: increasing your dietary iron intake through red meat, poultry, fish, beans, lentils, tofu and other soy products, spinach, and leafy greens, and considering an oral iron treatment like ACCUFeR® by Shield Therapeutics

In a clinical study, one-third of people taking ACCUFeR® had normal hemoglobin levels in 4 weeks, and by week 12, more than 70% of people had normal hemoglobin levels. Plus, it's FDA-cleared, and <5% of patients in their clinical study stopped taking the medication due to its side effects. 

Whatever you ultimately decide, it’s important to schedule routine bloodwork and check-ups with your doctor to see what’s working and what’s not in your current treatment protocol. Remember, you are your own best health advocate! 

Caroline McMorrow is a Content Manager at Rescripted.