By Kal Rahimi, Pharmacist
Millions of women across Canada live with unexplained fatigue, brain fog, poor exercise tolerance, low immunity, and an overall sense of diminished vitality — often chalking it up to stress, hormones, or just life.
And while many factors can contribute to these symptoms, one of the most common, and most overlooked, culprits is iron deficiency, especially in women of childbearing age. It could be the missing link.
Iron is essential. Without enough of it, your body can’t produce hemoglobin, the protein in red blood cells responsible for transporting oxygen.
When iron levels are suboptimal, your lungs may be taking in oxygen, but your cells, tissues, and organs aren’t receiving enough to function optimally. It’s like having a city full of lights, but not enough power lines to keep them on.
Despite its critical role, iron deficiency and iron deficiency anemia remain among the most common, underdiagnosed, and undertreated nutritional deficiencies in Canada.
And it’s holding women back — at school, at work, and in life — draining the clarity, energy, and resilience needed to fully show up.
A common problem that gets missed
Iron deficiency is frequently overlooked, especially in busy healthcare settings where system limitations affect how lab results are flagged and followed up.
In British Columbia, ferritin — the key marker used to assess iron stores — is only flagged when it drops below 15 mcg/L. In contrast, Ontario recently updated its threshold to 30 mcg/L.
That means women with ferritin levels between 15 and 30 are more likely to have their deficiency identified and addressed in Ontario, but not in BC.
This disparity in diagnostic guidelines leaves many women in BC falling through the cracks. And it’s not about blame, it’s about bandwidth.
In fast-paced clinics, if your labs don’t trigger an alert, the conversation might not happen. As a result, countless women are left feeling unwell, tired, foggy, and low in resilience — without ever knowing why.
When “normal” isn’t optimal
Even if you take Ontario’s updated threshold of 30 mcg/L as a guide, just because your ferritin isn’t flagged doesn’t mean you’re okay. “Normal” doesn’t always mean optimal.
Research shows that symptoms like fatigue, poor exercise tolerance, hair loss, low immune function, and restless legs can appear even when ferritin levels are above 30 mcg/L.
Many integrative and functional medicine practitioners agree that levels below 50 — or even 70 — can leave women symptomatic and depleted.
And in BC, where the bar is still set at 15, many women aren’t just left untreated — they’re completely overlooked.
Medical consensus is evolving. Health isn’t just the absence of disease, it’s the presence of vitality. And for many women, that means knowing their ferritin levels and understanding what range helps them feel their best.
The first step: know your ferritin
If you’re experiencing signs of iron deficiency — fatigue, brain fog, low immunity, poor exercise tolerance, hair loss, or cold hands and feet — ask your doctor for a ferritin test.
Know your last three ferritin results. Are they going up? Going down? Staying the same? Trends tell a story. And knowing your trend helps you and your practitioner make informed, proactive decisions.
Ferritin doesn’t tell the whole story, but it’s a powerful place to begin. Your healthcare provider will assess other labs and clinical factors, but this is often the first signal that something is off.
Breaking the cycle of iron deficiency
And if your levels are low, the next step is treatment. For most women, oral supplementation is first-line. But this is where many hit a wall.
Even with a diagnosis, many struggle to complete treatment due to side effects like nausea, constipation, and stomach pain.
Others opt for lower doses or forms of iron that are poorly absorbed, sacrificing efficacy for tolerability, and remain stuck in the cycle. It doesn’t have to be this way.
A thoughtful approach to iron supplementation
Iron deficiency is common, but that doesn’t mean the solution is one-size-fits-all. The right supplement can make a profound difference in how you feel, think, and show up in your life. What matters most is finding an option that works with your body, your stage of recovery, and your lifestyle.
Today, there are a range of high-quality iron supplements available, each offering different benefits. Some are formulated to be gentler on the stomach, others offer higher doses for more urgent deficiencies, and many are designed to support absorption while minimizing side effects.
For those with dietary restrictions or sensitivities, there are options that are clean, vegan, and free from common allergens. The key is to choose one that feels right for you, based on effectiveness, tolerability, and the guidance of your healthcare provider.
If oral supplements don’t get you where you need to be, intravenous (IV) iron therapy may also be worth exploring. Every woman’s journey is different, and your iron support should reflect that.
Knowledge is power — and so is support
No matter which approach you take, what matters most is this: listen to your body. If something feels off, even if your lab results say “normal,” it’s worth a deeper look.
Ask questions. Know your ferritin levels. Review trends over time with your practitioner. Whether through diet, supplements, or medical interventions, the path to healing starts with information — and the courage to act on it.
Energy can return. Clarity can return. You can return to yourself.
If you’ve been quietly carrying the weight of iron deficiency, this is your reminder: your symptoms are real, your health matters, and better is absolutely possible.
Let’s move beyond outdated definitions of normal. Let’s move toward strength, clarity, and vitality — on your terms and with a healthy partnership for the care you deserve.
