Beyond the Buzz: Are We Overlooking Iron Deficiency in the Perimenopause Conversation?
The term “perimenopause” has become a household word, a frequent topic of conversation amongst women, and a prominent subject in professional settings. As awareness campaigns gain momentum, championed by public figures and readily available online, it’s a positive shift from the era of hushed discussions and societal shame. However, experts are now raising concerns that the very ubiquity of the perimenopause narrative might be leading to a misdiagnosis, with other, more straightforward conditions being overlooked.
Philippa O’Brien, an employment lawyer, found herself at the doctor’s office at 39, experiencing a cascade of debilitating symptoms. Exhaustion, dizziness, hair loss, brain fog, memory lapses, palpitations, insomnia, and anxiety were becoming her daily reality. When her general practitioner (GP) suggested perimenopause, it didn’t come as a complete surprise. The term had become increasingly prevalent in her professional life and amongst her peer group as they approached their 40s.
However, when the proposed treatments included options like an intrauterine device (IUD), hormone replacement therapy (HRT), the combined pill, or antidepressants, a sense of unease settled in. Philippa felt a persistent doubt that these were the right solutions, as her symptoms had been a recurring issue for nearly two decades.
Her insistence on exploring further led her GP to order a comprehensive panel of blood tests. The results revealed a startlingly low serum ferritin level of just five. For context, NICE guidelines indicate that a ferritin level below 30 signifies iron depletion. Further investigation into her medical history showed consistently low ferritin levels over several years. Compounding this, she also had a B12 deficiency, which her doctor identified as pernicious anaemia, an autoimmune condition often co-occurring with iron deficiency. “It was just a bit of a shock, really,” Philippa admitted.
Following an iron infusion and treatment for pernicious anaemia, Philippa experienced a significant improvement. Many of her symptoms either disappeared entirely or were steadily resolving. “I’m so glad we did those tests,” she expressed, the relief evident. She continues to manage her condition under medical supervision.
The surge in perimenopause awareness is undoubtedly a positive development. For too long, discussions about menopause and its preceding stages were confined to private conversations, often accompanied by a sense of shame. The concerted efforts over the last decade to bring these experiences into the open, amplified by media personalities and readily accessible online resources, have undeniably reached more women. Yet, this widespread focus carries a potential pitfall: an over-readiness to attribute symptoms to perimenopause, potentially overshadowing other common and treatable conditions.
Andrea, a 43-year-old from Bath, also experienced what she believed were classic perimenopause symptoms, including hair loss, profound fatigue, migraines, and irregular menstrual cycles. Before initiating HRT, her GP recommended blood tests. These tests revealed a ferritin level of 16. Her physician suggested addressing the iron deficiency first. Andrea began taking iron supplements, and after approximately three months, she reported a dramatic transformation. Apart from slightly irregular periods, the symptoms she had attributed to perimenopause largely subsided. “So glad I didn’t just jump straight to HRT!” she exclaimed.
The Pervasive Problem of Iron Deficiency
Iron deficiency is a widespread issue, affecting almost one in three women in the UK, according to a 2025 Lancet study. The symptoms are remarkably diverse and can mimic those of perimenopause, including:
- Dizziness
- Extreme fatigue
- Brain fog
- Shortness of breath
- Palpitations
- Sores on the tongue
- Unusual cravings
- Memory problems
Dr. Sue Pavord, a consultant haematologist and president of the British Society for Haematologists, highlights that iron deficiency is chronically underdiagnosed and undertreated in the UK. She frequently encounters patients whose symptoms were initially presumed to be perimenopausal, only to find significant improvement or complete resolution after their iron deficiency was identified and treated.
“Many of these symptoms can occur with both iron deficiency and menopause,” Dr. Pavord explained, noting the high prevalence of iron deficiency in young women due to factors like pregnancy and regular menstruation. The good news, she added, is that prolonged iron deficiency typically doesn’t cause irreversible damage. “When corrected, the body cells will start working again.” However, this does not diminish the substantial impact it has on a person’s quality of life.
Correcting iron deficiency through diet alone can be challenging once a significant deficiency has developed. Therefore, GPs often prescribe iron tablets. For individuals who cannot tolerate oral iron, which is a common occurrence, iron infusions are an alternative.
Navigating Co-existing Conditions
Dr. Pavord clarifies that a diagnosis of iron deficiency does not preclude the possibility of perimenopause. “But if iron deficiency has not been corrected, it will still be a problem when women go through the menopause, and will add to their menopausal symptoms.” Her professional opinion is that even when both conditions are present, addressing the iron deficiency first is paramount.
Dr. Louise Newson, an NHS GP and hormone specialist who has been instrumental in advancing menopause awareness, concurs that co-existing iron deficiency and perimenopause are common. She points out the intricate relationship between hormones and iron absorption: “Our hormones, especially estrogen and testosterone, affect iron absorption. And so although we do give iron to people that need it, we also find that when we give hormones back, iron deficiency improves as well.”
Both Dr. Pavord and Dr. Newson emphasise the importance of comprehensive information. The current healthcare system, with its siloed specialisms, can present challenges. Dr. Newson observed, “If you’re a cardiologist and you see a woman with palpitations, you’ll think about a heart problem – you may not even think to check their iron, for example, or consider hormones.” In such a system, self-advocacy becomes crucial for patients.
The women interviewed for this article shared a common sentiment: relief at having their iron deficiency addressed, irrespective of whether they subsequently pursued perimenopause treatment. They expressed gratitude for pushing for further investigations. As Andrea put it, “The thing is, it’s like we’re taught to accept feeling tired and terrible as women — maybe you aren’t in perimenopause after all, or maybe you are — but wouldn’t you rather know what’s really going on?” The conversation around perimenopause is vital, but it must not overshadow the critical need to investigate and treat other common, yet often overlooked, health issues like iron deficiency.
