Look around, and you’ll easily spot a tired woman. She might be in line behind you at the post office or dropping off your Amazon package. You’ll see her at the school gates, breathless after rushing from the car, coffee in hand, apologizing for forgetting the PE kit. Or stifling a yawn in a long work meeting. Or dozing off on a noisy train, about to miss her stop.
Maybe this seems normal—after all, who isn’t exhausted in today’s fast-paced world? But look closer, and you’ll realize this fatigue often goes beyond what a quick nap can fix. These worn-out women are asking friends in WhatsApp groups why their hair is thinning, complaining to their beautician about brittle nails, or frantically searching online for reasons behind their brain fog or why they sometimes struggle to form a sentence, despite being young. They ask each other if anyone else is so anxious they can’t sleep. Some are on antidepressants, wondering why their racing thoughts won’t ease. They’ve asked their doctor why daily life leaves them so drained and been told it’s “inevitable” with young kids or asked if they’re exercising enough.
But what if the cause isn’t lack of exercise, overwork, or a mystery illness? What if their symptoms are actually common signs of a condition that affects nearly one in three women of reproductive age in the UK? And what if a simple blood test could explain much of this and lead to fairly quick treatment?
Because they aren’t “just tired.” They’re almost certainly iron deficient.
According to the Global Burden of Disease study, iron deficiency anemia is one of the top five causes of disability in women of reproductive age worldwide. The NHS defines it as the most common form of anemia, where blood can’t deliver enough oxygen to tissues and organs. Women are disproportionately affected because, mainly due to menstruation, they need and lose more iron than men. Women aged 19 to 49 need to consume almost twice as much iron daily as men to stay healthy, making diet a key factor—but that’s only part of the issue. A recent UK study by Randox Health found that almost one in three women visiting their clinics had absolute iron deficiency, meaning their iron stores couldn’t meet their needs. While treatment should be straightforward, it’s often hard to access, leaving many to endure symptoms that can be life-altering.
Sam, a 38-year-old mother of two from Bath, knows this well. After her second child was born in 2024, she struggled with dizziness and exhaustion and visited her GP. “They said I was just tired and dehydrated,” she recalls. “They didn’t do a blood test and told me to drink more water.” Though she expected that response, she felt something was being overlooked.
Earlier this year, after starting a new contraceptive pill, she bled for a full month and was advised to stop taking it. “That’s when the symptoms got worse,” she says. Her hair fell out, she was often dizzy, extremely tired, felt nauseous in the evenings, and had trouble shaking off illnesses her kids brought home from nursery. She returned to her GP, who ordered blood tests and an electrocardiogram (ECG). While the ECG was normal, her serum ferritin level—the protein that stores iron in the blood—was 10mcg, indicating iron deficiency.Sam felt a wave of relief when she saw her test results. “There was an answer,” she says. “It could be treated!” But her doctor didn’t seem to agree. The doctor told her she was only slightly below the healthy range, so her iron levels probably weren’t causing her symptoms. Although iron tablets were mentioned because her levels were low, they weren’t prescribed. Eager to feel better, Sam bought over-the-counter iron pills and started taking them right away.
In fact, Sam was showing many classic signs of iron deficiency. Dr. Kayathry John, a Manchester GP known online as Dr. Kai and co-host of the Talking Longevity podcast, lists other symptoms: aching joints, shortness of breath, a metallic taste in the mouth, hair loss, depression, anxiety, brain fog, weakness, and pale skin. She notes that while awareness of iron deficiency and its effects is increasing among UK doctors, whether it’s recognized depends on your GP’s experience. “Once you qualify as a GP, you’re expected to do your own research,” she explains. “We get updates and emails about new findings and medications, but that’s true for every medical topic.” This might be why Sam’s doctor didn’t link her low ferritin level to her symptoms.
If this were a condition that mainly affected men, clear diagnosis and treatment methods would have been established long ago.
