14 Signs of Iron Deficiency Anemia

1. Unusual tiredness

Feeling very tired is one of the most common symptoms of iron deficiency anemia. This symptom is also common in people who simply don’t have enough iron, even if they haven’t received a diagnosis of deficiency (2, 3).

This fatigue happens because your body lacks the iron it needs to make a protein called hemoglobin, which helps carry oxygen around your 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 (2).

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

Nonetheless, tiredness related to iron deficiency may go hand in hand with weakness, irritability, or difficulty concentrating (4).

Summary

Fatigue is one of the most common symptoms of iron deficiency. This is due to less oxygen reaching your tissues, depriving them of energy.

Share on Pinterest

2. Skin that’s paler than usual

Skin that’s paler than usual, as well as pale coloring of the inside of the lower eyelids, are other common symptoms of iron deficiency (5, 6).

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

A study in children ages 6–11 found that paleness associated with iron deficiency may appear all over the body or be limited to one area, such as the (7):

• face
• gums
• insides of lips or lower eyelids
• nails

Paleness is often one of the first things doctors will look for as a sign of iron deficiency. However, this condition should be confirmed with a blood test (6).

Paleness is more commonly seen in moderate or severe cases of anemia (7).

If you pull your lower eyelid down while looking in a mirror, the inside layer should be a vibrant red color. If it’s a very pale pink or yellow, you may have iron deficiency.

In people with darker skin tones, the eyelid may be the only area where this condition is noticeable.

Summary

Skin that’s paler than usual in areas like the face, lower inner eyelids, or nails may be a sign of moderate or severe iron deficiency. This paleness is caused by low levels of hemoglobin, which gives blood its redness.

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 are likewise low. This means that your muscles won’t receive enough oxygen to do normal activities, such as walking (8).

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 (2).

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

Summary

Shortness of breath is a symptom of iron deficiency, since low hemoglobin levels stop your body from effectively transporting oxygen to your muscles and tissues.

4. Headaches

Iron deficiency may cause headaches, particularly in those who are menstruating (5, 9).

While the link between iron deficiency and headaches is still unclear, researchers theorize there are several factors at play, including the relationship between altered dopamine function and estrogen levels (10).

Although there are many causes of headaches, frequent, recurrent headaches may be a symptom of iron deficiency.

Summary

Headaches may be a symptom of iron deficiency, although more research is needed on the connection between dopamine dysfunction, estrogen levels, and iron deficiency.

5. Heart palpitations

Noticeable heartbeats, also known as heart palpitations, are 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 (11).

Hemoglobin is the protein in red blood cells that helps transport oxygen around your 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.

Consequently, iron deficiency may worsen conditions that affect your heart, such as heart failure and coronary heart disease (12, 13).

Summary

In cases of iron deficiency, your heart has to work especially hard to transport oxygen. This can worsen conditions that affect heart health.

6. Dry and damaged hair and skin

Dry or damaged skin and hair may be signs of iron deficiency (14).

Iron deficiency lowers the level of hemoglobin in your blood, which may reduce the amount of oxygen available to cells that cause hair growth (15).

When skin and hair are deprived of oxygen, they may become dry and weak.

Iron deficiency is also associated with hair loss, and some research suggests it may be a cause — especially in female-bodied individuals of reproductive age (16, 17).

It’s completely typical for some hair to fall out during everyday washing and brushing. However, if you’re losing clumps or large amounts, it may be related to iron deficiency.

Summary

Skin and hair may receive less oxygen if you have iron deficiency, leading to dryness or damage. In more severe cases, this may lead to hair loss.

7. Swelling and soreness of your tongue or mouth

Sometimes, the inside or outside of your mouth indicates whether you have iron deficiency anemia. Signs include a swollen, inflamed, pale, or strangely smooth tongue (18).

Iron deficiency may also cause other symptoms around your mouth, such as (19):

• dry mouth
• a burning feeling in your mouth
• sore, red cracks at the corners of your mouth
• mouth ulcers

Summary

A sore, swollen, or strangely smooth tongue may be a sign of iron deficiency anemia, as are cracks on the corners of your mouth.

8. Restless legs

Iron deficiency has been linked to restless leg syndrome (20).

This condition involves a strong urge to move your legs while they’re at rest. It may also cause unpleasant crawling or itching sensations in your feet and legs.

