Iron: Why It Matters for Women’s Health, Fertility & Pregnancy
When we think about iron, we often think about energy and fatigue. But iron plays a much bigger role in the body — particularly during the reproductive years.
Iron supports oxygen transport, energy production, hormone production, immune function and neurological development. During pregnancy, it also supports placental development, increasing blood volume, oxygen delivery and your baby's developing brain, nervous system and organs.
And iron deficiency is incredibly common. Around 40% of women begin pregnancy with inadequate iron stores, while more than 1 in 10 Australian women develop iron deficiency anaemia during pregnancy. Women can also remain at increased risk during postpartum and breastfeeding.
You don't have to be anaemic to be iron deficient
This is an important distinction.
Iron deficiency means your iron stores are low, often reflected by low ferritin, even if your haemoglobin is still normal.
Iron deficiency anaemia occurs when iron stores have become depleted enough to affect haemoglobin production.
This means you can have symptoms of low iron before you technically have anaemia.
Signs can include:
Fatigue
Brain fog and poor concentration
Hair shedding
Dizziness
Shortness of breath
Poor exercise tolerance
Restless legs
Cold hands and feet
Headaches
Pale skin
Rapid heart rate
Reduced immunity
These symptoms can have many causes, so testing is important rather than simply assuming iron is the problem.
Why does iron become low?
It's not always because you're not eating enough.
Iron deficiency can be linked with:
Heavy menstrual bleeding
Pregnancy and increased requirements
Breastfeeding
Vegetarian or vegan diets
Restrictive eating
Coeliac disease
Gut inflammation
H. pylori
SIBO or inflammatory bowel disease
Chronic inflammation
Long-term antacid or PPI use
Sometimes the issue isn't intake — it's absorption, increased need or ongoing loss.
Eating for healthy iron levels
There are two main forms of dietary iron.
Haem iron is found in animal foods such as beef, lamb, kangaroo, chicken, fish, oysters and liver. It is generally considered more readily absorbed.
Non-haem iron is found in plant based foods such as lentils, chickpeas, tofu, pumpkin seeds, tahini, cashews, spinach and wholegrains. It is more affected by digestion and what you eat alongside it.
A few simple strategies can help:
Pair iron-rich foods with vitamin C
Think capsicum, citrus, kiwi, berries and tomatoes.
Separate tea and coffee from iron-rich meals
Large calcium intakes and red wine can also reduce absorption. Separating these from iron-rich meals or supplements by 1–2 hours may help.
What if you're taking an iron supplement?
More isn't necessarily better.
Large doses of iron can increase hepcidin, a hormone that regulates iron absorption, potentially reducing absorption of a subsequent dose. Higher doses can also contribute to constipation, nausea, bloating and other gastrointestinal symptoms. Common forms include ferrous sulphate and iron bisglycinate, but the best option depends on your individual needs, blood results, digestive health and tolerance. Iron bisglycinate is generally better tolerated and has higher bioavailability. For some people, lower or alternate-day dosing may improve absorption and reduce gastrointestinal side effects. This should be individualised with your healthcare practitioner.
Don't just treat the deficiency — find the reason
If your iron continues to drop or doesn't improve with supplementation, it's worth looking beyond the iron itself. Your practitioner may consider gut health, inflammation, stomach acid, menstrual or pregnancy-related blood loss, increased requirements and how well you're absorbing your iron.
And don't rely on one blood test
Depending on your individual situation, the following tests are what I usually look for at minimum when iron is concerned:
Full Blood Count (FBC), including Haemoglobin
Iron studies, not just Ferritin
CRP
Vitamin B12
Folate
Ferritin is useful for assessing iron stores, but it can also rise with inflammation or infection. Looking at your symptoms, history and multiple markers gives a more complete picture. For women planning pregnancy, preconception is an ideal time to check iron stores. Testing may also be important during pregnancy and postpartum, particularly if symptoms persist or there has been significant blood loss.
The takeaway
Iron is about much more than energy. It matters for fertility, pregnancy, your baby's development and postpartum recovery. If you're feeling exhausted, experiencing hair shedding or simply don't feel like yourself, don't automatically put it down to being busy, pregnant or postpartum.
Test — don't guess.
And if your iron is low, don't just ask "How much iron should I take?"
Ask: Why is my iron low in the first place?
Understanding the reason behind low iron is an important part of supporting healthy iron levels long-term.
Ready to understand your iron levels better?
At Nest & Nourish Naturopathy, we take a personalised approach to your health, considering your symptoms, history and relevant testing to understand what may be contributing to your concerns.
Book an appointment today and let's get to the root of it.
This article is for general education only and is not individual medical advice. If you are concerned about your iron levels or have persistent symptoms, speak with your naturopath or other qualified healthcare practitioner.