Low Ferritin or Burnout? Why Iron Deficiency Is Often Missed
For many women, long-term fatigue is explained as burnout.
Work is demanding. Life is full. Recovery feels harder than it used to. Burnout often seems like the most reasonable conclusion.
But in a significant number of cases, exhaustion is not only — or not primarily — about stress.
It is linked to low ferritin, a sign of depleted iron stores that is frequently overlooked when haemoglobin levels are still normal.
When “normal” iron results don’t match how you feel
Iron status is commonly assessed using two markers:
Haemoglobin, which reflects whether there is enough iron to make red blood cells
Ferritin, which reflects iron stores — the body’s reserve
Many laboratories list ferritin values from around 20 µg/L (and sometimes lower) as “normal”.
When haemoglobin is normal and ferritin falls within this range, women are often reassured that iron deficiency is not the issue.
However, for many women, low ferritin symptoms appear well before anaemia develops.
Clinically, a large proportion of women do not feel well until ferritin levels reach around 50 µg/L or higher.
Iron deficiency without anaemia (IDWA)
Iron deficiency does not begin with anaemia.
There is often a prolonged phase where:
ferritin is depleted
haemoglobin remains within range
symptoms are already present
This is known as iron deficiency without anaemia (IDWA).
Because haemoglobin is normal, iron deficiency may be ruled out — even though iron-dependent systems throughout the body are already affected.
This is one of the main reasons low ferritin symptoms in women are missed.
Low ferritin symptoms in women that are frequently overlooked
Many healthcare providers are trained to recognise anaemia, but fewer are trained to recognise iron deficiency without anaemia.
As a result, symptoms are often attributed to stress, burnout, or mental health rather than low iron stores.
Common low ferritin symptoms in women include:
persistent fatigue or exhaustion
brain fog or poor concentration
low mood, anxiety, or apathy
reduced exercise tolerance
shortness of breath on exertion
dizziness or light-headedness
physical heaviness or weakness
hair shedding
frequent or lingering infections
These symptoms strongly overlap with those of anaemia — despite haemoglobin remaining normal.
Why low ferritin affects more than energy
Iron is often described as being important for oxygen transport, but its role in the body is much broader.
Iron is involved in:
cellular energy production
cognitive function and mental clarity
neurotransmitter activity related to mood and motivation
immune system function
This is why women with low ferritin often report brain fog, poor stress tolerance, low motivation, and frequent coughs or colds — even without anaemia.
When iron stores are depleted, the body may struggle to support multiple systems at once.
Why low ferritin is so often missed
Low ferritin is frequently missed because:
reference ranges are broad and symptom-blind
haemoglobin is prioritised over iron stores
symptoms are explained by lifestyle or stress
iron deficiency is only considered once anaemia appears
As a result, women may be told everything is “normal” — while continuing to feel unwell.
Over time, many adapt to functioning below their baseline, until exhaustion becomes severe enough to resemble burnout.
When burnout and low ferritin coexist
For many women, the question is not low ferritin or burnout — it is both.
Work stress increases energy demands.
Low ferritin reduces the body’s capacity to meet them.
Together, they can lead to:
reduced resilience
prolonged recovery
fatigue that does not resolve with rest alone
In this context, low ferritin does not replace burnout — it lowers the physiological buffer, making burnout more likely and harder to recover from.
What to explore with your GP
If fatigue or burnout symptoms persist, it may be helpful to explore iron status more closely — even if haemoglobin is normal.
Some women choose to ask:
what their ferritin level actually is (not just whether it’s “normal”
whether symptoms could reflect iron deficiency without anaemia
how ferritin results are being interpreted in relation to symptoms
whether ferritin levels around 20 µg/L are sufficient for optimal function
These conversations don’t require confrontation — just informed curiosity.
Why this understanding matters
When low ferritin is missed, women may spend years trying to improve their mental health when the problem is at least partly in the body — or, physiological.
Recognising low ferritin symptoms in women:
reduces self-blame
provides clarity
and often changes the direction of care
Burnout can be real.
Iron deficiency can be real.
And sometimes, addressing depleted iron stores is what finally allows recovery to begin.
Reference:
Cappellini MD, Musallam KM, Taher AT. Iron deficiency without anaemia: a diagnosis that matters. European Journal of Haematology. 2020.
Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9692751/