One of the most common reasons for iron deficiency is heavy periods, which affect one in three women, according to Professor Toby Richards, a global expert on iron deficiency and founder of London’s Iron Clinic. He describes heavy periods as those requiring a tampon or pad change every one to two hours (or using both at once), needing to change during the night, bleeding for more than seven days, or worrying about accidents or passing clots. This can lead to blood loss exceeding the NHS’s normal range of 20ml to 90ml per month.
A study by Randox found that women of menstruating age are the most likely to have ferritin levels below 30 (85% of women with absolute iron deficiency were in this group), with 47.5% reporting heavy periods. As for other risk factors, Richards says the prevalence of iron deficiency among different ethnic groups in the UK is currently unknown. He mentions his involvement with the Shine Project at the University of East London, which aims to address this gap in knowledge.
Sam found that the iron tablets made her feel worse—a common experience, as Richards notes that one in four people can’t tolerate them, often due to gut-related side effects like constipation or nausea. Still, Sam took the pills as much as she could stand. “After about seven to 10 days on iron, my period came, and all the symptoms returned,” she says. She went back to her GP practice and saw a different doctor who apologized for her colleague and confirmed that Sam’s symptoms were clearly due to iron deficiency. This doctor prescribed a different type of oral iron and scheduled a follow-up in a few weeks. “It was very validating for me,” Sam says.
But the new tablets didn’t help, and Sam felt desperate. “The way I was feeling affected my whole life,” she explains. “I struggled to concentrate at work, play with my kids, cook meals, spend time with my partner in the evening, or even go for a short walk… It changed who I am. I just can’t enjoy my life the way I used to.”
Sam’s situation is not unusual. Richards states that nearly one in five women in the UK are unknowingly living with iron deficiency, and it takes an average of eight years to get diagnosed and treated. Why are women expected to put up with these symptoms? “Medical misogyny,” he says.
When you look at the data, which shows that only 3% of men have…It’s hard not to believe him when you consider that 2% of men in the UK have iron deficiency anaemia compared to 8% of women. Later, I visited the Iron Clinic and asked the clinician in charge, Asela Dharmadasa, the same question. He was quite direct: “Put it this way, if this mainly affected men, the pathways for diagnosis and treatment would have been sorted out long ago.”
Hannah, a 33-year-old mother of two, certainly shares this view. As she lies back in a leather chair at the clinic receiving synthetic iron through a drip, it’s clear she’s had enough. She recalls a summer day when she went to A&E with symptoms she thought were a heart attack—strong palpitations, sweating, and pain—and feels embarrassed for “making a fuss,” especially since the doctor quickly reassured her after an ECG that her heart was fine. However, he did mention that her blood tests showed a ferritin level of 15mcg per liter and that all her symptoms matched iron deficiency, so raising her levels would help her feel better.
“But I already knew this,” she says. Her ferritin had been low for years, and she had repeatedly visited her GP seeking answers for her extreme fatigue, frequent headaches, anxiety, dizziness, and breathlessness. Each time, she was sent away with oral iron tablets, which she told several doctors only made her feel worse.
Dr. Andrew Klein, who runs an iron clinic in Cambridge, explains that one in three people cannot absorb oral iron, complicating treatment. Even for those who can, it’s a slow process. In contrast, intravenous (IV) iron takes just over an hour and, depending on the cause of the deficiency, can replenish iron stores indefinitely. Serious side effects are rare, though many patients report feeling a bit flu-like for a few days, and the results can be life-changing. However, it’s more expensive than pills, costing the NHS about £600 per patient, which includes the drug, facility, nursing staff, supplies, administration, and blood tests.
Klein points out that part of the problem is a lack of high-quality research into treatments, leading to few effective, cheaper alternatives. The only randomized clinical trial he knows of showed significant benefits of IV iron over oral supplements. “If I were to develop a cheaper alternative, I’d be the richest person in the world,” he adds, noting that nearly a billion women worldwide have iron deficiency.
After reading online that an iron infusion could help, Hannah asked her GP for a referral. Despite NICE guidelines recommending referrals for people in her situation, she was told she likely wouldn’t qualify. Dr. Kai explains that access depends on several factors: “Severity of the deficiency is the priority, as are comorbidities, especially conditions that could worsen due to the deficiency. Symptoms are considered, but since most people report tiredness, those take precedence.”