It’s usually worse at night, meaning that you may find it difficult to sleep.

The causes of primary restless leg syndrome are not fully understood. However, it’s known to occur secondary to various medical conditions, including iron deficiency anemia (21).

Indeed, people with iron deficiency anemia are 6 times more likely to have restless leg syndrome than the general population (21).

Summary

People with iron deficiency anemia may have restless legs syndrome, which is a strong urge to move your legs while at rest.

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 (22).

Usually, the first sign is brittle nails that chip and crack easily.

In later stages of iron deficiency, spoon-shaped nails may occur, meaning that the middle of your nail dips and the edges raise 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 seen only in severe cases (22).

Summary

Brittle or spoon-shaped nails may indicate more severe iron deficiency anemia.

10–14. Other potential signs of iron deficiency anemia

Several other indicators signal that your iron levels may be low. These tend to be less common and may be linked to many conditions other than iron deficiency.

Other signs of iron deficiency anemia include:

10. 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 it may be a sign of iron deficiency. It may also occur during pregnancy (23).
11. Feelings of depression. Iron deficiency anemia may be associated with depression in adults. Pregnant individuals with iron deficiency may also have a higher risk of depression (24, 25).
12. Cold hands and feet. Iron deficiency means less oxygen delivery to your hands and feet. Some people may feel the cold more easily in general or experience cold hands and feet (5).
13. More frequent infections. Because iron is needed for a healthy immune system, lack of it may increase your risk of infections (26).
14. Poor appetite. Iron deficiency is associated with a poor appetite due to changes in the hunger hormone ghrelin (27).

Symptoms of anemia in children

Iron deficiency is the most prevalent nutritional deficiency in children and adolescents worldwide. Common signs and symptoms of anemia in children include (28):

• fatigue
• weakness
• paleness
• irritability
• lightheadedness

In chronic anemia, dry mouth, lip inflammation, hair loss, and atrophic glossitis — a condition that makes the tongue smooth and appear glossy — are common (28).

Neurological symptoms, like attention deficit hyperactivity disorder (ADHD), restless leg syndrome, and breath-holding spells, have also been observed in children with iron deficiency anemia (28).

Symptoms of anemia in older adults

Anemia is common in older adults. Symptoms in this population may be nonspecific and include (29):

• fatigue
• paleness
• shortness of breath
• chest pain
• edema, or fluid retention

Other times, symptoms may be more specific and include koilonychia, pica, and atrophic glossitis (29).

Compared with younger people, older adults are more likely to have conditions associated with iron deficiency anemia, since these conditions may cause chronic blood loss, lead to iron malabsorption, or involve long-term inflammation (29).

Examples include stomach and intestinal ulcers, intestinal cancer, and chronic kidney disease.

Older adults are also more likely to use certain medications, like non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, and proton pump inhibitors over a long period, which may cause blood loss in the stomach or reduce iron absorption (29).

Summary

Other signs of iron deficiency include strange cravings, depression, frequent infections, and cold hands and feet. Children and older adults share symptoms, but neurological symptoms, like ADHD, are more common in children.

Common causes of iron deficiency

Iron deficiency can be caused by a variety of factors and can happen at almost any age. A few of the most common causes are (5):

• inadequate iron intake due to a diet that doesn’t meet daily nutritional needs or is heavily restricted
• inflammatory bowel disease (IBD) or celiac disease
• increased iron requirements during pregnancy
• blood loss through heavy periods or internal bleeding

Bleeding in your stomach or intestines may also cause anemia in adults who are no longer menstruating. This bleeding can be triggered by (26):

• taking too many NSAIDs, such as ibuprofen or aspirin
• stomach ulcers
• hemorrhoids
• bowel or stomach cancer (although this is less common)

What causes anemia?

Anemia occurs when you lack enough healthy red blood cells to deliver oxygen to your tissues (30).

