At the American Infusion Center’s location on lower Broadway in Manhattan, La-Z-Boy recliners with laptop tables are positioned in front of windows overlooking the Hudson River. The majority of people sitting in those seats—click-clacking away on their computers with an IV dangling from one arm—are women, including me. And many, including me, are there to get an iron infusion—a treatment that, despite being well-informed about my health, I hadn’t even heard of until I was in dire need of it at 47.
My iron levels weren’t ever mentioned at doctor’s visits until I was pregnant with my daughter at 39. With another human growing inside me, the need for adequate nutrients had new urgency. Those levels were steady for the duration of my pregnancy, but after a whirlwind four years—living through a challenging postpartum period, perimenopause, and a global shutdown—they took a nosedive.
But the drop wasn’t something my doctors picked up on easily. It took a year of relentless symptoms (fatigue, hair-shedding, brain fog, restless legs, anxiety), monthly periods reminiscent of crime scenes, and two myomectomy surgeries (to remove clusters of uterine fibroids) before I was deemed anemic. Iron deficiency is the most common cause of anemia, a condition that occurs when your body doesn’t have enough healthy red blood cells. You can be iron deficient (meaning you have low stored iron, or ferritin) but not necessarily anemic, although untreated iron deficiency often leads to anemia.
Though my iron deficiency went largely unrecognized for a time, I’m certainly not alone in this journey, which—like so many diagnoses in women’s health—often follows a long and winding path. A 2024 report from JAMA Open Network found that 34% of women between the ages of 18 and 50 are iron deficient. Post-menopause it becomes less common, as women stop bleeding regularly, so there’s less iron loss; that’s also why iron deficiency is less common in men.
The reason so many women find themselves dealing with anemia, particularly in their 40s (I was 45 when I was diagnosed), is not so straightforward—which is why it comes as no surprise that many are searching for answers and sharing symptoms on TikTok. Ahead, we sort through the signs of iron deficiency, including fatigue, shortness of breath, dark circles, cracking skin, and what social media is calling “ferritin face.”
What do we need iron for anyway?
Iron is a building block for hemoglobin, a protein in your blood that is required for the production of the red blood cells that deliver oxygen throughout our bodies. It sounds vital because it is. It’s key for optimal skeletal and cardiac muscle function, for hair growth, and for making neurotransmitters in our brain (including the dopamine and serotonin that have such a profound effect on our moods), says Imo J. Akpan, MD, a hematologist at New York Presbyterian.
“[Iron] also plays a quieter but important role in supporting regular ovulation and a healthy uterine lining, both of which matter when someone is trying to conceive,” says Lora Shahine, MD, a reproductive endocrinologist and ob-gyn at Ivy Fertility in Seattle.
And iron is foundational to how our bodies produce energy. Explains Amanda Kahn, MD, an internist in New York, “When iron stores are low, women often feel it everywhere, from their energy levels to their mood to their hair.”
The face (and hair and body) of iron deficiency
Do you have heavy periods? Do you have brain fog? Do you get winded walking up stairs even when you’re in really good physical shape? These are some of the questions Jamie Rosen, a 40-something brand consultant in New York City, remembers being asked by her hematologist Rachel Kramer, MD, during her first visit. “I was like, ‘Yes, yes, yes, yes, yes,’ to everything she asked me,” says Rosen, who had a list of symptoms that she had long been brushing off.
