For the past six months, a 24-year-old woman named Hsiao-Mei had been feeling constantly fatigued, struggling to focus, and experiencing low moods. She also suffered from insomnia, restless legs, and an unusual craving for chewing ice — a condition known as pica. Initially, she believed she was suffering from autonomic nervous system imbalance, but after a medical consultation, she discovered the real culprit was iron deficiency, despite her hemoglobin levels being normal — a condition known as non-anemic iron deficiency, which is often overlooked.
Heavy Periods and Painkillers Linked to Hidden Iron Loss
Dr. You Guan-Tang, a psychiatrist from Hsinchu, explained that Hsiao-Mei reported having heavy menstrual bleeding and frequent menstrual pain, which led her to rely on painkillers for relief. He warned that these are high-risk factors for iron loss, especially since long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause chronic gastrointestinal bleeding — often without visible black or bloody stools — leading to low ferritin levels.
Further tests revealed that while her hemoglobin was within the normal range, her ferritin was only 12 ng/mL and her transferrin saturation (TSAT) was 17%, confirming non-anemic iron deficiency.
Iron Deficiency Affects More Than Blood — It Impacts Mood and Focus
Dr. You emphasized that iron is essential not only for producing hemoglobin but also for brain function, as it helps regulate neurotransmitters such as dopamine and serotonin. Iron deficiency can therefore cause symptoms beyond fatigue, dizziness, and shortness of breath — it may also lead to poor concentration, irritability, mood swings, and restless legs syndrome, significantly affecting one’s quality of life.
“Many people who struggle with low energy, poor focus, or emotional instability assume it’s due to stress or anxiety,” Dr. You noted. “But sometimes, the real reason is nutritional imbalance — particularly iron deficiency.”
Widespread Yet Overlooked — Especially Among Women
According to global research, around 38% of non-pregnant women of reproductive age in high-income countries experience non-anemic iron deficiency, and about 13% progress to iron-deficiency anemia. Pregnant women are at even higher risk — with up to 84% affected during their third trimester.
Common causes of iron deficiency include:
- Blood loss (heavy menstruation, gastrointestinal bleeding)
- Poor iron absorption (atrophic gastritis, celiac disease, post–weight-loss surgery)
- Inadequate dietary intake or pregnancy
- Chronic illnesses (kidney failure, heart failure, cancer)
Early Detection and Holistic Treatment Are Key
Dr. You advised women with heavy menstrual flow, long-term painkiller use, or chronic conditions to be especially cautious. Persistent fatigue, dizziness, breathlessness, irritability, low mood, poor attention, worsening restless legs at night, teeth grinding, pica, or declining exercise tolerance should all raise red flags for possible iron deficiency.
Treatment involves more than just taking iron supplements. Doctors must also identify and address underlying causes — for example, gynecological treatment for excessive menstrual bleeding or adjusting medications that cause gastrointestinal bleeding. Regular monitoring of ferritin, TSAT, and symptom improvement is essential to track recovery.
“When we identify and correct iron deficiency,” Dr. You concluded, “patients not only regain physical energy — their mood and mental clarity often improve dramatically as well.”
