Signs and Symptoms of Iron Deficiency

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Iron deficiency occurs when your body doesn’t have enough of the mineral iron. Your body needs iron to make hemoglobin, a protein in red blood cells that enables them to carry oxygen around the body.

If your body doesn’t have enough hemoglobin, your tissues and muscles won’t get enough oxygen to be able to work effectively. This leads to a condition called anemia.

Although there are different types of anemia, iron deficiency anemia is the most common worldwide.

Common causes of iron deficiency include:
  • inadequate iron intake due to a diet that doesn’t provide the daily nutritional needs or that’s heavily restricted
  • inflammatory bowel disease
  • increased iron requirements during pregnancy
  • blood loss through heavy periods or internal bleeding

Iron deficiency can result in symptoms that can affect your quality of life. These include shortness of breath, tiredness, and reduced concentration.

Signs and symptoms of iron deficiency vary depending on:
  • the severity of the anemia
  • how quickly it develops
  • your age
  • your current state of health

In some cases, people experience no symptoms.

Here are 10 signs and symptoms of iron deficiency, starting with the most common.

1. Unusual tiredness

Feeling very tired is one of the most common symptoms of iron deficiency. This symptom is common in people who don’t have enough iron. This fatigue happens because your body lacks the iron it needs to make a protein called hemoglobin, which helps carry oxygen around the body.

Without enough hemoglobin, less oxygen reaches your tissues and muscles, depriving them of energy. Your heart also has to work harder to move more oxygen-rich blood around your body, which can make you tired.

Since tiredness is often considered a normal part of a busy, modern life, it’s difficult to diagnose iron deficiency with this symptom alone.

However, many people with iron deficiency experience low energy alongside weakness, feeling cranky, or having difficulty concentrating.

2. Paleness

Pale skin or pale coloring of the inside of the lower eyelids are other common signs of iron deficiency.

The hemoglobin in red blood cells gives blood its red color, so low levels during iron deficiency make the blood less red. That’s why skin can lose its healthy color or warmth in people with iron deficiency.

This paleness in people with iron deficiency can appear all over the body, or it can be limited to one area. This includes the:

  • face
  • gums
  • inside the lips or lower eyelids
  • nails

This is often one of the first things doctors will look for as a sign of iron deficiency. However, it should be confirmed with a blood test.

Paleness is more commonly seen in moderate or severe cases of anemia.

If you pull your lower eyelid down, the inside layer should be a vibrant red color. If it is a very pale pink or yellow color, this may indicate that you have iron deficiency. In people with darker skin tones, this may be the only area it is noticeable.

3. Shortness of breath

Hemoglobin enables your red blood cells to carry oxygen around your body. When hemoglobin levels are low during iron deficiency, oxygen levels will also be low. This means your muscles won’t receive enough oxygen to do normal activities, such as walking.

As a result, your breathing rate will increase as your body tries to get more oxygen. This is why shortness of breath is a common symptom.

If you find yourself out of breath doing normal, daily tasks that you used to find easy, such as walking, climbing stairs, or working out, iron deficiency could be to blame.

4. Headaches and dizziness

Iron deficiency may cause headaches, particularly in women. This symptom seems to be less common than others and often occurs with lightheadedness or dizziness.

The link between iron deficiency and headaches is still unclear.

Headaches may occur because low levels of hemoglobin in red blood cells mean that not enough oxygen reaches the brain. As a result, blood vessels in the brain may swell, causing pressure and headaches.

Although there are many causes of headaches, frequent, recurrent headaches and dizziness could be a sign of iron deficiency.

5. Heart palpitations

Noticeable heartbeats, also known as heart palpitations, can be another symptom of iron deficiency anemia. The association between iron deficiency, anemia, and heart problems is still being studied, but it may be related to oxygen supply.

Hemoglobin is the protein in red blood cells that helps transport oxygen around the body. In iron deficiency, low levels of hemoglobin mean the heart has to work extra hard to carry oxygen.

This may lead to irregular heartbeats or the feeling that your heart is beating abnormally fast. In extreme cases, it can lead to an enlarged heart, heart murmur, or heart failure.

However, these symptoms tend to be a lot less common. You would need to have iron deficiency for a long time to experience them.

6. Dry and damaged hair and skin

Dry and damaged skin and hair can be signs of iron deficiency. Iron deficiency lowers the level of hemoglobin in the blood, which may reduce the amount of oxygen available to cells that cause hair growth. When skin and hair are deprived of oxygen, they can become dry and weak.

Iron deficiency is also associated with hair loss, and some research suggests it could be a cause.

It’s completely normal for some hair to fall out during everyday washing and brushing. If you’re losing clumps or much more than normal, though, it may be related to iron deficiency.

7. Swelling and soreness of the tongue and mouth

Sometimes just looking inside or around your mouth can indicate whether you have iron deficiency anemia. Signs include when your tongue becomes swollen, inflamed, pale, or strangely smooth.