Iron deficiency — while a common cause of anemia — is not the only cause. Other common causes include (30):

• inflammatory conditions, like autoimmune diseses, cancer, and chronic kidney disease
• thalassemia, an inherited blood disorder that causes your body to produce an abnormal form of hemoglobin
• folate or vitamin B12 deficiency
• lead poisoning
• alcohol use disorder
• liver disease
• hypothyroidism
• use of certain drugs, including chemotherapy, diabetes, and antimicrobial drugs, as well as diuretics

Anemia may also be hemolytic in nature, meaning that red blood cells are being destroyed faster than your body can produce them. Causes of hemolytic anemia include (30):

• sickle cell disease, a group of inherited red blood cell disorders
• enzymopathies, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency and pyruvate kinase (PK) deficiency
• other rare conditions, including autoimmune hemolytic anemia (AIHA), paroxysmal nocturnal hemoglobinuria (PNH), and microangiopathic hemolytic anemia (MAHA)

Summary

Anemia may be caused by inadequate iron intake, numerous health conditions, and blood loss — as well as a host of other issues unrelated to iron deficiency.

What to do if you think you have an iron deficiency

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

Talk with your doctor

If you think you’re showing signs or symptoms of iron deficiency, you should make an appointment to see a doctor.

If your doctor confirms that you have iron deficiency — typically via a blood test — it’s generally easy to treat. Your doctor will likely recommend increasing your intake of iron via your diet or supplements (2).

The main aim of treatment is to restore hemoglobin levels and replenish your body’s iron stores.

Your doctor will develop a treatment plan that best meets your healthcare needs. Before changing your diet or deciding on any supplements, it’s best to consult your doctor.

If you need help finding a primary care doctor, then check out our FindCare tool here.

Eat iron-rich foods

If your doctor thinks your iron deficiency is caused by a lack of iron in your diet, you may be told to eat more iron-rich foods.

There are two main dietary forms of iron — heme and nonheme (31).

Plants and iron-fortified foods contain nonheme iron only, whereas animal foods contain both forms.

While your body’s absorption of iron is generally low, you can absorb up 15–35% of heme iron but only 2–20% of nonheme iron. Still, it’s a good idea to include both forms of iron in your diet — assuming you don’t avoid animal products — to ensure a varied diet.

Iron-rich foods include:

• red meat, such as beef, pork, and poultry
• dark leafy greens, such as spinach and kale
• dried fruit, like raisins and apricots
• peas, beans, and other legumes
• seafood
• iron-fortified foods, such as breakfast cereals
• seeds and nuts
• organ meats

Take iron supplements if your doctor recommends them

You should take an iron supplement only if your doctor confirms that you have an iron deficiency — or are at risk for one — and can’t meet your needs through diet alone.

Keep in mind that taking iron supplements may cause side effects, including:

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

However, you can minimize these side effects by taking specific types of iron supplements, such as iron bisglycinate chelate (32).

Talk with your doctor if you’re experiencing side effects related to iron supplements.

Help boost your iron absorption

If you want to get the most out of your iron supplement, try to avoid taking it alongside medications, supplements, or foods that contain calcium, like antacids or milk. Calcium can limit iron absorption (32).

Conversely, combining iron with vitamin C can enhance iron absorption. Foods that are rich in vitamin C include (32, 33):

• bell peppers
• oranges
• grapefruit
• kiwifruit
• broccoli
• Brussels sprouts
• strawberries
• grapefruit

You’re also advised to avoid or limit high fiber foods or polyphenol-rich beverages, like coffee and tea, when you take your supplement. These may interfere with absorption (34).

Summary

If you have iron deficiency, your doctor may recommend that you eat more iron-rich foods or take iron supplements.

When to see a doctor

Talk with a doctor if you have symptoms of iron deficiency. If left untreated, it can develop into iron deficiency anemia. This condition may eventually result in complications, including:

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

Iron deficiency anemia is more common in women than in men (30).

People who are pregnant or have heavy menstrual periods have the highest risk and should talk with a doctor about being tested for iron deficiency anemia.

Take iron supplements only if your doctor prescribes them. Too much iron may damage your heart, liver, and pancreas.

Summary

Long-term complications of iron deficiency anemia include depression, pregnancy issues, and heart problems. So talk with your doctor if you’re experiencing any symptoms.

The bottom line

Iron deficiency anemia is the most common type of anemia worldwide.

Symptoms often depend on the severity of the anemia, but some people have obvious symptoms while others experience none at all.

Common symptoms include fatigue, palenes, shortness of breath, and dry or damaged hair and skin.

If you think you have symptoms of iron deficiency, talk with a doctor. Self-diagnosing is not recommended.

Most forms of iron deficiency can be treated fairly easily through an iron-rich diet or iron supplements, if recommended by a doctor.

Read this article in Spanish.