Richards highlights another issue: with GPs often overstretched, there’s a common misunderstanding that hinders correct diagnosis and treatment. “Many don’t realize that iron deficiency can occur without anaemia,” he says, “so they only check haemoglobin, a protein in red blood cells that carries oxygen to tissues and organs, which anaemic people lack, while ferritin requires a separate test.”
Focusing solely on haemoglobin levels can be misleading. “Iron is one of the components that make haemoglobin,” Richards explains. “If your iron stores—ferritin—are low, your body takes iron from other places.” Iron is essential for our mitochondria, the energy-producing powerhouses of our cells. “So if you have low iron in your muscles,”You feel tired and have trouble walking upstairs, with shortness of breath, chest pain, or palpitations. You might also feel dizzy. When iron levels drop in the brain, women often describe experiencing brain fog, forgetfulness, or difficulty thinking clearly.
Hannah expressed frustration with her GP not taking her seriously, her emotional exhaustion visible in her body language. When asked if she believed her gender influenced her experience, she replied, “100%.” Even after visiting the emergency room and directly requesting an IV from her regular doctor, she was told flatly that her symptoms weren’t due to low iron.
Dr. Richards notes that the NHS is struggling, with GPs limited in their ability to help women access IV iron in many hospitals. GP Dr. Mike Banna adds that when oral iron fails or isn’t tolerated, referral pathways for IV iron are often cumbersome and subject to the same pressures and waiting times that have become common since Covid. GPs must use resources cost-effectively, which involves following established, less invasive pathways before considering more expensive options.
However, saving money in one area can lead to costs elsewhere. When factoring in work or school absences, referrals to specialists, unnecessary prescriptions, expensive tests, and emergency visits—such as the 57,000 annual UK hospital admissions for iron deficiency anemia—providing IV iron access appears to be the more economical choice.
Hannah reached a point where she felt she wouldn’t survive more than a few weeks if her condition continued.
Changes in eating habits may contribute to iron deficiency. Nutritionist Nichola Ludlam-Raine explains that there are two types of iron: heme iron from animal sources like red meat, chicken, and fish, which is more easily absorbed, and non-heme iron from plant sources like beans and lentils, which requires vitamin C for better absorption. Switching to a vegan or vegetarian diet isn’t problematic in itself, but doing so without this knowledge can be.
Dr. Kai points out that caffeine can hinder non-heme iron absorption but suggests leaving a two-hour gap between coffee or tea and iron-rich meals or supplements to help.
Additionally, ultra-processed foods, while not directly harmful to iron levels, often displace nutrient-rich foods in our diets, leaving less room for what our bodies need. Ludlam-Raine emphasizes that diet alone may not suffice, especially if someone already has iron deficiency anemia.”It’s hard, or even impossible, to correct through food alone,” she explains.
Julie, a 51-year-old equine nutritionist from the north-east, experienced a rapid decline in her health over just a few months. She went from actively caring for her horses—riding, walking, and mucking out—to barely being able to stand. Her thinking became so foggy that she struggled to form sentences, and she could no longer manage her business effectively. A visit to her GP revealed severely low iron levels, with a serum ferritin reading of just 3mcg per litre, which is dangerously low. Despite this, her doctor dismissed her concerns, noting that since her blood was circulating normally and she didn’t appear pale, she couldn’t be that ill. She was sent home with iron tablets, even though she had already told him they made her feel worse. Over the following months, Julie repeatedly called the surgery for help but couldn’t secure an appointment, leaving her feeling hopeless about recovery. As her symptoms worsened, she began to fear she might die, saying, “I reached a point where I felt I wouldn’t survive more than a few weeks if things continued like this.”
Desperate for relief, Julie recently spent £800 on a private iron infusion. The improvement was almost immediate. “It’s like night and day,” she says. “My concentration has improved, and while I used to struggle climbing stairs, now I can run up them.” Most importantly, she’s back outside with her horses.