Iron deficiency may also cause other symptoms around your mouth. These include:

  • dry mouth
  • a burning feeling in your mouth
  • sore red cracks at the corners of your mouth
  • mouth ulcers
8. Restless legs

Iron deficiency has been linked to restless leg syndrome. Restless leg syndrome is a strong urge to move your legs at rest. It can also cause unpleasant and strange crawling or itchy sensations in your feet and legs.

It’s usually worse at night, meaning that you may find it difficult to sleep. The causes of restless leg syndrome are not fully understood.

However, around 25% of people with iron deficiency anemia have restless leg syndrome. The prevalence of restless leg syndrome is nine times higher in people with iron deficiency compared to the general population.

9. Brittle or spoon-shaped fingernails

A much less common symptom of iron deficiency is brittle or spoon-shaped fingernails. This condition is called koilonychia. Usually, the first sign is brittle nails that chip and crack easily.

In later stages of iron deficiency, spoon-shaped nails can occur where the middle of the nail dips and the edges are raised to give a rounded appearance like a spoon.

However, this is a rare side effect that occurs in only about 5% of people with iron deficiency. It’s usually only seen in severe cases of iron deficiency anemia.

10. Other potential signs

There are several other signs that your iron could be low. These tend to be less common and can be linked to many conditions other than iron deficiency.

Other signs of iron deficiency anemia include:

  • Strange cravings. A hankering for strange foods or non-food items is called “pica.” It usually involves cravings to eat ice, clay, dirt, chalk, or paper and could be a sign of iron deficiency. It can also occur during pregnancy.
  • Feeling depressed. Iron deficiency anemia may be associated with depression in adults. Pregnant women with iron deficiency may also have a higher chance of developing depression.
  • Cold hands and feet. Iron deficiency means less oxygen is being delivered to the hands and feet. Some people may feel the cold more easily in general or have cold hands and feet.
  • More frequent infections. Because iron is needed for a healthy immune system, lack of it may increase your risk for infections.
What to do if you think you’re iron deficient

If you think you have iron deficiency anemia, consider the following steps.

Talk to your doctor

If you think you’re showing signs or symptoms of iron deficiency, you should make an appointment to see your doctor. A simple blood test can confirm whether you have iron deficiency anemia.

If your doctor confirms you have iron deficiency, generally it’s fairly easy to treat. Your doctor will likely recommend increasing your intake of iron from your diet or with iron supplements.

Try to ensure you’re getting enough iron through real food in your diet. Only take supplements if your doctor recommends them. The main aim of treatment is to restore hemoglobin levels to normal and replenish iron stores.

Your doctor will develop a treatment plan that best meets your healthcare needs.

Eat iron-rich foods

If your doctor thinks your iron deficiency may be caused by a lack of iron in your diet, think about consuming more iron-rich foods, such as:

  • red meat, such as beef and pork, and poultry
  • dark green, leafy vegetables, such as spinach and kale
  • dried fruit, such as raisins and apricots
  • peas, beans, and other pulses
  • seafood
  • iron-fortified foods
  • seeds and nuts
  • organ meat
Help boost your iron absorption

Importantly, eating vitamin C will help your body absorb iron better. Try to eat enough vitamin C-rich foods, such as fruits and vegetables.

It may also help to avoid certain foods that, when eaten in large amounts, can keep your body from absorbing iron. These include tea, coffee, and foods high in calcium such as dairy products and calcium-fortified whole grain cereals.

Take iron supplements if your doctor recommends them

You should only take an iron supplement if your healthcare provider confirms that you’re iron deficient or are at risk for iron deficiency and can’t meet your needs through diet alone.

If you do take an iron supplement, try drinking orange juice with it to boost iron absorption or using a supplement that includes vitamin C.

Keep in mind that taking iron supplements may cause some side effects. These include:

  • stomach pain
  • constipation or diarrhea
  • heartburn
  • nausea or vomiting
  • black stools

However, these side effects can be minimized by taking specific types of iron supplements that may minimize negative effects such as iron bisglycinate chelate.

Talk to your doctor if you are experiencing side effects related to iron supplementation.

When to see a doctor

Talk to your doctor if you have symptoms of iron deficiency. Left untreated, it can develop into iron deficiency anemia. This could eventually result in complications, including:

  • heart problems
  • depression
  • higher chance of infections
  • pregnancy issues

Iron deficiency anemia is more common in women than in men. People who are pregnant or who have heavy menstrual periods have the highest risk and should talk to their doctor about being tested for iron deficiency anemia.

Only take iron supplements if your doctor prescribes them. Too much iron can damage your heart, liver, and pancreas.

You should also tell your doctor if you experience side effects from iron supplements, like a metallic taste or vomiting.

The bottom line

Iron deficiency anemia is the most common type of anemia worldwide. Some people have obvious symptoms, while others experience none at all. This often depends on the severity of the anemia.

Common signs and symptoms include tiredness, pale skin, feeling short of breath, and dry and damaged hair and skin. If you think you have symptoms of iron deficiency, talk to your doctor. Self-diagnosing is not recommended.

Most forms of iron deficiency can be treated fairly easily, usually through an iron-rich diet or iron supplements, if your doctor recommends them.

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