Addressing a Silent Epidemic in Women’s Health: Untreated Anemia and Iron Deficiency

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As I dug into research for this article, I couldn’t help but reflect on my own journey through adulthood, realizing that I had been grappling with iron deficiency for much of it. Throughout my late teens and early twenties, I frequently sought medical advice for persistent illness, fatigue, and restless leg syndrome, only to be assured that everything was normal after blood tests. I was the classic candidate for iron deficiency at the time.  I was vegetarian, experiencing regular blood loss through menstruation, and consuming copious amounts of black tea, green tea, and coffee, as many university students do.

It wasn’t until I reached my early thirties, with the desire to start a family, that I became more proactive in advocating for my health. After having my ferritin levels checked (ferritin being a marker for iron stores), I discovered that my iron reserves were indeed low. Despite regular iron supplementation, my ferritin levels didn’t improve significantly. Aware of the increased demand for iron during pregnancy, I discussed the option of intramuscular iron injections with my wonderful GP, who thankfully agreed.

The difference was remarkable.

Thanks to those two iron injections, my ferritin levels soared from 12 ug/L to 56 ug/L. I experienced a significant boost in energy and focus. And like many who finally address a chronic health issue, I couldn’t help but wonder, “What could I have achieved if this had been identified and treated earlier?”

The statistics concerning iron deficiency in reproductive-age women in Canada are concerning. Approximately one in five women meet the World Health Organization’s criteria for iron deficiency, as revealed in a recent study published in The Journal of Nutrition (1, 2).

In British Columbia, serum ferritin values between 15 and 30 ug/L are seen as indicative of probable iron deficiency (3). Both clinically and in studies, supplementing iron in women within this range who are experiencing symptoms of iron deficiency, has been shown to alleviate many of its symptoms, including fatigue (4).

Unfortunately, many women with iron deficiency go undetected. Fatigue, a predominant symptom, is often dismissed as a natural part of women’s life events, such as pregnancy, breastfeeding, or caring for young children (hello, sleep deprivation). Consequently, they may not think to get their iron levels checked or seek medical advice.

Furthermore, women may overlook early signs as iron deficiency develops gradually. Symptoms like fatigue, depression, brain fog, cold extremities, mouth sores, headaches, poor sleep quality, and hair loss can be attributed to various causes and may not be recognized as related to iron deficiency. In my clinical experience, women demonstrate remarkable resilience in enduring such symptoms. I’ve even encountered women training for triathlons with serum ferritin levels under 10 ug/L!

Just imagine the impact of identifying and treating iron deficiency and anemia in one in five reproductive-age women.

The first step is awareness. Herein lies a challenge: while serum ferritin is the most sensitive and reliable indicator of iron status, many doctors still only check red blood cell counts and hemoglobin, which are markers for anemia but not necessarily iron status. This was my own hurdle in my twenties; my hemoglobin and red blood cell counts were normal, masking my iron deficiency.

Women aged 14-50 face myriad demands, from excelling in education and career establishment to nurturing the next generation. Doing all this with low iron is akin to riding a bike with a flat tire—achievable, but significantly more challenging.

The most crucial step women can take if they suspect iron deficiency is to request a serum ferritin test. It’s a simple and inexpensive measure, with results typically available within 24 hours. Support in obtaining this test and subsequent treatment can be sought from primary care providers or naturopathic doctors.

Undoubtedly, this is a women’s health epidemic, but one that is entirely identifiable and treatable. With a little knowledge, many women can feel significantly better.


  1. Cooper M, Bertinato J, Ennis JK, Sadeghpour A, Weiler HA, Dorais V. Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012-2019. J Nutr. 2023;153(5):1534-1543. doi:10.1016/j.tjnut.2023.03.012
  2. WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations
  3. BC Gov: Common causes of and risk factors for iron deficiency and IDA in adults
  4. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184(11):1247-1254. doi:10.1503/cmaj.110950