Despite the government’s recent focus on the gender health gap, women’s exhaustion often goes unnoticed. Yet, statistics suggest it’s widespread and a major cause of poor health and work absences in the UK. Part of the problem is that exhaustion has become so common it’s almost normalized. “Many women accept tiredness as part of life,” says Dr. Kai. “We blame it on running a household, juggling work and childcare, or recovering from childbirth.” With so many reasons to be tired, women often don’t seek medical help. “Life is exhausting, and that often causes us to overlook underlying medical issues.”
Dr. Banna adds that distinguishing between normal tiredness and medical exhaustion can be challenging for doctors too. “Fatigue is a very vague symptom that can range from everyday tiredness to a sign of serious illness,” he notes.
A thorough GP investigation should include questions about other symptoms, lifestyle, mood, and sleep, along with blood tests to rule out common causes of fatigue, according to Dr. Banna. Dr. Kai takes it a step further, stating that whenever a woman presents with mental health issues, she considers iron deficiency. “When someone comes in with depression, low mood, or anxiety, one of my first steps is to screen their blood, as deficiencies in iron, vitamin D, and B12 can all contribute to mental strain.”
This brings to mind something Richards mentioned after my clinic visit that has stayed with me: many of the over 3,000 women he has treated have been able to stop taking anxiety and depression medication directly after receiving iron infusions. It makes me wonder how many women with poor mental health simply need more iron.
I considered whether taking iron supplements preventively might be a solution for those who suspect a deficiency and can tolerate them. However, Richards cautions against this, as too much iron can also be harmful.Iron is vital to our health. “Women should be screened regularly,” he advises, noting that in Australia, where iron deficiency is a health service priority and all women undergo regular screening, the rate of anemia is half that of the UK.
All the experts I consulted agree that if you have symptoms, it’s important to see a doctor and request a ferritin test. If your level is below 30 micrograms per liter, take oral iron supplements. If those don’t suit you or a follow-up blood test after three months shows no improvement, ask about an infusion. Just because fatigue is common doesn’t mean we should accept it as normal.
Julie has been told she’ll need two more infusions, six months apart. Despite the high cost, she feels it’s worth it. “I suddenly feel able to engage with life again,” she shares. “Everything before felt like it was shutting down, and now there’s hope.”
Sam recently got a call to schedule an iron infusion through the NHS after ten months of feeling terrible. Her relief is evident as we talk. “These are the most precious years of my children’s lives,” she says. “I just want to be present for them.”
Frequently Asked Questions
Of course Here is a list of helpful and concise FAQs about constant exhaustion
General Beginner Questions
Q Im always tired even after a full nights sleep Whats the deal
A Its a common issue While sleep is crucial exhaustion can be caused by many other factors like diet stress lack of movement or underlying health conditions Its often a combination of things
Q What are the most common simple causes of constant tiredness
A The most frequent culprits are poor sleep habits a diet high in sugar and processed foods dehydration chronic stress and not getting enough physical activity
Q How much sleep do I really need
A Most adults need 79 hours of quality sleep per night Quality means uninterrupted sleep where you cycle through all the necessary stages
Q Can what I eat and drink really make me feel exhausted
A Absolutely A diet high in sugar and refined carbs causes energy spikes and crashes Similarly not drinking enough water is a major and often overlooked cause of fatigue
Q Im so tired the last thing I want to do is exercise Should I force myself
A It sounds counterintuitive but yes gentle movement can actually boost your energy You dont need a hard workout A brisk 1015 minute walk can increase blood flow and oxygen making you feel more alert
Lifestyle Practical Tips
Q Whats one simple change I can make today to feel less tired
A Drink a large glass of water first thing in the morning Many people wake up mildly dehydrated which immediately saps energy
Q Are there any energyboosting foods I should be eating
A Focus on whole foods that provide sustained energy complex carbs lean proteins and healthy fats Ironrich foods are also key if youre deficient
Q How does stress cause physical exhaustion
A When youre constantly stressed your body produces high levels of the hormone cortisol Keeping your body in this high alert state is mentally and physically draining leading to burnout and fatigue
