Replacing the iron is the easy half. Finding out why it went low is the half that matters.
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Iron deficiency is the commonest nutritional deficiency in the world and a frequent cause of fatigue, breathlessness, poor concentration, hair shedding and restless legs.
Treatment is straightforward. What matters far more — and is skipped surprisingly often — is establishing why the iron is low in the first place. In a menstruating woman it is usually heavy periods. In a man, or a woman past the menopause, iron deficiency is a red flag that warrants bowel investigation until proven otherwise.
Oral iron — ferrous sulphate, ferrous fumarate or ferrous gluconate. Modern evidence supports taking it once daily or every other day rather than three times a day: absorption is actually better, and side effects far fewer.
Vitamin C taken alongside improves absorption meaningfully.
Intravenous iron is used where oral iron fails, is not tolerated, or replacement is needed quickly. It requires a clinic setting; we can arrange referral.
Ferritin and full blood count. Ferritin is the key number — it can be low while haemoglobin is still normal, which is deficiency without anaemia and still worth treating.
One caveat we always apply: ferritin rises with any inflammation, so a normal ferritin alongside raised inflammatory markers can hide real deficiency. We check both.
This is the clinically important step. Menstrual history, diet, gut symptoms, coeliac screening, and — where the picture warrants it — gastroenterology referral for bowel investigation.
Alternate-day dosing with vitamin C, and practical advice on tolerating it.
Bloods at 3 months. Continue for at least 3 months after haemoglobin normalises — stopping as soon as the count recovers leaves the stores empty and the deficiency returns.
Oral iron commonly causes constipation, nausea, stomach discomfort and black stools — the last of which is harmless and expected, but alarms people who were not warned.
Most side effects are dose-related, which is exactly why alternate-day dosing is preferable: similar absorption, far better tolerated.
If one salt disagrees with you, another often does not. Ferrous gluconate is gentler than ferrous sulphate.
Iron blocks the absorption of levothyroxine and some antibiotics — separate them by at least four hours. Tea and coffee taken with iron reduce absorption substantially.
Keep iron well out of reach of children. Iron overdose is a leading cause of poisoning deaths in young children.
Iron deficiency in a man, or in a woman past the menopause, should not simply be supplemented. It needs the cause found, and we will say so.
Before assuming the treatment failed, check: whether it is actually being taken; whether tea or coffee is being drunk alongside; whether there is ongoing blood loss that outpaces replacement; and whether there is a malabsorption problem such as coeliac disease.
Intravenous iron is the answer where oral iron fails, is not tolerated, or replacement is needed quickly. It needs a clinic setting and we can refer.
Iron deficiency in a man, or in a woman past the menopause, is a red flag and needs the cause found. That means bowel investigation until proven otherwise, not simply a repeat prescription — and it is where this goes seriously wrong when it is skipped.
In a menstruating woman it is usually heavy periods, which are themselves treatable rather than something to endure.
Iron overdose is a leading cause of poisoning deaths in young children. Store it well out of reach.
Replacement without explanation is where iron deficiency goes wrong, and it is skipped surprisingly often.
Ferrous sulphate, fumarate or gluconate — all available over the counter, and all effective. The difference between working and not is usually how it is taken rather than which one it is: alternate days, with vitamin C, away from tea, coffee and calcium.
Do not buy expensive "gentle" iron preparations before trying standard iron on alternate days. That change alone resolves most tolerance problems, and it costs nothing.
Where oral iron fails, is not tolerated, or replacement is needed quickly — in late pregnancy, before surgery, or in inflammatory bowel disease. It works fast and it needs a clinic setting. We can refer, and it is available on the NHS.
Diet alone rarely corrects an established deficiency, but it helps maintain stores afterwards.
Haem iron from meat and fish is absorbed far better than plant iron. For plant sources — pulses, dark leafy greens, fortified cereals — vitamin C alongside makes a substantial difference, and tea with the meal undoes it.
Iron tablets are extremely cheap, and available over the counter without any prescription. We earn nothing from what is prescribed.
If you simply need iron and have already had it confirmed, a pharmacy will sell it to you for a few pounds. We would rather say so.
The cause, and the interpretation — not the tablets.
Iron deficiency is investigated and treated free on the NHS, including bowel investigation and intravenous iron where needed — and that investigation is the part that matters most. If you are registered with a GP, that is the route we would point you to.
We sell nothing.
Worth looking at the actual number rather than the word.
Symptoms commonly occur below 30, and hair shedding and restless legs often need a level above 50 — well above the threshold at which a lab flags a result as low.
And ferritin rises with any inflammation, so a normal-looking ferritin alongside raised inflammatory markers can conceal genuine deficiency. That is why we check both.
Yes, and it is common. Ferritin measures the stores; haemoglobin only falls once those stores are exhausted.
Deficiency without anaemia causes fatigue, breathlessness, poor concentration, hair shedding and restless legs, and it is worth treating.
Because in a man, or a woman past the menopause, iron deficiency is a red flag for bowel bleeding until proven otherwise.
Supplementing without investigating can mask a serious diagnosis for months, and that is the single most important thing on this page.
In a menstruating woman it is usually heavy periods — which are themselves treatable rather than something to put up with.
Once daily or every other day, not three times a day. Absorption is better on alternate days and side effects are far fewer.
With vitamin C. Away from tea and coffee by an hour. Away from calcium, antacids and dairy. And at least four hours from levothyroxine, which iron blocks.
No — harmless and entirely expected on iron. It alarms people who were not warned, which is why we say so up front.
Black tarry stools with a foul smell are different, and that needs assessing.
Do not buy expensive "gentle" iron before trying those, which cost nothing.
Longer than most people are told. At least three months after the haemoglobin has normalised, because the point is to refill the stores rather than just correct the count.
Stopping early is why the deficiency comes back.
Diet alone rarely corrects an established deficiency, though it helps maintain stores afterwards.
Haem iron from meat and fish absorbs far better than plant iron. With plant sources, vitamin C alongside makes a real difference — and a cup of tea with the meal undoes much of it.
Iron given directly into a vein, used where oral iron fails, is not tolerated, or replacement is needed quickly — late pregnancy, before surgery, or in inflammatory bowel disease.
It works fast, needs a clinic setting, and is available on the NHS. We can refer.
Yes, which is why we test first. In haemochromatosis, an inherited iron-overload condition, supplementing is actively harmful.
And keep iron well out of reach of children — iron overdose is a leading cause of poisoning deaths in young children.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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