Iron Deficiency in Perimenopause: Signs, Symptoms, and Solution
As a nutritional therapist, I often see clients—particularly women in their 40s and early 50s—struggling with fatigue, brain fog and brittle nails. These symptoms are frequently brushed off as perimenopause symptoms or stress but actually women in this age group have a higher likelihood of low iron levels and even deficiency.
Why Is Iron So Important?
Iron is essential for the production of hemoglobin, the protein in red blood cells that carries oxygen throughout your body. But it does far more than that—iron is involved in energy production, thyroid function, neurotransmitter synthesis, and even immune resilience.
When your iron stores (ferritin) drop- even before anaemia sets in- you may experience:
· Chronic tiredness or exhaustion
· Poor concentration or “brain fog”
· Sensitivity to cold
· Hair thinning or brittle nails
· Pale skin, dark under-eye circles
· Increased susceptibility to infections
Why is Iron Deficiency More Common In Perimenopause?
Ongoing Menstrual Blood Loss
Many women in their 40s are still menstruating, and for some, cycles become heavier or more erratic during perimenopause. This increased blood loss can result in higher iron losses- up to 1.5–2 mg per day, which diet alone may not replenish.
Increased Physiological Demand
Even in the absence of menstruation, the female body in this age group is often recovering from years of iron depletion or navigating stress, hormonal shifts, and busy lifestyles that elevate nutritional needs.
Dietary Patterns
Many women reduce red meat intake during midlife for health or ethical reasons. While plant-based diets can be nutritious, they often provide non-heme iron, which is less efficiently absorbed—especially if not paired with strategies to enhance uptake.
Non-Anaemic Iron Deficiency is Common
A large-scale U.S. study of over 62,000 women found iron deficiency rates as high as 21% in premenopausal women, including those in their 40s and early 50s.
What You Can Do: A Nutritional Therapist’s Guide
If you have any of the symptoms go to your GP and ask for a blood test.
Boost the Iron in your diet:
· Include Red meat, liver, poultry, sardines. These contain haem iron which is more easily absorbed:
· Build meals around non-haem iron foods: dark green vegetables, beans and wholegrains whole grains.
· Combine non-haem iron foods alongside high vitamin C vegetables and fruit (peppers, cruciferous, kiwis, oranges, lemon) as these boost iron absorption from vegetables and wholegrains.
· Avoid drinking black tea and dairy at mealtimes – leave a few hours, (this includes if you are taking Iron in a multivitamin).
· Eat foods that contain yeast (e.g., bread), are sprouted (e.g., bean sprouts), and fermented (e.g., tempeh) to reduce inhibitors like phytates which can be found in wholegrains, legumes and dark green leafy vegetables.
· Consider Supplementation (with caution). Iron supplements can be helpful but must be targeted and well-tolerated. Not all forms are created equal- bisglycinate chelate is often gentler on digestion. Work with a practitioner to choose the right dose and form.
· Support your gut health - absorption starts in the gut. If you have IBS, coeliac disease, or low stomach acid, these can hinder iron uptake- so addressing digestion is a vital part of the puzzle.
Bottom Line
If you’re a woman between 40 and 55 and feeling persistently fatigued, it’s time to consider iron as part of your nutritional assessment. This stage of life is a natural inflection point, and optimizing your iron stores can have a profound impact on your energy, cognition, mood, and resilience.
You don’t have to settle for “just getting older.” With the right nutrition and insight, you can feel like yourself again.
Need help assessing or rebuilding your iron status?
Book a consultation and let’s create a personalised nutrition plan that supports your energy, balance, and wellbeing- at every stage of your journey.